Association of past colorectal cancer screening with family history of cancer and behavioral factors in Quito, Ecuador: a mixed methods study

Abstract

In Latin America, colorectal cancer is the third most common cancer among men and fourth most common cancer among women. Ecuador has experienced an upward trend in CRC incidence and mortality, highlighting the need to strengthen population-based prevention and early detection strategies. Previous studies in Ecuador recommended more comprehensive evaluations of CRC screening reach, effectiveness, and continuity of care. The study used an explanatory sequential mixed methods research design and collected data using quantitative surveys and individual interviews to explore perceived barriers and facilitators to CRC screening in Quito, Ecuador. For the survey data, bivariate analyses were performed to compare differences on CRC screening history (1 = yes; 2 = no). Categorical variables were compared using chi-square tests, and continuous variables, including scale variables, were compared using two sample t-tests. Independent variables based on previous work and that were identified to be related to CRC screening history in the bivariate analysis were then entered into a multivariable logistic regression model. Qualitative interview participants were asked about perceived causes of CRC, ways to reduce risk, the appropriate age to begin screening, and what types of CRC screening they had heard about or undergone. Content analysis was used to code the transcripts and generate themes from the interviews. Quantitative and qualitative findings were integrated at several stages. Bivariate analysis showed that individuals who had undergone screening had higher scores on negative beliefs about cancer (11.11 vs. 9.90; p =.03). CRC screening self-efficacy remained a significant independent variable in the multivariable model, showing that lower self-efficacy was associated with a lower probability of screening uptake (OR = 0.78; 95% CI: 0.61–0.99; p =.04). Qualitative analysis revealed that participants were unsure about the criteria for screening, the appropriate age to begin testing, and the differences between available screening tests. Some participants mentioned receiving CRC screening information through their healthcare providers, but they generally perceived public communication about the topic as limited. One finding from the study identified opportunities for stool-based testing during annual physical exams. The study also identified opportunities for improved communication in partnership with providers and patients to increase awareness of CRC prevention.