| Definition Of The Concepts Of Health Belief Model |
Application in the intervention of the study |
| 1. Perceived Susceptibility One's belief of the chances of getting a condition |
Population at risk and their risk levels was defined. Low, average and high risk population for colorectal cancer was described. |
| Personalized risk based on each person's behaviours and conditions e.g. their age and other personal habits such as eating habits were explored. |
| Perceived susceptibility was heightened by showing them pictures of patients undergoing surgery for colorectal cancer. |
| Recent statistics about colorectal cancer in the region, province and city was presented. |
| The prevalence and mortality rate of CRC in Iran and Fars province was provided |
| Regarding negative family history of CRC (perceived susceptibility), possibility of presence of a silent gene or development of solitary cancers without family history were explained. |
| They also were explained that lack of a positive family history does not guarantee immunity from the disease. |
| Booklet was reviewed with the subjects and they were asked to do risk assessment. |
| Lack of recommendation or advice for screening tests by the physician and care providers was identified as one of the important factors influencing perceived susceptibility. Therefore; the necessity of screening tests (despite of no recommendation from physician) was emphasized. |
| Necessity of conducting screening tests even in the absence of any clinical sign and symptom (perceived susceptibility) was described. The subjects were educated that lack of clinical sign or symptoms does not mean that they are healthy. In fact, the value of screening programs lies in their detection of pre-malignant lesions in people who do not show any clinical presentation and are apparently healthy. Increased risk with increased age was mentioned in order to motivate them. |
| 2. Perceived Severity |
Consequences of the risk and the conditions such as colostomy was specified and described. Pictures of patients with colostomy bags were shown to subjects. |
| One's belief of how serious a condition and its consequences are |
Subjects experience related to cancer was explored. |
| |
Statistics of negative consequences of colorectal cancer was provided. |
| |
They were asked to reflect on the conditions related to colorectal cancer and its consequences. |
| |
Early and delayed diagnosis was compared regarding mortality rate and complications. They were shown pictures of patients undergoing surgical operation for their CRC who are using a colostomy bags to understand the seriousness of the disease and the importance of accepting the test. |
| 3. Perceived Benefits |
Positive effects of a FOBT in preventing colorectal cancer was clarified and described. |
| One's belief in the efficacy of the advised action to reduce risk or seriousness of impact |
Difference between early and late diagnosis of colorectal cancer was clarified. |
| |
It was emphasized that polyps are benign neoplasms, however, potentially can progress to malignancy. Therefore; it is important to conduct screening tests for their early detection and removal in a treatable stage before advancing into an invasive cancer. |
| |
Action to take was defined: A card containing all the information they need (how, where, when) was provided. |
| |
The importance of screening behavior in reducing the seriousness of different cancer was explained |
| 4.Costs and Motivation (Perceived Barriers) |
barriers were Identified and reduced through reassurance, incentives, and assistance |
| One's belief in the tangible and psychological costs of the advised behavior. |
In order to address lack of knowledge about availability of screening programs as a perceived barrier face – to – face instruction was conducted and necessary information was provided. |
| |
They were reassured that the tests are free of charge (perceived cost) to eliminate the financial barrier. |
| |
Reminder cards were sent to them to increase their motivation and compliance. |
| |
The importance and advantages of screening and early diagnosis were reviewed with the subjects in order to overcome the feeling of embarrassment (perceived barrier). |
| |
They were provided the opportunity to collect fecal samples at home, work or lab. Aid by same sex investigators was offered in order to eliminate shame and embarrassment factor. The subjects were assured that colonoscopy in case of detecting a positive FOBT will be done by a physician of the same sex and their privacy will be respected (perceived barrier). |
| |
In regard to fear of risks and pain from each test (perceived barrier), the type, method and the place where the tests would be conducted were explained. Also risks and complications, medical and nursing care provision, and safety of tests were explained. It was emphasized that the colonoscopy would be performed only if the result of the FOBT is positive. |
| |
Psychological comfort after detecting a negative FOBT or colonoscopy was described |
| |
As the tests are perceived unpleasant (perceived barrier) the subjects were informed about the increasing risk of CRC in people after age 50. |
| |
To overcome their time limitation (perceived barrier) subjects were provided the possibility of special arrangement for delivering the sample to the lab in their comfort. (Since the bowel movement habits are different in different persons). This measure was used to relive their perceived cost. |
| 5. Cues to Action |
All the information about the test including preparation and facilities was provided to subjects in the forms of verbal and written (booklet, cards and reminders). |
| Strategies to activate "readiness" |
Considering all other components of the health belief model special cues to action was provided to increase their awareness |
| |
They were informed of the result of their tests by the phone. |
| 6. Self-Efficacy |
After each educational session they were asked to express their feeling about the confidence they have in their ability to perform the required test. |
| Confidence in one's ability to take action |
Based on their confidence training and guidance was provided. |
| |
They were informed of the result of their tests by the phone to reinforce them to recollect the sample for the second and third time. |
