Men and Women are Different: Predictors of an Informed Decision about Colorectal Cancer Screening Kelly Brittain, PhD, RN Michigan State University 2012 State of Nursing Science Congress on Nursing Research; Washington, D.C. September 13-15, 2012

Acknowledgements Funding: NIH/NINR: 1F31NR King/Chavez/Parks Future Faculty Fellowship from the Rackham Graduate School of the University of Michigan Dissertation Committee: Carol Loveland-Cherry, PhD, RN, FAAN Laurel Northouse, PhD, RN, FAAN Cleopatra H. Caldwell, PhD Jacquelyn Y. Taylor, PhD, PNP-BC, RN, FAAN

Colorectal Cancer (CRC)* ACS CRC Facts and Figures, *per 100,000, age adjusted to the 2000 US standard population

CRC Screening (%) among adults age 50 and older ACS CRC Facts and Figures,

Much of the research has been done in clinical settings Among first degree relatives and Caucasians Knowledge, barriers, beliefs related to CRC screening Gender differences were not examined Much of what has been tried has not significantly increased colorectal cancer screening Need to examine other possible factors to develop innovative tailored interventions Previous Colorectal Cancer Screening Research

Specific Aim Determine if the relationships among the study variables differed among African American men and women.

Conceptual Model Colorectal Cancer Beliefs Informed Decision About Colorectal Cancer Screening Cultural Identity Family Support and Influence Self-System Preventive Intention

Research Design Correlational Cross sectional 64 men and 64 women

Eligibility Criteria & Recruitment African American men and women Age 50 and older Able to read and write in English No personal history of colorectal cancer Have insurance coverage for CRC screening Recruited from Detroit businesses and peer-to-peer

Variables & Measures Cultural Identity: Cultural identity subscales: collectivism, religiosity, racial pride, present-time & future-time orientation (Kreuter, Lukwago, Bucholtz, Holt and Clark, 2001) (α = ) Family Support & Influence: Medical Outcomes Study Social Support Survey (Sherbourne & Stewart, 1991) (α =.93) & Family Influence Scale (Brittain, Loveland-Cherry, Northouse, Caldwell & Taylor, 2012) (α =.74) Colorectal Cancer Beliefs: Colorectal Cancer Perceptions Scale (Green & Kelly, 2004) (α =.92) Informed Decision Making: Informed decision regarding colorectal cancer screening (Brittain, Loveland-Cherry, Northouse, Caldwell & Taylor, 2012) (α =.68)

Results

Sample N= 129; 64 men & 65 women Age: 58.5 (SD=7.6) 60% were single (unmarried or divorced) 100% insured

Study variables and African American Men CRC beliefs related to: Collectivism (r =.36**) Religiosity (r =.33**) Present-time orientation (r = -.39**) Future-time orientation (r =.48**) Family support (r =.50**) Informed decision (r =.32*) **p<.01 *p<.05

Study variables and African American Men Family support related to: Collectivism (r =.46**) Religiosity (r =.33**) Present-time orientation (r = -.40**) Future-time orientation (r =.28*) Informed decision (r =.40**) **p<.01 *p<.05

Study variables and African American Men Informed decision related to: Collectivism (r =.32*) Racial pride (r =.38*) Present-time orientation (r = -.38**) CRC beliefs (r =.32*) Family support (r =.40**) **p<.01 *p<.05

Study variables and African American Women CRC beliefs related to : Family support (r =.45**) Racial pride (r = -.25*) Informed decision (r =.25*) Family support related to: Racial pride (r = -.25*) **p<.01 *p<.05

Collectivism Religiosity Present-time orientation* Future-time orientation CRC beliefs Family support *p<.05; Men scored higher African American men and women responses were significantly different:

Male Model Path Analysis

Female Model Path Analysis

Model Differences Male The male model did not fit the data well (X 2 =14.90, 6df, p =.021, N= 64, NFI =.912, CFI =.933, RMSEA =.153; R 2 =.44 (CRC beliefs), R 2 =.10 (Informed decision)) Female The female model fit the data well (X 2 =5.10, 6df, p =.531, N= 65, NFI =.905, CFI = 1.00, RMSEA =.000; R 2 =.30 (CRC beliefs), R 2 =.06 (Informed decision))

Limitations Correlational design Unable to generalize (age & location) Male model not supported Small explained variance

Conclusions One of a very few studies in the non clinical setting examining an informed decision Certain cultural factors related to CRC beliefs, but differ among men and women Relationship among variables related to an informed decision differ among men and women Family support related to CRC beliefs CRC beliefs related to an informed decision

Conclusions Model differs between men and women Other factors may influenced informed decision - not in model Adds knowledge Need more details Further research can inform intervention research that may improve colorectal cancer screening rates among African Americans

Thank you. Questions??