Determinants of Fecal Immunochemical Test (FIT) Uptake among Adults Aged 50 and Above: A Protection Motivation Theory Approach

Behrozi , Bahare; Charoghchian-Khorasani, Elham; Tehrani, Hadi; Gholami, Ali; Jamali, Jamshid; Gholian-aval, Mahdi

[Home ] [Archive]

[ فارسی ]

Iranian Journal of Health Education and Health Promotion

فصلنامه آموزش بهداشت و ارتقاء سلامت ایران

Main Menu

Home

Journal Information

Articles archive

For Authors

Publication Ethics

Editorial policy

Contact us

Site Facilities

Reviewe

Citation Impact

Search in website

Receive site information

COPE Membership

Creative Commons Licence

Open access

Back to the articles list

Back to browse issues page

Determinants of Fecal Immunochemical Test (FIT) Uptake among Adults Aged 50 and Above: A Protection Motivation Theory Approach

Bahare Behrozi

, Elham Charoghchian-Khorasani

, Hadi Tehrani

, Ali Gholami

, Jamshid Jamali

, Mahdi Gholian-aval ^*

Abstract: (42 Views)

Background and Objectives: Screening programs play a critical role in detecting early and treatable stages of colorectal cancer. However, a significant proportion of high-risk individuals fail to participate in these programs. This study aimed to identify the predictors of Fecal Immunochemical Test (FIT) uptake among adults over the age of 50 in Neyshabur, Iran, using the Protection Motivation Theory (PMT).

Materials and Methods: This cross-sectional study was conducted in 2024 on 433 individuals aged over 50 years (270 women and 163 men) attending comprehensive health service centers in Neyshabur. Participants were selected through stratified sampling with proportional allocation. Data were collected using a demographic questionnaire, a PMT-based questionnaire, and a FIT performance checklist. Data analysis was performed using Mann–Whitney, Kruskal–Wallis, Spearman correlation coefficient, and linear regression tests in SPSS version 25.

Results: The mean age of participants in the study was 58.26 ± 5.41 years. Most participants were aged between 50 and 59 years, and the majority (62.4%) were female. Perceived severity, perceived vulnerability, response efficacy, and self-efficacy showed a significant positive correlation with FIT behavior, while perceived rewards and response costs were negatively correlated (p < 0.05). In the regression model, protection motivation (β=0.266, p <0.001) and self-efficacy (β=0.165, p=0.005) significantly predicted FIT screening behavior. The Protection Motivation Theory explained 32.1% of the variance in FIT uptake behavior.

Conclusion: The Protection Motivation Theory can be an effective framework for promoting FIT screening behavior. Educational interventions based on PMT—particularly those enhancing protection motivation and self-efficacy—are recommended, especially in primary healthcare settings, to help prevent colorectal cancer.

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/

Keywords: Protection Motivation Theory, Fecal Immunochemical Test, Health Education, Colorectal Cancer

Type of Study: Research | Subject: Health Education & Health Promotion
Received: 2025/09/2 | Accepted: 2026/02/10

References

1. Sharifi M, Mohammadi Z, Makvandi Z, Rostami P, Moradi A. Assessment of cervical cancer screening and its barriers in 18-50 year old women referring to Asad Abad comprehensive health centers. Pajouhan Scientific Journal. 2018;16 (2):35-45. [DOI:10.21859/psj.16.2.35]

2. Pourfarzi F, Yazdanbod A, Daneshvar R, Saberi S. Evaluation of Effective Factors in Incidence of Colorectal Cancer. Journal of Ardabil University of Medical Sciences. 2013;12 (46):56.

3. Horaira MA, Islam MA, Kibria MK, Alam MJ, Kabir SR, Mollah MNH. Bioinformatics screening of colorectal-cancer causing molecular signatures through gene expression profiles to discover therapeutic targets and candidate agents. BMC Medical Genomics. 2023;16 (1):64. [DOI:10.1186/s12920-023-01488-w] [PMID] []

4. Shiu SI, Kashida H, Komeda Y. The prevalence of sessile serrated lesion in the colorectum and its relationship to synchronous colorectal advanced neoplasia: a systemic review and meta-analysis. Eur J Gastroenterol Hepatol. 2021;33 (12):1495-504. [DOI:10.1097/MEG.0000000000002062] [PMID] []

5. Ahmadi A, Hashemi-Nazari SS, Molavi Z, Nasri H. Comparing the Patterns of Hypertension and Type 2 Diabetes Mellitus in Patients with Colorectal Cancer. Journal of Isfahan Medical School. 2014;32:1537-45.

6. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71 (3):209-49. [DOI:10.3322/caac.21660] [PMID]

7. AziziKia H, Teymourzadeh A, Kouchaki H, Nakhostin-Ansari A, Jafari Doudaran P, Ahmadinejad I, Hoveidaei A, Roshandel G. Colorectal Cancer Incidence in Iran Based on Sex, Age, and Geographical Regions: A Study of 2014-2017 and Projected Rates to 2025. Arch Iran Med. 2024 Apr 1;27 (4):174-182. doi: 10.34172/aim.2024.26. [DOI:10.34172/aim.2024.26] [PMID] []

8. Arnold M, Sierra MS, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global patterns and trends in colorectal cancer incidence and mortality. Gut. 2017;66 (4):683-91. [DOI:10.1136/gutjnl-2015-310912] [PMID]

9. Maheri M, Darabi F, Khalili S, Hesari M. The effect of educational intervention based on theory of planned behavior on the improvement of colorectal cancer screening intention among average-risk individuals referring to Asadabad city clinics. J Educ Health Promot. 2021;10:57. [DOI:10.4103/jehp.jehp_741_20] [PMID] []

10. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61 (2):69-90. [DOI:10.3322/caac.20107] [PMID]

11. van den Puttelaar R, Lansdorp‐Vogelaar I, Hahn AI, et al. Impact and recovery from COVID‐19-related disruptions in colorectal cancer screening and care in the US: a scenario analysis. Cancer Epidemiol Biomarkers Prev. 2023;32 (1):22‐29. doi: 10.1158/1055-9965.EPI-22-0544. [DOI:10.1158/1055-9965.EPI-22-0544] [PMID] []

12. Goss PE, Lee BL, Badovinac-Crnjevic T, Strasser-Weippl K, Chavarri-Guerra Y, St Louis J, et al. Planning cancer control in Latin America and the Caribbean. Lancet Oncol. 2013;14 (5):391-436. [DOI:10.1016/S1470-2045(13)70048-2] [PMID]

13. Özmen V, Dağoğlu N, Dede İ, Akçakaya A, Kerem M, Göksel F, et al. Turkish Ministry of Health, 2 (nd) Turkish Medical General Assembly Clinical Oncology Study Group Report. J Breast Health. 2016;12 (1):9-17. [DOI:10.5152/tjbh.2015.2869] [PMID] []

14. SEER Cancer Stat Facts: Colorectal Cancer. National Cancer Institute. Bethesda, MD; 2015-2021. Available from: https://seer.cancer.gov/statfacts/html/colorect.html

15. Shouri Bidgoli AR, Taheri Kharame Z, Asayesh H, Sharififard F, Sheydaiyan Arani M, Hajaligol A, et al. A Study of Knowledge, Attitude, and PracticeonColorectal Cancer Screening among Individuals Older than50 Years Based on Health Belief Model. Qom University of Medical Sciences Journal. 2015;9 (1):59-65.

16. Rex DK, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T, et al. Colorectal Cancer Screening: Recommendations for Physicians and Patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol. 2017;112 (7):1016-30. [DOI:10.1038/ajg.2017.174] [PMID]

17. Lanier AP, Blasi PR, Meissner HI, et al. Guaiac Based FOBTs vs. Fecal Immunochemical Tests (FITs) for Colorectal Cancer Screening in Average Risk Adults: Evidence and Recommendations. Am Fam Physician. 2023.

18. Lee JK, Liles EG, Bent S, Levin TR, Corley DA. Accuracy of Fecal Immunochemical Tests vs Guaiac Fecal Occult Blood Tests in Colorectal Cancer Screening: A Systematic Review and Meta analysis. Ann Intern Med. 2014;160 (3):171 181. [DOI:10.7326/M13-1484] [PMID] []

19. Roozitalab M, Moatari M, Gholamzadeh S, SaberiFiroozi M, Zare N. The effect of health belief on participation of the official administrative personnel in colorectal cancer screening programs in Shiraz University of Medical Sciences: 2004. Govaresh. 2012;13 (1):19-24.

20. Javadzade SH, Reisi M, Mostafavi F, Hasanzade A, Shahnazi H, Sharifirad G. Factors associated with the fecal occult blood testing for colorectal cancer screening based on health belief model structures in moderate risk individuals, Isfahan, 2011. J Educ Health Promot. 2012;1:18. [DOI:10.4103/2277-9531.99218] [PMID] []

21. Hassanlouei B, Ostovar A, Motevalian SA, Ghanbari Motlagh A, Moradi Y, Salehi M, et al. Colorectal Cancer Screening Program Results in Iran. Med J Islam Repub Iran. 2022;36:118. [DOI:10.47176/mjiri.36.118] [PMID] []

22. Tehrani, H., Dadashi, N., Movahedzadeh, D., Khorasani, E.C., Jafari, A. The predictors of the use of complementary and alternative medicine among type 2 diabetes patients based on the health belief model. Journal of Diabetes and Metabolic Disorders, 21(1):285-292.

23. Alami A, Tavakoly Sany S, Tehrani H, Monfared E, Hosseini Z, Jafari A. The effect of educational intervention on iron and vitamin D consumption based on the theory of planned behaviour in Iranian adolescent girls: a quasi-experimental study. International Journal of Health Promotion and Education. 2019;57:1-16. [DOI:10.1080/14635240.2019.1632732]

24. Ahmadi A, Mobasheri M, Hashemi-Nazari SS, Baradaran A, Choobini ZM. Prevalence of hypertension and type 2 diabetes mellitus in patients with colorectal cancer and their median survival time: A cohort study. J Res Med Sci. 2014;19 (9):850-4.

25. Barati M, Allahverdipour H, Hidarnia A, Niknami S, Bashirian S. Belief-based Tobacco Smoking Scale: Evaluating the Psychometric Properties of the Theory of Planned Behavior's Constructs. Health Promot Perspect. 2015;5 (1):59-71. [DOI:10.15171/hpp.2015.008] [PMID] []

26. Morowatisharifabad MA, Vardanjani Z, Raiisi Z, Askarishahi M. Predictors of Pap Smear Test Based on Protection Motivation Theory among Women of Shahree-kord. The Journal of Tolooebehdasht. 2018. [DOI:10.18502/tbj.v17i4.185]

27. Chen YL, Lin YJ, Chang YP, Chou WJ, Yen CF. Differences in the Protection Motivation Theory Constructs between People with Various Latent Classes of Motivation for Vaccination and Preventive Behaviors against COVID-19 in Taiwan. Int J Environ Res Public Health. 2021;18 (13). [DOI:10.3390/ijerph18137042] [PMID] []

28. Rahaei Z, Ghofranipour F, Morowatisharifabad MA, Mohammadi E. Determinants of Cancer Early Detection Behaviors:Application of Protection Motivation Theory. Health Promot Perspect. 2015;5 (2):138-46. [DOI:10.15171/hpp.2015.016] [PMID] []

29. Baghianimoghadam MH, Mohammadi S, Mazloomi Mahmoudabad SS, Norbala MT. The Effect of Education Based on Protection-motivation Theory on Skin Cancer Preventive Practices Among Female High School Students in Yazd. Internal Medicine Today. 2011;17 (1):27-34.

30. Dehbari SR, Dehdari T, Dehdari L, Mahmoudi M. Predictors of Sun-Protective Practices among Iranian Female College Students: Application of Protection Motivation Theory. Asian Pac J Cancer Prev. 2015;16 (15):6477-80. [DOI:10.7314/APJCP.2015.16.15.6477] [PMID]

31. Jowzi F, Hashemifard T, Morowatisharifabad M, Bashir Z. Factors Associated with Pap Smear Screening Test among Women Aged 15-49 based on Protection Motivation Theory. Journal of Hayat. 2013;19 (1):29-40.

32. Azam ME, Bashirian S, Shahanjarini AK, Barati M. Factors associated with intention to perform fecal occult blood test among medical professionals: an application of the protection motivation theory. Govaresh. 2019;24 (3):147-55.

33. Huang J, Wang J, Pang TW-Y, Chan MK-Y, Leung S, Chen X, et al. Does theory of planned behaviour play a role in predicting uptake of colorectal cancer screening? A cross-sectional study in Hong Kong. BMJ Open. 2020;10 (8):e037619. [DOI:10.1136/bmjopen-2020-037619] [PMID] []

34. Davis JL, Buchanan KL, Katz RV, Green BL. Gender differences in cancer screening beliefs, behaviors, and willingness to participate: implications for health promotion. Am J Mens Health. 2012;6 (3):211-7. [DOI:10.1177/1557988311425853] [PMID] []

35. Khosravi V, Barati M, Moeini B, Mohammadi Y. Prostate Cancer Screening Behaviors and the Related Beliefs among 50- to 70-year-old Men in Hamadan: Appraisal of Threats and Coping. J Educ Community Health. 2018;4 (4):20-31. [DOI:10.21859/jech.4.4.20]

36. Jones RM, Woolf SH, Cunningham TD, Johnson RE, Krist AH, Rothemich SF, et al. The relative importance of patient-reported barriers to colorectal cancer screening. Am J Prev Med. 2010;38 (5):499-507. [DOI:10.1016/j.amepre.2010.01.020]

37. Rahimi T, Faryabi R. Factors Predicting Prostate Cancer Screening Behavior in Iranian Men Based on the Protection Motivation Theory. Health Education and Health Promotion. 2022;10 (4):827-33.

38. Mousavinejad SH, Tarrahi MJ, Fathian-Dastgerdi Z. Socio-Cognitive Factors Affecting Non-Participation in the Colorectal Cancer Screening Program of Adults Aged 50 to 70 in Iran. Iranian Journal of Health Education and Health Promotion. 2024;12 (3):245-53.

39. Babazadeh T, Nadrian H, Banayejeddi M, Rezapour B. Determinants of Skin Cancer Preventive Behaviors Among Rural Farmers in Iran: an Application of Protection Motivation Theory. Journal of Cancer Education. 2017;32 (3):604-12. [DOI:10.1007/s13187-016-1004-7] [PMID]

40. Morowatisharifabad m, Hadi varnamkhavasti L, Zare M, Fallahzadeh H, Karimiankakolaki z. Study of Determinants of Lung Cancer Protective Behaviors in Esfahan Steel Company Workers Based On Protection Motivation Theory. Tolooebehdasht. 2017;16 (3):67-80.

41. Hosseini ZS, Tavakoli Ghouchani H, Mehri A, Mohaddes Hakak HR, Lashkardoost H, Khankolabi M, et al. Factors Related to Breast Cancer Preventive Behaviors in Middle-aged Women: An Application of Protection Motivation Theory. Iranian Journal of Breast Diseases. 2022;14 (4):62-74. [DOI:10.30699/ijbd.14.4.62]

42. Tazval J, Ghafari M, Mohtashami Yeganeh F, Babazadeh T, Rabati R. Efficiency of Protection Motivation Theory on Prediction of Skin Cancer and Sunlight Preventive Behaviors in Farmers in Ilam County. Journal of Health and Hygiene. 2017;7 (5):656-67.

43. Bakht R, Shobeiri F,et al. The factors affecting cervical cancer screening among addicted women of Hamedan in 2015: On the basis of Protection Motivation Theory model. Jorjani Biomedicine Journal. 2016;4 (2):68-80.

Send email to the article author

Add your comments about this article