Evaluation and Comparison of Theoretical Models' Abilities to Explain and Predict Colorectal ...

203 Pages·2016·8.94 MB·English

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2015
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Anthony J. Molisani
Virginia Commonwealth University
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Evaluation and Comparison of Theoretical Models’ Abilities to Explain and Predict Colorectal
Cancer Screening Behaviors

A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of
Philosophy at Virginia Commonwealth University.

by

Anthony Molisani,
Bachelor of Science, University of Rochester, 2008
Master of Public Health, Drexel University, 2010

Director: Robin K Matsuyama, Ph. D.,
Associate Professor, Department of Health Behavior and Policy

Virginia Commonwealth University
Richmond, Virginia
November, 2015
Acknowledgement

The author wishes to thank several people for guiding and supporting him throughout his work.
I’d like to thank Robin Matsuyama, Ph.D. for her dedication and immense support in advising me
throughout my time at Virginia Commonwealth University. Thank you to my committee: Levent
Dumenci, Ph.D., Kellie Carlyle, Ph.D., M.P.H., Robert Perera, Ph.D., and Kathleen Ingram, Ph.D.
Each of you has provided unique perspective and guidance that has greatly enriched my work and
research approach. Thank you to the Department of Health Behavior and Policy, including Laura
Siminoff, Ph.D. Completion of this program would not have been possible without the collective
and individual support from all within the department. Also, I’d like to thank my family: Rick,
Lynne, Michael, and Joseph Molisani for being the foundation of my values and talents. Thank
you to Emily Brown for her unyielding strength and love. Lastly, thank you to Luca, my best friend
that has been unconditionally by my side throughout my entire graduate career.

Finally, I’d like to dedicate this work to the memory of Lisa Ulmer, Sc.D., M.S.W. Your faith and
vision set me on this path for which I am truly grateful.

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Table of Contents

List of Tables ................................................................................................................................ vii
List of Figures .............................................................................................................................. viii
Abstract .......................................................................................................................................... xi
Introduction ................................................................................................................................... 13
Background ................................................................................................................................... 14
Colorectal Cancer...................................................................................................................... 14
Staging of Colon and Rectum Cancers. ................................................................................ 14
Colorectal cancer rates and trends. ....................................................................................... 17
Screening Methods, Guidelines, and Rates............................................................................... 20
Types of colorectal cancer screening. ................................................................................... 20
Colorectal Screening Recommendations and Guidelines ..................................................... 22
Screening Rates ..................................................................................................................... 23
Screening Behaviors and Cues to Action.................................................................................. 24
Conceptual Framework ............................................................................................................. 26
Behavioral Theory .................................................................................................................... 27
Health Belief Model. ............................................................................................................. 30
Theory of Reasoned Action. ................................................................................................. 36
Theory of Planned Behavior. ................................................................................................ 40
iii
Attribution Theory. ............................................................................................................... 43
Theory Application in Colorectal Cancer Screening ................................................................ 45
Behavioral Value. ................................................................................................................. 45
Outcome Value. .................................................................................................................... 50
Summary. .............................................................................................................................. 51
Methods......................................................................................................................................... 53
Overview ................................................................................................................................... 53
Theory Testing .......................................................................................................................... 53
Study Design ............................................................................................................................. 57
Participant Criteria. ............................................................................................................... 57
Survey Administration. ......................................................................................................... 58
Variables and Measures ............................................................................................................ 60
Theory of Reasoned Action/Theory of Planned Behavior. ................................................... 60
Attribution Theory. ............................................................................................................... 61
Health Belief Model. ............................................................................................................. 62
Colorectal Cancer Screening Behavioral Intention............................................................... 63
Previous Colorectal Cancer Screening Behavior. ................................................................. 63
Participant Characteristics. ................................................................................................... 63
Analysis..................................................................................................................................... 63
Behavioral Theory Model Testing. ....................................................................................... 64
Theoretical Model Comparison. ........................................................................................... 75
Sample Size and Power Consideration ..................................................................................... 75
Methodological Considerations ................................................................................................ 78
Meeting Study Goals................................................................................................................. 79
Results ........................................................................................................................................... 80
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Descriptive Statistics ................................................................................................................. 80
Sociodemographics. .............................................................................................................. 80
Health Status. ........................................................................................................................ 81
Previous Colorectal Cancer Screening Behavior. ................................................................. 82
Colorectal Cancer Screening Behavioral Intentions. ............................................................ 84
Colorectal Cancer Screening Modality Preference. .............................................................. 86
Confirmatory Factor Analyses .................................................................................................. 87
Health Belief Model. ............................................................................................................. 87
Theory of Reasoned Action. ................................................................................................. 92
Theory of Planned Behavior. ................................................................................................ 94
Attribution Theory. ............................................................................................................... 96
Theoretical Structural Equation Models ................................................................................... 98
Health Belief Model. ........................................................................................................... 100
Theory of Reasoned Action. ............................................................................................... 106
Theory of Planned Behavior. .............................................................................................. 110
Attribution Theory. ............................................................................................................. 114
Discussion ................................................................................................................................... 119
Model Analyses ...................................................................................................................... 119
Confirmatory Factor Analyses. ........................................................................................... 119
Whole Theoretical Models. ................................................................................................. 124
Theoretical Models Comparison. ........................................................................................ 141
Theoretical Application .......................................................................................................... 144
Theory Evaluation. .............................................................................................................. 144
Theory Integration. ............................................................................................................. 148
Colorectal Cancer Screening Practical Application ................................................................ 152
v
Limitations .............................................................................................................................. 157
Design Limitations. ............................................................................................................. 157
Execution Limitations. ........................................................................................................ 158
Theoretical Limitations. ...................................................................................................... 159
Future Approach ..................................................................................................................... 160
Summary ..................................................................................................................................... 164
References ................................................................................................................................... 166
Appendix A – Survey Instrument ............................................................................................... 179

vi
List of Tables

1. Comparison of Summary Staging and Extent of Disease Codes for Colon Cancer as
Classified by the Surveillance, Epidemiology and End Results (SEER) Program
(National Cancer Institute, 2009)..…………………...................................................... ....16
2. Stages of Colorectal Cancer (National Cancer Institute, 2006)……................................... ....17
3. Sociodemographics……………………………………………………………………….. ....81
4. Study sample health status…..…..…..…..…....................................................................... ....82
5. General CRC screening adherence…...……...…………………………………………… ....83
6. Previous CRC screening behavior by modality…………………………………………... ....84
7. CRC screening behavioral intentions…………………………………………………….......85
8. Confirmatory factor analyses models information……………………………………...... ....99
9. Structural equation models information………………………………………………….....100

vii
List of Figures

1. Conceptual Framework for Colorectal Cancer Screening with Examples of Each Value
Type…………………………………………………………………………………… 27
2. Conceptual Model of Health Belief Model (Rosenstock, 1974b)………………………… 32
3. Conceptual Model of the Theory of Reasoned Action (Madden et al., 1992)…………… 40
4. Conceptual Model of the Theory of Planned Behavior (Ajzen, 1991)…………………… 41
5. Dimensions of Attribution Theory by perceived Locus of Control and Causal Stability… 45
6. Illustrative example of a linear regression model of a 4-construct theory……………….. 54
7. Structural Equation Model of a 4-construct theory……………………………………….. 56
8. Attitudes TRA/TPB construct………………………………………….............................. 67
9. Subjective norms TRA/TPB construct……………………………………......................... 68
10. Perceived behavioral control TPB construct……………………………………………… 68
11. Internal locus of control AT construct………………………………................................. 69
12. Stability AT construct……………………………………………….................................. 69
13. Perceived susceptibility HBM construct………………………………….......................... 70
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