R. B. had little knowledge about colorectal cancer or colorectal cancer screening tests. Within 2 weeks of educating R. B. about the various colorectal cancer tests, she contacted her physician’s office and went for an appointment. She received, conducted, and returned a completed fecal occult blood test kit within the following few days. The results came back positive. R. B. was upset not only by the test result but also by the way in which her physician reportedly handled the situation. Her physician reportedly asked her to complete another fecal occult blood test and referred her for a Papanicolaou test and mammogram. He reportedly did not schedule another follow-up appointment for 2 months. R. B. was very scared and very upset. She did not want to wait 2 months for a follow-up appointment. After considerable discussion with the health educator, she decided to find another physician. The new physician reportedly referred her for a colonoscopy immediately, which yielded a negative result. R. J. was not familiar with colorectal cancer or colorectal cancer screening tests. Once educated, she decided to call her physician to request a kit. When the health educator called R. J. to follow up, R. J. indicated that she had contacted the physician’s office and was told that fecal occult blood test kits were not distributed by mail and that she would have to come in for an appointment. R. J. did not want to go in for an appointment. Contact was made with the provider who was urged to send R. J. the kit by mail, which he agreed to do. Unfortunately, when the kit arrived by mail, it did not include an instruction sheet or return envelope. P. J. was quite knowledgeable about colorectal cancer and screening tests for colorectal cancer. Nevertheless, he had not received screening. P. J. was a recent immigrant, and his proficiency in English was somewhat limited. Although he intended to call his physician to request a kit, when the time came, he felt uncomfortable with his ability to pronounce the words “fecal occult blood test.” To overcome this barrier, it was necessary for P. J. to role-play with the health educator how to request the kit in order to have the confidence needed to place a call to his physician. When P. J. contacted his physician to request the kit, his physician advised him to instead receive a colonoscopy. P. J. did not want an invasive procedure and insisted on receiving the fecal occult blood test. His physician reportedly sent him the fecal occult blood test kit, and P. J. completed and returned the fecal occult blood test. R. T. was familiar with colorectal cancer screening tests and valued their importance. R. T. knew that her physician carried the fecal occult blood test kits and forecasted that there would be no difficulty in attaining one because his office is located 1 floor down from hers in the hospital where they both worked. Within 1 week of the initial intervention call, R. T. had obtained the kit from her physician, completed it, and returned it for analysis. Although R. T. was clearly motivated to participate in colorectal cancer screening practices, it was necessary for her to be reminded. E. G. had misconceptions about the need for colorectal cancer screening. She believed that you need to take a fecal occult blood test only if you feel pain. When the guidelines for colorectal cancer screening were clearly defined for her by the health educator, E. G. quickly made a verbal commitment to call her physician to request a fecal occult blood test. When E. G. received the test, she was discouraged by the nutritional restrictions that accompanied the kit. Consuming red meat was very important to E. G., and she was not willing to give up her red meat intake for 3 days to complete a valid fecal occult blood test. Despite repeated attempts to persuade E. G. to take the test and providing numerous suggestions for recipes involving meat substitutes, ultimately E. G. decided that she was not willing to stop eating red meat for 3 days. L. P. believed that she would need a colorectal cancer screening test only if she had visible blood in her stool. When the guidelines for colorectal cancer screening were described to her, L. P. decided that she should receive a fecal occult blood test. One of the main factors resulting in L. P.’s willingness to do a fecal occult blood test was support from her husband who was a laboratory technician. After discussing the test with him, he agreed that it was a good idea for her to complete the fecal occult blood test and to assist her in implementing the procedures required by the test. In a very short time, she obtained and completed the fecal occult blood test. C. C. was unfamiliar with colorectal cancer screening tests. She was comfortable discussing the topic on the telephone but indicated that she was not comfortable discussing the topic with her physician who was male. C. C.’s situation was particularly troubling because she reported having repeated episodes of rectal bleeding. After a great deal of education and encouragement, C. C. finally agreed to call her physician to request a fecal occult blood test kit through the mail. The physician, however, reportedly refused to send her a kit through the mail and requested that she come in for an appointment. C. C. was unwilling to schedule an office visit to address the topic of colorectal cancer screening because she was uncomfortable discussing the topic with her physician and with him examining her rectum. J. B. had never heard of any colorectal cancer screening tests or that colorectal cancer affects both men and women. Despite efforts to clarify these misconceptions, repeated efforts to encourage J. B. to seek screening were unsuccessful because he was adamant that colorectal cancer would not happen to him. |
Increasing knowledge alone may enhance an individual’s motivation to initiate a new behavior. A health educator should be prepared to deal with a full range of consequences that may result from helping to elicit a behavior change. Providing emotional and social support can be an important role of a health educator. In this case, helping an individual cope with her fear, and in taking control of her health care by finding a new provider, seemed paramount. An individual’s readiness and stage of change can affect the kind of messages that are relevant and effective. In this case, R. B. required only increased awareness to enhance motivation and to move along to stages of trial and adoption. Motivation alone is not always sufficient to modify a behavior. Educational approaches that address changes in individuals only and do not consider environmental barriers to implementing a new behavior will be limited in effectiveness. Knowledge and motivation may not be sufficient to modify a behavior. P. J. was knowledgeable, but he lacked both the communication skills and the self-efficacy in his skills to act on his motivation. Individuals may be knowledgeable of their options and have a preference for a specific test. Health care providers, however, may not always be supportive of the request. In these cases, assertiveness will be required for individuals to maintain control over their health care. Although an individual may be motivated to participate in screening practices, the individual may need a cue to action and social support to implement a behavior change. Access to resources increases the ease with which a new behavior may be adopted. What an individual values may enhance, as well as hinder, attempts to influence behavior change. Social support can be extremely powerful. We know such support is an extremely powerful influence in initiating or changing a new behavior, and it is even more important with respect to maintaining a behavior change once initiated. Perceived susceptibility may be an important factor in eliciting behavior change. Increased awareness may be enough to elicit behavior change in individuals. Embarrassment and a poor relationship with one’s health care provider can seriously compromise preventive health care. A common barrier to increasing many preventive health behaviors is denial. Denial is a powerful defense mechanism that most of us use at one time or another to convince ourselves that what we are doing or not doing is acceptable. Denial is a difficult barrier to overcome because it is rooted in emotion rather than factual knowledge. |
