Implementation of a home-based colorectal cancer screening intervention in Malaysia (CRC-SIM)

Désirée Schliemann*, Kogila Ramanathan, Nor Saleha Binti Ibrahim Tamin, Ciaran O'Neill, Christopher R Cardwell, Roshidi Ismail, Zaid Kassim, Frank Kee, Tin Tin Su, Michael Donnelly

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)
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Abstract

Introduction
The Colorectal Cancer Screening Intervention for Malaysia (CRC-SIM) was a CRC study of home-based testing designed to improve low screening uptake using the immunochemical fecal occult blood test (iFOBT) in Malaysia.

Methods
This quasi-experimental study was informed by the Implementation Research Logic Model and evaluated with the RE-AIM framework. Trained data collectors recruited by phone, randomly selected, asymptomatic adults aged 50-75 years from Segamat District, who previously completed a health census form for the South East Asia Community Observatory (SEACO). Participants were posted an iFOBT kit and asked to return a photo of the completed test for screening by health care professionals. A regression analysis of evaluation data was conducted to identify which variables were associated with the outcome indicators of ‘study participation’ and ‘iFOBT completion’ and the CRC-SIM was evaluated in terms of its appropriateness, feasibility and acceptability.

Results
Seven hundred forty-seven eligible adults (52%) agreed to participate in this study and received an iFOBT kit. Participation was significantly lower amongst Chinese Malaysians (adjusted OR 0.45, 95% CI 0.35 - 0.59, p<0.001) compared to Malays and amongst participants from the rural sub-district (Gemereh) (adjusted OR 0.71, 95% CI 0.54 - 0.92, p=0.011) compared to the urban sub-district (Sungai Segamat). Less than half of participants (42%, n=311/747) completed the iFOBT. Test-kit completion was significantly higher amongst Chinese Malaysians (adjusted OR 3.15, 95% CI 2.11 - 4.69, p<0.001) and lower amongst participants with a monthly household income ≥RM 4,850 (adjusted OR 0.58, 95% CI 0.39 - 0.87, p=0.009) compared to participants with a lower household income. The main reported reason for non-participation was ‘not interested’ (58.6%) and main implementation challenges related to invalid photographs from participants and engaging iFOBT positive participants in further clinic consultations and procedures.

Conclusion
Home-testing for CRC (test completion) appeared to be acceptable to only around one-fifth of the target population in Malaysia. However, mindful of the challenging circumstances surrounding the pandemic, the CRC-SIM merits consideration by public health planners as a method of increasing screening in Malaysia, and other low- and middle-income countries.
Original languageEnglish
Article number22
Number of pages12
JournalBMC Cancer
Volume23
DOIs
Publication statusPublished - 06 Jan 2023

Keywords

  • Screening
  • Colorectal Neoplasms
  • Early Detection
  • Fecal Occult Blood Test
  • Implementation Science
  • Lmic
  • Humans
  • Colonoscopy
  • Mass Screening
  • Occult Blood
  • Regression Analysis
  • Adult
  • Malaysia
  • Early Detection of Cancer

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