Colorectal cancer screening behaviors.

INTRODUCTION: Colorectal cancer screening program compliance in Turkey is around 20-30%. Factors that may affect preventive health behavior, mainly individuals' values, beliefs and attitudes, should be explored. A "Health Belief Model" (HBM) scale was developed in 1950 to explain the insufficient participation of some individuals in screening programs. The scale was adopted for colon cancer in 2002. The validity and reliability study of this scale for the Turkish language was conducted in 2007. In this study we aim to evaluate the health beliefs of relatively young individuals before the age of screening in relation to attitudes to colorectal cancer screening via the Turkish version of the scale. MATERIALS AND METHODS: A questionnaire composed of 14 sociodemographic questions and 33 HBM scale questions were applied to the patients of a Family Medicine outpatient clinic where the majority of the patients are relatively young people. The data was analyzed using the IBM SPSS version 21.0. RESULTS: A total of 310 subjects at the age of 18 and over were informed about the study. The study was completed with 215 subjects with a participation rate of 69.3%. The average age of the participants was 35.4 ± 12.8 years; 62.8% of them were women; 26.0% were students. 94.4% of the participants did not have a history of colon cancer among their first degree relatives. 58.1% agreed that "A colonoscopy should be done every ten years starting at age 50 to screen for colon cancer." Age, marital status, education and occupation status were found to have an effect on barrier scores. Young participants, singles, and those with a primary and/or secondary school education had statistically significant higher barrier scores. The motivation scores of high school graduates were higher than university graduates. The seriousness scores of men were found to be higher than women. CONCLUSION: Our study points out that attitudes about preventive health measures are mainly associated with age, gender, education level and marital status. These personal characteristics should be taken into consideration while offering screening programs and preventive health measures to individuals in order to protect against colorectal cancer. It is better to give specific messages according to personal characteristics and specific barriers instead of general messages about conducting screening tests beginning from a young age.

Unburdening dementia - a basic social process grounded theory based on a primary care physician survey from 25 countries.

OBJECTIVE: To explore dementia management from a primary care physician perspective. DESIGN: One-page seven-item multiple choice questionnaire; free text space for every item; final narrative question of a dementia case story. Inductive explorative grounded theory analysis. Derived results in cluster analyses. Appropriateness of dementia drugs assessed by tertiary care specialist. SETTING: Twenty-five European General Practice Research Network member countries. SUBJECTS: Four hundred and forty-five key informant primary care physician respondents of which 106 presented 155 case stories. MAIN OUTCOME MEASURES: Processes and typologies of dementia management. Proportion of case stories with drug treatment and treatment according to guidelines. RESULTS: Unburdening dementia - a basic social process - explained physicians' dementia management according to a grounded theory analysis using both qualitative and quantitative data. Unburdening starts with Recognizing the dementia burden by Burden Identification and Burden Assessment followed by Burden Relief. Drugs to relieve the dementia burden were reported for 130 of 155 patients; acetylcholinesterase inhibitors or memantine treatment in 89 of 155 patients - 60% appropriate according to guidelines and 40% outside of guidelines. More Central and Northern primary care physicians were allowed to prescribe, and more were engaged in dementia management than Eastern and Mediterranean physicians according to cluster analyses. Physicians typically identified and assessed the dementia burden and then tried to relieve it, commonly by drug prescriptions, but also by community health and home help services, mentioned in more than half of the case stories. CONCLUSIONS: Primary care physician dementia management was explained by an Unburdening process with the goal to relieve the dementia burden, mainly by drugs often prescribed outside of guideline indications. Implications: Unique data about dementia management by European primary care physicians to inform appropriate stakeholders. Key points Dementia as a syndrome of cognitive and functional decline and behavioural and psychological symptoms causes a tremendous burden on patients, their families, and society. •We found that a basic social process of Unburdening dementia explained dementia management according to case stories and survey comments from primary care physicians in 25 countries. •First, Burden Recognition by Identification and Assessment and then Burden Relief - often by drugs. •Prescribing physicians repeatedly broadened guideline indications for dementia drugs. The more physicians were allowed to prescribe dementia drugs, the more they were responsible for the dementia work-up. Our study provides unique data about dementia management in European primary care for the benefit of national and international stakeholders.