ASSOCIATION BETWEEN PREVENTIVE BEHAVIOUR ON COLORECTAL CANCER AND HEALTH LITERACY AMONG THE ADULT POPULATION IN SARAWAK, MALAYSIA
Health literacy has shown to have some influence in preventive behaviour, including on colorectal cancer. Such a relationship, however, is not well established in Malaysia, particularly Sarawak. This study is aimed to estimate the level of health literacy and preventive practice against colorectal cancer and factors associated with it. This was a cross-sectional study conducted in Sarawak, among adults aged 50 years and above. Data was collected by face to face interviews using a validated questionnaire. Descriptive statistics were used to determine the health literacy and preventive behaviour on colorectal cancer. Multiple linear regression was used to determine the factors associated with preventive behaviour on colorectal cancer and also to examine its relationship with health literacy. A p-value of ≤0.05 was considered as statistically significant. A total of 829 respondents were included in the analysis. Mean age (standard deviation) of the respondents was 55.78 (5.01) years. A large proportion had an educational background of upper secondary school and above (41%) and from Iban ethnicity (32.4%). Only 1.1% of them had a family history of colorectal cancer. Multiple linear regression analysis revealed that gender (p<0.01), ethnicity (p<0.05), functional health literacy (p<0.05), and knowledge on colorectal cancer (p<0.05) appeared to be significant predictors for preventive behaviour on colorectal cancer. Health literacy has a positive effect on preventive behaviour on colorectal cancer. The findings assist in designing and developing targeted informational campaigns to promote preventive behaviour, particularly among low health literate group.
World Cancer Research Fund International/American Institute for Cancer Research. Continuous Update Project Expert Report. Diet, nutrition,
physical activity and colorectal cancer; 2018. 109 p. www.wcrf.org/sites/default/files/Colorectal-cancer-report.pdf (accessed 28 December 2020).
Wing MC, Ding H, Wang J, et al. Prevalence and risk factors of colorectal cancer in Asia. Intestinal Research 2019; 17(3): 317-319.
Lopez PJT, Albero JS, Rodriguez-Montes JA. Primary and secondary prevention of colorectal cancer. Clinical Medicine Insight: Gastroenterology 2014; 7:33–46.
Torre LA, Siegel RL, Ward EM, Jemal A. Global cancer incidence and mortality rates and trends: An update. Cancer Epidemiology Biomarkers & Prevention 2016; 25(1):16–27.
Wang X, O’Connell K, Jeon J, et al. Combined effect of modifiable and non-modifiable risk factors for colorectal cancer risk in a pooled analysis of 11 population-based studies. BMJ Open Gastroenterology 2019; 6(1): e000339.
Naing C, Lai PK, Mak JW. Immediately modifiable risk factors attributable to colorectal cancer in Malaysia. BMC Public Health 2017; 17(637).
Batterham RW, Hawkins M, Collins PA, et al. Health literacy: applying current concepts to improve health services and reduce health inequalities. Public Health 2016; 132: 3-12.
Rudd RE. Health literacy: Insights and issues. In: Logan RA, Siegel ER, eds. Health Literacy: New directions in research, theory and practice. Amsterdam: IOS Press 2017: 60-64.
Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International 2000; 15(3); 259–267.
Davey J, Holden CA, Smith BJ. The correlates of chronic disease-related health literacy and its components among men: A systematic review. BMC Public Health 2015; 15:589.
Fernandez DM, Larson JL, Zikmund-fisher BJ. Associations between health literacy and preventive health behaviors among older adults: Findings from the health and retirement study. BMC Public Health 2016; 16(596).
Malaysian Journal of Public Health Medicine 2021, Vol. 21(1): 190-197
Kim K, Han H, Koay K., Potential links between health literacy and cervical cancer screening behaviors: a systematic review. Psycho-Oncology 2016; 25(2):122-130.
Sentell TL, Tsoh JY, Davis T, et al. Low health literacy and cancer screening among Chinese Americans in California: a cross-sectional analysis. BMJ Open 2015; 5: e006104.
Economic Planning Unit Sarawak. Sarawak Facts and Figures 2019. Sarawak: Chief Minister’s Department; 2019: 68 p. www.jkm.sarawak.gov.my/SPU/page-0-0-346-.html (accessed 30 December 2020).
Hilmi I, Hartono JL, Goh KL. Negative perception in those at highest risk - Potential challenges in colorectal cancer screening in an urban Asian population. Asian Pasific Journal of Cancer Prevention 2010; 11:815–22.
Suka M, Odajima T, Kasai M, et al. The 14-item health literacy scale for Japanese adults (HLS-14). Environ Health Prev Med 2013; 18:407–15.
Power E, Simon A, Juszczyk D, et al. Assessing awareness of colorectal cancer symptoms: Measure development and results from a population survey in the UK. BMC Cancer 2011; 11(366).
Dennis DL, Waring JL, Payeur N, Cosby C. Making lifestyle changes after colorectal cancer: Insights for program development. Current Oncology 2013; 20(6): e493-511.
IBM SPSS. IBM SPSS Statistics for Windows (Version 22) 2013. [Computer software].
Garson GD. Missing values analysis and data imputation (second). Statistical Associates Publishers 2015. http://www.statisticalassociates.com/missingvaluesanalysis.htm (accessed 2 November 2020).
Jakobsen JC, Gluud C, Wetterslev J, et al. When and how should multiple imputation be used for handling missing data in randomised clinical trials – a practical guide with flowcharts. BMC Medical Research Methodology 2017; 17(1):162.
Sharma A. Understanding Mahalanobis distance and its use cases. Analytics India Magazine 2018, July 10. https://www.analyticsindiamag.com/un
derstanding-mahalanobis-distance-and-its-use-cases/ (accessed 2 November 2020).
Garcia-Codina O, Juvinyà-Canal D, Amil-Bujan P, et al. Determinants of health literacy in the general population: Results of the Catalan health survey. BMC Public Health 2019; 19:1122.
Kobayashi LC, Wardle J, Wolf MS, et al. Health literacy and moderate to vigorous physical activity during aging , 2004–2013. American Journal of Preventive Medicine 2016; 51(4):463–472.
Reisi M, Javadzade SH, Heydarabadi AB, et al. The relationship between functional health literacy and health promoting behaviors among older adults. Journal of Education and Health Promotion 2014; 3:119.
Thompson AE, Anisimowicz Y, Miedema B, et al. The influence of gender and other patient characteristics on health care-seeking behaviour: a QUALICOPC study BMC Family Practice 2016; 17: 38
Hiller J, Schatz K, Drexler H. Gender influence on health and risk behavior in primary prevention: A systematic review. Journal of Public Health 2017, 25(4): 339–349.
Crimmins EM, Shum H, Zhang YS, et al. Differences between men and women in mortality and the health dimension of the morbidity process. Clinical Chemistry 2019; 65(1): 135-145.
Froze S, Arif MT, Saimon R. Determinants of health literacy and healthy lifestyle against Metabolic Syndrome among major ethnic groups of Sarawak, Malaysia: A multi-group path analysis. The Open Public Health Journal 2019; 12:172–83.
Taheri-Kharameh Z, Noorizadeh F, Sangy S, et al. Factors associated with Ng EST, Tan adherence to colorectal cancer screening among moderate risk individuals in Iran. Asian Pacific Journal of Cancer Prevention 2016; 16(18): 8371-8375.
Wutayd OA, Alamri F, Ali AM, et al. Colorectal cancer risk factors: a study of knowledge, attitude and practice among adults in Riyadh, Saudi Arabia. Cancer Research Journal 2015; 3(5): 94-99.
Sharbatti S Al, Muttappallymyalil J, Sreedharan J, et al. Knowledge, perception, and preventive practices
Malaysian Journal of Public Health Medicine 2021, Vol. 21(1): 190-197
regarding colorectal cancer among adults in Ajman, UAE. Gulf Medical Journal 2014; 3:35–49.