Effectiveness of Program Promoting Colorectal Cancer Prevention Literacy via mHealth in Risk Groups in Urban Communities

Abstract

Introduction The incidence of colorectal cancer continues to increase and is the second leading cause of death globally. Early-stage colorectal cancer is often asymptomatic. The Ministry of Public Health has established measures to prevent colorectal cancer by implementing strategies focused on health promotion, prevention, and reducing health risk factors through health literacy. This strategy improves people’s ability to access, comprehend, and utilize health information, influencing their decisions to take preventive behaviors. When combined with screening, early detection can help reduce colorectal cancer mortality rates. While people have access to health services, limitations such as taking time off work and losing income, particularly in urban areas, remain. The integration of mobile health (mHealth) systems offers a promising approach to enhancing access to health information, especially for those at high risk. 

Objectives This study aimed to 1) compare overall colorectal cancer prevention literacy and subscales before and after participating in the program and 2) compare self-care behaviors to prevent colorectal cancer before and after participating in the program.

Design This study employed a one-group quasi-experimental design with self-control, applying Nutbeam’s health literacy theory to develop a program promoting colorectal cancer prevention literacy via mHealth. The program focused on promoting health literacy at all three levels for risk groups: 1) Functional health literacy (FHL), 2) Interactive health literacy (IHL), and 3) Critical health literacy (CHL). The program consisted of four activities: 1) “Know how to fight colorectal cancer,” 2) “Move slightly to beat cancer,” 3) “Risks that can be avoided,” and 4) “Know it, prevent it.” These activities improve colorectal cancer prevention literacy and lead to self-care behaviors to prevent colorectal cancer.

Methodology This study consisted of 32 participants aged 20 years or older at risk for colorectal cancer, residing in 8 communities within the Bangkok metropolitan area. The participants met the following inclusion criteria: 1) Self-assessment results indicating a moderate risk for developing colorectal cancer, 2) A family history of first-degree relatives with colorectal cancer, 3) Experiencing any abnormal symptoms related to the digestive system, 4) Ability to communicate in Thai, 5) Having a smartphone with internet access and the ability to use the Line application and Google forms, and 6) No history of colorectal cancer or unknown diagnosis of colorectal cancer. The sample size was determined according to the principles of power analysis, using the G*Power program. The research instruments were divided into three sections: 1) A screening tool for self-assessment of colorectal cancer risk and a screening tool for dementia, 2) Tools for data collection, including an assessment of colorectal cancer prevention literacy and a questionnaire on self-care behaviors to prevent colorectal cancer, and 3) A program promoting colorectal cancer prevention literacy via mHealth, which included pamphlets, videos, lecture materials, and infographics. The program also featured assessments of physical activity and skill-training activities to enhance literacy. Data collection was conducted from April 1 to June 30, 2023, and data were analyzed using descriptive statistics, the Friedman test, and multiple comparisons using Bonferroni statistics.

Results The majority of the participants were female (78.1%), with the mean age of 60.59 years (SD = 10.64). Half of the participants had completed primary education (50.0%) and 56.3% had no family history of cancer. Most participants did not smoke (81.2%), did not consume alcoholic beverages (68.7%), and had never undergone colorectal cancer screening (96.9%). The analysis of overall colorectal cancer prevention literacy revealed that before usual care, the mean score was 164.75 (SD = 24.63), and after usual care, it was 167.65 (SD = 25.75), indicating a good literacy level. After the program, the score was 188.96 (SD = 22.08), which was significantly different (χ² = 21.39, p < .001), reaching a very good level. When comparing literacy in subscales, all showed significant differences, except for communication skills, where no statistically significant difference was found. The analysis of self-care behaviors to prevent colorectal cancer showed a mean score of 34.06 (SD = 8.55) before usual care, 35.84 (SD = 9.34) after usual care, and 41.09 (SD = 6.97) after the program, with statistically significant differences (χ² = 16.05, p < .001). Multiple comparisons revealed no significant difference between before usual care and after usual care (p > .05). However, significant differences were found between before usual care and after the program, as well as between after usual care and after the program (p < .017).

Recommendation: This study’s results indicate the program’s effectiveness in promoting colorectal cancer prevention literacy via mHealth. Community nurse practitioners and health teams can apply this program to enhance literacy and self-care behaviors to prevent and screen colorectal cancer among risk groups in urban areas. The program can also be modified to focus more on improving communication skills, literacy, and improving online materials to suit the target population better. Additionally, further testing and follow-up of the program should be conducted in future research.