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Effect of Colorectal Cancer Awareness on Colorectal Cancer Screening Practices among Adults in Nigeria

Abstract

Colorectal cancer is an increasingly important public health concern and contributes substantially to cancer-related morbidity and mortality. Early detection through appropriate screening can facilitate identification of colorectal abnormalities and cancer at earlier stages, thereby improving opportunities for effective treatment and reducing complications. Despite the importance of colorectal cancer screening, utilization remains limited among many adults due to inadequate awareness, misconceptions, fear of cancer diagnosis, concerns about screening procedures, stigma, cost, limited access to screening services, and inadequate knowledge of personal risk factors and available screening options. Colorectal cancer awareness provides adults with information about colorectal cancer, risk factors, warning signs, prevention, available screening methods, appropriate age and risk-based screening considerations, and the importance of discussing screening with qualified healthcare professionals. Colorectal cancer screening practices refer to behaviours related to the utilization of appropriate colorectal cancer screening services, including participation in recommended screening procedures, adherence to screening schedules, and seeking professional advice regarding screening based on individual risk. In Nigeria, inadequate knowledge and misconceptions about colorectal cancer may reduce perceived susceptibility and discourage adults from utilizing available screening services. Effective colorectal cancer awareness may improve knowledge, risk perception, and willingness to engage in appropriate screening practices. Against this background, this study investigates the effect of colorectal cancer awareness on colorectal cancer screening practices among adults in Nigeria. The study is anchored on the Health Belief Model, Social Cognitive Theory, and Knowledge-Attitude-Practice framework. The Health Belief Model explains cancer screening behaviour through perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action, providing a basis for understanding adults' decisions regarding colorectal cancer screening. Social Cognitive Theory emphasizes the interaction between knowledge, self-efficacy, social influences, behavioural capabilities, and environmental conditions in shaping health behaviour. The Knowledge-Attitude-Practice framework provides a basis for examining how improved knowledge and attitudes resulting from colorectal cancer awareness may influence screening practices. Collectively, these theoretical perspectives provide a suitable framework for explaining how colorectal cancer awareness may influence colorectal cancer screening practices among adults in Nigeria. The study will adopt a quantitative quasi-experimental research design. Primary data will be collected from adults in selected communities and healthcare facilities in Nigeria using a structured interviewer-administered questionnaire and, where feasible, verification of screening attendance through appropriate healthcare records with participants' consent and confidentiality safeguards. A multistage sampling technique will be employed to select states, local government areas, communities, healthcare facilities, and eligible adults. Where feasible, selected communities or participant groups will be assigned to intervention and comparison groups. Participants in the intervention group will receive structured colorectal cancer awareness education covering colorectal cancer, risk factors, warning signs, lifestyle-related prevention, family history, available screening methods, age- and risk-appropriate screening considerations, potential benefits and limitations of screening, and the importance of seeking professional healthcare advice. Colorectal cancer screening practices will be assessed using indicators such as previous participation in colorectal cancer screening, utilization of appropriate screening services, willingness to undergo screening when recommended, adherence to recommended screening schedules, and follow-up after abnormal screening results where applicable. Descriptive statistics will be used to summarize participants' sociodemographic characteristics, colorectal cancer knowledge, exposure to awareness education, and screening practices. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and logistic or multiple regression analysis, will be used to determine the effect of colorectal cancer awareness on colorectal cancer screening practices. Appropriate diagnostic tests will also be conducted to assess the reliability of the research instrument, model assumptions, goodness of fit, and robustness of the findings. The study is expected to find that colorectal cancer awareness has a significant positive effect on colorectal cancer screening practices among adults in Nigeria. Adults exposed to structured colorectal cancer awareness education are expected to demonstrate improved knowledge of colorectal cancer risk factors, warning signs, prevention, and available screening options. Education may increase perceived susceptibility and severity, reduce misconceptions and fear, improve awareness of screening services, and encourage adults to discuss and utilize appropriate screening services with qualified healthcare professionals. However, awareness alone may not guarantee sustained screening practices because adults may continue to face barriers such as screening costs, limited availability of screening facilities, geographical distance, fear or discomfort associated with screening procedures, stigma, competing health priorities, and inadequate access to professional counselling. Consequently, colorectal cancer awareness is expected to be most effective when supported by accessible and affordable screening services, appropriate healthcare counselling, trained healthcare professionals, effective referral systems, and community-based cancer prevention programmes. The study is expected to contribute to the literature on colorectal cancer prevention, cancer awareness, screening behaviour, non-communicable disease prevention, health education, adult health, and public health in Nigeria by providing empirical evidence on the effect of colorectal cancer awareness on colorectal cancer screening practices among adults. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency (NPHCDA), National Cancer Control Programme, state ministries of health, local government health authorities, healthcare facilities, oncologists, gastroenterologists, primary healthcare professionals, community health workers, development partners, and policymakers regarding strategies for improving colorectal cancer prevention and early detection. The study will also provide evidence-based recommendations for strengthening colorectal cancer awareness programmes, improving access to appropriate screening services, reducing misconceptions and stigma, enhancing professional counselling, strengthening referral and follow-up systems, and promoting appropriate colorectal cancer screening practices among adults across Nigeria.

Keywords: Colorectal cancer awareness, colorectal cancer screening practices, adults, colorectal cancer, cancer screening, cancer prevention, health education, early detection, non-communicable diseases, screening behaviour, public health, Nigeria.