Understanding Colorectal Cancer Screening Behavior: A Biopsychosocial Risk Analysis of Older Adults in Singapore

Colorectal cancer (CRC) is the second most prevalent cancer, yet screening rates in Singapore remain low. This study investigated the demographic and biopsychosocial health risks associated with non-participation in CRC screening and non-compliance with fecal immunochemical test (FIT) usage among adults aged ≥50 years in Singapore. It also assessed the effectiveness of a community-based health worker (CHW) program in promoting CRC screening uptake in a township. Using a quasi-experimental pre/post-design, anonymous data were collected from participants in the CHW program, which raised CRC awareness and provided free FIT kits, between June 2019 and December 2023. The study employed quantitative methods to assess demographic characteristics, biopsychosocial health risks (BioPsychoSocial risk screener), and CRC screening participation/FIT usage rates. Data were analyzed using various statistical techniques, including Chi-square/non-parametric tests and logistic regression (α = .05). The study cohort included 217 individuals with a mean age of 70.8 ± 6.7 years, 69.1% of whom were women. Results showed that older age and biological health risks increased the likelihood of non-participation in CRC screening by 8% and 93%, respectively, while age contributed to a 9% increase in the odds of non-compliance with FIT usage. The CRC screening uptake rate increased from 17.5% to 29.6% after the program implementation. The CHW program was associated with increased CRC screening participation rates, suggesting that future programs should focus on older adults with bio-functional issues to improve screening uptake.