Effectiveness of peer education on increasing awareness and Uptake of colorectal cancer screening among residents Of Mt. Elgon sub county, Bungoma County, Kenya

Abstract

Globally, Colorectal Cancer (CRC) is a leading cause of mortality with a slight preponderance to populations in low and middle-income countries (LMICs). CRC accounted for 10.2% of all cancers and 8.2% of all cancer deaths worldwide in 2018. In Kenya, CRC was estimated at 6.5% of new cancer cases and 4.5% of all cancer cases in 2020. Awareness and uptake of CRC screening remain suboptimal in LMICs due to less effective sensitization approaches. This study aimed at determining the effectiveness of Peer Education in increasing awareness and uptake of CRC screening among residents of Mt. Elgon Sub-County. Specifically, the study sought to assess the awareness of CRC screening; determine the uptake of CRC screening, establish trends in awareness and uptake of CRC screening during the intervention and to evaluate the effectiveness of the intervention. This was longitudinal interventional (pre-post) study using quantitative and qualitative approaches to data management over eight months. Trained peer educators were used to impart knowledge on CRC screening. The study was anchored on the Health Belief Model (HBM) augmented by the Diffusion of Innovation theory (DOI). From the population of 22,372 adults aged 45-75 years, some 440 participants were obtained using Taro Yamane’s Equation. Quantitative data for the baseline and endline surveys was collected using semi-structured questionnaires while qualitative data was collected through Key Informants Interviews and Focus Group Discussions. A total of 402 participated in the study. Quantitative data was analyzed using SPSS version 25, while qualitative data was thematically summarized and analyzed using the NVivo application. Chi Square test determined existence of associations between the independent and dependent variables. Cochran’s Q tests determined statistical significance of the differences in awareness and uptake of CRC screening at the different observation points. McNemar’s test confirmed statistical significance of the differences in awareness and uptake of CRC screening between the baseline and end-line. Before Peer Education intervention only 19 (4.7%) were aware of CRC screening, while 9 (2.2%) had undergone screening. After Peer Education intervention 291(72.4%) were aware of CRC screening while 34 (8.5%) had screened. Respondents in the qualitative survey reported that awareness and uptake were low because of the ineffective conventional sensitization programs and outreaches in the Sub- County. Chi square analysis before Peer Education intervention reported that all socioeconomic and sociodemographic factors had no significant association with CRC screening uptake: age (χ2 = 2.781, p = 0.249, gender (χ2 = 1.355, p = 0.244, ethnic background (χ2 = 3.889, p = 0.421), marital status (χ2 = 1.007, p = 0.604) and religious affiliation (χ2 = 1.192, p = 0.755. Cochrane Q test confirmed statistically significant increase in the awareness of CRC screening from 4.7% before Peer Education intervention to endline at (χ2(3) = 444.671, p < 0. 0001.Similarly, there were statistically significant increments in uptake of screening at (χ2(3) = 61.404, p < 0.0001). The increase in uptake of CRC screening was 6.3% while for screening awareness was 67.7%. Using McNemar’s test, the study confirmed the increases in both awareness and uptake of CRC were statistically significant screening at p=0.001 Conclusively, Peer Education anchored on HBM augmented by DOI theory attained statistically significant increases in awareness and uptake of CRC screening, with greater change observed in awareness. These findings will therefore inform national and county level efforts on enhanced awareness and uptake of CRC screening with emphasis on identifying further strategies to accelerate CRC screening uptake.