Health Belief Model Application in Encouraging Colorectal Cancer Screening in Adults: Meta-analysis


  • Audria Ersananda Catholic School of Health Sciences, St.Vincentius A Paulo, Surabaya, East Java
  • Aulia Siti Nur Rahmah Faculty of Public Health, Universitas Muhammadiyah Surakarta, Central Java


Background: Colorectal cancer is one of the cancers caused by the growth of malignant abnormal cells in the large intestine and rectum which are part of the gastrointestinal system. Screening has the potential to reduce the burden of colorectal cancer with the support of scientific literature showing a reduction in colorectal cancer mortality ranging from 18% to 57% (depending on the screening test used). The Health Belief Model is a health behavior model that can predict a person's interest in screening for colorectal cancer. This study aims to estimate the effect of the Health Belief Model in colorectal cancer screening by meta-analysis.

Subjects and Method: Meta-analyses were performed by searching articles from the PubMed, Google Scholar, and ScienceDirect databases. The keywords and Boolean operators used are Health Belief Model OR perceived susceptibilty OR perceived risk OR risk perception OR perception of risk AND screening colorectal OR colonoscopy OR faecal occult blood test OR sigmoidoscopy. The inclusion criteria in this study were full-text articles with a cross-sectional design. The articles were published in English from 2012 to 2022. The population used in this study were both male and female adults. Analysis of perceived susceptibility to final study results was reported using the adjusted odds ratio (aOR). Article analysis using RevMan 5.3 software.

Results: A total of 9 articles were used. The results showed that a person's perception of being vulnerable or at high risk will increase colorectal cancer screening by 1.81 times compared to someone who has a low perception of susceptibility to colorectal cancer screening (aOR= 1.81; 95% CI= 1.58 to 2.07) and the results are significant. statistically (p < 0.001).

Conclusion: Perceived susceptibility is statistically significant in predicting someone to be screened for colorectal cancer.

Keywords: health belief model, susceptibility perception, colorectal cancer screening.


Aulia Siti Nur Rahmah. Catholic School of Health Sciences, St.Vincentius A Paulo, Surabaya, East Java, Indonesia. Email:  Mobile: +6281233511180

Journal of Health Promotion and Behavior (2021), 06(04): 327-338



Aran V, Victorino AP, Thuler LC, Ferreira, CG. (2016). Colorectal Cancer: Epidemiology, Disease Mechanisms and Interventions to Reduce Onset and Mortality. Clinical Colorectal Cancer, 15(3), 195–203. DOI: 10.1016/j.clcc.2016.02.008.

Bae N, Park S, Lim S. (2014). Factors associated with adherence to fecal occult blood testing for colorectal cancer screening among adults in the Republic of Korea. European Journal of Oncology Nursing, 18(1), 72-77. DOI: 10.1016/j.ejon.2013.09.001.

Bujang NNA, Lee YJ, Mohd-Zain SAS, Aris JH, Md-Yusoff FA, Suli Z, Abu-Hassan MR, Bhoo-Pathy N. (2021). Factors Associated With Colorectal Cancer Screening Via Immunochemical Fecal Occult Blood Test in an Average-Risk Population From a Multiethnic, Middle-Income Setting. JCO Global Oncology, 7, 333–341. DOI: 10.1200/GO.20.00460

Cai S, Li Y, Ding Y, Chen K, Jin M. (2014). Alcohol drinking and the risk of colorectal cancer death: A meta-analysis. European Journal of Cancer Prevention, 23(6), 532–539. DOI: 10.1097/CEJ.0000000000000076

Cho YA, Oh JH (2019). Genetic Risk Score , Combined Lifestyle Factors and Risk of Colorectal Cancer. 51(3), 1033-1040. DOI: 10.4143/crt.2018.447

Choi E, Lee YY, Suh M, Park B, Jun JK, Kim Y., et al. (2018). Associations of perceived risk and cancer worry for colorectal cancer with screening behaviour. Journal of Health Psychology, 23(6), 840–852. DOI: 10.1177/1359-105316679721

Dashdebi KG, Noroozi A, Tahmasebi R. (2016). Factors Predicting Fecal Occult Blood Testing among Residents of Bushehr, Iran, Based on the Health Belief Model. Asian Pacific Journal of Cancer Prevention: APJCP, 17(S3), 17–22. DOI: 10.7314/APJCP.2016.17.S3.17

Gilfoyle M, Chaurasia A, Garcia J, Oremus M. (2020). Perceived susceptibility to developing cancer and screening for colorectal and prostate cancer: A longitudinal analysis of Alberta’s Tomorrow Project. Journal of Medical Screening. DOI: 10.1177/09691413-20941900

Gini A, Jansen EE, Zielonke N, Meester RG, Senore C, Anttila A, Priaulx J. (2020). Impact of colorectal cancer screening on cancer specific mortality in Europe: a systematic review. European Journal of Cancer, 127, 224-235. DOI: 10.1200/GO.20.00460

Hadley DW, Eliezer D, Addissie Y, Goergen A, Ashida S, Koehly L. (2020). Uptake and predictors of colonoscopy use in family members not participating in cascade genetic testing for Lynch syndrome. Scientific Reports, 10(1), 1-10.

Huang J, Choi P, Pang TWY, Chen X, Wang J, Ding H, Jin Y., et al. (2021). Factors associated with participation in colorectal cancer screening: A population-based study of 7200 individuals. European Journal of Cancer Care, 30(2). DOI: 10.1111/ECC.13369

Huang RL, Liu Q, Wang YX, Zou JY, Hu LF, Wang W, Huang YH., et al. (2021). Awareness, attitude and barriers of colorectal cancer screening among high-risk populations in China: A cross-sectional study. BMJ Open, 11(7), 1–10. DOI: 10.1-136/bmjopen-2020-045168

Kemenkes RI. (2016). Panduan Penatalak-sanaan Kanker kolorektal (Colorectal Cancer Management Guide). Kemen-terian Kesehatan Republik Indonesia, 76.

Llanos AA, Pennell ML, Young GS, Tatum CM, Katz ML, Paskett ED. (2015). No association between colorectal cancer worry and screening uptake in Appalachian Ohio. Journal of Public Health, 37(2), 322-327. DOI: 10.10-93/pubmed/fdlu031

Menon U, Szalacha L, Prabhughate A, Kue, J. (2014). Correlates of colorectal can-cer screening among South Asian immigrants in the United States. Cancer nursing, 37(1), E19-E27. DOI: 10.-1097/NCC.0b013e31828db95e

Miftahussurur M, PD-KGEH S, PD Y. (2021). Buku Ajar Aspek Diagnosis dan Terapi Terkini Kanker Kolorektal.;sig=qS79D1L9Sxjn1G9uMqGZV1V-QHk

Ordóñez-Mena JM, Walter V, Schöttker B, Jenab M, O’Doherty MG, Kee F. (2018). Impact of prediagnostic smo-king and smoking cessation on colorectal cancer prognosis: A meta-analysis of individual patient data from cohorts within the CHANCES consortium.Annals of Oncology, 29(2), 472–483. DOI: 10.1093/annonc/mdx761

Rawla P, Sunkara T, Barsouk A (2019). Epidemiology of colorectal cancer: Incidence, mortality, survival, and risk factors. Przeglad Gastroenterologiczny, 14(2), 89–103. DOI: 10.5114/pg.2018.81072.

Siegel RL, Jakubowski CD, Fedewa SA, Davis, A. (2022). Colorectal Cancer in the Young: Epidemiology, Prevention, Management. 75–88. DOI: 10.1200/EDBK_279901.

Simon K (2016). Colorectal cancer develop-ment and advances in screening. Clinical Interventions in Aging, 11, 967. DOI: 10.2147/CIA.S-109285.

Taheri-Kharameh Z, Noorizadeh F, Sangy S, Zamanian H, Shouri-Bidgoli AR, Oveisi H (2016). Factors associated with adherence to colorectal cancer screening among moderate risk individuals in Iran. Asian Pacific Journal of Cancer Prevention, 16(18),

-8375. DOI: 10.7314/APJCP.¬2015.¬16.¬18.8371

Tsoh JY, Tong EK, Sy AU, Stewart SL, Gildengorin GL, Nguyen TT (2018). Knowledge of colorectal cancer screening guidelines and intention to obtain screening among nonadherent Filipino, Hmong, and Korean Americans. Cancer, 124, 1560–1567. DOI: 10.-1002/CNCR.31097

WHO (2020). Cancer Country Profile 2020.

WHO (2020). WHO Cancer Regional Profile 2020.

Wong MCS, Hirai HW, Luk AKC, Lam T YT, Ching JYL, Griffiths SM, Chan FKL, et al. (2013). The Knowledge of Colorectal Cancer Symptoms and Risk Factors among 10,078 Screening Participants: Are High Risk Individuals More Knowledgeable? PLoS ONE, 8(4). DOI: 10.1-371/JOURNAL.PONE.0060366

Wong RK, Wong ML, Chan YH, Feng Z, Wai CT, Yeoh KG. (2013). Gender differences in predictors of colorectal cancer screening uptake: A national cross sectional study based on the health belief model. BMC Public Health, 13(1) .DOI: 10.1-186/1471-24-58-13-677




How to Cite

Ersananda, A., & Rahmah, A. S. N. (2021). Health Belief Model Application in Encouraging Colorectal Cancer Screening in Adults: Meta-analysis. Journal of Health Promotion and Behavior, 6(4), 327–338. Retrieved from