Using the Multi-Theory Model (MTM) of Health Behavior Change to Explain the Seeking of Stool-Based Tests for Colorectal Cancer Screening
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Participants’ Recruitment
2.2. Sampling and Data Collection
2.3. Ethical Considerations
2.4. Questionaire
2.5. Survey Validation
2.6. Construct Validity
2.7. Testing of Assumptions
2.8. Data Analysis
3. Results
3.1. Construct Validity
3.2. Characteristics of the Sample
3.3. Comparison of the MTM Constructs
3.4. Correlation and Reliability Diagnostics
3.5. Hierarchical Regression
4. Discussion
4.1. Implications for Practice
4.2. Strengths and Limitations of Our Study
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variable Name | Categories | Overall Sample | Had Any Form of Stool-Based Colorectal Cancer Screening | p Value | 95% Confidence Interval | |
---|---|---|---|---|---|---|
N = 640 | Group 1 Yes (n = 251) | Group 2 No (n = 389) | ||||
Age in years (M ± SD) | - | 58.26 ± 8.96 | 59.08 ± 8.94 | 57.80 ± 8.94 | 0.1 | 57.56, 58.96 |
Gender | Male | 271 (42.4) | 113 (45.0) | 158 (40.7) | 0.4 | 38.4, 46.2 |
Female | 368 (57.6) | 138 (55.0) | 230 (59.3) | 53.5, 61.3 | ||
Race | Black | 74 (11.6) | 28 (17.1) | 46 (15.3) | 0.6 | 9.0, 14.0 |
White | 331 (51.7) | 116 (70.7) | 215 (71.7) | 47.7, 55.6 | ||
AAPI | 23 (3.6) | 10 (6.1) | 13 (4.3) | 2.3, 5.3 | ||
Other | 36 (5.6) | 10 (6.1) | 26 (8.7) | 3.8, 7.4 | ||
Ethnicity | Hispanic | 86 (13.4) | 32 (15.0) | 54 (14.0) | 0.7 | 10.8, 16.0 |
Non-Hispanic | 513 (80.2) | 182 (85.0) | 331 (86.0) | 77.0, 83.2 | ||
Marital status | Married | 303 (47.3) | 114 (52.1) | 189 (49.1) | 0.4 | 43.5, 51.2 |
Divorced/Separated | 123 (19.2) | 39 (17.8) | 84 (21.8) | 16.1, 22.2 | ||
Widowed | 42 (6.5) | 19 (8.7) | 23 (6.0) | 4.6, 8.5 | ||
Single, never married | 103 (16.1) | 38 (17.4) | 65 (16.9) | 13.2, 18.9 | ||
Other | 33 (5.2) | 9 (4.1) | 24 (6.2) | 3.4, 6.8 | ||
Education | Less than a high school | 17 (2.6) | 5 (2.3) | 12 (3.1) | 0.8 | 1.4, 3.9 |
High school diploma or GED | 154 (24.0) | 53 (24.2) | 101 (26.2) | 20.7, 27.3 | ||
Some college but not degree | 161 (25.2) | 64 (29.2) | 97 (25.1) | 21.7, 28.5 | ||
College degree | 205 (32.0) | 71 (32.4) | 134 (34.7) | 28.4, 35.6 | ||
Graduate level degree | 61 (9.5) | 24 (11.0) | 37 (9.6) | 7.2, 11.8 | ||
Other | 7 (1.2) | 2 (0.9) | 5 (1.3) | 0.2, 1.9 | ||
Health insurance | Yes | 567 (88.5) | 213 (97.3) | 354 (91.9) | 0.009 | 86.1, 91.0 |
No | 37 (5.8) | 6 (2.7) | 31 (8.1) | 3.9, 7.6 | ||
Region | Rural | 176 (27.5) | 63 (28.8) | 113 (29.3) | 0.4 | 24.0, 30.9 |
Urban | 152 (23.7) | 62 (28.3) | 90 (23.3) | 20.5, 27.1 | ||
Suburban | 277 (43.2) | 94 (42.9) | 183 (47.4) | 39.4, 47.1 | ||
Employment status | Employed or self employed | 279 (43.5) | 97 (44.3) | 182 (47.2) | 0.8 | 39.7, 47.4 |
Not working (e.g., out of work, homemaker, retired) | 260 (40.6) | 98 (44.7) | 162 (42.0) | 36.8, 44.4 | ||
Unable to work | 66 (10.3) | 24 (11.0) | 42 (10.9) | 7.9, 12.7 | ||
Religion | Christian | 429 (67.0) | 153 (69.9) | 276 (71.5) | 0.7 | 63.3, 70.6 |
Non-Christian | 176 (27.5) | 66 (30.1) | 110 (28.5) | 24.0, 30.9 | ||
Median income | <USD 25,000 | 143 (22.3) | 49 (22.9) | 94 (25.5) | 0.2 | 19.1, 25.5 |
USD 25,000–USD 50,000 | 162 (25.3) | 61 (28.5) | 101 (27.4) | 21.9, 28.6 | ||
USD 50,001–USD 75,000 | 111 (17.3) | 42 (19.6) | 69 (18.7) | 14.4, 20.3 | ||
USD 75,001–USD 100,000 | 57 (8.9) | 24 (11.2) | 33 (8.9) | 6.7, 11.1 | ||
USD 100,001–USD 125,000 | 40 (6.2) | 14 (6.5) | 26 (7.0) | 4.4, 8.1 | ||
USD 125,001–USD 150,000 | 33 (5.2) | 17 (7.9) | 16 (4.3) | 3.4, 6.8 | ||
>USD 150,000 | 37 (5.7) | 7 (3.3) | 30 (8.1) | 3.9, 7.6 |
Variable Name | Categories | Overall Sample n (%) | Had Any Form of Stool-Based Colorectal Cancer Screening | p Value | |
---|---|---|---|---|---|
N = 640 | Group 1 Yes (n = 251) | Group 2 No (n = 389) | |||
Personal history of colorectal cancer | Yes | 16 (2.7) | 12 (5.6) | 4 (1.1) | 0.001 |
No | 577 (97.3) | 204 (94.4) | 373 (98.9) | ||
Family history of colorectal cancer | Yes | 87 (15.3) | 37 (18.0) | 50 (13.8) | 0.2 |
No | 481 (84.7) | 169 (82.0) | 312 (86.2) | ||
Personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease) | Yes | 50 (8.7) | 27 (13.0) | 23 (6.2) | 0.005 |
No | 528 (91.3) | 181 (87.0) | 347 (93.8) | ||
Personal history of confirmed or suspected hereditary colorectal cancer syndrome | Yes | 20 (3.7) | 14 (7.0) | 6 (1.7) | 0.001 |
No | 527 (96.3) | 185 (93.0) | 342 (98.3) | ||
Personal history of getting radiation to the abdomen (belly) or pelvic area to treat any prior cancer | Yes | 30 (5.0) | 20 (9.2) | 10 (2.6) | <0.001 |
No | 565 (95.0) | 197 (90.8) | 368 (97.4) | ||
Recommended a colorectal screening by healthcare provider (HCP) | Yes | 196 (34.8) | 93 (45.4) | 103 (28.7) | <0.001 |
No | 345 (61.2) | 110 (53.7) | 235 (65.5) | ||
Do not have HCP | 23 (4.1) | 2 (1.0) | 21 (5.8) | ||
Encouraged by a family member to undertake CRC screening | Yes | 195 (32.2) | 78 (35.5) | 117 (30.3) | 0.2 |
No | 411 (67.8) | 142 (64.5) | 269 (69.7) | ||
Have had a recent visit to a primary healthcare provider | Yes | 403 (68.7) | 171 (78.4) | 232 (62.9) | <0.001 |
No | 184 (31.3) | 47 (21.6) | 137 (37.1) |
MTM Construct | Had Any Form of Colorectal Cancer Screening | p Value | Mean Difference | 95% CI of Mean Difference | |
---|---|---|---|---|---|
Yes (n = 251) | No (n = 389) | ||||
Overall Initiation Score | 2.75 ± 1.16 | 2.22 ± 1.36 | <0.001 | 0.538 | 0.331, 0.745 |
Subscales | |||||
Perceived Advantages | 14.19 ± 5.09 | 13.04 ± 5.47 | 0.01 | 1.14 | 0.260, 2.039 |
Perceived Disadvantages | 9.50 ± 4.59 | 9.57 ± 4.80 | 0.85 | −0.076 | −0.864, 0.711 |
Participatory Dialogue | 4.69 ± 6.43 | 3.46 ± 6.50 | 0.03 | 1.22 | 0.149, 2.303 |
Behavioral Confidence | 12.10 ± 5.34 | 11.11 ± 5.53 | 0.03 | 0.987 | 0.757, 1.899 |
Changes in the Physical Environment | 8.45 ± 3.31 | 7.64 ± 3.70 | 0.006 | 0.817 | 0.240, 1.393 |
Change in the Social Environment | 7.51 ± 3.61 | 6.60 ± 3.87 | 0.004 | 0.916 | 0.286, 1.546 |
Variables | 1 | 2 | 3 | 4 |
---|---|---|---|---|
1. Participatory Dialogue | 1 | 0.510 ** [0.448, 0.567] | 0.447 ** [0.380, 0.508] | 0.417 ** [0.349, 0.481] |
2. Behavioral Confidence | 0.510 ** [0.448, 0.567] | 1 | 0.745 ** [0.707, 0.778] | 0.676 ** [0.631, 0.718] |
3. Changes in the Physical Environment | 0.447 ** [0.380, 0.508] | 0.745 ** [0.707, 0.778] | 1 | 0.765 ** [0.729, 0.796] |
4. Changes in the Social Environment | 0.417 ** [0.349, 0.481] | 0.676 ** [0.631, 0.718] | 0.765 ** [0.729, 0.796] | 1 |
Cronbach’s Alpha | - | 0.913 | 0.874 | 0.873 |
Variables | Model 1 | Model 2 | Model 3 | Model 4 | Model 5 | |||||
---|---|---|---|---|---|---|---|---|---|---|
B | β | B | β | B | β | B | β | B | β | |
Constant | 0.120 | 1.065 * | 0.457 | 0.482 | 0.601 | |||||
Age | 0.011 | 0.071 | 0.002 | 0.013 | 0.000 | −0.003 | −0.001 | −0.004 | −0.004 | −0.029 |
Gender: Male (Ref: Female) | −0.071 | −0.025 | −0.197 | −0.070 | −0.101 | −0.036 | −0.106 | −0.038 | −0.049 | −0.017 |
Race: White (Ref: Black) | 0.026 | 0.009 | −0.063 | −0.023 | −0.128 | −0.046 | −0.126 | −0.045 | −0.104 | −0.038 |
AAPI | −1.023 * | −0.128 | −0.702 | −0.088 | −0.524 | −0.065 | −0.502 | −0.063 | −0.398 | −0.050 |
Other | −0.225 | −0.042 | −0.127 | −0.024 | −0.240 | −0.044 | −0.232 | −0.043 | −0.227 | −0.042 |
Ethnicity: Non-Hispanic (Ref: Hispanic) | 0.048 | 0.012 | −0.063 | −0.016 | −0.053 | −0.013 | −0.066 | −0.016 | −0.032 | −0.008 |
Marital Status: Divorced/Separated (Ref: Married) | −0.229 | −0.068 | −0.219 | −0.065 | −0.166 | −0.049 | −0.180 | −0.053 | −0.068 | −0.020 |
Widowed | −0.099 | −0.018 | 0.014 | 0.002 | −0.060 | −0.011 | −0.073 | −0.013 | 0.020 | 0.004 |
Single, never married | −0.374 | −0.100 | −0.283 | −0.076 | −0.254 | −0.068 | −0.281 | −0.075 | −0.268 | −0.071 |
Other | −0.193 | −0.034 | −0.034 | −0.006 | −0.027 | −0.005 | −0.090 | −0.016 | −0.164 | −0.029 |
Education Less than a high school (Ref: High school diploma or GED) | −0.270 | −0.037 | −0.218 | −0.030 | −0.228 | −0.031 | −0.254 | −0.035 | −0.155 | −0.021 |
Some college but not degree | 0.211 | 0.063 | 0.044 | 0.013 | −0.177 | −0.053 | −0.175 | −0.053 | −0.091 | −0.027 |
College degree | 0.156 | 0.054 | −0.120 | −0.042 | −0.299 * | −0.104 | −0.322 * | −0.112 | −0.283 | −0.098 |
Graduate level degree | −0.155 | −0.034 | −0.193 | −0.042 | −0.363 | −0.079 | −0.369 | −0.081 | −0.352 | −0.077 |
Other | −0.247 | −0.020 | −0.445 | −0.036 | −0.615 | −0.049 | −0.656 | −0.052 | −0.710 | −0.057 |
Health insurance: Yes (Ref: No) | 1.102 ** | 0.224 | 0.660 * | 0.134 | 0.415 * | 0.084 | 0.363 | 0.074 | 0.260 | 0.053 |
Region: Urban (Ref: Rural) | 0.296 | 0.090 | 0.224 | 0.068 | 0.293 | 0.089 | 0.306 * | 0.093 | 0.358 * | 0.109 |
Suburban | 0.428 * | 0.154 | 0.262 | 0.094 | 0.182 | 0.066 | 0.172 | 0.062 | 0.190 | 0.069 |
Employment status: Not Working (Ref: Employed or self-employed) | 0.127 | 0.045 | −0.022 | −0.008 | −0.045 | −0.016 | −0.067 | −0.024 | −0.030 | −0.011 |
Unable to work | −0.101 | −0.021 | −0.201 | −0.041 | −0.234 | −0.048 | −0.247 | −0.051 | −0.177 | −0.036 |
Religion: Christian (Ref: Non-Christian) | 0.137 | 0.044 | 0.196 | 0.063 | 0.240 * | 0.077 | 0.218 | 0.070 | 0.162 | 0.052 |
Income: USD 25,000–USD 50,000 (Ref: <USD 25,000) | −0.127 | −0.041 | −0.039 | −0.012 | −0.085 | −0.027 | −0.099 | −0.032 | −0.130 | −0.042 |
USD 50,001–USD 75,000 | 0.003 | 0.001 | −0.003 | −0.001 | −0.140 | −0.039 | −0.167 | −0.046 | −0.241 | −0.067 |
USD 75,001–USD 100,000 | 0.766 * | 0.145 | 0.459 | 0.087 | 0.153 | 0.029 | 0.111 | 0.021 | 0.056 | 0.011 |
USD 100,001–USD 125,000 | 0.229 | 0.042 | 0.340 | 0.062 | 0.211 | 0.038 | 0.203 | 0.037 | 0.096 | 0.017 |
USD 125,001–USD 150,000 | 0.471 | 0.067 | 0.545 | 0.077 | 0.336 | 0.048 | 0.280 | 0.040 | 0.285 | 0.040 |
>USD 150,000 | 0.275 | 0.054 | 0.222 | 0.043 | −0.022 | −0.004 | −0.050 | −0.010 | −0.098 | −0.019 |
Personal history of colorectal cancer: Yes (Ref: No) | 0.684 | 0.047 | 1.003 | 0.069 | 1.208 * | 0.084 | 1.181 * | 0.082 | 0.993 | 0.069 |
Family history of colorectal cancer: Yes (Ref: No) | 0.195 | 0.046 | 0.003 | 0.001 | −0.132 | −0.031 | −0.147 | −0.035 | −0.120 | −0.028 |
Personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease): Yes (Ref: No) | 0.194 | 0.033 | −0.069 | −0.012 | −0.038 | −0.006 | −0.032 | −0.006 | −0.057 | −0.010 |
Participatory dialogue | - | - | 0.125 ** | 0.590 | 0.067 ** | 0.315 | 0.066 ** | 0.310 | 0.061 ** | 0.290 |
Behavioral confidence | - | - | - | - | 0.125 ** | 0.506 | 0.109 ** | 0.438 | 0.096 ** | 0.388 |
Changes in the physical environment | - | - | - | - | - | - | 0.039 | 0.102 | −0.014 | −0.036 |
Changes in the Social Environment | - | - | - | - | - | - | - | - | 0.099 ** | 0.274 |
R2 | 0.189 | - | 0.485 | - | 0.621 | - | 0.625 | - | 0.651 | - |
F | 2.257 ** | - | 8.826 ** | - | 14.798 ** | - | 14.538 ** | - | 15.730 ** | - |
ΔR2 | 0.189 | - | 0.297 | - | 0.136 | - | 0.004 | - | 0.026 | - |
ΔF | 2.257 ** | - | 167.232 ** | - | 103.352 ** | - | 2.976 | - | 21.286 ** | - |
Variables | Model 1 | Model 2 | Model 3 | Model 4 | Model 5 | |||||
---|---|---|---|---|---|---|---|---|---|---|
B | β | B | β | B | β | B | β | B | β | |
Constant | 1.790 | 2.048 * | 0.874 | 1.076 | 1.171 | |||||
Age | 0.005 | 0.038 | −0.003 | −0.025 | 0.007 | 0.053 | 0.002 | 0.016 | 0.000 | 0.003 |
Gender: Male (Ref: Female) | −0.012 | −0.005 | 0.143 | 0.061 | 0.101 | 0.043 | 0.150 | 0.064 | 0.190 | 0.081 |
Race: White (Ref: Black) | 0.063 | 0.027 | 0.043 | 0.018 | −0.054 | −0.023 | −0.062 | −0.026 | −0.034 | −0.014 |
AAPI | 0.360 | 0.067 | 0.410 | 0.076 | 0.823 * | 0.153 | 0.647 | 0.120 | 0.726 * | 0.135 |
Other | 0.332 | 0.065 | 0.297 | 0.058 | 0.140 | 0.027 | 0.134 | 0.026 | 0.125 | 0.024 |
Ethnicity: Non-Hispanic (Ref: Hispanic) | −0.191 | −0.060 | −0.239 | −0.075 | −0.304 | −0.095 | −0.306 | −0.096 | −0.302 | −0.095 |
Marital Status: Divorced/Separated (Ref: Married) | −0.199 | −0.064 | −0.012 | −0.004 | −0.077 | −0.025 | −0.071 | −0.023 | −0.069 | −0.022 |
Widowed | 0.255 | 0.062 | 0.244 | 0.059 | 0.085 | 0.021 | 0.101 | 0.024 | 0.232 | 0.056 |
Single, never married | −0.391 | −0.129 | −0.313 | −0.103 | −0.220 | −0.072 | −0.184 | −0.061 | −0.160 | −0.053 |
Other | −0.504 | −0.077 | −0.269 | −0.041 | −0.441 | −0.067 | −0.306 | −0.047 | −0.286 | −0.044 |
Education Less than a high school (Ref: High school diploma or GED) | −0.274 | −0.034 | 0.055 | 0.007 | 0.344 | 0.043 | 0.193 | 0.024 | 0.104 | 0.013 |
Some college but not degree | −0.170 | −0.065 | −0.158 | −0.060 | −0.042 | −0.016 | −0.140 | −0.054 | −0.094 | −0.036 |
College degree | 0.048 | 0.019 | −0.111 | −0.043 | −0.140 | −0.055 | −0.137 | −0.054 | 0.030 | 0.012 |
Graduate level degree | 0.221 | 0.063 | 0.163 | 0.046 | 0.205 | 0.058 | 0.081 | 0.023 | 0.131 | 0.037 |
Other | −2.249 * | −0.201 | −1.666 * | −0.149 | −1.437 * | −0.128 | −1.420 * | −0.127 | −1.166 | −0.104 |
Health insurance: Yes (Ref: No) | 0.985 | 0.150 | 0.948 * | 0.145 | 0.568 | 0.087 | 0.382 | 0.058 | 0.273 | 0.042 |
Region: Urban (Ref: Rural) | −0.154 | −0.058 | −0.216 | −0.082 | −0.194 | −0.074 | −0.227 | −0.086 | −0.261 | −0.099 |
Suburban | −0.035 | −0.015 | −0.057 | −0.024 | −0.057 | −0.024 | −0.057 | −0.024 | −0.040 | −0.017 |
Employment status: Not Working (Ref: Employed or self-employed) | −0.010 | −0.004 | −0.208 | −0.088 | −0.318 | −0.135 | −0.300 | −0.127 | −0.282 | −0.119 |
Unable to work | 0.268 | 0.073 | 0.034 | 0.009 | 0.041 | 0.011 | −0.001 | 0.000 | −0.052 | −0.014 |
Religion: Christian (Ref: Non-Christian) | −0.218 | −0.086 | −0.170 | −0.067 | −0.047 | −0.019 | −0.081 | −0.032 | −0.012 | −0.005 |
Income: USD 25,000–USD 50,000 (Ref: <USD 25,000) | −0.116 | −0.045 | −0.220 | −0.085 | −0.166 | −0.064 | −0.191 | −0.074 | −0.318 | −0.123 |
USD 50,001–USD 75,000 | 0.368 | 0.118 | 0.141 | 0.045 | 0.075 | 0.024 | 0.019 | 0.006 | −0.171 | −0.055 |
USD 75,001–USD 100,000 | 0.157 | 0.042 | 0.205 | 0.055 | 0.143 | 0.038 | 0.044 | 0.012 | −0.088 | −0.024 |
USD 100,001–USD 125,000 | 0.374 | 0.079 | 0.198 | 0.042 | 0.157 | 0.033 | 0.047 | 0.010 | −0.162 | −0.034 |
USD 125,001–USD 150,000 | 0.860 | 0.202 | 0.581 | 0.137 | 0.470 | 0.111 | 0.406 | 0.096 | 0.254 | 0.060 |
>USD 150,000 | 0.504 | 0.083 | 0.359 | 0.059 | 0.372 | 0.061 | 0.300 | 0.049 | 0.089 | 0.015 |
Personal history of colorectal cancer: Yes (Ref: No) | −0.093 | −0.017 | 0.028 | 0.005 | −0.202 | −0.037 | −0.083 | −0.015 | 0.039 | 0.007 |
Family history of colorectal cancer: Yes (Ref: No) | 0.039 | 0.012 | 0.065 | 0.021 | −0.106 | −0.034 | −0.055 | −0.017 | −0.030 | −0.009 |
Personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease): Yes (Ref: No) | −0.255 | −0.074 | −0.156 | −0.045 | −0.099 | −0.029 | −0.105 | −0.030 | −0.100 | −0.029 |
Participatory dialogue | - | - | 0.084 ** | 0.457 | 0.052 ** | 0.283 | 0.045 * | 0.244 | 0.042 * | 0.229 |
Behavioral confidence | - | - | - | - | 0.099 ** | 0.446 | 0.063 * | 0.283 | 0.043 * | 0.193 |
Changes in the physical environment | - | - | - | - | - | - | 0.096 * | 0.263 | 0.033 | 0.092 |
Changes in the Social Environment | - | - | - | - | - | - | - | - | 0.108 * | 0.331 |
R2 | 0.208 | - | 0.373 | - | 0.516 | - | 0.545 | - | 0.579 | - |
F | 1.313 | - | 2.856 ** | - | 4.934 ** | - | 5.334 ** | - | 5.916 ** | - |
ΔR2 | 0.208 | - | 0.165 | - | 0.143 | - | 0.029 | - | 0.035 | - |
ΔF | 1.313 | - | 39.128 ** | - | 43.879 ** | - | 9.287 * | - | 11.977 * | - |
MTM Construct | Crib Sheet Lines |
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Advantages | Cologuard is a non-invasive, home-based stool test for the early detection of polyps and colon cancer for people 45 years of age and older. |
Behavioral confidence | It is very easy to use and comes with all detailed instructions. |
Changes in the social environment | Should you decide to use it, our nurse will be able to explain all preliminary details to you. |
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Share and Cite
Sharma, M.; Johansen, C.; Batra, K.; Dai, C.-L.; Batra, R.; Hayes, T.; Singh, A. Using the Multi-Theory Model (MTM) of Health Behavior Change to Explain the Seeking of Stool-Based Tests for Colorectal Cancer Screening. Int. J. Environ. Res. Public Health 2023, 20, 6553. https://doi.org/10.3390/ijerph20166553
Sharma M, Johansen C, Batra K, Dai C-L, Batra R, Hayes T, Singh A. Using the Multi-Theory Model (MTM) of Health Behavior Change to Explain the Seeking of Stool-Based Tests for Colorectal Cancer Screening. International Journal of Environmental Research and Public Health. 2023; 20(16):6553. https://doi.org/10.3390/ijerph20166553
Chicago/Turabian StyleSharma, Manoj, Christopher Johansen, Kavita Batra, Chia-Liang Dai, Ravi Batra, Traci Hayes, and Aditi Singh. 2023. "Using the Multi-Theory Model (MTM) of Health Behavior Change to Explain the Seeking of Stool-Based Tests for Colorectal Cancer Screening" International Journal of Environmental Research and Public Health 20, no. 16: 6553. https://doi.org/10.3390/ijerph20166553