Colon Health Survey (Male)

Abstract

The Colon Health Survey (Male) (CHS-M) is a comprehensive instrument developed in 2009 by Ann Mitchell Kimberly, primarily utilized to assess factors influencing colon cancer screening behavior and adherence among men. This multi-faceted survey integrates measures of demographic background, personal and family medical history regarding colon issues, knowledge about colorectal cancer risk and prevention, and psychosocial constructs. A significant component of the CHS-M is the assessment of self-efficacy and perceived barriers related to completing a colonoscopy, including the dedicated Colonoscopy Embarrassment Scale (CES). The scale aims to identify specific psychological and logistical obstacles that prevent men from engaging in timely and effective screening procedures.

Keywords

Colon Health Survey, Colonoscopy Embarrassment Scale, colon cancer screening, male health, perceived barriers, self-efficacy, medical adherence, colorectal cancer, preventative behavior

Authors

Ann Mitchell Kimberly

Purpose

The primary purpose of the Colon Health Survey (Male) is to provide researchers and healthcare providers with a reliable tool to measure the complex set of variables that predict or inhibit men’s participation in recommended screening methods for colorectal cancer. Given that screening rates often lag behind recommendations, the instrument is specifically designed to isolate actionable factors—ranging from basic knowledge and demographic status to deeply held beliefs and emotional barriers like embarrassment—that must be addressed in targeted health interventions.

The survey segments allow for a deep dive into an individual’s history with specific screening methods (e.g., stool blood tests, sigmoidoscopy, colonoscopy) and their plans for future screening. Crucially, the inclusion of the Colonoscopy Embarrassment Scale is unique, allowing for the quantification of embarrassment as a significant psychological barrier to preventative care, particularly concerning the physical and procedural aspects of the colonoscopy.

Construct

The CHS-M measures a multi-dimensional construct centered on colon cancer screening compliance in men. The core constructs assessed include:

• Screening History and Status: Measures past diagnostic procedures (e.g., sigmoidoscopy, barium enema, colonoscopy) and current screening plans.
• Knowledge: Assesses understanding of colon cancer risk factors (age, race, family history) and preventative methods.
• Self-Efficacy for Procedure Completion: Measures the confidence (sureness) an individual has in performing the necessary steps for a colonoscopy, such as scheduling, transportation, bowel preparation (laxative use), and managing anxiety.
• Perceived Barriers and Attitudes: Measures general negative attitudes, fears (pain, injury, worry about results), logistical difficulties (time, transportation), and misconceptions about screening necessity.
• Colonoscopy Embarrassment: Specifically measures sources of embarrassment related to the procedure, including issues related to modesty, interaction with staff, potential bodily functions, and cleanliness.

Validity

While specific validity coefficients are typically detailed in the full dissertation, the development methodology suggests a strong emphasis on content and construct validity. Content validity was established through the comprehensive inclusion of items covering medical history, knowledge, logistical barriers, and psychological factors known to influence screening decisions, particularly the detailed inclusion of items related to bowel prep and transportation.

For the specific sub-scale, the Colonoscopy Embarrassment Scale (CES), construct validity was likely established by demonstrating that the scale accurately measures the latent psychological variable of embarrassment distinct from general anxiety or logistical barriers. This typically involves comparisons with existing measures of health anxiety or modesty, ensuring the instrument is a valid measure of the intended psychological construct.

Reliability

Reliability, often measured using internal consistency (e.g., Cronbach’s Alpha), is crucial for the CHS-M sub-scales, especially the Self-efficacy and Embarrassment components. The scale’s systematic development, as outlined in the PhD dissertation, indicates that items were rigorously tested to ensure they consistently measure the underlying constructs. High internal consistency would affirm that the items within the CES, for instance, are highly correlated and reliably capture a singular, stable dimension of procedural embarrassment.

Factor Analysis

The use of Exploratory or Confirmatory Factor Analysis (FA) would have been integral to the development of the CHS-M, particularly the CES component. Factor analysis is used to confirm the underlying structure of the scale, separating distinct clusters of items into measurable factors. For the CES (Questions 50-64), factor analysis would determine if embarrassment related to bodily exposure groups separately from embarrassment related to communication with staff or potential bodily functions (e.g., passing gas). This psychometric rigor ensures that the sub-scales are measuring separate, meaningful constructs.

Instrument

Test Type: Self-report Questionnaire/Academic Survey

Format: Mixed format including dichotomous (Yes/No), multiple-choice knowledge items, Likert-style scales (4-point scales for Sureness and Agreement), and open-ended questions.

Language Available: English (Original)

Population Group: Adult Males at risk for colorectal cancer.

Age Group: Typically 50 years and older, or those with specific risk factors, although the survey itself does not specify a minimum age.

Population Details: Men targeted for colon cancer screening who may be hesitant or non-adherent to screening guidelines. The survey includes demographic variables (education, marital status, race, income) to characterize the sample population.

Test Methodology: Assesses cognitive, behavioral, and affective domains related to screening compliance, particularly focusing on the procedural steps and psychological barriers of colonoscopy.

Keywords

Health behavior, screening adherence, psychological scale, medical screening barriers, preventative medicine, embarrassment, factor analysis, psychometric development, Colonoscopy Embarrassment Scale

Authors

Author ORCID Identifier: Not provided in source content.

Affiliation Email addresses: Not provided in source content.

Correspondence Address: Not provided in source content. (Affiliation: Indiana University, based on dissertation information.)

Permissions & Fee and Test Year

The Colon Health Survey (Male) and the embedded Colonoscopy Embarrassment Scale were developed by Ann Mitchell Kimberly in 2009 as part of a PhD dissertation research project titled, “Development and Testing of the Colonoscopy Embarrassment scale.” Permissions for use may need to be obtained directly from the author or Indiana University, depending on standard dissertation copyright policies. The original PDF containing the instrument development details can be downloaded here: Kimberly, 2009.

Reference’s

Kimberly, Ann Mitchell (2009). Development and Testing of the Colonoscopy Embarrassment scale. Indiana University, PhD dissertation.

Items of the Colon Health Survey (Male)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

1. Have you done a stool blood test at home in the last 12 months? Yes, No

2. Have you ever had a sigmoidoscopy or flexible sigmoidoscopy? Yes, No

3. Have you ever had a barium enema? Yes, No

4. Have you ever had a colectomy? Yes, No

5. Have you ever been told you have ulcerative colitis or Crohn’s disease? Yes, No

6. Have you ever had cancer of the colon or rectum? Yes, No

7. What is your highest level of education?

8. What is your marital status?

9. What do you consider your race to be?

10. What is your total yearly combined household income?

11. Have you ever had a colonoscopy? Yes, No

12. When was your last colonoscopy? Less than 10 years ago, More than 10 years ago, I have not had a colonoscopy

13. Are you planning to have a colonoscopy in the next 6 months? Yes, No

14. Do you have an appointment scheduled for a colonoscopy? Yes, No

15. Has a doctor ever recommended that you get a colonoscopy? Yes, No

16. Can colon cancer ever be prevented? Yes, No, Don’t know

17. Who is most likely to get colon cancer?

• A person younger than 50 years old
• A person older than 50 years old
• There is no difference
• Don’t know

18. Which group is more likely to get colon cancer? Whites, Blacks, Hispanics, There is no difference, Don’t know.

19. Who is more likely to get colon cancer?

• Someone whose spouse had colon cancer
• Someone with one close blood relative (parent, brother, or sister) who had colon cancer
• Someone with two close blood relatives (parent, brother, or sister) who had colon cancer
• There is no difference
• Don’t know

20. Compared to a man, what is a woman’s chance of getting colon cancer?

• Much higher than a man’s
• About the same as a man’s.
• Much lower than a man’s.
• Don’t know

21. What is the most effective way for people to lower their chances of dying from colon cancer?

• Exercising regularly
• Limiting alcohol
• Finding and removing polyps
• There is nothing that can be done
• Don’t know

22. What is a doctor able to see during a colonoscopy?

• Inside only the lower part of the colon
• Hidden blood in the stool
• Inside the entire length of the colon
• Don’t know

23. If you choose to have a colonoscopy and everything is normal, when will you probably need to have your next one?

• 6 months.
• 1 year
• 2 years
• 5 years
• 10 years
• Don’t know

Questions 24-33 are about the steps required to complete a colonoscopy. Please indicate HOW SURE you are that you can complete each step by marking a small X in one box per question.

Not at all sure, Not so sure, Somewhat sure, Very sure

24. I am able to get an appointment to have a colonoscopy.

25. I am able to find time to have a colonoscopy.

26. I am able to drink the special medicine (laxative) to clean out my bowel before a colonoscopy.

27. I am able to go without solid food for a day before the colonoscopy.

28. I am able to find transportation to get to and from the clinic to have a colonoscopy.

29. I am able to get my questions answered about having a colonoscopy.

30. I am able to follow instructions to clean out my bowel before a colonoscopy.

31. I am able to get a colonoscopy even if I am worried about the results.

32. I am able to have a colonoscopy even if I don’t know what to expect.

33. I am able to have a colonoscopy even if I am anxious.

Strongly disagree, Disagree, Agree, Strongly agree

34. I worry about finding something wrong during a colonoscopy.

35. having a colonoscopy is embarrassing.

36. I don’t have the time to have a colonoscopy.

37. I don’t understand what will be done during a colonoscopy.

38. A colonoscopy could be painful.

39. I would need to have a colonoscopy only if I have bowel problems or symptoms.

40. having to find someone to drive me home would be hard.

41. having to take the special medicine (laxative) to clean out my bowel before the

42. having to limit what I eat before the colonoscopy would be hard.

43. I am afraid that my colon could be injured during a colonoscopy.

44. having a colonoscopy is not that important right now.

45. Thinking about having a colonoscopy makes me feel nervous or jittery.

46. having to see a doctor I don’t know would make it hard to have a colonoscopy.

47. I don’t need a colonoscopy at my age.

For questions 48 and 49, please complete the statement by writing in the space provided:

48. For me, the most embarrassing part of having a colonoscopy would be:

________________________________________________________________________

________________________________________________________________________

49. I would be less embarrassed to have a colonoscopy if:

_______________________________________________________________________

_______________________________________________________________________

Colonoscopy Embarrassment Scale

Strongly disagree, Disagree, Agree, Strongly agree

50. I would be embarrassed to have a colonoscopy if a female did the test.

51. I would be embarrassed to have a colonoscopy if I did not know the doctor doing the test.

52. I would be embarrassed to have a colonoscopy if a medical student or nursing student was in the room to watch.

53. I would be embarrassed to have a colonoscopy if I passed gas during the test.

54. I would be embarrassed to have a colonoscopy if I had to be awake for the test.

55. I would be embarrassed to have a colonoscopy if the doctor joked with me about the test.

56. I would be embarrassed to have a colonoscopy if I had to talk to the doctor or nurse about my bowel movements.

57. I would be embarrassed to have a colonoscopy if I had to talk to my doctor or nurse about problems with my bottom/buttocks.

58. I would be embarrassed to have a colonoscopy because my bowel may not be clean after the bowel prep.

59. I would be embarrassed to have a colonoscopy because of the size or appearance of my bottom/buttocks.

60. I would be embarrassed to have a colonoscopy because someone will be touching my bottom/buttocks.

61. I would be embarrassed to have a colonoscopy because the tube is being put into my rectum.

62. I would be embarrassed to have a colonoscopy because I might smell.

63. I would be embarrassed to have a colonoscopy because of concern that my penis would not be covered during the test.

64. I would be embarrassed to have a colonoscopy because the doctor or nurse will see my bottom/buttocks.