الفهرس 
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Abstract
Cancer is predominately a chronic disease of older adults so, it is expected that the
incidence rate with cancer between older adults patients largely increased. Colorectal cancer
(CRC) is the most common malignant tumor diagnosed in elder in all over the world; yet its
incidence differs from one region to another. About sixty percent of colorectal cancer patients
are elderly. Many elders are unaware of their increased CRC risk, and have little knowledge
about early CRC symptoms, and have comorbidities which may hinder participation in CRC
health practices and screening, so elder are being diagnosed with CRC at more advanced stages
of the disease.
CRC does not strike older adults alone but the whole family unit and community. The only
way to decrease mortality and morbidity from CRC is to prevent and detect the disease early
through health practices and screening activities. Early detection remains the cornerstone of
colorectal cancer control that requires early diagnosis in symptomatic elders and regular
screening in asymptomatic elders. Despite the effectiveness of health practices and screening
behaviors in reducing mortality, research findings indicate that participation of older adults in
health practices and screening behaviors remain low. Several factors could influence older
adults’ CRC health practices and screening participation such as perception regarding CRC,
sociocultural, religious, demographic, environmental, and psychological factors. Therefore,
performing CRC health practices and screening procedures among older adults is vitally
important in achieving CRC control goals and improving older adults’ health related quality of
life.
Aim of the study:
The present study aimed to determine the effect of nursing interventions on health practices
and perceptions regarding colorectal cancer among community dwelling older adults.
Research hypotheses:
H1: Older adults who receive the proposed nursing interventions achieve higher scores in health
practices regarding colorectal cancer post the intervention than before it.
H2: Older adults who receive the proposed nursing interventions achieve higher scores in
perceptions regarding colorectal cancer post the intervention than before it.
Study design:
The study followed a quasi-experimental research design (one group pre-test and post-test).
Setting:
The study was carried out in El-Waffa club of elderly persons at Alexandria. This club is
affiliated to the Ministry of Social Solidarity, Egypt.
Subjects:
The Epi info V 7.0 was used to estimate the required sample size. This study included a
convenience sample of sixty (60) older adults aged 60 years and above, had no cognitive
impairment (score 24 and more on the Mini Mental State Examination), had no or mild depression
(score 0 to 4 or 5 to 8 on the geriatric depression scale short form (GDS-SF), able to read and write
and not currently diagnosed with colorectal cancer.
Tools of the study:
Six tools were used to collect the necessary data from the study subjects as following:
Tool (I): Mini Mental State Examination (MMSE) Scale:
The Arabic version of the MMSE translated by El OKL (2002) was be used. It is a reliable
measure for assessing cognitive function of the elderly. This tool is used for the selection of the
study subjects. The Arabic version of this scale was used in the present study.
Tool (II): Geriatric Depression Scale Short-Form (GDS-SF):
The Geriatric Depression Scale – short Form (GDS-SF) by Yesavage, etal (1983) to assess
depression and general well-being in the elderly. The Arabic version of this scale was used in the
present study.
Tool (III): Older Adults Socio–Demographic and Clinical Data Structured Interview Schedule
This tool will be developed by the researcher based on relevant literature to collect the
following information from the study subjects:-
A. Socio-demographic data of the older adults such as, age, marital status, educational level,
occupation prior to retirement, income, source of income, social support such as presence of
spouse, or other significant personnel.
B. Clinical data of the older adults include such as medical health history: the presence of any
medical problems, family history of colorectal cancer or other tumors (benign or malignant),
previous history of benign colon tumor, or rectal cancer, or inflammatory bowel disease
elders, previous exposure to radiation, availability and accessibility of medical services
within the older adult area of residence, as well as type and frequency of performing
colorectal cancer screening procedures.
Tool (IV): Colorectal Cancer Knowledge Questionnaire (CRCKQ)
This tool was translated by the researcher and included 12 questions.These questions assesse
knowledge regarding incidence of colorectal cancer, symptoms of colorectal cancer, prognosis, and
methods of detection.
Tool (V): Colorectal Cancer Perceptions scale (CRCPS)
This tool was translated by the researcher and included 36 items representing 6 subscales
related to perceptions about susceptibility to CRC, seriousness of CRC, benefits of colon screening,
barriers to colon screening, health motivation for colon screening, and confidence in colon screening.
Tool (VI): Older adults’ health practices regarding prevention of colorectal cancer
This tool will be developed by the researcher based on relevant literature to assess older
adults’ health practices regarding colorectal cancer and CRC screening. This part will include
questions about health practices regarding colorectal cancer that affect the liability of the older
adults for having CRC. For example, obesity, physical inactivity, smoking, diet high in red or
processed meats, and excessive exposure for stress.
B- Method
After the necessary approval has been taken and the tool used to assess socio–demographic and
clinical data structured interview schedule. Then the study older adults informed about the aim of
the study and the schedule of the sessions that were conducted at the study of the setting. A flip
chart containing illustrative pictures was used by the researcher in order to clarify the desired
knowledge and practices for each elders, other teaching method was used such as open discussion,
videos, and power Point. Each session ended with objectives and action plan to achieve it.
Before starting a new session, the action plan was checked to assess older adult’s commitment
with the plan and to identify obstacles that hinder the achievement of the present goals and try to
overcome them. the older adults were asked questions related to the topic discussed in the previous
session to identify their understanding, misses or unclear points were re-emphasized by the
researcher. Then a summary of the previous session was started to help older adults to refresh their
information. Assessment of the study subjects’ socio-demographic and clinical data, knowledge,
perceptions and health practices were done using tool number 4, 5, and 6 respectively. It was done
three times. The first one was before the administration of any interventions, followed by immediate
evaluation after the interventions, and 4 weeks after the interventions. Data time collection ranged
between 45 to 60 minutes, with provision of rest periods. The data collection started from the
beginning of January until the beginning of May 2019. The evaluation of the effectiveness of the
proposed self-care strategies was determined through using the proper statistical analysis.
The main results obtained were as follows:
The age of the study subjects ranges from 60 to 83 years, with a mean of 68.10 ±
4.36years. 76.7 % of the older adults included in this study are females and 23.3% are males. As
regards the marital status, older adults who are married constitute 56.7% of the study subjects
and widowhood is found in 38.3% of them. As for the educational level; university education
and secondary are found in 60 % and 3.3% of older adults in the study group respectively.
Concerning the previous occupation of the study subjects, 61.7% of them were employees. As
well as, it is found that 18.3% of older adults in the study are housewives. As for the monthly
income; 70.0% the study reported having sufficient income and 30% of them reported having
insufficient income. As regard the study subjects’ previous history of tumors; 78.3% of the study
subjects didn’t have any previous history of tumors compared to 21.7% of them reported having
previous history of tumors.
In current study, before the implementation of study interventions, 61.7 % of the studied
older adult’s had poor knowledge and 11.7% of them had good knowledge. Immediately after the
implementation of the study interventions, 96.7 % of the study subjects had good knowledge.
Four weeks of the implementation of the study interventions, 88.3% of the study subjects had
good knowledge. There is a highly statistically significant difference between the older adults’ knowledge level before, immediately after and 4 weeks after of the application of the study
interventions as (p=0.000)
Concerning the perception regarding CRC, prior to the implementation of the nursing
interventions, 40% of them had low perception and 60% of them reported to have high
perception. Immediately after the implementation of the study interventions, 90% of studied
subjects had high perception. Four weeks later, 93.3% of studied subjects had high perception.
The difference on the whole is highly statistically significant (P<0.000).
In relation to health practices, before to the implementation of the study interventions,
86.7% had satisfactory level had good health practices. Immediately after the implementation of
the study interventions, 90% of them had good health practices and 10% of them had a
satisfactory level. Four weeks later, 86.7% of them had a good level of health practices. The
difference on the whole is highly statistically significant (P<0.000).
Conclusion:
Based on the findings of the present study, it can be concluded that knowledge about
colorectal cancer, perceptions and practices regarding colorectal cancer have been improved in
the majority of the studied older adults after the implementation of the study interventions than
before it, and the difference is highly statistically significant. Both study hypotheses are
supported by the study data.
The main recommendations suggested are:
1. Raising awareness of the public about CRC, its management, its prevention and CRC
screening measures in order to prevent and detect CRC early through mass media.
2. Encouragement of governmental and private organization/agencies to allocate funds to
carry out CRC screening methods such as colonoscopy and sigmoidoscopy in low cost
manner.
3. Preparation of an instructional booklets and posters to include the interventions for older
adults for increasing the awareness with health practices regarding CRC to be distributed
at all outpatients and assisted living facilities. Necessary criteria for written materials for
the elders should be considered. Educational materials should be provided to this
population with materials in low –literacy level and in audiovisual format.
Recommended future researches:
1. Further research is required for the prevention of CRC among high risk group.