الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Colorectal cancer (CRC) poses a significant public health challenge, ranking as the second leading cause of cancer-related deaths globally and the third most common cancer worldwide. In Egypt, there is a concerning upward trend in CRC cases, particularly among younger individuals, which could be linked to factors like adopting a more westernized lifestyle and challenges in healthcare delivery, funding and infrastructure for screening initiatives.
Implementing effective CRC screening programs is of crucial significance as it offers an affordable means of secondary prevention and disease management, substantially enhancing survival rates through early detection and appropriate medical interventions. The role of PHCPs in effectively implementing screening tools is crucial in boosting CRC screening participation rates. Effective screening programs can dramatically reduce the incidence of CRC, highlighting the critical role of PHCPs. Studies have shown that the knowledge level of PHCPs significantly influences their attitudes and practices towards CRC screening.
This study aimed to assess the level of knowledge, attitudes, self-efficacy, and practices of PHCPs regarding CRC screening in Alexandria, Egypt. Additionally, it examined the capacity of PHC facilities for CRC screening and identified barriers to CRC screening from the physicians’ perspectives.
To achieve these objectives, a descriptive cross-sectional design involving both PHCPs from the eight health districts of Alexandria (n=158) and PHC managers (n=39) was carried out. A self-administered questionnaire for PHCPs and structured interview formats with PHC managers were used to allow for a multifaceted approach of data collection, which likely provided valuable insights into the current status and challenges surrounding CRC screening in Alexandria. Data was entered and analyzed using SPSS version 25.0 and the chosen level of significance was set at < 0.05.
A summary of the key findings is presented in 5 sections:
Section 1: characteristics of Participating PHCPs:
• The majority of participating PHCPs were females (84.8%) and younger than 40 years (75.9%).
• More than half of participating PHCPs were general practitioners (55.7%), with a median of 8 years of experience in PHC.
• A significant proportion (75.9%) had never referred any CRC cases and only a minority (16.5%) had received prior training on CRC screening.
Section 2: Knowledge, Attitudes, Self-Efficacy, and Practices of Participating PHCPs:
• Knowledge level of participating PHCPs on CRC varied, with most PHCPs having good (65.8%) or very good (22.8%) knowledge levels. However, gaps existed in knowledge related to CRC risk factors and screening recommendations.
• The majority of participating PHCPs had a positive attitude (mean score percent of 77.7%) and moderate self-efficacy (mean score percent of 59.0 %).
• Around 39.2% of PHCPs were not practicing CRC screening at all, while 32.3% were properly practicing it.
Section 3: Capacity of selected PHC Facilities for CRC Screening:
• Overall, PHC facilities had inadequate capacity for CRC screening, with no established policies or protocols for screening, referral or follow-up of CRC cases.
• None of the facilities had the necessary kits for performing fecal occult blood tests (FOBT) and only 12.8% of them had healthcare providers trained in conducting FOBT.
Section 4: Perceived Barriers to CRC Screening
• Major barriers at the patient level were lack of knowledge about CRC, fear of cancer diagnosis and disbelief in the importance of screening.
• At the provider level, lack of knowledge about updated guidelines and shortage of trained providers were significant barriers.
• Health system-level barriers included shortages of screening kits, absence of clear protocols and lack of reminder systems for both patients and providers.