Sample Characteristics A total of 34 people in this study met the inclusion and exclusion criteria of this study. Among them, 9 people (29%) were interrupted in the interview, 4 people (12%) refused to participate, and 21 people (59%) finally agreed and accepted the interview. Their demographic characteristics in Table 2.
Table 2
Socio-demographic characteristics of respondents
Interviewee | Age | Education | Vocation | Household monthly income per capita (Yuan) | Cost-bearing method | Types of physical examination packages |
M1 | 54 | high school | a | ≥ 5000 and < 8000 | 1 | A |
M2 | 55 | Junior college | b | ≥ 3000 and༜5000 | 2 | B |
M3 | 57 | Master | c | ≥ 5000 and < 8000 | 2 | A |
M4 | 65 | Undergraduate | b | ≥ 5000 and < 8000 | 2 | VIP |
M5 | 48 | Undergraduate | b | ≥ 8000 | 2 | B |
M6 | 56 | Undergraduate | b | ≥ 8000 | 2 | B |
M7 | 63 | Undergraduate | d | ≥ 5000 and < 8000 | 1 | C |
M8 | 54 | Undergraduate | c | ≥ 5000 and < 8000 | 2 | A |
M9 | 63 | Undergraduate | b | ≥ 5000 and < 8000 | 2 | A |
M10 | 58 | Undergraduate | b | ≥ 5000 and < 8000 | 2 | B |
M11 | 55 | Undergraduate | b | ≥ 8000 | 2 | A |
M12 | 50 | Undergraduate | b | ≥ 8000 | 2 | B |
M13 | 76 | Technical secondary school | e | ≥ 3000 and༜5000 | 2 | A |
M14 | 57 | Primary school | f | ༜3000 | 1 | A |
M15 | 81 | Junior college | b | ≥ 5000 and༜8000 | 2 | B |
M16 | 63 | Junior high school | a | ≥ 8000 | 1 | VIP |
M17 | 44 | Junior college | a | ≥ 5000 and < 8000 | 1 | D |
M18 | 52 | Master | g | ≥ 5000 and < 8000 | 2 | B |
M19 | 46 | Undergraduate | h | ≥ 3000 and༜5000 | 2 | A |
M20 | 50 | Undergraduate | a | ≥ 3000 and༜5000 | 1 | A |
M21 | 58 | PhD | i | ≥ 5000 and༜8000 | 2 | C |
Note: Interviewee number: M1ཞM21. Vocation: a- Self-employed persons; b-Business management personnel; c- Civil servants; d-Teacher; e-Worker; f-Farmer; g-Engineer; h-Staff; i-Researcher. Cost-bearing method:1-Own expense;2- Public expense. Types of physical examination packages are divided into five levels: A, B, C, D, and VIP according to the price. The higher the level, the more comprehensive the physical examination items. The packages of level B and above Prostate series test items. |
Theme extraction 45,000 words were totally transcribed in the interview. Three themes as relevant to Middle-aged and elderly men’ willingness to screen for prostate cancer, extracted from these interviews (Table 3 Select interviewee quotes by theme).
The first theme centered on the attitudes of prostate cancer screening. This topic explores the positive or negative evaluations of middle-aged and elderly men on prostate cancer and its screening.
Many middle-aged and elderly men regard prostate cancer screening as a willingness to improve their health. Interviews found that middle-aged and elderly men who recognize the importance of prostate cancer screening generally have a higher willingness to screen for prostate cancer. Many interviewees believe that if cancer is present, early detection through screening will lead to more successful treatment and fewer complications, and ultimately save a person's life. However, people who hold the concept of cancer fatalism regard the occurrence of cancer as a kind of fate, luck, or God’s will. The corresponding prevention, screening, and treatment are meaningless. Death is inevitable [10], which is their reluctance or One of the reasons for refusing to participate in cancer screening. This finding shows that cancer fear hinders their actual screening behavior to a certain extent, which depends on cancer fatalism beliefs. In addition, most people lack understanding of the preventive nature of prostate cancer screening. Therefore, it is necessary to emphasize prostate cancer screening for the majority of the population. The importance and necessity of cancer screening.
Besides, some interviewees said that compared with local hospitals, the medical equipment of the city's top three general hospitals is more advanced, and the doctors have more experience, and the examination results may be more comprehensive and accurate. Therefore, in order to improve people’s negative impression of small hospitals, it is recommended to increase the level of early diagnosis of prostate cancer in grassroots hospitals, standardize the implementation path of prostate cancer screening and clinical diagnosis in the physical examination population and determine simple and feasible screening and follow-up indicators and screening process.
Prostate cancer screening refers to a series of prostate examinations in asymptomatic men [11], however, some middle-aged and elderly men report that they do not know how the screening is performed and the risks and benefits of it. Surprisingly, even respondents who have undergone prostate cancer screening still have a certain degree of confusion about how to perform prostate cancer screening. Some of them think that abdominal color doppler ultrasound is sufficient to screen for prostate cancer. Therefore, it’s necessary to strengthen the popularization of knowledge about prostate cancer prevention and treatment. Although the current physical examination center has listed the serum prostate-specific antigen (PSA) test as a diagnosis item for prostate cancer screening [12], middle-aged and elderly men rarely pay attention to this item and understand little when performing health examinations. Probably due to the large number of medical examinations, the medical staff in the medical examination center are usually rushed to give relevant instructions to the examinee, directly tell the examinee what to do. Sometimes, the results of cancer screening plan and physical examination report lack personalized or incomplete explanation, which hinders middle-aged and elderly men from actively performing related physical examinations for prostate cancer screening.
The Chinese do not want others to know that they have cancer, because they are afraid of receiving bad news and prefer not to obtain information about the situation, although it is possible to make better decisions based on this information. Interviews found that elderly men over 70 years of age generally have low willingness to screen for prostate cancer. Most elderly people have the psychology of not wanting to trouble their children when they are sick, and fear and avoidance seem to interact [13], which makes them not want to think about prostate cancer.
Individuals said that receiving screening allows them to understand their current health status. They believe that it is an obligation and responsibility to keep their families healthy. In addition, screening reduces their worries about the risk of prostate cancer, which makes them feel at ease. It can be seen that cancer fear may also be a contributing factor. Consistent with the results of other studies, serious concerns about cancer have strengthened their willingness to conduct screening, which in turn promotes their actual screening behavior, which may be out of seeking psychological comfort [14]. Some interviewees reported that the older they get, the more likely they are to get sick. Regardless of their health status, cancer is a hidden disease that develops quietly in the body. Participating in screening is a way and an opportunity to maintain their own health and can convince them They do not have prostate cancer, especially if they do not have regular physical examinations.
Table 3
Select interviewee quotes by theme
Theme | Quotes |
Theme 1: Attitudes of Behavior Importance of screening | M4: "Now that medicine is advanced, some cancers can be overcome. Early detection and early treatment should not be a big problem. I think (prostate cancer) should be cured. Anyway, if you get rid of it, it will be over. Is this inflammation? You don’t know about cancer. If you find cancer after screening, you won’t be able to deal with it as soon as possible.” M17: "I think all cancer screenings are necessary. If you have a disease, treat it as soon as possible. It may be better to treat it early. It is necessary for life." M21: “All cancers are detected and treated early to get a good recovery or a longer survival period." |
Fatalistic belief | M10: "Cancers are all discovered in the later stages. What use is there when you find them later? It can only be said to be waiting (die)." M18: "Actually, there are many people around me who are afraid of physical examination, especially those who work at the bottom. They think that they may live for 3 years without cancer detection. If they are found out, they may be dead in the same year, because if they don't know, there will be no trouble in this area. This kind of disease has too much psychological impact!" |
Distrust | M5: "Many physical examinations are a bit of a formality, I think the probability of finding out is very low." M13: "Because the hospital physical examination is for you to find no problems, you feel disgusted when it is necessary and unnecessary, such as hardening of the blood vessels. It’s impossible not to harden when you reach your age." M14: "The medical level of the small clinics or small hospitals in the area is not as good as that of the big hospitals in the city. I don't really believe in their medical methods, so I come here for the physical examination, hoping to be more comprehensive and accurate." |
Confusion | M1: "The physical examination of the unit usually includes color Doppler ultrasound for men's abdomen. This should be able to detect it. If there is an abnormality in the prostate, the doctor will say." M3: "I don't understand the risks of PSA blood testing. This is a bit confusing for me, because I have done blood tests for other items and there is no problem." M6: "How exactly is this screening? I don't know much, so I can't talk about what I think about it." M16: "I have done PET-CT for the whole body. Isn't this one can screen for all cancers, the report is all normal, so I don't understand why it is necessary to screen for prostate cancer. " |
Worry | M13: "You said that you are about to be over 80 years old, what else do you have to check? Normally this age is almost dead. Why spend that money to suffer the crime and make the children worry about it." M15: "You don't know about our elderly people." Mentality, we are so old, now we try not to organize a physical examination by the unit. I don't want to come to the hospital. If I become ill, it will cause a lot of trouble to the relatives of the children, and the medical expenses will also affect the children." |
Peace of mind | M7: "I haven't had a physical examination in 2 years, so this time I chose a package with a more comprehensive range of items, including cardiovascular and cerebrovascular, tumor screening, and so on. After all, my age has gone up." M16: "I will do a comprehensive cancer check every year. If I say that I am not at risk of cancer, I will feel at ease psychologically." M19: "At our age, there are old and young people, and work pressure is also great. So I pay much attention to health. If I have a disease, I still hope that I can find it and treat it early, so I feel at ease." |
Topic 2: Subjective Norms |
Medical staff's advice and guidance | M2: "If the doctor advises me to go, I will definitely go. The doctor will do what the doctor says. I still have to listen to the doctor." M6: "The suggestions of relatives, friends or colleagues will have some influence but they may not go, although this suggestion is definite. They are all positive, but they will still consider their physical conditions; like a doctor’s purposeful and directional advice, he will definitely go there. Generally speaking, his advice must be well-founded." |
Related experiences of relatives, friends or colleagues | M7: "My dad is prostate cancer. The mortality rate of this disease is not the highest among cancers. Especially when you are over 55 to nearly 60 years old, you should check regularly. Men's prostate function declines around 60 years old. During menopause, his body hormones have changed. This aspect is prone to disease. At this age, it is necessary to have a screening." M8: "For example, a unit has more patients. You must have it. Pay attention. Besides, if your relatives have prostate cancer, you have to pay attention, mainly relatives, and colleagues, classmates, comrades-in-arms, friends, etc. You can get it, people around you get it more or which local area has it. Then you are nervous and want to go automatically." M16: "Because we have cancer in our family history, there are more people like this, almost all of whom have died of cancer, so I am wary of having a comprehensive cancer check every year." |
Propaganda of media information | M1: "There is still cancer in the prostate. I have never heard of it. You are like children who are getting the cervical cancer vaccine in the community. I often use my mobile phone. I know." M5: "We often see breast cancer on TV, cervix I have never seen prostate cancer. I don’t think there are so many people who deserve this disease, or it’s not that important. Everyone may not pay attention to it, unless the professionals know who the ordinary people are. I understand this (laughs)." M9: "I listen to the health radio every day. In fact, there is not much information about it (prostate cancer), but I have heard of prostatitis and prostatic hyperplasia." |
Topic 3: Perceived Behavioral Control |
Cost | M4: "There are no symptoms. If the cost is very low and popular, and the individual's financial strength is reached, then I think it should be screened." M6: "Especially prostate cancer screening. I think the penetration rate is very low. One is for individuals. The reason for the cognitive level is the cost. In fact, the lower the income level, the less people want to do this." M13: "Can this screening be reimbursed for medical insurance? If it can be reimbursed, you can consider doing it." M14: "You need a little bit of money for the screening. It costs one or two thousand, and the common people can't afford it! (Emotional)" |
Physical examination package setting | M2 said, "If this item must be included in the group medical examination package, there is no need to consider it (add or not); the unit is all group medical examinations, and now women’s group packages include gynecology, and men should also Add one (prostate cancer screening program), but you control this age". M4: "Aren't all the packages for physical examinations? If you list this item, it will be over. When you take the blood, you can bring it together." |
| M4: "Serum PSA? Then don't you just draw a tube of blood. It's easy, and it doesn't cost much..." M12: "I still choose what physical examination item according to my own situation, because every year I will choose the item that I haven't undergone physical examination. If there is an abnormality in the body, further examinations will be carried out.” M21: “I have been screened before, and the results are normal. Although I no longer worry about getting cancer, I still have regular physical examinations.” |
Self-efficacy | M3: "I have some problems with the prostate when I get older. I should check it but I won’t actively add this because I don’t have any special symptoms, and I heard that prostate cancer is rare, unlike breast cancer and stomach cancer. If you feel uncomfortable in the situation, you will be checked, or if you do a color Doppler ultrasound, you can check it out.” M10: “I know very little about prostate cancer. The prostate itself is a very weak part of the body, compared to the five organs. As far as the device is concerned, people may not pay too much attention to it, and they will not deliberately screen it, but only pay attention to it." |
The second theme is subjective norms. This theme explores the social pressure that individuals feel when deciding whether or not to undergo prostate cancer screening, such as important people or groups [7]. Respondents said that the advice and guidance of medical staff can affect their willingness to screen prostate cancer to the greatest extent, although relatives and friends and colleagues also have some influence on them. This may be because medical staff usually play the role of educators, leaders, and experts in the process of patients seeking medical care, and in their active medical treatment behaviors. Plays a key role [15]. Men who have no history of cancer or related experience simply say, “I will do what the doctor requires.” This finding also emphasizes the key role that doctors’ recommendations play in shaping the attitudes and behaviors of middle-aged and elderly men in PSA screening [16]. Respondents who have blood relatives with poor quality of life or death at the end of life due to cancer generally have a desire to avoid a similar fate. Many men with a family history of cancer are strongly aware of the impact of cancer on health and quality of life, and cancer in family members or people around them. Experience makes him pay more attention to his own health, which affects his prostate cancer screening. The acquisition of multimedia information is one of the important ways to improve the level of health knowledge, effective communication between healthcare providers, policy makers, and the general public through educational programs and the media is also important for raising men’s awareness of prostate cancer screening.
The final topic explores the individual’s obstacles that may be encountered in the actual process before undergoing prostate cancer screening [7]. First of all, the cost of screening is an important consideration for interviewees for prostate cancer screening. Most middle-aged and elderly men in the physical examination center have medical insurance and/or unit medical assistance, and only one-twentieth are not insured. They will show obvious negative emotional reactions when the screening is not covered by the insurance because most interviewees hope that prostate cancer screening is free, simple and fast. Therefore, including cancer screening in the medical insurance reimbursement is one of the important measures to increase the screening rate of prostate cancer in my country. Moreover, the domestic physical examination is mainly based on the unit physical examination at present. In view of the fact that physical examination is the main method for people to prevent diseases at this stage [17], scientific, reasonable and personalized physical examination items have become an important means to protect the vital interests of the majority of people being examined. Last but not the least, self-efficacy is a key factor for people to change their original behavior and maintain a healthy lifestyle [18], which is positively correlated with the healthy behavior of prostate cancer screening. The higher the self-efficacy level of middle-aged and elderly men, the more significant the behavioral intention of prostate cancer screening [19]. Individuals with low self-efficacy in prostate cancer screening are also more likely to refuse the screening and are less likely to repeat the screening.