Intergenerational differences in the trajectories of health beliefs toward colorectal cancer screening among first-degree relatives: A longitudinal mixed-methods study.

Abstract

To examine longitudinal changes in health belief trajectories regarding colonoscopy screening across generations among first-degree relatives (FDRs) of colorectal cancer (CRC) patients and to inform tailored intervention strategies. An explanatory sequential mixed-methods design was conducted. In the quantitative phase, 200 FDRs of CRC inpatients were recruited from a tertiary hospital in Wuhan (April-November 2025) using convenience sampling. Health beliefs were measured using the Chinese version of the Colorectal Cancer Screening Health Belief Scale at hospitalization, 3 months, and 6 months post-discharge. Of these, 184 participants completed all assessments. Generalized estimating equations were used to analyze temporal and intergenerational effects. In the qualitative phase, 17 participants were selected via maximum variation sampling and underwent semi-structured interviews. Thematic analysis was performed to explain and complement quantitative findings. Quantitative analysis revealed significant temporal changes in overall health beliefs (Wald χ² = 66.37, P < 0.001) and a significant group-by-time interaction (Wald χ² = 130.97, P < 0.001). Generation A (born 1950-1969, aged 56-75) exhibited a rise-then-fall pattern. Generation B (born 1970-1989, aged 36-55) remained relatively stable. Generation C (born 1990-2009, aged 16-35) showed a continuous decline. All groups demonstrated the lowest health belief scores at 6 months post-discharge. Qualitative analysis identified two major themes: dynamic evolution of screening health beliefs (three generational patterns) and intergenerational difference factors (role positioning, information access, emotional support, and health awareness). The perceived illness warning effect gradually weakened over time, with generation-specific influencing mechanisms. Intergenerational differences in health belief trajectories highlight the need for stage-specific and generation-tailored interventions to improve CRC screening adherence among FDRs. Healthcare providers should enhance risk perception and screening guidance during hospitalization. Post-discharge, personalized multi-channel reminders are recommended: emotional support for Generation A, practical assistance for Generation B, and new media-based risk communication for Generation C.