The effectiveness of BCW-based family-participated digital-assisted intervention on health belief, health literacy and social support in old individuals with high-risk of colorectal cancer: A single- blinded randomized controlled trial

Colorectal cancer is a disease that often grows silently, but it is also one that can be stopped early if found in time. For older adults, the path to finding it early usually involves a simple screening test, yet many people skip this step. The reasons are rarely just about forgetting; they often involve a mix of worry, a lack of understanding about how the tests work, and the feeling that they are facing the process alone. When people do not believe the test is necessary, do not understand the instructions, or feel anxious about the outcome, they are less likely to follow through. Health researchers have long known that changing a person's behavior requires more than just handing them a pamphlet. It requires addressing their ability to do the task, the opportunities available to them, and their motivation to start.

In a recent study conducted in a community in Shanghai, researchers tested a new way to help older adults who had just received a positive result on a preliminary cancer screening. These individuals were at high risk and needed to undergo further testing, specifically a colonoscopy, to confirm their health status. The researchers wanted to see if a structured program, built on a framework for changing behavior, could improve the participants' confidence, knowledge, and mental well-being. They also wanted to know if bringing family members into the process made a difference. The study compared three groups: one that received standard care, one that received a digital support program, and one that received the same digital program but with active family participation. The goal was to see which approach best helped these older adults feel ready and willing to complete their medical follow-up.

The study involved 183 older adults who had tested positive for high risk of colorectal cancer. The researchers divided them into three equal groups. The first group, serving as the control, received the usual care available in the community. This included a one-time health booklet, a single lecture, and a few phone calls to remind them to make appointments. The second group received a more intensive digital intervention based on the Behavior Change Wheel, a method that focuses on building capability, opportunity, and motivation. This group got a weekly schedule of activities delivered through a mix of online and offline methods. Every Wednesday, they received educational comics and key facts in a WeChat group. On Fridays, they attended lectures by specialists, either in person or via live stream, followed by a question-and-answer session. Saturdays brought short videos to reinforce learning, and Sundays featured a quick quiz to test their knowledge. They also had access to expert help for booking appointments and planning travel to the hospital.

The third group received everything the second group got, but with a crucial addition: their family members were trained to help them. These family members joined a separate weekly training program. In the first week, they learned how to discuss risk factors with their older relatives. In the second week, they watched a detailed video on how to prepare for a colonoscopy, learning how to guide their family member through dietary changes and medication. The third week focused on creating a personalized support plan, dividing up responsibilities for diet, companionship, and post-procedure care. In the fourth week, family members heard from other families who had successfully completed the process, offering encouragement and real-world advice. This approach treated the family not just as observers, but as active partners in the health journey.

After four weeks of these interventions, the researchers measured the outcomes using several standard tools. They looked at how much the participants believed in the importance of screening, how well they understood health information, and their levels of anxiety and depression. They also checked how much social support the participants felt they had. The results showed a clear difference between the groups. Both the digital group and the family-participated group did significantly better than the group that received only standard care. The participants in the two intervention groups felt more confident about the screening process, understood the health information better, and reported lower levels of anxiety and depression.

When the researchers compared the two intervention groups against each other, a specific pattern emerged. The group that included family participation showed even greater improvements in health beliefs, health literacy, and mental health than the group that only received the digital support. The family members helped boost the older adults' motivation and emotional state. However, when it came to the feeling of social support, both intervention groups improved equally compared to the control group, and there was no significant difference between the digital-only group and the family group. This suggests that while the digital tools were enough to make people feel supported, the active involvement of family members provided an extra layer of psychological benefit that helped them feel more prepared and less worried.

The study concluded that combining a structured digital program with family involvement is a powerful way to help older adults navigate the difficult period after a positive cancer screening. The digital tools successfully broke down barriers to knowledge and access, while the family component added a vital emotional boost. The researchers noted that while the family support did not change the objective resources available to the patients, it significantly improved how the patients felt about the support they had. This approach offers a practical model for community health programs, suggesting that when older adults are at risk, bringing their families into the conversation can make the difference between giving up and moving forward with life-saving care.