Abstract
Background/Objectives: Colorectal cancer (CRC) is a major health concern in South Korea, where incidence and mortality rates remain high despite the National Cancer Screening Program. Understanding the factors associated with CRC screening behaviors is essential for developing effective interventions. The purpose of this study was to examine the associations of sociodemographic characteristics, access to health care, knowledge, health beliefs, and cultural beliefs with CRC screening behaviors among Koreans. Methods: A cross-sectional survey was conducted with 648 Koreans aged 50 years and older at average risk for CRC. Participants completed questionnaires assessing sociodemographic characteristics, access to health care, knowledge, health beliefs, cultural beliefs, and CRC screening behaviors. Data were analyzed using descriptive statistics, bivariate logistic regression, and multivariate logistic regression with stepwise procedures. Results: Physician recommendation and perceived barriers were the strongest predictors of fecal occult blood test (FOBT) adherence, while physician recommendation, a usual source of health care, perceived benefits, and perceived barriers significantly predicted colonoscopy use. Perceived barriers reduced the likelihood of adhering to both, FOBT or colonoscopy (OR = 0.431, 95% CI = 0.316-0.588) or colonoscopy (OR = 0.432, 95% CI = 0.313-0.596), respectively, by 57%, whereas higher perceived benefits doubled the odds of colonoscopy participation (OR = 1.871, 95% CI = 1.331-2.631). Knowledge gaps were evident regarding CRC seriousness and the need for screening beginning at age 50 without symptoms. Conclusions: CRC screening participation among Koreans is associated primarily with access to care and health belief components. Encouraging physician recommendation and reducing perceived barriers are essential for improving screening rates. Culturally informed education and consideration of expanding colonoscopy services within the national cancer screening program is needed to further enhance CRC screening adherence.