Abstract: Objective To investigate colonoscopy screening adherence and its associated risk factors among high-risk individuals for colorectal cancer (CRC) in Shanghai, providing an evidentiary basis for enhancing colonoscopy screening rates and CRC prevention. Methods Utilizing a cluster stratified random sampling method, permanent residents from eight communities in Shanghai were selected as study participants between January and December 2024. A survey was conducted to assess high-risk status for CRC, and screening was implemented. The colonoscopy screening adherence rate among the high-risk population was analyzed. Univariate and multivariate logistic regression analyses were employed to identify factors influencing adherence. Results A total of 3 925 community residents in Shanghai completed the questionnaire and fecal occult blood test (FOBT), yielding a CRC high-risk detection rate of 27.29% (1 071/3 925). Among the 1 071 high-risk individuals, 354 underwent colonoscopy, corresponding to a screening adherence rate of 33.05%. The mean total score for CRC screening knowledge was (12.5±3.6). The mean total score for health beliefs regarding CRC was (120.2±16.7), and the mean total score on the Colorectal Cancer Screening Aversion Scale was (77.8±16.7). Multivariate logistic regression analysis indicated that the following factors were significantly associated with colonoscopy screening adherence in the high-risk population (all P<0.05): educational attainment of college level or higher (OR=2.445), average monthly household income ≥5 000 yuan (OR=1.644), married status (OR=1.906), a first-degree relative with a history of CRC (OR=3.343), a personal history of malignant tumors (OR=4.158), a history of intestinal polyps (OR=2.643), presence of mucous and bloody stools (OR=1.956), regular physical examinations (OR=4.707), high perceived risk (OR=6.753), prior discussion of screening (OR=2.173), poor self-rated health status (OR=2.203), CRC screening knowledge (OR=1.709), perceived susceptibility to colorectal cancer (OR=1.478), aversion to colonoscopy (OR=0.264), and health consciousness (OR=0.603). Conclusion The adherence to colonoscopy screening among high-risk individuals in Shanghai communities requires further improvement. It is imperative to provide targeted guidance and health education tailored to the characteristics of the high-risk population to alleviate aversion and concerns regarding colonoscopy, thereby strengthening CRC screening efforts.

Key words: Colorectal neoplasms, High-risk populations, Colonoscopy, Adherence, Correlated factors