Open Access Research article

Clinical and psychosocial variables associated with behavioral intentions to undergo surveillance endoscopy

John M Hollier12, Marilyn Hinojosa-Lindsey13, Shubhada Sansgiry134, Hashem B El-Serag13 and Aanand D Naik13*

Author Affiliations

1 Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Department of Veterans Affairs Medical Center, (152), 2002 Holcombe Blvd, Houston, TX 77030, USA

2 Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA

3 Department of Medicine, Baylor College of Medicine, Houston, TX, USA

4 South Central Mental Illness Research Education and Clinical Center (MIRECC), Houston, TX, USA

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BMC Gastroenterology 2014, 14:107  doi:10.1186/1471-230X-14-107

Published: 10 June 2014



Many patients with Barrett’s esophagus do not adhere to guideline-recommended endoscopic surveillance. Among patient factors related to cancer prevention behaviors, patients’ stated behavioral intention is a strong predictor of behavior performance. Little is known about the patient factors associated with having a strong behavioral intention to pursue surveillance endoscopy. This study explores the association of clinical and psychosocial variables and behavioral intention to pursue surveillance endoscopy among patients with Barrett’s Esophagus and no or low-grade dysplasia.


Potential subjects were screened using electronic medical records of a regional Veterans Affairs Medical Center and a pathologically confirmed Barrett’s esophagus registry. Eligible participants were recruited by a mailer or phone call and completed a questionnaire to measure six distinct psychosocial factors, their behavioral intention to undergo surveillance endoscopy, and various demographic and clinical variables. Univariate and multivariate linear regression identified the relation of behavioral intention with each of six psychosocial variables.


One-hundred and one subjects consented and returned surveys. The analytical sample for this study consists of the 94% of surveys with complete responses to the behavior intention items. Three of the six psychosocial domains were statistically significant predictors of intention in both univariate and adjusted univariate analysis (salience/coherence β = 0.59, 95% CI = 0.45-0.76, P <0.01; self-efficacy β = 0.30, 95% CI = 0.10-0.51, P <0.01; and social influence β = 0.20, 95% CI = 0.08-0.33, P <0.01). In a multivariate analysis only salience/coherence (β = 0.65, 95% CI = 0.42-0.88, P <0.01) remained statistically significant predictor of intention.


This study established the validity of a scale to measure psychosocial variables associated with behavioral intentions to undergo surveillance endoscopy. Results demonstrate the importance of assessing self-efficacy, social influences, and bottom-line belief in the value of surveillance endoscopy when evaluating a patient’s likelihood of completing surveillance endoscopy.

Barrett’s esophagus; Surveillance; Intention; Endoscopy