Knowledge of Colorectal Cancer Warning Symptoms, Attitudes Toward Early Presentation, and Associated Factors Among Outpatient Attendants at Tikur Anbessa Specialized Hospital, Ethiopia

Background: Colorectal cancer (CRC) is a major cause of cancer-related morbidity and mortality worldwide. Early diagnosis largely depends on public awareness of warning symptoms and prompt healthcare-seeking behavior. However, evidence on CRC awareness and attitudes towards early presentation remains limited in low- and middle-income countries, including Ethiopia.

Objective: To assess knowledge of colorectal cancer warning symptoms, attitudes toward early presentation, and factors associated with knowledge and attitude among outpatient attendants at Tikur Anbessa Specialized Hospital.

Methods: An institution-based cross-sectional study was conducted among attendants visiting outpatient departments at Tikur Anbessa Specialized Hospital. Data were collected using the validated Cancer Awareness Measure (CAM) questionnaire. Good knowledge was defined as correctly identifying ≥70% of the five key CRC warning symptoms. A positive attitude toward early presentation was defined as intending to seek healthcare within three months of noticing a warning symptom. Binary and multivariable logistic regression analyses were performed to identify factors associated with good knowledge and positive attitude. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported, and statistical significance was declared at p < 0.05.

Result: A total of 394 participants were included in the study. Most participants were younger than 40 years (64.7%), male (65.0%), married (64.5%), and had an educational level below grade 12 (49.2%). Approximately half (51.5%) were residents of Addis Ababa. Overall, 23.1% of participants demonstrated good knowledge of CRC warning symptoms. Change in bowel habit was the least recognized warning symptom (29.7%). Participants who had previously heard of CRC were more likely to have good knowledge (AOR = 1.79; 95% CI: 1.03–3.13), as were those with a family member or close friend diagnosed with CRC (AOR = 2.44; 95% CI: 1.22–4.88). Educational status showed a positive but borderline significant association with knowledge. Educational level, having a family member or close friend with CRC, and good knowledge of CRC warning symptoms were independently associated with a positive attitude toward early presentation. Good knowledge was the strongest predictor of a positive attitude.

Conclusion: Knowledge of colorectal cancer warning symptoms was low among outpatient attendants at Tikur Anbessa Specialized Hospital, and more than half of participants had an unfavorable attitude toward early presentation. Previous awareness of CRC, personal exposure to the disease, and better knowledge of warning symptoms were associated with more favorable attitudes. Strengthening public awareness and health education initiatives may improve timely healthcare-seeking behavior and support earlier diagnosis of colorectal cancer.