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Peng W, McKinnon-Crowley J, Huang Q, Mao B. Assessing Fear, Embarrassment, and Disgust in Colonoscopy: The Development of Measurement Instruments and Psychometric Evidence. HEALTH EDUCATION & BEHAVIOR 2024; 51:601-612. [PMID: 37293778 DOI: 10.1177/10901981231177075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Avoidance of colonoscopy is often associated with fear, embarrassment, and disgust aroused in screening procedures. However, each emotion can be linked to different challenges faced by patients. More research is needed to evaluate and address the causes of these respective emotions. AIM The purpose of this study was to develop and assess the scales of three negative emotions (i.e., fear, embarrassment, and disgust) caused by specific issues in colonoscopy screening. METHOD The measurement items were developed based on multiple common barriers in colonoscopy screening procedures. An online sample of 232 adults aged 45-75 was recruited from Amazon Mechanical Turk to test the scales. Explorative and confirmatory factor analyses were conducted to validate the measurement models. RESULTS Psychometric evidence demonstrated the factor structures of three negative emotions. Each emotional factor was caused by unique combinations of barriers in the preparation, screening, and recovery stages of colonoscopy. Most of the emotional factors were associated with attitudes and screening intention. CONCLUSION This study showed different dimensions of negative emotions and their underlying causes in colonoscopy. These findings will help assess specific causes of negative emotions in colonoscopy and develop effective interventions to improve screening uptake.
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Affiliation(s)
- Wei Peng
- Washington State University, Pullman, WA, USA
| | | | | | - Bingjing Mao
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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2
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Kruse-Diehr AJ, Cegelka D, Holtsclaw E, Edward JS, Vos SC, Karrer M, Bathje K, Rogers M, Russell E, Knight JR. Feasibility and efficacy of a novel audiovisual tool to increase colorectal cancer screening among rural Appalachian Kentucky adults. Front Public Health 2024; 12:1415607. [PMID: 39056077 PMCID: PMC11269215 DOI: 10.3389/fpubh.2024.1415607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 06/28/2024] [Indexed: 07/28/2024] Open
Abstract
Introduction Residents of Appalachian regions in Kentucky experience increased colorectal cancer (CRC) incidence and mortality. While population-based screening methods, such as fecal immunochemical tests (FITs), can reduce many screening barriers, written instructions to complete FIT can be challenging for some individuals. We developed a novel audiovisual tool ("talking card") to educate and motivate accurate FIT completion and assessed its feasibility, acceptability, and efficacy. Materials and methods We collected data on the talking card via: (1) cross-sectional surveys exploring perceptions of images, messaging, and perceived utility; (2) follow-up focus groups centered on feasibility and acceptability; and (3) efficacy testing in community-based FIT distribution events, where we assessed FIT completion rate, number of positive vs. negative screens, demographic characteristics of participants, and primary drivers of FIT completion. Results Across the three study phases, 692 individuals participated. Survey respondents positively identified with the card's sounds and images, found it highly acceptable, and reported high-to-very high self-efficacy and response efficacy for completing FIT, with nearly half noting greater likelihood to complete screening after using the tool. Focus group participants confirmed the acceptability of the individuals featured on the card. Nearly 75% of participants provided a FIT accurately completed it, with most indicating the talking card, either alone or combined with another strategy, helped with completion. Discussion To reduce CRC screening disparities among Appalachian Kentuckians, population-based screening using contextually relevant implementation strategies must be used alongside clinic-based education. The talking card represents a novel and promising strategy to promote screening uptake in both clinical and community settings.
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Affiliation(s)
- Aaron J. Kruse-Diehr
- University of Kentucky College of Medicine, Lexington, KY, United States
- Center for Implementation, Dissemination and Evidence-Based Research, University of Kentucky Center for Clinical and Translational Science, Lexington, KY, United States
- Markey Cancer Center, Lexington, KY, United States
| | - Derek Cegelka
- Hawaii Pacific University School of Nursing, Honolulu, HI, United States
| | | | - Jean S. Edward
- Markey Cancer Center, Lexington, KY, United States
- University of Kentucky College of Nursing, Lexington, KY, United States
| | - Sarah C. Vos
- University of Kentucky College of Public Health, Lexington, KY, United States
| | | | - Katie Bathje
- American Cancer Society, Atlanta, GA, United States
| | - Melinda Rogers
- Markey Cancer Center, Lexington, KY, United States
- Kentucky Cancer Program, Somerset, KY, United States
| | - Elaine Russell
- Kentucky Cancer Consortium, Lexington, KY, United States
| | - Jennifer Redmond Knight
- Markey Cancer Center, Lexington, KY, United States
- University of Kentucky College of Public Health, Lexington, KY, United States
- Kentucky Cancer Consortium, Lexington, KY, United States
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Scaglioni G, Chiereghin A, Squillace L, De Frenza F, Kregel JM, Bazzani C, Mezzetti F, Cavazza N. Didactic and narrative persuasion: An experiment to promote colorectal cancer screening. Appl Psychol Health Well Being 2024; 16:497-514. [PMID: 37840199 DOI: 10.1111/aphw.12501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 09/30/2023] [Indexed: 10/17/2023]
Abstract
We tested whether a didactic and a narrative video (i.e. educational content and personal stories versus irrelevant information) could boost colorectal cancer (CRC) screening intention directly and through cognitive predictors of CRC screening behavior. We also tested whether exposure to a story changed participants' affective forecasting, reducing the perception of negative emotions associated with CRC screening (disgust, embarrassment, and fear). The study was conducted online with a between-participants design and recruiting a convenience sample (N = 375). We found that, compared with watching the control video, being exposed to the narrative video about CRC screening was indirectly associated with greater screening intention via vicarious experience and positive attitudes, whereas watching the didactic video was positively associated with CRC screening intention only among participants who had received an invitation letter but did not get screened, and among those yet to receive an invitation to screen. In the latter group, screening intention was boosted through positive attitudes. Our findings do not confirm that stories change affective forecasting, but narration likely fosters messages acceptance through vicarious experience. We also found support for the effectiveness of physicians' recommendations in promoting CRC screening, an intervention that might be effectively administered through a generalized, cost-effective video.
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Affiliation(s)
- Giulia Scaglioni
- Department of Humanities, Social Sciences, and Cultural Industries, University of Parma, Parma, Italy
| | - Angela Chiereghin
- Governance of Screening Programs Unit, Local Health Authority of Bologna, Bologna, Italy
| | - Lorena Squillace
- Governance of Screening Programs Unit, Local Health Authority of Bologna, Bologna, Italy
| | | | - John Martin Kregel
- Public Health Department, Local Health Authority of Bologna, Bologna, Italy
| | - Carmen Bazzani
- Governance of Screening Programs Unit, Local Health Authority of Bologna, Bologna, Italy
| | - Francesca Mezzetti
- Governance of Screening Programs Unit, Local Health Authority of Bologna, Bologna, Italy
| | - Nicoletta Cavazza
- Department of Communication and Economics, University of Modena and Reggio Emilia, Reggio Emilia, Italy
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Scaglioni G, Capasso M, Bianchi M, Caso D, Cavazza N. Facing the Emotional Barriers to Colorectal Cancer Screening. The Roles of Reappraisal and Situation Selection. Int J Behav Med 2024:10.1007/s12529-024-10284-4. [PMID: 38637471 DOI: 10.1007/s12529-024-10284-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Disgust, embarrassment, and fear can hinder the attendance of colorectal cancer (CRC) screening. However, individuals can respond to these emotions differently. The present study tested whether reappraising a negative stimulus versus avoiding a negative stimulus is associated with age; whether these two emotion regulation strategies (reappraisal and situation selection) moderate the effects of disgust, embarrassment and fear on CRC screening intention; and the efficacy of a message based on participants' preferred emotion regulation strategy. METHODS We recruited 483 Italian participants (aged 40-84 years) through snowball sampling. Participants were randomly assigned to one of four conditions differing for a message promoting CRC screening with an affective lever, a cognitive lever, both levers or none. Key variables included emotion regulation strategies, emotional barriers and intention to get screened. RESULTS The preference for reappraisal over situation selection increased with age. Reappraisal neutralized the effect of disgust on CRC screening intention. The combined message with both affective and cognitive levers increased CRC screening intention (b = 0.27, β = 0.11, SE = 0.13 p = .049), whereas reading the message based only on the affective (b = 0.16, β = 0.06, SE = 0.14 p = .258) or the cognitive (b = 0.22, β = 0.09, SE = 0.14 p = .107) lever was not effective. CONCLUSIONS Communication campaigns should support the activation of a reappraisal strategy of emotion control, and messages promoting CRC screening should highlight both the instrumental (i.e., early detection) and affective (i.e., peace of mind) benefits of attendance.
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Affiliation(s)
- Giulia Scaglioni
- Department of Communication and Economics, University of Modena and Reggio Emilia, Reggio Emilia, Italy.
| | - Miriam Capasso
- Department of Humanities, University of Naples Federico II, Naples, Italy
| | - Marcella Bianchi
- Department of Humanities, University of Naples Federico II, Naples, Italy
| | - Daniela Caso
- Department of Humanities, University of Naples Federico II, Naples, Italy
| | - Nicoletta Cavazza
- Department of Communication and Economics, University of Modena and Reggio Emilia, Reggio Emilia, Italy
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5
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Scaglioni G, Chiereghin A, Bazzani C, Mezzetti F, Cavazza N. Psychosocial Predictors of Colorectal Cancer Screening Intention: An Experiment on the Invitation Letter. Int J Behav Med 2023; 30:867-877. [PMID: 36515798 DOI: 10.1007/s12529-022-10142-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND In Italy, attendance rates for colorectal cancer (CRC) screening are suboptimal. The present work analysed cognitive and emotional predictors of CRC screening intention and tested an intervention on a real invitation letter to improve CRC screening intention, both directly and in interaction with the predictors of our model. METHODS Our model included variables from the theory of planned behaviour and the emotional barriers to bowel screening scale. We applied six changes to an invitation letter used in Italy to avoid the repetition of words like 'faeces', 'blood', or 'occult' and reduce the prompting of disgust. The 228 participants were randomly assigned to a between-participants design (original letter vs. manipulated letter). RESULTS Disgust hindered CRC screening intention, while embarrassment, fear, and subjective norms (i.e., perception of the social pressures to attend CRC screening) were not associated with intention to screen. More positive attitudes towards CRC screening were associated with a higher intention to screen. The positive association between perceived behavioural control and CRC screening intention was stronger for participants who read the letter with fewer (vs. more) references to bodily waste. Letter manipulation did not affect intention to screen. CONCLUSIONS The disgust associated with faecal matter is a critical factor in determining CRC screening attendance, and it should be acknowledged as such in public policies. Until new screening tests avoiding the activation of this emotional reaction are concretely available, public campaigns should improve CRC screening participation by boosting both positive attitudes towards screening and patients' perceived behavioural control.
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Affiliation(s)
- Giulia Scaglioni
- Department of Humanities, Social Sciences, and Cultural Industries, University of Parma, Borgo Carissimi 10, 43121, Parma, Italy.
| | - Angela Chiereghin
- Governance of Screening Programs Unit, Local Health Authority of Bologna, Via Montebello 6, 40121, Bologna, Italy
| | - Carmen Bazzani
- Governance of Screening Programs Unit, Local Health Authority of Bologna, Via Montebello 6, 40121, Bologna, Italy
| | - Francesca Mezzetti
- Governance of Screening Programs Unit, Local Health Authority of Bologna, Via Montebello 6, 40121, Bologna, Italy
| | - Nicoletta Cavazza
- Department of Communication and Economics, University of Modena and Reggio Emilia, Viale Antonio Allegri 9, 42121, Reggio Emilia, Italy
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Napit K, Ratnapradipa KL, King KM, Ramos AK, Luma LBL, Dinkel D, Robinson T, Schabloske L, Tchouankam T, Watanabe-Galloway S. Qualitative Analysis of Colorectal Cancer Screening for African American and Hispanic Populations in Nebraska: an Application of the PRECEDE Framework. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1767-1776. [PMID: 37466902 DOI: 10.1007/s13187-023-02343-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 07/20/2023]
Abstract
Nationally and in Nebraska, African Americans (AA) and Hispanics have lower colorectal cancer (CRC) screening rates compared to non-Hispanic Whites. We aimed to obtain perspectives from AA and Hispanic cancer survivors and caregivers in Nebraska about CRC screening to improve outreach efforts. Data from four virtual focus groups (AA female, AA male, Hispanic rural, and Hispanic urban) conducted between April-August 2021 were analyzed using a directed content approach based on the Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) model. Most of the 19 participants were female (84%) and survivors (58%). Across groups, awareness of colonoscopy was high, but awareness of fecal testing needed to be higher, with confusion about different types of fecal tests. Predisposing factors were trust in the health system; awareness of CRC screening; machismo; fear of cancer; embarrassment with screening methods; and negative perceptions of CRC screening. Enabling factors included provider recommendations, healthcare access, and insurance. Reinforcing factors included prioritizing personal health and having a support system. Suggestions to improve screening included increasing healthcare access (free or low-cost care), increasing provider diversity, health education using various methods and media, and enhancing grassroots health promotion efforts. Lack of awareness, accessibility issues, attitudes and perceptions of CRC and CRC screening, trust, and cultural and linguistic concerns are major issues that need to be addressed to reduce CRC screening disparities among AA and Hispanic adults.
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Affiliation(s)
- Krishtee Napit
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Kendra L Ratnapradipa
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Keyonna M King
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Athena K Ramos
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Lady Beverly L Luma
- Office of Community Outreach and Engagement, Fred & Pamela Buffett Cancer Center, Omaha, NE, USA
| | - Danae Dinkel
- School of Health & Kinesiology, University of Nebraska at Omaha, Omaha, NE, USA
| | | | | | - Tatiana Tchouankam
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Shinobu Watanabe-Galloway
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
- Office of Community Outreach and Engagement, Fred & Pamela Buffett Cancer Center, Omaha, NE, USA
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7
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Blake SN, Hugtenburg JG, van der Vlugt M, Dekker E, Fransen MP. Decision-making on colorectal cancer screening in Curaçao - interviews with the target population. BMC Public Health 2023; 23:1437. [PMID: 37501171 PMCID: PMC10373279 DOI: 10.1186/s12889-023-16335-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 07/18/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND During the first year of the population based colorectal cancer (CRC) screening program on Curaçao, about 20% of invitees participated. This study explored the target population's perceptions and awareness on CRC (screening), beliefs on the program provision, their preferences and information needs for informed decision-making. METHODS Semi-structured interviews with 23 individuals, who were not yet invited for CRC screening, were recorded, transcribed, coded and analyzed. RESULTS CRC (screening) was discussed in the context of personal health, where own responsibility and food were important. Cancer was perceived as an unpredictable disease that causes suffering and leads to death and was also associated with fear. Despite being aware of the program, most respondents were not familiar with the screening procedure. Provision of the screening program was regarded positively and as an opportunity to contribute to health improvement. This seemed related to the expressed trust in the Caribbean Prevention Center (program organizer). Respondents preferred to make independent decisions about CRC screening participation. A personal approach, visual aids and media were the preferred sources of information. CONCLUSION The results of our interviews suggest that it may be beneficial to provide information on CRC screening in Curaçao within the context of personal health. While including sensitivity to fears and respect for the autonomy of the target population. Finally, electronic media maybe useful in supporting informed decision-making.
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Affiliation(s)
- Shacara N Blake
- Caribbean Prevention Center (Fundashon Prevenshon), Willemstad, Curaçao.
- Department of Gastroenterology and Hepatology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Gastroenterology, Endocrinology and Metabolism (AGEM), Amsterdam, the Netherlands.
| | - Jacqueline G Hugtenburg
- Caribbean Prevention Center (Fundashon Prevenshon), Willemstad, Curaçao
- Faculty of Social and Behavioral Sciences, University of Curaçao, Willemstad, Curaçao
- Department of Clinical Pharmacology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Manon van der Vlugt
- Department of Gastroenterology and Hepatology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism (AGEM), Amsterdam, the Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism (AGEM), Amsterdam, the Netherlands
| | - Mirjam P Fransen
- Department of Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- National Institute for Public Health and the Environment, Centre for Nutrition Prevention and Health Services, Bilthoven, the Netherlands
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8
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Kruse-Diehr AJ, Cegelka D, Holtsclaw E, Stapleton J, Burnett C, Wood R, Combs C, Williams LB. Barriers and Facilitators to Stool-Based Screening for Colorectal Cancer Among Black Louisville Residents. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1050-1058. [PMID: 36301412 PMCID: PMC10501315 DOI: 10.1007/s13187-022-02231-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 06/02/2023]
Abstract
Knowledge of colorectal cancer (CRC) screening options remains suboptimal in Black populations, contributing to screening disparities. Guided by community-based participatory research (CBPR) principles, we partnered with five Black churches in Louisville, a region of Kentucky with high Black-white CRC screening disparities, to explore screening barriers and facilitators for CRC education and outreach. Project champions (n = 5) served as primary points of contact, developed project support within their churches, and were trained to recruit church and community members (n = 39) to participate in five semi-structured focus groups. Interview questions probed actual and perceived barriers to CRC screening, focusing on knowledge and perceptions of stool-based tests. Subsequent questions explored perceptions of different screening tests, CRC knowledge and beliefs, and trusted community locations for screening outreach. Transcripts were analyzed iteratively, and codes were derived inductively and refined to develop overarching themes. Participants experienced multilevel barriers to completing CRC screening. Primary themes about CRC screening included acknowledgment of importance, positive and negative personal experiences, need for increased outreach, and desire for greater cultural representation in educational materials. Participants frequently discussed perceptions of inadequate medical care, with most having only ever been offered colonoscopy; subsequently, knowledge of stool-based tests was low. To address this knowledge gap, participants stressed interpersonal communication from trusted individuals, such as local Black medical providers and CRC survivors. Given the low knowledge of stool-based testing among participants and identified inequities in receipt of clinical care, community-based CRC screening interventions are warranted to reduce Black-white CRC screening disparities.
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Affiliation(s)
- Aaron J Kruse-Diehr
- Department of Family and Community Medicine, University of Kentucky College of Medicine, 2195 Harrodsburg Rd., Suite 125, Lexington, KY, 40504, USA.
| | - Derek Cegelka
- Department of Public Health, Hawaii Pacific University, Honolulu, HI, USA
| | | | - Jerod Stapleton
- Department of Health, Behavior & Society, University of Kentucky College of Public Health, Lexington, KY, USA
| | - Camille Burnett
- Institute for Inclusion, Inquiry, and Innovation (iCubed), Virginia Commonwealth University, Richmond, VA, USA
| | - Rose Wood
- Department of Health, Behavior & Society, University of Kentucky College of Public Health, Lexington, KY, USA
| | - Carlee Combs
- Department of Health, Behavior & Society, University of Kentucky College of Public Health, Lexington, KY, USA
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9
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Clarke N, Hayes L, McQueen A, Gallagher P, Kearney PM, McNamara D, O'Morain CA, von Wagner C, Mooney T, Sharp L. The role of defensive information processing in population-based colorectal cancer screening uptake. Cancer 2023; 129:1253-1260. [PMID: 36740959 DOI: 10.1002/cncr.34603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Internationally, colorectal cancer screening participation remains low despite the availability of home-based testing and numerous interventions to increase uptake. To be effective, interventions should be based on an understanding of what influences individuals' decisions about screening participation. This study investigates the association of defensive information processing (DIP) with fecal immunochemical test (FIT)-based colorectal cancer screening uptake. METHODS Regression modeling of data from a cross-sectional survey within a population-based FIT screening program was conducted. The survey included the seven subdomains of the McQueen DIP measure. The primary outcome variable was the uptake status (screening user or nonuser). Multivariable logistic regression was used to estimate the odds ratio (OR) for screening nonuse by DIP (sub)domain score, with adjustments made for sociodemographic and behavioral factors associated with uptake. RESULTS Higher scores (equating to greater defensiveness) on all DIP domains were significantly associated with lower uptake in the model adjusted for sociodemographic factors. In the model with additional adjustments for behavioral factors, the suppression subdomains of "deny immediacy to be tested" (OR, 0.53; 95% confidence interval [CI], 0.43-0.65; p < .001) and "self-exemption" (OR, 0.80; 95% CI, 0.68-0.96; p < .001) independently predicted nonuse of FIT-based screening. CONCLUSIONS This is the first study outside the United States that has identified DIP as a barrier to colorectal cancer screening uptake, and it is the first focused specifically on FIT-based screening. The findings suggest that two suppression barriers, namely denying the immediacy to be tested and self-exempting oneself from screening, may be promising targets for future interventions to improve uptake.
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Affiliation(s)
- Nicholas Clarke
- School of Psychology, Dublin City University, Dublin, Ireland
| | - Louise Hayes
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Amy McQueen
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
- Division of General Medical Sciences, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | | | | | - Deirdre McNamara
- Department of Clinical Medicine, Adelaide and Meath Hospital, Dublin, Ireland
| | - Colm A O'Morain
- Faculty of Health Science, Trinity College Dublin, Dublin, Ireland
| | - Christian von Wagner
- Department of Epidemiology and Public Health, University College London, London, UK
| | | | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
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10
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Le Bonniec A, Sun S, Andrin A, Dima AL, Letrilliart L. Barriers and Facilitators to Participation in Health Screening: an Umbrella Review Across Conditions. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:1115-1142. [PMID: 35705780 DOI: 10.1007/s11121-022-01388-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 11/28/2022]
Abstract
Screening is an essential prevention practice for a number of health conditions. However, screening coverage remains generally low. Studies that investigate determinants of screening participation are becoming more common, but oftentimes investigate screening for health conditions in an individualized rather than integrated fashion. In routine clinical practice, however, healthcare professionals are often confronted with situations in which several screening procedures are recommended for the same patient. The consideration of their common determinants may support a more integrated screening approach. The objectives of this umbrella review were therefore to examine: 1) the determinants (barriers and facilitators) that have been identified in relation to recommended health screening procedures; and 2) the modifiable determinants (in primary care) common across health conditions or specific to individual procedures. Results were presented through a narrative synthesis. PubMed, PsycInfo and Cochrane were searched up to January 2022. Systematic reviews reporting determinants of participation in health screening procedures with grade A or B recommendation according to the US Preventive Services Task Force were included. A total of 85 systematic reviews were included, most which contained both qualitative and quantitative studies on determinants that describe individual factors (961 occurrences), social factors (113 occurrences, healthcare professional factors (149 occurrences), health system factors (105 occurrences) and screening procedure factors (99 occurrences). The most studied screening procedures concerned cervical cancer/human papillomavirus (n = 33), breast cancer (n = 28), colorectal cancer (n = 25) and the human immunodeficiency virus (n = 12). Other conditions have been under-studied (e.g. cardiovascular problems, lung cancer, syphilis). The individual domain, including determinants such as knowledge, beliefs and emotions, was the most covered across health conditions. Healthcare professional's recommendations and the quality of patient-provider communication were identified to have a strong influence on screening participation in most conditions. The other three domains included determinants which were more specific to a condition or a population. Various determinants modifiable in primary care were found in the individual domain and in the health system, healthcare professional and screening procedure domains. Quality was assessed as low for most systematic reviews included. The identification of various modifiable determinants common across conditions highlights the potential of an integrated screening participation approach. Interventions may address common determinants in a broader person-centred framework within which tailoring to specific procedures or populations can be considered. This approach needs to be explored in intervention studies. The systematic review registration is PROSPERO CRD42019126709.
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Affiliation(s)
- Alice Le Bonniec
- Research On Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France.
- Groupe de Recherche en Psychologie Sociale (GRePS) EA4163, Université Lumière Lyon 2, Lyon, France.
| | - Sophie Sun
- Research On Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Collège Universitaire de Médecine Générale, Université Claude Bernard Lyon 1, Lyon, France
| | - Amandine Andrin
- Research On Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Groupe de Recherche en Psychologie Sociale (GRePS) EA4163, Université Lumière Lyon 2, Lyon, France
| | - Alexandra L Dima
- Research On Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - Laurent Letrilliart
- Research On Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Collège Universitaire de Médecine Générale, Université Claude Bernard Lyon 1, Lyon, France
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