McCaffery, Kirsten; (2000) Participation in bowel cancer screening: Examination of psychosocial processes. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

The research was nested within a randomised controlled trial to investigate the efficacy of FS screening for the prevention of bowel cancer among older adults (55-64 years). The research comprised three studies. Study 1 (n=6,187) was a prospective quantitative investigation of socio-economic variation in screening uptake using the Health Belief Model (HBM) with some additional possible predictors (cancer fear, anxiety, avoidant beliefs and fatalistic beliefs about cancer) to explain the socio-economic variation. The study identified a clear gradient in uptake of FS by socio-economic deprivation and suggested that psychosocial variables mediated screening intentions and behaviour, with the additional variables accounting for much of the mediation effect. Study 2 (n=361) employed a qualitative, data driven approach to explore reasons for participation/nonparticipation and socio-economic differences decision-making. Cancer fear and avoidant attitudes emerged as important barriers to screening, particularly among low socioeconomic groups. In-depth thematic analysis was carried out on respondents reporting cancer fear. The findings suggested that negative emotional responses were closely entwined with avoidant beliefs and indicated that people held personal models about cancer which related to its cause, consequences, control and cure. Leventhal's (1984) Self Regulation Theory provided a coherent theoretical framework to interpret the qualitative findings and the theory was examined further using a quantitative methodology in study 3. The Self Regulation Model (SRM) and the HBM were combined to investigate socio-economic variation in intention to participate with FS (n=4,668). SRM factors were significantly associated with deprivation with negative cognitions about cancer, fear responses and avoidant coping as higher in low socio-economic groups. Linear regression indicated that the model explained 23% of the variance in screening intentions alone and 49% of the variance when entered with the HBM. However, the HBM accounted for most of the variance with the SRM contributing only 1% beyond the HBM. The research highlighted conceptual problems with the SRM and the measures used to operationalise the model. Further research is needed to clarify the components of the model and its operationalisation before it is employed to understand screening behaviour in the future.

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