Abstract
The notion of candidacy emerged three decades ago through Davison and colleagues’ exploration of people’s understanding of the causes of coronary heart disease. Candidacy was a mechanism to estimate one’s own or others risk of disease informed by their lay epidemiology. It could predict who would develop illness or explain why someone succumbed to it. Candidacy’s predictive ability, however, was fallible, and it was from this perspective that the public’s reticence to adhere to prevention messages could be explained, as ultimately anybody could be ‘at-risk’. This work continues to resonate in health research, with over 700 citations of Davison’s Candidacy paper. Less explored however, is the candidacy framework in its entirety in other illness spheres, where prevention efforts could potentially impact health outcomes. This paper revisits the candidacy framework to reconsider it use within prevention. In doing so, candidacy within coronary heart disease, suicide prevention, diabetes, and cancer will be examined, and key components of candidacy and how people negotiate their candidacy within differing disease contexts will be uncovered. The applicability of candidacy to address modifiable breast cancer risk factors or cancer prevention more broadly will be considered, as will the implications for public health policy.
Highlights
How this translates to the assessment of their own or other’s candidacy for breast cancer, and how this impacts their participation in both primary prevention activities such as reducing alcohol, increasing physical activity, and addressing weight, as well as their participation in secondary prevention activities is yet to be understood
The key purpose of this paper was to present the concept of candidacy, from its emergence within coronary heart disease (CHD) to its application in other health contexts, and to elucidate the key components of the concept
Important questions regarding the applicability of the concept within primary cancer prevention have been posed
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Other research that examined people’s views of the link between alcohol and cancer showed participants were defensive or dismissive of cancer prevention messages [26] and were reluctant to consider behaviour change strategies given a prevailing perception that ‘everything causes cancer’ [27] Whilst this aligns with previous research reflecting confusion about modifiable risk factors for cancer, it is likely to reflect the high social acceptability and normalisation of alcohol consumption within society [28]. Reconsidering the novel approach of candidacy in the context of primary cancer prevention may offer new understandings that can inform public health policy to increase women’s knowledge of and action toward reducing modifiable risk factors at individual levels that have population/ community level impact on cancer reduction
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