Abstract
Background. This study examined if and how sociodemographic differences in colorectal cancer (CRC) screening uptake can be explained by social cognitive factors. Methods. Face-to-face interviews were conducted with individuals aged 60–70 years (n = 1309) living in England as part of a population-based omnibus survey. Results. There were differences in screening uptake by SES, marital status, ethnicity, and age but not by gender. Perceived barriers (stand. b = −0.40, p < 0.001), social norms (stand. b = 0.33, p < 0.001), and screening knowledge (stand. b = 0.17, p < 0.001) had independent associations with uptake. SES differences in uptake were mediated through knowledge, social norms, and perceived barriers. Ethnic differences were mediated through knowledge. Differences in uptake by marital status were primarily mediated through social norms and to a lesser extent through knowledge. Age differences were largely unmediated, except for a small mediated effect via social norms. Conclusions. Sociodemographic differences in CRC screening uptake were largely mediated through social cognitive factors. Impact. Our findings suggest that multifaceted interventions might be needed to reduce socioeconomic inequalities. Ethnic differences might be reduced through improved screening knowledge. Normative interventions could emphasise screening as an activity endorsed by important others outside the immediate family to appeal to a wider audience.
Highlights
Colorectal cancer (CRC) screening using a guaiac-based faecal occult blood test lowers colorectal cancer (CRC) mortality by up to 25% among those who participate [1, 2]
Positive effect on uptake and a smaller indirect effect via social norms. These findings indicate that, with the exception of age, sociodemographic differences in uptake may be largely mediated via social cognitive factors derived from psychological models such as the Theory of Planned Behaviour (TPB) [15] and the Health Belief Model (HBM) [14]
This study suggests that social cognitive factors derived from common psychological models are mediators of socioeconomic difference in CRC screening uptake
Summary
Colorectal cancer (CRC) screening using a guaiac-based faecal occult blood test (gFOBt) lowers CRC mortality by up to 25% among those who participate [1, 2]. Socioeconomic status (SES) has consistently been associated with CRC screening uptake across healthcare systems [5, 6]. This study examined if and how sociodemographic differences in colorectal cancer (CRC) screening uptake can be explained by social cognitive factors. There were differences in screening uptake by SES, marital status, ethnicity, and age but not by gender. SES differences in uptake were mediated through knowledge, social norms, and perceived barriers. Differences in uptake by marital status were primarily mediated through social norms and to a lesser extent through knowledge. Age differences were largely unmediated, except for a small mediated effect via social norms. Sociodemographic differences in CRC screening uptake were largely mediated through social cognitive factors. Normative interventions could emphasise screening as an activity endorsed by important others outside the immediate family to appeal to a wider audience
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