Screening Intentions Research Articles

Colorectal cancer screening: Associations between information provision, attitudes and intended participation

ObjectiveProperly informing target audiences is crucial in population-based screening programs. We aimed to evaluate the impact of information about CRC screening on attitudes and intended participation in a screening-naive population. Methods614 persons (aged 55–75 years) received a survey. Information on CRC and screening was provided piece by piece, and per piece its impact on attitudes and intended participation was assessed. All persons received the same information content, but the sequence of information differed per condition: information on the high mortality rate of colorectal cancer was presented in the first or the second piece. Educational levels, the extent people considered future consequences, and value concordance between attitudes and intentions were assessed. Results436 persons (response 71%) completed the survey. Overall most respondents reported positive attitudes towards CRC screening (78%) and intentions to participate in CRC screening (83%), independent of sequence of information provision. Intentions about participation were value concordant in the majority (88%). Results were similar in low educated groups. ConclusionProviding balanced information about CRC screening (also addressing negative effects) did not impede value concordance and high rates of intended participation. Practice implicationsHigh rates of screening intentions are possible without omitting threatening health information in communication materials.

Assessing the effectiveness of a knowledge-based intervention to tackle barriers to cervical screening: A pilot study.

Key Points • Knowledge and fear may act as barriers to cervical screening • Women (N = 402) received no information about screening, statistical information or barrier-tackling information • Statistical and barrier-tackling information improved knowledge of how frequently women should be screened • Barrier-tackling information reduced the false belief that screening tests for cancer • Screening intention did not vary between the conditions

College Women’s Responses to a Celebrity Health Disclosure

ABSTRACTCelebrities can have a powerful influence on people’s health-related attitudes and behaviors, often by publicly disclosing their own personal health decisions. In May 2013, Angelina Jolie, an internationally recognized actress, director, and author, wrote an op-ed for the New York Times disclosing her decision to undergo a prophylactic double mastectomy to reduce her risk of breast cancer after learning that she carried the BRCA1 gene mutation. This cross-sectional study examined whether exposure to Angelina Jolie and her mastectomy disclosure and parasocial involvement (PSI) with Angelina Jolie were related to female college students’ perceived risk of breast cancer and breast cancer screening intentions. Participants were 198 female undergraduate college students. Data were collected anonymously via an online questionnaire and analyzed using bivariate correlations and hierarchical linear regression analyses. Neither exposure to Angelina and her disclosure nor PSI with Angelina Jolie was related to participants’ attitudes or behaviors related to breast cancer. However, having a family history of cancer was associated with more exposure to Angelina Jolie and her disclosure. Findings suggest that exposure to and PSI with a celebrity who has disclosed a health-related message may not be sufficient to motivate young women to change their health-related attitudes and behaviors. Future studies should explore how celebrities disclosing different types of health issues might influence the attitudes and behaviors of young women.

Protection motivation theory in predicting intention to receive cervical cancer screening in rural Chinese women.

Despite the significance of cervical cancer screening, motivating more women to participate remains a challenge in resource-limited settings. In this study, we tested the protection motivation theory (PMT) in predicting screening intentions. Participants were women from Wufeng, a typical rural county in China. Participants (n=3000) with no cervical cancer history were recruited from 10 randomly selected villages. As mediating variables, 6 PMT constructs (Perceived Risk, Fear Arousal, Perceived Severity, Response Efficacy, Response Cost, and Self-Efficacy) were measured using the standardized questionnaire. Structural equation modeling (SEM) method was employed to test PMT-based prediction models. Of the total sample, 57.77% believed that regular screening may reduce cervical cancer risk, and 45.26% agreed that women should be screened regularly. Our data fit the PMT model well (GFI=0.95, AGFI=0.93, CFI=0.90, RMSEA=0.06, SRMR=0.04, Chi-square/df=2.47). Knowledge of screening was directly and positively associated with screening intention. Age, annual income, and awareness of and prior experience with screening were significantly associated with screening intention by enhancing cervical cancer risk perception and by reducing response cost (P<0.05 for both). PMT can be used as guidance to investigate cervical cancer screening intentions among rural women in China with focus on cancer knowledge, some demographic factors, and awareness of and previous experience with screening. These findings, if verified with longitudinal data, can be used for intervention program development.

Breast Density Awareness and Knowledge, and Intentions for Breast Cancer Screening in a Diverse Sample of Women Age Eligible for Mammography.

The objectives of this study were to assess breast density knowledge and breast density awareness, and to identify information associated with intention to complete routine and supplemental screening for breast cancer in a diverse sample of women age eligible for mammography. We quantitatively (self-report) assessed breast density awareness and knowledge (N=264) in black (47.7%), Latina (35.2%), and white (17%) women recruited online and in the community. Most participants reported having heard about breast density (69.2%); less than one third knew their own breast density status (30.4%). Knowing their own breast density, believing that women should be notified of their breast density in their mammogram report, and feeling informed if being provided this information are associated with likelihood of completing mammogram. Intending mammogram completion and knowledge regarding the impact of breast density on mammogram accuracy are associated with likelihood of completing supplemental ultrasound tests of the breast. These findings help inform practitioners and policy makers about information and communication factors that influence breast cancer screening concerns and decisions. Knowing this information should prepare practitioners to better identify women who may have not been exposed to breast density messages.

Preferences for cervical cancer screening: The role of implicit associations

ObjectivesImplicit associations influence behaviour, but their impact on cancer screening intentions is unknown. MethodsWe assessed implicit associations with cervical cancer screening using an evaluative priming task. Participants were shown primes (‘Pap test’, neutral or non-word) followed by positive or negative target words. The test is based on the assumption that response times are shorter if primes and targets are strongly associated in the participant's mind. The Dutch screening program targets women aged 30–60, 226 of them completed online assessments twice. Prior to the second assessment participants were randomized to reading versus not reading the leaflet about the cervical screening program. ResultsAfter controlling for knowledge and screen history, response times for ‘Pap test’ no longer differed between positive and negative targets. Implicit associations were not correlated with explicit attitudes or screening intentions. Reading the screening leaflet resulted in improved knowledge levels (p<0.001), but implicit associations, explicit attitudes, and screening intentions remained similar. ConclusionCervical cancer screening intentions were related to explicit attitudes, but not to implicit associations. The screening leaflet did not affect screening intentions. Practice implicationsWe recommend achieving a deepened interest in the screening program among risk groups, e.g. by adapting the information leaflet.

Effect of population breast screening on breast cancer mortality to 2005 in England and Wales: A nested case-control study within a cohort of one million women.

Objectives To evaluate the effectiveness of the NHS breast screening programme (NHSBSP) on breast cancer mortality in England and Wales and to compare findings with a cohort analysis of the same underlying population. Methods A nested case-control study within a cohort of 959,738 women in England and Wales aged 49-64 who were eligible for routine NHSBSP screening during 1991-2005. Cases who died from breast cancer in 1991-2005 were matched to controls without breast cancer at the case diagnosis date and alive when the case died. Risk of breast cancer mortality associated with intention to screen (ITS) (7047 cases/28,188 controls) and screening attendance (4707 cases/9413 controls) was examined. Bias was minimised in accordance with currently advocated best practice. Odds ratios (ORs) were calculated using conditional logistic regression. Results were compared with findings from an incidence-based breast cancer mortality cohort analysis. Results ITS was associated with a 21% breast cancer mortality reduction (OR = 0.79, 95% confidence interval [CI]: 0.71-0.88, P < 0.001). Attendance ≤5 years before diagnosis was associated with a 47% reduction in breast cancer mortality after self-selection correction (OR = 0.53, 95% CI: 0.46-0.62, P < 0.001). Breast cancer mortality reduction associated with ITS was 21% in both the case-control and cohort analyses, but the impact of attendance was marginally greater in the case-control analysis (36% vs. 32%). Conclusions Case-control studies designed and analysed according to current best practice guidelines offer an effective means of evaluating population breast screening.

Do Race and Insurance Matter? Exploring Differences in Response to an Educational Intervention on Cancer Prevention

To explore relationships of demographics, insurance status, cancer screening history, and intention to implement cancer preventive behaviors (screening, nutrition, and physical activity) among participants of an Extension program: Cooking for a Lifetime of Cancer Prevention (C4L). C4L is an educational intervention (2.5 hours) designed to improve intention to implement cancer preventive nutrition, physical activity (PA) and screening recommendations, particularly among uninsured women. Participants (n = 281) were 100% female (52 ± 14 y, 40% Black, 39% Hispanic, 35% uninsured). Demographics, breast, cervical, and colorectal cancer screening history, screening intention, and intention to implement nutrition and PA recommendations were assessed using a researcher-designed questionnaire administered post-intervention. Probit models were used to estimate binary variables and ordinal regression analyses explored relationships of participant characteristics with intention to implement recommendations. Preliminary analyses suggest Black (b = 0.579, P < 0.01) and Hispanic (b = 0.862, P < 0.01) participants were more likely to intend to implement recommended nutrition and PA behaviors than Whites. Those with Medicaid were less likely to intend to implement nutrition and PA behaviors than those with private insurance (b = -0.601, P < 0.05). Black respondents who had not recently been screened were more likely to intend to get screened (b = 0.464, P < 0.05). Black and Hispanic women may be more likely to respond to educational interventions regarding cancer prevention, while those with Medicaid may be less likely to respond. Further study is needed to elucidate why this intervention is more or less effective for some groups.

The effects of social media virality metrics, message framing, and perceived susceptibility on cancer screening intention: The mediating role of fear

Social media platforms are increasingly playing a vital role in the process of dissemination and sharing of health information. The present study investigated whether and how online health information and virality metrics associated with social media platforms jointly shape persuasive outcomes in the context of cancer screening promotion. One important area of research on cancer screening promotion concerns loss-versus-gain message framing, which has highlighted the persuasive advantage of loss framing relative to gain framing. Given this, we examined how social media virality metrics, loss-versus-gain message framing, and perceived susceptibility influence message-evoked fear and intention to perform colonoscopy in the context of colorectal cancer screening. Results from an online experiment showed that loss framing, relative to gain framing, led to greater message-evoked fear when the message was presented with high-virality metrics, and this pattern was particularly pronounced among those with low perceived susceptibility to colorectal cancer. Furthermore, a formal test of moderated mediation showed that the indirect effect of loss framing on colonoscopy intention through message-evoked fear was significantly moderated by perceived susceptibility to colorectal cancer when the message was presented with high-virality metrics. Theoretical and practical implications of these findings are discussed.

Does the Screening Status of Message Characters Affect Message Effects?

Public health messages can be used to increase awareness about colorectal cancer screenings. Free or inexpensive images for creating health messages are readily available, yet little is known about how a pictured individual's engagement in the behavior of interest affects message outcomes. Participants ( N = 360), aged 50 to 75 years, completed an online survey in which they viewed a colorectal cancer screening message and were then randomly assigned to view one of four different messages about the pictured individual's screening status. Analyses revealed no significant differences in message credibility, message effectiveness, or screening intention among the four conditions. The pictured individual's level of knowledge was rated significantly lower among those participants who were told the screening status of the pictured individual was unknown, compared with those who received no screening status information, U = 3574.50, p = .005. Future studies could build on the design of this study to examine the effects of using free or purchased images on intent to screen and other message outcomes over time.

Understanding the heterogeneity of cervical cancer screening non-participants: Data from a national sample of British women

BackgroundUptake of cervical cancer screening in the United Kingdom (UK) is falling year on year, and a more sophisticated understanding of non-participation may help design interventions to reverse this trend. This study ascertained the prevalence of different non-participant types using the Precaution Adoption Process Model (PAPM). MethodsHome-based computer-assisted interviews were carried out with 3113 screening-eligible women in Britain. Survey items assessed self-reported screening uptake and intention to attend in future. Responses to these items were used to classify women into one of five different types of non-participants. ResultsOf 793 non-participants, 28% were unaware of screening, 15% had decided not to attend and 51% were intending to have screening but were currently overdue. Younger women were more likely to be unaware of screening or to intend to be screened, while older women were more likely to have decided not to be screened. Women from ethnic minority backgrounds were more likely to be unaware of screening than white women. Being in a lower social grade was associated with increased odds of all three types of non-participation. ConclusionThe majority of cervical cancer screening non-participants are not making an active decision not to attend but rather are either unaware or unable to act. There are clear sociodemographic differences between non-participant types, which could be used to identify where tailored interventions may be best targeted.

Theorizing the Impact of Targeted Narratives: Model Admiration and Narrative Memorability

Communication campaigns often include components that have been designed for a specific population, a strategy referred to as targeting. Targeted narratives are story-based components of a campaign that feature a character or situation relevant to the intended audience. Though commonplace, few studies have explicated the underlying mechanisms by which targeted narratives exert influence. In a message evaluation study, 316 women aged 40–75 (Mage = 51.19, SD = 8.11) were exposed to one of two targeted narratives and asked to complete measures of model admiration, narrative memorability, and intentions to receive a mammography. Targeting was based upon affiliation with the Mormon church. The results revealed that the relationship between the targeted narratives and screening intentions was especially strong for women from the target population who admired the depicted models and found the stories memorable.

Occupational Stress, Job Satisfaction and Cervical Screening Intention of Maternity Oncology Nurses

&lt;em&gt;Background: Cervical Cancer could be a preventable disease, and a key aspect of its interference is &lt;/em&gt;&lt;em&gt;that the detection of the premalignant form by cervical screening. Nursing could be a skilled job &lt;/em&gt;&lt;em&gt;characterized by high stress. Stress could be associated with less practice of health promoting &lt;/em&gt;&lt;em&gt;behaviors; however, no study has investigated the relationship between job stress and health screening&lt;/em&gt;&lt;br /&gt;&lt;em&gt;behaviors among nurses in Egypt. Aim: describe the rate of Pap smears in hospital nurses and assess &lt;/em&gt;&lt;em&gt;the effects of job stress on receiving cervical cancer screening. Subject and Methods: Purposive &lt;/em&gt;&lt;em&gt;sampling included 30 nurses who worked in gynecological inpatient and outpatient department in all &lt;/em&gt;&lt;em&gt;general hospitals in Beni-Suef city. Data collection was carried out by self-administered structured &lt;/em&gt;&lt;em&gt;questionnaire, Job stressors &amp;amp; Job Satisfaction Scales for Nurses. Results: 86.7% of staff nurses &lt;/em&gt;&lt;em&gt;working in maternity oncology units never Performed cervical screening pap smear Previously. 90% &amp;amp; &lt;/em&gt;&lt;em&gt;93.4% of the nurses, respectively, were unsatisfied with their salary and job. 70% of them had an&lt;/em&gt;&lt;br /&gt;&lt;em&gt;occupational stress and 100% Perceived occupational health risks. Conclusion: The great majority of &lt;/em&gt;&lt;em&gt;nurses has unsatisfied and job stress. Most of them never Performed pap smear Previously and &lt;/em&gt;&lt;em&gt;absolutely refuse to do in future. The main cause for refusing cervical screening as mentioned by nurses &lt;/em&gt;&lt;em&gt;was a high flow rate of positive cases.&lt;/em&gt;

Tu1065 - Development of a Colorectal Cancer Screening Incentive Program for Homeless Patients

Tu1065 - Development of a Colorectal Cancer Screening Incentive Program for Homeless Patients

Impact of breast cancer awareness month on detection of breast cancer in a private hospital.

ObjectiveBreast cancer awareness month increases public awareness in association with increased rates of screening and new diagnoses. This study aimed to evaluate the effect of breast cancer awareness month on primary diagnosis of breast cancer.MethodsAsymptomatic women with the intention of breast cancer screening were included. The non-BCAM (Breast cancer awareness month) group were screened from February to September 2016 and the BCAM group during October 2016. Ultrasound and mammography were performed in all women and in those aged ≥ 40 years, respectively. A BIRADS (Breast Imaging Reporting And Data Systems) score of ≥4 and solid palpable masses without features suggestive of malignancy and/or the physician’s preference were regarded as indications for histopathological analysis. Requirement for histopathological analysis and detection of breast cancer were identified as the main variables.ResultsThere were 198 women with a mean age of 49.3 ± 9.5 years. Sixty-nine and 129 women were in the non-BCAM and BCAM groups, respectively. Percutaneous biopsy was performed in seven (10.1%) and three patients (2.3%) in the non-BCAM and BCAM groups, respectively (P = 0.035). Pathological examinations were benign.ConclusionAlthough public awareness campaigns lead to increased rates of screening, they may lose their impact on detecting breast cancer because of widespread use of routine screening programs.

The role of fear in predicting sexually transmitted infection screening

Objective: This study assessed the extent to which social-cognitive factors (attitude, subjective norm and perceived control) and the fear of a positive test result predict sexually transmitted infection (STI) screening intentions and subsequent behaviour.Design: Study 1 (N = 85) used a longitudinal design to assess the factors that predict STI screening intention and future screening behaviour measured one month later at Time 2. Study 2 (N = 102) used an experimental design to determine whether the relationship between fear and screening varied depending on whether STI or HIV screening was being assessed both before and after controlling for social-cognitive factors.Main Outcome Measures: Across the studies the outcome measures were sexual health screening.Results: In both studies, the fear of having an STI positively predicted STI screening intention. In Study 1, fear, but not the social-cognitive factors, also predicted subsequent STI screening behaviour. In Study 2, the fear of having HIV did not predict HIV screening intention, but attitude negatively and response efficacy positively predicted screening intention.Conclusion: This study highlights the importance of considering the nature of the health condition when assessing the role of fear on health promotion.

Use of patient decision aids increased younger women's reluctance to begin screening mammography: a systematic review and meta-analysis.

As breast cancer screening guidelines have changed recently, additional investigation is needed to understand changes in women's behavior after using breast cancer screening patient decision aids (BCS-PtDAs) and the potential effect on mammography utilization. This systematic review and meta-analysis sought to evaluate the effect of BCS-PtDAs on changes in women's intentions to undergo screening mammography and whether women deciding to begin or discontinue screening mammography displayed similar changes in screening intentions after using a BCS-PtDA. We searched Medline, Scopus, PsycINFO, CENTRAL, Health and Psychosocial Instruments, Health Technology Assessment Database, PsycARTICLES, and cited references in eligible papers for randomized controlled trials (RCTs) and observational studies, published through August 24, 2016. The proportions of women who did and not intend to undergo screening and who were uncertain about undergoing screening mammography were pooled, using risk ratios (RR) and random effects. According to the protocol, RCTs or observational studies and any language were considered eligible for systematic review if they included data about women for which shared decision making is recommended. We ultimately included six studies with screening intention data for 2040 women. Compared to usual care, the use of BCS-PtDAs in three RCTs resulted in significantly more women deciding not to undergo screening mammography (RR 1.48 [95% CI 1.04-2.13]; P = 0.03), particularly for younger (38-50 years) women (1.77 [1.34-2.34]; P < 0.001). The use of BCS-PtDAs had a non-significant effect on the intentions of older women (69-89 years) to discontinue screening. The use of BCS-PtDAs increased younger women's reluctance to undergo screening for breast cancer. The implementation of such BCS-PtDAs in clinical practice would be expected to result in a 77% increase in the number of younger women (aged 38-50) who do not intend to be screened, and as a consequence, may reduce utilization of screening mammography. The protocol of this review is registered in the PROSPERO database, #CRD42016036695.

Credit Risk Models: Lessons for Nigerian Banks

Credit risk arises because of the possibility that promised cash flows on financial claims held by banks and other financial institutions (BOFIs) will not be paid in full. Virtually all BOFIs face this risk. BOFIs are operating in markets with asymmetric information wherein prospective borrowers have more information about their repayment ability than the lenders. A key role of BOFIs involves gathering information which acts as reliable signal and to provide incentives for screening and monitoring loan applicants to ensure funding of the most credit worthy loans. This paper delves into these issues. It begins by explaining the various types of loans advanced by BOFIs, determinants of return on a loan and evaluation of issues in measurement of credit risk. The key idea here is that a top-down risk analysis facilitates the design of targeted controls or safeguards against credit risk losses. Various default risk models were also reviewed and the article concludes that credit control should emphasize appropriate chains of approval, collateral requirements, accurate pricing, the optimal loan size for specific borrowers, credit monitoring and knowledge of market dynamics to determine loan performance sensitivity to changing market conditions.

Correlates of Patient Intent and Preference on Colorectal Cancer Screening.

Information is limited on patient characteristics that influence their preference among screening options and intent to be screened for colorectal cancer (CRC). A mechanistic pathway to intent and preference was examined through a formal mediation analysis. From 2012 to 2014, a total of 570 adults aged 50-75 years were recruited from 15 primary care practices in Metro Detroit for a trial on decision aids for CRC screening. Confirmatory factor, regression, and mediation analyses were performed in 2015-2016 on baseline cross-sectional data. Main outcomes were patient intent and preference. Perceived risk and self-efficacy were secondary outcomes. Covariates included demographic information, health status, previous CRC screening experience, patient attitudes, and knowledge. Mean age was 57.7 years, 56.1% were women, and 55.1% white and 36.6% black. Women had 32% and 41% lower odds than men of perceiving CRC to be high/moderate risk (OR=0.68, 95% CI=0.47, 0.97, p=0.03) and having high self-efficacy (OR=0.59, 95% CI=0.42, 0.85, p=0.006), respectively. Whites had 63% and 47% lower odds than blacks of having high self-efficacy (OR=0.37, 95% CI=0.25, 0.57, p<0.001) and intent to undergo CRC screening (OR=0.53, 95% CI=0.34, 0.84, p=0.007), respectively. Younger age, higher knowledge, lower level of test worries, and medium/high versus low self-efficacy increased the odds of intent of being screened. Self-efficacy, but not perceived risk, significantly mediated the association between race, attitude, and test worries and patient screening intent. Self-efficacy mediated the association between race, attitude, and test worries and patient intent.

Exploring Cues to Action in Health Belief Model

The Health Belief Model (HBM) has played a key role in describing, explaining, and predicting health-related outcomes. As one of the major health behavior theories, HBM has been well applied in numerous health-related studies. However, these studies often ignore the original conception of HBM as a theoretical model because they focus mainly on the predictive roles of risk perception variables – i.e., perceived susceptibility, severity, benefit, and barrier. Within that process, cues to action has not been comprehensively studied. The current study addresses these limitations in HBM research in two ways: (1) following the original conception of HBM and the recommendation by previous researchers, we did not use risk perception constructs as separate predictors but rather used perceived threat (perceived severity×perceived susceptibility) and perceived evaluation of action (perceived benefit-barrier); (2) we explored both internal and external cues in predicting health-related outcome and separated out interpersonal and media cues from external cues. Path analysis of 992 representative Korean adult samples in the context of tuberculosis (TB) revealed three major findings: (1) Interpersonal and (2) media cues are related to TB screening intention directly and indirectly through perceived threat; (3) perceived threat, but not perceived evaluation of action, is significantly related to TB screening intention. Theoretical and practical implications for our findings are discussed.