Social-cognitive and emotion predictors of colorectal cancer screening reluctance in Australia

Colorectal cancer (CRC) screening is an effective but relatively underutilized screening test in Australia and internationally. Many studies have sought to explain this problem by applying major social-cognitive health behaviour models grounded in assumptions about rational, cognizant decision-making. A large literature amalgamates components and constructs from different models however, there is relatively little variance in screening uptake explained by the few studies exploring the unique contribution of any single theoretical model. Further issues include the deficit of research exploring the contribution of discrete emotions in health intentions and behaviours such as cancer screening, compounded by insufficient integration of emotion into social-cognitive models. As well, heuristics and their related biases have been under-explored in health behaviour research. The dual-process theoretical approach from which they are understood may offer additional insight into the processes underlying screening intention. In addition to some of the most common variables from major health behaviour models, including demographic, and health variables, this dissertation describes an in-depth examination of the roles of heuristics and discrete emotions on CRC screening intentions and participation in an Australian sample. Two related studies explore the facility of both traditional and emerging cognitive, emotion, and social factors in explaining CRC screening intention and behaviour. Study 1 was a preliminary investigation in a sample of convenience (N = 202) with 47 men and 155 women ranging in age from 18 to 75 years (M = 27). It was designed to examine the psychometric properties of the scales, refine the measures using factor analysis, and investigate the relationships between variables, in order to inform a second, community-based study. From the results of this pilot study, a range of variables were understood to be related to screening reluctance, in particular, heuristic biases and a number of different types of emotion relating to embarrassment in medical settings, and fear in connection with screening procedures and complications. Traditional social-cognitive variables also emerged as important correlates, including self-efficacy and social support. Study 2 largely confirmed the preliminary findings in a community sample of 240 Australians (80 men; 160 women) aged 35 to 87 years (M = 59), and further tested the ability of these variables to predict reluctance to screen for colorectal cancer. The results of a discriminant analysis suggest that specific emotions such as fear of screening procedures and medical embarrassment, and heuristic biases, are important in the prediction of colonoscopy and faecal occult blood test intentions, while screening participation may be best predicted by ‘fixed’ demographic and health factors, and by cognitions, including screening biases. Together, the findings support an emerging research focus on broader experiential processes, such as discrete emotions and heuristic biases, in the prediction of screening reluctance. The conclusions drawn from the present results include recommendations for greater systematic, empirical study of these variables and the incorporation of such evidence into public health interventions for cancer detection and prevention.