Department of Psychological Sciences, Birkbeck, University of London, London, United Kingdom.
Cancer Epidemiol Biomarkers Prev. 2011 Oct;20(10):2132-40. doi: 10.1158/1055-9965.EPI-11-0453. Epub 2011 Sep 27.
Little is known about the psychological predictors of colorectal screening uptake in England and mediators of associations between uptake and socioeconomic status (SES). This study tested the hypotheses that although higher threat and efficacy beliefs, lower cancer fatalism, lower depression, and better self-rated health would predict higher screening uptake, only efficacy beliefs, fatalism, depression, and self-rated health would mediate associations between uptake and SES.
Data from 529 adults aged 60 to 69 who had completed a postal survey in 2005-2006 were linked with data on fecal occult blood test (FOBt) uptake recorded at the screening "hub" following its introduction in 2007, resulting in a prospective study.
Screening uptake was 56% and was higher among people with higher SES, better self-rated health, higher self-efficacy beliefs, and lower cancer fatalism in univariate analyses. Path analysis on participants with complete data (n = 515) showed that both better self-rated health and lower cancer fatalism were directly associated with higher uptake of FOBt screening and significantly mediated pathways from SES to uptake. Lower depression only had an indirect effect on uptake through better self-rated health. Efficacy beliefs did not mediate the relationship between SES and uptake.
SES differences in uptake of FOBt in England are partially explained by differences in cancer fatalism, self-rated health, and depression.
This is one of only a few studies to examine mediators of the relationship between SES and screening uptake, and future research could test the effectiveness of interventions to reduce fatalistic beliefs to increase equality of uptake.
对于英格兰人群接受结直肠癌筛查的心理预测因素以及接受程度与社会经济地位（SES）之间关联的中介因素知之甚少。本研究检验了以下假设：尽管较高的威胁和效能信念、较低的癌症宿命论、较低的抑郁程度和较好的自我健康评估会预测更高的筛查参与度，但只有效能信念、宿命论、抑郁程度和自我健康评估会调节接受程度与 SES 之间的关联。
2005 年至 2006 年，对 529 名年龄在 60 至 69 岁之间的成年人进行了邮寄调查，随后在 2007 年引入粪便潜血试验（FOBt）筛查后，将其与筛查“中心”记录的 FOBt 接受情况的数据进行了关联，从而开展了一项前瞻性研究。
筛查参与率为 56%，在单变量分析中，SES 较高、自我健康评估较好、自我效能信念较高和癌症宿命论较低的人群筛查参与度更高。对具有完整数据的参与者（n = 515）进行路径分析显示，自我健康评估更好和癌症宿命论更低与更高的 FOBt 筛查接受度直接相关，并且显著调节了 SES 与参与度之间的路径。抑郁程度仅通过自我健康评估对参与度有间接影响。效能信念并未调节 SES 与参与度之间的关系。
英格兰人群 FOBt 筛查接受度的 SES 差异部分可由癌症宿命论、自我健康评估和抑郁程度的差异来解释。
这是为数不多的研究 SES 与筛查参与度之间关系的中介因素的研究之一，未来的研究可以检验减少宿命论信念以提高平等参与度的干预措施的有效性。
