Orbell Sheina, Szczepura Ala, Weller David, Gumber Anil, Hagger Martin S
Department of Psychology, University of Essex.
Faculty of Health & Life Sciences, University of Coventry.
Health Psychol. 2017 Dec;36(12):1161-1172. doi: 10.1037/hea0000525. Epub 2017 Jul 20.
Although ethnicity and socioeconomic status (SES) correlate with health inequality, efforts to explain variance in health behavior attributable to these factors are limited by difficulties in population sampling. We used ethnicity identification software to test effects of psychological beliefs about screening as mediators of ethnicity and SES on faecal occult blood colorectal screening behavior in a no-cost health care context.
Adults aged 50-67 years (N = 1,678), of whom 28% were from minority South Asian religiolinguistic ethnic groups (Hindu-Gujarati/Hindi, Muslim-Urdu and Sikh-Punjabi), participated in a prospective survey study. Subsequent screening participation was determined from medical records.
Screening nonparticipation in the most deprived SES quintile was 1.6 times that of the least deprived quintile. Nonparticipation was 1.6 times higher in South Asians compared with non-Asians. A process model in which psychological variables mediated effects of ethnicity and SES on uptake was tested using structural equation modeling. Self-efficacy and perceived psychological costs of screening were, respectively, positive and negative direct predictors of uptake. Paths from Hindu, Muslim, and Sikh ethnicity, and SES on uptake were fully mediated by lower self-efficacy and higher perceived psychological costs. Paths from South Asian ethnicity to participation via self-efficacy and psychological costs were direct, and indirect via SES.
SES is implicated, but does not fully account for low colorectal screening uptake among South Asians. Targeting increased self-efficacy and reduced perceived psychological costs may minimize health inequality effects. Future research should test independent effects of SES and ethnicity on lower self-efficacy and higher psychological costs. (PsycINFO Database Record
尽管种族和社会经济地位（SES）与健康不平等相关，但由于人群抽样困难，解释这些因素导致的健康行为差异的努力受到限制。我们使用种族识别软件，在免费医疗保健背景下，测试关于筛查的心理信念作为种族和SES对粪便潜血结直肠癌筛查行为的中介作用。
年龄在50 - 67岁的成年人（N = 1678）参与了一项前瞻性调查研究，其中28%来自南亚宗教语言少数族裔群体（印度教古吉拉特语/印地语、穆斯林乌尔都语和锡克教旁遮普语）。随后的筛查参与情况通过医疗记录确定。
最贫困SES五分位数组的筛查未参与率是最不贫困五分位数组的1.6倍。南亚人的未参与率是非亚洲人的1.6倍。使用结构方程模型测试了一个心理变量介导种族和SES对接受度影响的过程模型。自我效能感和感知到的筛查心理成本分别是接受度的正向和负向直接预测因素。印度教、穆斯林和锡克教种族以及SES对接受度的路径完全由较低的自我效能感和较高的感知心理成本介导。从南亚种族通过自我效能感和心理成本到参与的路径是直接的，并且通过SES是间接的。
SES与之相关，但不能完全解释南亚人结直肠癌筛查接受率低的情况。提高自我效能感和降低感知心理成本可能会使健康不平等影响最小化。未来的研究应该测试SES和种族对较低自我效能感和较高心理成本的独立影响。（PsycINFO数据库记录
