Discipline of Public Health, Flinders University, Adelaide 5001, Australia.
General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8QQ, UK.
Int J Environ Res Public Health. 2021 Sep 27;18(19):10157. doi: 10.3390/ijerph181910157.
The notion of candidacy emerged three decades ago through Davison and colleagues' exploration of people's understanding of the causes of coronary heart disease. Candidacy was a mechanism to estimate one's own or others risk of disease informed by their lay epidemiology. It could predict who would develop illness or explain why someone succumbed to it. Candidacy's predictive ability, however, was fallible, and it was from this perspective that the public's reticence to adhere to prevention messages could be explained, as ultimately anybody could be 'at-risk'. This work continues to resonate in health research, with over 700 citations of Davison's Candidacy paper. Less explored however, is the candidacy framework in its entirety in other illness spheres, where prevention efforts could potentially impact health outcomes. This paper revisits the candidacy framework to reconsider it use within prevention. In doing so, candidacy within coronary heart disease, suicide prevention, diabetes, and cancer will be examined, and key components of candidacy and how people negotiate their candidacy within differing disease contexts will be uncovered. The applicability of candidacy to address modifiable breast cancer risk factors or cancer prevention more broadly will be considered, as will the implications for public health policy.
候选性概念是三十年前由 Davison 及其同事在探索人们对冠心病病因的理解时提出的。候选性是一种根据他们的非专业流行病学知识来估计自己或他人疾病风险的机制。它可以预测谁会患病，或者解释为什么有人会患病。然而，候选性的预测能力是不可靠的，正是从这个角度出发，可以解释为什么公众不愿意遵守预防信息，因为最终任何人都可能“处于危险之中”。这项工作在健康研究中仍有共鸣，Davison 的候选性论文被引用了 700 多次。然而，在其他疾病领域，候选性框架的整体情况却鲜有人研究，而预防工作可能会对健康结果产生影响。本文重新审视候选性框架，以重新考虑其在预防中的应用。为此，将检查候选性在冠心病、自杀预防、糖尿病和癌症中的应用，并揭示候选性的关键组成部分以及人们在不同疾病背景下如何协商自己的候选性。还将考虑候选性在解决可改变的乳腺癌风险因素或更广泛的癌症预防方面的适用性，以及对公共卫生政策的影响。
