School of Psychology, Dublin City University, Dublin, Ireland.
Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK.
Cancer. 2023 Apr 15;129(8):1253-1260. doi: 10.1002/cncr.34603. Epub 2023 Feb 6.
Internationally, colorectal cancer screening participation remains low despite the availability of home-based testing and numerous interventions to increase uptake. To be effective, interventions should be based on an understanding of what influences individuals' decisions about screening participation. This study investigates the association of defensive information processing (DIP) with fecal immunochemical test (FIT)-based colorectal cancer screening uptake.
Regression modeling of data from a cross-sectional survey within a population-based FIT screening program was conducted. The survey included the seven subdomains of the McQueen DIP measure. The primary outcome variable was the uptake status (screening user or nonuser). Multivariable logistic regression was used to estimate the odds ratio (OR) for screening nonuse by DIP (sub)domain score, with adjustments made for sociodemographic and behavioral factors associated with uptake.
Higher scores (equating to greater defensiveness) on all DIP domains were significantly associated with lower uptake in the model adjusted for sociodemographic factors. In the model with additional adjustments for behavioral factors, the suppression subdomains of "deny immediacy to be tested" (OR, 0.53; 95% confidence interval [CI], 0.43-0.65; p < .001) and "self-exemption" (OR, 0.80; 95% CI, 0.68-0.96; p < .001) independently predicted nonuse of FIT-based screening.
This is the first study outside the United States that has identified DIP as a barrier to colorectal cancer screening uptake, and it is the first focused specifically on FIT-based screening. The findings suggest that two suppression barriers, namely denying the immediacy to be tested and self-exempting oneself from screening, may be promising targets for future interventions to improve uptake.
尽管有家庭检测和许多增加参与度的干预措施，国际上结直肠癌筛查的参与率仍然很低。为了有效，干预措施应该基于对影响个体筛查参与决策的因素的理解。本研究调查了防御性信息处理（DIP）与粪便免疫化学测试（FIT）为基础的结直肠癌筛查参与之间的关联。
对基于人群的 FIT 筛查计划的横断面调查数据进行回归建模。该调查包括 McQueen DIP 测量的七个子域。主要结局变量是筛查的使用情况（筛查使用者或非使用者）。使用多变量逻辑回归估计 DIP（子）域评分的筛查非使用者的比值比（OR），并对与使用率相关的社会人口统计学和行为因素进行调整。
在调整社会人口统计学因素的模型中，所有 DIP 域的得分较高（表示防御性更强）与模型中调整社会人口统计学因素后的较低使用率显著相关。在调整行为因素的模型中，“否认接受检测的即时性”（OR，0.53；95%置信区间 [CI]，0.43-0.65；p<0.001）和“自我豁免”（OR，0.80；95% CI，0.68-0.96；p<0.001）这两个抑制子域独立预测了 FIT 为基础的筛查的不使用。
这是美国以外的第一项确定 DIP 是结直肠癌筛查参与障碍的研究，也是第一项专门针对 FIT 为基础的筛查的研究。研究结果表明，两个抑制性障碍，即否认接受检测的即时性和自我豁免筛查，可能是未来提高使用率的干预措施的有希望的目标。
