The Role of Defensive Information Processing in the Acceptance of Population-Based Colorectal Cancer Screening Summary Background Internationally, participation in colorectal cancer screening remains low despite the availability of at-home testing and numerous interventions to increase uptake. To be effective, interventions must be based on an understanding of what influences people’s decisions about participating in screening. This study investigates the association of defensive information processing (DIP) with fecal immunochemical test (FIT)-based colorectal cancer screening. Methods Regression modeling was performed on cross-sectional survey data within a population-based FIT screening program. The survey included all seven subdomains of McQueen’s DIP measure. The primary outcome variable was acceptance status (user or non-user). Multivariable logistic regression was used to estimate the odds ratio (OR) for detection of non-use using the DIP (sub)domain score, with adjustments made for sociodemographic and behavioral factors associated with uptake. Results Higher scores (equating to greater defensiveness ) on all DIP domains were significantly associated with lower acceptance in the model adjusted for sociodemographic factors. In the model with additional adjustments for behavioral factors, the suppression subdomains of “deny immediacy to be evaluated” (OR, 0.53; 95% confidence interval [CI], 0.43–0.65; p < 0.001) and “self-exemption” (OR, 0.80; 95% CI, 0.68–0.96; p < 0.001) independently predicted nonuse of FIT-based screening. Conclusions This is the first study outside the United States to have identified DIP as a barrier to colorectal cancer screening adoption, and is the first to specifically focus on FIT-based screening. The findings suggest that two suppression barriers, namely denying the immediacy of testing and self-exemption from screening, may be promising targets for future interventions to improve uptake. |
Comments
To increase detection rates, strategies are needed to address these beliefs.
Colorectal cancer is one of the most treatable cancers, especially if caught early; However, many people do not undergo recommended screening tests, even despite the availability of at-home fecal immunochemical test (FIT) kits. New research published by Wiley online in CANCER , a peer-reviewed journal of the American Cancer Society, reveals that people who react defensively to the invitation to get tested are less likely to participate.
For the study, Nicholas Clarke, PhD, of Dublin City University in Ireland, surveyed people in Dublin who had been invited to participate in a FIT screening program in 2008–2012. The questionnaires were mailed in September 2015 to all people who were invited to participate (in two rounds of selection) but a random sample of people who had participated were already refused. After two reminders, questionnaires were completed by 1988 people who participated in screening and 311 who did not.
Individuals who did not participate in the FIT-based assessment were more likely to provide responses indicating greater defensiveness. This was evident for all questions related to the different domains of what is called defensive information processing (DIP). The four DIP domains include:
- Attention avoidance (reducing risk awareness through avoidance).
- Dullness (active mental disconnection through avoidance and accepted denial).
- Repression (recognizing the risk of others but avoiding personal inferences through self-exemption beliefs).
- Counter-argument (arguing against the evidence).
“People who react defensively to the invitation to be screened for colorectal cancer are less likely to participate, and this appears to be due to misconceptions that having a healthy lifestyle or having regular bowel movements means they do not need to be screened.” proof. Similarly, some people believe that testing can be delayed while they wait for a “better” test (although the current test works very well) or wait until their other health problems are under control,” Dr. Clarke explained. “Some people also react defensively because they believe that cancer is always fatal, which is not true. “All of these factors can lead people to make the decision not to get screened at home.”
Dr. Clarke noted that the study’s findings indicate that even well-designed health communication campaigns and proactive screening programs can be hampered by people’s defensive beliefs. “The measures used in this study could be used to help identify people who may need additional support to participate in colorectal cancer screening programs around the world,” he said. “The results suggest that screening programs need strategies to decrease procrastination and address misconceptions about colorectal cancer and screening.”
He also stressed the importance of trying to make colorectal cancer screening something everyone does routinely as they reach middle age.
An accompanying editorial by Beverly Beth Green MD, MPH of Kaiser Permanente Washington and Kaiser Permanente Washington Health Research Institute argues for additional research to test different strategies, such as financial incentives, to decrease DIP.
