BackgroundSocial cognitive variables are often examined for their association with initial participation in colorectal cancer screening. Few studies have examined the association of these variables with adherence to multiple screening offers i.e., rescreening. This study aimed to describe patterns of participatory behaviour after three rounds of screening using faecal immunochemical tests (FIT) and to determine social cognitive, demographic and background variables predictive of variations in adherence.MethodsParticipants were 1,540 men and women aged 50 to 75 living in South Australia who completed a behavioural survey measuring demographic (for example, age, gender) and social cognitive variables relevant to FIT screening (for example, perceived barriers, benefits, self-efficacy). The survey was followed by three, free FIT screening offers mailed on an annual basis from 2008 to 2010. Patterns of participation after three screening rounds were described as one of five screening behaviours; 1) consistent re-participation (adherent with all screening rounds), 2) consistent refusal (adherent with no screening rounds), 3) drop out (adherent with earlier but not later rounds), 4) intermittent re-participation (adherent with alternate rounds) and 5) delayed entry (adherent with later but not initial round(s)). Univariate (Chi Square and Analysis of Variance) and multivariate (Generalised Estimating Equations) analyses were conducted to determine variables predictive of each category of non-adherence (those that did not participate in every screening offer, groups 2, 3, 4 and 5) relative to consistent re-participation.ResultsSignificant social cognitive predictors of non-adherence were; less self-efficacy (drop out and consistent refusal), greater perceived barriers (drop out) and lower levels of response efficacy (consistent refusal). Demographic predictors of non-adherence included; male gender (delayed entry), younger age (intermittent, delayed and consistent refusal), less frequent GP visits (intermittent re-participation) and 'ancillary only' private health insurance (drop out). Less satisfaction with screening at baseline predicted drop out, consistent refusal and delayed entry.ConclusionsDifferent combinations of demographic and behavioural variables predicted different patterns of rescreening adherence. Rescreening interventions may benefit from a targeted approach that considers the different needs of the population subgroups. Satisfaction with past FOBT screening measured prior to the study screening offers was an important predictor of adherence.

BackgroundPrevious research points to differences between predictors of intention to screen for colorectal cancer (CRC) and screening behavior, and suggests social ecological factors may influence screening behavior. The aim of this study was to compare the social cognitive and social ecological predictors of intention to screen with predictors of participation.MethodsPeople aged 50 to 74 years recruited from the electoral roll completed a baseline survey (n = 376) and were subsequently invited to complete an immunochemical faecal occult blood test (iFOBT).ResultsMultivariate analyses revealed five predictors of intention to screen and two predictors of participation. Perceived barriers to CRC screening and perceived benefits of CRC screening were the only predictor of both outcomes. There was little support for social ecological factors, but measurement problems may have impacted this finding.ConclusionsThis study has confirmed that the predictors of intention to screen for CRC and screening behaviour, although overlapping, are not the same. Research should focus predominantly on those factors shown to predict participation. Perceptions about the barriers to screening and benefits of screening are key predictors of participation, and provide a focus for intervention programs.

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The majority of the population were not found to have progressed beyond contemplation. Certain demographic characteristics varied significantly between people at different stages of readiness to screen for CRC.

Colorectal cancer (CRC) is a common cancer and an ideal target for early detection and prevention through screening. The Australian National Bowel Cancer Screening Program currently provides free testing to Australians at 5-year age intervals between the ages of 50 and 65. Despite the effectiveness of screening, participation in the program is suboptimal, with men participating at a significantly lower rate than women. Men’s reluctance to use health services and seek help for health problems is a common concern across Western cultures, often attributed to “traditional” masculine traits such as stoicism, strength, and independence. In this qualitative study we interviewed 35 older men (50 to 74 years) who had been invited to screen for CRC through participation in a randomized controlled trial, and explored the extent to which the men’s discussions of screening for CRC were consistent with theories of masculinity. Using theoretical thematic analysis we identified that men drew on discourses of responsibility, risk, rationality, and control in discussing their views of screening for CRC, demonstrating an interconnection between discourses of hegemonic masculinity and dominant discourses of neoliberalism.