Emotional Barriers to Bowel Screening in Italy: Scale psychometric properties and effects on screening attendance

Abstract

Objective: To assess a three-factor version of the Emotional Barriers to Bowel Screening (EBBS) scale; analyze the scale's psychometric properties; and investigate the associations of fecal disgust, embarrassment, and fear with colorectal cancer (CRC) screening avoidance.Methods: Retrospective design: We asked participants to rate negative emotions associated with CRC screenings as well as whether they had ever attended a fecal occult blood test. Sample: 268 Italian adults aged 45−74 years. Measures: negative emotions, screening knowledge, CRC risk perception, demographic and background data, and hypothetical medical help-seeking. Analyses: Confirmatory factor analyses, correlations, logistic regressions. Results:The EBBS scale is a multidimensional instrument and, at least where fecal tests are of interest, can be used without the insertion disgust subscale. The analyzed negative emotions were negatively correlated with screening attendance and positively correlated with intention to delay seeking medical help. However, logistic regression models showed that, of the three analyzed emotions, fear about outcome was the only significant predictor of screening behavior and delaying medical care. Conclusions:Further studies can adopt the version of the EBBS scale that is most suitable for their research contexts. Interventions must be designed to reassure patients.

Development and psychometric evaluation of the Aversion to Bowel Cancer Screening Scale

“…Interestingly, the FOBT Aversion subscale did not include items referring to fear, and Colonoscopy Aversion items were void of disgust based on item face validity. This contrasts Scaglioni and Cavazza's ( 2021 ) findings that found only fear predicted FOBT avoidance, using the EBBS. However, the multidimensionality of the measure has been contested with some findings indicating that the items are more consistent with fecal disgust (Davis et al, 2017 ).…”

“…Correlations between the ABCSS and CRC relevant behaviours (i.e., self-reported screening behaviours and intention) were examined (see Table 4). The This contrasts Scaglioni and Cavazza's (2021) findings that found only fear predicted FOBT avoidance, using the EBBS. However, the multidimensionality of the measure has been contested with some findings indicating that the items are more consistent with fecal disgust (Davis et al, 2017).…”

“…Validation with an Australian sample (Davis et al, 2017 ) failed to support the measure as a multidimensional instrument, with psychometric evaluation suggesting a single factor measuring fecal disgust. The suggested unidimensional nature of the EBBS has recently been contested by researchers using the measure to assess emotions (i.e., fecal disgust, embarrassment and fear) limited to the fecal test (Scaglioni & Cavazza, 2021 ). However, to predict screening behaviour and delayed medical care, these researchers only used 10 items from the EBBS with 5 items, regarding insertion disgust, removed, following confirmatory factor analysis (CFA) that had supported the multidimensional structure.…”

Men and women experience different barriers to care seeking for fecal incontinence

“…16,17 Scaglioni et al found that patients that reported fear about their screening outcome were more likely to not get screened and delay seeking care. 16 Similarly, Bhise et al reported that fear of pain, fear of finding cancer, and fear of complications about the procedure were barriers among patients who missed their colonoscopy appointments. 17 In contrast, in our sample, the most common fears were related to treatment, with only 44% of respondents reporting fear of evaluation ("being poked and prodded") and only 30% endorsing fear of symptoms being related to cancer.…”

Psychometric properties of a Chinese version of four-factor colorectal cancer screening belief scale

“…Rawl 36 recruited patients with adenomatous polyps and the first-degree relatives of patients with CRC and established the construct validity of a CRC screening scale using EFA; the results confirmed the structural unidimensionality of the scale for assessing the perceived benefits of and barriers to CRC screening. Scaglioni 37 found that emotional barriers and, in particular, fear of the screening outcome, were associated with CRC screening attendance. Based on the above, perceived benefits, perceived barriers, and self-efficacy are the most frequently discussed components of the psychosocial structure of CRC screening.…”