Understanding Intentions and Action in Colorectal Cancer Screening

  • Emily Power
  • Cornelia H. M. Van Jaarsveld
  • Kirsten McCaffery
  • Anne Miles
  • Wendy Atkin
  • Jane Wardle
Original Article



Factors involved in forming intentions to attend cancer screening may be different from those involved in translating intentions into action.


To test the hypotheses that social cognition variables predict intention better than action, and that life difficulty variables predict action better than intention, in colorectal screening.


Participants from one center in the UK Flexible Sigmoidoscopy Trial (n = 2,969) were categorized according to their screening intention, measured at baseline, and their subsequent attendance at screening (recorded at the clinic). Differences in factors related to life difficulty (socioeconomic deprivation, health, stress, social support) and social cognition variables were examined, and discriminant analysis was used to identify sets of variables that best differentiated the groups.


Social cognition variables were strongly associated with intention but only weakly with action. In contrast, factors related to life difficulties (socioeconomic deprivation, poor health status) were better predictors of action than intention.


Social cognition variables appeared to be important determinants of screening intentions. Other variables—that may be markers of barriers to implementing plans—were more strongly associated with action. To maximize colorectal screening participation, research is needed to identify a wider range of determinants of attendance.


Colorectal cancer Screening Intention Socioeconomic Psychological 



This work was supported by Cancer Research UK and the Medical Research Council.


  1. 1.
    Becker MH. The health belief model and personal health behavior. Health Educ Monogr. 1974; 2: 324–474.Google Scholar
  2. 2.
    Fishbein M, Ajzen I. Belief, Attitude, Intention and Behavior: An Introduction to Theory and Research. Reading, MA: Addison-Wesley; 1975.Google Scholar
  3. 3.
    Ajzen I. The theory of planned behavior. Org Behav Human Decis Process. 1991; 50: 179–211.CrossRefGoogle Scholar
  4. 4.
    Rogers RW. A protection motivation theory of fear appeals and attitude change. J Psychol. 1975; 91: 93–114.Google Scholar
  5. 5.
    Armitage CJ, Conner M. Social cognition models and health behaviour: A structured review. Psychol Health. 2000; 15: 173–189.CrossRefGoogle Scholar
  6. 6.
    Armitage C, Conner M. Efficacy of the theory of planned behaviour: A meta-analytic review. Br J Soc Psychol. 2001; 40: 471–497.PubMedCrossRefGoogle Scholar
  7. 7.
    Sutton S. Predicting and explaining intentions and behavior: How well are we doing. J Appl Soc Psychol. 1998; 28: 1317–1338.CrossRefGoogle Scholar
  8. 8.
    Sheeran P. Intention–behaviour relations: A conceptual and empirical review. In: Stroebe W, Hewstone M, eds. European Review of Social Psychology. New York: Wiley; 2002; 12: 1–36.CrossRefGoogle Scholar
  9. 9.
    Koehler DJ, Poon CSK. Self-predictions overweight strength of current intentions. J Exp Soc Psychol. 2006; 42: 517–524.CrossRefGoogle Scholar
  10. 10.
    Webb TL, Sheeran P. Does changing behavioral intentions engender behaviour change? A meta-analysis of the experimental evidence. Psychol Bull. 2006; 132: 249–268.PubMedCrossRefGoogle Scholar
  11. 11.
    McBroom WH, Reed FW. Toward a reconceptualization of attitude-behavior consistency. Soc Psychol Q. 1992; 55: 205–216.CrossRefGoogle Scholar
  12. 12.
    Orbell S, Sheeran P. Inclined abstainers: A problem for predicting health-related behaviour. Br J Soc Psychol. 1998; 37: 151–165.PubMedGoogle Scholar
  13. 13.
    Schwarzer R. Self-efficacy in the adoption and maintenance of health behaviors: Theoretical approaches and a new model. In: Schwarzer R, ed. Self-efficacy: Thought Control of Action. Washington, DC: Hemisphere; 1992: 217–242.Google Scholar
  14. 14.
    Perkins DD, Taylor RB. Ecological assessments of community disorder: Their relationship to fear of crime and theoretical implications. Am J Community Psychol. 1996; 24: 63–107.PubMedCrossRefGoogle Scholar
  15. 15.
    Afridi A. Community Cohesion and Deprivation: A Discussion Paper for the Commission on Integration and Cohesion. London: The Stationery Office; 2007.Google Scholar
  16. 16.
    Stafford M, Bartley M, Sacker A, et al. Measuring the social environment: Social cohesion and material deprivation in English and Scottish neighbourhoods. Environ Plann A. 2003; 35: 1459–1475.CrossRefGoogle Scholar
  17. 17.
    Atkin WS, Edwards R, Wardle J, et al. Design of a multicentre randomised trial to evaluate flexible sigmoidoscopy in colorectal cancer screening. J Med Screen. 2001; 8: 137–144.PubMedCrossRefGoogle Scholar
  18. 18.
    Prescott-Clarke P, Primatesta P, eds. Health Survey for England. London: HMSO; 1996.Google Scholar
  19. 19.
    Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983; 24: 385–396.PubMedCrossRefGoogle Scholar
  20. 20.
    Cohen S, Willis TA. Stress, social support and the buffering hypothesis. Psychol Bull. 1985; 98: 310–357.PubMedCrossRefGoogle Scholar
  21. 21.
    Weinstein ND. Unrealistic optimism about susceptibility to health problems: Conclusions from a community-wide sample. J Behav Med. 1987; 10: 481–500.PubMedCrossRefGoogle Scholar
  22. 22.
    Sutton S, Bickler G, Sanchoaldridge J, Saidi G. Prospective study of predictors of attendance for breast screening in inner London. J Epidemiol Community Health. 1994; 48: 65–73.PubMedCrossRefGoogle Scholar
  23. 23.
    Champion VL. Instrument development for health belief model constructs. Adv Nurs Sci. 1984; 6: 73–85.Google Scholar
  24. 24.
    Kinnear PR, Gray CD. SPSS 12 Made Simple. Hove, East Sussex: Psychology; 2004.Google Scholar
  25. 25.
    Tabachnick BG, Fidell LS. Using Multivariate Statistics. New York: Harper & Row; 1989.Google Scholar
  26. 26.
    McQueen A, Vernon SW, Myers RE, Watts BG, Lee ES, Tilley BC. Correlates of predictors of colorectal cancer screening among male automotive workers. Cancer Epidemiol Biomarker Prev. 2007; 163: 500–509.CrossRefGoogle Scholar
  27. 27.
    Sutton S, Wardle J, Taylor T, et al. Predictors of attendance in the UK flexible sigmoidoscopy screening trial. J Med Screen. 2000; 72: 99–104.PubMedCrossRefGoogle Scholar
  28. 28.
    Abraham C, Sheeran P. Acting on intentions: The role of anticipated regret. Br J Soc Psychol. 2003; 42: 495–511.PubMedCrossRefGoogle Scholar
  29. 29.
    Sheeran P, Orbell S. Augmenting the theory of planned behavior: Roles for anticipated regret and descriptive norms. J Appl Soc Psychol. 1999; 29: 2107–2142.CrossRefGoogle Scholar
  30. 30.
    Fishbein M, Capella JN. The role of theory in developing effective health communications. J Commun. 2006; 56: S1–S17.CrossRefGoogle Scholar
  31. 31.
    Bagozzi RP, Yi YJ. The degree of intention formation as a moderator of the attitude-behavior relationship. Soc Psychol Q. 1989; 52: 266–279.CrossRefGoogle Scholar
  32. 32.
    Powe BD, Finnie R. Cancer fatalism: The state of science. Cancer Nurs. 2003; 26: 454–465.PubMedCrossRefGoogle Scholar
  33. 33.
    Straughan PT, Seow A. Fatalism reconceptualized: A concept to predict health screening behavior. J Gend Cult Health. 1998; 3: 85–100.CrossRefGoogle Scholar
  34. 34.
    Ajzen I, Madden TJ. Prediction of goal-directed behavior: Attitudes, intentions and perceived behavioral control. J Exp Soc Psychol. 1986; 22: 453–474.CrossRefGoogle Scholar
  35. 35.
    Bandura A. Desire for Control: Personality, Social and Clinical Perspectives. New York: Plenum; 1992.Google Scholar
  36. 36.
    Fishbein M, Ajzen I. Theory-based behavior change interventions: Comments on Hobbis and Sutton. J Health Psychol. 2005; 101: 27–31.PubMedCrossRefGoogle Scholar
  37. 37.
    Gollwitzer PM. Implementation intentions: Strong effects of simple plans. Am Psychol. 1999; 54: 493–503.CrossRefGoogle Scholar
  38. 38.
    Gollwitzer PM, Sheeran P. Implementation intentions and goal achievement: A meta-analysis of effects and processes. Adv Exp Soc Psychol. 2006; 38: 69–119.CrossRefGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 2008

Authors and Affiliations

  • Emily Power
    • 1
  • Cornelia H. M. Van Jaarsveld
    • 1
  • Kirsten McCaffery
    • 2
  • Anne Miles
    • 1
  • Wendy Atkin
    • 3
  • Jane Wardle
    • 1
  1. 1.Health Behaviour Research Centre, Department of Epidemiology and Public HealthUniversity College LondonLondonUK
  2. 2.Screening and Test Evaluation Program, School of Public Health, Faculty of MedicineUniversity of SydneySydneyAustralia
  3. 3.Colorectal Cancer Population and Screening Research GroupImperial College LondonLondonUK

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