Action Control of Colorectal Cancer Screening Participation with fecal immunochemical test (FIT)

Abstract

Background

Most of the individuals concerned by colorectal cancer screening recognize the importance of screening participation. However, the screening rates for this cancer remain low in most countries, including France. Based on the action control framework, the present study aimed to (i) explore the distribution of intentions-behavior profiles toward colorectal cancer screening and (ii) to determine to what extent the profiles could be differentiated on theory of planned behavior (TPB) (i.e., attitudes, subjective norms, perceived behavioral control [PBC]) and self-regulation variables (i.e., action planning, coping planning).

Method

A total of 149 participants from the general French population (M = 60 years, SD = 7.04) completed a questionnaire measuring TPB and self-regulation variables. Subsequent screening behavior was determined from medical records. Participants were notably categorized as non-intenders, unsuccessful intenders, or successful intenders. Data were analyzed using discriminant function analysis and analyses of covariance.

Results

Main findings revealed that 71% of the intenders were unsuccessful intenders. TPB and self-regulation variables were significantly correlated with the discriminant function (rs ≥ .40). Successful and unsuccessful intenders reported significantly higher levels of subjective norms, PBC, and coping planning than non-intenders (ps < .01). Successful intenders reported a significantly higher level of coping planning than unsuccessful intenders (p < .01).

Conclusions

Further research appears necessary to empirically test to what extent interventions targeting subjective norms, PBC, and coping planning could enhance the proportion of successful intenders toward colorectal cancer screening.

Appendices

Appendix 1

Descriptive statistics of the sample

	Participants (N)	Percentage (%)
Age M = 60.3 (SD = 7.04)	–	–
Sex
Men	72	45.9
Women	85	54.1
Occupational category
Farmer	1	0.6
Craftsman, shopkeeper, business owner	5	3.2
Executive officer	23	14.6
Intermediate profession	9	5.7
Liberal profession	7	4.5
Employee	25	15.9
Worker	3	1.9
Retiree	67	42.7
Unemployed	13	8.3
Other	2	1.3
Working in the field of health
Yes	17	10.8
No	133	84.7
Having a General Practitioner
Yes	153	97.5
No	2	1.3
Having a health care professional’s recommendation for screening
Yes	64	40.8
No	89	56.7
Personal history of cancer (all types)
Yes	26	16.6
No	130	82.8
Family history of cancer (all types)
Yes	87	55.4
No	66	42
Family history of colorectal cancer or colorectal adenoma
Yes	29	18.5
No	123	78.3
Knowing individual(s) suffering from cancer
Yes	124	79
No	32	20.4
Knowing individual(s) suffering from colorectal cancer
Yes	49	31.2
No	107	68.2
Previous participation in colorectal cancer screening
Yes	86	54.8
No	68	43.3
Frequency of screening by faecal occult blood test
Never	67	42.7
Every 5 years/1 or 2 time in total	31	19.7
Every 2 or 3 years	45	28.7
Every year	2	1.3
Other screening tests achieved
Yes	79	50.3
No	74	47.1
Other type of screening tests achieved
Mammography	69	43.9
Prostate cancer	7	4.5
Pap-smear	40	25.5

Appendix 2

Items of the questionnaire measuring variables of the theory of planned behavior and self-regulation variables

Variables	Items
Intentions	I intend to perform a screening test for colorectal cancer in the next few months
	I wish to perform a screening test for colorectal cancer in the next few months
Attitudes	If I do a screening test for colorectal cancer, it will allow to detect a potential health problem as soon as possible
	It is possible to recover from colorectal cancer if it is detected early thanks to the screening test
	I think that the new immunological test for colorectal cancer is reliable
	I don’t like thinking about the colorectal cancer screening test (R)
	I think that performing a colorectal cancer screening test is something unpleasant (R)
	I feel disgusted to have to take a sample of my stool myself to do the screening test (R)
	I dread the results of my colorectal cancer screening test (R)
Norms	I often heard about colorectal cancer in the media and it encourages me to get screened
	I feel that most people of my age do regularly a screening test for colorectal cancer
	I think the majority of my relatives over the age of fifty are regularly testing for colorectal cancer
	My general practitioner has already recommended me to participate in screening for colorectal cancer
	If the screening center in my area sends me an invitation letter to get screened for colorectal cancer, then I have to do it
Behavioral perceived control	I think the new immunological test for colorectal cancer is easy to perform
	I feel able to perform alone the screening test for colorectal cancer properly
	In my daily life, I feel able to visit my general practitioner to collect the colorectal cancer screening kit even if it takes time
	In my daily life, I think I can take the time necessary to perform a colorectal cancer screening test
Coping planning	For my next screening, I know how to get organized if I am out of time
	For my next screening, I know how to motivate myself if I don’t want to do it anymore
	For my next screening, I know how to react if my emotions block me at the time of performing the test
Action planning	I have already planned when I will get the screening kit for colorectal cancer from my general practitioner for my next screening
	I have already planned when I will perform my next screening for colorectal cancer

1. This is a translation of the questionnaire submitted in French to the participants. The items of this questionnaire are based on existing guidelines (Ajzen, 2006 [31]; Sniehotta, 2005 [32]) and two qualitative studies presented in the doctoral thesis of Alice Le Bonniec (2018) [33]
2. R reverse item