Background
Methods
Study population
Study design
Materials
Behavioural survey
Demographic variables
Social cognitive variables
Variable | Example | Items | Source |
---|---|---|---|
Chance health locus of control
| “My good health is largely a matter of good fortune” | 4 | Wallston et al. [27] |
Internal health locus of control
| “If I take the right actions I can stay healthy” | 2 | Wallston et al. [27] |
Health value
| “If you don’t have your health you don’t have anything” | 4 | Lau & Hartman [28] |
Response efficacy
| “Participation in home stool test screening leads to early detection if something is wrong.” | 4 | Boer & Seydel [29] |
Self-efficacy
| “I am confident that I will be able to screen regularly for bowel cancer with a home stool test even if I find the test to be embarrassing” | 6 | - |
Barriers
| “Home stool tests are inconvenient” | 7 | - |
Benefits
| “Screening can pick up bowel cancer early when it can be easily treated” | 4 | - |
Severity
| “The health consequences of developing bowel cancer are severe” | 2 | Gregory et al. [25] |
Susceptibility
| “Compared to other people my age my chance of getting bowel cancer is high” | 2 | Gregory et al. [25] |
Social support
| “I can count on my friends when things go wrong” | 6 | Gregory et al. [25] |
Social influence
| “My doctor thinks I should have bowel cancer screening” | 4 | Tiro et al. [30] |
Background variables
FIT screening offer
Study outcomes
Defining patterns of participatory behaviour
Participation patterns across three screening rounds | Adherence category | ||
---|---|---|---|
Round 1
|
Round 2
|
Round 3
| |
Y | Y | Y | Consistent re-participation |
Y | Y | N | Drop out |
Y | N | N | |
N | Y | N | |
Y | N | Y | Intermittent re-participation |
N | Y | Y | Delayed entry |
N | N | Y | |
N | N | N | Consistent refusal |
Analyses
Primary analyses
Secondary analyses
Exclusions
Ethical considerations
Results
Description of the sample
Rescreening adherence
Adherence category | Number (%) |
---|---|
Consistent re-participation | 860 (55.8%) |
Drop out | 134 (8.7%) |
Intermittent re-participation | 68 (4.4%) |
Delayed entry | 166 (10.8%) |
Consistent refusal | 312 (20.3%) |
Total | 1540 (100%) |
Univariate differences between consistent re-participation and non-adherence
Variable | Consistent re-participation (n = 860) | Drop out (n = 134) | Intermittent re-participation (n = 68) | Delayed entry (n = 166) | Consistent refusal (n = 312) | F(df) | p |
---|---|---|---|---|---|---|---|
Mean (SD)
| |||||||
Barriers
|
16.28 (4.22)
| 17.96 (4.33)** | 16.51 (3.65) | 16.57 (4.34) | 18.04(4.80)** | 12.46 (4,709.51) | <.001 |
Benefits
|
16.14 (1.96)
| 15.74 (1.99) | 15.96 (1.75) | 15.90 (1.93) | 15.07(2.24)** | 16.49 (4,1535) | <.001 |
Self-efficacy
|
23.73 (4.69)
| 22.36 (4.29)* | 23.63 (4.22) | 23.35 (4.61) | 21.57(5.01)** | 14.24 (4,678.72) | <.001 |
Response efficacy
|
11.06 (1.45)
| 11.26 (1.13) | 10.79 (1.88) | 10.96 (1.61) | 10.46(1.73)** | 36.94 (4)a
| <.001 |
Social support
|
22.96 (3.81)
| 22.91 (3.61) | 22.88 (3.26) | 22.47 (3.52) | 21.80(4.38)** | 5.80 (4,725.81) | <.001 |
Social influence
|
13.76 (2.60)
| 13.52 (2.61) | 13.13 (2.65) | 13.38 (2.43) | 12.75(2.78)** | 8.79 (4,1535) | <.001 |
Variable | Consistent re-participation (n = 860) | Drop out (n = 134) | Intermittent re-participation (n = 68) | Delayed entry (n = 166) | Consistent refusal (n = 312) | F (df) | p |
---|---|---|---|---|---|---|---|
Mean(SD)
| |||||||
Agea
|
61.18 (6.33)
| 58.86 (6.55)** | 57.69 (6.20)** | 57.86 (5.57)** | 58.57 (6.62)** | 19.92 (4,599.32) | <.001 |
GP visits
a
|
3.98 (1.16)
| 4.04 (1.13) | 3.47 (1.31)** | 3.95 (1.23) | 3.85 (1.29) | 3.29 (4,546.14) | .011 |
Number (%)
|
χ
2
(df)
|
p
| |||||
Private health insurance, None
|
145 (17.0)
| 33 (25.0)** | 17 (25.0) | 31 (18.7) | 75 (24.1) | 26.80 (12) | .008 |
Ancillary
|
74 (8.7)
| 21 (15.9) | 6 (8.8) | 9 (5.4) | 21 (6.8) | ||
Hospital
|
55 (6.4)
| 5 (3.8) | 4 (5.9) | 9 (5.4) | 14 (4.5) | ||
Both
|
579 (67.9)
| 73 (55.3) | 41 (60.3) | 117 (70.5) | 201 (64.6) | ||
Gender (male)
|
369 (42.9)
| 58 (43.3) | 24 (35.3) | 100 (60.2)** | 159 (51.0) | 23.48 (4) | <.001 |
Married (yes)
b
|
689 (80.7)
| 93 (70.5) ** | 54 (79.4) | 131 (79.4) | 222 (71.2)** | 16.46 (4) | .002 |
Workforce (yes)b
|
383 (45.4)
| 78 (60.0)** | 43 (64.2)** | 109 (66.5)** | 189 (61.4)** | 45.88 (4) | <.001 |
Disadvantage, 1 |
167 (19.4)
| 28 (20.9) | 16 (23.9) | 34 (19.4) | 81 (26.0)** | 36.73 (16) | .002 |
2
|
140 (16.3)
| 35 (26.1) | 11 (16.4) | 26 (15.8) | 56 (18.0) | ||
3
|
152 (17.7)
| 20 (14.9) | 16 (23.9) | 20 (12.1) | 39 (12.5) | ||
4
|
149 (17.3)
| 24 (17.9) | 4 (6.0) | 31 (18.8) | 34 (10.9) | ||
5 (least)
|
251 (29.2)
| 27 (20.1) | 20 (29.9) | 54 (32.7) | 101 (32.5) | ||
Knowledge (incorrect)
c
|
124 (14.5)
| 23 (17.2) | 13 (19.4) | 23 (13.9) | 72 (23.1)** | 13.51 (4) | .009 |
Known CRC (yes)
b
|
622 (72.7)
| 83 (62.9) | 43 (63.2) | 105 (63.6) | 191 (62.0)** | 17.40 (4) | .002 |
Discussed FOBT (yes)
b
|
542 (63.0)
| 65 (48.9)** | 39 (57.4) | 91 (55.2) | 120 (38.7)** | 57.59 (4) | <.001 |
Known a screener (yes)
b
|
469 (54.7)
| 54 (40.6)** | 33 (48.5) | 63 (38.2)** | 93 (30.1)** | 63.00 (4) | <.001 |
Past other screening (yes)
b
|
564 (65.9)
| 80 (60.2) | 39 (57.4) | 116 (70.3) | 174 (56.1)** | 14.42 (4) | .006 |
SR past FOBT (yes)b
|
482 (56.0)
| 45 (33.6)** | 32 (47.1) | 83 (50.0) | 78 (25.0)** | 99.19 (4) | <.001 |
Multivariate predictors of non-adherence (primary analyses)
Variable | Drop out n = 129a
| Intermittent re-participation n = 67a
| Delayed entry n = 163a
| Consistent refusal n = 300a
| |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
RR | p | 95% CI | RR | p | 95% CI | RR | p | 95% CI | RR | p | 95% CI | ||
Social cognitive
|
Barriers
|
1.05
|
.032
|
(1.00-1.10)
| 1.01 | .620 | (0.98-1.03) | ||||||
Benefits
| 0.97 | .231 | (0.91-1.02) | ||||||||||
Self-efficacy
|
0.97
|
.047
|
(0.94-1.00)
|
0.97
|
.004
|
(0.95-0.99)
| |||||||
Response efficacy
|
0.93
|
.004
|
(0.88-0.98)
| ||||||||||
Social support
| 1.01 | .452 | (0.99-1.04) | ||||||||||
Social influence
| 0.97 | .281 | (0.93-1.02) | ||||||||||
Background
|
Known CRC (yes)
b
| 0.88 | .173 | (0.73-1.06) | |||||||||
Discussed FOBT (yes)
b
| 1.02 | .917 | (0.71-1.47) | 0.97 | .806 | (0.77-1.23) | |||||||
Known a screener (yes)
b
| 0.86 | .390 | (0.60-1.22) |
0.72
|
.029
|
(0.53-0.97)
|
0.73
|
.010
|
(0.58-0.93)
| ||||
GP visits
|
0.80
|
.015
|
(0.67-0.96)
| ||||||||||
Knowledge (incorrect)
c
| 1.07 | .573 | (0.85-1.33) | ||||||||||
Other screening (yes)
b
| 0.88 | .168 | (0.73-1.06) | ||||||||||
SR past FOBT (yes)
b
|
0.66
|
.042
|
0.44-0.98
|
0.59
|
<.001
|
(0.45-0.77)
| |||||||
Demographic
|
Age
| 0.98 | .157 | (0.94-1.01) |
0.93
|
.007
|
(0.88-0.98)
|
0.94
|
<.001
|
(0.91-0.97)
|
0.98
|
.011
|
(0.96-0.99)
|
Workforce (yes)
b
| 1.38 | .116 | (0.93-2.05) | 1.05 | .869 | (0.60-1.82) | 1.21 | .302 | (0.84-1.75) | 1.25 | .064 | (0.99-1.57) | |
Married (yes)
b
| 0.77 | .133 | (0.54-1.09) | 0.82 | .068 | (0.67-1.02) | |||||||
Private insurance (none)
d
| 1.43 | .076 | (0.96-2.13) | ||||||||||
Private insurance (ancillary only)
d
|
1.57
|
.044
|
(1.01-2.43)
| ||||||||||
Private insurance (hospital only)
d
| 0.75 | .501 | (0.33-1.73) | ||||||||||
Gender (male)
e
|
1.77
|
<.001
|
(1.32-2.38)
| ||||||||||
Disadvantage (1)
| 0.99 | .926 | (0.78-1.25) | ||||||||||
Disadvantage (2)
| 0.87 | .312 | (0.66-1.14) | ||||||||||
Disadvantage (3)
|
0.71
|
.031
|
(0.53-0.97)
| ||||||||||
Disadvantage (4)
f
| 0.76 | .098 | (0.55-1.05) |
Satisfaction with past FOBT use (secondary analyses)
Variable | Drop out n = 40a
| Intermittent re-participation n = 31a
| Delayed entry n = 81a
| Consistent refusal n = 76a
| |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
RR | p | 95% CI | RR | p | 95% CI | RR | p | 95% CI | RR | p | 95% CI | ||
Behavioural (social cognitive and satisfaction)
|
Barriers
| 1.07 | .112 | (0.98-1.17) | 1.00 | .873 | (0.93-1.06) | ||||||
Benefits
| 1.01 | .936 | (0.89-1.14) | ||||||||||
Self-efficacy
| 1.00 | .965 | (0.94-1.17) | 1.00 | .847 | (0.96-1.05) | |||||||
Response efficacy
| 0.94 | .333 | (0.82-1.07) | ||||||||||
Social support
| 1.02 | .455 | (0.97-1.08) | ||||||||||
Social influence
| 0.94 | .186 | (0.86-1.03) | ||||||||||
Satisfaction
|
0.60
|
<.001
|
(0.46-0.78)
| 0.99 | .960 | (0.66-1.48) |
0.78
|
.008
|
(0.65-0.94)
|
0.74
|
.005
|
(0.60-0.92)
| |
Background
|
Known CRC (yes)
b
| 0.80 | .348 | (0.51-1.27) | |||||||||
Discussed FOBT (yes)
b
| 0.84 | .642 | (0.40-1.75) | 0.82 | .465 | (0.50-1.37) | |||||||
Known screener (yes)
b
| 1.20 | .582 | (0.62-2.31) | 0.76 | .183 | (0.51-1.14) | 0.74 | .153 | (0.49-1.11) | ||||
GP visits
|
0.64
|
<.001
|
(0.51-0.82)
| ||||||||||
knowledge (incorrect)
c
| 1.27 | .458 | (0.67-2.40) | ||||||||||
Other screening (yes)
b
| 0.97 | .891 | (0.63-1.50) | ||||||||||
Demographic
|
Age
| 0.99 | .654 | (0.93-1.05) | 0.96 | .218 | (0.89-1.03) |
0.93
|
<.001
|
(0.89-0.97)
| 0.97 | .209 | (0.93-1.02) |
Workforce (yes)
b
| 1.92 | .067 | (0.95-3.84) | 1.49 | .256 | (0.75-3.00) | 1.41 | .198 | (0.84-2.39) |
1.73
| .054 |
(0.99-3.03)
| |
Married (yes)
b
| 0.95 | .896 | (0.45-1.95) | 0.98 | .918 | (0.61-1.57) | |||||||
Gender (male)
d
|
2.00
|
.002
|
(1.30-3.10)
| ||||||||||
Disadvantage (1)
|
0.49
|
.050
|
(0.24-1.00)
| ||||||||||
Disadvantage (2)
| 0.66 | .155 | (0.37-1.17) | ||||||||||
Disadvantage (3)
|
0.41
|
.023
|
(0.19-0.88)
| ||||||||||
Disadvantage (4)
e
|
0.48
|
.032
|
(0.25-0.94)
|