TY - JOUR
T1 - "i'm not doing that." An in-depth examination of nonparticipation in mail-out bowel cancer screening programs
AU - Goodwin, Belinda C.
AU - March, Sonja
AU - Crawford-Williams, Fiona
AU - Chambers, Suzanne K.
AU - Dunn, Jeff
PY - 2020/12
Y1 - 2020/12
N2 - Despite a clear association between the early detection of bowel cancer and increased survival, participation in mail-out screening programs is poor. Several key barriers to participation have been identified, yet research has failed to examine the specific cognitions, actions, and individual contexts from which barriers emerge. The purpose of the current study was to gain a detailed understanding of the actual experience of kit receipt from the perspective of nonparticipants including their opinion on interventions that may be effective in promoting participation. Demographic differences in reasons for nonparticipation are also examined. Opt-out data from a national program was analyzed to detect demographic differences in reasons for nonparticipation. Qualitative interviews were conducted in a sample of "at risk"nonparticipants. Thematic analysis was conducted using an inductive phenomenological approach. Older, higher SES, male and previously screened participants were more likely to provide a medical reason for opting out of participation. Four key themes emerged from interview data. The first reflected intention; whereby participants were either intenders (i.e., they planned to participate) or refusers. Subsequent themes reflected practicalities, emotional reactions, and necessity. Differences between intenders and refusers within these themes as well as opinions regarding interventions were identified. Interventions involving interactions with health professionals, autonomous decision making, and those which emphasize the positive outcomes of screening may encourage refusers to participate in mail-out bowel cancer screening programs. Messages that reinforce the importance of screening or provide a practical reminder may be more useful for intenders.
AB - Despite a clear association between the early detection of bowel cancer and increased survival, participation in mail-out screening programs is poor. Several key barriers to participation have been identified, yet research has failed to examine the specific cognitions, actions, and individual contexts from which barriers emerge. The purpose of the current study was to gain a detailed understanding of the actual experience of kit receipt from the perspective of nonparticipants including their opinion on interventions that may be effective in promoting participation. Demographic differences in reasons for nonparticipation are also examined. Opt-out data from a national program was analyzed to detect demographic differences in reasons for nonparticipation. Qualitative interviews were conducted in a sample of "at risk"nonparticipants. Thematic analysis was conducted using an inductive phenomenological approach. Older, higher SES, male and previously screened participants were more likely to provide a medical reason for opting out of participation. Four key themes emerged from interview data. The first reflected intention; whereby participants were either intenders (i.e., they planned to participate) or refusers. Subsequent themes reflected practicalities, emotional reactions, and necessity. Differences between intenders and refusers within these themes as well as opinions regarding interventions were identified. Interventions involving interactions with health professionals, autonomous decision making, and those which emphasize the positive outcomes of screening may encourage refusers to participate in mail-out bowel cancer screening programs. Messages that reinforce the importance of screening or provide a practical reminder may be more useful for intenders.
KW - Bowel cancer screening
KW - Colorectal cancer
KW - Intention
KW - Intervention
KW - Interview
KW - Refusal
UR - http://www.scopus.com/inward/record.url?scp=85092666069&partnerID=8YFLogxK
U2 - 10.1093/tbm/ibz096
DO - 10.1093/tbm/ibz096
M3 - Article
C2 - 31228202
AN - SCOPUS:85092666069
SN - 1869-6716
VL - 10
SP - 1515
EP - 1524
JO - Translational Behavioral Medicine
JF - Translational Behavioral Medicine
IS - 6
ER -