Inequalities in cancer screening participation: examining differences in perceived benefits and barriers.
Inequalities exist in colorectal cancer (CRC) screening uptake, with people from lower socioeconomic status backgrounds less likely to participate. Identifying the facilitators and barriers to screening uptake is important to addressing screening disparities. We pooled data from 2 trials to examine educational differences in psychological constructs related to guaiac fecal occult blood testing.



Patients (n = 8576) registered at 7 general practices in England, within 15 years of the eligible age range for screening (45-59.5 years), were invited to complete a questionnaire. Measures included perceived barriers (emotional and practical) and benefits of screening, screening intentions, and participant characteristics including education.



After data pooling, 2181 responses were included. People with high school education or no formal education reported higher emotional and practical barriers and were less likely to definitely intend to participate in screening, compared with university graduates in analyses controlling for study arm and participant characteristics. The belief that one would worry more about CRC after screening and concerns about tempting fate were strongly negatively associated with education. In a model including education and participant characteristics, respondents with low emotional barriers, low practical barriers, and high perceived benefits were more likely to definitely intend to take part in screening.



In this analysis of adults approaching the CRC screening age, there was a consistent effect of education on perceived barriers toward guaiac fecal occult blood testing, which could affect screening decision making. Interventions should target specific barriers to reduce educational disparities in screening uptake and avoid exacerbating inequalities in CRC mortality.
Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK. sam.smith@qmul.ac.uk.|Department of Epidemiology and Public Health, University College London, London, UK. sam.smith@qmul.ac.uk.
S G
SG
Smith
Department of Epidemiology and Public Health, University College London, London, UK.
L M
LM
McGregor
Department of Applied Health Research, University College London, London, UK.
R
R
Raine
Department of Epidemiology and Public Health, University College London, London, UK.
J
J
Wardle
Department of Epidemiology and Public Health, University College London, London, UK.
C
C
von Wagner
Department of Epidemiology and Public Health, University College London, London, UK.|Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
K A
KA
Robb
D000368:Aged; D015179:Colorectal Neoplasms / Q000523:psychology; D055088:Early Detection of Cancer / Q000523:psychology* / Q000706:statistics & numerical data; D004739:England; D005260:Female; D006801:Humans; D007182:Income; D033182:Intention; D008297:Male; D008403:Mass Screening / Q000523:psychology; D008875:Middle Aged; D009042:Motivation; D009780:Occult Blood; D010342:Patient Acceptance of Health Care; D010465:Perception; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
cancer; colorectal cancer screening; education; inequalities; oncology; uptake