Psychological correlates of free colorectal cancer screening uptake in a Scottish sample: A cross-sectional observational study

Abstract

Objectives Colorectal cancer (CRC) screening uptake in Scotland is 56%. This study examined whether psychological factors were associated with CRC screening uptake. Design Cross-sectional observational study. Setting This study used data from the Healthy AGeing In Scotland (HAGIS) pilot study, a study designed to be representative of Scottish adults aged 50 years and older. Participants 908 (505 female) Scottish adults aged 50 to 80 years (mean age=65.84, SD=8.24), who took part in the HAGIS study (2016-2017). Primary and secondary outcome measures Self-reported participation in CRC screening was the outcome measure. Logistic regression was used to test whether scores on measures of health literacy, cognitive ability, risk aversion, time preference (e.g., present-oriented or future-oriented), and personality were associated with CRC screening when these psychological factors were entered individually and simultaneously in the same model. Results Controlling for age, age-squared, sex, living arrangement, and sex*living arrangement, a one-point increase in risk aversion (OR=0.66, 95% CI 0.51 to 0.85), and present-orientation (OR=0.86, 0.80 to 0.94) was associated with reduced odds of screening. Higher scores on health literacy (OR per one-point increase=1.20, 1.09 to 1.31), cognitive ability (OR per SD increase=1.51, 1.25 to 1.81), and the intellect personality trait (OR per one-point increase=1.05, 1.01 to 1.09) were associated with increased odds of screening. Higher risk aversion was the only psychological variable that was associated with CRC screening participation when all psychological variables were entered in the same models, and remained associated with CRC screening when additionally adjusting for deprivation and education. A backward elimination model retained two psychological variables as correlates of CRC screening; risk aversion and cognitive ability. Conclusion Individuals who are more risk averse are less likely to participate in free, home CRC screening.