Why people do not get screened for colorectal cancer. Socio-psychological antecedents of screening intention and possible interventions

Colorectal cancer screening low attendance rates are a serious health issue. In the current work, we analyse the socio-psychological factors that boost or hinder the attendance of these cancer detection exams, and we apply persuasive communication theories to test how to promote colorectal cancer screening. We first examine the research on disgust and the avoidance of colorectal cancer screening with a systematic review and meta-analysis. We then broaden our view to enclose embarrassment and fear, two emotions previously identified as further emotional barriers to colorectal cancer screening. In Study 1, we adapt an instrument to operationalise these barriers in the Italian context, the Emotional Barriers to Bowel Screening scale. In Study 2, following the theory of planned behaviour, we also start considering cognitive determinants of the intention to screen: attitudes, subjective norms, and perceived behavioural control. Overall, we test three interventions aimed at improving the communication materials promoting colorectal cancer screening: we try to improve the wording of the invitation letter (Study 2); we test whether a message targeting cognitive and/or affective attitudes towards colorectal cancer screening can boost participants’ willingness to screen, also as a function of their preference towards specific emotion regulation strategies (Study 3); and we explore the effects of a narrative and a didactic video on the main predictors of our framework (i.e., disgust, embarrassment, fear, attitudes, subjective norms, and self-efficacy) and, ultimately, on colorectal cancer screening intention. Our findings expanded the research on the negative emotions associated with colorectal cancer screening and provided several suggestions for further research and practical application.