Promoting volitional self-efficacy to uptake colorectal cancer screening using implementation intentions

Abstract

Background: Colorectal screening uptake in the UK and elsewhere is modest and is persistently inversely associated with socioeconomic deprivation. Worldwide, interventions have tended to focus upon structural aspects of delivery rather than psychological processes and theory. A few previous studies in different types of screening have investigated the potential for planning interventions based upon implementation intentions to promote uptake, and have produced mixed results. Methods: A preliminary survey (N= 500) investigated volitional self efficacy by exploring methods used by individuals who had successfully completed faecal sampling and completed colorectal screening. A pilot controlled intervention (N = 2000) employed an intervention comprising motivational information and an implementation intention in an area of high socioeconomic deprivation in Scotland. Screen eligible adults were sent a supplementary leaflet along with standard instructions and a test kit. Subsequent screening uptake was objectively determined from medical records. Results: Participation rates amongst screen eligible adults who received the supplementary leaflet was substantially higher than amongst those who did not receive the leaflet (59.7% vs 44.8% controls, p < 0.001). The intervention effect on FOBt uptake was maintained after adjusting for age and gender. Discussion: A planning intervention based upon implementation intentions was an effective tool for promoting screening uptake. Results are discussed in the context of similar interventions that have produced mixed results, with reference to the roles of prior motivation, goal commitment, education and self-versus-other generated plans.