Understanding Colorectal Cancer Screening Attendance: A Comprehensive Theory of Planned Behaviour Model

Abstract

Population-based colorectal cancer screening programs decrease mortality, but the participation rates are still unsatisfactory. Drawing from relevant psychosocial literature, this study aims to test a widely integrated theory of planned behaviour model applied to colorectal cancer screening attendance. The model considered, at the same time, additional proximal predictors (anticipated regret and self-identity) and distal (via attitude) predictors (trust in institutions and perceived risk in their affective and cognitive facets) of intention. On top, to bridge the intention–behaviour gap, the role of two additional mediators (action and coping planning) was explored. In May-June 2022, 435 adults residing in Campania (Italy) joined a survey assessing variables of interest. Structural equation model results showed that both action and coping planning, which were predicted by intention, significantly predicted attendance. Intention was predicted by attitude, subjective norms, perceived behavioural control, anticipated regret and self-identity. Attitude was predicted by trust in institutions and affective perceived risk. A parallel mediation analysis confirmed the role of both action and coping planning as full mediators in the intention–behaviour relation. The proposed comprehensive model can inform future interventions and orienteer the improvement of healthcare access processes.