Original Research

Geographic variation in compliance with Australian colorectal cancer screening programs: the role of attitudinal and cognitive traits


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Belinda C Goodwin1
PhD, Research Fellow *

Sonja March2 PhD, Director of research

Michael Ireland3 PhD, Senior research fellow

Fiona Crawford Williams4 PhD, Research fellow

Donna Manksi5 B.PSych (Hons), Student

Martelle Ford6 B.PSych (Hons), Student

Jeff Dunn7 PhD, Chair of Social and Behavioural Sciences


1, 4 Institute for Resilient Regions, University of Southern Queensland, Springfield, Qld, Australia

2, 3 Institute for Resilient Regions and School of Psychology and Counselling, University of Southern Queensland, Springfield, Qld, Australia

5, 6 School of Psychology and Counselling, University of Southern Queensland, Springfield Central, Qld, Australia

7 Institute for Resilient Regions, University of Southern Queensland, Springfield, Qld, Australia; Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Qld, Australia; and School of Medicine, Griffith University, Brisbane, Qld, Australia

ACCEPTED: 22 April 2019

early abstract:

Introduction: Colorectal cancer (CRC) patients in regional and rural areas tend to be diagnosed at a more advanced stage than metropolitan patients and have poorer 5 year survival rates. Environmental and cultural factors in non-metropolitan areas often facilitate a more reactive approach to healthcare, which can result in lower participation in preventative health measures such as screening for early signs of cancer. Individual differences in attitudes and cognitive styles can also act as barriers to cancer screening. Currently, evidence regarding geographical disparity in CRC screening is inconclusive and based largely on test return in nationwide screening programs as opposed to compliance with program guidelines. This study investigates the effect of attitudinal and cognitive traits on compliance with, as opposed to participation in, population CRC screening programs in rural, regional, and metropolitan environments.

Methods: A representative cross-section of recipients (n=371, 71% female) of a faecal occult blood test as part of the National Bowel Cancer Screening Program were surveyed in 2017 (Mage = 61.26, SD=7.05). Participants were asked if they completed and returned the kit or had a valid reason not to (i.e., prior screening). Postcodes were used to identify participants as metropolitan, regional, or rural using the Australian Standard Geographical Classification system. Fatalism, minimization of problems and resignation (MPR), need for control and self-reliance, and consideration of future consequences (CFC) were measured as traits known to effect health related help-seeking behaviour. Program compliance rates were compared between rural, regional and metropolitan areas and logistic regression models with interaction terms were applied to test the differential effects of attitudinal and cognitive factors on program compliance across metropolitan, regional, and rural groups.

Results: Compliance was significantly lower in regional compared to metropolitan areas (OR = 0.49, CI = 0.29 – 0.84) Rural status significantly moderated the effect of MPR (OR = 0.28, CI = 0.11 – 0.71) and CFC (OR = 6.66, CI = 1.80 – 24.63) on compliance and regional status significantly moderated the effect of CFC on compliance (OR = 3.41, CI = 1.37 – 8.44)Simple slopes analyses showed that high MPR was associated with lower bowel screening program compliance in rural (OR = 0.26, CI = 0.11 - 0.59) and regional (OR = 0.60, CI = 0.38 – 0.95) areas, but not in metropolitan areas. High CFC was associated with higher bowel screening program compliance in rural (OR = 4.46, CI = 1.39 - 14.47) and regional (OR = 2.30, CI = 1.19 – 4.43), but not metropolitan, areas.

Conclusions: Sub-optimal compliance rates are evident in non-metropolitan areas with intervention most needed in regional areas where compliance is lowest, leaving residents at a potentially higher risk of CRCs going undetected. Efforts to increase CRC screening in rural and regional areas should promote the consideration of one’s future and discourage attitudes that minimize health issues. This research highlights the way in which individual attitudes and thinking styles may impact preventive health behaviours differently in non-metropolitan communities.