Toggle Main Menu Toggle Search

Open Access padlockePrints

The role of defensive information processing in population-based colorectal cancer screening uptake

Lookup NU author(s): Dr Nicholas Clarke, Dr Louise HayesORCiD, Dr Patricia Kearney, Professor Linda Sharp



This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


© 2022 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society. Background: Internationally, colorectal cancer screening participation remains low despite the availability of home-based testing and numerous interventions to increase uptake. To be effective, interventions should be based on an understanding of what influences individuals’ decisions about screening participation. This study investigates the association of defensive information processing (DIP) with fecal immunochemical test (FIT)–based colorectal cancer screening uptake. Methods: Regression modeling of data from a cross-sectional survey within a population-based FIT screening program was conducted. The survey included the seven subdomains of the McQueen DIP measure. The primary outcome variable was the uptake status (screening user or nonuser). Multivariable logistic regression was used to estimate the odds ratio (OR) for screening nonuse by DIP (sub)domain score, with adjustments made for sociodemographic and behavioral factors associated with uptake. Results: Higher scores (equating to greater defensiveness) on all DIP domains were significantly associated with lower uptake in the model adjusted for sociodemographic factors. In the model with additional adjustments for behavioral factors, the suppression subdomains of “deny immediacy to be tested” (OR, 0.53; 95% confidence interval [CI], 0.43–0.65; p <.001) and “self-exemption” (OR, 0.80; 95% CI, 0.68–0.96; p <.001) independently predicted nonuse of FIT-based screening. Conclusions: This is the first study outside the United States that has identified DIP as a barrier to colorectal cancer screening uptake, and it is the first focused specifically on FIT-based screening. The findings suggest that two suppression barriers, namely denying the immediacy to be tested and self-exempting oneself from screening, may be promising targets for future interventions to improve uptake.

Publication metadata

Author(s): Clarke N, Hayes L, McQueen A, Gallagher P, Kearney PM, McNamara D, O'Morain CA, von Wagner C, Mooney T, Sharp L

Publication type: Article

Publication status: Published

Journal: Cancer

Year: 2023

Volume: 129

Issue: 8

Pages: 1253-1260

Print publication date: 15/04/2023

Online publication date: 06/02/2023

Acceptance date: 25/08/2022

Date deposited: 22/02/2023

ISSN (print): 0008-543X

ISSN (electronic): 1097-0142

Publisher: John Wiley and Sons Inc.


DOI: 10.1002/cncr.34603

PubMed id: 36740959


Altmetrics provided by Altmetric


Funder referenceFunder name