Most participants held positive attitudes towards cancer treatment and outcomes. Positive attitudes towards, and awareness of, cancer and cancer screening play a role in adopting proactive strategies to prevent cancer, and so it is important for public awareness campaigns to emphasize the benefits of screening, while at the same time not catastrophizing the disease or instilling fatalistic beliefs. Interestingly, none of the beliefs about cancer treatment or outcomes were associated with differences in CRC screening behaviour. This is encouraging because this suggests that even those who hold more fatalistic beliefs may still participate in screening. It is possible that the observed associations between beliefs and screening behaviour may be influenced by socioeconomic or other confounding factors for which we didn’t control.
Most participants also held positive beliefs about cancer screening, with few concerned about risks of false positives leading to unnecessary surgery, and even fewer who stated their fears about what might be found would prevent them from participating in screening. Interestingly, three of the four beliefs about cancer screening in the ‘negative domain’, but only one of the four beliefs in the ‘positive domain’, were associated with differences in behaviour. This suggests that awareness campaigns may benefit more from addressing fears or negative beliefs participants have about screening, rather than just promoting the benefits. As those who never had CRC screening were more likely to believe screening was only necessary if they had symptoms, there may be some role for improving public awareness on the purpose of screening. There were no associations between CRC screening behaviour and believing that cancer screening is not necessary if someone has a healthy lifestyle, and more surprisingly, nor were there associations with believing that cancer screening is now very routine, or believing that it can reduce their chances of dying from cancer.
In our sample, only 55.9% of participants ages 50–74 agreed or strongly agreed with the statement that cancer screening is now very routine. However, since there was no association with having had CRC screening, this suggests that trying to change public perception on the routine nature of cancer screening may not improve screening participation. This is counterintuitive, but perhaps this finding is because other factors beyond beliefs are at play. Alternatively, it could be because we looked at having ever had CRC screening, and not at having regular or recent CRC screening. Believing that regular screening would give them a feeling of control over their health was associated with having had CRC screening. A large majority of participants agreed that they would participate in screening if their doctor told them how important it was, and but this was not associated with a difference in CRC screening behaviour.
To find only a few small differences between screening beliefs and screening behaviors, and no differences in screening behaviours across the beliefs about cancer treatment and outcomes, should be considered a favorable finding. This is because it suggests that even those who have fatalistic beliefs about cancer are barely, if at all, less likely to have participated in CRC screening. We interpret this as an encouraging sign that, despite their beliefs, people are still engaging in cancer screening. That said, Newfoundland and Labrador still has the second lowest rate, behind Quebec, of being up-to-date for CRC screening among all provinces in Canada (H. Singh, Bernstein, Samadder, & Ahmed, 2015). Just over half of participants ages 50–74 have ever had FIT (or FOBT) or flexible sigmoidoscopy CRC screening (57.36% [409/713]). Due to the limitations of our non-random sampling design, this number should not be generalized as a population estimate. This also does not mean that these individuals are up-to-date with screening. That said, these findings further support our assertion that there are gaps between attitudes and action. The lack of large associations between beliefs and CRC screening rates further suggests that interventions beyond health awareness and education may be necessary if public health campaigns wish to improve screening rates.
There were no independent associations with CRC screening behaviour observed based on ethnicity, BMI class, geography, whether someone was living with a partner, education, income, or whether the participants, or their first-degree, had a history of cancer. This was unexpected as previous research has identified that income and BMI class were associated with rates of being up-to-date on CRC screening (H. Singh et al., 2015; S. M. Singh et al., 2004). In contrast, another study found little difference in ever-screening rates based on rural/urban geography or income (Sewitch et al., 2008). Also unexpectedly, among our participants, men had higher odds of ever having had CRC screening compared to women, whereas Singh et al. (2015) found absolute rates of screening were slightly higher among women in NL, and that country-wide, the odds were no different. It is possible that the difference between our findings and that of the literature is due to the different outcome variables assessed, such that these factors may not play a role in having ever had CRC screening, but that they do play a role in being up-to-date with CRC screening. As expected, we found screening was lowest among individuals ages 50–54 and that, compared to this group, odds were more than double among people 55–59, and the odds increased with increasing age, with approximately triple odds among ages 70–74.
There are a number of important limitations to note. We used Facebook advertising to recruit our sample, which is a non-random method and may thus lead to sampling bias. While this prevents generalizing findings about the prevalence of beliefs, we see no reason why it would lead to bias in associations. Another limitation is that we compared people who had ever had, versus never had, CRC screening, rather than comparing people who were up to date and people who were not up to date with screening. It is possible that the effect of beliefs and sociodemographic factors on being up-to-date with screening may be more or less significant than the effects on ever vs never having had screening. One additional consideration is that we assessed beliefs about cancer in general, but this paper explored CRC screening behaviour in particular. It is possible that beliefs and behaviours vary differently based on cancer type and that general beliefs about may differentially affect specific screening behaviours. We did survey screening behaviours related to other cancers but, for this paper, we chose to look at CRC screening because it is a prevalent problem in NL, and we feel that it receives considerably less attention in awareness and screening campaigns.