Determinants of non-participation in a mass screening program for colorectal cancer in Finland

Artama, Miia; Heinävaara, Sirpa; Sarkeala, Tytti; Prättälä, Ritva; Pukkala, Eero; Malila, Nea

doi:10.1080/0284186x.2016.1175658

Cited by 14 publications

(11 citation statements)

References 18 publications

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“…In Flanders, males, younger age groups, lower socio-economic groups and immigrants (except Dutch) are less likely to participate in the CRC screening programme. These findings are in line with other European countries [18,25]. The CRC screening by FIT is completely free of charge, indicating that other than financial factors play a role.…”

Section: Discussionsupporting

confidence: 89%

Does the Flemish colorectal cancer screening programme reach equity in FIT uptake?

Hoeck

Veerdonk

Brabander³

et al. 2019

European Journal of Public Health

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Background To investigate colorectal cancer (CRC) screening rates by the faecal immunochemical test (FIT) according to sociodemographic characteristics and nationality. Methods Men and women, aged 56–74, invited to participate in the Flemish CRC screening programme in 2013 and 2014 were included in this study. We analysed the association between CRC screening uptake and sex, age, (first and current) nationality and several proxies for socio-economic status (SES). The statistical analysis was based on descriptive analyses and logistic regression models. Results A total of 1 184 426 persons were included in our analysis. The overall screening uptake was 52.3%, uptake varied by sex, age, nationality and SES. Lower participation rates were associated with the youngest and oldest age categories (56–60 and 70–74) and being male. All nationalities other than Belgian or Dutch were significantly less screened. Lower uptake of screening was also associated with several proxy’s for low SES, such as having an allowance for being disabled, not being able to work, being an extended minor and having a social allowance/minimum wage. The descriptive analysis showed a 27% difference in CRC screening uptake between the (early) retired and the people entitled to a minimum wage. Conclusions There is a significant difference between screening uptake and demographic and socio-economic variables in the first 2 years of the population-based screening programme in Flanders. Based on the study results, implementing strategies to improve participation in those subgroups is needed.

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Section: Discussionsupporting

confidence: 89%

Does the Flemish colorectal cancer screening programme reach equity in FIT uptake?

Hoeck

Veerdonk

Brabander³

et al. 2019

European Journal of Public Health

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“…This is in contrast to other health behavioral and preventative care intervention studies in the literature, which historically suggest a higher rate of non-participation and drop-out among smokers [20, 21, 25, 26]. In this case, we would have expected to see a higher decline rate compared to consent rate in the intervention sites.…”

Section: Discussioncontrasting

confidence: 63%

Selection bias and subject refusal in a cluster-randomized controlled trial

Yang

Carter

Gums

et al. 2017

BMC Med Res Methodol

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BackgroundSelection bias and non-participation bias are major methodological concerns which impact external validity. Cluster-randomized controlled trials are especially prone to selection bias as it is impractical to blind clusters to their allocation into intervention or control. This study assessed the impact of selection bias in a large cluster-randomized controlled trial.MethodsThe Improved Cardiovascular Risk Reduction to Enhance Rural Primary Care (ICARE) study examined the impact of a remote pharmacist-led intervention in twelve medical offices. To assess eligibility, a standardized form containing patient demographics and medical information was completed for each screened patient. Eligible patients were approached by the study coordinator for recruitment. Both the study coordinator and the patient were aware of the site’s allocation prior to consent. Patients who consented or declined to participate were compared across control and intervention arms for differing characteristics. Statistical significance was determined using a two-tailed, equal variance t-test and a chi-square test with adjusted Bonferroni p-values. Results were adjusted for random cluster variation.ResultsThere were 2749 completed screening forms returned to research staff with 461 subjects who had either consented or declined participation. Patients with poorly controlled diabetes were found to be significantly more likely to decline participation in intervention sites compared to those in control sites. A higher mean diastolic blood pressure was seen in patients with uncontrolled hypertension who declined in the control sites compared to those who declined in the intervention sites. However, these findings were no longer significant after adjustment for random variation among the sites. After this adjustment, females were now found to be significantly more likely to consent than males (odds ratio = 1.41; 95% confidence interval = 1.03, 1.92).ConclusionsThough there appeared to be a higher consent rate for females than for males, the overall impact of potential selection bias and refusal to participate was minimal. Without rigorous methodology, selection bias may be a threat to external validity in cluster-randomized trials.Trial registration NCT01983813. Date of registration: Oct. 28, 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/s12874-017-0368-7) contains supplementary material, which is available to authorized users.

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“…Our findings for the influence of health behaviours on CRC screening participation add to the limited evidence available. Studies based on CRC screening programmes in England, Finland and France, [13][14][15] as well as studies of CRC screening in the United States 16 17 have found similar associations between current smoking and non-participation in CRC screening. Our study did not find significant…”

Section: Discussionmentioning

confidence: 85%

Factors associated with participation in colorectal cancer screening in Australia: Results from the 45 and Up Study cohort

Lew

Egger

et al. 2018

Preventive Medicine

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The Australian Government's National Bowel Cancer Screening Program (NBCSP) was introduced in 2006 to provide free home-based immunochemical faecal occult blood test (iFOBT) to eligible Australians turning 55 and 65years in that year. With the gradual inclusion of additional age cohorts, the rollout of the NBCSP is being implemented in the context of a degree of opportunistic or de facto screening. This study investigated factors associated with self-reported ever-uptake of the NBCSP and of any CRC screening using follow-up questionnaire data from 105,897 Australians aged ≥45years enrolled in the 45 and Up Study in New South Wales, Australia. Of the 91,968 study participants with information on CRC screening behaviour, 70,444 (76.6%) reported ever-uptake of any CRC screening. 63,777 study participants were eligible for a NBCSP invitation, of these 33,148 (52.0%) reported ever-uptake of screening through the NBCSP. Current smoking (RR=0.86, 0.83-0.90), non-participation in breast cancer screening (female) or PSA testing (male) (RR=0.84, 0.81-0.86), poor self-reported health (RR=0.89, 0.86-0.91), lower levels of education (RR=0.91, 0.90-0.93), and not speaking English at home (RR=0.88, 0.85-0.91) were associated with reduced ever-uptake of screening within the NBCSP and of any CRC screening. Individuals with a family history of CRC were less likely to screen through the NBCSP (RR=0.71, 0.69-0.73), but more likely to participate in any CRC screening (RR=1.18, 1.17-1.19). Smokers, disadvantaged groups and those with non-English speaking backgrounds are less likely to have ever-participated in organised screening through the NBCSP or in any form of CRC screening, supporting efforts to improve participation in these groups.

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Determinants of non-participation in a mass screening program for colorectal cancer in Finland

Cited by 14 publications

References 18 publications

Does the Flemish colorectal cancer screening programme reach equity in FIT uptake?

Does the Flemish colorectal cancer screening programme reach equity in FIT uptake?

Selection bias and subject refusal in a cluster-randomized controlled trial

Factors associated with participation in colorectal cancer screening in Australia: Results from the 45 and Up Study cohort

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