Psychological correlates of free colorectal cancer screening uptake in a Scottish sample: A cross-sectional observational study

Chloe Fawns-Ritchie* (Corresponding Author), C. Miller, Marjon van der Pol, E. Douglas, , D. Bell, R O'Carroll, Ian J. Deary

*Corresponding author for this work

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Colorectal cancer (CRC) screening uptake in Scotland is 56%. This study examined whether psychological factors were associated with CRC screening uptake.

Cross-sectional observational study.

This study used data from the Healthy AGeing In Scotland (HAGIS) pilot study, a study designed to be representative of Scottish adults aged 50 years and older.

908 (505 female) Scottish adults aged 50–80 years (mean age=65.85, SD=8.23), who took part in the HAGIS study (2016–2017).

Primary and secondary outcome measures Self-reported participation in CRC screening was the outcome measure. Logistic regression was used to test whether scores on measures of health literacy, cognitive ability, risk aversion, time preference (eg, present oriented or future oriented) and personality were associated with CRC screening when these psychological factors were entered individually and simultaneously in the same model.

Controlling for age, age-squared, sex, living arrangement, and sex*living arrangement, a one-point increase in risk aversion (OR=0.66, 95% CI 0.51 to 0.85) and present orientation (OR=0.86, 95% CI 0.80 to 0.94) was associated with reduced odds of screening. Higher scores on health literacy (OR per one-point increase=1.20, 95% CI 1.09 to 1.31), cognitive ability (OR per SD increase=1.51, 95% CI 1.25 to 1.81) and the intellect personality trait (OR per one-point increase=1.05, 95% CI 1.01 to 1.09) were associated with increased odds of screening. Higher risk aversion was the only psychological variable that was associated with CRC screening participation when all psychological variables were entered in the same model and remained associated with CRC screening when additionally adjusting for deprivation and education. A backward elimination model retained two psychological variables as correlates of CRC screening: risk aversion and cognitive ability.

Individuals who are more risk averse are less likely to participate in free, home CRC screening.
Original languageEnglish
Article numbere042210
Number of pages11
JournalBMJ Open
Issue number2
Early online date1 Feb 2022
Publication statusPublished - 1 Feb 2022

Bibliographical note

This work was supported by the University of Edinburgh Centre for Cognitive Ageing and Cognitive Epidemiology, part of the cross council Lifelong Health and Well-being Initiative, funded by the Biotechnology and Biological Sciences Research Council and Medical Research Council (grant number: MR/K026992/1). The Healthy AGeing in Scotland (HAGIS) study (data resource) was part-funded by the National Institute of Ageing (grant number: RAG044535A) in the USA and was also part-funded by the Nuffield Foundation (grant number: OPD/42197). MvdP is supported by the Chief Scientist Office (CSO) of the Scottish Government Health and Social Care Directorates (grant number: not applicable).

Data Availability Statement

Data are available on reasonable request. The anonymised HAGIS pilot data will be made available via the Gateway to Global Aging Data:

Prepublication history and additional supplemental material for this paper are available online. To view these files, please visit the journal online (


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