Micro actions in colorectal cancer screening participation: a population-based survey study

Background: Low uptake of colorectal cancer (CRC) screening is a cause for concern. This study explored people's anticipated response to receiving the test kit to shed light on past screening uptake and help inform future interventions to increase participation. Methods: Face-to-face interviews were conducted with respondents living in England who were eligible for CRC screening as part of a population-based 'omnibus' survey. Respondents were asked what they would do ('micro actions') if they received a CRC screening test kit through the mail (apart from completing it or not), and their unprompted responses were coded (multiple codes allowed). Past 'ever' uptake and screening intention were also recorded. The final analysis included 1237 respondents aged 60-70. Results: Respondents who said that they would decide after some thought' (p <.001), 'put [it] aside to deal with later' (p <.001), 'put it on the "to do list/pile"' (p <.05) or 'discuss it with a health care professional' (p <.01) had decreased odds of having participated. Those who said they would 'read the instruction leaflet' (p <.001), 'put the kit near the toilet' (p <.001) or 'decide when to do the test' (p <.05) were more likely to have taken part in CRC screening. With the exception of 'decide when to do the test' and 'discuss it with a health care professional', all associations with past uptake remained significant after adjusting for other micro actions and screening intention. 'Make a note somewhere (to remind myself)' was mentioned by less than 1 % of respondents. Conclusions: Delay-causing and preparatory micro actions were associated with past CRC screening uptake. Self-regulatory micro actions (e.g. making a note to remind oneself) were rarely mentioned as responses to receiving a screening invitation. Interventions aimed at reducing delay and facilitating preparatory and self-regulatory behaviours might help increase uptake. The behaviour-focused survey method is a promising avenue for future health behaviour research.