Emotional predictors of bowel screening avoidance: the unearthed role of disgust (#103)
Aims: Emerging research suggests that fear and embarrassment predict less frequent bowel screening. However, the avoidance-producing emotion of disgust is yet to be studied despite a clear link between bowel-related phenomena (e.g., faeces, insertions) and both disgust and avoidance. The current report evaluated the psychometric characteristics and predictive validity of a newly constructed scale, the EBBS (Emotional Barriers to Bowel Screening).
Methods: 201 people aged 45+ completed a questionnaire which included measures of perceived CRC risk, access to health care, screening history, dispositional disgust, potential emotional barriers to bowel screening and a decision-making task assessing FOBT delay.
Results: The overall EBBS showed high reliability (Cronbach’s alpha .96), with each of the subscales also highly reliable – faecal disgust .91, insertion disgust .93, embarrassment .88, and fear .84. Concurrent and discriminant validity were adequate, as assessed by associations with dispositional metrics. Forward-entry multiple regression showed that emotional barriers predicted both FOBT decision-making and bowel screening history. In models controlling for age, sex, medical and health variables, subscales of the EBBS uncovered patterns consistent with expectation; embarrassment uniquely predicted a greater odds of deciding to delay FOBT (Wald=22.95, df=1, p<.00) odds ratio 2.84 (95% CI 1.86 – 4.36) while greater disgust predicted a reduced odds of prior invasive bowel screening (Wald=7.96, df=1, p=.01) odds ratio .43 (95% CI .24 – .77).
Conclusions: The EBBS measure has good reliability, shows an interpretable pattern of relationships with dispositional metrics, and predicted both bowel screening history and the decision to delay FOBT where other more general metrics of emotion did not. Avoidance of bowel screening has serious implications – understanding the role that distinct emotions – fear, embarrassment, and disgust – have in this context has potential to inform clinical practice and communications in this area.