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Abstract
Overuse of low-value cancer screening may result in overdiagnosis and overtreatment of low-risk cancers that can harm patients’ well-being and the healthcare system. This dissertation developed theoretical frameworks explicating the processes underlying cancer screening intention by extending the multicomponent theory of planned behavior to include risk perceptions and anticipated regret. The developed frameworks were applied to the design of communication-based strategies to curb low-value screening: (1) removing the word cancer from the disease label to reduce risk perceptions, (2) highlighting negative affective consequences of cancer screening to reduce attitudes, and (3) providing information about diagnostic uncertainty to reduce anticipated regret. 612 South Korean women aged 20 to 59 participated in an online survey-based experiment employing a 2 (disease label: thyroid cancer vs. a borderline thyroid neoplasm) × 2 (a message about affective consequences: absent vs. present) × 2 (diagnostic uncertainty information: absent vs. present) full-factorial between-subject design with a control condition. Participants read a scenario in which they had a regular health checkup scheduled and then received an information booklet about an optional screening test for thyroid disease.
Attitudes and injunctive norms increased screening intention directly and indirectly (via anticipated regret). Perceived susceptibility increased screening intention only indirectly (via anticipated regret). The interaction effect between perceived severity and susceptibility on screening intention was significant, such that when perceived severity was low, perceived susceptibility directly increased intention. When perceived severity was high, perceived susceptibility directly reduced intention. Capability directly increased screening intention, but unexpectedly autonomy reduced it.
The alternative disease label reduced perceived severity not susceptibility; and that reduction led to a decrease in anticipated regret, which then reduced screening intention. The affective message reduced screening intention through two pathways: (1) lower positive attitudes and (2) lower positive attitude to less anticipated regret. Although the diagnostic uncertainty information reduced anticipated regret, its effect disappeared when included in a model with other predictors of anticipated regret. Of the three strategies, only the alternative label increased intention not to undergo screening, but the effect was not explained by the developed theoretical framework. Implications of these findings are discussed along with directions for future research.