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Cited by 154Colorectal Cancer Screening and DetectionGlobal Cancer Incidence and ScreeningHealth Promotion and Cardiovascular Prevention

The health belief model and colorectal cancer screening in the general population: A systematic review

Open access
Lau, Jerrald, Lim, Tian-Zhi, Jianlin Wong, Gretel, Tan, Ker-Kan·2020·Preventive Medicine Reports
DOI 10.1016/j.pmedr.2020.101223PMC PMC7567954
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Abstract

Colorectal cancer screening saves lives and is cost-effective. It allows early detection of the pathology, and enables earlier medical intervention. Despite clinical practice guidelines promoting screening for average risk individuals, uptake remains suboptimal in many populations. Few studies have examined how sociobehavioural factors influence screening uptake in the context of behaviour change theories such as the health belief model. This systematic review therefore examines how the health belief model's constructs are associated with colorectal cancer screening. Four databases were systematically searched from inception to September 2019. Quantitative observational studies that used the health belief model to examine colorectal screening history, intention or behaviour were included. A total of 30 studies met the criteria for review; all were of cross-sectional design. Perceived susceptibility, benefits and cues to action were directly associated with screening history or intention. Perceived barriers inversely associated with screening history or intention. The studies included also found other modifying factors including sociodemographic and cultural norms. Self-report of screening history, intention or behaviour, convenience sampling and lack of temporality among factors were common limitations across studies. The health belief model's associations with colorectal cancer screening uptake was consistent with preventive health behaviours in general. Future studies should examine how theory-based behavioural interventions can be tailored to account for the influence of socioecological factors.

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  • In countries without free screening programmes, high screening costs were a key barrier in a systematic review of CRC screening attendance.

    “In countries without free screening programmes, high screening costs were a key barrier in a systematic review of CRC screening attendance [15].”

    From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [15]

    The Discussion (page not provided) identifies screening cost as a structural barrier and says perceived barriers were inversely associated with screening intention or behaviour in most studies reviewed. It does not establish that high costs were a key barrier specifically in countries without free screening programmes. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Embarrassment or shame can hinder CRC and CC screening.

    “Embarrassment or shame can hinder CRC and CC screening [7,15,30].”

    From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [15]

    Table 3 (Results; page not provided) lists embarrassment as a perceived barrier to colorectal cancer (CRC) screening, and the Discussion says perceived barriers were generally inversely associated with screening. Our copy does not address whether embarrassment or shame hinders CC screening, so that part of the sentence is unsupported by this source. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • If preparation for screening is viewed as too difficult, it might hinder CRC screening participation.

    “Conversely, if preparation for screening (e.g., going without eating, preparation of test kit) is viewed as too difficult, it might hinder CRC screening participation [15].”

    From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [15]

  • Fear of cancer is an emotional barrier.

    “Emotional barriers include fear of cancer, screening results and treatment [8,9,15] and fatalism [10,24].”

    From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [15]

  • Primary care providers' or general practitioners' endorsement, encouragement and recommendations to attend cancer screening are often key.

    “Primary care providers' or general practitioners' (GP) endorsement, encouragement and recommendations to attend cancer screening are often key [e.g., 15,28,35], and might be particularly important for subpopulations, e.g., immigrants [7].”

    From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [15]

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Cited by

Sorted by citations

Authors
Lau, J., Lim, T.-Z., Jianlin Wong, G., & Tan, K.-K.
Affiliations
National University of Singapore (SG)
Corresponding author
Tan, Ker-Kan
ORCID
Venue
Preventive Medicine Reports
Publisher
Elsevier BV
Published
2020-12
Volume
20
Pages
101223
ISSN
2211-3355 (ISSN-L)
DOI
10.1016/j.pmedr.2020.101223
PMC
PMC7567954
OpenAlex
W3092570186
Cited by
154
References
0
Citations by year
2026: 21 · 2025: 38 · 2024: 29 · 2023: 30 · 2022: 25 · 2021: 8 · 2020: 2
FWCI
1.74
Type
journal article
Language
en
Open access
Licence
Locations
  • Preventive Medicine Reports (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • National University of Singapore (submittedVersion, cc-by-nc-nd)
Funders
National University of Singapore
Topics
  • Health Sciences › Medicine › Oncology › Colorectal Cancer Screening and Detection
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
Keywords
Health Belief Model, colorectal cancer screening, screening uptake, perceived susceptibility, perceived benefits, cues to action, perceived barriers, screening intention, sociodemographic factors, cultural norms, preventive health behavior, behaviour change theory

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