Emotional Barriers to Bowel Screening in Italy: Scale psychometric properties and effects on screening attendance

Objective: To assess a three-factor version of the Emotional Barriers to Bowel Screening (EBBS) scale; analyze the scale's psychometric properties; and investigate the associations of fecal disgust, embarrassment, and fear with colorectal cancer (CRC) screening avoidance. Methods: Retrospective design: We asked participants to rate negative emotions associated with CRC screenings as well as whether they had ever attended a fecal occult blood test. Sample: 268 Italian adults aged 45−74 years. Measures: negative emotions, screening knowledge, CRC risk perception, demographic and background data, and hypothetical medical help-seeking. Analyses: Confirmatory factor analyses, correlations, logistic regressions. Results: The EBBS scale is a multidimensional instrument and, at least where fecal tests are of interest, can be used without the insertion disgust subscale. The analyzed negative emotions were negatively correlated with screening attendance and positively correlated with intention to delay seeking medical help. However, logistic regression models showed that, of the three analyzed emotions, fear about outcome was the only significant predictor of screening behavior and delaying medical care. Conclusions: Further studies can adopt the version of the EBBS scale that is most suitable for their research contexts. Interventions must be designed to reassure patients.