Socio-psychological factors in the Expanded Health Belief Model and subsequent colorectal cancer screening

•Tested association between Expanded Health Belief Model factors and colorectal cancer screening.•Self-efficacy, stage of readiness, and discussions with provider were associated with screening.•Neither barriers nor knowledge were statistically significantly associated with screening.•Data are useful in parsimoniously predicting patients most likely to engage in CRC screening.

ObjectiveCRC screening interventions tailored to the Expanded Health Belief Model (EHBM) socio-psychological factors have been developed, but the contributions of individual factors to screening outcomes are unclear.MethodsIn observational analyses of data from a randomized intervention trial, we examined the independent associations of five EHBM factors - CRC screening knowledge, self-efficacy, stage of readiness, barriers, and discussion with a provider - with objectively measured CRC screening after one year.ResultsWhen all five factors were added simultaneously to a base model including other patient and visit characteristics, three of the factors were associated with CRC screening: self-efficacy (OR = 1.32, p = 0.001), readiness (OR = 2.72, p < 0.001), and discussion of screening with a provider (OR = 1.59, p = 0.009). Knowledge and barriers were not independently associated with screening. Adding the five socio-psychological factors to the base model improved prediction of CRC screening (area under the curve) by 7.7%.ConclusionPatient CRC screening self-efficacy, readiness, and discussion with a provider each independently predicted subsequent screening.Practice implicationsSelf-efficacy and readiness measures might be helpful in parsimoniously predicting which patients are most likely to engage in CRC screening. The importance of screening discussion with a provider suggests the potential value of augmenting patient-focused EHBM-tailored interventions with provider-focused elements.