Is the Accuracy of Self-Reported Colorectal Cancer Screening Associated with Social Desirability?

University of Texas-Houston School of Public Health, Division of Health Promotion and Behavioral Sciences, 7000 Fannin Street, Suite 2560, Houston, TX 77030, USA.
Cancer Epidemiology Biomarkers & Prevention (Impact Factor: 4.13). 12/2011; 21(1):61-5. DOI: 10.1158/1055-9965.EPI-11-0552
Source: PubMed


Self-reported cancer screening behaviors are often overreported and may lead to biased estimates of prevalence and of subgroup differences in screening. We examined whether the tendency to give socially desirable responses was associated with concordance between self-reported colorectal cancer (CRC) screening behaviors and medical records.
Primary care patients (n = 857) age 50 to 74 years completed a mail, face-to-face, or telephone survey that assessed CRC screening and social desirability measured by a short version of the Marlowe-Crowne scale. We used medical records to verify self-reports of fecal occult blood testing (FOBT), sigmoidoscopy, colonoscopy, and barium enema.
Social desirability scores were lower for whites versus African Americans, college graduates, and patients reporting no prior screening tests; they were higher for telephone versus mail or face-to-face survey respondents. In univariable logistic regression analysis, social desirability scores were not associated with concordance for FOBT (OR = 1.03, 95% CI = 0.94-1.13), sigmoidoscopy (OR = 0.95, 95% CI = 0.86-1.04), or colonoscopy (OR = 0.99, 95% CI = 0.88-1.11); however, lower social desirability scores were associated with increased concordance for barium enema (OR = 0.87, 95% CI = 0.77-0.99). In multivariable analyses, no associations were statistically significant.
Social desirability as measured by the Marlowe-Crowne scale was not associated with accuracy of self-reported CRC tests in our sample, suggesting that other explanations for overreporting need to be explored.
By understanding sources of response bias, we can improve the accuracy of self-report measures.

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Available from: Jan Marie Eberth, Oct 07, 2015
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    • "The impact of the intention item is premised on the notion that by asking people if they intend to engage in a socially desirable behavior such as CRC screening before the actual past behavior, they will feel less pressure to misrepresent their past practice of that behavior in a positive light. However, recent studies have found that the accuracy of self-reported CRC screening is unrelated to social desirability [14,15], so one could posit that the accuracy of CRC screening would be little impacted by the inclusion of the intention item. "
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    ABSTRACT: Self-reported colorectal cancer (CRC) screening behavior is often subject to over-reporting bias. We examined how the inclusion of a future intention to screen item (viz. asking about future intentions to get screened before asking about past screening) and mode of survey administration impacted the accuracy of self-reported CRC screening. The target population was men and women between 49 and 85 years of age who lived in Olmsted County, MN, for at least 10 years at the time of the study. Eligible residents were randomized into four groups representing the presence or absence the future intention to screen item in the questionnaire and administration mode (mail vs. telephone). A total of 3,638 cases were available for analysis with 914, 838, 956, and 930 in the mail/future intention, mail/no future intention, telephone/future intention, and telephone/no future intention conditions, respectively. False positives were defined as self-reporting being screened among those with no documented history of screening in medical records and false negatives as not self-reporting screening among those with history of screening. Comparing false positive and false negative reporting rates for each specific screening test among the responders at the bivariate level, regardless of mode, there were no statistically significant differences by the presence or absence of a preceding future intention question. When considering all tests combined, the percentage of false negatives within the telephone mode was slightly higher for those with the future intention question (6.7% vs 4.2%, p = 0.04). Multivariate models that considered the independent impact of the future intention question and mode, affirmed the results observed at the bivariate level. However, individuals in the telephone arm (compared to mail) were slightly (though not significantly) more likely to report a false positive (36.4% vs 31.8%, OR = 1.11, p = 0.55). It may be that in the context of a questionnaire that is clearly focused on CRC and with specific descriptions of the various CRC screening tests, certain design features such as including intention to screen items or mode of administration will have very little impact on the accuracy of self-reported CRC screening.
    BMC Medical Research Methodology 02/2014; 14(1):19. DOI:10.1186/1471-2288-14-19 · 2.27 Impact Factor
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    • "However, the validity of self-report may be of particular concern for these same groups, and the literature is not clear on the subject. For example, the tendency to give socially desirable responses may be higher among those with less education and among non-White survey respondents, but lower among the unscreened.19 As well, previous reviews of the literature have suggested that Hispanic and African-American women disproportionately over-report Pap test screening compared with their White counterparts,3,7 and contradictorily, that minority or low socioeconomic status is not associated with accuracy of Pap test recall.6 "
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    ABSTRACT: The aim was to review the international literature on the validity of self-report of cervical cancer screening, specifically of studies that made direct comparisons among women with and without social disadvantage, based on race/ethnicity, foreign-born status, language ability, income, or education. The databases of Medline, EBM Reviews, and CINAHL from 1990 to 2011 were searched using relevant search terms. Articles eligible for data extraction documented the prevalence of cervical cancer screening based on both self-report and an objective measure for women both with and without at least one measure of social disadvantage. The report-to-record ratio, the ratio of the proportion of study subjects who report at least one screening test within a particular time frame to the proportion of study subjects who have a record of the same test within that time frame, was calculated for each subgroup. Five studies met the extraction criteria. Subgroups were based on race/ethnicity, education, and income. In all studies, and across all subgroups, report-to-record ratios were greater than one, indicative of pervasive over-reporting. The findings suggest that objective measures should be used by policymakers, researchers, and public-health practitioners in place of self-report to accurately determine cervical cancer screening rates.
    International Journal of Women's Health 01/2013; 5(1):29-33. DOI:10.2147/IJWH.S39556
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    ABSTRACT: In a previous report, we demonstrated the efficacy of an intervention to promote colorectal cancer screening among African Americans in a controlled community intervention trial. Participants in the intervention, named EPICS (Educational Program to Increase Colorectal Cancer Screening), were twice as likely to be screened after six months as those in the control group. In the current project, we put the intervention into practice through an academic-health department partnership, and the intervention performed as well as it had in the controlled trial. This success may be due to the community-based participatory methods used in designing and testing the intervention. Clin Trans Sci 2012; Volume 5: 412-415.
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