Explaining Individual Differences in Colorectal Cancer Screening Preferences: Analysis and Meta-analysis of Discrete Choice Experiments
- Author(s): Boyajian, Jonathan Graeme
- Advisor(s): Brown, Paul M.
- et al.
Colorectal cancer (CRC) is the second leading cause of cancer related death in the U.S. among men and women combined. In addition to the personal toll it takes, CRC is estimated to cost billions of dollars annually in medical costs. Due to the high rates and costs of CRC, a significant public health effort has been made to promote participation in screening, which has been shown to be effective at reducing CRC incidence and mortality rates; however, despite efforts to promote screening and research showing its effectiveness, screening rates remain low. Approaches to increasing screening participation focus on understanding the decision-making process people go through regarding screening. Health economics and health psychology provide two unique approaches to understanding this decision-making process. Health economics approaches model screening behavior as a function of the screening characteristics themselves while health psychology approaches model screening behavior as a function of individual factors related to perceptions and beliefs. This dissertation set out to explain individual differences in screening preferences using both health economics and health psychology approaches. This dissertation utilized three different methods, including a systematic review and meta-analysis, a latent class analysis of discrete choice data, and a discrete choice experiment (DCE) that included psychological factors as characteristics of the screening process. We found evidence to support the hypothesis that differences in screening preferences exist and that individual factors like socio-demographic and psychological factors may play a role in explaining these differences. We also found evidence to support the validity of including psychological factors as attributes that vary in a DCE. This dissertation discusses the implications of the findings for theory, research, and the development of future screening programs.