Cancer screening participation shows a strong, graded association with socioeconomic status (SES) not only in countries such as the United States, where insurance status can be a barrier for lower income groups, but also in the United Kingdom, where the National Health Service provides all health care to residents, including screening, for free. Traditionally, the literature on socioeconomic inequalities has focused on upstream factors, but more proximal (downstream) influences on screening participation also need to be examined, particularly those that address the graded nature of the association rather than focusing specifically on underserved groups. This review offers a framework that links some of the components and corollaries of SES (life stress, educational opportunities, illness experience) to known psychosocial determinants of screening uptake (beliefs about the value of early detection, fatalistic beliefs about cancer, self-efficacy). The aim is to explain why individuals from lower SES backgrounds perceive cancer screening tests as more threatening, more difficult to accomplish, and less beneficial. A better understanding of the mechanisms through which lower SES causes negative attitudes toward screening could facilitate the development of intervention strategies to reduce screening inequalities.

中文翻译：

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癌症筛查参与中社会经济不平等的社会心理决定因素：一个概念框架。

癌症筛查参与显示出与社会经济地位 (SES) 的强烈分级关联，不仅在美国等国家，保险状况可能成为低收入群体的障碍，而且在英国，国家卫生服务提供免费为居民提供所有医疗保健服务，包括筛查。传统上，关于社会经济不平等的文献主要关注上游因素，但也需要检查对筛查参与的更近端（下游）影响，尤其是那些解决关联分级性质的问题，而不是专门关注服务不足的群体。本综述提供了一个框架，将 SES 的一些组成部分和推论（生活压力、教育机会、疾病经历）到筛查采用的已知心理社会决定因素（关于早期检测价值的信念、关于癌症的宿命论信念、自我效能）。目的是解释为什么来自较低 SES 背景的人认为癌症筛查测试更具威胁性、更难完成且获益更少。更好地了解较低 SES 导致对筛查的负面态度的机制可以促进干预策略的制定，以减少筛查不平等。