Predictors of gastric cancer screening behavior during the COVID-19 pandemic: A longitudinal study in Japan

BACKGROUND: Cancer screening rates declined during the COVID-19 pandemic. Identifying the psychological processes that promote participation in cancer screening, even during infectious disease outbreaks, is essential. This study focused on gastric cancer, which has a high incidence rate in Asia, and examined the factors promoting cancer screening intentions during the pandemic, considering the health intention model, implementation intention, and risk perceptions/fear of COVID-19. METHODS: Two waves of longitudinal surveys were conducted in August 2022, when the pandemic continued, among Japanese individuals without a history of cancer. Wave 1 (N = 317) measured health literacy, perceived susceptibility, cues to action, implementation intentions, and COVID-19 cognition. Wave 2 (N = 270), conducted four months later, assessed about the actual screening behavior since wave 1. RESULTS: Structural equation modeling showed that health literacy, perceived susceptibility, and cues to action increased screening intentions. Furthermore, screening intention increased implementation intentions, which in turn promoted actual screening behavior four months later. Conversely, fear of COVID-19 increased screening intention in the short term, but inhibited screening behavior in the long term. CONCLUSION: These results indicate that screening behavior during a pandemic could be promoted by factors that previous research has shown to play an important role. However, it also suggests that fear of COVID-19 could function as both a promoter and inhibitor of screening uptake, warranting careful consideration when encouraging cancer screening during a pandemic.