Understanding lung cancer screening motivation: cognitive, affective, and thought-based predictors in a UK screening-eligible sample

Background: A nationwide targeted lung cancer screening program is underway in the United Kingdom, but uptake in recent trials remains modest, and little is known about the psychological processes that might influence uptake. Purpose: This study aimed to understand how individuals respond to a lung cancer screening invitation by identifying the key psychological, cognitive, and affective variables shaping screening intention and the thought processes underlying them. Methods: UK screening-eligible current and former smokers aged 55-74 years (N = 1106) read an online lung screening invitation before providing their unprompted thoughts and completing measures of cognitive and affective variables (attitude; descriptive, subjective, and moral norms; perceived behavioral control; fear; anticipated regret; and fatalism). Logistic regressions examined predictors of screening intention, with follow-up analyses linking thought content to significant cognitive and affective predictors. Results: Moral and descriptive norms, perceived behavioral control, and inaction regret were positively associated with intention, while fear and anticipated regret associated with taking part and receiving abnormal results were negatively associated. Thoughts reflecting NHS program doubts, stigma, and cancer worry were consistently negatively associated with cognitive and affective predictors, whereas perceived screening benefits of early detection and peace of mind, and personal/family cancer history were positively associated. Conclusion: Screening motivation was shaped by both cognitive and affective factors, underpinned by distinct thoughts. Findings suggest that health communication interventions may strengthen moral and descriptive norms, leverage inaction regret, and enhance self-efficacy by addressing feelings of stigma, embarrassment, and cancer worry to increase screening participation at this critical stage of national implementation.