Construct Definition and Scale Development for Defensive Information Processing: An Application to Colorectal Cancer Screening

Objective: Individuals have a large repertoire of defensive strategies for dealing with personally relevant negative feedback including health risk information. Defensive processes are covered in a diverse literature and in theoretical models such as the extended parallel process model, but outside the psychopathological domain, little attention has been paid to the conceptualization and measurement of defenses. In this study, we reviewed the broad literature and developed an integrated conceptual model of various defensive strategies to guide measurement development. In addition, we developed and tested measures of defensiveness for colorectal cancer screening, an important public health issue. Method: We conducted 2 surveys of independent samples of screening-age adults (n = 226, 287) to iteratively test and refine measures using confirmatory factor analysis and structural equation models. Results: Our conceptual model informed our development of measures for 4 stages of defensive information processing (attention avoidance, blunting, suppression, and counterarguing) and the literature review identified potential measures for each stage. Final subscales ranged from 3 to 8 items, showed good internal reliability, and demonstrated expected patterns of association with other correlates of colorectal cancer screening. Items available in both surveys were found to be largely invariant across adherence status to screening guidelines. Conclusion: Future research is planned to replicate and validate these scales. We anticipate that the conceptual model and sample measures will increase understanding of defensive processes and can be used in the design and evaluation of future interventions and cancer risk communications to potentially reach and impact more resistant individuals.