Indigenous Fatalism Attribution and Colorectal Cancer Screening Uptake in Nigerian Primary Care: A Factorial Vignette Experiment on Causal Beliefs and Refusal

Colorectal cancer screening uptake in Nigeria remains low, and clinicians commonly attribute refusal to fatalistic beliefs rooted in indigenous causal attributions. Participants were randomised across a 4 × 2 × 2 design crossing causal attribution with provider recommendation strength and cost framing. The primary outcome was a five-point intention-to-screen scale. Contrary to the fatalism hypothesis, spiritual and witchcraft attributions did not reduce intention relative to biomedical attribution; hereditary destiny produced the lowest intention (adjusted mean difference = −0.41, 95% CI [−0.72, −0.10], p =.009). Provider recommendation strength exerted the largest effect (adjusted mean difference = 0.68, 95% CI [0.44, 0.92], p <.001). The findings suggest that indigenous fatalism is not a unitary barrier and that attributional beliefs operate through perceived controllability rather than through resignation. Screening promotion in Nigerian primary care should target hereditary-destiny attributions and strengthen provider recommendation rather than attempting to displace spiritual causal beliefs.