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Background: Social inequalities in colorectal cancer screening participation are evident. Barriers to screening participation include discomfort from diagnostic modalities. We aimed to describe the discomfort experienced from colonoscopy and colon capsule endoscopy (CCE) and investigate the discrepancy between expected and experienced discomfort stratified by socioeconomic status. Methods: A randomised controlled trial was conducted offering half of the colorectal cancer screening invitees the choice between CCE and colonoscopy after a positive faecal immunochemical test. This paper includes those who elected to undergo CCE. A positive CCE elicited referral for a therapeutic colonoscopy. Participants reported their discomfort from CCE and from any following colonoscopies in electronically distributed questionnaires. Discomfort was measured using visual analogue scales and compared between socioeconomic subgroups determined by educational level and income. Results: The experienced discomfort from CCE and colonoscopy differed significantly between educational levels but not income levels. The bowel preparation contributed the most to the experienced discomfort in both CCE and colonoscopy. The discrepancy between expected and experienced discomfort from colonoscopy increased with increasing educational and income levels. A similar trend was seen in CCE between educational levels but not income levels. Conclusions: None of the results indicated a higher discomfort in lower socioeconomic subgroups. Regardless of the investigation modality, the bowel preparation was the main contributor to experienced discomfort. The discrepancy between expected and experienced discomfort did not seem to be larger in lower socioeconomic subgroups, indicating that this is not a major barrier causing inequalities in screening uptake. This is the first study investigating individual discomfort discrepancy in both CCE and colonoscopy, while being able to stratify by socioeconomic status.

Interventions that support social relationships are widely used to promote mental health and increasingly involve the use of digital technologies. Solid theoretical underpinning is crucial for interventions to achieve the intended outcomes and avoid unintended consequences. Several theories linking social relationships to mental health exist in the literature but plurality and overlapping elements complicate the choice of appropriate theory. The aim of this study was to systematically review and synthesize theories linking social relationships to mental health to extract key theoretical assumptions to explain 1) how social relationships influence mental health, and 2) the circumstances that distinguish beneficial social relationships from relationships that have no effects or cause harm. Results of the synthesis are discussed in relation to general interventions, and implications for the use of digital interventions as novel tools to support social relationships and mental health are drawn out. The systematic search was performed in five electronic databases: PubMed, Sociological Abstracts, PsycINFO, CINAHL, and Embase. Six theoretical frameworks met our inclusion criteria and were included in the synthesis. The theory synthesis followed three stages: 1. synthesis preparation, 2. synthesis, and 3. synthesis refinement. Findings show that various social relationships influence people's mental health, both in adverse situations and in those without adversities. Their impact is shaped by a complex interplay of individual and relational circumstances and the individual's subjective perceptions. Quality and content are central to separating beneficial relationships from those that are not beneficial. Findings support the potential of interventions based on social relationships to improve mental health but highlight the need to consider the circumstances where relationships might do more harm than good. Digital interventions may improve people's opportunities to develop new relationships or strengthen existing ones, but they require a special focus on ensuring the quality and content of relationships to maximize this potential benefit.