Abstract for: From Recruitment to Reinforcement: Dynamics of Participation in Lung Cancer Screening

Lung cancer screening can reduce mortality through early detection, yet participation among eligible individuals remains low. Existing models typically treat participation as exogenous, limiting understanding of how participation evolves over time and constraining the ability to evaluate interventions that depend on behavioral responses within the population. This study develops a system dynamics model that represents screening participation as an endogenous process shaped by disease progression, treatment outcomes, and behavioral perceptions, including perceived benefit, threat, and exposure. The model also incorporates an exogenous recruitment intervention representing time-limited outreach efforts that temporarily increase participation through mechanisms such as targeted invitations and community engagement. Simulation results show that recruitment interventions alone produce only short-term increases in participation and recovery, with system behavior returning to baseline after the intervention ends. In contrast, when recruitment is combined with perception-driven feedback mechanisms, the system exhibits sustained increases in participation, leading to higher long-term recovery rates and improved population-level outcomes. These findings highlight the importance of behavioral feedback mechanisms in shaping participation dynamics and help explain persistent low uptake in lung cancer screening. Interventions that target underlying perceptions and behavioral responses, rather than participation alone, may be necessary to achieve lasting improvements. Modeling participation as an endogenous process provides a useful framework for evaluating such strategies. Proof reading