Improving colorectal screening uptake: lessons from higher uptake of breast and cervical screening using mixed-methods

Abstract

Background: The aim of this research was to inform new approaches to increase uptake of colorectal cancer screening by comparing facilitators and barriers across the breast, cervical and colorectal screening programmes. Methods: Phase 1 examined factors (age, socioeconomic status, comorbidities) associated with lower uptake of colorectal cancer screening relative to breast and cervical screening among women using linked data from NHS Greater Glasgow and Clyde. Data were analysed using logistic regression. Phase 2 investigated why women chose to participate in none, some or all screening programmes and examined unique barriers to colorectal screening using qualitative interviews with a purposive sample of women identified through the Phase 1 dataset. Data were analysed using framework analysis. Findings: Phase 1–430,591 women were invited to at least one of the screening programmes during 2009-2013. Uptake was 62% for colorectal, 73% for breast and 81% for cervical screening. Those living in more deprived areas and those with more multi-morbid illness were less likely to participate in all screening programmes. Phase 2-women who avoided colorectal screening found this self-completed test posed more practical barriers, induced disgust, and was easier to postpone or forget about than breast or cervical screening. Discussion: To identify targets to increase uptake of colorectal screening the results of Phases 1 and 2 were synthesised into the four categories described by Sheeran, Klein and Rothman (2016): i) cognitions about the health threat; ii) cognitions about the health behaviour; iii) implicit cognition; iv) volitional factors.