Psychosocial and sociodemographic factors influencing colorectal cancer screening uptake: a qualitative analysis

Abstract

Background: Colorectal cancer (CRC) is a leading cause of mortality and morbidity. Regular screening is linked to significant reductions in CRC incidence and mortality, however uptake remains low. We explored factors influencing decision-making in relation to CRC screening by variation in ethnicity, socioeconomic status (SES), gender and screening history. Methods: Semi-structured interviews were undertaken with 27 people aged 60-74 years. Men (n=12) and women (n=15), who had previously been screened (n=15) or not (n=12), took part. Participants were from White British (n=13) and ethnic minority backgrounds (n=14), and had either low (n=11) or high SES (n=16). SES was assessed based on postcodes using the Index of Multiple Deprivation. Interviews were analysed using Thematic Analysis. Findings: Main themes were Perceived Barriers, Perceived Benefits and Improving Uptake. Non-screeners were more negative towards screening, more likely to perceive cancer as a ‘taboo’ and expressed less positive views towards treatment options. Men were less positive towards the screening process and experienced more aversive emotions (e.g. embarrassment, disgust) than women. Cancer fear was a barrier for all ethnic groups of varying SES. Valuing early diagnosis and a sense of obligation towards the health system facilitated screening for female, White British participants. Difficulty to understand health information was a barrier for low SES and ethnic minority participants. Discussion: Structural barriers, such as the difficulty to process health-related information, as well as emotional barriers, such as fear and disgust, may contribute to explaining low CRC screening uptake. Consideration of particular groups could be useful for intervention development.