Article Figures & Data
Figures
- Figure 1.
Study selection PRISMA flow chart.
- Figure 2.
A novel conceptual framework of factors influencing the decision to participate in colorectal cancer screening.
Tables
- Table 1.
Themes, according to facilitators and barriers, associated with participation in colorectal cancer screening, with exemplary quotes
Theme Factor Exemplary quote Facilitators Awareness Appropriate awareness of CRC screening and purpose of screening are pre-requisites for CRC screening participation (9–11, 13, 31, 34–40, 52, 57, 60, 67, 68, 75, 78, 80, 87, 106, 108) “If the cancer was found at the first stage, of course, the cancer will be cured more easily than the cancer found at the third or fourth stage… So when the doctor asked me to have a [FOBT], I did it right away” (11) Positive attitudes towards CRC screening tests Positive attitudes and preferences for CRC screening test (13, 18, 31, 34, 35, 37, 38, 40–42, 46, 56, 57, 63, 66, 77, 80, 82, 83, 85, 88, 89, 93, 95, 106, 124–126) “At least [its] not painful…it's in privacy of your own home” (41) Motivation for screening Desire to stay healthy and peace of mind (10, 19, 36, 48, 54–57, 68, 73, 80, 86, 88, 90) “Put your mind at ease that you're not effected by whatever they are screening for” (54). Having a close individual affected by CRC (10, 13, 52, 54, 55, 58–62, 74, 75, 121) “If somebody you know has suffered with whatever then it makes you think ‘should I be tested for this, should I do that?” (58) Spouse as motivators (13, 31, 34, 57, 58, 61–66) “Well simply that wives frequently provide guidance in these matters to their husbands.” (61) Barriers Lack of awareness Lack of awareness of CRC screening (9, 10, 13, 16–18, 20, 31, 34, 36–38, 40–44, 47–50, 63, 65, 69, 71, 72, 78–80, 82, 83, 90, 107) “I have never heard of colorectal cancer screening. I was never recommended to do it and nobody has ever told me it's available. If I had known that there are various methods of colorectal cancer screening, I would you have gone for it or at least find out more about it” (82) Symptom-driven testing (11, 13, 17, 18, 31, 36–38, 41, 44, 46, 48, 53–56, 58, 59, 62, 68, 71, 74, 75, 77, 78, 80, 82, 84, 86, 90, 97, 98, 100, 102) “Nothing wrong with me. Why should I do that [screening test]?” (102) Negative views of cancer Fear of cancer, screening results and treatment (10, 11, 13, 17, 31, 34–36, 41, 42, 44–46, 48–50, 52–58, 60, 65, 68–70, 74, 75, 77, 82–87, 90, 93, 96, 106, 121, 127–129) “…you are afraid that the doctor is going to tell you that you have cancer, so a lot of times you don't go because you are scared” (49) Cancer is fatal and no screening can stop it (9, 10, 31, 34, 36, 38, 45–47, 49, 52, 53, 55, 58, 63, 65, 68, 72, 74, 82, 83, 87, 98, 108, 127) “When I hear about cancer, the first thing I think is death” (53) Negative attitudes towards CRC screening tests Negative attitudes towards CRC screening tests (12, 17, 18, 31, 38, 40–42, 45–48, 50, 52, 55, 66, 68–71, 73–75, 82, 84, 86, 88, 90, 102, 105–107, 124, 126) “I think they're [colonoscopy, flexible sigmoidoscopy], you know, invasive and physically unpleasant” (40) Embarrassment (13, 33, 41, 42, 44, 45, 48, 49, 54, 55, 58, 60, 63, 65, 67, 72, 73, 80, 105, 124, 127) “I think what happens is that it is something intimate and embarrassing. – Ashamed. – More intimate than a pap smear or mammography” (13) Questioning efficacy of the test (9, 18, 19, 31, 34, 41, 42, 49, 56, 72, 82, 88, 89) “[Every] six months you go see your doctor and he said you got no cancer, next six month you see your doctor he says you are going to die…” (56) Lack of motivation Other health concerns deterred from seeking screening (13, 18, 35, 36, 43, 45, 50, 55, 56, 90, 91) “I don't think too much about [CRC risk]… I worry more, I think, that I might get it [cancer] in the breast than anywhere else. Cause I've had lumps there” (90) Competing life demands deterred from seeking screening (13, 17, 20, 36, 39, 43, 45, 47, 48, 50, 54, 60, 82) “I've been busy with work and looking after the family. When I go home, I'm so tired I can't take out extra time to go down to the hospital. And the queue's really long in hospital, right?” (82) Scheduling challenges (34, 50, 70, 76, 85, 86, 92, 93) “It was more of a scheduling problem with the endoscopy clinic” (86) Cultural, gender, socioeconomic Natural remedies conquer CRC (11, 54, 59, 68, 69) “Back home we have a lot of good home remedies. These remedies can cure most anything. I have a good remedy for stomach aches. Whenever I get a cold I boil ‘ti bonm’ and drink it hot and right away my stomach feels better” (69) Ethnic food protect from CRC (18, 53, 59, 60) “We are different because our diet is predominantly fibre-based… so maybe there isn't [CRC] a lot in our community” (80) Wellness visits are not part of the culture (13, 63, 69, 72, 73, 84) “In our culture we don't do these kinds of tests unless vital” (73) CRC screening tests are offensive to masculinity and manhood (13, 16, 31, 36, 40, 44, 45, 57, 64, 65, 79–81, 95, 127) “a threat to masculinity: “an attack on your armour” (80) Females perceived CRC as a male disease (31, 33, 34, 36, 65, 80, 90, 105–107) “I thought it [CRC] was a man's disease” (106) Taking time off was not possible (17, 42, 63, 66, 84, 86, 96) “The time when the office or hospital is operand is not a good time for me. I work during the weekday and cannot get a day off” (96) Transportation and finding an escort was a challenge (36, 84, 85, 88, 92, 96) “We do not have cars or a second car, and there is no public transportation in our area so it is not as easy to go see the doctor.” (85) Low health literacy (11, 18, 31, 36, 38, 40, 45, 46, 63, 71, 89, 93, 106) “Then we go into as to the polyps and the lumps and so forth and it seems to be oriented a little more for some of us familiar with this type of, well with these names and so forth…” (71) Language barriers (9–11, 49, 72, 80, 92, 97, 99) “[Providers from another clinic] just told us to take [the FOBT instructions] back and read it ourselves… You know Chinese—we don't understand English that much. So I just threw it aside…I did not do it because I don't quite understand” (11) Abbreviation: CRC, colorectal cancer.
- Table 2.
Modifiers of facilitators and barriers associated with participation in colorectal cancer screening, with exemplary quotes
Modifiers Exemplary quote Facilitators Public education raises awareness and addresses misconceptions and unrealistic fears (10, 18, 31, 37, 65, 86) “The more it's in the media, the more socially acceptable it is to talk about it [CRC]” (31) PCP recommendation motivate individuals to get screened (10, 11, 18, 19, 31, 34, 36–38, 43, 54–56, 60, 65, 68, 71, 75, 121) “If my doctor says to… I'd go ahead and have one done.” (34) Interpersonal communication with PCP (12, 48, 63, 69, 78, 81, 90, 97, 108, 124) “Talking to the patient in the language the patient can understand…that's the key.” (81) Friends, family, and partners are important source of information and emotional support (18, 38, 49, 61, 81, 128) “If she [spouse] says, ‘Ah, I'm not going to do it’, I say, ‘Ah, neither am I', but if she says, ‘I'm going to do it’, I say, ‘Ah, me too” (13) Barriers Little public education about CRC compared with other cancers (13, 17, 19, 31, 43–45, 59, 64, 65, 69, 80, 85, 99, 101, 102, 107) “I couldn't tell you what could cause colon cancer because they don't talk much about this subject. Talk about other types of cancer is more common” (44) Lack of physician's recommendation and approach was a powerful deterrent for CRC screening participation (9, 16, 18, 20, 31, 33, 36, 42, 45, 52, 59, 65, 70, 84, 90, 92, 99, 130) “My doctor never said anything to me about it. If he wanted me to have it, wouldn't he say something?” (65) Friends, family, and kin accounts of a negative experience (31, 45, 60, 61, 70, 75–77) (36) “I know people who found out they had cancer and they died in 2 months” (36) PCP inadequate explanation (47, 67, 81, 90, 104, 126, 131) “You can go all high falutin' [sic] and talk about prostate-specific antigens, and if the patient doesn't understand what that means, he's going to get frightened.” (81) Abbreviations: CRC, colorectal cancer; PCP, primary care physician.
Supplementary Data
- Supplementary Tables S1-S3 - Supplementary tables include: details of search strategy (S1), characteristics of included studies (S2), and quality assessment of included studies (S3).
June 2016
Volume 25, Issue 6
Volume 25, Issue 6
Systematic Review and Meta-study Synthesis of Qualitative Studies Evaluating Facilitators and Barriers to Participation in Colorectal Cancer Screening
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