Table 1.

Themes, according to facilitators and barriers, associated with participation in colorectal cancer screening, with exemplary quotes

ThemeFactorExemplary quote
Facilitators
AwarenessAppropriate 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 testsPositive 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 screeningDesire 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 awarenessLack 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 cancerFear 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 testsNegative 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 motivationOther 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, socioeconomicNatural 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.