Systematic Review and Meta-study Synthesis of Qualitative Studies Evaluating Facilitators and Barriers to Participation in Colorectal Cancer Screening

In a Dutch study, 12% of non-attenders had sufficient knowledge to make an informed decision.

“whereas 12% of the non-attenders had sufficient knowledge to make an informed decision [9].”

The results are mixed about the role of health literacy in different populations and minority groups.

“The results are mixed about the role of health literacy in different populations and minority groups [9].”

For CRC, lack of awareness of CRC as a disease and lack of knowledge of the role of screening in CRC prevention can be barriers to screening.

“For CRC for example, the lack of awareness of CRC as a disease and lack of knowledge of the role of screening in CRC prevention [9]”

Motivation is positively associated with screening attendance.

“Motivation has been positively associated with screening attendance [9,14,17,18].”

In a Dutch study, 19% of participants who attended screening did not have sufficient knowledge to make an informed choice.

“In a Dutch study 19% of the participants who attended the screening did not have sufficient knowledge to make an informed choice”

Fear of treatment is an emotional barrier.

“Emotional barriers include fear of cancer, screening results and treatment [8,9,15] and fatalism [10,24].”

Fear of cancer is an emotional barrier.

“Emotional barriers include fear of cancer, screening results and treatment [8,9,15] and fatalism [10,24].”

For women, perceiving CRC as a male disease has been a barrier for screening.

“For women, perceiving CRC as a male disease has been a barrier for screening [7,9].”

Motivation to stay healthy and have peace of mind is associated with increased screening.

“For example, autonomous motivation [16], i.e., acting out of a sense of willingness as opposed to pressure [19], motivation to stay healthy and have peace of mind, and motivation due to someone close being affected by cancer [9] have been associated with increased screening.”

Motivation due to someone close being affected by cancer is associated with increased screening.

“For example, autonomous motivation [16], i.e., acting out of a sense of willingness as opposed to pressure [19], motivation to stay healthy and have peace of mind, and motivation due to someone close being affected by cancer [9] have been associated with increased screening.”

Belief that natural remedies thwart cancer is a barrier to CRC screening in ethnic minority and male groups.

“Barriers to CRC screening in ethnic minority and male groups include beliefs that natural remedies thwart cancer, ethnic food protects from cancer, and screening offends masculinity and manhood [9].”

Belief that ethnic food protects from cancer is a barrier to CRC screening in ethnic minority and male groups.

“Barriers to CRC screening in ethnic minority and male groups include beliefs that natural remedies thwart cancer, ethnic food protects from cancer, and screening offends masculinity and manhood [9].”

Belief that screening offends masculinity and manhood is a barrier to CRC screening in ethnic minority and male groups.

“Barriers to CRC screening in ethnic minority and male groups include beliefs that natural remedies thwart cancer, ethnic food protects from cancer, and screening offends masculinity and manhood [9].”

Lack of transportation and difficulties in finding an escort for older adults are accessibility barriers.

“Accessibility barriers include long distances and lack of access to healthcare services [10] as well as lack of transportation and difficulties in finding an escort for older adults [9].”

Competing life demands such as other diseases, childcare responsibility, no possibility to take time off, and being busy with housework are widely cited barriers.

“Barriers such as other diseases, responsibility of childcare, no possibility to take time off, and being busy with housework are widely cited [9,13,22,23,30].”

Addressing structural and motivational barriers may be essential to raising participation rates as knowledge does not always translate into action.

“Addressing structural and motivational barriers may be essential to raising participation rates as knowledge does not always translate into action [9, 44, 51, 65].”

In RCTs, small media has had a modest impact on CRC screening uptake, although not demonstrated in all studies.

“In RCTs, small media has had a modest impact on CRC screening uptake, although not demonstrated in all studies [9].”

Awareness raising usually relies on one-way information provision through small media (booklets, videos, letters) and less often mass media.

“Awareness raising usually relies on one-way information provision through small media e.g., booklets, videos, letters [9,38,39], and less often mass media [38].”

The influence of mass media on cancer screening is inconsistent and difficult to assess.

“The influence of mass media is inconsistent and difficult to assess [9].”