A Qualitative Exploration of the Decision Not to Take Part in Colorectal Cancer Screening Among Women Living in Lower Socio-Economic Areas.

Abstract

Background: Organized colorectal (CRC) screening programmes offer an opportunity to reduce the burden of the disease on populations. CRC screening participation among women is substantially lower than breast or cervical cancer screening. Uptake is also lower in areas of greater deprivation which could exacerbate inequalities in CRC; however, few studies have been conducted with women resident in lower socio-economic areas who were invited for screening but did not participate. The aim of this study was to explore women's decisions not to take part in Ireland's population-based BowelScreen programme.

Methods: Semi-structured interviews were conducted with women resident in lower socio-economic areas, who had not participated in BowelScreen. Deductive thematic analysis, guided by the Theoretical Domains Framework (TDF: 14 domain version), using the framework approach was conducted.

Results: Fifteen women from lower socio-economic areas in Ireland who had not participated in BowelScreen were interviewed. Six TDF domains were identified as influencing non-participation; (1) Environmental Context and Resources; stressful life events and lack of healthcare professional recommendations, (2) Memory, Attention and Decision Making; delayed decision making and deciding screening is not personally relevant, (3) Knowledge; poor knowledge negating need for screening, (4) Emotions; disgust, embarrassment and fear, (5) Skills; low self-efficacy and instruction complexity, and (6) Social influence; did not encourage testing or was overridden by emotion and poor knowledge.

Conclusions: Greater consideration should be given to the targeting of interventions towards specific determinants of non-participation within subgroups of the population, in particular non-participant women living within lower socio-economic areas. Tackling environmental stressors, emotional factors, lack of healthcare professional support and the perception that feeling healthy equates with not needing screening could help improve CRC screening uptake among women living in low socioeconomic areas.