Factors related to longitudinal adherence in colorectal cancer screening: qualitative research findings
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The effectiveness of screening in colorectal cancer prevention depends on sustained participation rates. The objective of this study was to explore factors related to the longitudinal adherence of screening behavior in the context of a biennial population-based cancer screening program.
Eight focus groups were conducted with individuals who were invited two or three consecutive times to a population-based colorectal cancer screening program using a fecal occult blood test and who agreed to participate in the program at least once (n = 45). The criteria used to select the study members included adherence to fecal occult blood test maintenance, factors regarding their initial participation in the colorectal cancer screening, sex, and contextual educational level.
The participants expressed a high level of satisfaction with the program; however, they showed a low level of understanding with respect to cancer screening. Consulting a general practitioner was cited by all participants as an important factor that mediated their final decision or influenced their behavior as a whole with regard to the program. Fear played a different role in the screening behavior for regular and irregular adherent participants. In the adherent participants, fear facilitated their continued participation in the screening program, whereas for the irregular participants, fear led them to avoid or refuse further screening. Having a close person diagnosed with colorectal cancer was a facilitator for the regular adherent participants. The irregular adherent participants showed some relaxation with respect to screening after a negative result and considered that further screening was no longer necessary.
Considering the importance of primary healthcare professionals in the decision regarding sustained participation, it is important to better engage them with cancer screening programs, as well as improve the communication channels to provide accurate and balanced information for both health professionals and individuals.
KeywordsColorectal cancer Participation Mass screening Longitudinal adherence Barriers Qualitative study
The funding was supported by Department of Health of Catalonia (Grant No. SLT002/16/00407).
- 11.Commission of the European Communities (CEC) (2003) Proposal for a council recommendation on cancer screening. 2003/0093 (CNS). Commission of the European Communities (CEC), BrusselsGoogle Scholar
- 19.Grazzini G, Castiglione G, Ciabattoni C, Franceschini F, Giorgi D, Gozzi S, Mantellini P, Lopane P, Perco M, Rubeca T, Salvadori P, Visioli CB, Zappa M (2004) Colorectal cancer screening programme by faecal occult blood test in Tuscany: first round results. Eur J Cancer Prev 13:19–26CrossRefPubMedGoogle Scholar
- 22.Hol L, van Leerdam ME, van Ballegooijen M, van Vuuren AJ, van Dekken H, Reijerink JC, van der Togt AC, Habbema JD, Kuipers EJ (2010) Screening for colorectal cancer: randomised trial comparing guaiac-based and immunochemical faecal occult blood testing and flexible sigmoidoscopy. Gut 59:62–68CrossRefPubMedGoogle Scholar
- 23.Honein-AbouHaidar GN, Kastner M, Vuong V, Perrier L, Daly C, Rabeneck L, Straus S, Baxter NN (2016) Systematic review and meta-study synthesis of qualitative studies evaluating facilitators and barriers to participation in colorectal cancer screening. Cancer Epidemiol Biomarkers Prev 25:907–917CrossRefPubMedGoogle Scholar
- 24.Jandorf L, Ellison J, Villagra C, Winkel G, Varela A, Quintero-Canetti Z, Castillo A, Thélémaque L, King S, Duhamel K (2010) Understanding the barriers and facilitators of colorectal cancer screening among low income immigrant Hispanics. J Immigr Minor Health 12:462–469CrossRefPubMedPubMedCentralGoogle Scholar
- 30.L’Hospitalet de Llobregat City Council (2010) http://www.l-h.cat/laciutat/265243_1.aspx?id=1. Accessed 25 June 2010
- 39.Muhr T (2004) ATLAS.ti 5.0 [Version 5:]. ATLAS.ti scientific software development GmbH, Berlin, Germany. Available from http://www.atlasti.com/
- 42.Orton M, Fitzpatrick R, Fuller A, Mant D, Mlynek C, Thorogood M (1991) Factors affecting women’s response to an invitation to attend for a second breast cancer screening examination. Br J Gen Pract 41:320Y322Google Scholar
- 44.Panidi, Ksenia and Job Market. Ostrich effect in health care decisions: theory and empirical evidence. Diss. Dissertation (2014)Google Scholar
- 45.Papin-Lefebvre F, Guillaume E, Moutel G, Launoy G, Berchi C (2017) General practitioners’ preferences with regard to colorectal cancer screening organisation Colon cancer screening medico-legal aspects. Health Policy 121:1079–1084Google Scholar
- 47.Patton MQ (2002) Qualitative research and evaluation methods, 3rd edn. SAGE, LondonGoogle Scholar
- 50.Ponti A, Anttila A, Ronco G, Senore C (2017) Cancer Screening in the European Union Report on the implementation of the Council Recommendation on cancer screening. Cancer screening in the European Union. Report on the implementation of the Council Recommendation on cancer screening (reprint May 2017)Google Scholar
- 51.Schoen RE, Pinsky PF, Weissfeld JL, Yokochi LA, Church T, Laiyemo AO, Bresalier R, Andriole GL, Buys SS, Crawford ED, Fouad MN, Isaacs C, Johnson CC, Reding DJ, O’Brien B, Carrick DM, Wright P, Riley TL, Purdue MP, Izmirlian G, Kramer BS, Miller AB, Gohagan JK, Prorok PC, Berg CD, PLCO Project Team (2012) Colorectal-cancer incidence and mortality with screening flexible sigmoidoscopy. N Engl J Med 366:2345–2357CrossRefPubMedPubMedCentralGoogle Scholar
- 52.Segnan N, Armaroli P, Bonelli L, Risio M, Sciallero S, Zappa M, Andreoni B, Arrigoni A, Bisanti L, Casella C, Crosta C, Falcini F, Ferrero F, Giacomin A, Giuliani O, Santarelli A, Visioli CB, Zanetti R, Atkin WS, Senore C, SCORE Working Group (2011) Once-only sigmoidoscopy in colorectal cancer screening: follow-up findings of the Italian Randomized Controlled Trial-SCORE. J Natl Cancer Inst. 103:1310–1322CrossRefPubMedGoogle Scholar
- 58.von Karsa L, Anttila A, Ronco G, Ponti A, Malila N, Arbyn M, Segnan N, Castillo-Beltran M, Boniol M, Ferlay J, Hery C, Sauvaget C, Voti L, Autier P (2008) Cancer screening in the European Union. Report on the implementation of the Council Recommendation on Cancer Screening. International Agency for Research of Cancer, European CommunitiesGoogle Scholar
- 59.von Wagner C, Baio G, Raine R, Snowball J, Morris S, Atkin W, Obichere A, Handley G, Logan RF, Rainbow S, Smith S, Halloran S, Wardle J (2011) Inequalities in participation in an organized national colorectal cancer screening programme: results from the first 2.6 million invitations in England. Int J Epidemiol 40:712–718Google Scholar