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Barriers for Participation in the Danish Colorectal Cancer Screening Program: a Qualitative Study

  • Original Research
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Abstract

Purpose

The participation rate in the Danish National Screening Program for Colorectal Cancer is around 60%. Since early detection of cancer through the colorectal cancer screening program (CRCS) reduces mortality rates, it is important to understand why people do not participate. The aim of this study was therefore to examine in depth why some people do not participate in the Danish CRCS program.

Methods

Individual semi-structured interviews were conducted with 18 people who had not participated in the national CRCS program. Data was analyzed using an inductive hermeneutic approach.

Results

The analysis uncovered three main themes describing barriers to screening: (a) the accountability for ensuring personal health covered the following sub-themes: (i) when invitation is out of sight it is out of mind, (ii) aversion against own stool sample collection, and (iii) the perceived risk of getting colorectal cancer (CRC); (b) attitudes towards the healthcare system and its organization covered the following sub-themes: (i) positivity towards CRCS, (ii) trust in the healthcare system, (iii) lack of internal communication in the healthcare system, and (iv) wish for involvement of the general practitioner (GP); (c) knowledge about disease and screening covered the following sub-themes: (i) knowledge about CRC and CRCS, (ii) wish for information via new channels, and (iii) CRC is rarely something you talk about.

Conclusion

Among the informants included in this study, lack of participation in the CRCS program was not due to an active opt-out, as most informants had intentions of participating. The informants thought it would motivate them to participate if their GP would remind them of the screening program.

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Data Availability

The dataset generated during this study are not publicly available but are available from the corresponding author on reasonable request.

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Funding

This research was part of a larger research project funded by the Health Foundation (Helsefonden) (19-B-0032), the Capital Region’s Research Foundation for Health Research (A6205), Danish Cancer Research Foundation (FID20823), the Gangsted Foundation (A35137), Inge and Jørgen Memorial Fund (10537–003), and a research grant from Bispebjerg and Frederiksberg Hospital.

Author information

Authors and Affiliations

  1. Faculty of Health Sciences, University of Southern Denmark, J.B. Winsløvs Vej 19.3, DK-5000, Odense, Denmark

    Sofie Phillipsen & Louise Kongsmark Weltz

  2. Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark

    Jannie Dressler, Morten Rasmussen & Lars Nannestad Jorgensen

  3. User Perspectives and Community-Based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark

    Marie Konge Nielsen

  4. Department of Nursing, University College Absalon, Slagelse, Denmark

    Marie Konge Nielsen

  5. Institute of Psychology, University of Southern Denmark, Odense, Denmark

    Anna Thit Johnsen

  6. Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde and Naestved, Denmark

    Anna Thit Johnsen

Authors
  1. Sofie Phillipsen
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  2. Louise Kongsmark Weltz
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  4. Marie Konge Nielsen
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  6. Lars Nannestad Jorgensen
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  7. Anna Thit Johnsen
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Contributions

M. R. and L. N. J. conceived of the study. J. D. and A. T. J. designed the method. J. D. carried out the interviews with support from A. T. J. S. P. and L. K. W. extracted and analyzed the data under supervision of M. K. N. and A. T. J. S. P. drafted the manuscript in consultation with L. K. W., J. D., and A. T. J., which was critically revised by all authors.

Corresponding author

Correspondence to Sofie Phillipsen.

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Competing interests

The authors declare no competing interests.

Ethics Approval

The manuscript is a qualitative study and according to Danish law, ethical approval is not necessary for qualitative studies.

Consent to Participate

All participants gave free and informed consent to participate.

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Not applicable.

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Phillipsen, S., Weltz, L.K., Dressler, J. et al. Barriers for Participation in the Danish Colorectal Cancer Screening Program: a Qualitative Study. J Gastrointest Canc 54, 873–881 (2023). https://doi.org/10.1007/s12029-022-00876-2

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  • DOI: https://doi.org/10.1007/s12029-022-00876-2

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