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Why colorectal screening fails to achieve the uptake rates of breast and cervical cancer screening: a comparative qualitative study
  1. Marie Kotzur1,
  2. Colin McCowan2,
  3. Sara Macdonald1,
  4. Sally Wyke1,
  5. Lauren Gatting1,
  6. Christine Campbell3,
  7. David Weller4,
  8. Emilia Crighton5,
  9. Robert J C Steele6,
  10. Kathryn A Robb1
  1. 1 Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
  2. 2 School of Medicine, University of St Andrews, St Andrews, Fife, UK
  3. 3 Usher Institute, University of Edinburgh, Edinburgh, UK
  4. 4 General Practice, University of Edinburgh, Edinburgh, UK
  5. 5 Public Health Directorate, NHS Greater Glasgow and Clyde, Glasgow, UK
  6. 6 School of Medicine, University of Dundee, Dundee, UK
  1. Correspondence to Dr Kathryn A Robb, Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8QQ, UK; katie.robb{at}


Background In Scotland, the uptake of clinic-based breast (72%) and cervical (77%) screening is higher than home-based colorectal screening (~60%). To inform new approaches to increase uptake of colorectal screening, we compared the perceptions of colorectal screening among women with different screening histories.

Methods We purposively sampled women with different screening histories to invite to semistructured interviews: (1) participated in all; (2) participated in breast and cervical but not colorectal (‘colorectal-specific non-participants’); (3) participated in none. To identify the sample we linked the data for all women eligible for all three screening programmes in Glasgow, Scotland (aged 51–64 years; n=68 324). Interviews covered perceptions of cancer, screening and screening decisions. Framework method was used for analysis.

Results Of the 2924 women invited, 86 expressed an interest, and 59 were interviewed. The three groups’ perceptions differed, with the colorectal-specific non-participants expressing that: (1) treatment for colorectal cancer is more severe than for breast or cervical cancer; (2) colorectal symptoms are easier to self-detect than breast or cervical symptoms; (3) they worried about completing the test incorrectly; and (4) the colorectal test could be more easily delayed or forgotten than breast or cervical screening.

Conclusion Our comparative approach suggested targets for future interventions to increase colorectal screening uptake including: (1) reducing fear of colorectal cancer treatments; (2) increasing awareness that screening is for the asymptomatic; (3) increasing confidence to self-complete the test; and (4) providing a suggested deadline and/or additional reminders.

  • qualitative research
  • decision making
  • human factors
  • health policy

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  • Contributors CMC, KR, SM and SW conceived the study and planned it along with MK, EC, CC, DW and RJCS. MK, LG, KR and SM carried out the data collection and analysis. All authors contributed to the writing of the paper. KR is the guarantor of the study. All coauthors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding This research was supported by a National Awareness and Early Diagnosis Initiative Grant (C9227/A17676) awarded to co-PIs KR and CMcC.

  • Disclaimer The funder and sponsor had no involvement in the study design, data collection or analysis, or the writing and publication of the report. All researchers involved in this study were independent of the funder.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was obtained from the NHS Health Research Authority (NRES Committee North West–Liverpool Central, REC reference: 4/NW/1300). Participants provided informed consent to take part in the study which was performed in accordance with the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.