Factors related to longitudinal adherence in colorectal cancer screening: qualitative research findings

Cancer Causes Control. 2018 Jan;29(1):103-114. doi: 10.1007/s10552-017-0982-z. Epub 2017 Nov 23.


Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Barriers; Colorectal cancer; Longitudinal adherence; Mass screening; Participation; Qualitative study.

MeSH terms

  • Aged
  • Colorectal Neoplasms / diagnosis*
  • Decision Making
  • Early Detection of Cancer / psychology*
  • Female
  • Humans
  • Male
  • Mass Screening / psychology*
  • Middle Aged
  • Occult Blood
  • Patient Compliance
  • Primary Health Care
  • Qualitative Research