Abstract
To synthesise qualitative evidence related to barriers and facilitators of flexible sigmoidoscopy screening (FSS) intention and uptake, particularly within low socio-demographic uptake groups. FSS uptake is lower amongst women, lower socio-economic status (SES), and Asian ethnic groups within the United Kingdom (UK) and United States of America. A total of 12 168 articles were identified from searches of four databases: EMBASE, MEDLINE, PsycINFO and Web of Science. Eligibility criteria included: individuals eligible to attend FSS and empirical peer-reviewed studies that analysed qualitative data. The Critical Appraisal Skills Program tool evaluated the methodological quality of included studies, and thematic synthesis was used to analyse the data. Ten qualitative studies met the inclusion criteria. Key barriers to FSS intention and uptake centred upon procedural anxieties. Women, including UK Asian women, reported shame and embarrassment, anticipated pain, perforation risk, and test preparation difficulties to elevate anxiety levels. Religious and cultural-influenced health beliefs amongst UK Asian groups were reported to inhibit FSS intention and uptake. Competing priorities, such as caring commitments, particularly impeded women's ability to attend certain FSS appointments. The review identified a knowledge gap concerning factors especially associated with FSS participation amongst lower SES groups. Studies mostly focussed on barriers and facilitators of intention to participate in FSS, particularly within UK Asian groups. To determine the barriers associated with FSS uptake, and further understand how screening intention translates to behaviour, it is important that future qualitative research is equally directed towards factors associated with screening behaviour.
Highlights
An average of 42 042 new cases of colorectal cancer were diagnosed yearly in the United Kingdom (UK) between 2014 and 2016,1 with 1.80 million cases estimated annually worldwide (2018).[2]
To determine the barriers associated with flexible sigmoidoscopy screening (FSS) uptake, and further understand how screening intention translates to behaviour, it is important that future qualitative research is directed towards factors associated with screening behaviour
In comparison to the UK, the United States Preventive Services Task Force (USPSTF) recommends colorectal cancer screening to start at 50 years of age, with home tests completed annually and flexible sigmoidoscopy every 3 to 5 years.[11]
Summary
An average of 42 042 new cases of colorectal cancer were diagnosed yearly in the United Kingdom (UK) between 2014 and 2016,1 with 1.80 million cases estimated annually worldwide (2018).[2]. Key health and lifestyle factors found to significantly increase FSS uptake[25] were: having a family history of colorectal cancer,[18,24,30,36,48] good self-reported health,[14,29,30,49] and having health insurance.[18,38] To improve FSS participation, it is imperative to clarify which barriers and facilitators are of most relevance to particular low uptake groups (eg, women, UK Asians). While existing review literature[25] is useful in providing confirmation of associations regarding factors which affect FSS uptake and allows comparison to other colorectal cancer screening modalities through cross-sectional evidence, it fails to provide depth of understanding regarding barriers and facilitators identified.
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