Background Since being established in 2006, the English NHS Bowel Cancer Screening Programme (NHS BCSP) offers the faecal occult blood (FOB) test to adults aged 60 – 74. This bowel cancer screening test is sent by post every two years to recipients who are required to provide six small samples of faeces from three bowel movements. The kit is returned by post to be tested for minute traces of blood that may be an early warning sign for the development of bowel cancer. Analysis shows that approximately 53% of people offered bowel cancer screening by FOB test take it up, and that uptake varies from 35% to 60% in the most and least deprived areas, respectively.
Methods We used a qualitative approach to explore views and experiences about bowel cancer screening in people who did not take part in the screening programme when invited to do so. We conducted 16 focus groups in London and South Yorkshire to generate extensive textual data, and analysed our data thematically using grounded theory techniques to explore and examine accounts of non-uptake. Previous research examining ‘non-uptake’, of this and other medical interventions has identified considerable challenges in terms of identifying and recruiting individuals who may be defined in this way. We therefore used a novel recruitment approach, working with the National BCSP Hubs to identify and recruit ‘non-uptakers’ of bowel cancer screening. We present the findings from our thematic analysis of 16 focus groups undertaken with people who did not participate in bowel cancer screening and explore the complexity of ‘non-uptakers’’ accounts.
Results & Conclusion During preliminary analyses, we identified common accounts through which participants rationalised non-uptake and which present one or several barriers to undertaking bowel cancer screening. Participants rationalised their non-uptake of screening in a number of ways, for example by making reference to perceptions of low personal risk informed by ‘feeling well’ or having had no family history of bowel cancer. Others expressed sophisticated doubts about the benefits or value of the FOB test specifically, or in relation to diagnostic or treatment interventions for cancer more generally. Finally, the necessity to provide samples of faeces to complete the FOB test emerged repeatedly as a troubling aspect of the bowel cancer screening methodology offered by the English NHS BCSP.
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