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Bowel cancer is major global public health problem. In the United Kingdom, it is the third most common cancer in men and women and second major cause of cancer deaths. It has been suggested that the risk of bowel cancer deaths can be reduced by 16% through regular bowel screening. However, screening uptake remains low. This research explored factors influencing participation in the NHS bowel cancer screening programme, specifically ‘the faecal occult blood test (FOBt)’ in the North East, Yorkshire and the Humber, (NEYH) regions. Drawing on grounded theory, (GT) a qualitative research approach enabled the development of an understanding of participants’ experience of the FOBt and the processes involved in the choices they made. Twenty-six research participants were recruited through the bowel cancer screening hub in accordance with ethical approval. Data collection was by semi-structured, face-to-face interviews. Analysis was done using grounded theory techniques of constant comparative method and theoretical sampling aided by Nvivo and mind genius software. Awareness of the FOBt prior to screening invitation was found to be low. Knowledge of bowel cancer seemed to come mostly from past personal experience and family history. Decisions to participate in the FOBt were largely influenced by three main themes: Social contexts such as demographic, cognition and cultural issues; Knowledge and awareness; and Practicalities associated with obtaining samples for FOBt. Knowledge and awareness seemed to be a key influence in participation and pivotal to social contexts and practicalities. Screening was viewed positively by all participants particularly in relation to health protection. Within the social contexts and practicality issues, there are facilitators and potential barriers. The interactions of social and practical contexts tend to dissuade people from participating in the FOBt. However, knowledge and awareness seem to mediate the two in such a way as to encourage people to participate. A tentative explanatory model called “awareness-led behaviour model” was developed and appears to have commonalities with the health belief model typically used to explain health behaviours. This study is one of the few studies to investigate factors affecting uptake of the NHSBCSP in the NEYH. The results obtained in this study are likely to have high policy and practice importance as they represent user-focused perspectives. Recommendations and implications for further research, policy, practice and education are offered in the concluding chapter. |
