Exploring the decision to participate in the National Health Service Bowel Cancer Screening Programme

Cancer is a leading cause of mortality and one of the most feared diseases in modern society. A combination of early detection, accurate diagnosis and effective treatment provides the best defence against cancer morbidity; therefore, promoting cancer awareness and encouraging cancer screening is a priority in any comprehensive cancer control policy. Colorectal cancer is the third most common form of cancer in the UK and in an effort to reduce the high incidence, prevalence, morbidity and mortality rates, the National Health Service (NHS) has introduced the NHS Bowel Cancer Screening Programme (NHS BCSP). For the NHS BCSP to succeed in its goal of reducing the incidence and prevalence rates for colorectal cancer, individuals need to be persuaded to complete the test. Since it was first introduced in 2007, however, participation rates have been low. In an effort to understand why participation rates remain low, this article reports on the findings of a series of focus groups conducted in the East Midlands of England. These focus groups were designed to explore the factors that influence an individual's decision to participate in cancer screening. The findings revealed eight factors that affected participation in the NHS BCSP: (i) the association of screening with entry into old age; (ii) prior experience with health systems; (iii) the support of a significant other; (iv) individual perceptions of risk (and benefit); (v) fear of becoming a cancer patient after the screening test; (vi) lack of disease symptoms; (vii) embarrassment associated with completing the test and (viii) messages that adopt a paternalistic ethos. Overall, our results suggest that more people may participate in the screening programme if it was more sensitive to these psychosocial and contextual factors that shape an individual's decision to be tested.