Exploring Attitudes to Lung Cancer Screening in England: An Inductive Content Analysis of Online Commentary Following...

On 26 June 2023, National Health Service (NHS) England announced plans for a national lung cancer screening programme, sparking significant online discussion and debate. Whilst screening has been shown to improve mortality in lung cancer, uptake is lower than desired. We hypothesised that online public responses to national news articles may provide an honest insight into public perceptions of lung cancer screening, particularly among those who may be underrepresented in research. The aim of this study was to explore online attitudes to lung cancer screening, identifying potential barriers and facilitators to screening participation.

This qualitative content analysis involved a targeted online search of the major UK news outlets, and their affiliate social media sites for articles published between 19 June 2023 and 26 July 2023. Seventeen relevant articles were included, and 921 comments were extracted. Inductive content analysis was used to analyse the data.

A variety of attitudes and perspectives on the announcement of lung cancer screening were identified which were organised into four categories: Stigmatisation of smoking behaviour; Feasibility of NHS delivery; Eligibility and prioritisation; Scepticism and misinformation. Comments were often contextualised by personal health experiences, societal influences, and the politicisation of healthcare.

This study identifies a barrier to lung cancer screening participation that has not been reported in previous work - concern regarding NHS capacity. It builds upon previously identified themes including screening misinformation, and scepticism. The prevalence and strength of smoking-related stigma, and the associated internalised shame expressed by people who smoke, may help explain the reduced uptake of lung screening seen in this group. The inclusion of voices not previously captured in screening uptake research builds on existing knowledge from prior qualitative work and provides a fuller picture of the personal and societal barriers to lung screening attendance. Interventions aiming to improve informed participation in screening need to consider both individual- and societal-level barriers to engagement.

The data incorporated within this study are entirely derived from comments and opinions shared on social media and news outlet comment sections. Comments are anonymous, and hence sources cannot be traced, but commenters are likely to encompass eligible screening participants, relatives, and the general public. By utilising online comments, we aimed to capture voices not previously included in lung cancer screening uptake research, helping to identify novel perspectives on the screening programme.