Participation Barriers in Risk-Stratified Endoscopic Screening for Upper GI Cancer: A Mixed-Methods Study

The purpose of this study was to identify participation determinants among high-risk individuals in risk-stratified upper GI (UGI) cancer screening.

This sequential mixed-methods study was conducted in a population-based UGI cancer screening program in Ningxia Province, China. It integrates quantitative and qualitative methods to comprehensively examine participation determinants. Between April and December 2023, quantitative data were collected from 2,571 high-risk individuals identified by validated diagnostic models. Subsequently, 42 high-risk individuals (median age: 63.0 years; 81.0% male) were interviewed by stratified purposive sampling from March to April 2024. Logistic regression explored factors associated with screening adherence. Thematic analysis of qualitative interviews integrated quantitative findings using the Capability, Opportunity, and Motivation-Behavior framework.

Of the high-risk individuals, 52.8% declined endoscopy. Nonparticipation was significantly associated with older age (adjusted odds ratio [aOR], 1.28 [1.06-1.54]), male sex (1.31 [1.01-1.70]), Hui ethnicity (1.35 [1.12-1.62]), nonsmoking (1.23 [1.01-1.50]), nondrinking (1.36 [1.09-1.71]), no family history of UGI cancer (1.48 [1.20-1.84]), fewer UGI symptoms (2.64 [2.19-3.18]), and no prior UGI examination (1.67 [1.37-2.05]). In the qualitative phase, seven key barriers were identified, including insufficient knowledge about UGI cancer and risk assessment, physical limitations, low perceived risk, gastroscopy-related fears, cost concerns, time constraints, and inadequate information.

Addressing limited knowledge and program accessibility may improve participation and real-world implementation of risk-stratified UGI cancer screening.