Factors influencing participation in lung cancer screening among screening-eligible adults: a scoping review

Participation in low-dose computed tomography (LDCT) lung cancer screening remains suboptimal, and evidence on participation determinants is heterogeneous. This scoping review mapped participation factors using the Capability-Opportunity-Motivation-Behavior (COM-B) framework to guide intervention development.

We conducted an international scoping review of studies published between January 2013 and June 2025. PubMed, Embase, CINAHL, PsycINFO, Web of Science, and the Cochrane Library were searched. Quantitative, qualitative, and mixed-methods studies examining participation among adults eligible for LDCT screening were included. Factors were coded inductively and mapped to framework domains. Overall, 3229 unique records were screened.

Thirty-nine studies were included: 22 quantitative, 13 qualitative, and four mixed-methods studies. Determinants spanned all framework domains. Factors most often associated with higher participation included risk awareness (n = 15), perceived benefits (n = 13), and clinician recommendation (n = 12). Factors most often associated with lower participation included misconceptions (n = 13), competing priorities (n = 12) and fear of results (n = 11).

Participation reflects interacting factors. Health literacy barriers, misconceptions, and practical constraints may prevent favorable intentions from translating into uptake. Interventions should combine tailored communication, clinician engagement, improved access, and support addressing risk perception, fear, stigma, and trust.