Perceived Barriers and Facilitators to Colorectal Cancer Screening Among First-Degree Relatives in China: A Qualitative Interview Study

Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide. In 2020, approximately 560,000 new CRC cases were estimated in China. First-degree relatives (FDRs) of people with CRC have an elevated CRC risk and are recommended to begin screening earlier. Despite this elevated risk, screening uptake among FDRs remains suboptimal, and the reasons for non-uptake in the Chinese context are not fully understood.

To explore perceived barriers and facilitators to CRC screening among FDRs of patients with CRC in China and to identify implications for health education and screening services.

We used a qualitative phenomenological design. From April to May 2025, FDRs of patients attending the Colorectal Surgery Department of Ningbo Second Hospital were recruited purposively. Of 56 eligible relatives, 24 agreed to participate. Interviews and preliminary analysis proceeded iteratively, and data saturation was judged to have been reached after 10 interviews. Data were analyzed using Colaizzi's seven-step phenomenological method.

Analysis of participant interviews identified four barriers to screening: limited awareness and underestimation of familial risk; fear and psychological resistance; financial and time burdens; and limited access to screening services. Four facilitators were also identified: witnessing a relative's illness and treatment; personalized and targeted health education; convenient and accessible screening services; and policy and social support.

Screening decisions were shaped by interacting individual, practical, and health-system factors. The findings suggest potential targets for intervention at individual, service, and policy levels. This three-level framework is a conceptual implication of the qualitative findings and requires evaluation in larger and more diverse settings.