Barriers and facilitators to colonoscopy adherence among populations with high risk of being diagnosed with colorectal cancer: A qualitative study using the Theoretical Domains Framework and COM-B model.

Abstract

This study aims to investigate the barriers to and facilitators of colonoscopy screening adherence among high-risk populations for colorectal cancer (CRC) in rural China. Twenty-seven individuals from high-risk CRC populations in rural China participated face-to-face, semi-structured, in-depth interviews, approximately 30 mins each. Content analysis was used to analyze the collected data. In the motivation component, related to the emotion domain and the beliefs about consequences domain, high-risk populations from rural China often overemphasize immediate costs (e.g., time, inconvenience) and negative emotions (e.g., fear, anxiety), while underestimating the long-term health benefits of colonoscopy. Knowledge gaps in the capability component are also critical: non-completers lack an accurate medical understanding of positive screening results (knowledge domain), which weakens their motivation for timely follow-up colonoscopy. Social opportunity significantly influences behavior as well. Clear support and encouragement from healthcare providers and family members (social influences domain) directly promote colonoscopy adherence. Multiple barriers and facilitators to colonoscopy adherence coexist. Future efforts should focus on developing tailored interventions aimed at reducing barriers and enhancing facilitators to improve adherence to timely colonoscopy screening. The elements of the COM-B model provide guidance for identifying barriers and facilitators and developing intervention strategies to promote colonoscopy adherence among high-risk populations.