Barriers to and facilitators of colorectal cancer screening in different population subgroups in Adelaide, South Australia

Objectives: To identify barriers to and facilitators of colorectal cancer (CRC) screening participation among different cultural subgroups in South Australia, and to describe how these might be shared or be distinct across these groups. Design, participants and setting: Qualitative study using individual interviews in Adelaide, South Australia, between July 2009 and December 2010. Participants were recruited from five culturally distinct groups in SA (Greek, Vietnamese, Iranian, Indigenous and Anglo-Australian) and included people who had participated in CRC screening and people who had not. Main outcome measures: Factors that may act as barriers to or enablers of CRC screening. Results: We interviewed 121 people. Members of all groups expressed positive attitudes towards cancer screening. However, we also noted a lack of knowledge about bowel cancer and its screening tests across all groups, and that the tests were viewed as unpleasant. Issues that differed across groups included language barriers, fatalistic views about cancer, embarrassment, the importance of privacy, the significance of a doctor's recommendation, moral obligations, and culture-specific concerns. Conclusions: This study suggests that population-based screening programs may need to be modified to facilitate access and participation among minority I populations and Indigenous people if equity in screening is to be achieved.