title: Factors influencing participation in colorectal cancer screening-a qualitative study in an ethnic and socio-economically diverse inner city population.
abstract: Ethnic and socio-economic inequalities have been reported in the uptake of colorectal cancer (CRC) screening. This study aimed to explore the factors affecting CRC screening participation in an ethnically and socio-economically diverse inner city population.
  
  
  
  Semi-structured interviews were undertaken with 50 people aged 55-74 years, recruited from GP practices in south-east London. Participants were from Black African (n=13), Black Caribbean (n=15), White British (n=17), Black other (n=2) and White other (n=3) backgrounds. Participants' socio-economic status (SES) was assessed using a combined measure of educational attainment, housing tenure and car ownership. Participants' SES varied although there were more participants from less deprived backgrounds than those from more deprived backgrounds. The interview topic guide was informed by the Theoretical Domains Framework. Interviews were recorded, transcribed and analysed using framework analysis.
  
  
  
  Lack of awareness of CRC screening was a barrier for all participants. There were also some notable group differences by ethnicity and SES. Cancer fear was a barrier for White British participants of varying SES. Misunderstanding instructions for completing the guaiac faecal occult blood test (gFOBt) was a barrier for people of low SES regardless of ethnicity. For Black African and Black Caribbean participants, of any SES, religious faith and a perceived civic duty to participate in screening encouraged participation.
  
  
  
  This is the first study to provide detailed information on the separate views of Black African and Black Caribbean participants about screening. Consideration of ethnicity and SES together also allowed us to identify pertinent barriers for particular groups that can be targeted to improve access to screening for those who wish to take part.
authors.affiliation: Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
authors.forename: Nimarta
authors.initials: N
authors.lastname: Dharni
authors.affiliation: Department of Primary Care and Public Health Services, King's College London, London, UK.
authors.forename: David
authors.initials: D
authors.lastname: Armstrong
authors.affiliation: King's College Hospital NHS Foundation Trust, London, UK.
authors.forename: Guy
authors.initials: G
authors.lastname: Chung-Faye
authors.affiliation: Department of Primary Care and Public Health Services, King's College London, London, UK.
authors.forename: Alison J
authors.initials: AJ
authors.lastname: Wright
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000208:ethnology; D055088:Early Detection of Cancer / Q000523:psychology*; D005006:Ethnicity / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D036301:Qualitative Research; D012959:Socioeconomic Factors; D014505:Urban Population
keywords: FOBt; bowel cancer screening; colorectal cancer screening; ethnicity; psychological beliefs; socio-economic status