Evid Based Nurs 9:31 doi:10.1136/ebn.9.1.31
  • Qualitative

Perceived barriers and benefits were factors in decision making about colorectal screening

 Q What factors influence decision making about colorectal screening?


Qualitative study based on the health belief model.


Central Kentucky, USA.


30 people 48–55 years of age (mean age 54 y, 57% women) were recruited using a sampling frame including factors most likely to influence health related decisions: sex, ethnicity, domicile, type of health insurance, length of time with health provider, cancer history, screening history, and frequency of checkups. The sampling frame ensured inclusion of people who had and had not received colorectal screening.


Data were collected in 30 minute semistructured interviews that were conducted in a location mutually agreeable to the participant and interviewer. Interviews were tape recorded and transcribed verbatim. The transcripts were independently analysed by 3 investigators to identify factors influencing the screening decision until data saturation occurred. Results were discussed during analysis meetings, and ⩾2 investigators had to agree on a factor for it to be included. The investigators compiled a master list of factors from the 30 individual transcripts and developed a thematic scheme to categorise the factors.


10 themes described the factors influencing decisions about colorectal screening. (1) Concern for one’s own personal well being. Participants stated that the benefit to one’s health outweighed the unpleasantness of the screening procedure. (2) Competing demands. Despite recognising the importance of colorectal screening, some participants claimed that other demands on their time prevented them from having the procedure. (3) Preparing for the procedure. Participants described the at-home preparation for some of the screening procedures (eg, drinking 8 ounces of a solution every 15 min for 4 h to empty the colon) as daunting. (4) The screening process. Some participants described the screening process as uncomfortable and intimidating, whereas others were not bothered by it. (5) Gender concerns. Gender influenced the decision to have screening, and who would do it. Several women preferred a woman physician to do the procedure. (6) Fear of having cancer. Some participants indicated that they might avoid screening for fear of receiving bad news. (7) Feeling healthy. Some participants had a “leave well enough alone” attitude, feeling that if they had no symptoms, there was no need for screening. (8) Cost. All but 1 participant had health insurance to cover colorectal screening, but some expressed concern that their coverage might not cover their preferred method of screening. (9) The experiences of others. Participants were particularly influenced by the negative screening experiences of friends or relatives when deciding whether to be screened; the positive experiences of others tended to not have as much influence on participants’ screening decisions. Some participants considered knowing someone with cancer to be an incentive to have screening. (10) Turning 50 years old. Some participants felt that the recommendation for screening at 50 years of age was another negative aspect of ageing. Others viewed the age milestone as an opportunity for a thorough health assessment.


10 themes emerged among several factors influencing peoples’ decision making about colorectal screening. Many themes were bi-directional, with factors perceived as both barriers and benefits.


  1. John Oliffe, RN, PhD
  1. University of British Columbia
 Vancouver, Canada

      The complex connections between health beliefs and colorectal screening decisions are highlighted in the study by Wackerbarth et al. The findings reiterate barriers and benefits, augmenting an emergent body of literature in the area of colorectal screening. This is important information given that screening uptake continues to be low despite colorectal cancer being one of the most clinically preventable cancers.1

      There are 2 limitations of the study that require highlighting. Firstly, the themes overlap considerably in terms of content, and higher levels of conceptualisation might have realised fewer categories but more focused and accessible findings. Secondly, the dual direction (both barriers and benefits) attributed to many “factors” could have been used to theoretically advance applications of the health belief model.

      Despite these concerns, the study offers nurses insight to the complexities associated with patient uptake of colorectal screening. Moreover, the findings are sure to stimulate clinicians to think creatively about practical interventions to counter some of the perceptions highlighted in this study.



      • For correspondence: Dr S B Wackerbarth, Martin School of Public Policy and Administration, University of Kentucky, Lexington, KY, USA. sbwack0{at}

      • Sources of funding: National Cancer Institute and American Cancer Society.

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