ystematic Review of Focus Group Discussions & Mixed Method Surveys Regarding Colorectal Cancer Screening




Sakowski, Ross
Mathai, Jacob
White, Annesha
Rasu, Rafia
Sambamoorthi, Usha


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Colorectal cancer (CRC) screening has a significant potential to decrease mortality from CRC. Many published studies have used either focus groups or structured interviews to identify barriers and facilitators of CRC. However, a systematic review of methods and findings from focus groups is lacking.


The objective of this study was to conduct a systematic literature review that describes the characteristics of focus group participants and synthesize major themes of CRC screening barriers and facilitators. A secondary objective was to identify the impact of barriers related to social determinants of health (SDoH) factors.


A systematic review of qualitative studies was conducted on CRC screening focus groups following ENTREQ guidelines and the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). Our inclusion criteria were as follows: (1) empirical scientific studies with a qualitative focus group or mixed methods study design; (2) that have been published in a peer-reviewed journal; (3) from January 1, 2012, and August 12, 2022; (4) in English; (5) exploring the attitudes, beliefs and behaviors related to adults and colon cancer screening; (6) face-to-face and online format. Keyword searches were conducted in the electronic databases PubMed and SCOPUS. After review, 31 studies contributing to our research questions were found eligible for inclusion.


Findings revealed that the number of participants per focus group (where reported) ranged from 2 to 23 participants with a median of 6 participants. There was a range of 20 to 232 total focus group participants per study while the mixed method studies ranged from 25 to 492. Most of the studies utilized education, income level, and access to healthcare as social determinants of health factors. The most commonly reported SDoH variable noted as a barrier to CRC screening was the lack of recommendation or education of a screening by their healthcare provider (15 of 31, 48%) with embarrassment or disgust regarding the procedure as a secondary barrier (11 of 31, 35%).


Main themes for barriers and facilitators that emerged from the review were insurance status and awareness of the benefits of screening. Commonly reported concerns for barriers were embarrassment or disgust regarding the procedure and lack of trust in their provider relationship. Previous awareness of this disease through family history was a common facilitator. Opportunities to increase CRC screening arise in ensuring education and access to alternatives that provoke less embarrassment, such as FIT or FOBT tests.