To participate or not? Giving voice to gender and socio-economic differences in colorectal cancer screening programmes.

This paper examines the influence of gender and socio-economic status (SES) on participation in colorectal cancer (CRC) screening. Qualitative study with eight focus groups comprised of participants and non-participants in a CRC screening programme in Valencia (Spain), structural sample design and discursive analysis by gender, SES and participation. Non-participants and those with lower SES tended to have less knowledge about both the disease and the programme. Reasons for participation varied according to gender: women were motivated because they value the importance of self-care and early detection in order to prevent personal and family suffering while men were encouraged by their partners. Reasons for non-participation were also influenced by gender: women feared the results and considered the test unpleasant whereas men showed carelessness and lack of concern. In population-based programmes, people with lower SES and men are those with the most obstacles to participation due to low health literacy and traditional gender roles respectively. To increase participation in CRC screening programmes based on informed decision making and taking into account social inequalities, information should be more accessible, comprehensible and adapted to gender and SES differences and emphasise the greater vulnerability of men for CRC and the benefits of early detection.