Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
University of Queensland, Faculty of Medicine, Herston, Queensland, Australia.
Health Promot J Austr. 2024 Jan;35(1):9-36. doi: 10.1002/hpja.732. Epub 2023 Apr 26.
Colorectal cancer (CRC) screening through fecal occult blood testing (FOBT) has saved thousands of lives globally with multiple countries adopting comprehensive population wide screening programs. Participation rates in FOBT based CRC screening for the socially and economically disadvantaged remains low. The aim of this systematic review is to explore empirical evidence that will guide targeted interventions to improve participation rates within priority populations.
PubMed, Embase, Scopus, Cinahl and PsycInfo were systematically searched from inception to 22 June 2022. Eligible studies contained qualitative evidence identifying barriers to FOBT based CRC screening for populations impacted by the social determinants of health. An inductive thematic synthesis approach was applied using grounded theory methodology, to explore descriptive themes and interpret these into higher order analytical constructs and theories.
A total of 8,501 publications were identified and screened. A total of 48 studies from 10 countries were eligible for inclusion, representing 2,232 subjects. Coding within included studies resulted in 30 key descriptive themes with a thematic frequency greater than 10%. Coded themes applied to four overarching, interconnected barriers driving inequality for priority populations: social, behavioural, economic and technical/interfaces. SO WHAT?: This study has highlighted the need for stronger patient/provider relationships to mitigate barriers to FOBT screening participation for diverse groups. Findings can assist health professionals and policy makers address the systemic exclusion of priority populations in cancer screening by moving beyond the responsibility of the individual to a focus on addressing the information asymmetry driving low value perceptions.
通过粪便潜血检测（FOBT）进行的结直肠癌（CRC）筛查在全球范围内挽救了数千人的生命，多个国家都采用了全面的人群筛查计划。社会经济弱势群体参与 FOBT 结直肠癌筛查的比例仍然较低。本系统评价的目的是探索实证证据，以指导针对优先人群的干预措施，提高参与率。
从建库到 2022 年 6 月 22 日，系统检索了 PubMed、Embase、Scopus、Cinahl 和 PsycInfo。合格的研究包含定性证据，确定了受健康社会决定因素影响的人群进行 FOBT 结直肠癌筛查的障碍。采用扎根理论方法，应用归纳主题综合方法，探索描述性主题，并将其解释为更高层次的分析结构和理论。
共确定了 8501 篇文献并进行了筛选。共有来自 10 个国家的 48 项研究符合纳入标准，共纳入 2232 名受试者。纳入研究中的编码产生了 30 个关键描述性主题，其编码主题频率大于 10%。编码主题适用于四个相互关联的障碍，这些障碍推动了优先人群的不平等：社会、行为、经济和技术/接口。因此：本研究强调了需要加强医患关系，以减轻不同群体参与 FOBT 筛查的障碍。研究结果可以帮助卫生专业人员和政策制定者通过超越个人责任，关注驱动低价值观念的信息不对称，解决优先人群在癌症筛查中被系统排除的问题。
