Matovu Nicholas, Coleman Helen G, Mutungi Gerald, Donnelly Michael, Lohfeld Lynne, Johnston Brian T, Loughrey Maurice B, Mugisha Noleb M, McShane Charlene M
Centre for Public Health, Queen's University Belfast, Belfast, UK.
Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK.
Cancer Med. 2025 Mar;14(6):e70662. doi: 10.1002/cam4.70662.
Colorectal cancer (CRC) incidence is increasing in Uganda. Despite this, and the disproportionately high burden of early onset and late-stage CRC cases, no CRC screening program exists in Uganda. To guide and inform future CRC prevention efforts, interviews with key stakeholders were undertaken to better understand the perceived barriers and opportunities relevant to the development and implementation of a CRC screening program in Uganda.
Semi-structured key informant interviews were conducted with key stakeholders in cancer prevention, screening and policy/programming (n = 11, 6 medically qualified and 5 non-medical), who were recruited across Uganda using maximum variation sampling between March and April 2022. Interviews were audio recorded, transcribed, coded and later analysed using a deductive thematic analysis approach guided by the social ecological model.
Major barriers included lack of government priority for CRC prevention programs, lack of resources/funding for CRC screening (policy level), inadequate screening facilities and equipment, limited training/knowledge of CRC and capacity of the health workforce (health system level), challenges in the delivery of CRC awareness messages (community level), emotions associated with CRC screening and poor awareness of CRC and its symptoms (individual level). Major opportunities included the existence of a draft national cancer control plan (policy level), existence of less costly CRC screening alternatives, less costly primary prevention measures (health system level), existence of community leadership and structures (community level), likely acceptability of the faecal occult blood test and peer support (individual level).
There are substantive barriers to CRC screening program development and implementation in Uganda. However, there are signs, like the development of a cancer control plan, that suggest a shift towards strategic planning and allocation of resources at a population level for addressing the issues of cancer prevention and care, including CRC. In the meantime, efforts should prioritise primary prevention interventions such as mass education to promote CRC awareness.
乌干达的结直肠癌（CRC）发病率正在上升。尽管如此，早期和晚期结直肠癌病例负担过高且不成比例，但乌干达尚无结直肠癌筛查项目。为指导并为未来的结直肠癌预防工作提供信息，我们与关键利益相关者进行了访谈，以更好地了解与乌干达结直肠癌筛查项目开发和实施相关的感知障碍和机遇。
2022年3月至4月期间，我们对癌症预防、筛查及政策/项目规划方面的关键利益相关者进行了半结构化关键信息访谈（n = 11，其中6名具有医学资质，5名非医学专业），采用最大差异抽样法在乌干达各地招募。访谈进行了录音、转录、编码，随后采用社会生态模型指导的演绎主题分析方法进行分析。
主要障碍包括政府对结直肠癌预防项目缺乏重视，缺乏结直肠癌筛查的资源/资金（政策层面），筛查设施和设备不足，卫生工作人员对结直肠癌的培训/知识及能力有限（卫生系统层面），结直肠癌宣传信息传递方面的挑战（社区层面），与结直肠癌筛查相关的情绪以及对结直肠癌及其症状的认识不足（个人层面）。主要机遇包括国家癌症控制计划草案的存在（政策层面），存在成本较低的结直肠癌筛查替代方案、成本较低的一级预防措施（卫生系统层面），存在社区领导力和结构（社区层面），粪便潜血试验可能具有可接受性以及同伴支持（个人层面）。
在乌干达，结直肠癌筛查项目的开发和实施存在重大障碍。然而，有迹象表明，如癌症控制计划的制定，这意味着朝着在人群层面进行战略规划和资源分配转变，以解决包括结直肠癌在内的癌症预防和护理问题。与此同时，应优先开展一级预防干预措施，如大众教育以提高对结直肠癌的认识。
