Zafar Ali, Koch Milena, Weller Luis, Tschobur Nelli, Ihrig Andreas, Bugaj Till Johannes, Mayer Gwendolyn, Baessler Franziska
Center for Psychosocial Medicine, Heidelberg University Hospital, Thibautstrasse 4, 69115, Heidelberg, Germany.
Heidelberg Academy of Sciences and Humanities, Heidelberg, Germany.
BMC Public Health. 2025 Jul 19;25(1):2505. doi: 10.1186/s12889-025-23656-6.
Participation rates in early cancer detection and follow-up cancer related healthcare services are lower than anticipated in many high-income countries. Germany also provides a variety of these services free-of-charge under its highly subsidized public healthcare system. This qualitative study aimed to determine the barriers perceived or experienced by service users in Germany against utilizing cancer screenings and treatment services.
A semi-structured interview protocol was developed based on current literature and in consultation with stakeholders in cancer-related professions. The interviews aimed at exploring the underlying reasons for underutilization of cancer prevention or treatment services. Interviews were conducted from a pool of respondents (N = 57) from an earlier phase of the study based on voluntary response sampling. All interviews were transcribed verbatim from audio recordings and transcripts were processed in MAXQDA 2022. Two authors analyzed the qualitative data using hybrid inductive-deductive coding methodology described by Udo Kuckartz.
Overall 23 interviews were conducted. The participants included 13 current or former cancer patients and 10 non-patients [male = 14, female = 9; mean age = 58.65 years (SD = 13.79)]. Lack of awareness and absence of reminders emerged as the most common reason for not attending cancer screenings or treatment services. Most participants described lack of information regarding the availability or timing of the recommended screenings as their main reasons. Other predominant barriers against accessing cancer-related healthcare services were associated with time constraints and work responsibilities, unavailability of physicians and appointments, administrative bureaucracy, fear of negative news, pain or side-effects, low personal relevance, norms of gendered behavior, feelings of shame and insecurity, and communication difficulties with practitioners.
Most pertinent barriers were rooted in lack of information and awareness about existing cancer-related healthcare services among participants. Our findings suggest that tailored interventions that address systemic, personal and social factors are essential for improving screening uptake. A proactive approach by healthcare personnel and health insurance companies for providing concise and timely information on cancer-related offers to service users is recommended to improve participation rates.
在许多高收入国家，早期癌症检测及后续癌症相关医疗服务的参与率低于预期。德国在其高额补贴的公共医疗体系下也免费提供多种此类服务。这项定性研究旨在确定德国服务使用者在利用癌症筛查和治疗服务方面所感知到或经历的障碍。
基于当前文献并与癌症相关专业的利益相关者协商，制定了一份半结构化访谈方案。访谈旨在探究癌症预防或治疗服务利用不足的潜在原因。访谈对象来自研究早期阶段通过自愿回应抽样选取的一组受访者（N = 57）。所有访谈均根据录音逐字转录，转录文本在MAXQDA 2022中进行处理。两位作者使用Udo Kuckartz描述的混合归纳 - 演绎编码方法对定性数据进行分析。
共进行了23次访谈。参与者包括13名现任或前任癌症患者和10名非患者[男性 = 14人，女性 = 9人；平均年龄 = 58.65岁（标准差 = 13.79）]。缺乏意识和没有提醒是未参加癌症筛查或治疗服务的最常见原因。大多数参与者将缺乏关于推荐筛查的可获得性或时间安排的信息描述为主要原因。其他阻碍获得癌症相关医疗服务的主要因素包括时间限制和工作职责、医生和预约不可用、行政官僚作风、对负面消息的恐惧、疼痛或副作用、个人相关性低、性别行为规范、羞耻和不安全感以及与从业者沟通困难。
最相关的障碍源于参与者对现有癌症相关医疗服务缺乏信息和意识。我们的研究结果表明，针对系统、个人和社会因素的定制干预措施对于提高筛查参与率至关重要。建议医疗人员和健康保险公司采取积极主动的方法，向服务使用者提供关于癌症相关服务的简洁及时信息，以提高参与率。
