Barriers and facilitators to colonoscopy adherence among populations with high risk of being diagnosed with colorectal cancer: A qualitative study using the Theoretical Domains Framework and COM-B model.

[OBJECTIVE] This study aims to investigate the barriers to and facilitators of colonoscopy screening adherence among high-risk populations for colorectal cancer (CRC) in rural China.

[METHODS] Twenty-seven individuals from high-risk CRC populations in rural China participated face-to-face, semi-structured, in-depth interviews, approximately 30 mins each. Content analysis was used to analyze the collected data.

[RESULTS] In the motivation component, related to the emotion domain and the beliefs about consequences domain, high-risk populations from rural China often overemphasize immediate costs (e.g., time, inconvenience) and negative emotions (e.g., fear, anxiety), while underestimating the long-term health benefits of colonoscopy. Knowledge gaps in the capability component are also critical: non-completers lack an accurate medical understanding of positive screening results (knowledge domain), which weakens their motivation for timely follow-up colonoscopy. Social opportunity significantly influences behavior as well. Clear support and encouragement from healthcare providers and family members (social influences domain) directly promote colonoscopy adherence.

[CONCLUSIONS] Multiple barriers and facilitators to colonoscopy adherence coexist. Future efforts should focus on developing tailored interventions aimed at reducing barriers and enhancing facilitators to improve adherence to timely colonoscopy screening.

[PRACTICE IMPLICATIONS] The elements of the COM-B model provide guidance for identifying barriers and facilitators and developing intervention strategies to promote colonoscopy adherence among high-risk populations.