Key recommendations to improve equity and access in colorectal cancer screening for rural and remote communities. A grounded theory study.

[OBJECTIVES] To explore barriers contributing to low participation in bowel cancer screening among rural populations, while investigating community-identified recommendations to improve access.

[METHODS] A grounded theory approach was applied to qualitative, online, semi structured interviews. Empirical data were inductively coded with constant comparison applied across the data corpus to contextualise meaning.

[RESULTS] 31 rural and remote Queenslanders participated. Theory surrounding the phenomena of low participation in bowel cancer screening highlighted broader system-level design-inhibited participation for geographically diverse populations. Pervasive themes prohibiting bowel cancer screening access stemmed from a lack of local healthcare availability across both primary care and endoscopic outpatient services as necessitated for community engagement and participation in bowel cancer screening.

[CONCLUSION] This study highlights that access to both immunochemical faecal occult blood test (iFOBT) and follow-up colonoscopy is fraught with barriers preventing equitable access to bowel cancer screening for rural and remote communities. Consumer-driven patient navigation strategies, improved healthcare availability and adjustments to the current program design are required to mitigate program disparities.

[IMPLICATIONS FOR PUBLIC HEALTH] Elevating the voices of lived-experience experts to influence existing models of delivery has the potential to increase participation in the National Bowel Cancer Screening Program and improve health outcomes for geographically diverse populations.