By Dr Nicholas Clarke, Senior Research Fellow and lecturer at the School of Population Health, RCSI University of Medicine and Health Sciences
We’ve completed research to help us better understand why some women living in lower socio-economic areas choose not to take part in bowel screening.
Our study explored the different factors that influenced their decisions to help us find out how we could better support people to make an informed choice about taking part.
Listening to women who do not take part
We interviewed 15 women living in disadvantaged areas in Ireland. All of them had previously been invited to take part in BowelScreen and had not done so.
The research identified 6 main areas that influenced women’s decisions not to take part:
- what was happening in their lives at the time
- how they thought about and made decisions about screening
- their knowledge of bowel cancer and screening
- emotions such as fear, embarrassment and disgust
- confidence in completing the screening test
- influence from family, friends and other people around them.
These factors did not always happen separately. They often overlapped and combined to influence a woman’s decision.
Sometimes screening was simply not a priority
For some women, difficult events or other health concerns took priority when their BowelScreen invitation arrived.
Women spoke about experiences including bereavement, mental health difficulties, serious illness or injury, caring responsibilities and existing health conditions. For some, bowel screening was simply placed further down their list of priorities.
Feeling well could make screening seem less relevant
Some women felt that bowel screening was not relevant to them because they felt well, had no symptoms or did not believe they were at risk of bowel cancer.
Some also had limited knowledge about bowel cancer, the BowelScreen programme or what happened to their sample after they complete the test. Most participants reported having very limited knowledge of the testing process or BowelScreen.
This affected how some women viewed the invitation. If screening did not feel relevant to them, it could be easier to put the invitation aside or decide not to take part.
Fear, embarrassment and disgust also mattered
Some women described being afraid of what their result might show. Others spoke about embarrassment, feeling self-conscious or feeling disgust at the thought of completing the test. In some cases, women regretted their decision not to take part afterwards.
For others, confidence was a barrier. Some women were unsure that they could complete the home test correctly or felt that the instructions were complicated. Some said they would feel more confident having a test carried out in a healthcare setting.
Trusted healthcare professionals could make a difference
Some women said they would have been more likely to take part if their GP had recommended BowelScreen. The study also found that all but one of the women had taken part in breast and/or cervical screening, with some women talking positively about the importance of these programmes to their health.
What we can learn from this research
There was no single reason why women did not take part in BowelScreen.
The research shows how knowledge, emotions, confidence, social influences and circumstances in a person’s life can come together when someone decides whether or not to take part.
The study suggests that approaches to improving participation could include:
- stronger recommendations from trusted healthcare professionals, including GPs and pharmacists
- addressing the belief that people who feel healthy or have no symptoms do not need screening
- greater integration of bowel screening messages with breast and cervical screening programmes
- additional reminders which address knowledge and emotional barriers
- using the experiences of other people to help build confidence in completing the test.
The study also highlights the importance of looking beyond overall screening participation and understanding the experiences of population groups who may face particular barriers.
Read the full research published in Psycho-Oncology: A qualitative exploration of the decision not to take part in colorectal cancer screening among women living in lower socio-economic areas.
- This research was funded by the HSE National Screening Service through the Women’s Health Fund.
- N. Clarke, L. Hayden, A. Smith, et al., “A Qualitative Exploration of the Decision Not to Take Part in Colorectal Cancer Screening Among Women Living in Lower Socio-Economic Areas,” Psycho-Oncology (2026): e70600, https://doi.org/10.1002/pon.70600.