A qualitative exploration of healthcare workers' perspectives on and experiences with colorectal cancer screening in the Western and Eastern Cape

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dc.contributor.advisorKnight, Lucia
dc.contributor.authorPayne, Alexandra
dc.date.accessioned2026-01-20T10:47:30Z
dc.date.available2026-01-20T10:47:30Z
dc.date.issued2025
dc.date.updated2026-01-20T10:41:41Z
dc.description.abstractIn South Africa (SA), colorectal cancer (CRC) incidence and mortality is growing at an alarming rate. CRC is often diagnosed at an advanced stage in SA with a noted increase in younger diagnoses and poor outcomes. However, CRC screening and specifically faecal immunochemical testing (FIT) is not currently offered in the public healthcare sector in SA. Before implementing any sort of screening test, it is important to address health system related factors that are specific to the South African context to better understand the potential feasibility and acceptability of a screening test. To establish a foundation for the potential implementation of a FIT screening program, this qualitative study aimed to explore primary and secondary healthcare workers' perceptions of CRC screening. Materials and Methods: The PRECEDE portion of the PRECEDE-PROCEED model, which identifies predisposing (intrapersonal), reinforcing (interpersonal) and enabling (structural) constructs within the context of health behaviours, served as the theoretical framework for this study. Eight healthcare providers (n=6 physicians and n=2 nurses) practicing in both the Western and Eastern Cape were purposively sampled to participate in semi-structured qualitative interviews. Interviews were analysed using thematic analysis guided by the model. Results: Perceived barriers to CRC screening were identified as socioeconomic status, work status and personal discomfort with tests (predisposing); geographical challenges and healthcare worker related factors (reinforcing); and pathology lab services, test costs, lack of proper ablutions, and lack of clinical continuity and communication (enabling). Perceived facilitators were identified as health education (predisposing); primary care physicians' training in CRC risk and testing location (reinforcing); and test affordability, communication across different health systems, and test availability at primary care level (enabling). Conclusion: This study identifies context specific perceived barriers and facilitators among primary and secondary healthcare workers to CRC screening in South Africa. If CRC FIT screening were to be implemented in SA, relevant policy makers and stakeholders would need to address these perceived barriers across multiple levels.
dc.identifier.apacitationPayne, A. (2025). <i>A qualitative exploration of healthcare workers' perspectives on and experiences with colorectal cancer screening in the Western and Eastern Cape</i>. (). University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine. Retrieved from http://hdl.handle.net/11427/42624en_ZA
dc.identifier.chicagocitationPayne, Alexandra. <i>"A qualitative exploration of healthcare workers' perspectives on and experiences with colorectal cancer screening in the Western and Eastern Cape."</i> ., University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine, 2025. http://hdl.handle.net/11427/42624en_ZA
dc.identifier.citationPayne, A. 2025. A qualitative exploration of healthcare workers' perspectives on and experiences with colorectal cancer screening in the Western and Eastern Cape. . University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine. http://hdl.handle.net/11427/42624en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Payne, Alexandra AB - In South Africa (SA), colorectal cancer (CRC) incidence and mortality is growing at an alarming rate. CRC is often diagnosed at an advanced stage in SA with a noted increase in younger diagnoses and poor outcomes. However, CRC screening and specifically faecal immunochemical testing (FIT) is not currently offered in the public healthcare sector in SA. Before implementing any sort of screening test, it is important to address health system related factors that are specific to the South African context to better understand the potential feasibility and acceptability of a screening test. To establish a foundation for the potential implementation of a FIT screening program, this qualitative study aimed to explore primary and secondary healthcare workers' perceptions of CRC screening. Materials and Methods: The PRECEDE portion of the PRECEDE-PROCEED model, which identifies predisposing (intrapersonal), reinforcing (interpersonal) and enabling (structural) constructs within the context of health behaviours, served as the theoretical framework for this study. Eight healthcare providers (n=6 physicians and n=2 nurses) practicing in both the Western and Eastern Cape were purposively sampled to participate in semi-structured qualitative interviews. Interviews were analysed using thematic analysis guided by the model. Results: Perceived barriers to CRC screening were identified as socioeconomic status, work status and personal discomfort with tests (predisposing); geographical challenges and healthcare worker related factors (reinforcing); and pathology lab services, test costs, lack of proper ablutions, and lack of clinical continuity and communication (enabling). Perceived facilitators were identified as health education (predisposing); primary care physicians' training in CRC risk and testing location (reinforcing); and test affordability, communication across different health systems, and test availability at primary care level (enabling). Conclusion: This study identifies context specific perceived barriers and facilitators among primary and secondary healthcare workers to CRC screening in South Africa. If CRC FIT screening were to be implemented in SA, relevant policy makers and stakeholders would need to address these perceived barriers across multiple levels. DA - 2025 DB - OpenUCT DP - University of Cape Town KW - qualitative research KW - colorectal cancer KW - colorectal cancer screening KW - Faecal immunochemical test (FIT) KW - primary health care KW - barriers and facilitators KW - South Africa KW - Low- and middle- income countries (LMIC) LK - https://open.uct.ac.za PB - University of Cape Town PY - 2025 T1 - A qualitative exploration of healthcare workers' perspectives on and experiences with colorectal cancer screening in the Western and Eastern Cape TI - A qualitative exploration of healthcare workers' perspectives on and experiences with colorectal cancer screening in the Western and Eastern Cape UR - http://hdl.handle.net/11427/42624 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/42624
dc.identifier.vancouvercitationPayne A. A qualitative exploration of healthcare workers' perspectives on and experiences with colorectal cancer screening in the Western and Eastern Cape. []. University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine, 2025 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/42624en_ZA
dc.language.isoen
dc.language.rfc3066eng
dc.publisher.departmentDepartment of Public Health and Family Medicine
dc.publisher.facultyFaculty of Health Sciences
dc.publisher.institutionUniversity of Cape Town
dc.subjectqualitative research
dc.subjectcolorectal cancer
dc.subjectcolorectal cancer screening
dc.subjectFaecal immunochemical test (FIT)
dc.subjectprimary health care
dc.subjectbarriers and facilitators
dc.subjectSouth Africa
dc.subjectLow- and middle- income countries (LMIC)
dc.titleA qualitative exploration of healthcare workers' perspectives on and experiences with colorectal cancer screening in the Western and Eastern Cape
dc.typeThesis / Dissertation
dc.type.qualificationlevelMasters
dc.type.qualificationlevelMasters
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