Understanding low uptake of colorectal cancer screening in South East London
: exploration of demographic, psychological, social and cultural factors

Student thesis: Doctoral ThesisDoctor of Philosophy


Colorectal Cancer (CRC) screening is offered in the UK to individuals aged 60-75 years through the faecal occult blood test (FOBt). Uptake of CRC screening is variable but particularly low in South East (SE) London, an area with high ethnic diversity and socio-economic deprivation. Reasons for this low uptake are unclear. This thesis explores the role of psychological, social and cultural factors in the low uptake of CRC screening in SE London.
Mixed methods were employed where a narrative synthesis examined the beliefs of various ethnic minority and socio-economic groups about the FOBt; a qualitative study explored the beliefs of 50 people of Black African, Black Caribbean and White British backgrounds from SE London; and a prospective questionnaire study (n=507) identified the demographic and psychological predictors of screening intentions and uptake. The narrative synthesis, interview topic guide and questionnaire were underpinned by Theoretical Domains Framework (TDF; Michie et al 2005).
Findings of the narrative synthesis indicated a dearth of research examining both ethnicity and SES factors together. The qualitative study highlighted many similarities in the views of participants from the three main ethnic groups after considering SES. The survey indicated intentions and participation in CRC screening were underpinned by psychological and demographic factors, where psychological factors mediated the impact of ethnic differences. Although SES was not related to screening intentions or uptake, more deprived groups were significantly less likely to make an informed choice about screening.
This thesis has bridged an important gap by examining the beliefs of Black African and Black Caribbean who have been previously neglected from research. Exploration of ethnicity and SES and the integrated use of a theoretical framework are distinct strengths of this thesis. These findings can help inform the design of interventions to influence screening uptake.
Date of Award2013
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorAlison Wright (Supervisor), Rachel; Crockett (Supervisor), David Armstrong (Supervisor) & Roger Jones (Supervisor)

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