Abstract
Bowel cancer (BC) is a major type of cancer in the UK. Population based bowel cancer screening (BCS) was introduced to the UK in 2006. Bowel screening, via a faecal occult blood test (FOBt), has been speculated to reduce BC mortality by approximately sixteen percent. However, the effectiveness of the screening programme to reduce mortality is reliant upon substantial participation. Prior to the national roll-out of the BCS programme, a UK pilot reported that approximately forty percent of the population declined the invitation to be screened for bowel cancer. Literature to date has identified psychosocial factors and barriers which may result in an individual declining BCS. However, only a limited amount of research was found to be specific to screening via FOBt, and to participation in the new BCS programme. Furthermore, relatively little research was dedicated to the reasons why individuals chose to decline screening. Therefore, within this thesis, three qualitative studies were conducted initially to explore the factors affecting screening participation via FOBt. These studies revealed that there were a number of emotions, beliefs and issues with a FOBt affecting screening participation. To ascertain if any of these factors were more predominant than others, a wider-based quantitative study was conducted. This study indicated that males and older individuals may be more likely to decline routine BCS, and that overall the practical elements of carrying out a FOBt may reduce screening participation. To address this issue, a systematic review identifying the effect of a FOBt on participation was carried out. This revealed that the type of FOBt affected participation rates. Hence, the final study conducted was an intervention to address attitudes towards the practical elements of completing a FOBt, and whether these were altered by seeing a FOBt, or by the type of FOBt. The findings indicated that these factors affected attitudes about BC and BCS. Consequently, implications for further research and future directions for the BCS programme were discussed.