Table 2. Provider-identified barriers to colorectal cancer screening according the theoretical domains framework in the EMR.
| Domain | Target | Patient-level Factors | Provider-level Factors | Health System-level Factors |
|---|---|---|---|---|
| Knowledge | Barriers to recommending CRC screening | Lack of CRC awareness and related screening modalities (49) | Unawareness of symptoms of CRC (15) | Inadequate training for laboratory technicians and providers (50) |
| Lack of public awareness, signs, and symptoms (23) | Belief that only high-risk patients should be screened (50) | |||
| Low awareness and knowledge of CRC, risk factors, symptoms, and associated screening modalities (26) | ||||
| Barriers to conducting CRC screening | Lack of sufficient knowledge (27) | Lack of sufficient knowledge (27) | Lack of hospital policy or protocols for cancer screening, shortage of trained HCPs (Health Care Providers) to conduct CRC screening or to follow up with invasive procedures, limited availability of screening services, and long waiting time for screening appointments (51) | |
| Lack of awareness of CRC tests (51) | HCPs (Health Care Providers) are not knowledgeable about CRC screening recommendations (42) | |||
| Poor knowledge of who should receive CRC screening and the frequency of screening (48) | ||||
| Skills | Barriers to recommending CRC screening | – | Inability to identify correct screening tests (52) | Inadequate training for laboratory technicians and providers (50) |
| Barriers to conducting CRC screening | – | – | – | |
| Social/professional role and identity | Barriers to recommending CRC screening | – | – | – |
| Barriers to conducting CRC screening | – | – | – | |
| Beliefs about capabilities | Barriers to recommending CRC screening | – | Lack of confidence in providers to perform and interpret screening test appropriately (50) | – |
| Barriers to conducting CRC screening | – | – | – | |
| Beliefs about consequences | Barriers to recommending CRC screening | – | – | – |
| Barriers to conducting CRC screening | – | – | – | |
| Optimism | Barriers to recommending CRC screening | – | – | – |
| Barriers to conducting CRC screening | – | – | – | |
| Reinforcement | Barriers to recommending CRC screening | – | Lack of emphasis on prevention (50) | – |
| Barriers to conducting CRC screening | – | – | – | |
| Intentions | Barriers to recommending CRC screening | – | Lack of emphasis on prevention (50) | – |
| Barriers to conducting CRC screening | – | – | – | |
| Goals | Barriers to recommending CRC screening | – | – | – |
| Barriers to conducting CRC screening | – | – | – | |
| Memory, attention, and decision processes | Barriers to recommending CRC screening | – | – | – |
| Barriers to conducting CRC screening | – | – | – | |
| Environmental context and resources | Barriers to recommending CRC screening | Socioeconomic status (50) | Inadequate training for providers (50) | Inadequate training for laboratory technicians, cost (50) |
| Barriers to conducting CRC screening | – | – | Shortage of specialized healthcare providers (49) | |
| Lack of hospital policy or protocols for cancer screening, shortage of trained HCPs (Health Care Providers) to conduct CRC screening or to follow up with invasive procedures, limited availability of screening services, and long waiting time for screening appointments (51) | ||||
| Social influences | Barriers to recommending CRC screening | – | – | – |
| Barriers to conducting CRC screening | – | – | – | |
| Emotion | Barriers to recommending CRC screening | Fear of painful procedures (23) | Fear (51) | – |
| Barriers to conducting CRC screening | – | – | – | |
| Behavioral regulation | Barriers to recommending CRC screening | – | – | – |
| Barriers to conducting CRC screening | – | – | – |
EMR, Eastern Mediterranean Region; CRC, colorectal cancer.