Table 2.

Overarching themes and constituent barriers and facilitators to cancer screening uptake

Theme: Knowledge of screening programmes and processes
Constituent barriers	Constituent facilitators
SU: Not knowing what to expect or what to do; unsure of need for screening; difficult to process information SP: Communication skills training not available to all MHP: Lack of knowledge of programme and/or procedures; promotion of screening not prioritised; lack of physical health expertise	SU: Wanting to be informed; understanding the benefits of screening; feeling health conscious; encouragement MHP: Health promotion seen as their role; aware that SU are at risk of cancer; understanding emotional and practical barriers to screening uptake for SU
Theme: Knowledge of, and attitudes towards mental illness
Constituent barriers	Constituent facilitators
SU: Lack of understanding of mental illness in screening professionals; made to feel like a burden on health service; stigma of mental illness SP: Lack of knowledge of severe mental illness; find complex patients difficult MHP: Stigma of mental illness (among others)	SU: Staff being understanding; staff knowledge of mental illness SP: Understanding of emotional and practical barriers to screening uptake for SU; staff motivated to encourage screening for all groups; importance of good communication skills recognised; confidence to screen anyone associated with good communication skills
Theme: Health service delivery factors
Constituent barriers	Constituent facilitators
SU: Screening environment aggravates mental health symptoms; staff can be rushed; staff can be rough; exclusion from GP registers SP: Lack of time; no means of knowing patient needs in advance; computer systems not linked MHP: Lack of a structured behaviour change approach; lack of collaboration between healthcare services; no one has clear responsibility to promote screening; patient’s mental state; lack of resources	SU: Continuity of care SP: Practice nurses can access patients’ records; reactive measures in place if advance notice of need is given MHP: Diagnostic overshadowing known to be a problem; willingness to promote screening; cancer screening promotion included in routine health promotion
Theme: Service users’ beliefs and concerns
Constituent barriers	Constituent facilitators
SU: Additional burden; mental health symptoms reduce motivation for self-care; past negative experience; embarrassment; traumatising; fear of bad news; poor relationship with GP; diagnostic overshadowing	SU: Feeling health conscious; being anxious to avoid further health problems; physical symptoms (e.g. finding a lump); past positive experience; good relationship with GP; good relationship with practice nurse SP/MHP: Awareness of some of these difficulties
Theme: Practicalities for service users
Constituent barriers	Constituent facilitators
SU: Appointment booking; transport difficulties; difficulty remembering appointments; difficulty leaving the house due to mental health problems; taking time off	SU: Familiar location; reminders SP/MHP: Awareness of some of these difficulties

SU service user, SP screening professional, MHP mental health professional