Table 3.

Participant quotes: Cancer screening barriers

Barrier	Quote
Cost	“In my particular plan, we have a high deductible, and so many of the tests require putting money on it. There are some preventive tests that we don’t get charged for or that we get some reduced amount for, but it [has] definitely cost us money to have the test done.” [Woman aged 21–49 years] “They said that if they found some abnormality, like a polyp, it would not be all covered …. Now it’s going to cost you money.” [Man aged 50–75 years]
Not at risk	“I’ve got no history in my family at all. I mean even my parents are still alive; I just lost my grandparents recently. Pretty long life. Until about 5 years ago, I’ve usually been in pretty good shape. I exercise every day, but I just haven’t felt sick. I just don’t get sick. I haven’t felt the need [for screening].” [Man aged 50–75 years] “Especially someone like me who has no family history. I look at that [reminder] page and say, ‘That’s a waste of time.’” [Woman aged 21–49 years]
Procrastination	“Doctor says I need to do this …. I’ve got better things to do. I believe he is right. I have faith that he knows what he is doing. I don’t know if I’m in avoidance or in denial, but I just kept putting it off, kept putting it off. No physical barrier, just mental attitude.” [Man aged 50–75 years] “The only thing that I ever resisted was a colonoscopy. I was going to a doctor who had recommended one because of my family history when I was about 47 or 48. I said, ‘I feel fine, everything is great, I’m under 50, I eat healthy, I eat pretty healthy,’ and I didn’t think it was necessary. I absolutely refused to do it. I don’t know why I was so stubborn.” [Woman aged 50–75 years]
Fear	“Nobody wants to be told they have cancer …. I think that’s always there.” [Man aged 50–75 years] “I think you’re afraid of what you’re going to find out.” [Woman aged 50–75 years]
Pain/discomfort	“If you’re getting screening for colon cancer, a lot of people are put off with the prep.” [Woman aged 50–75 years] “A doctor recommended a colonoscopy, and I said, ‘There’s no way.’ They were painful back then too, and I heard lots of stories that you really don’t want to get that done.” [Woman aged 50–75 years]
Distrust	“To heck with it, maybe it’ll be a false-positive anyway. I just won’t do it.” [Woman aged 21–49 years] “Are you wasting a bunch of money having been poked and prodded for something that would never develop into anything bad?” [Woman aged 21–49 years]
No time	“Especially nowadays you can’t just get in on the day you want. You have to really think out like 3 months in advance to be able to get in to see someone, and so same kind of idea, ‘Well, I don’t know what it’s going to be like in 3 months, I’ll wait.’ … It just doesn’t get done.” [Woman aged 21–49 years] “It’s hard enough to find time for yourself let alone a buddy to go with ya [for colonoscopy].” [Woman aged 50–75 years]
Guideline confusion	“I have heard different doctors say different [recommendations] … about how many years you go between, so I’m very confused about it at this point. First, because of that, I always [went] every 2 years, then every 5 years. I went in this last time and they said ‘Oh, 10 years.’ I don’t know who to trust, basically.” [Woman aged 50–75 years] “The frequency of when you need to do a mammogram has changed because of fashion or statistics or whatever, but anyway they have different years. Oh, you have to do it every 2 years; oh, you have to do it every year; you have to do it, … and it changes with your age too.” [Woman aged 50–75 years]