Table 2.
Overview of original and revised conceptual frameworks (original framework synthesized from previous literature, see: Kerrison et al., 2021).
| Revised framework | Original framework |
|---|---|
| 1. Sociocultural factors | |
| 1.1. Social support and influences | 1.1. The role of positive relationships, social networks and other influences |
| 1.1.1. Support / lack of support from friends and family | 1.1.1. Support / lack of support from local community and social networks* |
| 1.1.2. Family influenced participation | – |
| 1.1.3. Media coverage | – |
| 1.1.4. Knowing someone with CRC | – |
| 1.1.5. GP recommendation | 1.1.5. Test recommended / not recommended* |
| 1.1.6. Hearing other people’s experiences with colonoscopy | – |
| – | 1.1.7. Patient provider relationship |
| – | 1.1.8. Previous conversations with patient-provider |
| 1.2. Cultural and religious beliefs and attitudes | 1.2. Cultural taboos and perceptions of masculinity* |
| 1.2.1. Unable to have a male practitioner for religious reasons | – |
| 1.2.2. Colonoscopy, colon and rectum ‘culturally taboo’ topics | 1.2.2 Colonoscopy as a culturally taboo topic* |
| 1.2.3. Gender and engagement with healthcare | – |
| 1.2.4. Fatalistic beliefs | – |
| 1.2.5. Unable to accept blood products for religious reasons | – |
| – | 1.2.6. Colonoscopy not ‘manly’ |
| – | 1.2.7. Perceived threat of bodily invasion to masculinity |
| – | 1.3. Past experiences and experiences of important others |
| – | 1.3.1 Hearing other people’s experiences with colonoscopy |
| – | 1.3.2. Previous personal experiences with colonoscopy |
| 2. Practical factors | |
| 2.1. Language barriers | – |
| 2.1.1. Language barriers | – |
| 2.2. Competing priorities and accessibility issues | 2.2. Competing priorities and accessibility issues |
| 2.2.1. Transport / travel | 2.2.1. Difficulties getting to the appointment* |
| 2.2.2. Traveling / on holiday | – |
| 2.2.3. Family, work and religious commitments | 2.2.2. Family and work commitment* |
| 2.2.4. Lack of car parking | – |
| 2.2.5. Indirect costs | – |
| 2.2.6. Initial invitation not received | – |
| – | 2.2.7. Cost of colonoscopy |
| – | 2.2.8. Colonoscopy not covered by health insurance |
| – | 2.2.9. Difficulties arranging an appointment |
| – | 2.2.10. Existing health conditions (Moved to ‘Health-related factors’) |
| 2.3. Unexpected events on the day of the appointment | – |
| 2.3.1. Failed bowel preparation | – |
| 2.3.2. Feeling unwell | – |
| 2.3.3. Personal emergency | – |
| 3. Psychological factors | |
| 3.1. Concerns about the procedure | 3.1. Concerns about the procedure |
| 3.1.1. Concerns about doing the bowel preparation | 3.1.1. Concerns about doing the bowel preparation |
| 3.1.2. Fear about pain and discomfort | 3.1.2. Fear of pain and discomfort |
| 3.1.3. Concerns about test invasiveness | 3.1.3. Concerns about test invasiveness |
| 3.1.4. Shame and embarrassment | 3.1.4. Shame and embarrassment |
| 3.1.5. Concerns about availability and necessity of sedation | 3.1.5. Concerns about availability and necessity of sedation |
| 3.1.6. Concerns about perforation and procedural risks | 3.1.6. Concerns about perforation and procedural risks |
| 3.1.7. Concerns about practitioner performing the test | – |
| – | 3.1.8. Fear of not knowing |
| – | 3.1.9. Existing health conditions interfering with ability to do the bowel preparation (Moved to ‘Health-related factors’) |
| 3.2. Knowledge about CRC, screening and colonoscopy | 3.2. Knowledge about CRC and screening |
| 3.2.1. Lack of understanding that bowel cancer can be asymptomatic and the test is looking for invisible traces of blood | 3.2.1. Lack of understanding that bowel cancer can be an asymptomatic disease* |
| 3.2.2. Lack of awareness and understanding of colonoscopy procedure | 3.2.2. Awareness and understanding / lack of awareness and understanding of the procedure* |
| 3.3. Emotional responses during the assessment | – |
| 3.3.1. Anxiety | – |
| 3.3.2. Denial | – |
| 3.3.3. Avoidance | – |
| 3.3.4. Shock | – |
| 3.4. Cognitive abilities and ability to make an informed decision | – |
| 3.4.1. Lack of capacity | – |
| 3.4.2. Low health literacy | – |
| 3.4.3. Memory issues | – |
| 3.5. Perceived CRC risk and perceived benefits of colonoscopy | 3.5. Perceived risk and perceived mortality |
| 3.5.1. Proactive desire to stay healthy | – |
| 3.5.2. Peace of mind | – |
| 3.5.3. Having CRC symptoms | 3.5.3. Having CRC symptoms |
| 3.5.4. Having a family history of CRC | 3.5.4. Having a family history of CRC |
| – | 3.5.5. Cancer fear |
| – | 3.5.6. Perceived mortality and potential to benefit from colonoscopy |
| – | 3.6. Enhanced peace of mind |
| – | 3.6.1. Colonoscopy provides long lasting peace of mind |
| – | 3.6.2. Colonoscopy examines whole bowel |
| – | 3.7. Enhanced peace of mind |
| – | 3.7.1. Lack of interest and procrastination |
| – | 3.7.2. Proactive desire to stay healthy* |
| – | 3.8. Post hoc rationalization for abnormal screening result |
| – | 3.8.1. Providing an alternative explanation for the test results |
| – | 3.8.2. Distrust in the screening result |
| 4. Health related factors | |
| 4.1. Existing health conditions and medical history affecting clinical eligibility to have the test | – |
| 4.1.1. Clinically ineligible or inappropriate | – |
| 4.2. Existing health conditions and medical history affecting patient willingness to have the test | – |
| 4.2.1. Recent Colonoscopy | – |
| 4.2.2. Existing health condition interfering with ability to do the bowel preparation | – |
| 4.2.3. Previous personal experiences with colonoscopy and other medical investigations | – |
| 4.2.4. Existing health conditions as a competing priority | – |
| 5. COVID-Related factors | |
| 5.1. Impact of COVID | – |
| 5.1.1. Fear of getting COVID | – |
| 5.1.2. Unable to leave the house due to shielding | – |
| 5.1.3. Fear of spreading COVID | – |
| 5.2. Impact of COVID measures | – |
| 5.2.1. Unable to get in contact with patients | – |
| 5.2.2. Patients unable to bring friend / family for emotional support | – |
| 5.2.3. Patient and household required to self-isolate prior to procedure | – |
*
Indicates that the theme or subtheme has been relabeled in the revised model.