# Public and Healthcare Professional Attitudes Towards Risk‐Stratified Bowel Screening: A Qualitative Study Using an Info‐Comic Book

## TL;DR

This study explores public and healthcare professionals' views on risk-based bowel cancer screening using an info-comic book to facilitate discussion.

## Contribution

The study introduces a novel approach using an info-comic book to gather qualitative insights on attitudes toward risk-stratified screening.

## Key findings

- Both the public and healthcare professionals agree that higher-risk individuals should receive more intense screening, but not at the expense of lower-risk individuals.
- Participants expressed concerns that focusing on risk factors might disadvantage those with minimal risk.
- There is a desire to streamline bowel screening across the UK and ensure any changes do not compromise current equitable practices.

## Abstract

Screening for bowel cancer (colorectal cancer, CRC) is well established in many high‐income countries. There has been considerable interest in moving towards risk‐based bowel screening to increase the efficiency and effectiveness of screening. This UK‐based qualitative study explored public and healthcare professionals (HCPs)' attitudes towards risk‐based bowel screening.

Five virtual focus groups were held with members of the public of bowel screening age (60–74 in England; 50–74 in Scotland) and HCPs to explore attitudes towards risk‐based bowel screening. Public participants (n = 12) were invited through our existing patient and public involvement (PPI) networks. HCPs (n = 11) were recruited through existing networks and with the support of screening hubs.

A co‐created info‐comic book was used to facilitate discussion on bowel cancer risk factors. Following transcription, qualitative data were analysed thematically.

There was consensus that more intense screening for those of higher risk is acceptable, but this should not imply less screening for those of lower risk. There was some agreement between the public and HCPs over concerns with undue focus on risk factors, which could disadvantage those with minimal risk factors. There was also a desire to streamline existing bowel screening across the UK nations. It was felt that the current screening programme, by treating people with all risk levels in the same way, is equitable—so clear communication is needed if this is to be changed.

Findings indicate a preference that any changes to the bowel screening programme should enhance the current screening offer, and not compromise screening offered to individuals deemed to be low risk. Changes need to be acceptable to the public and HCPs—if unacceptable, there is a risk of lowering bowel screening uptake, which could potentially exacerbate health inequities in screening outcomes.

The info‐comic book was co‐created with two PPI networks, INVOLVE Hull and People and Research Together, Bowel Research UK, supported by Humber All Nations Alliance. The PPI network provided invaluable feedback on the development of the info‐comic book, to ensure inclusivity and avoid the reproduction of dominant stereotypes associated with bowel cancer.