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It was clear from comments made about FS screening and bowel cancer that the non- attenders believed bowel cancer to be a serious disease. There were no comments that suggested that bowel cancer was considered an insignificant illness.

4.3.3.111. Benefits and Barriers

Benefits were described by a large proportion of the NAs in comparison to the other non­ participant groups. This is not suprising since this groups were explaining their initial interest in the FS test as well as describing the reasons why they had not attended.

4.3.3.111.a. Benefits

Benefits of FS screening were described by 77.2% of interview respondents from the NA group. The main benefit of screening identified by NAs was the view that early

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detection/screening was a ‘good thing’ and this was identified by 59.6% (n=34) of interview respondents in this group.

“the sooner something like this is detected the better”.

The next largest category within the heading of benefits was importance of maintaining good health or having a bowel check. This was a view put forward by a much smaller proportion of respondents, compared to the previous category (8.8% n=5 of NA respondents).

“Weil just to look after yourself sort of thing”.

Another benefit that emerged from NA accounts was the potential for reassurance offered by the test. In total, 7% (n=4) said they felt the test would give them peace of mind/reassurance about their health.

“Weil it puts your mind at rest”.

A few of the NA respondents (5.3% n=3) said they had initially felt they wanted to help medical research.

4.3.3.}ii.b. Barriers

All the non-attenders described some sort of barrier to FS screening when they explained either their initial interest in the test or more commonly, when they explained their decision not to attend their test appointment. Practical and physical barriers featured prominently in NA respondents' accounts to explain non-attendance at screening. However, psychological barriers were also mentioned with much frequency suggesting it was not only practical and physical obstacles that prevented attendance at the test. There were anxieties, concerns and perceptions of the test which were similar to those expressed by the other non­ participant groups the NRs and NIs.

Practical and physical barriers

Practical and physical factors were by far the largest category of reasons given to explain non attendance and were described by 70.2% (n=40) of the NA sample. Illness was the largest category within this heading and was given by 26.3% (n=15) of NAs as their reason for non-attendance. Most of the illnesses described were serious in nature ranging from

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heart attacks to gall bladder operations and cancer. A small number of NA respondents described more minor illnesses such as flu and also bowel problems.

"/ had a stroke actually”.

“At that particular time I had haemorrhoids...I’m terribly irritated down there, I’m really in a mess”.

The next largest category given by NAs to explain non-attendance was the time of the appointment. This was given by 24.6% (n=14) of NAs despite the fact that appointment times could readily be changed. Typical comments made by interview respondents within this category were,

7 was away on holiday”.

“Oh I’d got a wedding and I think it was the day before”. ‘The time didn’t suit me”.

Non-attenders also reported being too busy to go for the test (12.3% n=7). Explanations included lack of time for the test working away from home and working long hours.

“i ’m self-employed you see... and unfortunately I was working away from home”.

Family illness was described by 8.8% (n=5) of the NA sample and family commitments were described by 5.3% (n=3). Difficulty with travel to the screening clinic was given as a reason by 8.8% (n=5) interview respondents.

“if it’d been nearer you know.....my local hospital”.

Psychological barriers

Negative attitudes towards the FS test also featured frequently as barriers to attendance at FS and were identified by 57.9% of NAs interviewed. The most important category within this heading was concerns about the enema. 19.3% (n=11) of NA respondents described the self-administered enema (which is mailed to participants prior to the test as part of the test protocol) as an important barrier to attendance. Several of these interview respondents described shock and concern about being expected to perform the enema at home and felt unconfident they could do this correctly. Worries about travelling to the clinic after taking the enema were also expressed.

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'When the apparatus [the enema] came I could Just not see me doing that at home”. “I thought, no I can’t do that”.

“I was frightened, I’m not actually sure what happens”.

The next largest category within the heading ‘Concerns about the FS test’ was negative feelings towards the test (pain/discomfort and the unpleasantness of the test procedure) which was described by 17.5% of NAs. 15.8% (n=9) described various fears about the test. Fear of the procedure (5.3% n=3) and fear of finding cancer (5.3% n=3) were the largest categories under this heading. Fear of the unknown in terms of both procedure and results was described by 3.5% (n=2) of NA respondents and fear of medical tests was described by one person. 7% (n=4) of NA sample had heard of bad experiences with the FS test since their decision to respond that they were interested in screening, which deterred attendance at the test.

Embarrassment about the test was expressed by was 14.3% (n=8) of NAs and concerns about the ‘part of the body’ the test examined were also given by 15.8% (n=9).

Vust as the day got closer and I got worried, it’s really embarrassment”.

"/ think actually for myself that is probably the most private part of my body that I really don’t fancy any tests or anything like that in it”.

A small number of NAs (8.8% n=5) had been advised to undergo bowel tests by their GP since the offer of FS screening for bowel cancer had been made and so screening was no longer appropriate. 5.3% (n=3) of interview respondents reported that they had had other medical checks/ treatments since responding they were interested in screening were consequently too preoccupied to go for bowel screening.