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Public Health Res Pract. 2019 Mar 6;29(1). pii: 28231810. doi: 10.17061/phrp28231810.

Factors contributing to low readiness and capacity of culturally diverse participants to use the Australian national bowel screening kit.

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Faculty of Social Sciences, University of Wollongong, NSW, Australia; Australian Health Services Research Institute, University of Wollongong, NSW, Australia,
Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia; Multicultural and Refugee Health Service, Wollongong, NSW, Australia.
Faculty of Social Sciences, University of Wollongong, NSW, Australia.
Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia; Illawarra Cancer Care Centre, Wollongong Hospital, NSW, Australia.



Bowel screening is an effective way to promote early detection of bowel cancer. Culturally and linguistically diverse (CALD) people face considerable barriers to screening. This qualitative study explored perceptions towards, and usability of, Australia's national bowel screening kit with members of two migrant communities.


Thirty-three people (aged 50-79 years) from Serbian and Macedonian communities in the Illawarra region in New South Wales, Australia, participated in one of five interactive focus group sessions. Sessions used innovative 'customer journey' techniques to understand participants' experience of each step of the faecal occult blood test process. Participants discussed knowledge of bowel cancer and attitudes to screening, and participated in a collective mock use of a test kit. Sessions were audio recorded, transcribed and thematically analysed by two researchers in collaboration with bicultural health workers.


Multiple factors contributed to low readiness and capacity to use the kit, including limited promotion of the program in community languages, complicated and poorly sequenced kit instructions, and confusion around the order and labelling of kit components. Participants suggested several ways to improve kits to improve uptake by CALD communities.


Simplified and targeted promotion of bowel screening programs in community languages, and improved kit design, may support participation of CALD populations in screening programs.

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