Participants’ and non-participants’ views of workplace-based colorectal cancer screening in Japan: a secondary qualitative study

Colorectal cancer (CRC) screening is one of the main causes of death in high-income countries. In Japan, cancer screening programmes are delivered by different insurers, and these programmes are based mainly on communities and workplaces. Although several surveys have suggested participation rates are higher in workplace-based programmes, the experiences and views of participants and non-participants are poorly understood. We conducted a secondary qualitative analysis of transcripts from interviews with people who shared their experiences and/or views of employer-based CRC screenings. By using a qualitative database called DIPEx-Japan, we purposely selected participants who had been on social insurance which indicated they were eligible for workplace-based cancer screening. We excluded (i) individuals with a history of inflammatory colorectal diseases; (ii) individuals who stated that they had been exclusively on National Health Insurance; and (iii) individuals who did not mention workplace-based screening. We conducted a thematic analysis for the selected interviews. We selected 24 cases for analysis. The participants were encouraged to attend workplace-based CRC screening alongside other annual legislated health check-ups or by offering financial assistance to attend comprehensive general health check-ups in hospitals that also include screening by default. Two interviewees who had not attended workplace-based screening said that it was not provided as a mandatory option. The participants often lacked the information required to make an informed choice regarding their participation in workplace-based screening. Several interviewees who had not attended further examinations explained that they were not informed of the necessity or purpose of the screening. Follow-up strategies varied across employers. However, there was an indication that interviewees who had an established relationship with healthcare professionals expressed their willingness to take up further examinations if needed and continued to participate in screening after their retirement. Workplace-based cancer screening programmes may improve uptake of cancer screening because of their mandatory arrangements. However, better communication is needed to explain the risks and benefits of screening which will support their decisions to take up further examinations or encourage continuous participation in screening.