Closing the Loop After Positive Fecal Immunochemical Test (FIT) Results: Barriers to Colonoscopy Completion Within the Saudi Model of Care in Qassim Health Cluster

Background and aim In the Qassim Region of Saudi Arabia, a significant proportion of patients with a positive fecal immunochemical test (FIT) do not proceed to diagnostic colonoscopy, compromising colorectal cancer (CRC) screening efforts. The specific reasons behind this drop-off remain poorly characterized. This study aimed to identify and evaluate the multidimensional barriers, including knowledge gaps, psychosocial factors, and sociodemographic traits, that prevent patients from undergoing follow-up colonoscopy after a positive FIT. Methods A cross-sectional study was conducted between January and October 2024 among 212 nonadherent patients in the Qassim Region. Data were collected using a structured questionnaire. Descriptive statistics were utilized to evaluate barriers, and a multivariable logistic regression analysis was performed to identify sociodemographic predictors of psychological barriers. Results The cohort was predominantly male (160; 75.47%), with a university-level education (104; 49.06%). A significant knowledge gap regarding colonoscopy was identified. The most frequently reported barriers were embarrassment (65; 30.95%), fear of a cancer diagnosis (43; 20.48%), and the misconception of not needing the test due to being asymptomatic (32; 15.24%). Multivariable regression indicated that higher educational attainment showed a trend toward a lower likelihood of reporting psychological barriers (OR: 0.56, p = 0.078). Additionally, gender was significantly associated with reporting family history (p = 0.004) and perceiving screening as important (p = 0.048). Conclusions Nonadherence to follow-up colonoscopy after a positive FIT in the Qassim region is primarily driven by psychosocial stigma (embarrassment and fear) and procedural knowledge deficits. These barriers can be minimized through targeted continuous patient education and culturally sensitive psychological support, which are essential to bridging gaps in the CRC screening cascade.