Satisfaction with cancer screening programs and its associated factors: a cross-sectional study in 26 provinces across China

BACKGROUND: Satisfaction is a crucial indicator for evaluating cancer screening programs. However, the current levels of satisfaction with cancer screening services in China and the associated factors remain unclear. METHODS: A national survey was conducted in 2022, including 5,024 participants aged 35 to 69 years who were involved in cancer screening programs across 26 provinces in China. Logistic regression models were used to investigate the associations between socioeconomic factors, lifestyle factors, and individual health status with satisfaction regarding cancer screening. Multilevel logistic regression was performed to examine provincial-level contextual factors and quantify regional disparities. Additionally, structural equation models were utilized to examine the pathways associated with screening satisfaction. RESULTS: Overall, 82.8% of participants were satisfied with cancer screening. Provinces with relatively high satisfaction rates included Gansu (91%), Shandong (92%), and Anhui (87%), while provinces with relatively low satisfaction rates included Hainan (67%), Jiangxi (76%), and Jilin (75%). Independent factors associated with satisfaction were physical activity (OR = 1.27, 95% CI = 1.08-1.48), and self-rated health (OR for excellent health status = 4.51, 95% CI: 2.35-8.65; trend P < 0.001). For free screenings, independent factors were physical activity (OR = 1.45, 95% CI: 1.14-1.84) and family history of cancer (OR = 0.63, 95% CI: 0.48-0.84), with self-rated health showing a positive trend (trend P < 0.001). For paid screenings, independent factor was self-rated health (OR for excellent health status = 3.20, 95% CI: 1.62-6.34; trend P < 0.001). Multilevel modeling revealed that provincial-level differences accounted for only 1.4% of the total variance in satisfaction (ICC = 1.4%). None of the measured regional contextual factors (GDP per capita, hospital bed density, or number of tertiary hospitals) were significantly associated with satisfaction (all P > 0.05). Furthermore, self-rated health partially mediated the association between household income and satisfaction. In paid screening programs, chronic disease and service expectations also served as mediators. CONCLUSIONS: Satisfaction with cancer screening is generally high in China, although regional disparities persist. Provincial-level differences accounted for only a small proportion of the total variance, with individual-level factors being the primary drivers of satisfaction. Household income indirectly influences cancer screening satisfaction through its association with reduced chronic disease burden and improved self-rated health. Additional attention should be directed toward participants with unhealthy lifestyles and those with lower household income to effectively enhance overall satisfaction.