Barriers and facilitators to colonoscopy completion after FIT + in Alberta: a qualitative description of healthcare providers’ perspectives

Timely colonoscopy following a positive fecal immunochemical test (FIT+) is essential for CRC screening effectiveness. Despite established guidelines, colonoscopy completion after FIT+ remains suboptimal in Alberta. While previous research has examined patient-level barriers, limited evidence captures healthcare providers’ perspectives. Understanding providers’ perspectives on barriers and facilitators to colonoscopy completion following FIT + in Alberta is needed to identify actionable opportunities to improve the health system performance and patient-centered care. We conducted a qualitative descriptive study using semi-structured interviews with healthcare providers involved in colonoscopy follow-up after FIT+ across Alberta. Participants were purposively recruited using snowball sampling and included physicians, nurses, clinic managers, and administrative staff. Interviews were conducted virtually, audio-recorded, transcribed, and analyzed using a combined inductive and deductive thematic approach. Findings were mapped to the Capability, Opportunity, Motivation–Behaviour (COM-B) and Theoretical Domains Framework (TDF) at the individual-level, and to the Consolidated Framework for Implementation Research (CFIR) 2.0 at the health system-level. Seventeen providers participated. Important barriers to colonoscopy completion occurred prior to the procedure. At the patient-level, providers identified some patients had limited understanding of FIT+ results and the colonoscopy process, fear and anxiety related to colonoscopy, competing life responsibilities, socio-economic constraints, and challenges related to transportation, travel, and social support. At the provider-level, barriers included inappropriate FIT use, gaps in knowledge regarding CRC screening pathways, limited resources to support patient follow-up, and challenges related to episodic care in walk-in clinic settings. Health system-level barriers included geographic inequities, variable referral and triage models, limitations related to Connect Care, staffing and space constraints, and communication gaps between primary and hospital teams in some regions. Facilitators included system navigation, patient education, reminder systems, virtual consultations, and centralized intake and triage models. Pre-procedure barriers to colonoscopy completion after FIT + are multifaceted across patient, provider, and health system levels. Addressing these barriers requires coordinated, multi-level, and regionally tailored strategies that strengthen patient education, provider support, and system integration. Applying implementation science frameworks supports actionable opportunities to improve timely and equitable access to colonoscopy following FIT+.