Multi-Level Drivers of Colorectal Cancer Screening Uptake in the Gaza Strip: A Qualitative Focus Group Study

Colorectal cancer is a disease that affects the large intestine and rectum, and it remains one of the most common causes of cancer death worldwide. In many places, this disease is highly treatable if found early, often before symptoms even appear. This is why doctors recommend screening, which involves simple tests to look for signs of the disease in people who feel healthy. However, getting people to agree to these tests is not just a matter of handing out information. Human behavior is shaped by a complex web of influences, ranging from what a person believes about their own health to the laws their government passes. In regions facing conflict or poverty, these layers of influence become even more tangled, making it difficult for people to access life-saving care. Understanding how these different levels of society interact is essential for designing programs that actually work.

In the Gaza Strip, a densely populated area where healthcare has been severely disrupted by ongoing conflict, researchers set out to understand why colorectal cancer screening rates are so low. They did not simply ask people if they had been tested; instead, they gathered a wide variety of voices to understand the full picture. The team brought together patients, family members, community leaders, doctors, and government officials for a series of group discussions. By listening to these different groups, the researchers mapped out the specific barriers and helpers that exist at every level of society, from the individual mind to national policy. Their goal was to find practical ways to encourage more people to get screened, despite the difficult circumstances of living in a conflict zone.

The study revealed that the decision to get screened is rarely made in isolation. At the personal level, many individuals were driven by a genuine desire to catch the disease early, but this motivation was often held back by fear or a lack of knowledge. Some participants worried about what a diagnosis might mean for their future, while others simply did not know that screening was an option. However, the researchers found that cultural and religious beliefs in Gaza could actually work in favor of screening. Unlike in some other places where discussing cancer is taboo, many participants in Gaza felt that their religious values supported taking care of one's health. When doctors or religious leaders framed screening as a responsible act of preserving life, it resonated deeply with the community.

Family played a surprisingly powerful role in this process. In Gaza, health decisions are often made collectively rather than individually. The study found that when family members encouraged one another, it created a supportive environment that reduced fear. A husband might encourage his wife, or a child might urge a parent to get checked, often using the same language of care and protection found in religious teachings. This family support acted as a safety net, making the idea of facing a potential diagnosis feel less lonely and more manageable. The researchers noted that this dynamic was different from some other cultures where family pressure might sometimes discourage screening due to shame or stigma.

Beyond the home, the community itself served as a vital channel for information. Religious leaders, who are highly trusted figures in Gaza, were identified as key messengers. When these leaders spoke about health during weekly gatherings, their words carried significant weight. Similarly, local schools and community centers were seen as ideal places to teach people about the importance of early detection. The researchers observed that when health messages were delivered through these familiar and trusted networks, people were more likely to listen and act. Peer stories also mattered; hearing from a neighbor who had been screened and found healthy helped to normalize the process and reduce anxiety.

At the level of hospitals and workplaces, the study highlighted that trust in the medical system is crucial. Many people in Gaza expressed a desire to be screened but felt held back by logistical hurdles, such as not knowing where to go or fearing they could not afford the test. When healthcare providers took the time to explain the benefits clearly and when workplaces offered flexible policies, such as paid time off for medical appointments, participation increased. The researchers found that when organizations showed a genuine commitment to employee health, it signaled to individuals that screening was a priority worth their time.

Finally, the study looked at the broader policies that shape the healthcare landscape. The participants, including government officials, agreed that for screening to become routine, it must be affordable and accessible. They emphasized that national policies need to ensure that tests are free or low-cost and that public awareness campaigns are widespread. The researchers concluded that no single solution would work on its own. Instead, a successful approach requires a coordinated effort that aligns personal beliefs, family support, community leadership, and government policy. By weaving these different threads together, it is possible to build a system where getting screened feels like a natural and supported part of life, even in the most challenging environments. The study suggests that in Gaza, and in similar settings, the path forward lies in respecting local culture and leveraging the strong social bonds that already exist within the community.