Table 2.

Participants’ attitudes toward the ColonCancerCheck Primary Care Invitation Pilot

Invitation letter reaction
  • I don’t remember … I have everything filed and I went through the medical file and I can honestly say that, as far as I know, 100% I did not see this letter. (FG1, Ottawa, Ont)

  • My doctor for the last 2 years has been mentioning that I should do one of those kits and I’m a procrastinator and I don’t go and pick it up. I saw this [letter] and I thought, “Oh yeah, I’ve got to pick that up.” (FG2, Thunder Bay, Ont)

  • My doctor just said you’re at that age and you should go get this done … he’s pretty knowledgeable so I thought, “Yeah, this is a good idea.” So when it [the letter] came in the mail, I read the stuff. So it reinforced me. His opinion reinforced the process. (FG1, Thunder Bay)

  • [It] came out of the blue. I’m wondering why the doctor that … never talks to you much … sends … a letter saying you should come in and talk about … colonoscopy. I was in a … state of panic: “What’s going on here; what isn’t he saying?” (FG2, Thunder Bay)

  • What threw me off was, “Please call my office for an appointment,” because I had just been there and thought, “Who’s this letter from, actually?” (FG2, Hamilton, Ont)

  • [I did] exactly what I do to any mail-out I get, I put it in a little pile ... and never see it any more. (FG1, Hamilton)

  • I wouldn’t have even brought it up to my family physician if I hadn’t received the letter. That’s what I needed—a trigger. (FG2, Hamilton)

  • I remember getting it and it was very clear and I acted on it. (FG1, Ottawa)

Suggestions about changing the invitation letter format and content
  • If the doctor’s name hadn’t been on the bottom I’d … give it a toss. (FG1, Thunder Bay)

  • The fact that your own doctor’s name is on there, makes it a little more personal. (FG1, Hamilton)

  • [I found it] very confusing that it’s coming from my doctor … [it] should be coming … from Cancer Care Ontario … and … say, “On behalf of your doctor.” (FG1, Ottawa)

  • Put … in the first paragraph ... [that] it’s a simple test that can be done at home. (FG1, Hamilton)

  • If the letter is going to work, it’s got to be more scary … powerful … you need to give people something to grab onto at the very beginning like … that this simple little test could save your life. (FG1, Ottawa)

  • I like lots of information. There wasn’t enough information in this for me. (FG1, Thunder Bay)

  • I still was wondering how prevalent it [colorectal cancer] was and I was thinking it would be nice to know that ... to know it [screening] was something that would make a difference or not. (FG1, Thunder Bay)

  • It says I’ve missed the FOBT … and then you should have a … colonoscopy. Now it says if you’re at risk … you really should have [a colonoscopy] but if I’m average do I still get one? (FG2, Thunder Bay)

FOBT responses and experiencesMotivators to use FOBT
Personal health factors
  • [I am] getting older … a few years ago I didn’t want to … but now I do. (FG1, Thunder Bay)

  • I have family that has colon cancer. (FG1, Thunder Bay)

Social factors
  • My wife wanted me to. (FG2, Hamilton)

  • [I have] relatives that had cancer ... and my husband’s sister died of colon cancer … so did his father. That’s enough … fear … for me to do the screening … going to be safe [rather] than sorry. (FG1, Thunder Bay)

  • I needed a little push, which I got from my union and I got from this letter. (FG1, Hamilton)

Health system interventions
  • My physician … directed me to have the stool test. (FG1, Ottawa)

  • My doctor just gave me this kit, I did the test and … put it in the mailbox. (FG2, Thunder Bay)

  • I saw the commercial on TV, so I asked my doctor for the envelope to do the stool test. (FG1, Ottawa)

  • I can honestly say I would have never have gone if I didn’t get this letter … it was a trigger that reminded me. (FG1, Ottawa)

Barriers to FOBT
  • Once you got past the yuck factor … it was pretty simple. (FG1, Hamilton)

  • I didn’t really like the whole process … I thought, “That’s disgusting.” (FG2, Hamilton)

  • What bothered me more was what I could eat or not eat. (FG1, Hamilton)

  • It’s like a fear thing … if I do the FOBT and something shows up … then I have a colonoscopy. (FG2, Hamilton)

Receiving results
  • I don’t remember getting the results. (FG1, Ottawa)

  • I thought since I sent in the test that I would get results but then I thought, “Well, maybe my doctor got the results,” and since she never … they never call if it’s negative. (FG1, Ottawa)

  • The first time I had … [FOBT] done and he [physician] called me into the office to say it was negative and I said, “Well, that’s a waste of time.” So, this time when I did get [the results] in the letter form, I felt it was better because I wasn’t wasting up valuable doctor time. (FG1, Ottawa)

Direct mailing of FOBT kit
  • If ... kits are sent … directly, you’d have a lot more people participating. (FG1, Hamilton)

  • If it [the kit] would come in the mail, I’d say, “Oh, I got this, I’d better do it.” (FG1, Thunder Bay)

  • If they sent me the kit the first time I wouldn’t have done it … because I’ve done it once, I’ll do it again. (FG1, Thunder Bay)

  • My doctor gets me all the tests … more tests than I want already and I don’t need this. It’s a waste, sending it to me. (FG2, Ottawa)

Screening promotion strategiesStrategies that would be novel to the ColonCancerCheck program
  • If you use the educational system to get the information out, also you’re going to reach the parents of these children that are [minority] ethnic cultures. (FG2, Ottawa)

  • Gyms and sporting areas. That’s big … getting fit again. Health clubs, gymnasiums ... (FG1, Ottawa)

  • The Internet. That’s what everybody’s looking at. (FG1, Hamilton)

  • What about … e-mail, with a link to a website that has some testimonials of people that had the test, didn’t have the test, what it

    feels [like]. (FG2, Hamilton)

  • They are the minority so maybe something specific to get males to go might be [a possible strategy]. (FG2, Thunder Bay)

Strategies previously or currently used by program
  • Oh, maybe part of the medical … just automatically give you the kit at your yearly medical. (FG2, Thunder Bay)

  • When you’re standing at the pharmacy waiting for your prescription to be picked up, if something like this could be there. (FG2, Ottawa)

  • If you could have them hand them [FOBT kits] out with the prescriptions, put one in with the prescriptions. (FG1, Thunder Bay)

Birthday invitation
  • Sure, I think that would be a good idea because a lot of people … reach 50 and they don’t realize that that’s the time you start all these preventative tests. There’s a whole list of things you could do when you turn 50 [that] would be good. (FG1, Thunder Bay)

  • It kind of smacks of Cracker Barrel … [a] little cheesy. (FG2, Hamilton)

  • FG—focus group, FOBT–fecal occult blood testing.