Laypersons' views of material incentives for enhancing colorectal cancer screening

Background: Colorectal cancer (CRC) early detection improves health outcomes; screening programmes invest efforts in initiating invitations to target populations to be tested. Enhanced adherence is essential for reduction of morbidity and mortality. Participation rates in Israel are still relatively low. Objective: To explore lay views regarding the concept of receiving material incentives in exchange for enhanced adherence to CRC screening. Research design: Qualitative study. Between November 2009 and February 2010 six focus group discussions were carried out in two urban, middle and low socio-economic status primary care clinics in a Northern city in Israel. Participants were eligible individuals for CRC screening, aged 50-68 (N = 24). Data analysis followed the principles of grounded theory, supported by qualitative software. Results: Participants found administering incentives in exchange for CRC screening inappropriate on rational and moral grounds. They valued their relations with the medical team and the health system more than the potential gain expected. Individuals eligible for CRC screening perceived themselves as responsible for their health, admitting difficulties in realizing this responsibility. Incentives were reported unsuitable for solving reported screening difficulties and a potential harm to the doctor-patient relationship. Conclusions: Focus group participants expressed an unconventional voice towards the use of material incentives. They pointed to the need for focused support of health behaviour change and valued their autonomy. While a proportion of the invitees in the target population see the importance of screening and appreciate the HMO's initiative to invite them for testing, they also expressed their need for support from the HMO in realizing the recommended health behaviour.