Colorectal cancer (CRC) is a major public health issue in France, with an estimated 47,000 new cases and 17,000 deaths annually. Early screening among eligible patients aged 50-74 years with no history of chronic intestinal pathologies can reduce mortality by up to 30-40%; yet participation rate among these patients remains suboptimal, below 40%. Since 2022, pharmacists have become key players for CRC screening. We have previously shown that they contribute effectively to increase accessibility and reduce health-system burden, particularly for underserved populations.
 

We propose to evaluate the behavioural, perceptual, and contextual factors associated with patients’ decisions to undergo or refuse CRC screening when offered in community pharmacies. Findings are expected to generate practical and scalable public health actions that strengthen screening uptake, reduce disparities and improve population-level cancer prevention.
 

A mixed-methods cross-sectional study was conducted with eligible patients in western France pharmacies between April and December 2025. Participating pharmacies were distributed evenly across urban, suburban, and rural areas, based on the localized potential accessibility indicator for pharmacists. Qualitative semi-structured interviews and quantitative anonymous online questionnaires were guided by the Theory of Planned Behavior, capturing attitudes, subjective norms, perceived control, and intentions toward screening. Sociodemographic characteristics, knowledge about CRC and screening, previous screening experience, and health history were also collected. Completion of the pharmacy-based screening was the primary outcome. Qualitative interviews were thematically coded using NVivo 12, and quantitative data were analyzed using IBM-SPSS version 28. Descriptive statistics summarized patient characteristics, and multivariable regression assessed drivers and barriers to screening.


A total of 66 interviews (n=33 acceptors, n=33 decliners) were obtained to achieve data saturation and to have a homogeneous geographical distribution. They revealed four relevant themes: Sociodemographic factors (age, education, prior screening) shaped perceived susceptibility and attitudes; health factors (comorbidities, perceived CRC risk, hospitalization) influenced behavioural beliefs; psychosocial factors (fear, embarrassment, media campaigns) reflected attitudes and normative pressures; and pharmacy/pharmacist specificities (accessibility, convenience, trust in pharmacists) affected perceived behavioural control.
A total of 500 patients completed the online questionnaire. Factors positively associated with acceptance included strong perceived benefit of early CRC screening (aOR=2.4, 95% CI: 1.6-3.7), prior pharmacist recommendation (aOR=3.1, 95% CI: 2.0-4.8), and pharmacy accessibility (aOR=1.9, 95% CI: 1.2-3.0). Barriers included fear of the result (aOR=0.6, 95% CI: 0.4-0.9), perceived embarrassment (aOR 0.5, 95% CI 0.3-0.8) and concerns about confidentiality in a pharmacy setting (aOR 0.7, 95% CI 0.5-0.95). Screening uptake was higher among women (aOR 1.33, 95% CI 1.21-1.45) and among those with higher educational (aOR 1.40, 95% CI 1.07-1.83).


While existing literature focused on medical screening pathways, this first French study describes the key role of pharmacists in CRC screening. This study brings new evidence by showing how emotions, knowledge, pharmacist accessibility, and clarity of instructions shape patients’ decisions. Public health interventions should target more men and patients with lower education by leveraging oriented media, and providing incentives. Integrating CRC screening in pharmacies with digital reminders, educational brochures, and short motivational videos can also encourage patients to get screened. These measures may help guide similar initiatives elsewhere.