Abstract
<title>Abstract</title> <p>Background Migrant and ethnic minority populations participate in organised colorectal cancer (CRC) screening programmes at consistently lower rates than host populations across high-income countries. Prior qualitative research has identified barriers spanning cultural beliefs, health literacy, and system access, but these have predominantly been examined as discrete, domain-specific factors, with little focus on how these barriers co-occur and interact. First-generation Middle Eastern migrants are particularly under-screened and remain largely absent from qualitative research on screening engagement. This study explored factors influencing CRC screening participation among first-generation Middle Eastern migrants in Australia, using inductive thematic analysis to examine how barriers are experienced within this community. Methods A qualitative study using semi-structured interviews with nineteen first-generation Middle Eastern migrants aged 50–74 years, eligible for Australia’s National Bowel Cancer Screening Program (NBCSP), was conducted in New South Wales between August 2023 and August 2024. Participants were recruited through community organisations. Data were analysed using inductive thematic analysis following Braun and Clarke, supplemented by participant-level barrier matrix mapping. Results Of the 19 participants: 12 had never completed screening, 5 had completed at least one kit but not their most recent, and 2 completed their screening consistently. Despite high rates of non-participation, most reported openness to future screening. Four themes shaped participation: psycho-socio-cultural attitudes towards cancer and risk; socially mediated health information and trust; health system access and engagement; and modality-specific barriers related to the faecal immunochemical test (FIT) process. Barriers co-occurred and interacted across domains within individual accounts, and barrier configurations varied markedly across participants: no two participants presented the same barrier combination. Screening readiness was context-dependent, with cycles of intention and deferral shaped by life circumstances and programme timing. Conclusions Our findings show that barriers to colorectal cancer screening among first-generation Middle Eastern migrants co-occur, differ across individuals, and shift over time. This heterogeneity argues against uniform targeted interventions and for an adaptive screening architecture – flexible in modality, timing, engagement, and educational framing – that delivers equity of opportunity rather than equality of offering.</p>