EP415 - Multilevel Determinants of Fecal Immunochemical Test Uptake for Colorectal Cancer Screening in Ghana

Sunday, May 10, 2026

12:51 PM - 12:56 PM ET

ePoster Presenter(s)

JD

Jocelyn Di Nolfi, MD

Colon and Rectal Surgery Fellow
University of Utah
Salt Lake City, Utah, United States

Disclosure information not submitted.

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Author(s)

LE

Liz Elvira, BS

Program Coordinator
University of Utah
Salt Lake City, Utah, United States

Disclosure information not submitted.
KA

Kwabena Agbedinu, MD

Surgeon
Komfo Anokye Teaching Hospital
Kumasi, Ashanti, Ghana

Disclosure information not submitted.
KK

Kimberly A. Kaphingst, ScD

Professor
University of Utah
Salt Lake City, Utah, United States

Disclosure information not submitted.
SB

Samuel Brenu, BSc MBChB MSc MWACS

Surgeon
Komfo Anokye Teaching Hospital
Kumasi Metropolitan District, Ashanti, Ghana

Disclosure information not submitted.
DA

Daniel Acquah, n/a

Research Assistant
Komfo Anokye Teaching Hospital
Salt Lake City, Utah, United States

Disclosure information not submitted.
JJ

Jordan E. Johnson, MPH

Clinical Research Coordinator
University of Utah
Salt Lake City, Utah, United States

Disclosure information not submitted.

Senior Author(s)

LH

Lyen C. Huang, MD, MPH

Associate Professor
University of Utah
Salt Lake City, Utah, United States

Disclosure information not submitted.

Author(s)

OH

Olivia Hanson, BS

Medical Student
Spencer Fox Eccles School of Medicine, University of Utah
Salt Lake City, Utah, United States

Disclosure information not submitted.
Ann C. Lowry, MD

Adjunct Professor of Surgery
University of Minnesota
Minnetonka, Minnesota, United States

Disclosure information not submitted.
Jonathan A. Laryea, MD

Professor
University of Arkansas for Medical Sciences
University of Arkansas for Medical Sciences
Little Rock, AR, United States

Disclosure information not submitted.
Gifty Kwakye, MD MPH

Associate Professor
University of Michigan
University of Michigan
Ann Arbor, Michigan, United States

Disclosure information not submitted.

Purpose/Background: Access to early colorectal cancer (CRC) screening remains limited in Sub-Saharan Africa. The fecal immunochemical test (FIT) is a low-cost, non-invasive screening option, but contextual determinants of uptake and feasibility in Ghana are not well described. This study explored multilevel factors shaping participation in FIT-based CRC screening and early implementation.

Methods/Interventions: We conducted a multi-method qualitative study at Komfo Anokye Teaching Hospital (KATH), a tertiary referral center in Kumasi, Ghana. The study was done in conjunction with a pilot program offering FIT screening to all hospital staff ≥45 years with colonoscopy for positive results. To determine factors influencing the uptake and early implementation of FIT, we completed in-depth interviews (IDIs) with 14 hospital staff who participated in FIT screening using purposive sampling and verbal informed consent. IDIs were coded with a hybrid inductive-deductive approach informed by the socio-ecological framework. To contextualize findings, we conducted structured observations of the FIT workflow and mapped qualitative insights onto a visual process model. Ethical approvals were obtained from KATH and the University of Utah.

Results/Outcomes: Motivators included affordability/access through the study, desire for reassurance, personal/family cancer experience, and professional appreciation of early detection. Hesitations centered on fear of colonoscopy, discomfort with stool sampling, fear of a cancer diagnosis, and confidentiality concerns. Interpersonally, encouragement from senior colleagues, trust in the research team, and family support shaped participation. Community-level barriers included low public awareness, cancer-related stigma, and perceptions of cancer as a "death sentence". System-level facilitators included existing laboratory, endoscopy, and treatment capacity at KATH; barriers included limited national colonoscopy availability, a prevailing emphasis on curative-care, and delays in communicating FIT results. Workflow mapping allowed us to trace each step of the FIT process and align qualitative themes with day-to-day operations, revealing bottlenecks that could erode the gains in other parts of the continuum.

Conclusion/Discussion: Implementation of FIT screening in Ghana demonstrated feasibility but revealed significant barriers that threaten uptake and sustainability. While limited by single-site design, small sample size, and reliance on self-reported data, this study will guide future CRC screening strategies in Ghana.