Table 4 Thematic division of major barriers

Sociodemographic factors associated with under screening

Extreme age groups (older/ younger)

[16, 19, 22, 23]

Lower educational attainment

[10, 11, 16,17,18,19,20,21,22, 24]

Less acculturation

[18, 19]

Being single

[11, 17, 19, 22]

Economic barriers

Costs (transportation/ child care/ time off work)

[15, 24, 26,27,28]

Low income/ socioeconomic status

[10, 16, 19, 20, 22,23,24, 28]

Frequent moving of immigrants

[24, 28]

Intervention not adequately reimbursed

[15, 28,29,30]

Healthcare system-related barriers

No regular doctor

[15,16,17, 22]

Lack of appropriate reminder system

[15, 29, 30]

Dissatisfaction with patient/provider interaction

[15, 21, 32]

Lack of physician recommendation/consult

[15, 20, 22, 27, 31, 33, 37,38,39]

Heavy workloads of physicians

[34]

Dearth of acceptable health care provider/ female provider

[15, 16, 19, 20, 26, 27, 29,30,31,32,33,34,35,36,37]

Long waiting time

[15, 27, 32]

Service is inconvenient/difficult to access

[15, 26, 32, 33]

Lack of appropriate services/referral pattern

[15]

Lack of appropriate educational materials/services

[15, 26, 28, 32]

Difference in the institutionalization of healthcare

[40]

Cultural barriers

Cultural differences/religious belief

[21, 27,28,29,30,31, 34, 38, 40, 41]

Stigma

[15, 28,29,30,31, 40]

Embarrassment/modesty

[15, 20, 26, 30,31,32,33,34, 36,37,38]

Preference for traditional/alternative care

[40]

Patriarchy

[15, 31]

Physician-patient hierarchy

[28, 34]

Language barriers

Language/communication difficulties

[10, 11, 16, 17, 20, 21, 24, 26, 29, 31, 36, 41]

Lack of interpretation/translation services

[26, 28]

Knowledge-related barriers

Lack of information about how to access/navigate services

[11, 15, 21, 27, 31, 39]

Lack of preventive health concept/knowledge of screening tests

[15, 18, 21, 27, 31,32,33,34, 36]

Lack of cancer literacy

[15, 20, 26,27,28, 31, 34, 36]

Belief that screening is not necessary/ ineffective

[17, 18, 20, 22, 26, 29,30,31, 39]

Physicians unaware of screening guideline

[15]

Individual-level barriers

Lack of time

[15, 19, 24, 30, 31, 35]

It is not a priority/self-sacrifice

[15, 27, 29, 30]

Not getting around to it/procrastination

[17, 22, 35]

Concern about cancer diagnosis/ prognosis

[15, 20, 26, 32]

Concern about side effects of treatment

[15]

Fear of procedure (pain/discomfort)

[15, 19, 26, 33, 38, 39]

Sense of confidentiality/privacy

[15, 28, 31, 37]

Limited support/ encouragement

[15, 21]