Asia-Pacific journal of clinical oncology
October 8, 2026 · via Europe PMC
Access, Affordability, and Willingness to Undergo Screening Colonoscopy in a Low- and Middle-Income Country-A Cross-sectional Study From Sri Lanka.
Wickramasinghe D, Perera P, Wickramasinghe DP
AI summary — for doctors, generated from the abstract only
About 70% of surveyed adults in Sri Lanka would accept screening colonoscopy if a doctor recommended it, but cost and perceived benefit strongly shape willingness.
What was studied
Cross-sectional survey of 500 adults at the National Hospital of Sri Lanka assessing willingness to undergo screening colonoscopy and its links with sociodemographics, knowledge, perceived benefits and harms, and cost.
Key findings
- 69.7% were willing to undergo colonoscopy if recommended, but 42.7% would only do so if it were free.
- Belief that early detection improves outcomes was independently associated with willingness (aOR 2.96, 95% CI 1.94-4.53).
- Sociodemographic characteristics were not independently associated with willingness.
Clinical relevance
For countries without organised screening, affordability and communication about benefit are key levers for uptake.
Who should care
Limitations
Stated willingness at a single hospital is not actual uptake, and hospital attendees may not represent the general population.
When designing or advocating for screening in resource-limited settings, plan for free or subsidised testing, non-invasive options and clear messaging on benefit.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
BACKGROUND
Colorectal cancer (CRC) incidence is rising rapidly across low- and middle-income countries (LMICs), yet most lack organised screening programmes. While colonoscopy is the diagnostic gold standard, its uptake depends not only on service availability but also on behavioural perceptions and health system design. Sri Lanka, an LMIC with a strong public health system but no national CRC screening programme, provides a relevant policy setting to examine these dynamics.
METHODS
A cross-sectional survey of 500 adults at the National Hospital of Sri Lanka assessed willingness to undergo screening colonoscopy. Sociodemographics, CRC-related knowledge, perceptions of benefit/harm, and cost considerations were evaluated using non-parametric tests and multivariable logistic regression.
RESULTS
Overall, 69.7% of participants were willing to undergo colonoscopy if recommended by a doctor; however, 42.7% would do so only if the procedure were free. Willingness was independently associated with belief that early detection improves outcomes (adjusted Odds Rate (aOR) 2.96, 95% confidence interval [CI] 1.94-4.53, p < 0.001) and fear of CRC (aOR 1.72, 95% CI 1.13-2.61, p = 0.012). Misconceptions about colonoscopy-related harm and fear of cancer diagnosis significantly reduced acceptance. Sociodemographic variables, education level, prior colonoscopy experience, and insurance status were not independently associated with willingness. Cost-related conditional willingness highlights substantial access barriers despite high stated acceptability.
CONCLUSIONS
Among the variables examined, perceived benefit and affordability were important correlates of stated screening acceptability, while sociodemographic characteristics were not independently associated. Implementation requires strategies addressing affordability, capacity, and perceptions. A phased, publicly financed programme incorporating non-invasive testing and targeted communication may provide a feasible pathway for LMICs.
DOI
10.1111/ajco.70204
PMID
42850897
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
Want more like this?
Browse more from the feed. A free account unlocks the full feed, saving and communities.
Back to the research feed