Knowledge Attitude and Practices of Health Care Workers towards Colorectal Cancer Screening in Primary Care Settings in Durban, South Africa: A Cross-Sectional Survey

BACKGROUND- South Africa has the highest number of colorectal cancer (CRC) patients in sub-Saharan Africa, with the CRC projected new cases at 8 000 per 100 000 population by 2030. Screening assists with the early detection and control of cancer. This study determined knowledge, attitude, and practices (KAP) related to CRC among Health Care Workers (HCWs). METHODS- A cross-sectional descriptive study was conducted between April and November 2021 using a self-administered close-ended questionnaire. Data was collected from 109 HCWs in public primary health care facilities in Durban, South Africa. Summary descriptive and association analysis were conducted using IBM SPSS vs. 28. RESULTS- Overall CRC screening knowledge score was 12% (mean 13) with 39% that were familiar with the National Department of Health Cancer Control framework. Only 15% of participants perceived the Perceived the National Cancer Control Guidelines to be influential for the implementation of colorectal cancer screening. 70% of participants would recommend CRC screening to patients. Over one-fifth, (22%) of participants felt that fecal occult blood, flexible sigmoidoscopy, and colonoscopy were effective for CRC screening. Over a third (44%) preferred a structured CRC screening programme. Most participants (81%) were willing to recommend CRC screening to their patients. Only 10% of participants had ever conducted colorectal screening before. The vast majority were unfamiliar with the types of CRC screening tests. Lack of CRC screening guidelines, training, equipment and CRC low burden were identified as barriers to screening. CONCLUSION- The vast majority of HCWs lacked knowledge of the CRC screening programme and its procedures. However, the vast majority of HCWs were willing to conduct screening once trained. This study also highlighted perceived health systems barriers affecting CRC screening. Currently, South Africa does not have national guidelines for CRC screening in South Africa, hence, a national risk differentiation CRC screening guideline is needed to guide implementation at the PHC level. Health systems strengthening interventions, including training of HCWs, availability of screening tests and materials to facilitate the integration of CRC screening noting that PH already implements screening programmes for other cancer types.