Knowledge, attitude, practice, and perceived barriers of colorectal cancer screening among primary care physicians in the Kingdom of Bahrain


  • Fatima A. Mahmood Department of Primary Health Care, Ministry of Health, Department of Family Medicine, Royal College of Surgeons in Irland-Medical University of Bahrain, Bahrain
  • Afaf A. M. Ali Department of Primary Health Care, Ministry of Health, Bahrain
  • Adel S. Alsayyad Department of Public Health and Epidemiology, Ministry of Health, Arabian Gulf University, Bahrain
  • Naseem F. Alalwan Department of Primary Health Care, Ministry of Health, Bahrain
  • Mona A. M. Ali Department of Primary Health Care, Ministry of Health, Bahrain



Colorectal cancer, Screening, Primary care, Physicians, Bahrain


Background: Colorectal cancer (CRC) is one of the lethal cancers all over the world. Early detection of colorectal cancer has been shown to reduce incidence and mortality. Primary care physicians have a crucial role in early detection of cancer. This study aims to explore the knowledge, attitude and practice of primary care physicians in Bahrain towards CRC screening and to determine the barriers related to CRC screening.

Methods: A cross sectional study was carried out among primary care physicians working at primary health care centers in Bahrain. It included 174 physicians. A self-filled questionnaire that includes demographic information, knowledge scale, attitude scale, practice scale items and barriers of not performing CRC screening was used as the study tool.

Results: The overall knowledge score revealed that 51.7% had poor knowledge score and 48.3% had adequate knowledge score. Majority of the participants (93.7%) agreed to have a structured screening program for colorectal cancer rather than an opportunistic one. Most of the physicians (60%) reported that less than 25% of those eligible patients truly receive a screening. Physician’s lack of time was the top barrier of not performing CRC screening.

Conclusions: This study showed that most primary care physicians have poor knowledge regarding CRC screening and the majority do not screen their eligible patients for CRC.


World Health Organization. Fact sheet: Cancer, 2020. Available at Accessed 3 March 2021.

Al-Madouj A., Eldali A., Al-Zahrani A., Al-Kawari M., Alsayyad J., Bazarbashi S. Gulf Center for Cancer Control and Prevention [Executive Board of Health Ministers’ Council for The Gulf Cooperation Council State] (Director). (2001, September). Ten-Year cancer incidence among nationals of the GCC states. 1998-2007.

Rex, DK, Johnson DW, Anderson JC, Schoenfeld, PS, Burke CA, Inadomi JM. American College of Gastroenterology Guidelines for Colorectal Cancer Screening 2008. Am J Gastroenterol. 2009;104(3):739-50.

Al Awadhi MA, Abulfateh NM, Abu-Hassan F, Fikree MA, Janahi E, Carlo R. Cancer incidence and mortality in the Kingdom of Bahrain statistics and trends. Bahrain Med Bulletin. 2016;158(5877):1-5.

Shubbar AS, Al Shaikh S, Mohamed MA. Colorectal Cancer Epidemiology: Incidence, Clinical, Pathological and Molecular Features. Bahrain Medical Bulletin. 2019;41(4):222-5.

Welch HG, Robertson DJ. Colorectal cancer on the decline—why screening can’t explain it all. N Engl J Med. 2016;374(17):1605-7.

Winawer SJ, Zauber AG, Ho MN, O'brien MJ, Gottlieb LS, Sternberg SS, Waye JD, Schapiro M, Bond JH, Panish JF, Ackroyd F. Prevention of colorectal cancer by colonoscopic polypectomy. New England J Med. 1993;329(27):1977-81.

Zauber AG, Winawer SJ, O'Brien MJ, Lansdorp-Vogelaar I, van Ballegooijen M, Hankey BF, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012;366:687-96.

Wolf AM, Fontham ET, Church TR, Flowers CR, Guerra CE, LaMonte SJ, et al. Colorectal cancer screening for average‐risk adults: 2018 guideline update from the American Cancer Society. CA: a Cancer J Clin. 2018;68(4):250-81.

Von Karsa L, Patnick J, Segnan N, Atkin W, Halloran SP, Lansdorp-Vogelaar I, et al. European guidelines for quality assurance in colorectal cancer screening and diagnosis: Overview and introduction to the full Supplement publication. Endoscopy. 2013;45(01):51-9.

Bénard F, Barkun AN, Martel M, von Renteln D. Systematic review of colorectal cancer screening guidelines for average-risk adults: Summarizing the current global recommendations. World J of gastroenterology. 2018;24(1):124.

Demagny L, Holtedahl K, Bachimont J, Thorsen T, Letourmy A, Bungener M. General practitioners' role in cancer care: a French-Norwegian study. BMC Research Notes. 2009;2(1):1-6.

Triantafillidis JK, Vagianos C, Gikas A, Korontzi M, Papalois A. Screening for colorectal cancer: the role of the primary care physician. European J of Gastroenterology & Hepatology. 2017;29(1):e1.

Post DM, Katz ML, Tatum C, Dickinson SL, Lemeshow S, Paskett ED. Determinants of colorectal cancer screening in primary care. J of Cancer Education. 2008;23:241-7.

Sewitch MJ, Burtin P, Dawes M, Yaffe M, Snell L, Roper M, et al. Colorectal cancer screening: physicians’ knowledge of risk assessment and guidelines, practice, and description of barriers and facilitators. Canadian J of Gastroenterology. 2006;20(11):713-8.

Shin HY, Suh M, Park B, Jun JK, Choi KS. Perceptions of colorectal cancer screening and recommendation behaviors among physicians in Korea. BMC Cancer. 2017;17(1):1-9.

Demyati, E. Knowledge, Attitude, Practice, and Perceived Barriers of Colorectal Cancer Screening among Family Physicians in National Guard Health Affairs, Riyadh. Int J Family Med. 2014:1–7.

Banamah OB, Al-Mutairi OM, Alshuaibi AM, Alamri RS, AlRahmani DA, Alhojaily MM. Knowledge, Attitudes and Practices of Primary Care Physicians in Colorectal Cancer Screening, Jeddah, Saudi Arabia 2012. Int J Biol Med Res. 2017;8(1):5799-804.

Yusoff M, Zin FM, Daud N, Yusoff HM, Draman N. Colorectal Cancer Screening: Knowledge and Practice among Private General Practitioners in Northeast Peninsular Malaysia. Edu Med J. 2021;13(1).

Muliira JK, Melba SD, Ahmed SM, Al-Dhahli SN, Al-Jahwari FR. Barriers to colorectal cancer screening in primary care settings: attitudes and knowledge of nurses and physicians. Asia-pacific J Oncol Nursing. 2016;3(1):98-107.

Alshaikhi S, Assiri A, Alshaikh A, Alshaikhi S, Assiri H, Alshaiki O, et al. Knowledge, Attitude and Practice of Primary Care Physicians Regarding Colon Cancer in Abha City, Saudi Arabia. World Family Med. 2021;19(5):68-80.

Norwati D, Harmy MY, Norhayati MN, Amry A. Colorectal Cancer Screening Practices of Primary Care Providers: Results of a National Survey in Malaysia. Asian Pacific J Cancer Prevention. 2014;15(6):2901-24.

Brown T, Lee JY, Park J, Nelson CA, McBurnie MA, Liss DT, et al. Colorectal cancer screening at community health centers: A survey of clinicians' attitudes, practices, and perceived barriers. Preventive Med reports. 2015;2:886-91.

Mosli M, Alnahdi Y, Alghamdi A, Baabdullah M, Hadadi A, Khateery K, Alsulami I, AlHoqail A, Almadi M, Jawa H, Aljahdli E. Knowledge, attitude, and practices of primary health care physicians toward colorectal cancer screening. J Saudi Gastroenterol Association. 2017;23(6):330.

Ooi CY, Hanafi NS, Liew SM. Knowledge and practice of colorectal cancer screening in an urban setting: cross-sectional survey of primary care physicians in government clinics in Malaysia. Singapore Med J. 2019;60(11):596.

Xilomenos A, Mauri D, Kamposioras K, Gkinosati A, Zacharias G, Sidiropoulou V, Papadopoulos P, Chatzimichalis G, Golfinopoulos V, Peponi C. Colorectal cancer screening awareness among physicians in Greece. BMC Gastroenterol. 2006;6(1):1-6.

Hamdan R, Johnson J, Fatemi M, Benjamin K, Moosa A. Exploring the Barriers Toward Colorectal Cancer Screening: A Literature Review. Middle East J of Nursing. 2021;15(2):3-12.

Aubin-Auger I, Mercier A, Lebeau J, Baumann L, Peremans L, Van Royen P. Obstacles to colorectal screening in general practice: a qualitative study of GPs and patients. Family Pract. 2011;28(6):670-6.




How to Cite

Mahmood, F. A., Ali, A. A. M., Alsayyad, A. S., Alalwan, N. F., & Ali, M. A. M. (2023). Knowledge, attitude, practice, and perceived barriers of colorectal cancer screening among primary care physicians in the Kingdom of Bahrain . International Journal Of Community Medicine And Public Health, 10(6), 2015–2023.



Original Research Articles