Knowledge, Attitudes and Barriers to Colorectal Cancer Screening in Split, Croatia

Colorectal cancer (CRC) represents one of the most significant public health challenges worldwide. It is the third most commonly diagnosed cancer and the second leading cause of cancer deaths worldwide. Croatia launched its National Colorectal Cancer Screening Program in 2007, targeting citizens aged 50–74 years with a biennial guaiac-based fecal occult blood test (gFOBT) (6). Early program data revealed that uptake was worryingly low: of the 1,056,694 individuals invited to participate by 2011, only 210,239 (19.9%) returned completed tests. Croatia’s Ministry of Health decided to modernize the program by introducing the fecal immunochemical test (FIT) as the primary screening method starting in autumn 2025. FIT offers several advantages: it requires only a single stool sample, there are no dietary restrictions, and it uses antibodies specific to human hemoglobin, improving both sensitivity and specificity for lower gastrointestinal bleeding. This reduces the likelihood of false positives caused by diet and enhances detection of significant lesions. However, changing the test alone will not be enough to address the underlying participation problem. Research shows that many people lack basic knowledge about CRC and the purpose of screening. Fear of a cancer diagnosis, embarrassment, and misconceptions about the procedure are common reasons for not participating. In Split-Dalmatia County in Croatia, these challenges may be even more pronounced. Participation in the national program here has been among the lowest in the country despite the region’s high and rising CRC incidence. This study aims to examine knowledge levels, perceived barriers and socioeconomic factors affecting CRC screening participation in the Split population. By identifying the most important factors influencing participation, it will be possible to develop practical interventional strategies that will encourage more people to get tested and ultimately reduce the region’s CRC mortality rates.