Strength and limitations of the study

The diversity of study participants in terms of age, social background and stage of cancer, obtained via purposive sampling, is one of the strengths of the current study because it captures the views of a wide range of the male population with CRC in WA. However, the findings of this study rely on participants’ recall of events from the pre-diagnostic period. It is possible that CRC diagnosis may have biased participants’ recollections. Some

participants’ accounts of their experiences may have been tainted by factors such as a sense of personal responsibility for any delays, thereby overestimating system-related delays (23, 36). The recall bias may also lead to underestimation of patient delays by participants, as the experience of symptoms such as rectal bleeding may be easier to remember and recall than other non-specific symptoms (37).

Future studies could focus on the help-seeking behaviours of both men and women and apply the gender lens to explore any differences. The findings of this study were consistent with the first four stages of Andersen’s Model (7): appraisal, illness, behavioural and scheduling. Under the treatment delay stage of Andersen’s Model, referral delays and the waiting period for a colonoscopy were the delaying factors. However, participants were not asked about any delays from colonoscopy to first treatment. Future studies could explore these factors using the expanded stage of treatment delay proposed by Walter et al. (8): pre- diagnostic interval (time between first consultation with healthcare provider and cancer diagnosis) and pre- treatment interval (time between formal cancer diagnosis and initiation of treatment). Some of the themes generated in the study were more important than others as they were supported by more data. However, the themes were not classified as major themes

and sub-themes in the current study.

6.6 Conclusion

The findings of Study 4 helped to explore and understand why some men in WA experience delays in CRC diagnosis. In some instances, delays resulted from men’s failure to attribute their symptoms to cancer and subsequent delay in establishing a diagnosis. Delays may have been further compounded by the lack of a timely referral to a specialist and the subsequent delay in scheduling a colonoscopy. These findings may contribute to efforts to develop interventions that encourage men to seek timely medical advice leading to early CRC diagnosis. The findings also mandate further research to develop interventions to reduce diagnostic delays at the primary care level. In the next Chapter, findings from all the four studies conducted, as part of this thesis will be discussed in relation to each other and to literature. Based on the common barriers and facilitators to help seeking in each of the

studies, indicating different points along the illness trajectory, potential implications of the findings will be discussed.

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