Social Determinants of Health Influencing Colorectal Cancer Screening Behaviors Among Community Residents in China: A Scoping Review Protocol

Background

Colorectal cancer (CRC) has emerged as a significant public health challenge in China, with incidence and mortality rates continuing to rise. Although CRC screening has been well established as an effective approach to reducing disease burden, participation among community residents remains suboptimal. This is especially true for high-risk individuals, among whom adherence to follow-up colonoscopy is notably low. International evidence indicates that social determinants of health (SDoH)—including education level, income status, and accessibility of healthcare services—play a substantial role in influencing screening behaviors. However, in China, a standardized framework for the classification and assessment of SDoH has yet to be established. Existing evidence is fragmented, making it difficult to comprehensively understand how these social factors affect screening participation within the local sociocultural and health system context.This scoping review aims to identify and mapSDoH that influence CRC screening behaviors among community-dwelling adults in mainland China. It will also summarize how these determinants are defined and measured in the literature, Provide a foundational overview to inform future research,and equity-oriented screening interventions within the Chinese context.

Methods

This scoping review will be conducted in accordance with the JBI methodology for scoping reviews. The literature search will cover both English and Chinese databases, including PubMed, Embase, Web of Science, Scopus, Google Scholar, CNKI, and Wanfang Database. The inclusion period spans from January 1, 2012, to April 23, 2025. Eligible sources will include quantitative studies, qualitative studies, and mixed-methods research, encompassing peer-reviewed journal articles, conference proceedings, and grey literature.A three-stage search strategy will be employed to ensure comprehensive coverage. Two reviewers will independently extract data from eligible studies. The findings will be initially categorized based on the five key domains of SDoH defined by the Healthy People 2030 framework, with additional attention given to China-specific contextual factors. Data to be extracted will include the type of SDoH, frequency of appearance, relevant stage of screening (initial or follow-up), direction of influence, study design, conceptual definitions, and measurement tools. Results will be presented through narrative synthesis and structured tables to support clarity and applicability in primary care and public health practice.

Discussion

To our knowledge, this will be the first scoping study in China to systematically apply a SDoH framework to research on CRC screening behaviors. The findings of this scoping review will provide a comprehensive overview of the SDoH associated with CRC screening behaviors among community residents in China. By mapping the range, frequency, and contextual meanings of these factors, this review will help identify which SDoH are most consistently linked to screening participation and follow-up adherence.

The findings will carry important implications for public health practice and community-level interventions. First, they will provide evidence to support the development of targeted strategies by health authorities, highlighting modifiable social barriers and facilitators within specific subpopulations. Second, the results will assist primary care providers and public health practitioners in identifying priority groups during the implementation of CRC screening programs, thereby enhancing the precision of resource allocation and improving coverage while reducing potential inequities in service delivery. Third, this review will contribute to the localization of SDoH measurement by synthesizing how these determinants have been defined and assessed in existing Chinese studies, offering a foundation for developing culturally adapted assessment tools.

Systematic review registration

Registered in OSF on April 23, 2025 (osf.io/v3mq7/)