Drivers of Colorectal Cancer Screening in the Gaza Strip, Palestine Territory: A Qualitative Study

Background Colorectal cancer (CRC) is a growing public health concern in the Gaza Strip, where late-stage diagnosis and low screening rates contribute to preventable mortality. Cultural, logistical, and systemic barriers complicate screening uptake, necessitating a deeper understanding of multi-level drivers to inform targeted interventions. We aimed to explore multi-level drivers and facilitators influencing CRC screening uptake in Gaza through a qualitative analysis of perspectives from patients, families, community leaders, healthcare providers, and policy-makers, identifying actionable themes and subthemes. Methods: We conducted a multi-level qualitative research design. Data were collected through a series of focus group discussions. Participants included patients, family members, community representatives, healthcare providers, and policy-makers in the Gaza Strip. Thematic analysis was done by identifying and categorising drivers of major themes and corresponding subthemes. Results Our analysis identified several multi-level drivers of CRC screening in Gaza. Cultural alignment (We are Muslims… no myths), financial incentives, and clinician guidance motivated participation at the individual level. Families fostered support through encouragement ( no hindering traditions ) and media /workshops. Communities leveraged religious leaders ( mosques spread health messages ), peer testimonials, and media campaigns. Organisations promoted screening via paid leave, telemedicine, and NGO partnerships ( 60% uptake via mobile units ). Policy-makers prioritised affordability, awareness campaigns ( national policies influence decisions ), and legislative mandates. Systemic integration of culturally aligned strategies, trusted networks (families, leaders), and education across levels emerged as pivotal to enhancing CRC screening uptake and reducing mortality. Conclusion The success of CRC screening is attributed to aligning interventions with cultural values, leveraging trusted networks, and systemic integration. A coordinated approach across individual, familial, community, organisational, and policy levels is critical to enhancing CRC screening uptake and reducing mortality.