PUB - Publikationen an der Universität Bielefeld

Background: Cancer screening (CS) in Germany is structured by age- and gender-specific risk profiles, defining when individuals are invited to participate. Knowledge about participation in CS among first-generation migrants, especially those from the Middle East and a growing popula- tion group in Germany since recent regional conflicts, remains limited and fragmented. We asked: 1) What individual, social, and structural fac- tors influence (non-)participation in CS? 2) Which types of orientations towards CS can be distinguished? Methods: We triangulated 15 narrative interviews with first-generation migrants without a professional healthcare background with 15 interviews with physicians (e.g., gynecology, dermatology, urology) from different Middle Eastern countries. Based on semi-structured interview guides, thematic analysis with inductive and deductive coding was conducted. Result: 1) Participation was shaped by health beliefs, gender roles, social responsibilities, and system barriers. 2) We identified four orientation types: limited access—individuals with constrained language skills, care- giving duties, and limited institutional familiarity, often unable to partic- ipate; competing priorities—those who perceive CS as low relevance due to daily stressors and low risk awareness; deliberate distance—principally interested but deterred by mistrust rooted in prior experiences; and pre- vention-oriented—those with strong motivation and CS experience, yet frustrated by institutional hurdles. Discussion: Our findings point to intersecting barriers shaped by struc- tural access, past healthcare experiences, and migration-specific trajecto- ries. They point to the need for integrated approaches that consider these intersecting barriers. Conclusion: Improving participation in CS requires more than the trans- lation of health information and should address structural access and institutional trust in ways that reflect the lived realities of diverse migrant populations.