Factors associated with bowel cancer screening participation among First Nations Peoples receiving home health care services in New South Wales, Australia

First Nations Australians consistently exhibit lower bowel screening participation rates than non-First Nations Australians. However, limited studies have been conducted to understand the factors associated with bowel cancer screening participation among First Nations Australians. This study aims to identify factors associated with bowel cancer screening participation among older First Nations Peoples receiving home health care services in New South Wales (NSW), Australia. A cross-sectional study among older First Nations customers receiving Australian Unity Aboriginal home health care services in NSW was conducted from June to September 2023. Data were collected through face-to-face interviews administered by trained First Nations staff, using a structured, culturally appropriate online survey. Multivariable logistic regression was performed, and adjusted odds ratios (aOR) with 95% confidence intervals (CIs) were reported. Statistical significance was set at p < 0.05. Of 333 study participants, 72% (95% CI: 67%-77%) reported that they had ever participated in bowel cancer screening. Participants aged 50–54 (aOR = 0.29; 95% CI: 0.09–0.87), 55–59 (aOR = 0.20; 95% CI: 0.08–0.50), and 60–64 years (aOR = 0.16; 95% CI: 0.06–0.39) were less likely to participate in bowel cancer screening than participants aged 70–74. Males were less likely (aOR 0.34; 95% CI: 0.17–0.68) to participate in bowel cancer screening than females. Those who said they had been informed about bowel cancer screening were more likely (aOR: 11.1; 95% CI: 5.45–22.60) to participate in bowel cancer screening than those who said they had not been informed. Those who said they had been given a bowel cancer screening kit by their doctor to perform the test themselves were more likely (aOR: 2.29; 95% CI: 1.15–4.55) to participate in bowel cancer screening than those who said they had not been given it. Being informed about bowel cancer screening was associated with higher bowel cancer screening participation, and culturally appropriate information provision should be further evaluated in intervention studies. Younger age and being male were associated with lower bowel cancer screening participation. Efforts to promote bowel cancer screening should continue, with a particular emphasis on increasing participation among First Nations Australian men.