Barriers and facilitators of cancer screening in Singapore primary care: a qualitative study exploring the perspectives of primary care doctors and policymakers

Background: Cancer screening uptake remains low in Singapore despite high public awareness. While public perspectives are well studied, less is known about primary care doctors and policymakers. This study explores barriers and facilitators to implementing screening from their perspectives.Methods: Thirty doctors and five policymakers were recruited through purposive and snowball sampling. Semi-structured interviews were conducted from May to July 2025. Transcripts were analysed using inductive and deductive coding guided by the Integrated Screening Action Model (I-SAM). Findings:Barriers and facilitators to cancer screening were considered at patient, doctor/clinic level and policy level.Doctors and clinics: Barriers included limited consultation time, deprioritisation compared to chronic disease management, and lack of incentives reflecting the physical opportunity construct in I-SAM. Most clinics lacked reminder or prompt systems making screening largely opportunistic. Trust and endorsement from doctors were identified as facilitators.Patients: Embarrassment, fear, and discomfort, compounded by limited female doctors contributed to avoidance. Low perceived need, cultural beliefs, and fatalistic attitudes demonstrated reflective and automatic motivation. Higher health literacy and family and community encouragement, reflecting psychological capability and social opportunity constructs in I-SAM, were motivators for screening.Policies: Cost concerns, especially among older Singaporeans and foreign residents, and limited awareness of subsidies were barriers linked to physical opportunity and capability. Government-led campaigns were proposed due to high public trust, aligning with social opportunity within I-SAM.Interpretation: Singapore has well-established subsidised screening programmes and recognises the key role of doctors, but time pressures and competing demands limit their effectiveness. Strengthening EMR-based reminders, recall systems, and alternative delivery models, alongside community and policy alignment, could enhance uptake.