Open Access Highly Accessed Research article

Designing an intervention to help people with colorectal adenomas reduce their intake of red and processed meat and increase their levels of physical activity: a qualitative study

George Dowswell1*, Angela Ryan1, Aliki Taylor2, Amanda Daley1, Nick Freemantle3, Matthew Brookes5, Janet Jones1, Richard Haslop1, Chloe Grimmett4, Kar-Keung Cheng6, Wilson Sue1 and on behalf of the Colorectal Cancer Prevention Group

Author affiliations

1 Department of Primary Care and General Practice, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK

2 Amgen Ltd, 1 Uxbridge Business park, Sanderson Road, Uxbridge, UB8 1DH, UK

3 Department of Primary Care and Population Health, Medical School (Royal Free Hospital), University College London, Rowland Hill Street, London, NW3 2PF, UK

4 Macmillan Survivorship Research Group, University of Southampton, University Road, Southampton, SO17 1BJ, UK

5 Royal Wolverhampton Hospitals NHS Trust, Wednesfield Road, Wolverhampton, WV10 0QP, UK

6 University Hospitals NHS Foundation Trust, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK

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Citation and License

BMC Cancer 2012, 12:255  doi:10.1186/1471-2407-12-255

Published: 18 June 2012



Most cases of colorectal cancer (CRC) arise from adenomatous polyps and malignant potential is greatest in high risk adenomas. There is convincing observational evidence that red and processed meat increase the risk of CRC and that higher levels of physical activity reduce the risk. However, no definitive randomised trial has demonstrated the benefit of behaviour change on reducing polyp recurrence and no consistent advice is currently offered to minimise patient risk. This qualitative study aimed to assess patients’ preferences for dietary and physical activity interventions and ensure their appropriate and acceptable delivery to inform a feasibility trial.


Patients aged 60–74 included in the National Health Service Bowel Cancer Screening Programme (NHSBCSP) were selected from a patient tracking database. After a positive faecal occult blood test (FOBt), all had been diagnosed with an intermediate or high risk adenoma (I/HRA) at colonoscopy between April 2008 and April 2010. Interested patients and their partners were invited to attend a focus group or interview in July 2010. A topic guide, informed by the objectives of the study, was used. A thematic analysis was conducted in which transcripts were examined to ensure that all occurrences of each theme had been accounted for and compared.


Two main themes emerged from the focus groups: a) experiences of having polyps and b) changing behaviour. Participants had not associated polyp removal with colorectal cancer and most did not remember being given any information or advice relating to this at the time. Heterogeneity of existing diet and physical activity levels was noted. There was a lack of readiness to change behaviour in many people in the target population.


This study has confirmed and amplified recently published factors involved in developing interventions to change dietary and physical activity behaviour in this population. The need to tailor the intervention to individuals, the lack of knowledge about the aetiology of colon cancer and the lack of motivation to change behaviour are critical factors.

Trial registration

Current Controlled Trials ISRCTN03320951

Adenomatous polyps; Feasibility studies; Prevention & control; Health behaviour; Attitude to health; Qualitative research; Colorectal neoplasms