Overall study design for colorectal cancer screening research.

The central overlapping circles denote the primary qualitative and embedded quantitative data sources. Above this is a rectangle representing the fundamental literature review. The methodological flow of this study is delineated as (1) literature review, (2) quantitative analysis, and (3) qualitative analysis. A larger rectangular surrounding these methods represents the knowledge-to-action cycle. Each segment within this framework represents specific stages of the action process. Key findings from the methods that feed into each phase are highlighted under each phase. Although monitoring and refinement are not detailed in this protocol, they are presented to illustrate the entire cycle from knowledge to action.</p

All tables are provided in Annexes 1–5.

IntroductionColorectal cancer is a growing global health concern and the number of reported cases has increased over the years. Early detection through screening is critical to improve outcomes for patients with colorectal cancer. In Malaysia, there is an urgent need to optimize the colorectal cancer screening program as uptake is limited by multiple challenges. This study aims to systematically identify and address gaps in screening service delivery to optimize the Malaysian colorectal cancer screening program.MethodsThis study uses a mixed methods design. It focuses primarily on qualitative data to understand processes and strategies and to identify specific areas that can be improved through stakeholder engagement in the screening program. Quantitative data play a dual role in supporting the selection of participants for the qualitative study based on program monitoring data and assessing inequalities in screening and program implementation in healthcare facilities in Malaysia. Meanwhile, literature review identifies existing strategies to improve colorectal cancer screening. Additionally, the knowledge-to-action framework is integrated to ensure that the research findings lead to practical improvements to the colorectal cancer screening program.DiscussionThrough this complex mix of qualitative and quantitative methods, this study will explore the complex interplay of population- and systems-level factors that influence screening rates. It involves identifying barriers to effective colorectal cancer screening in Malaysia, comparing current strategies with international best practices, and providing evidence-based recommendations to improve the local screening program.</div