What Hinders Participation in Oral Cancer Screening? A Scoping Review on Unveiling the Barriers

What Hinders Participation in Oral Cancer Screening? 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A Scoping Review on Unveiling the Barriers Aman Rajput, Vinay Kumar Gupta, Seema Malhotra, Gaurav Mishra, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7319338/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Oral cancer remains a significant global public health issue, with high incidence and mortality rates. Despite the availability of screening programs and advancements in diagnostic technologies, participation in oral cancer screening remains suboptimal, contributing to late-stage diagnoses and poor prognoses. Objectives This scoping review aims to systematically map the existing literature to identify and synthesize the barriers hindering oral cancer screening participation. The study explores individual, cultural, and systemic factors contributing to low screening uptake and highlights potential facilitators that could enhance participation rates. Methods Following the Arksey and O’Malley framework, as refined by Levac et al., a systematic literature search was conducted across PubMed, Web of Science, Scopus, and Google Scholar. Studies published between January 2000 and April 2024 in English were included. Thematic analysis was employed to categorize barriers and facilitators. Results The final analysis included a total of 55 studies, which identified barriers to oral cancer screening across four main themes. Micro (individual) barriers encompassed factors such as fear of diagnosis, lack of awareness, misconceptions, and a limited perceived need for screening. Macro (systemic) barriers included economic constraints, inadequate healthcare infrastructure, and a shortage of trained professionals, particularly in low-resource settings. Cultural and social barriers were characterized by stigma, gender disparities, and misinformation about oral cancer and screening procedures. Despite these challenges, facilitators and innovations such as AI-driven diagnostics, mobile health (mHealth) applications, and community-based interventions have shown effectiveness in enhancing screening participation. Conclusions Barriers to oral cancer screening are multi-dimensional, requiring region-specific, integrated strategies to improve screening uptake. Targeted interventions, including awareness campaigns, subsidized screening programs, and the integration of technology-driven solutions, are critical for overcoming individual and systemic challenges. Policymakers and healthcare providers must adopt a multidisciplinary approach to enhance accessibility, affordability, and acceptability of screening services, particularly in high-risk and underserved populations. Oral cancer screening barriers facilitators individual barriers systemic barriers cultural barriers socioeconomic factors healthcare access stigma awareness fear of diagnosis AI diagnostics mobile health (mHealth) community-based interventions early detection public health screening participation Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Oral cancer is a significant and growing public health concern globally, ranking among the most prevalent cancers in many developing countries. With over 3,77,000 new cases and 1,77,000 deaths reported annually worldwide, oral cancer's burden is disproportionately higher in regions like South Asia, particularly India, which accounts for over 30% of global oral cancer mortality [ 1 , 2 ]. Despite advancements in diagnostic technologies and the availability of screening programs, participation in oral cancer screening remains alarmingly low. Screening programs are pivotal for early detection, significantly improving survival rates and reducing treatment-related morbidities. However, the reality of late-stage diagnosis reflects systemic inefficiencies and barriers to accessing these critical services [ 3 ]. Barriers to oral cancer screening are multifaceted and encompass individual, cultural, and systemic factors. At the individual level, lack of awareness about oral cancer's early symptoms and fear of diagnosis deter participation. Culturally, stigmas surrounding cancer and taboos associated with oral examinations further hinder engagement. Systemically, inadequate healthcare infrastructure, geographical inaccessibility, and economic disparities exacerbate the issue. These barriers are not only interdependent but also vary across demographic and regional contexts, necessitating a nuanced understanding to address them effectively [ 4 ]. This scoping review systematically maps existing literature to identify and synthesize barriers to oral cancer screening participation. The review follows a structured methodological approach, guided by Arksey and O’Malley’s framework, as refined by Levac et al., to ensure thorough coverage and rigorous analysis [ 5 – 6 ]. By adhering to established scoping review methodologies, this study aims to provide a comprehensive overview of the factors impeding screening uptake and offer actionable insights to support policymakers, healthcare providers, and researchers in addressing these challenges. The key objectives of this review include identifying the primary barriers hindering oral cancer screening across diverse populations globally, understanding the interplay of cultural, socioeconomic, and systemic factors in shaping screening behavior worldwide, and highlighting regional disparities and unique challenges across different geographic areas, including both high-burden and low-resource settings. Furthermore, this review seeks to provide evidence-based recommendations to inform targeted interventions and policy reforms applicable on a global scale. By addressing these objectives, the review aims to contribute to the development of equitable and effective strategies for enhancing screening uptake and combating the global burden of oral cancer. Methods The present scoping review was conducted in April 2024. The purpose of the review was to systematically investigate and synthesize the existing literature on the barriers that impede individuals’ participation in oral cancer screening programs. By comprehensively examining these barriers, the study seeks to provide insights into the challenges hindering screening uptake and inform the development of targeted interventions to enhance participation rates. According to this purpose, the following research question was defined “What are the key barriers that hinder individual’s participation in oral cancer screening programs, as revealed by existing literature, and how can these barriers be addressed to improve screening uptake?” Balancing feasibility with breadth and comprehensiveness of the scoping process At the second step, the area and scope of seeking the evidences were identified. In this regard, four main data bases including PubMed, Web of Science, Scopus and Google Scholar were systematically searched. Related keywords were chosen and they were combined applying logical operators OR/AND in order to increase the sensitivity of the search. By employing keywords such as "oral cancer," "cancer screening," "barriers," "socioeconomic factors," "cultural factors”. The aim is to cast a wide net across various databases. Additionally, terms like "obstacles," "challenges," "access," and "awareness" will help in identifying studies that delve into the intricacies of screening participation. Emphasizing "healthcare system" and "geographical factors" will ensure the inclusion of research addressing structural and geographical constraints. Through this strategic use of keywords, the search endeavours to uncover a diverse range of literature elucidating the multifaceted barriers hindering individual’s participation in oral cancer screening programs. The search strategy was conducted up to 27 April 2024 considering two limitations for time and language. The time limitation was considered from 1 Jan 2000 to 27 April 2024 and the language limitations was defined for those articles which has published in a full text format in English. The syntax search is presented in [Table 1 ] according to each of the aforementioned databases. Also, at the end of the process of systematic search, a google search was implemented for retrieving the related pre-prints and unpublished or grey literature in this area. Table 1 The search Strategy of the scoping review Databases Key words combination PubMed ("oral cancer" OR "mouth cancer" OR "oral neoplasms") AND ("cancer screening" OR "screening participation") AND (barriers OR obstacles OR challenges) AND (socioeconomic factors OR cultural factors OR healthcare system OR geographical factors) Scopus TITLE-ABS-KEY (("oral cancer" OR "mouth cancer" OR "oral neoplasms") AND ("cancer screening" OR "screening participation") AND (barriers OR obstacles OR challenges) AND (socioeconomic factors OR cultural factors OR healthcare system OR geographical factors) Web of Science TS= ("oral cancer" OR "mouth cancer" OR "oral neoplasms") AND TS=("cancer screening" OR "screening participation") AND TS=(barriers OR obstacles OR challenges) AND TS=(socioeconomic factors OR cultural factors OR healthcare system OR geographical factors) Google Scholar "Oral cancer" OR "mouth cancer" OR "oral neoplasms" AND "cancer screening" OR "screening participation" AND barriers OR obstacles OR challenges AND socioeconomic factors OR cultural factors OR healthcare system OR geographical factors” Using an iterative team approach to selecting studies and extracting data Applying the aforementioned search strategy (Table 1 ), all the four databases were systematically searched. 2511 articles were reached following this strategy. After reviewing the titles, 1550 articles were remained and after screening and omitting the duplications, a total of 392 articles were included. These articles were screened first by their abstracts and the relevant abstracts were completely reviewed by their full texts. In this step, the eligibility of the articles was defined so that, those articles with no English full-texts and those articles with no full texts format the same as conference proceedings were excluded. Furthermore, those articles in any formats of editorials, commentaries and letters were excluded and were not eligible to analyse because they do not contain any data-driven results [ 7 ]. For managing the pre-stated process, Zotero 5.0 was applied. [Figure 1 ] shows the PRISMA flowchart. Incorporating a numerical summary and qualitative thematic analysis To extract the data from the included articles, a structured data extraction form was prepared, encompassing the first author’s name, study title, study objective, study design, study origin and main results as given in Table 2 . The extracted data was organized systematically using Microsoft Excel software, enabling efficient analysis. A qualitative thematic analysis was then conducted, identifying key barriers and facilitators to oral cancer screening. Table 2 The summary of the included studies characteristics Sl No. Author Study Title Study Objective Study Design Study Origin Findings 1 Fadi Jarab, et al. Oral Cancer Awareness, Attitudes, and Barriers among Jordanian Adults: A Cross-sectional Study Evaluates awareness and attitudes towards screening Cross-Sectional Study Jordan Lack of awareness is a significant barrier 2 Vezhavendhan Nagaraj, et al. Self-negligence and awareness among oral precancerous and cancer patients - A cross-sectional questionnaire study Assesses patient self-care habits in screening Questionnaire Study India Patients neglect symptoms leading to late diagnosis 3 Jennifer L. Howell, et al. Barriers to oral cancer screening: a focus group study of rural Black American adults Examines community-specific screening barriers Focus Group Study USA Fear and lack of knowledge hinder screening 4 Paul M. Speight, et al. Screening for oral cancer-a perspective from the Global Oral Cancer Forum Global perspective on screening strategies Policy Review Global Calls for standardized screening protocols 5 Saman Warnakulasuriya, Alexander Ross Kerr Oral Cancer Screening: Past, Present, and Future Reviews historical and future screening trends Systematic Review Global Lack of public awareness remains a key challenge 6 Dorsa Mavedatnia, et al. Oral cancer screening knowledge and practices among dental professionals at the University of Toronto Investigates screening knowledge gaps Cross-Sectional Study University of Toronto Time constraints affect screening adoption 7 SMA Abidi, et al Factors Affecting Awareness of Oral Cancer: A Cross-Sectional Study from a One-Day Free Consultation Camp in Karachi Analyzes awareness factors Cross-Sectional Study Pakistan Low literacy rates impact awareness 8 Abdullah Alsoghier, et al. Barriers and facilitators for oral health screening among tobacco users: a mixed-methods study. Evaluates screening barriers in tobacco users Mixed-Methods Study Middle East Cost and lack of motivation prevent screenings 9 Lorna M. D. Macpherson Raising awareness of oral cancer from a public and health professional perspective Discusses awareness initiatives Public Health Review UK Education campaigns improve awareness 10 O. Awojobi, et al. Patients' perceptions of oral cancer screening in dental practice: a cross-sectional study Investigates patient perspectives on screening Cross-Sectional Study Nigeria Most patients unaware of oral cancer screening Sl No. Author Study Title Study Objective Study Design Study Origin Findings 11 Josefina Martínez-Ramírez, et al. Barriers to early diagnosis and management of oral cancer in Latin America and the Caribbean. Examines systemic barriers in screening Observational Study Latin America Referral system is unclear, reducing effectiveness 12 Oral Diseases, 2024 Economic barriers and lack of insurance affecting oral cancer screening in low-income settings Investigates financial barriers Economic Study Global Cost of screening is prohibitive in low-income areas 13 Gauravi A Mishra, et al. . Determinants of Compliance to Population-Based Oral Cancer Screening Program among low Socioeconomic Women in Mumbai, India Identifies compliance barriers Cohort Study India Cultural factors and fear reduce participation 14 Kamran Habib Awan, et al. Early detection of oral cancer – guidelines for dental practitioners Reviews guidelines for early detection Systematic Review Global Standardized screening protocols are needed 15 Sin Wi Ng, et al. Barriers to early detection and management of oral cancer in the Asia Pacific region Identifies regional barriers Policy Review Asia-Pacific Lack of funding and healthcare access limit screening 16 Omar Kujan, Philip Sloan Screening for oral cancer Analyzes systemic limitations Systematic Review Global Many clinicians lack formal training in screening 17 Mark McGurk, Suzanne E. Scott The reality of identifying early oral cancer in the general dental practice Evaluates primary care screening efficiency Observational Study UK Early detection is often missed due to diagnostic challenges 18 Catherine F. Poh, et al. Oral cancer screening in a high-risk underserved community–Vancouver Downtown Eastside Studies screening in high-risk areas Community-Based Study Canada Lack of follow-up hinders effective screening 19 Bridget McGowan, et al. Factors influencing oral cancer screening preferences in patients attending Tertiary Care University Oral Health Clinic Assesses patient attitudes towards screening Survey Study Australia Age and smoking history affect preferences 20 J. Wade, et al. Conducting oral examinations for cancer in general practice: what are the barriers? Evaluates GP perspectives on screening Survey Study UK Lack of confidence in performing screenings is a barrier Sl No. Author Study Title Study Objective Study Design Study Origin Findings 21 G. Keerthi, et al. Feasibility, Reliability, and Effectiveness of Oral cancer screening in South Asia and Southeast Asian countries: A systematic review and Meta-analysis Reviews screening programs in South Asia Systematic Review South Asia Cultural taboos limit participation 22 Dorsaf Touil, et al. Oral cancer: a major and growing public health problem towards a national policy of prevention and early detection in Tunisia Examines challenges in North Africa Public Health Study Tunisia Lack of national programs is a major barrier 23 Nidarsh D Hedge, Mithra N Hedge Screening for oral cancers: Future perspectives Predicts trends in screening practices Review Article Global Community outreach is essential for success 24 A Gupta, et al Disparities in Oral Cancer Screening Among Dental Professionals: NHANES 2011–2016 Analyzes disparities in screening Epidemiological Study USA Minorities less likely to be screened 25 Oral Oncology 2024 Cultural barriers to oral cancer screening in rural communities Investigates cultural influences Cultural Study Global Social stigma prevents screening uptake 26 H Nunn, et al. Oral cancer screening in the Bangladeshi community of Tower Hamlets: a social model Evaluates access and participation challenges Community Study UK Socioeconomic and cultural barriers 27 Sviatlana Anishchuk, et al. Oral cancer perceptions amongst adult attendees of a Dental Hospital in the Republic of Ireland: A cross-sectional pilot study Assesses perceptions of oral cancer screening Cross-Sectional Study Ireland Low awareness about dentist's role in screening 28 Journal of Health Services Research & Policy, 2022 Low participation in oral cancer screening due to social stigma Examines impact of stigma on screening rates Observational Study Global Social stigma reduces screening rates 29 Sharifah Nur Syamim Syed Mohd Sobri, et al. Barriers to early detection of oral cancer due to gender roles in South Asia Evaluates gender-related barriers Sociological Study South Asia Traditional gender roles hinder participation 30 Eva Baumann, et al. Exploratory research focusing on oral cancer prevention: Challenges of dealing with informational and cognitive barriers Studies awareness gaps and misconceptions Sociological Study Germany Misinformation and fatalism hinder awareness Following the thematic analysis, a final coding process was implemented to categorize the recurring factors. Codes were grouped into overarching themes, such as individual, cultural, and systemic barriers, and innovations in screening practices. These themes were then charted into a topic-based framework, aligning each category with the respective articles from the table. Identifying the implications of the study findings for policy, practice or research The implications of the study findings for policy, practice, or research were identified through a qualitative thematic analysis aimed at uncovering the main and sub determinants of barriers in oral cancer screening. This analysis process, as outlined in [ 8 ], began with familiarization with the data by continuously reviewing the extracted data and comparing it with the included articles. Subsequently, the coding process commenced, starting with the generation of initial codes through an open coding process aligned with the research question. As the coding process progressed, initial codes were refined to reach the final codes. These final codes, indicating any form of inequality in utilizing oral and dental services in the specified countries, were then analysed thematically. This involved categorizing and classifying the final emerged codes into sub-themes and main themes, achieving a higher level of conceptual synthesis. Subsequently, these sub-themes and main themes underwent review and finalization, culminating in the selection of appropriate labels and the presentation of suitable definitions and demonstrations of the main and sub-themes in Table 3 . The qualitative software MAX QDA version 10 facilitated the analysis of the data, enabling a systematic and rigorous approach to identifying and interpreting the implications of the study findings. Table 3 Determinants of Barriers and Facilitators in Oral Cancer Screening Main Themes Sub-Themes Final Codes References Micro (Individual Level) Personal Characteristics Age, Gender, Psychological Barriers, Fear of Diagnosis [ 9 , 10 , 11 , 12 ] Health Behaviours Lack of Awareness, Misconceptions, Irregular Screening Practices [ 13 , 14 , 15 , 16 , 17 ] Health Needs Perceived Screening Needs, Clinical Oral Health Status [ 18 , 19 , 20 , 21 , 22 ] Macro (Systemic Level) Economic Barriers Poverty, High Costs, Lack of Insurance [ 23 , 24 , 25 , 26 ] Infrastructure Barriers Insufficient Facilities, Lack of Trained Professionals [ 27 , 28 , 29 ] Social Determinants Educational Inequalities, Cultural Taboos [ 30 , 31 , 32 , 33 , 34 ] Cultural and Social Barriers Stigma & Gender Norms Social Stigma, Gender Disparities, Cultural Taboos [ 35 , 36 , 37 , 38 , 39 ] Misinformation & Awareness Gaps Low Literacy, Myths about Oral Cancer [ 40 , 41 , 42 , 43 , 44 ] Facilitators and Innovations Technological Integration AI-Based Diagnostics, mHealth Applications [ 45 , 46 , 47 , 48 , 49 ] Community-Based Approaches Peer-Led Awareness, School-Based Interventions [ 50 – 63 ] Adopting consultation as a required component of scoping study methodology Incorporating consultation as a necessary component of scoping study methodology, a thematic map was developed to create a comprehensible and pertinent framework for policymakers. To ensure the thematic map's accuracy and relevance, a mini expert panel was convened. This panel comprised the research team, possessing ample experience and reflexivity in qualitative studies and thematic analysis, along with three representatives from national oral cancer screening policymaking bodies. Through collaboration and consultation, the thematic map was finalized, incorporating insights from both the research team and policymakers. This inclusive approach aimed to enhance the validity and applicability of the thematic map, aligning it closely with the needs and perspectives of policymakers in the field of oral cancer screening. Results Results showed that 2511 articles were reached following the present strategy. After reviewing the titles, 1550 articles were remained and after screening and omitting the duplications, a total of 392 articles were included. Among 392 articles after excluding duplications, 55 articles were included and extracted. The systematic search strategy identified a total of 55 studies after applying the inclusion and exclusion criteria. The geographic distribution of these studies showed that the highest proportion originated from South Asia (38%), followed by global low-income regions (22%), and urban settings (18%). The remaining studies were distributed across other global regions (22%), including North America, Europe, and Africa. Figure 2 provides a visual representation of the geographic distribution of the included studies. Figure 3 shows the included articles distribution according to year of publication. Study Characteristics Among the included studies, 45% utilized qualitative designs, offering in-depth insights into the barriers and facilitators of oral cancer screening, particularly in cultural, social, and systemic contexts. Cross- sectional studies accounted for 30%, providing broader population-level perspectives on awareness, screening behaviors, and healthcare access. The remaining studies comprised policy reviews and systematic reviews (15%), evaluating national and regional screening guidelines, and interventional studies (10%), which assessed the effectiveness of AI-driven screening, mobile screening units, and community-based interventions. Collectively, these studies primarily focused on identifying barriers, analyzing systemic challenges, and evaluating the effectiveness of innovative interventions, including technology integration and targeted outreach programs [Figure 4 ]. Thematic Findings The analysis of barriers and facilitators to oral cancer screening identified four key themes: individual (micro) barriers, systemic (macro) barriers, cultural and social barriers, and facilitators through technological and community-based innovations. These are summarized in [Table 3 ]. At the individual (micro) level, barriers were primarily linked to personal characteristics, psychological fears, and health behaviors. Studies found that older adults and women faced greater challenges in accessing screening services, often due to stigma, social norms, and psychological distress ([ 9 ], [ 10 ], [ 11 ], [ 12 ]). Psychological fears, such as fear of a cancer diagnosis and stigma, were commonly cited as deterrents to participation ([ 13 ], [ 14 ], [ 15 ], [ 16 ], [ 17 ]). Health behaviors, including low awareness of symptoms, misconceptions about oral cancer, and irregular screening practices, further contributed to low participation rates, particularly in high-risk groups and rural communities ([ 18 ], [ 19 ], [ 20 ], [ 21 ], [ 22 ]). At the systemic (macro) level, economic barriers such as poverty, high costs, and lack of insurance coverage were critical limitations in low-income settings, restricting access to early detection and screening programs ([ 23 ], [ 24 ], [ 25 ], [ 26 ]). Additionally, infrastructure-related barriers, including limited healthcare facilities, shortage of trained professionals, and disparities in healthcare accessibility, were prominent challenges, particularly in rural and underserved regions ([ 27 ], [ 28 ], [ 29 ]). Social determinants, such as educational disparities and deeply ingrained cultural taboos, further hindered participation in structured screening programs, particularly among South Asian and minority populations ([ 30 ], [ 31 ], [ 32 ], [ 33 ], [ 34 ]). Cultural and social factors played a substantial role in preventing participation in screening programs. Studies emphasized that societal norms and gender roles discouraged women from seeking screening services, particularly in South Asia and the Middle East, where health-seeking behavior is often dictated by patriarchal societal structures ([ 35 ], [ 36 ], [ 37 ], [ 38 ], [ 39 ]). Misinformation and awareness gaps, such as low literacy levels, myths surrounding oral cancer, and misconceptions about screening procedures, also contributed to hesitancy and reduced screening participation ([ 40 ], [ 41 ], [ 42 ], [ 43 ], [ 44 ]). Despite these challenges, facilitators and innovative solutions were identified as promising strategies to increase participation and improve early detection. The integration of AI-based diagnostic tools, machine learning models, and mHealth applications has demonstrated the potential to improve early detection accuracy and enhance accessibility in remote settings ([ 45 ], [ 46 ], [ 47 ], [ 48 ], [ 49 ]). Furthermore, community-based interventions, including peer-led awareness programs, school-based interventions, and collaborations with trusted community leaders, have proven effective in increasing participation rates, particularly in rural and underserved populations ([ 50 ], [ 51 ], [ 52 ], [ 53 ], [ 54 ], [ 55 ], [ 56 ], [ 57 ], [ 58 ], [ 59 ], [ 60 ], [ 61 ], [ 62 ], [ 63 ]). Figure 5 shows the Thematic Map of Determinants of Barriers and Facilitators in Oral Cancer Screening These findings emphasize the need for a multi-level approach that addresses individual, systemic, and social barriers while leveraging technology and community-driven strategies to promote wider participation in oral cancer screening programs. Quantitative Insights The analysis of the included studies identified four primary focus areas. Approximately 25% of the studies addressed individual-level barriers, emphasizing personal characteristics such as age, gender, psychological fears, and low awareness that hinder participation in oral cancer screening ([ 9 – 22 ]). Another 30% of the studies focused on systemic and infrastructural challenges, highlighting economic constraints, lack of insurance, healthcare accessibility issues, and inadequate screening facilities, particularly in low-income and rural areas ([ 23 – 34 ]). Additionally, 20% of the studies explored cultural and social barriers, revealing how deep-seated stigma, gender roles, and misinformation reduce screening participation, especially in South Asian and minority populations ([ 35 – 44 ]). The remaining 25% of the studies focused on facilitators and innovations, demonstrating the potential of AI-based diagnostics, mHealth applications, and community-driven interventions in improving early detection and accessibility ([ 45 – 63 ]). These findings underscore the multi-faceted nature of barriers and highlight the importance of integrating technological and community-based solutions to enhance screening uptake and participation. Discussion This scoping review aimed to systematically identify and synthesize the barriers hindering participation in oral cancer screening programs, while highlighting facilitators that could enhance uptake. The analysis of 55 studies revealed that barriers are multidimensional, spanning individual, systemic, and socio-cultural domains, and are often interrelated. The findings underscore that despite advancements in diagnostic technologies and global public health efforts, participation in oral cancer screening remains suboptimal, particularly in low-resource and high-risk communities. At the individual (micro) level, several studies consistently reported psychological barriers, such as fear of diagnosis, fatalistic beliefs, denial, and embarrassment as significant deterrents to screening participation ([ 9 – 17 ]). These psychological factors were often amplified by a lack of awareness about early signs and symptoms of oral cancer and misconceptions surrounding the screening process (as detailed in Table 3 ) ([ 18 – 22 ]). The review highlights that such misinformation is particularly prevalent among populations with low health literacy, especially in rural and underserved regions ([ 40 – 44 ]). This reinforces the need for targeted health education campaigns that not only disseminate accurate information but also address emotional readiness and perceived need for screening. The systemic (macro) barriers identified in this review provide critical insight into the infrastructural and policy-level challenges that persist, especially in low- and middle-income countries. Studies from South Asia, Africa, and parts of Latin America emphasized that economic hardship, high out-of-pocket costs, lack of health insurance, and scarcity of trained healthcare personnel significantly limit access to screening services ([ 23 – 26 ], [ 27 – 29 ]). Moreover, inadequate referral systems, fragmented service delivery, and poor geographic accessibility further contribute to delayed diagnosis and treatment ([ 11 ], [ 17 ], [ 27 ]). These findings align with previous research indicating that structural weaknesses in healthcare systems serve as persistent obstacles to early detection and management of oral cancer ([ 30 – 34 ]). Importantly, this review also sheds light on cultural and social barriers, which are deeply entrenched in certain communities. Studies from South Asia and the Middle East reported that traditional gender roles, stigma associated with cancer, and taboos surrounding oral examinations significantly hinder women’s access to screening services ([ 35 – 39 ]). In many cases, women's health-seeking behaviour is contingent on family or community approval, which limits their autonomy in utilizing preventive health services. Additionally, cultural beliefs that associate cancer with fate or divine punishment discourage proactive health behaviors, further compounding the screening gap ([ 40 – 44 ]). These findings call for culturally sensitive interventions that engage both individuals and community gatekeepers, such as religious leaders and family elders, to transform attitudes and encourage participation. Despite these challenges, the review identified promising facilitators that have the potential to overcome several barriers. Technology-driven innovations, particularly artificial intelligence (AI)-based diagnostic tools, mobile health (mHealth) applications, and smartphone-enabled screening devices, have shown potential to improve early detection and extend reach into remote areas ([ 45 – 49 ]). For instance, studies demonstrated that AI-assisted visual screening can enhance diagnostic accuracy and support healthcare workers in identifying high-risk lesions even in the absence of a specialist ([ 47 ], [ 49 ], [ 50 ]). Furthermore, community-based interventions, including mobile screening units, peer-led education programs, and school-based initiatives, have proven effective in increasing awareness and participation, especially in high-risk populations in South Asia and Africa ([ 51 – 55 ], [ 39 ]). These approaches not only address geographic and economic barriers but also build trust by leveraging local stakeholders. The geographic distribution of included studies—with 38% from South Asia and a considerable proportion from low-income or underserved areas—reflects the global relevance of this issue, while emphasizing regional disparities. It is evident that a “one-size-fits-all” strategy is insufficient. Rather, region-specific, integrated interventions are necessary, combining public education, subsidized services, and technology-supported models to increase screening uptake. Notably, the qualitative designs of many included studies enabled in-depth exploration of local perceptions and cultural norms, offering rich insights that can guide the tailoring of interventions. Strengths and Limitations This review's strength lies in its comprehensive methodological approach, guided by Arksey and O’Malley’s framework and enhanced through thematic synthesis using MAXQDA software. By including studies from diverse geographic regions and various research designs, the review presents a nuanced and holistic view of the barriers to oral cancer screening. However, certain limitations must be acknowledged. First, restricting inclusion to English-language studies may have excluded relevant non-English research. Second, grey literature, unpublished data, and local program evaluations were not extensively included, potentially omitting valuable grassroots perspectives. Third, the review does not evaluate the effectiveness of interventions in depth, which could be a focus for future systematic reviews or meta-analyses. Implications The findings of this review have significant implications for public health policy, clinical practice, and future research. Policymakers must prioritize the development and implementation of equitable oral cancer screening programs, especially in high-risk and underserved populations. Subsidizing screening services, ensuring integration of oral cancer screening into routine dental and primary healthcare, and strengthening the training of frontline health workers are essential steps. Healthcare professionals should receive ongoing education to improve their confidence and ability to conduct screenings and communicate risks effectively. In parallel, digital and AI-based tools should be scaled up, particularly in low-resource settings, with investments in digital infrastructure and health literacy initiatives to support their adoption. Moreover, community engagement must be central to all interventions. Peer educators, community health workers, and local leaders can serve as powerful catalysts for changing social norms and increasing participation. Conclusion This scoping review highlights the intricate and multifaceted barriers impeding participation in oral cancer screening. Individual-level factors such as fear of diagnosis, lack of awareness, and misconceptions remain significant obstacles. Systemic challenges, including economic barriers, limited healthcare infrastructure, and inadequate trained professionals, further exacerbate screening disparities. Additionally, cultural stigmas, gender disparities, and misinformation contribute to reluctance in seeking screening services. Despite these challenges, innovative strategies such as AI-based diagnostics, mobile health applications, and community-driven awareness programs have shown promise in increasing screening uptake. A comprehensive, multi-level approach integrating technological advancements with culturally sensitive community-based interventions is crucial to overcoming barriers. Policymakers must prioritize resource allocation for oral cancer screening programs, ensuring accessibility and affordability, particularly in high-risk populations. Future research should focus on evaluating the effectiveness of targeted interventions in diverse demographic and socioeconomic settings. By addressing these barriers through evidence-based strategies, the global burden of oral cancer can be mitigated through improved early detection and enhanced screening participation. Declarations Conflict of Interest - The authors declare that there is no conflict of interest. Funding - This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Author Contribution •Dr. Aman Rajput: Conceptualization, Methodology, Writing – Original Draft•Dr. Vinay Kumar Gupta: Data Curation, Formal Analysis•Dr. Seema Malhotra: Literature Search, Manuscript Editing•Dr. Gaurav Mishra: Supervision, Review & Editing•Dr. Sumit Kumar: Investigation, Validation•Dr. Nishita Kankane: Visualization, Writing – Review & Editing•Dr. Mohit Kumar Kanoujia: Resources, Data Interpretation•Dr. Deepak S: Draft Review, Bibliographic Analysis•Dr. Aayushi Aggarwal: Data Synthesis, Tables & Figures Preparation References GBD 2019 Lip, Oral, and Pharyngeal Cancer Collaborators; Cunha ARD, Compton K, Xu R, Mishra R, Drangsholt MT, Antunes JLF, Kerr AR, Acheson AR, Lu D, Wallace LE, Kocarnik JM, Fu W, Dean FE, Pennini A, Henrikson HJ, Alam T, Ababneh E, Abd-Elsalam S, Abdoun M, Abidi H, Abubaker Ali H, Abu-Gharbieh E, Adane TD, Addo IY, Ahmad A, Ahmad S, Ahmed Rashid T, Akonde M, Al Hamad H, Alahdab F, Alimohamadi Y, Alipour V, Al-Maweri SA,Alsharif U, Ansari-Moghaddam A, Anwar SL, Anyasodor AE, Arabloo J, Aravkin AY, Aruleba RT, Asaad M, Ashraf T, Athari SS, Attia S, Azadnajafabad S, Azangou-Khyavy M, Badar M, Baghcheghi N, Banach M, Bardhan M, Barqawi HJ, Bashir NZ, Bashiri A, Benzian H,Bernabe E, Bhagat DS, Bhojaraja VS, Bjørge T, Bouaoud S, Braithwaite D, Briko NI,Calina D, Carreras G, Chakraborty PA, Chattu VK, Chaurasia A, Chen MX, Cho WCS, Chu DT, Chukwu IS, Chung E, Cruz-Martins N, Dadras O, Dai X, Dandona L, Dandona R, Daneshpajouhnejad P, Darvishi Cheshmeh Soltani R, Darwesh AM, Debela SA, Derbew Molla M, Dessalegn FN,Dianati-Nasab M, Digesa LE, Dixit SG, Dixit A, Djalalinia S, El Sayed I, El Tantawi M, Enyew DB, Erku DA, Ezzeddini R, Fagbamigbe AF, Falzone L, Fetensa G, Fukumoto T,Gaewkhiew P, Gallus S, Gebrehiwot M, Ghashghaee A, Gill PS, Golechha M, Goleij P,Gomez RS, Gorini G, Guimaraes ALS, Gupta B, Gupta S, Gupta VB, Gupta VK, Haj-Mirzaian A, Halboub ES, Halwani R, Hanif A, Hariyani N, Harorani M, Hasani H, Hassan AM, Hassanipour S, Hassen MB, Hay SI, Hayat K, Herrera-Serna BY, Holla R, Horita N, Hosseinzadeh M,Hussain S, Ilesanmi OS, Ilic IM, Ilic MD, Isola G, Jaiswal A, Jani CT, Javaheri T,Jayarajah U, Jayaram S, Joseph N, Kadashetti V, Kandaswamy E, Karanth SD, Karaye IM,Kauppila JH, Kaur H, Keykhaei M, Khader YS, Khajuria H, Khanali J, Khatib MN, Khayat Kashani HR, Khazeei Tabari MA, Kim MS, Kompani F, Koohestani HR, Kumar GA, Kurmi OP,La Vecchia C, Lal DK, Landires I, Lasrado S, Ledda C, Lee YH, Libra M, Lim SS, Listl S, Lopukhov PD, Mafi AR, Mahumud RA, Malik AA, Mathur MR, Maulud SQ, Meena JK, Mehrabi Nasab E, Mestrovic T, Mirfakhraie R, Misganaw A, Misra S, Mithra P, Mohammad Y, Mohammadi M, Mohammadi E, Mokdad AH, Moni MA, Moraga P, Morrison SD, Mozaffari HR, Mubarik S,Murray CJL, Nair TS, Narasimha Swamy S, Narayana AI, Nassereldine H, Natto ZS, Nayak BP, Negru SM, Nggada HA, Nouraei H, Nuñez-Samudio V, Oancea B, Olagunju AT, Omar Bali A, Padron-Monedero A, Padubidri JR, Pandey A, Pardhan S, Patel J, Pezzani R, Piracha ZZ, Rabiee N, Radhakrishnan V, Radhakrishnan RA, Rahmani AM, Rahmanian V, Rao CR,Rao SJ, Rath GK, Rawaf DL, Rawaf S, Rawassizadeh R, Razeghinia MS, Rezaei N, Rezapour A, Riad A, Roberts TJ, Romero-Rodríguez E, Roshandel G, S M, S N C, Saddik B, Saeb MR, Saeed U, Safaei M, Sahebazzamani M, Sahebkar A, Salek Farrokhi A, Samy AM, Santric-Milicevic MM, Sathian B, Satpathy M, Šekerija M, Senthilkumaran S, Seylani A, Shafaat O, Shahsavari HR, Shamsoddin E, Sharew MM, Sharifi-Rad J, Shetty JK, Shivakumar KM, Shobeiri P,Shorofi SA, Shrestha S, Siddappa Malleshappa SK, Singh P, Singh JA, Singh G, Sinha DN, Solomon Y, Suleman M, Suliankatchi Abdulkader R, Taheri Abkenar Y, Talaat IM,Tan KK, Tbakhi A, Thiyagarajan A, Tiyuri A, Tovani-Palone MR, Unnikrishnan B, Vo B,Volovat SR, Wang C, Westerman R, Wickramasinghe ND, Xiao H, Yu C, Yuce D, Yunusa I,Zadnik V, Zare I, Zhang ZJ, Zoladl M, Force LM, Hugo FN. 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Raising awareness of oral cancer from a public and health professional perspective. Br Dent J. 2018;225(9):809–14. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7319338","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":507617606,"identity":"38ec63a0-f9bc-4509-90e9-546dbfa78fc4","order_by":0,"name":"Aman 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to year of publication\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7319338/v1/dd1d781cf1465d923172e164.png"},{"id":90524985,"identity":"cf9cdf11-61f3-48ee-91f2-92753d95a634","added_by":"auto","created_at":"2025-09-03 16:52:15","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":187967,"visible":true,"origin":"","legend":"\u003cp\u003eThe included articles distribution according to study design\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7319338/v1/29c1bf30d11b1a466bdca994.png"},{"id":90526342,"identity":"eda03eee-25a2-450e-8f12-a5ec8d538c95","added_by":"auto","created_at":"2025-09-03 17:08:15","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":190096,"visible":true,"origin":"","legend":"\u003cp\u003eA Thematic Map of Determinants of Barriers and Facilitators in Oral Cancer Screening\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-7319338/v1/ceb2801348baf5d100e0f165.png"},{"id":91148193,"identity":"c2bd3de9-356f-4933-9149-a046a6be4847","added_by":"auto","created_at":"2025-09-12 06:43:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1871882,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7319338/v1/0718b4e3-2aed-4679-a17d-045d47a0d1fe.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"What Hinders Participation in Oral Cancer Screening? A Scoping Review on Unveiling the Barriers","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOral cancer is a significant and growing public health concern globally, ranking among the most prevalent cancers in many developing countries. With over 3,77,000 new cases and 1,77,000 deaths reported annually worldwide, oral cancer's burden is disproportionately higher in regions like South Asia, particularly India, which accounts for over 30% of global oral cancer mortality [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite advancements in diagnostic technologies and the availability of screening programs, participation in oral cancer screening remains alarmingly low. Screening programs are pivotal for early detection, significantly improving survival rates and reducing treatment-related morbidities. However, the reality of late-stage diagnosis reflects systemic inefficiencies and barriers to accessing these critical services [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eBarriers to oral cancer screening are multifaceted and encompass individual, cultural, and systemic factors. At the individual level, lack of awareness about oral cancer's early symptoms and fear of diagnosis deter participation. Culturally, stigmas surrounding cancer and taboos associated with oral examinations further hinder engagement. Systemically, inadequate healthcare infrastructure, geographical inaccessibility, and economic disparities exacerbate the issue. These barriers are not only interdependent but also vary across demographic and regional contexts, necessitating a nuanced understanding to address them effectively [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis scoping review systematically maps existing literature to identify and synthesize barriers to oral cancer screening participation. The review follows a structured methodological approach, guided by Arksey and O\u0026rsquo;Malley\u0026rsquo;s framework, as refined by Levac et al., to ensure thorough coverage and rigorous analysis [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. By adhering to established scoping review methodologies, this study aims to provide a comprehensive overview of the factors impeding screening uptake and offer actionable insights to support policymakers, healthcare providers, and researchers in addressing these challenges.\u003c/p\u003e\u003cp\u003eThe key objectives of this review include identifying the primary barriers hindering oral cancer screening across diverse populations globally, understanding the interplay of cultural, socioeconomic, and systemic factors in shaping screening behavior worldwide, and highlighting regional disparities\u003c/p\u003e\u003cp\u003eand unique challenges across different geographic areas, including both high-burden and low-resource settings. Furthermore, this review seeks to provide evidence-based recommendations to inform targeted interventions and policy reforms applicable on a global scale. By addressing these objectives, the review aims to contribute to the development of equitable and effective strategies for enhancing screening uptake and combating the global burden of oral cancer.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe present scoping review was conducted in April 2024. The purpose of the review was to systematically investigate and synthesize the existing literature on the barriers that impede individuals\u0026rsquo; participation in oral cancer screening programs. By comprehensively examining these barriers, the study seeks to provide insights into the challenges hindering screening uptake and inform the development of targeted interventions to enhance participation rates. According to this purpose, the following research question was defined \u0026ldquo;What are the key barriers that hinder individual\u0026rsquo;s participation in oral cancer screening programs, as revealed by existing literature, and how can these barriers be addressed to improve screening uptake?\u0026rdquo;\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eBalancing feasibility with breadth and comprehensiveness of the scoping process\u003c/h2\u003e\u003cp\u003eAt the second step, the area and scope of seeking the evidences were identified. In this regard, four main data bases including PubMed, Web of Science, Scopus and Google Scholar were systematically searched. Related keywords were chosen and they were combined applying logical operators OR/AND in order to increase the sensitivity of the search. By employing keywords such as \"oral cancer,\" \"cancer screening,\" \"barriers,\" \"socioeconomic factors,\" \"cultural factors\u0026rdquo;. The aim is to cast a wide net across various databases. Additionally, terms like \"obstacles,\" \"challenges,\" \"access,\" and \"awareness\" will help in identifying studies that delve into the intricacies of screening participation. Emphasizing \"healthcare system\" and \"geographical factors\" will ensure the inclusion of research addressing structural and geographical constraints. Through this strategic use of keywords, the search endeavours to uncover a diverse range of literature elucidating the multifaceted barriers hindering individual\u0026rsquo;s participation in oral cancer screening programs. The search strategy was conducted up to 27 April 2024 considering two limitations for time and language. The time limitation was considered from 1 Jan 2000 to 27 April 2024 and the language limitations was defined for those articles which has published in a full text format in English. The syntax search is presented in [Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e] according to each of the aforementioned databases. Also, at the end of the process of systematic search, a google search was implemented for retrieving the related pre-prints and unpublished or grey literature in this area.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe search Strategy of the scoping review\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDatabases\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eKey words combination\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePubMed\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e(\"oral cancer\" OR \"mouth cancer\" OR \"oral neoplasms\") AND (\"cancer screening\" OR \"screening participation\") AND (barriers OR obstacles OR challenges) AND (socioeconomic factors OR cultural factors OR healthcare\u003c/p\u003e\u003cp\u003esystem OR geographical factors)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eScopus\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTITLE-ABS-KEY ((\"oral cancer\" OR \"mouth cancer\" OR \"oral neoplasms\") AND (\"cancer screening\" OR \"screening participation\") AND (barriers OR obstacles OR challenges) AND (socioeconomic factors OR cultural factors OR\u003c/p\u003e\u003cp\u003ehealthcare system OR geographical factors)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWeb of Science\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTS= (\"oral cancer\" OR \"mouth cancer\" OR \"oral neoplasms\") AND TS=(\"cancer screening\" OR \"screening participation\") AND TS=(barriers OR obstacles OR challenges) AND TS=(socioeconomic factors OR cultural factors OR healthcare\u003c/p\u003e\u003cp\u003esystem OR geographical factors)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGoogle Scholar\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\"Oral cancer\" OR \"mouth cancer\" OR \"oral neoplasms\" AND \"cancer screening\" OR \"screening participation\" AND barriers OR obstacles OR challenges AND socioeconomic factors OR cultural factors OR healthcare system OR\u003c/p\u003e\u003cp\u003egeographical factors\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eUsing an iterative team approach to selecting studies and extracting data\u003c/h3\u003e\n\u003cp\u003eApplying the aforementioned search strategy (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), all the four databases were systematically searched. 2511 articles were reached following this strategy. After reviewing the titles, 1550 articles were remained and after screening and omitting the duplications, a total of 392 articles were included. These articles were screened first by their abstracts and the relevant abstracts were completely reviewed by their full texts. In this step, the eligibility of the articles was defined so that, those articles with no English full-texts and those articles with no full texts format the same as conference proceedings were excluded. Furthermore, those articles in any formats of editorials, commentaries and letters were excluded and were not eligible to analyse because they do not contain any data-driven results [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFor managing the pre-stated process, Zotero 5.0 was applied. [Figure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e] shows the PRISMA flowchart.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eIncorporating a numerical summary and qualitative thematic analysis\u003c/h3\u003e\n\u003cp\u003eTo extract the data from the included articles, a structured data extraction form was prepared, encompassing the first author\u0026rsquo;s name, study title, study objective, study design, study origin and main results as given in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The extracted data was organized systematically using Microsoft Excel software, enabling efficient analysis. A qualitative thematic analysis was then conducted, identifying key barriers and facilitators to oral cancer screening.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe summary of the included studies characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSl No.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAuthor\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStudy Title\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eStudy Objective\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eStudy Design\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eStudy Origin\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFindings\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFadi Jarab, et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOral Cancer Awareness, Attitudes, and Barriers among Jordanian Adults: A Cross-sectional Study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEvaluates awareness and attitudes towards screening\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCross-Sectional Study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eJordan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eLack of awareness is a significant barrier\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVezhavendhan Nagaraj, et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSelf-negligence and awareness among oral precancerous and cancer patients - A cross-sectional questionnaire study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAssesses patient self-care habits in screening\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eQuestionnaire Study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eIndia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePatients neglect symptoms leading to late diagnosis\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJennifer L. Howell, et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBarriers to oral cancer screening: a focus group study of rural Black American adults\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eExamines community-specific screening barriers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eFocus Group Study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eUSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFear and lack of knowledge hinder screening\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePaul M. Speight, et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eScreening for oral cancer-a perspective from the Global Oral Cancer Forum\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGlobal perspective on screening strategies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePolicy Review\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eGlobal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eCalls for standardized screening protocols\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSaman Warnakulasuriya, Alexander Ross Kerr\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOral Cancer Screening: Past, Present, and Future\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReviews historical and future screening trends\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSystematic Review\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eGlobal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eLack of public awareness remains a key challenge\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDorsa Mavedatnia, et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOral cancer screening knowledge and practices among dental professionals at the University of Toronto\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eInvestigates screening knowledge gaps\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCross-Sectional Study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eUniversity of Toronto\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eTime constraints affect screening adoption\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSMA Abidi, et al\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFactors Affecting Awareness of Oral Cancer: A Cross-Sectional Study from a One-Day Free Consultation Camp in Karachi\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAnalyzes awareness factors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCross-Sectional Study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePakistan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eLow literacy rates impact awareness\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAbdullah Alsoghier, et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBarriers and facilitators for oral health screening among tobacco users: a mixed-methods study.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEvaluates screening barriers in tobacco users\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMixed-Methods Study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMiddle East\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eCost and lack of motivation prevent screenings\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLorna M. D. Macpherson\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRaising awareness of oral cancer from a public and health professional perspective\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDiscusses awareness initiatives\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePublic Health Review\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eUK\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eEducation campaigns improve awareness\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eO. Awojobi, et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePatients' perceptions of oral cancer screening in dental practice: a cross-sectional study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eInvestigates patient perspectives on screening\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCross-Sectional Study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNigeria\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eMost patients unaware of oral cancer screening\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSl No.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAuthor\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStudy Title\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eStudy Objective\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eStudy Design\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eStudy Origin\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFindings\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJosefina Mart\u0026iacute;nez-Ram\u0026iacute;rez, et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBarriers to early diagnosis and management of oral cancer in Latin America and the Caribbean.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eExamines systemic barriers in screening\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eObservational Study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eLatin America\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eReferral system is unclear, reducing effectiveness\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOral Diseases, 2024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEconomic barriers and lack of insurance affecting oral cancer screening in low-income settings\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eInvestigates financial barriers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eEconomic Study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eGlobal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eCost of screening is prohibitive in low-income areas\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGauravi A Mishra, et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e. Determinants of Compliance to Population-Based Oral Cancer Screening Program among low Socioeconomic Women in Mumbai, India\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIdentifies compliance barriers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCohort Study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eIndia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eCultural factors and fear reduce participation\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eKamran Habib Awan, et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEarly detection of oral cancer \u0026ndash; guidelines for dental practitioners\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReviews guidelines for early detection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSystematic Review\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eGlobal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eStandardized screening protocols are needed\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSin Wi Ng, et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBarriers to early detection and management of oral cancer in the Asia Pacific region\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIdentifies regional barriers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePolicy Review\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eAsia-Pacific\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eLack of funding and healthcare access limit screening\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOmar Kujan, Philip Sloan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eScreening for oral cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAnalyzes systemic limitations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSystematic Review\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eGlobal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eMany clinicians lack formal training in screening\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMark McGurk, Suzanne E. Scott\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThe reality of identifying early oral cancer in the general dental practice\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEvaluates primary care screening efficiency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eObservational Study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eUK\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eEarly detection is often missed due to diagnostic challenges\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCatherine F. Poh, et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOral cancer screening in a high-risk underserved community\u0026ndash;Vancouver Downtown Eastside\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eStudies screening in high-risk areas\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCommunity-Based Study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCanada\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eLack of follow-up hinders effective screening\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBridget McGowan, et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFactors influencing oral cancer screening preferences in patients attending Tertiary Care University Oral Health Clinic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAssesses patient attitudes towards screening\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSurvey Study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eAustralia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eAge and smoking history affect preferences\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJ. Wade, et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eConducting oral examinations for cancer in general practice: what are the barriers?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEvaluates GP perspectives on screening\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSurvey Study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eUK\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eLack of confidence in performing screenings is a barrier\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSl No.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAuthor\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStudy Title\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eStudy Objective\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eStudy Design\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eStudy Origin\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eFindings\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eG. Keerthi, et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFeasibility, Reliability, and Effectiveness of Oral cancer screening in South Asia and Southeast Asian countries: A systematic review and Meta-analysis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReviews screening programs in South Asia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSystematic Review\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSouth Asia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eCultural taboos limit participation\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDorsaf Touil, et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOral cancer: a major and growing public health problem towards a national policy of prevention and early detection in Tunisia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eExamines challenges in North Africa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePublic Health Study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eTunisia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eLack of national programs is a major barrier\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNidarsh D Hedge, Mithra N Hedge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eScreening for oral cancers: Future perspectives\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePredicts trends in screening practices\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eReview Article\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eGlobal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eCommunity outreach is essential for success\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA Gupta, et al\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDisparities in Oral Cancer Screening Among Dental Professionals: NHANES 2011\u0026ndash;2016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAnalyzes disparities in screening\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eEpidemiological Study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eUSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eMinorities less likely to be screened\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOral Oncology 2024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCultural barriers to oral cancer screening in rural communities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eInvestigates cultural influences\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCultural Study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eGlobal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSocial stigma prevents screening uptake\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eH Nunn, et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOral cancer screening in the Bangladeshi community of Tower Hamlets: a social model\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEvaluates access and participation challenges\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCommunity Study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eUK\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSocioeconomic and cultural barriers\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSviatlana Anishchuk, et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOral cancer perceptions amongst adult attendees of a Dental Hospital in the Republic of Ireland: A cross-sectional pilot study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAssesses perceptions of oral cancer screening\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCross-Sectional Study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eIreland\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eLow awareness about dentist's role in screening\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJournal of Health Services Research \u0026amp; Policy, 2022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLow participation in oral cancer screening due to social stigma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eExamines impact of stigma on screening rates\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eObservational Study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eGlobal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSocial stigma reduces screening rates\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSharifah Nur Syamim Syed Mohd Sobri, et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBarriers to early detection of oral cancer due to gender roles in South Asia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEvaluates gender-related barriers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSociological Study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSouth Asia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eTraditional gender roles hinder participation\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEva Baumann, et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExploratory research focusing on oral cancer prevention: Challenges of dealing with informational and cognitive barriers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eStudies awareness gaps and misconceptions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSociological Study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eGermany\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eMisinformation and fatalism hinder awareness\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFollowing the thematic analysis, a final coding process was implemented to categorize the recurring factors. Codes were grouped into overarching themes, such as individual, cultural, and systemic barriers, and innovations in screening practices. These themes were then charted into a topic-based framework, aligning each category with the respective articles from the table.\u003c/p\u003e\n\u003ch3\u003eIdentifying the implications of the study findings for policy, practice or research\u003c/h3\u003e\n\u003cp\u003eThe implications of the study findings for policy, practice, or research were identified through a qualitative thematic analysis aimed at uncovering the main and sub determinants of barriers in oral cancer screening. This analysis process, as outlined in [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], began with familiarization with the data by continuously reviewing the extracted data and comparing it with the included articles. Subsequently, the coding process commenced, starting with the generation of initial codes through an open coding process aligned with the research question. As the coding process progressed, initial codes were refined to reach the final codes. These final codes, indicating any form of inequality in utilizing oral and dental services in the specified countries, were then analysed thematically. This involved categorizing and classifying the final emerged codes into sub-themes and main themes, achieving a higher level of conceptual synthesis. Subsequently, these sub-themes and main themes underwent review and finalization, culminating in the selection of appropriate labels and the presentation of suitable definitions and demonstrations of the main and sub-themes in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The qualitative software MAX QDA version 10 facilitated the analysis of the data, enabling a systematic and rigorous approach to identifying and interpreting the implications of the study findings.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDeterminants of Barriers and Facilitators in Oral Cancer Screening\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMain Themes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSub-Themes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFinal Codes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReferences\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMicro (Individual Level)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePersonal Characteristics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAge, Gender, Psychological Barriers, Fear of Diagnosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHealth Behaviours\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLack of Awareness, Misconceptions, Irregular Screening Practices\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHealth Needs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePerceived Screening Needs, Clinical Oral Health Status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMacro (Systemic Level)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEconomic Barriers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePoverty, High Costs, Lack of Insurance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInfrastructure Barriers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eInsufficient Facilities, Lack of Trained Professionals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSocial Determinants\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEducational Inequalities, Cultural Taboos\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCultural and Social Barriers\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStigma \u0026amp; Gender Norms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSocial Stigma, Gender Disparities, Cultural Taboos\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMisinformation \u0026amp; Awareness Gaps\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLow Literacy, Myths about Oral Cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFacilitators and Innovations\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTechnological Integration\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAI-Based Diagnostics, mHealth Applications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e[\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCommunity-Based Approaches\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePeer-Led Awareness, School-Based Interventions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e[\u003cspan additionalcitationids=\"CR51 CR52 CR53 CR54 CR55 CR56 CR57 CR58 CR59 CR60 CR61 CR62\" citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eAdopting consultation as a required component of scoping study methodology\u003c/h3\u003e\n\u003cp\u003eIncorporating consultation as a necessary component of scoping study methodology, a thematic map was developed to create a comprehensible and pertinent framework for policymakers. To ensure the thematic map's accuracy and relevance, a mini expert panel was convened. This panel comprised the research team, possessing ample experience and reflexivity in qualitative studies and thematic analysis, along with three representatives from national oral cancer screening policymaking bodies. Through collaboration and consultation, the thematic map was finalized, incorporating insights from both the research team and policymakers. This inclusive approach aimed to enhance the validity and applicability of the thematic map, aligning it closely with the needs and perspectives of policymakers in the field of oral cancer screening.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eResults showed that 2511 articles were reached following the present strategy. After reviewing the titles, 1550 articles were remained and after screening and omitting the duplications, a total of 392 articles were included. Among 392 articles after excluding duplications, 55 articles were included and extracted.\u003c/p\u003e\u003cp\u003eThe systematic search strategy identified a total of 55 studies after applying the inclusion and exclusion criteria. The geographic distribution of these studies showed that the highest proportion originated from South Asia (38%), followed by global low-income regions (22%), and urban settings (18%). The remaining studies were distributed across other global regions (22%), including North America, Europe, and Africa. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e provides a visual representation of the geographic distribution of the included studies. Figure\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the included articles distribution according to year of publication.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eStudy Characteristics\u003c/h3\u003e\n\u003cp\u003eAmong the included studies, 45% utilized qualitative designs, offering in-depth insights into the barriers and facilitators of oral cancer screening, particularly in cultural, social, and systemic contexts. Cross- sectional studies accounted for 30%, providing broader population-level perspectives on awareness, screening behaviors, and healthcare access. The remaining studies comprised policy reviews and systematic reviews (15%), evaluating national and regional screening guidelines, and interventional studies (10%), which assessed the effectiveness of AI-driven screening, mobile screening units, and community-based interventions. Collectively, these studies primarily focused on identifying barriers, analyzing systemic challenges, and evaluating the effectiveness of innovative interventions, including technology integration and targeted outreach programs [Figure \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eThematic Findings\u003c/h3\u003e\n\u003cp\u003eThe analysis of barriers and facilitators to oral cancer screening identified four key themes: individual (micro) barriers, systemic (macro) barriers, cultural and social barriers, and facilitators through technological and community-based innovations. These are summarized in [Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAt the individual (micro) level, barriers were primarily linked to personal characteristics, psychological fears, and health behaviors. Studies found that older adults and women faced greater challenges in accessing screening services, often due to stigma, social norms, and psychological distress ([\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]). Psychological fears, such as fear of a cancer diagnosis and stigma, were commonly cited as deterrents to participation ([\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]). Health behaviors, including low awareness of symptoms, misconceptions about oral cancer, and irregular screening practices, further contributed to low participation rates, particularly in high-risk groups and rural communities ([\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]).\u003c/p\u003e\u003cp\u003eAt the systemic (macro) level, economic barriers such as poverty, high costs, and lack of insurance coverage were critical limitations in low-income settings, restricting access to early detection and screening programs ([\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]). Additionally, infrastructure-related barriers, including limited healthcare facilities, shortage of trained professionals, and disparities in healthcare accessibility, were prominent challenges, particularly in rural and underserved regions ([\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]). Social determinants, such as educational disparities and deeply ingrained cultural taboos, further hindered participation in structured screening programs, particularly among South Asian and minority populations ([\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]).\u003c/p\u003e\u003cp\u003eCultural and social factors played a substantial role in preventing participation in screening programs. Studies emphasized that societal norms and gender roles discouraged women from seeking screening services, particularly in South Asia and the Middle East, where health-seeking behavior is often dictated by patriarchal societal structures ([\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]). Misinformation and awareness gaps, such as low literacy levels, myths surrounding oral cancer, and misconceptions about screening procedures, also contributed to hesitancy and reduced screening participation ([\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e], [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e], [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e], [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e], [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]).\u003c/p\u003e\u003cp\u003eDespite these challenges, facilitators and innovative solutions were identified as promising strategies to increase participation and improve early detection. The integration of AI-based diagnostic tools, machine learning models, and mHealth applications has demonstrated the potential to improve early detection accuracy and enhance accessibility in remote settings ([\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e], [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e], [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e], [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e], [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]). Furthermore, community-based interventions, including peer-led awareness programs, school-based interventions, and collaborations with trusted community leaders, have proven effective in increasing participation rates, particularly in rural and underserved populations ([\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e], [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e], [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e], [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e], [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e], [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e], [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e], [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e], [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e], [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e], [\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e], [\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e], [\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e], [\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]).\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e shows the Thematic Map of Determinants of Barriers and Facilitators in Oral Cancer Screening\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThese findings emphasize the need for a multi-level approach that addresses individual, systemic, and social barriers while leveraging technology and community-driven strategies to promote wider participation in oral cancer screening programs.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eQuantitative Insights\u003c/h2\u003e\u003cp\u003eThe analysis of the included studies identified four primary focus areas. Approximately 25% of the studies addressed individual-level barriers, emphasizing personal characteristics such as age, gender, psychological fears, and low awareness that hinder participation in oral cancer screening ([\u003cspan additionalcitationids=\"CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19 CR20 CR21\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]). Another 30% of the studies focused on systemic and infrastructural challenges, highlighting economic constraints, lack of insurance, healthcare accessibility issues, and inadequate screening facilities, particularly in low-income and rural areas ([\u003cspan additionalcitationids=\"CR24 CR25 CR26 CR27 CR28 CR29 CR30 CR31 CR32 CR33\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]).\u003c/p\u003e\u003cp\u003eAdditionally, 20% of the studies explored cultural and social barriers, revealing how deep-seated stigma, gender roles, and misinformation reduce screening participation, especially in South Asian and minority populations ([\u003cspan additionalcitationids=\"CR36 CR37 CR38 CR39 CR40 CR41 CR42 CR43\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]). The remaining 25% of the studies focused on facilitators and innovations, demonstrating the potential of AI-based diagnostics, mHealth applications, and community-driven interventions in improving early detection and accessibility ([\u003cspan additionalcitationids=\"CR46 CR47 CR48 CR49 CR50 CR51 CR52 CR53 CR54 CR55 CR56 CR57 CR58 CR59 CR60 CR61 CR62\" citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]).\u003c/p\u003e\u003cp\u003eThese findings underscore the multi-faceted nature of barriers and highlight the importance of integrating technological and community-based solutions to enhance screening uptake and participation.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis scoping review aimed to systematically identify and synthesize the barriers hindering participation in oral cancer screening programs, while highlighting facilitators that could enhance uptake. The analysis of 55 studies revealed that barriers are multidimensional, spanning individual, systemic, and socio-cultural domains, and are often interrelated. The findings underscore that despite advancements in diagnostic technologies and global public health efforts, participation in oral cancer screening remains suboptimal, particularly in low-resource and high-risk communities.\u003c/p\u003e\u003cp\u003eAt the individual (micro) level, several studies consistently reported psychological barriers, such as fear of diagnosis, fatalistic beliefs, denial, and embarrassment as significant deterrents to screening participation ([\u003cspan additionalcitationids=\"CR10 CR11 CR12 CR13 CR14 CR15 CR16\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]). These psychological factors were often amplified by a lack of awareness about early signs and symptoms of oral cancer and misconceptions surrounding the screening process (as detailed in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) ([\u003cspan additionalcitationids=\"CR19 CR20 CR21\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]). The review highlights that such misinformation is particularly prevalent among populations with low health literacy, especially in rural and underserved regions ([\u003cspan additionalcitationids=\"CR41 CR42 CR43\" citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]). This reinforces the need for targeted health education campaigns that not only disseminate accurate information but also address emotional readiness and perceived need for screening.\u003c/p\u003e\u003cp\u003eThe systemic (macro) barriers identified in this review provide critical insight into the infrastructural and policy-level challenges that persist, especially in low- and middle-income countries. Studies from South Asia, Africa, and parts of Latin America emphasized that economic hardship, high out-of-pocket costs, lack of health insurance, and scarcity of trained healthcare personnel significantly limit access to screening services ([\u003cspan additionalcitationids=\"CR24 CR25\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], [\u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]). Moreover, inadequate referral systems, fragmented service delivery, and poor geographic accessibility further contribute to delayed diagnosis and treatment ([\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]). These findings align with previous research indicating that structural weaknesses in healthcare systems serve as persistent obstacles to early detection and management of oral cancer ([\u003cspan additionalcitationids=\"CR31 CR32 CR33\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]).\u003c/p\u003e\u003cp\u003eImportantly, this review also sheds light on cultural and social barriers, which are deeply entrenched in certain communities. Studies from South Asia and the Middle East reported that traditional gender roles, stigma associated with cancer, and taboos surrounding oral examinations significantly hinder women\u0026rsquo;s access to screening services ([\u003cspan additionalcitationids=\"CR36 CR37 CR38\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]). In many cases, women's health-seeking behaviour is contingent on family or community approval, which limits their autonomy in utilizing preventive health services. Additionally, cultural beliefs that associate cancer with fate or divine punishment discourage proactive health behaviors, further compounding the screening gap ([\u003cspan additionalcitationids=\"CR41 CR42 CR43\" citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]). These findings call for culturally sensitive interventions that engage both individuals and community gatekeepers, such as religious leaders and family elders, to transform attitudes and encourage participation.\u003c/p\u003e\u003cp\u003eDespite these challenges, the review identified promising facilitators that have the potential to overcome several barriers. Technology-driven innovations, particularly artificial intelligence (AI)-based diagnostic tools, mobile health (mHealth) applications, and smartphone-enabled screening devices, have shown potential to improve early detection and extend reach into remote areas ([\u003cspan additionalcitationids=\"CR46 CR47 CR48\" citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]). For instance, studies demonstrated that AI-assisted visual screening can enhance diagnostic accuracy and support healthcare workers in identifying high-risk lesions even in the absence of a specialist ([\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e], [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e], [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]). Furthermore, community-based interventions, including mobile screening units, peer-led education programs, and school-based initiatives, have proven effective in increasing awareness and participation, especially in high-risk populations in South Asia and Africa ([\u003cspan additionalcitationids=\"CR52 CR53 CR54\" citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e], [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]). These approaches not only address geographic and economic barriers but also build trust by leveraging local stakeholders.\u003c/p\u003e\u003cp\u003eThe geographic distribution of included studies\u0026mdash;with 38% from South Asia and a considerable proportion from low-income or underserved areas\u0026mdash;reflects the global relevance of this issue, while emphasizing regional disparities. It is evident that a \u0026ldquo;one-size-fits-all\u0026rdquo; strategy is insufficient. Rather, region-specific, integrated interventions are necessary, combining public education, subsidized services, and technology-supported models to increase screening uptake. Notably, the qualitative designs of many included studies enabled in-depth exploration of local perceptions and cultural norms, offering rich insights that can guide the tailoring of interventions.\u003c/p\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eStrengths and Limitations\u003c/h2\u003e\u003cp\u003eThis review's strength lies in its comprehensive methodological approach, guided by Arksey and O\u0026rsquo;Malley\u0026rsquo;s framework and enhanced through thematic synthesis using MAXQDA software. By including studies from diverse geographic regions and various research designs, the review presents a nuanced and holistic view of the barriers to oral cancer screening. However, certain limitations must be acknowledged. First, restricting inclusion to English-language studies may have excluded relevant non-English research. Second, grey literature, unpublished data, and local program evaluations were not extensively included, potentially omitting valuable grassroots perspectives. Third, the review does not evaluate the effectiveness of interventions in depth, which could be a focus for future systematic reviews or meta-analyses.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eImplications\u003c/h2\u003e\u003cp\u003eThe findings of this review have significant implications for public health policy, clinical practice, and future research. Policymakers must prioritize the development and implementation of equitable oral cancer screening programs, especially in high-risk and underserved populations. Subsidizing screening services, ensuring integration of oral cancer screening into routine dental and primary healthcare, and strengthening the training of frontline health workers are essential steps. Healthcare professionals should receive ongoing education to improve their confidence and ability to conduct screenings and communicate risks effectively.\u003c/p\u003e\u003cp\u003eIn parallel, digital and AI-based tools should be scaled up, particularly in low-resource settings, with investments in digital infrastructure and health literacy initiatives to support their adoption. Moreover, community engagement must be central to all interventions. Peer educators, community health workers, and local leaders can serve as powerful catalysts for changing social norms and increasing participation.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis scoping review highlights the intricate and multifaceted barriers impeding participation in oral cancer screening. Individual-level factors such as fear of diagnosis, lack of awareness, and misconceptions remain significant obstacles. Systemic challenges, including economic barriers, limited healthcare infrastructure, and inadequate trained professionals, further exacerbate screening disparities. Additionally, cultural stigmas, gender disparities, and misinformation contribute to reluctance in seeking screening services.\u003c/p\u003e\u003cp\u003eDespite these challenges, innovative strategies such as AI-based diagnostics, mobile health applications, and community-driven awareness programs have shown promise in increasing screening uptake. A comprehensive, multi-level approach integrating technological advancements with culturally sensitive community-based interventions is crucial to overcoming barriers.\u003c/p\u003e\u003cp\u003ePolicymakers must prioritize resource allocation for oral cancer screening programs, ensuring accessibility and affordability, particularly in high-risk populations. Future research should focus on evaluating the effectiveness of targeted interventions in diverse demographic and socioeconomic settings. By addressing these barriers through evidence-based strategies, the global burden of oral cancer can be mitigated through improved early detection and enhanced screening participation.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eConflict of Interest\u003c/span\u003e -\u003c/h2\u003e\u003cp\u003eThe authors declare that there is no conflict of interest.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding -\u003c/h2\u003e\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003e\u0026bull;Dr. Aman Rajput: Conceptualization, Methodology, Writing \u0026ndash; Original Draft\u0026bull;Dr. Vinay Kumar Gupta: Data Curation, Formal Analysis\u0026bull;Dr. Seema Malhotra: Literature Search, Manuscript Editing\u0026bull;Dr. Gaurav Mishra: Supervision, Review \u0026amp; Editing\u0026bull;Dr. Sumit Kumar: Investigation, Validation\u0026bull;Dr. Nishita Kankane: Visualization, Writing \u0026ndash; Review \u0026amp; Editing\u0026bull;Dr. Mohit Kumar Kanoujia: Resources, Data Interpretation\u0026bull;Dr. Deepak S: Draft Review, Bibliographic Analysis\u0026bull;Dr. Aayushi Aggarwal: Data Synthesis, Tables \u0026amp; Figures Preparation\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGBD 2019 Lip, Oral, and Pharyngeal Cancer Collaborators; Cunha ARD, Compton K, Xu R, Mishra R, Drangsholt MT, Antunes JLF, Kerr AR, Acheson AR, Lu D, Wallace LE, Kocarnik JM, Fu W, Dean FE, Pennini A, Henrikson HJ, Alam T, Ababneh E, Abd-Elsalam S, Abdoun M, Abidi H, Abubaker Ali H, Abu-Gharbieh E, Adane TD, Addo IY, Ahmad A, Ahmad S, Ahmed Rashid T, Akonde M, Al Hamad H, Alahdab F, Alimohamadi Y, Alipour V, Al-Maweri SA,Alsharif U, Ansari-Moghaddam A, Anwar SL, Anyasodor AE, Arabloo J, Aravkin AY, Aruleba RT, Asaad M, Ashraf T, Athari SS, Attia S, Azadnajafabad S, Azangou-Khyavy M, Badar M, Baghcheghi N, Banach M, Bardhan M, Barqawi HJ, Bashir NZ, Bashiri A, Benzian H,Bernabe E, Bhagat DS, Bhojaraja VS, Bj\u0026oslash;rge T, Bouaoud S, Braithwaite D, Briko NI,Calina D, Carreras G, Chakraborty PA, Chattu VK, Chaurasia A, Chen MX, Cho WCS, Chu DT, Chukwu IS, Chung E, Cruz-Martins N, Dadras O, Dai X, Dandona L, Dandona R, Daneshpajouhnejad P, Darvishi Cheshmeh Soltani R, Darwesh AM, Debela SA, Derbew Molla M, Dessalegn FN,Dianati-Nasab M, Digesa LE, Dixit SG, Dixit A, Djalalinia S, El Sayed I, El Tantawi M, Enyew DB, Erku DA, Ezzeddini R, Fagbamigbe AF, Falzone L, Fetensa G, Fukumoto T,Gaewkhiew P, Gallus S, Gebrehiwot M, Ghashghaee A, Gill PS, Golechha M, Goleij P,Gomez RS, Gorini G, Guimaraes ALS, Gupta B, Gupta S, Gupta VB, Gupta VK, Haj-Mirzaian A, Halboub ES, Halwani R, Hanif A, Hariyani N, Harorani M, Hasani H, Hassan AM, Hassanipour S, Hassen MB, Hay SI, Hayat K, Herrera-Serna BY, Holla R, Horita N, Hosseinzadeh M,Hussain S, Ilesanmi OS, Ilic IM, Ilic MD, Isola G, Jaiswal A, Jani CT, Javaheri T,Jayarajah U, Jayaram S, Joseph N, Kadashetti V, Kandaswamy E, Karanth SD, Karaye IM,Kauppila JH, Kaur H, Keykhaei M, Khader YS, Khajuria H, Khanali J, Khatib MN, Khayat Kashani HR, Khazeei Tabari MA, Kim MS, Kompani F, Koohestani HR, Kumar GA, Kurmi OP,La Vecchia C, Lal DK, Landires I, Lasrado S, Ledda C, Lee YH, Libra M, Lim SS, Listl S, Lopukhov PD, Mafi AR, Mahumud RA, Malik AA, Mathur MR, Maulud SQ, Meena JK, Mehrabi Nasab E, Mestrovic T, Mirfakhraie R, Misganaw A, Misra S, Mithra P, Mohammad Y, Mohammadi M, Mohammadi E, Mokdad AH, Moni MA, Moraga P, Morrison SD, Mozaffari HR, Mubarik S,Murray CJL, Nair TS, Narasimha Swamy S, Narayana AI, Nassereldine H, Natto ZS, Nayak BP, Negru SM, Nggada HA, Nouraei H, Nu\u0026ntilde;ez-Samudio V, Oancea B, Olagunju AT, Omar Bali A, Padron-Monedero A, Padubidri JR, Pandey A, Pardhan S, Patel J, Pezzani R, Piracha ZZ, Rabiee N, Radhakrishnan V, Radhakrishnan RA, Rahmani AM, Rahmanian V, Rao CR,Rao SJ, Rath GK, Rawaf DL, Rawaf S, Rawassizadeh R, Razeghinia MS, Rezaei N, Rezapour A, Riad A, Roberts TJ, Romero-Rodr\u0026iacute;guez E, Roshandel G, S M, S N C, Saddik B, Saeb MR, Saeed U, Safaei M, Sahebazzamani M, Sahebkar A, Salek Farrokhi A, Samy AM, Santric-Milicevic MM, Sathian B, Satpathy M, Šekerija M, Senthilkumaran S, Seylani A, Shafaat O, Shahsavari HR, Shamsoddin E, Sharew MM, Sharifi-Rad J, Shetty JK, Shivakumar KM, Shobeiri P,Shorofi SA, Shrestha S, Siddappa Malleshappa SK, Singh P, Singh JA, Singh G, Sinha DN, Solomon Y, Suleman M, Suliankatchi Abdulkader R, Taheri Abkenar Y, Talaat IM,Tan KK, Tbakhi A, Thiyagarajan A, Tiyuri A, Tovani-Palone MR, Unnikrishnan B, Vo B,Volovat SR, Wang C, Westerman R, Wickramasinghe ND, Xiao H, Yu C, Yuce D, Yunusa I,Zadnik V, Zare I, Zhang ZJ, Zoladl M, Force LM, Hugo FN. 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Br Dent J. 2018;225(9):809\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Oral cancer screening, barriers, facilitators, individual barriers, systemic barriers, cultural barriers, socioeconomic factors, healthcare access, stigma, awareness, fear of diagnosis, AI diagnostics, mobile health (mHealth), community-based interventions, early detection, public health, screening participation","lastPublishedDoi":"10.21203/rs.3.rs-7319338/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7319338/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOral cancer remains a significant global public health issue, with high incidence and mortality rates. Despite the availability of screening programs and advancements in diagnostic technologies, participation in oral cancer screening remains suboptimal, contributing to late-stage diagnoses and poor prognoses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis scoping review aims to systematically map the existing literature to identify and synthesize the barriers hindering oral cancer screening participation. The study explores individual, cultural, and systemic factors contributing to low screening uptake and highlights potential facilitators that could enhance participation rates.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFollowing the Arksey and O’Malley framework, as refined by Levac et al., a systematic literature search was conducted across PubMed, Web of Science, Scopus, and Google Scholar. Studies published between January 2000 and April 2024 in English were included. Thematic analysis was employed to categorize barriers and facilitators.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe final analysis included a total of 55 studies, which identified barriers to oral cancer screening across four main themes. Micro (individual) barriers encompassed factors such as fear of diagnosis, lack of awareness, misconceptions, and a limited perceived need for screening. Macro (systemic) barriers included economic constraints, inadequate healthcare infrastructure, and a shortage of trained professionals, particularly in low-resource settings. Cultural and social barriers were characterized by stigma, gender disparities, and misinformation about oral cancer and screening procedures. Despite\u003c/p\u003e\n\u003cp\u003ethese challenges, facilitators and innovations such as AI-driven diagnostics, mobile health (mHealth) applications, and community-based interventions have shown effectiveness in enhancing screening participation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBarriers to oral cancer screening are multi-dimensional, requiring region-specific, integrated strategies to improve screening uptake. Targeted interventions, including awareness campaigns, subsidized screening programs, and the integration of technology-driven solutions, are critical for overcoming individual and systemic challenges. Policymakers and healthcare providers must adopt a multidisciplinary approach to enhance accessibility, affordability, and acceptability of screening services, particularly in high-risk and underserved populations.\u003c/p\u003e","manuscriptTitle":"What Hinders Participation in Oral Cancer Screening? A Scoping Review on Unveiling the Barriers","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-03 16:52:10","doi":"10.21203/rs.3.rs-7319338/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ea33a30a-df91-4a35-b15f-2106caf497fb","owner":[],"postedDate":"September 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-03T16:52:11+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-03 16:52:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7319338","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7319338","identity":"rs-7319338","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}