There is a complex interaction of various factors that determine whether someone will participate in the bowel cancer screening programme. These include socio-economic factors, demographic factors, the presence of any symptoms and the acceptability of the faecal occult blood test to the participants. Mumtaz Meeran and Caroline Smith outline the barriers to uptake and interventions to increase involvement in the screening programme, discussing the results of focus groups to further understand motivations and avoidance.