Barriers and Enablers to Capsule Sponge Screening Among People With Heartburn : A Community-Based Qualitative Study in the UK

INTRODUCTION: Non-endoscopic capsule sponge devices are a promising new technology. They could potentially improve oesophageal cancer outcomes by detecting and monitoring Barrett's oesophagus and identifying dysplasia early to allow timely treatment. Trials assessing their clinical utility are underway. OBJECTIVE: This study sought to understand potential barriers and enablers to capsule sponge screening among people with heartburn. METHODS: Forty semi-structured interviews were conducted between October 2024 and April 2025 with men aged 55-79 and women aged 65-79 taking regular reflux medication. Participants were purposively sampled. Transcripts were analysed using Thematic Framework Analysis. RESULTS: Participants were generally enthusiastic about the test, but not all felt willing or able to take part. Key factors influencing their attitudes are described in three overarching themes. First, participants described how they navigate reflux-related care and negotiate this with healthcare professionals. They considered how capsule sponge screening would fit into this collaborative model. Second, participants showed an aversion to uncertainty, noting that capsule sponge screening could both create and reduce uncertainty about their health. Third, participants' understanding of their candidacy varied based on risk perceptions, self-efficacy and views about acting on test results. Some expressed a sense of being less 'worthy' candidates than others. CONCLUSION: Overall, the capsule sponge test screening appealed to many due to its quick, simple and minimally invasive approach. Nevertheless, concerns about responsibility for reflux care, candidacy and uncertainty will likely shape attitudes and intention towards the test and should be key considerations if this test is implemented. LIVED EXPERIENCE OR PUBLIC CONTRIBUTION: Three individuals with lived experience of reflux, Barrett's oesophagus and oesophageal cancer were involved in the design of this study and associated materials.