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Devotta K, O’Campo P, Bender J, Lofters AK. Important and Feasible Actions to Address Cervical Screening Participation amongst South Asian Women in Ontario: A Concept Mapping Study with Service Users and Service Providers. Curr Oncol 2024; 31:4038-4051. [PMID: 39057173 PMCID: PMC11276223 DOI: 10.3390/curroncol31070301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/15/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
Regular cervical screening can largely prevent the development of cervical cancer and innovative methods are needed to better engage people in screening. In Ontario, Canada, South Asian women have some of the lowest rates of screening in the province. In this study, we used concept mapping to engage two stakeholder groups-South Asian service users and service providers-to identify and prioritize points of intervention to encourage the uptake of cervical screening. After participants brainstormed a master list of statements, 45 participants rated the statements based off 'importance' and 'ease to address' in relation to encouraging cervical screening. A bivariate plot (X-Y graph) that shows the average rating values for each statement across the two rating variables (a 'go-zone' display) was produced to display priorities for implementation. Statements that were considered high priority to address reflected issues around education and awareness including understanding and communication related to cervical screening and preventative care, as well as the need for trusted sources of information. Statements that were considered high priority but challenging to implement were centered around fear, stigma, discomfort, family and personal priorities. This study highlighted that stigma, norms and social relations that impact the uptake of screening must be addressed in order for education and awareness raising to be effective and to move people from conviction around screening to action.
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Affiliation(s)
- Kimberly Devotta
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T3M7, Canada
- Women’s College Hospital, Toronto, ON M5S1B2, Canada
| | - Patricia O’Campo
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T3M7, Canada
- St. Michael’s Hospital, Unity Health Toronto, Toronto, ON M5B1W8, Canada
| | - Jacqueline Bender
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T3M7, Canada
- University Health Network, Toronto, ON M5G2C4, Canada
| | - Aisha K. Lofters
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T3M7, Canada
- Women’s College Hospital, Toronto, ON M5S1B2, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G1V7, Canada
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Devotta K, Vahabi M, Prakash V, Lofters AK. Implementation of a Cervical Cancer Screening Intervention for Under- or Never-Screened Women in Ontario, Canada: Understanding the Acceptability of HPV Self-Sampling. Curr Oncol 2023; 30:6786-6804. [PMID: 37504357 PMCID: PMC10378307 DOI: 10.3390/curroncol30070497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/08/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023] Open
Abstract
With appropriate screening, cervical cancer can be prevented. In Ontario, Canada, some groups of women have low screening rates. South Asian, Middle Eastern and North African women are particularly at risk of under-screening. Currently, cytology-based screening is used in Ontario, although the growing evidence and adoption of HPV testing for cervical screening has encouraged many jurisdictions around the world to move towards HPV testing, with the option of self-sampling. We conducted an intervention beginning in June 2018, where we recruited over 100 under- or never-screened (UNS) women who identify as South or West Asian, Middle Eastern or North African from the Greater Toronto Area, to understand the uptake and acceptability of HPV self-sampling as an alternative to a Pap test. Participants self-selected if they tried the kit or not and completed both quantitative and qualitative research activities. This paper focuses on the qualitative arm of the study, where follow-ups and five focus groups were conducted with those who tried the kit (three groups) and those who did not (two groups), as well as eight key informant interviews with community champions and others who were involved in our recruitment. We used the Consolidated Framework for Implementation Research (CFIR) to guide our data collection and analysis. Major themes around convenience, privacy and comfort came from the data as important drivers of the uptake of the intervention. The role of community champions and peers in engaging and educating UNS women, as well as having self-confidence to collect the sample, also came out as factors impacting uptake and plans for continued use. Overall, the intervention showed that HPV self-sampling is an acceptable alternative to a Pap test for some but not all UNS women in Ontario.
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Affiliation(s)
- Kimberly Devotta
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, ON M5S 1B2, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON M5B 1T8, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Mandana Vahabi
- Daphne Cockwell School of Nursing, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON M5B 1Z5, Canada
| | - Vijayshree Prakash
- WECAN Research Project, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON M5B 1Z5, Canada
| | - Aisha K Lofters
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, ON M5S 1B2, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON M5B 1T8, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
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3
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Lee J, Ewing B, Holmes D. Barriers and Facilitators to Colorectal Cancer Screening in South Asian Immigrants: A Systematic Review. Asian Pac J Cancer Prev 2023; 24:1463-1475. [PMID: 37247265 PMCID: PMC10495916 DOI: 10.31557/apjcp.2023.24.5.1463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/22/2023] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVE The purpose of this systematic review is to broaden our knowledge of colorectal cancer (CRC) screening in South Asian immigrants living in Canada, Hong Kong, the United Kingdom, the United States, and Australia by determining the barriers and facilitators and examining interventions for CRC screening. METHODS A literature search of PubMed, Ovid Medline, and Google was conducted using South Asian, Asian Indians, cancer screening, colorectal neoplasm, early detection of cancer, and mass screening as search terms. The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Only research articles written in English from 2000 to July 2022 were collected. Inclusion criteria included all English-language articles, the South Asian population, and either reporting barriers, facilitators, interventions, or recommendations for CRC screening. Exclusion criteria included all articles that did not meet inclusion criteria or were duplicates. A total of 32 articles were deemed eligible for inclusion and were retrieved for further analysis. The countries of origin in the articles reviewed included Canada, Hong Kong, the United Kingdom, the United States, and Australia. RESULTS In general, the studies indicated that South Asians have low CRC screening rates. The most common barriers reported were poor knowledge/awareness of CRC and CRC screening, lack of physician recommendation, psychological factors (e.g., fear, anxiety, and shame), cultural/religious factors, and sociodemographic factors (language barrier, lower income, and female gender). The most important facilitator reported was the physician's recommendation. Six intervention studies of either education or organized screening programs were shown to have a positive influence by increasing knowledge and improving attitudes toward CRC screening. CONCLUSION Of the limited number of studies identified, the population categorized as South Asians was largely heterogeneous, including a diversity of ethnicities. Although the rates of CRC among South Asians were relatively low, there remain many cultural barriers to the awareness of and screening for CRC in this population. Further research in this population is needed to better identify the factors related to CRC in individuals of South Asian ethnicity. Recommending CRC screening by physicians and mid-level providers and educating patients with culturally sensitive programs and materials are important to increase knowledge and awareness of CRC and CRC screening.
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Affiliation(s)
- James Lee
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA.
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Devotta K, Vahabi M, Prakash V, Lofters A. Reach and effectiveness of an HPV self-sampling intervention for cervical screening amongst under- or never-screened women in Toronto, Ontario Canada. BMC Womens Health 2023; 23:36. [PMID: 36698140 PMCID: PMC9876406 DOI: 10.1186/s12905-023-02174-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 01/12/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Cervical cancer is almost entirely preventable with appropriate and timely screening. In Ontario, Canada, South Asian, Middle Eastern and North African women have some of the lowest rates of screening and a suggested higher burden of cervical cancer. With increasing international evidence and adoption of HPV testing, many screening programs are making the move away from Pap tests and towards HPV testing with the option of HPV self-sampling seeming promising for under- or never-screened (UNS) women. Our study aimed to understand the uptake and acceptability of an HPV self-sampling intervention amongst these disproportionately UNS women in Peel region and surrounding areas in Ontario. METHODS A community -based mixed methods approach guided by the RE-AIM framework was used to recruit approximately 100 UNS racialized immigrant women aged 30-69, during the period of June 2018 to December 2019. The main recruitment strategy included community champions (i.e. trusted female members of communities) to engage people in our selected areas in Peel Region. Participants completed a study questionnaire about their knowledge, attitudes and practices around cervical cancer screening, self-selected whether to use the HPV self-sampling device and completed follow-up questions either about their experience with self-sampling or going to get a Pap test. RESULTS In total, 108 women participated in the study, with 69 opting to do self-sampling and 39 not. The majority of women followed through and used the device (n = 61) and found it 'user friendly.' The experience of some participants suggests that clearer instructions and/or more support once at home is needed. Survey and follow-up data suggest that privacy and comfort are common barriers for UNS women, and that self-sampling begins to address these concerns. Across both groups addressing misinformation and misconceptions is needed to convince some UNS women to be screened. Family, friends and peers also seemed to play a role in the decision-making process. CONCLUSIONS HPV self-sampling is viewed as an acceptable alternative to a Pap test for cervical screening, by some but not all UNS women. This method begins to address some of the barriers that often prevent women from being screened and is already being offered in some jurisdictions as an alternative to clinical cervical cancer screening.
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Affiliation(s)
- Kimberly Devotta
- grid.415502.7MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON M5B 1T8 Canada ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7 Canada ,grid.417199.30000 0004 0474 0188Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital, Toronto, ON M5S 1B2 Canada
| | - Mandana Vahabi
- grid.68312.3e0000 0004 1936 9422Daphne Cockwell School of Nursing, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON M5B 1Z5 Canada
| | - Vijayshree Prakash
- grid.68312.3e0000 0004 1936 9422WECAN Research Project, Toronto Metropolitan University (Formerly Ryerson University), Toronto, ON M5B 1Z5 Canada
| | - Aisha Lofters
- grid.415502.7MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON M5B 1T8 Canada ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7 Canada ,grid.417199.30000 0004 0474 0188Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital, Toronto, ON M5S 1B2 Canada ,grid.17063.330000 0001 2157 2938Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7 Canada
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Bouissiere A, Laperrouse M, Panjo H, Ringa V, Rigal L, Letrilliart L. General practitioner gender and use of diagnostic procedures: a French cross-sectional study in training practices. BMJ Open 2022; 12:e054486. [PMID: 35523487 PMCID: PMC9083381 DOI: 10.1136/bmjopen-2021-054486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES The acceleration in the number of female doctors has led to questions about differences in how men and women practice medicine. The aim of this study was to assess the influence of general practitioner (GP) gender on the use of the three main categories of diagnostic procedures-clinical examinations, laboratory tests and imaging investigations. DESIGN Cross-sectional nationwide multicentre study. SETTING French training general practices. PARTICIPANTS The patient sample included all the voluntary patients over a cumulative period of 5 days per office between November 2011 and April 2012. The GP sample included 85 males and 43 females. METHODS 54 interns in general practice, observing their GP supervisors, collected data about the characteristics of GPs and consultations, as well as the health problems managed during the visit and the processes of care associated with them. Using hierarchical multilevel mixed-effect logistic regression models, we performed multivariable analyses to assess differences in each of the three main categories of diagnostic procedures, and two specific multivariable analyses for each category, distinguishing screening from diagnostic or follow-up procedures. We searched for interactions between GP gender and patient gender or type of health problem managed. RESULTS This analysis of 45 582 health problems managed in 20 613 consultations showed that female GPs performed more clinical examinations than male GPs, both for screening (OR 1.75; 95% CI 1.19 to 2.58) and for diagnostic or follow-up purposes (OR 1.41; 95% CI 1.08 to 1.84). Female GPs also ordered laboratory tests for diagnostic or follow-up purposes more frequently (OR 1.21; 95% CI 1.03 to 1.43). Female GPs performed even more clinical examinations than male GPs to diagnose or follow-up injuries (OR 1.69; 95% CI 1.19 to 2.40). CONCLUSION Further research on the appropriateness of diagnostic procedures is required to determine to what extent these differences are related to underuse or overuse.
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Affiliation(s)
- Amandine Bouissiere
- Collège universitaire de médecine générale, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Marine Laperrouse
- Collège universitaire de médecine générale, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Henri Panjo
- INSERM CESP, Université Paris-Saclay, Saint-Aubin, France
- Unité Santé et droits sexuels et reproductifs, INED, Paris, France
| | - Virginie Ringa
- INSERM CESP, Université Paris-Saclay, Saint-Aubin, France
- Unité Santé et droits sexuels et reproductifs, INED, Paris, France
| | - Laurent Rigal
- INSERM CESP, Université Paris-Saclay, Saint-Aubin, France
- Unité Santé et droits sexuels et reproductifs, INED, Paris, France
| | - Laurent Letrilliart
- Collège universitaire de médecine générale, Université Claude Bernard Lyon 1, Villeurbanne, France
- Research on Healthcare Performance (RESHAPE), INSERM, Lyon, France
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6
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Sayon-Orea C, Carlos S, Rico-Campà A, Fernández-Montero A, de la Fuente-Arrillaga C, Toledo E, Kales S, Martínez-González MA. Physicians' characteristics and practices associated with the provision of cancer screening advice to their patients: the Spanish SUN cohort study. BMJ Open 2022; 12:e048498. [PMID: 35022167 PMCID: PMC8756273 DOI: 10.1136/bmjopen-2020-048498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To evaluate the association between cancer screening counselling provided by medical doctors to their patients and each doctor's own anthropometrics, lifestyle, cancer screening practices, and personal and family history of cancer. DESIGN Prospective cohort study. SETTING Substudy including physicians participating in a Spanish cohort study with open enrolment. PARTICIPANTS Among 22 800 participants in the cohort as of May 2018, there were 2371 physicians who had replied to the cohort baseline questionnaire, had an email account and were younger than 65 years (retirement age in Spain). From this subsample, 890 replied to an online questionnaire focused on their clinical practices related to the counselling provided to their patients and to their prescription practices of preventive medications. Their mean age was 51.7 (SD 9.4) years and 48% were women. OUTCOME MEASURES Frequency of counselling given to their patients on specific practices of breast, colorectal and prostate cancer screenings. RESULTS Counselling on cancer screening to their patients was provided by 65% of physicians in a scenario of colorectal cancer, 59% for prostate cancer and 58% for breast cancer. More frequent cancer screening counselling was associated with the specialties of family medicine (OR=9.4, 95% CI 5.1 to 17.1) and internal medicine (OR=2.9, 95% CI 1.5 to 5.7) as compared with other specialties. Recommending cancer screening was associated with more frequent counselling on smoking cessation (OR=3.7, 95% CI 2.6 to 5.4), having personally attended colorectal cancer screening (OR=2.2, 95% CI 1.1 to 4.7) and prescribing blood pressure medication more often than their colleagues (OR=2.1, 95% CI 1.2 to 3.7). CONCLUSIONS Among medical doctors, cancer screening counselling was provided to their patients more frequently for doctors with family medicine or internal medicine specialties and for physicians who regularly offered counselling on certain lifestyle behaviours, and those having personally attended colorectal cancer screening. Doctors' own personal practices and knowledge of healthy lifestyles may help doctors to more frequently provide counselling on cancer screening to their patients.
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Affiliation(s)
- Carmen Sayon-Orea
- Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra, IdiSNA, Pamplona, Spain
| | - Silvia Carlos
- Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra, IdiSNA, Pamplona, Spain
| | - Anaïs Rico-Campà
- Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
| | - Alejandro Fernández-Montero
- Instituto de Investigación Sanitaria de Navarra, IdiSNA, Pamplona, Spain
- Occupational Medicine, University of Navarra, Pamplona, Navarra, Spain
| | - Carmen de la Fuente-Arrillaga
- Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra, IdiSNA, Pamplona, Spain
| | - Estefanía Toledo
- Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra, IdiSNA, Pamplona, Spain
| | - Stefanos Kales
- Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Miguel Angel Martínez-González
- Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra, IdiSNA, Pamplona, Spain
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Lofters AK, Baker NA, Corrado AM, Schuler A, Rau A, Baxter NN, Leung FH, Weyman K, Kiran T. Care in the Community: Opportunities to improve cancer screening uptake for people living with low income. Prev Med Rep 2022; 24:101622. [PMID: 34976677 PMCID: PMC8684029 DOI: 10.1016/j.pmedr.2021.101622] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/11/2021] [Accepted: 10/23/2021] [Indexed: 11/16/2022] Open
Abstract
Despite organized provincial cancer screening programs, people living with low income consistently have lower rates of screening in Ontario, Canada than their more socioeconomically advantaged peers. We previously published results of a two-phase, exploratory qualitative study involving both interviews and focus groups whose objective was to integrate knowledge of people living with low income on how to improve primary care strategies aimed at increasing cancer screening uptake. In the current paper, we report previously unpublished findings from that study that identify how taking a community outreach approach in primary care may lead to increased cancer screening uptake among people living with low income. Participants told us that they saw value in a community outreach approach to cancer screening. They recommended specific actionable approaches, in particular, mobile community-based screening and community information sessions, and recommended taking an ethno-specific lens depending on the communities being targeted. Participants expressed a desire for primary care providers to go out into the community to learn more about the whole patient, such as could be achieved with home visits, but they simultaneously believed that this may be challenging in urban settings and in the context of perceived physician shortages. Models of primary care that provide support to an entire local community and provide some of their services directly in that community may have a meaningful impact on cancer screening for socially marginalized groups.
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Affiliation(s)
- Aisha K Lofters
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, ON M5S 2B1, Canada.,MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada.,Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada.,ICES, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.,Dalla Lana School of Public Health, 155 College Street, Health Science Building 6th floor, Toronto, ON M5T 3M7, Canada.,Ontario Health (Cancer Care Ontario), 620 University Avenue, Toronto, ON M5G 2L7, Canada
| | - Natalie Alex Baker
- Dalla Lana School of Public Health, 155 College Street, Health Science Building 6th floor, Toronto, ON M5T 3M7, Canada.,Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada
| | - Ann Marie Corrado
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, ON M5S 2B1, Canada
| | - Andree Schuler
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada
| | - Allison Rau
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada
| | - Nancy N Baxter
- Melbourne School of Population and Global Health, University of Melbourne, Australia.,Department of Surgery, University of Toronto, Toronto, ON M5B 1W8, Canada.,Institute of Health Policy, Management and Evaluation, 155 College Street, Health Science Building 6th floor, Toronto, ON M5T 3M6, Canada
| | - Fok-Han Leung
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada
| | - Karen Weyman
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada
| | - Tara Kiran
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada.,Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada.,ICES, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada.,Institute of Health Policy, Management and Evaluation, 155 College Street, Health Science Building 6th floor, Toronto, ON M5T 3M6, Canada
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8
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Lofters AK, Gatov E, Lu H, Baxter NN, Corrado AM, Guilcher SJT, Kopp A, Vahabi M, Datta GD. Stage of colorectal cancer diagnosis for immigrants: a population-based retrospective cohort study in Ontario, Canada. Cancer Causes Control 2021; 32:1433-1446. [PMID: 34463874 PMCID: PMC8541965 DOI: 10.1007/s10552-021-01491-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/20/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) is the second most common cause of cancer death in Canada. Immigrants in Ontario, Canada's most populous province, are known to have lower rates of CRC screening, but differences in stage of CRC diagnosis are not known. METHODS We utilized linked administrative databases to compare early (stage I-II) versus late (stage III-IV) stage of CRC diagnosis for immigrants versus long-term residents among patients diagnosed in Ontario between 2012 and 2017 (n = 37,717) and examined the association of immigration-related, sociodemographic, and healthcare-related factors with stage. RESULTS Almost 45% of those with CRC were diagnosed at a late stage. Immigrants were slightly more likely to be diagnosed at a late stage than their long-term resident counterparts [Adjusted relative risks (ARRs) 1.06 (95% CI 1.02-1.10)], but after adjusting for age and sex, this difference was no longer significant. In fully adjusted models, we observed a higher likelihood of late-stage diagnosis for people with the fewest co-morbidities (ARR 0.86 [95% CI 0.83-0.89]) and those with no visits to primary care (versus a high level of continuity of care) [ARR 1.07 (95% CI 1.03-1.12)]. CONCLUSION Immigrants were not more likely to have a late-stage CRC diagnosis after adjusting for relevant factors, but access to primary care and healthcare contact was significantly associated with diagnostic stage. IMPACT Attachment to a primary care provider who provides regular preventive care may play a role in more favorable stage at diagnosis for CRC and thus should be a healthcare system priority.
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Affiliation(s)
- A K Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
- Women's College Hospital Research Institute, Toronto, Canada.
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, 76 Grenville St., Toronto, ON, M5S 1B2, Canada.
- ICES, Toronto, Canada.
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada.
| | | | | | - N N Baxter
- ICES, Toronto, Canada
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - A M Corrado
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, 76 Grenville St., Toronto, ON, M5S 1B2, Canada
| | - S J T Guilcher
- ICES, Toronto, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | | | - M Vahabi
- ICES, Toronto, Canada
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Canada
| | - G D Datta
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, Canada
- Research Center of the University of Montreal Hospital Center (CR-CHUM), Montreal, Canada
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9
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Rollet Q, Tron L, De Mil R, Launoy G, Guillaume É. Contextual factors associated with cancer screening uptake: A systematic review of observational studies. Prev Med 2021; 150:106692. [PMID: 34166675 DOI: 10.1016/j.ypmed.2021.106692] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 05/19/2021] [Accepted: 06/17/2021] [Indexed: 12/13/2022]
Abstract
We conducted a systematic review of a wide range of contextual factors related to cancer screening uptake that have been studied so far. Studies were identified through PubMed and Web of Science databases. An operational definition of context was proposed, considering as contextual factors: social relations directly aimed at cancer screening, health care provider and facility characteristics, geographical/accessibility measures and aggregated measures at supra-individual level. We included 70 publications on breast, cervical and/or colorectal cancer screening from 42 countries, covering a data period of 24 years. A wide diversity of factors has been investigated in the literature so far. While several of them, as well as many interactions, were robustly associated with screening uptake (family, friends or provider recommendation, provider sex and experience, area-based socio-economic status…), others showed less consistency (ethnicity, urbanicity, travel time, healthcare density …). Screening inequities were not fully explained through adjustment for individual and contextual factors. Context, in its diversity, influences individual screening uptake and lots of contextual inequities in screening are commonly shared worldwide. However, there is a lack of frameworks, standards and definitions that are needed to better understand what context is, how it could modify individual behaviour and the ways of measuring and modifying it.
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Affiliation(s)
- Quentin Rollet
- U1086 "ANTICIPE" INSERM-University of Caen Normandie, Centre François Baclesse: 3, Avenue du Général Harris, 14000 Caen, France.
| | - Laure Tron
- U1086 "ANTICIPE" INSERM-University of Caen Normandie, Centre François Baclesse: 3, Avenue du Général Harris, 14000 Caen, France
| | - Rémy De Mil
- U1086 "ANTICIPE" INSERM-University of Caen Normandie, Centre François Baclesse: 3, Avenue du Général Harris, 14000 Caen, France
| | - Guy Launoy
- U1086 "ANTICIPE" INSERM-University of Caen Normandie, Centre François Baclesse: 3, Avenue du Général Harris, 14000 Caen, France
| | - Élodie Guillaume
- U1086 "ANTICIPE" INSERM-University of Caen Normandie, Centre François Baclesse: 3, Avenue du Général Harris, 14000 Caen, France
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10
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Understanding the Acceptability and Uptake of HPV Self-Sampling Amongst Women Under- or Never-Screened for Cervical Cancer in Toronto (Ontario, Canada): An Intervention Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179114. [PMID: 34501703 PMCID: PMC8430523 DOI: 10.3390/ijerph18179114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/16/2021] [Accepted: 08/20/2021] [Indexed: 11/21/2022]
Abstract
Cervical cancer remains a global public health concern, even though scientific advancements have made the disease almost entirely preventable. With the link between human papillomavirus (HPV) and cervical cancer, and the subsequent improvement in screening technology, there is potential to improve access and coverage of cervical screening with the introduction of HPV self-sampling. In Ontario, Canada, a province with a cytology-based screening program (i.e., Pap test), women who identify as South Asian, West Asian, Middle Eastern and North African have some of the lowest rates of screening, and research suggests they have a higher burden of cervical cancer. In this study, we will use both quantitative and qualitative methods to understand the acceptability and uptake of a take-home HPV self-sampling kit. Working with community champions—people with pre-existing connections with local groups—we will recruit women from these groups who are under- or never-screened for cervical cancer. Women will self-select whether they are in the group that tries HPV self-sampling or in the group that does not. We will aim for 100 women in each group. All participants will provide feedback on the feasibility, acceptability and preferences for cervical screening through a survey and phone follow-up. Women who self-select the HPV self-sampling group, will be followed up to find out if they followed through with self-sampling and to understand their experience using the device. Women who do not want to try self-sampling will be followed up to see if they went on to get a Pap test. The qualitative phase of this study consists of five focus groups with participants and semi-structured interviews with key informants in the community.
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11
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Alam Z, Shafiee Hanjani L, Dean J, Janda M. Cervical Cancer Screening Among Immigrant Women Residing in Australia: A Systematic Review. Asia Pac J Public Health 2021; 33:816-827. [PMID: 33829888 DOI: 10.1177/10105395211006600] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Since the introduction of systematic population-based cervical cancer screening in Australia in 1991, age-standardized incidence of cervical cancer has halved. Given recent advances in human papillomavirus (HPV) vaccination and screening, cervical cancer may be eliminated nationally within 20 years. However, immigrant women are not equitably reached by screening efforts. This study systematically reviewed evidence on cervical cancer screening practices among immigrant women in Australia. A systematic search of MEDLINE, Embase, PubMed, CINAHL, and PsycINFO and gray literature for English language studies published till March 1, 2019, was conducted. Observational and qualitative studies evaluating cervical cancer screening awareness and participation of immigrant women were screened. Of 125 potentially relevant studies, 25 were eligible: 16 quantitative (4 cohort, 12 cross-sectional), 6 qualitative, and 3 mixed-methods studies. Quantitative studies indicated 1% to 16% lower screening rates among migrant women compared with Australian-born women, with participation of South Asian women being significantly lower (odds ratio = 0.54, 95% confidence interval = 0.48-0.61). Qualitative studies illustrated factors affecting women's willingness to participate in screening, including insufficient knowledge, low-risk perception, and unavailability of a female health professionals being key barriers. Future studies should focus on South Asian women, due to recent increase in their immigration.
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Affiliation(s)
- Zufishan Alam
- The University of Queensland, Woolloongabba, Queensland, Australia
| | | | - Judith Dean
- The University of Queensland, Herston, Queensland, Australia
| | - Monika Janda
- The University of Queensland, Woolloongabba, Queensland, Australia
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12
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Malone C, Buist DSM, Tiro J, Barlow W, Gao H, Lin J, Winer RL. Out of reach? Correlates of cervical cancer underscreening in women with varying levels of healthcare interactions in a United States integrated delivery system. Prev Med 2021; 145:106410. [PMID: 33388329 PMCID: PMC7956225 DOI: 10.1016/j.ypmed.2020.106410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/22/2020] [Accepted: 12/28/2020] [Indexed: 01/14/2023]
Abstract
One in five U.S. women with health insurance are underscreened for cervical cancer. We sought to identify whether underscreening correlates differed among women with different levels of health care interaction. Among women age 30-64 years who were members of an integrated U.S. health system, we used 2014-2015 electronic health record data to identify underscreened cases (≥3.4 years since last Papanicolaou (Pap) test, n=3352) and screening-adherent controls (<3.4 years since last Pap test, n=45,359) and extracted data on potential underscreening correlates (demographics, health history, and healthcare utilization). We calculated the odds of underscreening in the total population and by subgroups defined by healthcare visits and online health portal usage in the prior 12 months. Underscreening was associated with older age (50-64 vs. 30-39; odds ratio (OR)=1.6; 95%CI=1.4-1.8), current tobacco use (vs. never use; OR=2.1; 95%CI=1.8-2.2), higher BMI (≥35 kg/m2 vs <25 kg/m2, OR=2.0; 95%CI=1.8-2.3), screening non-adherence for colorectal cancer (OR=5.1; 95%CI=4.6-5.7) and breast cancer (OR=8.1, 95%CI=7.2-9.0), and having no recent visit with their primary care provider (PCP) nor recent health portal use (vs. recent PCP visit and portal use; OR=8.4, 95%CI=7.6-9.4). Underscreening correlates were similar between the total study population and within all healthcare interaction groups. Interaction with the healthcare system is associated with lower odds of underscreening, but sociodemographic and health status correlates are similar regardless of primary care visits or online portal use. These data support the need for additional interventions to reach insured women who remain underscreened for cervical cancer.
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Affiliation(s)
- Colin Malone
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Diana S M Buist
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Jasmin Tiro
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - William Barlow
- SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Hongyuan Gao
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - John Lin
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Rachel L Winer
- Department of Epidemiology, University of Washington, Seattle, WA, USA; Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
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13
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Sayani A, Vahabi M, O'Brien MA, Liu G, Hwang SW, Selby P, Nicholson E, Lofters A. Perspectives of family physicians towards access to lung cancer screening for individuals living with low income - a qualitative study. BMC FAMILY PRACTICE 2021; 22:10. [PMID: 33413135 PMCID: PMC7791696 DOI: 10.1186/s12875-020-01354-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/16/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Individuals living with low income are less likely to participate in lung cancer screening (LCS) with low-dose computed tomography. Family physicians (FPs) are typically responsible for referring eligible patients to LCS; therefore, we sought to understand their perspectives on access to lung cancer screening for individuals living with low income in order to improve equity in access to LCS. METHODS A theory-informed thematic analysis was conducted using data collected from 11 semi-structured interviews with FPs recruited from three primary care sites in downtown Toronto. Data was coded using the Systems Model of Clinical Preventative Care as a framework and interpretation was guided by the synergies of oppression analytical lens. RESULTS Four overarching themes describe FP perspectives on access to LCS for individuals living with low income: the degree of social disadvantage that influences lung cancer risk and opportunities to access care; the clinical encounter, where there is often a mismatch between the complex health needs of low income individuals and structure of health care appointments; the need for equity-oriented health care, illustrated by the neglect of structural origins of health risk and the benefits of a trauma-informed approach; and finally, the multiprong strategies that will be needed in order to improve equity in health outcomes. CONCLUSION An equity-oriented and interdisciplinary team based approach to care will be needed in order to improve access to LCS, and attention must be given to the upstream determinants of lung cancer in order to reduce lung cancer risk.
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Affiliation(s)
- Ambreen Sayani
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
| | - Mandana Vahabi
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Mary Ann O'Brien
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Geoffrey Liu
- Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter Selby
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Erika Nicholson
- Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Aisha Lofters
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Department of Family Medicine, Women's College Hospital, Toronto, Ontario, Canada
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14
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Delpech R, Bloy G, Panjo H, Falcoff H, Ringa V, Rigal L. Physicians' preventive practices: more frequently performed for male patients and by female physicians. BMC Health Serv Res 2020; 20:331. [PMID: 32312327 PMCID: PMC7168941 DOI: 10.1186/s12913-020-05136-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 03/20/2020] [Indexed: 01/01/2023] Open
Abstract
Background We sought to analyze gender differences in General Practitioners’ (GP) preventive practices: variations according to the GP’s and the patient’s genders, separately and combined, and the homogeneity of GPs’ practices according to gender. Methods Fifty-two general practitioners volunteered to participate in a cross-sectional study. A sample of 70 patients (stratified by gender) aged 40–70 years was randomly chosen from each GP’s patient panel. Information extracted from the medical files was used to describe the GPs’ preventive practices for each patient: measurements of weight, waist circumference, glucose, and cholesterol; inquiry and counseling about smoking, alcohol consumption, diet, and physical activity, and dates of cervical smears and mammographies. An aggregate preventive score was calculated to assess the percentage of these practices performed by each GP for patients overall and by gender. Mixed models were used to test for gender differences. Results Questionnaires were collected in 2008–2009 for 71% of the 3640 patients and analyzed in June 2017. Male patients and female GPs were associated with the most frequent performance of many types of preventive care. The aggregate preventive score was higher for male patients (OR = 1.60, 95% CI 1.47–1.75) and female GPs (OR = 1.35, 95% CI 1.05–1.73). There was no combined effect of the genders of the two protagonists. Female patients of male GPs appeared to receive preventive care least frequently and female GPs to deliver preventive care more consistently than their male colleagues. Conclusion Physicians need to be aware of these differences, for both patient gender and their own.
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Affiliation(s)
- Raphaëlle Delpech
- General Practice Department, Université Paris-Saclay, Le Kremlin Bicêtre, France.
| | - Géraldine Bloy
- LEDi, EA 7467, University of Burgundy Franche-Comté, Dijon, France
| | - Henri Panjo
- CESP, INSERM, Paris-Saclay University, Paris-Sud University, UVSQ, Villejuif, France.,Institut National d'Études Démographiques (INED), Paris, France
| | - Hector Falcoff
- Société de Formation Thérapeutique du Généraliste, Paris, France
| | - Virginie Ringa
- CESP, INSERM, Paris-Saclay University, Paris-Sud University, UVSQ, Villejuif, France.,Institut National d'Études Démographiques (INED), Paris, France
| | - Laurent Rigal
- General Practice Department, Université Paris-Saclay, Le Kremlin Bicêtre, France.,CESP, INSERM, Paris-Saclay University, Paris-Sud University, UVSQ, Villejuif, France.,Institut National d'Études Démographiques (INED), Paris, France
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15
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Litwin O, Sontrop JM, McArthur E, Tinmouth J, Rabeneck L, Vinden C, Sood MM, Baxter NN, Tanuseputro P, Welk B, Garg AX. Uptake of Colorectal Cancer Screening by Physicians Is Associated With Greater Uptake by Their Patients. Gastroenterology 2020; 158:905-914. [PMID: 31682852 DOI: 10.1053/j.gastro.2019.10.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 09/30/2019] [Accepted: 10/10/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND & AIMS Physicians' own screening practices might affect screening in their patients. We conducted a population-based study to evaluate whether family physicians who underwent colorectal cancer testing were more likely to have patients who underwent colorectal cancer testing. METHODS We collected demographic and health care information on residents of Ontario, Canada from administrative databases; the sample was restricted to individuals at average risk of colorectal cancer who were 52-74 years old as of April 21, 2016. We obtained a list of all registered physicians in the province; physicians (n = 11,434) were matched with nonphysicians (n = 45,736) on age, sex, and residential location. Uptake of colorectal tests was defined by a record of a fecal occult blood test in the past 2 years, flexible sigmoidoscopy in the past 5 years, or colonoscopy in the past 10 years. Patients were assigned to family physicians based on billing claim frequency, and then the association between colorectal testing in family physicians and their patients was examined using a modified Poisson regression model. RESULTS Uptake of colorectal tests by physicians and nonphysicians (median age 60 years; 71% men) was 67.9% (95% confidence interval [CI], 67.0%-68.7%) and 66.6% (95% CI, 66.2%-67.1%), respectively. Physicians were less likely than nonphysicians to undergo fecal occult blood testing and were more likely to undergo colonoscopy; prevalence ratios were 0.44 (95% CI, 0.42-0.47) and 1.24 (95% CI, 1.22-1.26), respectively. Uptake of colorectal tests by family physicians was associated with greater uptake by their patients (adjusted prevalence ratio, 1.10; 95% CI, 1.08-1.12). CONCLUSIONS Approximately one-third of physicians and nonphysicians are overdue for colorectal cancer screening. Patients are more likely to be tested if their family physician has been tested. There is an opportunity for physicians to increase their participation in colorectal cancer screening, which could, in turn, motivate their patients to undergo screening.
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Affiliation(s)
- Owen Litwin
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Jessica M Sontrop
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; ICES Toronto, Ontario, Canada
| | | | - Jill Tinmouth
- ICES Toronto, Ontario, Canada; Cancer Care Ontario, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Public Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Linda Rabeneck
- ICES Toronto, Ontario, Canada; Cancer Care Ontario, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Public Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Christopher Vinden
- ICES Toronto, Ontario, Canada; Division of General Surgery, Department of Surgery, Western University, London, Ontario, Canada
| | - Manish M Sood
- ICES Toronto, Ontario, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Nancy N Baxter
- ICES Toronto, Ontario, Canada; Cancer Care Ontario, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Public Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Peter Tanuseputro
- ICES Toronto, Ontario, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Blayne Welk
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; ICES Toronto, Ontario, Canada; Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - Amit X Garg
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; ICES Toronto, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada.
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16
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Crawford J, Morfaw F, Ahmad F, Thabane L, Frisina A. The colon cancer screening behaviours survey for South Asians: a pilot study of feasibility and psychometric evaluation. J Patient Rep Outcomes 2020; 4:12. [PMID: 32056042 PMCID: PMC7064674 DOI: 10.1186/s41687-019-0160-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/08/2019] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The purpose of the study was to pilot test the English and Urdu version of the Colon Cancer Screening Behaviours Survey among South Asians in Canada. The first objective was to evaluate feasibility of administration, data collection using computer assisted personal interviewing software on a tablet, and response burden. The second objective was to examine the prevalence of colorectal cancer screening among South Asians and evaluate the psychometric properties of sub-scales in the survey. METHODS Purposive, network and snowball sampling were used to recruit participants for this cross-sectional study. Interviewer-led administration of the Colon Cancer Screening Behaviours Survey was conducted across two cities in Ontario, Canada. Qualitative data analysis assessed feasibility; and sub-scales were evaluated through principal component analysis, item-scale correlations, and construct validity using multiple linear and logistic regression. RESULTS A total of 328 South Asians participated, 47% Urdu speaking, and 53% English speaking. There was a 23% refusal rate to participate. Feasibility identified: (1) successful recruitment despite reasons for refusal; (2) problematic items and response categories; and (3) computer/tablet limitations. Principal component analysis identified 14 components that explained 68.7% of total variance; 34 items were retained after factor analysis. Internal consistency of 4 scales ranged from 0.79-0.91. There were significant differences in perceived barriers scale scores (- 12.21; 95% CI, - 17.13 to - 7.28; p < 0.0001) between those who participated and those who did not participate in screening. No association was found with years of residence and uptake of screening after adjustment (OR 0.91 (0.46-1.79), p = 0.783). CONCLUSIONS Recruitment and data collection methods are feasible among South Asians if functionality of the tablet selected is improved. The Colon Cancer Screening Behaviours Survey was finalized and retained items in sub-scales demonstrated good psychometric properties to assess behaviours for colon cancer screening among South Asians in Canada. The interviewer-led survey may be used by public health, cancer care or other health practitioners to describe or predict colorectal cancer screening behaviours among South Asians in similar settings or adapted and tested in other contexts.
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Affiliation(s)
- Joanne Crawford
- Faculty of Applied Health Sciences, Department of Nursing, Brock University, St. Catharines, 1812 Sir Isaac Brock Way, St. Catharines, ON L2S 3A1 Canada
| | - Frederick Morfaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON Canada
| | - Farah Ahmad
- School of Health Policy & Management, York University, Toronto, ON Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON Canada
| | - Angela Frisina
- School of Nursing, McMaster University, Hamilton, ON Canada
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17
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Lofters AK, Baker NA, Schuler A, Rau A, Baxter A, Baxter NN, Kucharski E, Leung FH, Weyman K, Kiran T. A "Tea and Cookies" Approach: Co-designing Cancer Screening Interventions with Patients Living with Low Income. J Gen Intern Med 2020; 35:255-260. [PMID: 31637642 PMCID: PMC6957607 DOI: 10.1007/s11606-019-05400-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 08/16/2019] [Accepted: 09/03/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND In our primary care organization, we have observed income gradients in cancer screening for our patients despite outreach. We hypothesized that outreach strategies could be improved upon to be more compelling for our patients living with low income. OBJECTIVE To use co-design to adapt our current strategies and create new strategies to improve cancer screening uptake for patients living with low income. DESIGN An exploratory, qualitative study in two phases: interviews and focus groups. PARTICIPANTS For interviews, we recruited 25 patient participants who were or had been overdue for cancer screening and had been identified by their provider as potentially living with low income. For subsequent focus groups, we recruited 14 patient participants, 11 of whom had participated in Phase I interviews. APPROACH To analyse written transcripts, we took an iterative, inductive approach using content analysis and drawing on best practices in Grounded Theory methodology. Emergent themes were expanded and clarified to create a derived model of possible strategies to improve the experience of cancer screening and encourage screening uptake for patients living with low income. KEY RESULTS Fear and competing priorities were two key barriers to cancer screening identified by patients. Patients believed that a warm and encouraging outreach approach would work best to increase cancer screening participation. Phone calls and group education were specifically suggested as potentially promising methods. However, these views were not universal; for example, women were more likely to be in favour of group education. CONCLUSIONS We used input from patients living with low income to co-design a new approach to cancer screening in our primary care organization, an approach that could be broadly applicable to other contexts and settings. We learned from our patients that a multi-modal strategy will likely be best to maximize screening uptake.
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Affiliation(s)
- Aisha K Lofters
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
- Department of Family and Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
- ICES, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
- Dalla Lana School of Public Health, 155 College Street, Health Science Building 6th floor, Toronto, Ontario, M5T 3M7, Canada.
- Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada.
| | - Natalie A Baker
- Dalla Lana School of Public Health, 155 College Street, Health Science Building 6th floor, Toronto, Ontario, M5T 3M7, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Andree Schuler
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Allison Rau
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Alison Baxter
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Nancy N Baxter
- ICES, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
- Dalla Lana School of Public Health, 155 College Street, Health Science Building 6th floor, Toronto, Ontario, M5T 3M7, Canada
- Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Edward Kucharski
- Cancer Care Ontario, 620 University Avenue, Toronto, ON, M5G 2L7, Canada
| | - Fok-Han Leung
- Department of Family and Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Karen Weyman
- Department of Family and Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Tara Kiran
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
- ICES, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
- Health Quality Ontario, 130 Bloor Street W, Toronto, ON, M5S 1N5, Canada
- Institute of Health Policy, Management and Evaluation, 4th Floor, 155 College St, Toronto, ON, M5T 3M6, Canada
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Associations between area-level deprivation, rural residence, physician density, screening policy and late-stage colorectal cancer in Canada. Cancer Epidemiol 2019; 64:101654. [PMID: 31837534 DOI: 10.1016/j.canep.2019.101654] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 10/11/2019] [Accepted: 11/25/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Important social disparities in colorectal screening exist in Canada. Few studies have assessed disparities further along the cancer control continuum. Here we assess the associations between social and material deprivation, physician density, rural residence, and the absence of provincial mail-based screening programs and colorectal cancer (CRC) stage at diagnosis. METHODS Colorectal cancer cases and stage data ("local or regional" if stage 0, I, or II, "late" if stage III or IV) were obtained through the Canadian Cancer Registry (2011-2015, N = 54,745). Cases were linked to 2006 Canadian Census Dissemination Area-level data on rural/urban status, exposure to a provincial mail-based screening program, and social and material deprivation (Pampalon Index quintile groups); and to Scott's Medical Database 2011 physician density data (<7 vs. ≥ 7/10,000). Age, sex, and predictor-adjusted Generalized estimating equation (GEE) Poisson models were used to determine independent associations between predictors and late-stage at diagnosis. RESULTS Half of CRC cases are diagnosed at stage III or IV (51 %), with younger age groups experiencing higher late-stage prevalence (57 % among those aged 18-49). The covariate-adjusted late-stage prevalence was 2-percentage points higher in most materially- and socially-deprived areas (95 % CI: 1 %, 4 %, in both, respectively) and in provinces with no mail-based screening programs (95 % CI: 1 %, 2 %). No significant differences were observed according to rural residence or physician density. CONCLUSIONS Social disparities in late-stage CRC diagnosis are modest. Continued surveillance of these disparities may be warranted as provinces continue to promote early cancer detection through screening, and stage distributions may change overtime.
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Lofters AK, Kopp A, Vahabi M, Glazier RH. Understanding those overdue for cancer screening by five years or more: A retrospective cohort study in Ontario, Canada. Prev Med 2019; 129:105816. [PMID: 31445111 DOI: 10.1016/j.ypmed.2019.105816] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/23/2019] [Accepted: 08/20/2019] [Indexed: 01/21/2023]
Abstract
Populations that are more than just slightly overdue for breast, cervical and colorectal screening should likely be targeted for policy and practice interventions. We used provincial-level administrative data to describe the Ontario population who are screen-eligible for breast, cervical and colorectal cancers but overdue by at least five years. For each cancer screening type, we created three cohorts and a binary outcome: screened at least once in the previous five years or not, using March 31, 2017 as our index date. We conducted simple descriptive analyses as well as multivariable logistic regression, where age category, immigrant status, neighbourhood income quintile, region, urban/suburban/rural status, primary care model type, and healthcare utilization were included in the models. More than 20% of Ontarians eligible for each of breast, cervical and colorectal cancer screening respectively had no history of screening in the previous five years. In multivariable analyses, people were significantly more likely to have no recent screening history if they lived in lower-income neighbourhoods (e.g. adjusted odds ratio [95% confidence interval]: 0.59 [0.58-0.59] for cervical screening), were recent immigrants, did not have a primary care provider, had a provider who practiced in a traditional fee-for-service model. Despite the presence of three provincial organized screening programs, we have found that more than one-fifth of Ontarians who are eligible for each of breast, cervical and colorectal screening respectively have not been screened for five years or more. Ensuring that all Ontarians have access to high-quality primary care, may be crucial to increasing screening uptake.
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Affiliation(s)
- Aisha K Lofters
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Dalla Lana School of Public Health, Toronto, ON, Canada.
| | | | - Mandana Vahabi
- ICES, Toronto, ON, Canada; Daphne Cockwell School of Nursing, Ryerson University, Toronto, Canada
| | - Richard H Glazier
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Dalla Lana School of Public Health, Toronto, ON, Canada
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20
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Vahabi M, Lofters A, Wong JPH, Ellison L, Graves E, Damba C, Glazier RH. Fecal occult blood test screening uptake among immigrants from Muslim majority countries: A retrospective cohort study in Ontario, Canada. Cancer Med 2019; 8:7108-7122. [PMID: 31568705 PMCID: PMC6853827 DOI: 10.1002/cam4.2541] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 11/18/2022] Open
Abstract
Background Colorectal cancer (CRC) is the second and third highest cause of cancer deaths among Canadian men and women, respectively. Population‐based screening through fecal occult blood testing (FOBT) has been proven to be effective in reducing CRC morbidity and mortality. Although participation in Ontario's organized CRC screening program has been increasing steadily since 2008, its uptake remains low among recent immigrant populations despite the known benefits of screening. To promote participation in CRC screening, it is imperative to understand both individual and system level barriers and enablers. Although a number of immigrant and nonimmigrant factors have been associated with low participation, there is a dearth of knowledge related to the religious affiliation in CRC screening uptake. Our study is among the first to examine this issue in Ontario, one of the most ethnically diverse Canadian provinces and preferred settlement destinations for immigrants. Methods We conducted a population‐based retrospective cohort study using linked health care administrative databases. Our cohort included Ontario residents, age 50‐74 who were eligible for FOBT from 1 April 2013 to 31 March 2015. Results We found that immigrants from the Middle East and North Africa and Eastern Europe and Central Asia had the lowest rates of screening. Furthermore, being born in a Muslim‐majority country was associated with lower FOBT screening even after controlling for other confounders including world region and income (ie, overall adjusted relative risk (ARR) of screening 0.92 [95% CI 0.90‐0.93]). Moreover, being enrolled in a primary care model, having a female primary care provider and having an internationally trained physician were associated with increased screening among immigrants from Muslim‐majority countries. Conclusions These findings can inform future efforts to improve screening uptake like: enhancing access to primary care providers and enrollment in primary care models, targeted FOBT education for male providers and providers not in a primary care model, development of culturally sensitive and appropriate educational materials, and use of interactive approaches for communication of cancer screening information.
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Affiliation(s)
- Mandana Vahabi
- Faculty of Community Services, Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada.,Graduate Program in Immigration and Settlement Studies, Ryerson University, Toronto, ON, Canada.,Ryerson Centre for Global Health and Health Equity, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Aisha Lofters
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, St. Michael Hospital, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Josephine Pui-Hing Wong
- Faculty of Community Services, Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Lisa Ellison
- Department of Family and Community Medicine, St. Michael Hospital, Toronto, ON, Canada
| | - Erin Graves
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Cynthia Damba
- Toronto Central Local Health Integration, Toronto, ON, Canada
| | - Richard H Glazier
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, St. Michael Hospital, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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21
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Zechmann S, Di Gangi S, Kaplan V, Meier R, Rosemann T, Valeri F, Senn O. Time trends in prostate cancer screening in Swiss primary care (2010 to 2017) - A retrospective study. PLoS One 2019; 14:e0217879. [PMID: 31194773 PMCID: PMC6565361 DOI: 10.1371/journal.pone.0217879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 05/20/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction Following years of controversy regarding screening for prostate cancer using prostate-specific antigen, evidence evolves towards a more restrained and preference-based use. This study reports the impact of landmark trials and updated recommendations on the incidence rate of prostate cancer screening by Swiss general practitioners. Methods We performed a retrospective analysis of primary care data, separated in 3 time periods based on dates of publications of important prostate-specific antigen screening recommendations. 1: 2010-mid 2012 including 2 updates; 2: mid 2012-mid 2014 including a Smarter Medicine recommendation; 3: mid-2014—mid-2017 maintenance period. Period 2 including the Smarter Medicine recommendation was defined as reference period. We further assessed the influence of patient’s age and the number of prostate-specific-antigen (PSA) tests, by the patient and within each time period, on the mean PSA concentration. Uni- and multivariable analyses were used as needed. Results 36,800 men aged 55 to 75 years were included. 14.6% had ≥ 2 chronic conditions, 11.7% had ≥ 1 prostate-specific antigen test, (mean 2.60 ng/ml [SD 12.3]). 113,921 patient-years were covered. Data derived from 221 general practitioners, 33.5% of GP were women, mean age was 49.4 years (SD 10.0), 67.9% used prostate-specific antigen testing. Adjusted incidence rate-ratio (95%-CI) dropped significantly over time periods: Reference Period 2: incidence rate-ratio 1.00; Period 1: incidence rate-ratio 1.74 (1.59–1.90); Period 3: incidence rate-ratio 0.61 (0.56–0.67). A higher number of chronic conditions and a patient age between 60–69 years were significantly associated with higher screening rate. Increasing numbers of PSA testing per patient, as well as increasing age, were independently and significantly associated with an increase in the PSA value. Conclusion Swiss general practitioners adapted screening behavior as early as evidence of a limited health benefit evolved, while using a risk-adapted approach whenever performing multiple testing. Updated recommendations might have helped to maintain this decrease. Further recommendations and campaigns should aimed at older patients with multimorbidity, to sustain a further decline in prostate-specific antigen screening practices.
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Affiliation(s)
- Stefan Zechmann
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
- * E-mail:
| | - Stefania Di Gangi
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Vladimir Kaplan
- Department of Internal Medicine, Hospital Muri, Muri, Switzerland
| | - Rahel Meier
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Fabio Valeri
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
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22
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Aboueid S, Meyer SB. Factors affecting access and use of preventive and weight management care: A public health lens. Healthc Manage Forum 2019; 32:136-142. [PMID: 30943766 DOI: 10.1177/0840470418824345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Obesity is an important risk factor for various chronic diseases. While people with obesity use the health system more and incur higher costs, they may forego using preventive care services (e.g., gynecological cancer screenings) due to issues of service use and service access. The aim of this paper was to use a public health lens to elucidate system level factors that affect healthcare access and utilization for preventive and weight management care by patients with obesity. Some elucidated factors include lack of access to a Primary Care Provider (PCP) and multidisciplinary healthcare settings, gender of the PCP, duration of medical visits and health professionals' attitudes about obesity. We highlight potential strategies for leaders to use when improving access and use of health services by patients with obesity in Canada and the need for future empirical studies in this research area.
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Affiliation(s)
- Stephanie Aboueid
- 1 School of Public Health and Health Systems, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Samantha B Meyer
- 1 School of Public Health and Health Systems, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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23
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Blair A, Gauvin L, Ouédraogo S, Datta GD. Area-level income disparities in colorectal screening in Canada: evidence to inform future surveillance. ACTA ACUST UNITED AC 2019; 26:e128-e137. [PMID: 31043818 DOI: 10.3747/co.26.4279] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Participation in colorectal screening remains low even in countries with universal health coverage. Area-level determinants of low screening participation in Canada remain poorly understood. Methods We assessed the association between area-level income and two indicators of colorectal screening (having never been screened, having not been screened recently) by linking census-derived local area-level income data with self-reported screening data from urban-dwelling respondents to the Canadian Community Health Survey (50-75 years of age, cycles 2005 and 2007, n = 18,362) who reported no known risk factors for colorectal cancer. Generalized estimating equation Poisson models estimated the prevalence ratios and differences for having never been screened and having not been screened recently, adjusting for individual-level income, education, marital status, having a regular physician, age, and sex. Results About 53% of the study population had never been screened. Among individuals who had ever been screened, 35% had been screened recently. Adjusting for covariates, lower area-level income was associated with having never been screened [covariate-adjusted prevalence ratios: 1.24 for quartile 1; 95% confidence limits (cl): 1.16, 1.34; 1.25 for quartile 2; 95% cl: 1.15, 1.33; 1.15 for quartile 3; 95% cl: 1.08, 1.23]. Among individuals who had been screened in their lifetime, area-level income was not associated with having not been screened recently. Conclusions Lower area-level income is associated with having never been screened for colorectal cancer even after adjusting for individual socioeconomic factors. Those findings highlight the potential importance of socioeconomic contexts for colorectal screening initiation and merit attention in both future research and surveillance efforts.
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Affiliation(s)
- A Blair
- Department of Social and Preventive Medicine, École de Santé Publique de l'Université de Montréal Montreal, QC.,Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC
| | - L Gauvin
- Department of Social and Preventive Medicine, École de Santé Publique de l'Université de Montréal Montreal, QC.,Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC
| | - S Ouédraogo
- Department of Social and Preventive Medicine, École de Santé Publique de l'Université de Montréal Montreal, QC.,Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC
| | - G D Datta
- Department of Social and Preventive Medicine, École de Santé Publique de l'Université de Montréal Montreal, QC.,Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC
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24
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Blair A, Gauvin L, Schnitzer ME, Datta GD. The Role of Access to a Regular Primary Care Physician in Mediating Immigration-Based Disparities in Colorectal Screening: Application of Multiple Mediation Methods. Cancer Epidemiol Biomarkers Prev 2019; 28:650-658. [PMID: 30642839 DOI: 10.1158/1055-9965.epi-18-0825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/25/2018] [Accepted: 01/08/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Colorectal cancer screening participation is lower among recent immigrants than among Canadian-born individuals. We assessed whether this screening disparity is mediated by access to regular primary care physicians (PCP). METHODS Pooling years 2003 to 2014 of the Canadian Community Health Survey, lifetime screening in respondents aged 50 to 75 years of age who immigrated in the previous 10 years (n = 1,067) was compared with Canadian-born respondents (N = 102,366). Regression- and inverse probability weighting-based methods were used to estimate the total effect (TE) and controlled direct effect (CDE) of recent immigration on never having received either a stool- or endoscopic-based screening test. The proportion of the TE that would be eliminated if all had a PCP was computed using these estimates [proportion eliminated (PE) = (TE - CDE)/(TE - 1)]. Analyses were stratified by visible minority status and adjusted for income, rurality, age, sex, marital status, education, and exposure to a provincially organized colorectal screening program. RESULTS The prevalence of never having been screened was 71% and 57% in visible minority and white recent immigrants, respectively, and 46% in white Canadian-born respondents. If all had regular PCPs, there would be no reduction in the screening inequality between white recent immigrants and Canadian-born (null PE), and the inequality between visible minority immigrants and white Canadian-born may increase by 6% to 13%. CONCLUSIONS Ensuring all have regular PCPs may lead to greater screening gains among Canadian-born than recent immigrants. IMPACT Improving access to PCPs may increase colorectal screening overall, but not reduce immigration-based disparities screening. Alternative interventions to reduce this disparity should be explored.
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Affiliation(s)
- Alexandra Blair
- Department of Social and Preventive Medicine, École de Santé Publique de l'Université de Montréal (ESPUM), Montreal, Quebec, Canada.,Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Lise Gauvin
- Department of Social and Preventive Medicine, École de Santé Publique de l'Université de Montréal (ESPUM), Montreal, Quebec, Canada.,Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Mireille E Schnitzer
- Faculté de pharmacie, Université de Montréal, Pavillon Jean-Coutu, Montreal, Quebec, Canada
| | - Geetanjali D Datta
- Department of Social and Preventive Medicine, École de Santé Publique de l'Université de Montréal (ESPUM), Montreal, Quebec, Canada. .,Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada
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25
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Lofters AK, Slater M, Vahabi M. Cancer Screening Among Patients Who Self-Identify as Muslim: Combining Self-Reported Data with Medical Records in a Family Practice Setting. J Immigr Minor Health 2019; 20:44-50. [PMID: 27714588 DOI: 10.1007/s10903-016-0508-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cancer screening is a core component of family medicine but screening inequalities are well documented in Canada for foreign-born persons. Although people of Muslim faith and culture are the fastest growing immigrant population in Canada, there is little information in the literature about their cancer screening practices. Determining screening gaps could inform practice-based quality improvement initiatives. We conducted a retrospective chart review combining patient-level medical record data with self-reported religious affiliation to examine the relationship between religion and cancer screening in a large multi-site urban family practice. Religious affiliation was classified as Muslim, other affiliation, or atheist/no religious affiliation. 5311 patients were included in the study sample. Muslim patients were significantly less likely to prefer English for spoken communication than the other two groups, less likely to be Canadian-born, more likely to have a female family physician, and were over-represented in the lowest income quintile. Muslim women were most likely to be up-to-date on breast cancer screening (85.2 vs. 77.5 % for those with other religions vs. 69.5 % for those with no religious affiliation). There were no significant differences in cancer screening by physician sex. In this pilot study conducted within a primary care practice, we used self-reported data on religious affiliation to examine possible inequities in cancer screening and observed intriguing variations in screening by self-identified religious affiliation. Future efforts to collect and use similar patient-level data should incorporate non-official languages and intensively outreach to patients with less health system contact. Regardless, the family medicine context may be the ideal setting to collect and act on patient-level sociodemographic data such as religious affiliation.
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Affiliation(s)
- A K Lofters
- Department of Family & Community Medicine, St. Michael's Hospital, University of Toronto, 30 Bond St, Toronto, ON, M5B 1W8, Canada. .,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. .,Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Canada.
| | - M Slater
- Department of Family & Community Medicine, St. Michael's Hospital, University of Toronto, 30 Bond St, Toronto, ON, M5B 1W8, Canada.,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - M Vahabi
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Canada
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26
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Lofters AK, McBride ML, Li D, Whitehead M, Moineddin R, Jiang L, Grunfeld E, Groome PA. Disparities in breast cancer diagnosis for immigrant women in Ontario and BC: results from the CanIMPACT study. BMC Cancer 2019; 19:42. [PMID: 30626375 PMCID: PMC6327524 DOI: 10.1186/s12885-018-5201-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 12/09/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In Canada, clinical practice guidelines recommend breast cancer screening, but there are gaps in adherence to recommendations for screening, particularly among certain hard-to-reach populations, that may differ by province. We compared stage of diagnosis, proportion of screen-detected breast cancers, and length of diagnostic interval for immigrant women versus long-term residents of BC and Ontario. METHODS We conducted a retrospective cohort study using linked administrative databases in BC and Ontario. We identified all women residing in either province who were diagnosed with incident invasive breast cancer between 2007 and 2011, and determined who was foreign-born using the Immigration Refugee and Citizenship Canada database. We used descriptive statistics and bivariate analyses to describe the sample and study outcomes. We conducted multivariate analyses (modified Poisson regression and quantile regression) to control for potential confounders. RESULTS There were 14,198 BC women and 46,952 Ontario women included in the study population, of which 11.8 and 11.7% were foreign-born respectively. In both provinces, immigrants and long-term residents had similar primary care access. In both provinces, immigrant women were significantly less likely to have a screen-detected breast cancer (adjusted relative risk 0.88 [0.79-0.96] in BC, 0.88 [0.84-0.93] in Ontario) and had a significantly longer median diagnostic interval (2 [0.2-3.8] days in BC, 5.5 [4.4-6.6] days in Ontario) than long-term residents. Women from East Asia and the Pacific were less likely to have a screen-detected cancer and had a longer diagnostic interval, but were diagnosed at an earlier stage than long-term residents. In Ontario, women from Latin America and the Caribbean and from South Asia were less likely to have a screen-detected cancer, had a longer median diagnostic interval, and were diagnosed at a later stage than long-term residents. These findings were not explained by access to primary care. CONCLUSIONS There are inequalities in breast cancer diagnosis for Canadian immigrant women. We have identified particular immigrant groups (women from Latin America and the Caribbean and from South Asia) that appear to be subject to disparities in the diagnostic process that need to be addressed in order to effectively reduce gaps in care.
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Affiliation(s)
- A. K. Lofters
- Department of Family & Community Medicine, St. Michael’s Hospital, 30 Bond St, Toronto, M5B 1W8 Canada
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, Canada
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
| | - M. L. McBride
- BC Cancer, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - D. Li
- BC Cancer, Vancouver, Canada
| | | | - R. Moineddin
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
| | - L. Jiang
- ICES, Queen’s University, Kingston, Canada
- Critical Care Services Ontario, Toronto, Ontario Canada
| | - E. Grunfeld
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Ontario Institute for Cancer Research, Toronto, ON Canada
| | - P. A. Groome
- ICES, Queen’s University, Kingston, Canada
- Department of Public Health Sciences, Queen’s University, Kingston, Canada
- Cancer Research Institute, Queen’s University, Kingston, Canada
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27
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Banks A, Samuel S, Johnson D, Hecker K, McLaughlin K. Reducing physician voiding cystourethrogram ordering in children with first febrile urinary tract infection: evaluation of a purposefully sequenced educational intervention. CANADIAN MEDICAL EDUCATION JOURNAL 2018; 9:e6-e14. [PMID: 30498539 PMCID: PMC6260512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Physicians often fail to implement clinical practice guidelines. Our aim was to evaluate whether a purposefully sequenced, multifaceted educational intervention would increase physician adherence to a guideline for voiding cystourethrogram (VCUG) use following first urinary tract infection (UTI) in young children. METHODS Using a single centre, pretest-posttest design, we compared the proportion of guideline adherent VCUG orders and the VCUG ordering rate before and after three educational interventions (interactive lecture, clinical pathway, faxed reminder) selected and sequenced according to the PRECEDE (Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation) health promotion model. RESULTS One hundred and nine physicians ordered 219 VCUGs for 219 children. Following the interventions, there was an increase in the monthly proportion of adherent VCUGs ordered by pediatricians (analysis of variance (ANOVA) F(2,29) = 3.38, p = .048) and non-pediatricians (ANOVA F(2,28) = 14.71, p < .001). Also, pediatricians decreased their monthly VCUG ordering rate (linear trend incidence rate ratio 0.74, 95% confidence interval (CI) [0.54, 0.99]). Pediatricians were more likely to adhere with the guideline than were non-pediatricians (odds ratio 2.91, 95% CI [1.5, 5.5]). CONCLUSION Exposure to purposefully sequenced educational interventions based on the PRECEDE model was associated with increased adherence to guideline recommendations.
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Affiliation(s)
- Anke Banks
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Susan Samuel
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - David Johnson
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Kent Hecker
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Kevin McLaughlin
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
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28
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Lofters AK, Mark A, Taljaard M, Green ME, Glazier RH, Dahrouge S. Cancer screening inequities in a time of primary care reform: a population-based longitudinal study in Ontario, Canada. BMC FAMILY PRACTICE 2018; 19:147. [PMID: 30157772 PMCID: PMC6116433 DOI: 10.1186/s12875-018-0827-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 08/14/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Primary care has been reformed in recent years in Ontario, Canada, with a move away from traditional fee-for-service to enhanced fee-for-service and capitation-based models. It is unclear how new models have affected disparities in cancer screening. We evaluated whether Ontario's enhanced fee-for-service model was associated with a change in the gaps in cancer screening for people living with low income and people who are foreign-born. METHODS We conducted a population-based longitudinal analysis from 2002 to 2013 of Ontario family physicians who transitioned from traditional fee-for-service to enhanced fee-for-service. The binary outcomes of interest were adherence to cervical, breast and colorectal cancer screening recommendations. Outcomes were analyzed using mixed-effects logistic regression. Analyses produced annual odds ratios comparing the odds of being up-to-date for screening among patients in enhanced fee-for-service versus patients in traditional fee-for-service for each social stratum separately. We calculated the ratios of stratum-specific odds ratios to assess whether the transition from traditional to enhanced fee-for-service was associated with a change in screening gaps between immigrants and long-term residents, and between people in the lowest and highest neighbourhood income quintiles. RESULTS Throughout the study period, cancer screening was consistently lower among immigrants and among people in the lowest income quintile. Transition to enhanced fee-for-service was generally associated with increased screening uptake for all, however for most years, ratios of ratios were significantly less than 1 for all three cancer screening types, indicating that there was a widening of the screening gap between immigrants and long-term residents and between people living in the lowest vs. highest income quintile associated with transitions. CONCLUSION The transition to enhanced fee-for-service in Ontario was generally associated with a widening of screening inequities for foreign-born and low-income patients.
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Affiliation(s)
- Aisha K. Lofters
- Department of Family & Community Medicine, St. Michael’s Hospital, 30 Bond St, Toronto, ON M5B1W8 Canada
- Department of Family & Community Medicine, University of Toronto, 500 University Ave. 5th Floor, Toronto, ON M5G1V7 Canada
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond St, Toronto, ON M5B1W8 Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St. 6th Floor, Toronto, ON M5T3M7 Canada
- Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Ave, Toronto, ON M4N3M5 Canada
| | - Amy Mark
- Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Ave, Toronto, ON M4N3M5 Canada
| | - Monica Taljaard
- Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Ave, Toronto, ON M4N3M5 Canada
- Ottawa Hospital Research Institute, 501 Smyth Box 511, Ottawa, ON K1H 8L6 Canada
| | - Michael E. Green
- Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Ave, Toronto, ON M4N3M5 Canada
- Department of Family Medicine, Queen’s University, 220 Bagot St, Kingston, ON K7L5E9 Canada
| | - Richard H. Glazier
- Department of Family & Community Medicine, St. Michael’s Hospital, 30 Bond St, Toronto, ON M5B1W8 Canada
- Department of Family & Community Medicine, University of Toronto, 500 University Ave. 5th Floor, Toronto, ON M5G1V7 Canada
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond St, Toronto, ON M5B1W8 Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St. 6th Floor, Toronto, ON M5T3M7 Canada
- Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Ave, Toronto, ON M4N3M5 Canada
| | - Simone Dahrouge
- Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Ave, Toronto, ON M4N3M5 Canada
- CT Lamont Primary Health Care Research Centre, Bruyere Research Institute, 43 Bruyère St, Ottawa, ON K1N5C8 Canada
- Department of Family Medicine, University of Ottawa, 600 Peter Morand Crescent Suite 201, Ottawa, ON K1G 5Z3 Canada
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Woods RR, McGrail KM, Kliewer EV, Kazanjian A, Mar C, Kan L, Sam J, Spinelli JJ. Breast screening participation and retention among immigrants and nonimmigrants in British Columbia: A population-based study. Cancer Med 2018; 7:4044-4067. [PMID: 29984906 PMCID: PMC6089191 DOI: 10.1002/cam4.1608] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/04/2018] [Accepted: 05/11/2018] [Indexed: 12/12/2022] Open
Abstract
Breast cancer screening programs operate across Canada providing mammography to women in target age groups with the goal of reducing breast cancer mortality through early detection of tumors. Disparities in breast screening participation among socio‐demographic groups, including immigrants, have been reported in Canada. Our objectives were to: (1) assess breast screening participation and retention among immigrant and nonimmigrant women in British Columbia (BC), Canada; and (2) to characterize factors associated with screening among screening‐age recent immigrant women in BC. We examined 2 population‐based cohorts of women eligible for breast screening participation (537 783 women) and retention (281 052 women) using linked health and immigration data. Breast screening rates were presented according to socio‐demographic and health‐related variables stratified by birth country. Factors associated with screening among recent immigrant women were explored using Poisson regression. We observed marked variation in screening participation across birth country cohorts. Eastern European/Central Asian women showed low participation (37.9%) with rates from individual countries ranging from 35.0% to 49.0%. Participation rates for immigrant women from the most common birth countries, such as China/Macau/Hong Kong/Taiwan (45.7%), India (44.5%), the Philippines (45.9%), and South Korea (39.0%), were lower than the nonimmigrant rates (51.2%). Retention rates showed less variation by birth country; however, some disparities between immigrant and nonimmigrant groups persisted. Associations between screening indicators and study factors varied considerably across immigrant groups. Primary care physician visits were consistently positively associated with screening participation; this variable was also the only predictor associated with screening within each of the groups of recent immigrants. Our study provides unique data on both screening participation and retention among Canadian immigrant women compiled by individual country of birth. Our results are further demonstration that screening disparities exist among immigrant populations as well as in comparison with nonimmigrant women.
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Affiliation(s)
- Ryan R Woods
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,Population Oncology, BC Cancer, Vancouver, BC, Canada
| | - Kimberlyn M McGrail
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Erich V Kliewer
- Population Oncology, BC Cancer, Vancouver, BC, Canada.,Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Arminee Kazanjian
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Colin Mar
- Population Oncology, BC Cancer, Vancouver, BC, Canada
| | - Lisa Kan
- Population Oncology, BC Cancer, Vancouver, BC, Canada
| | - Janette Sam
- Population Oncology, BC Cancer, Vancouver, BC, Canada
| | - John J Spinelli
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,Population Oncology, BC Cancer, Vancouver, BC, Canada
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Leinonen MK, Campbell S, Ursin G, Tropé A, Nygård M. Barriers to cervical cancer screening faced by immigrants: a registry-based study of 1.4 million women in Norway. Eur J Public Health 2018; 27:873-879. [PMID: 28957477 PMCID: PMC5881680 DOI: 10.1093/eurpub/ckx093] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Immigrants from certain low- and middle-income countries are more prone to cancers attributed to viral infections in early life. Cervical cancer is caused by human papillomavirus but is highly preventable by regular screening. We assessed participation among immigrants in a population-based cervical screening programme and identified factors that predicted non-adherence within different immigrant groups. Methods We used data from several nationwide registries. The study population consisted of 208 626 (15%) immigrants and 1 157 223 (85%) native Norwegians. Non-adherence was defined as no eligible screening test in 2008–12. We estimated prevalence ratios with 95% confidence intervals (CIs) for factors associated with non-adherence by modified Poisson regression. Results In total, 52% of immigrants were not screened. All immigrants showed 1.72 times higher non-adherence rates (95% CI 1.71–1.73) compared with native Norwegian women when adjusted for age and parity. The proportion of non-adherent immigrants varied substantially by region of origin and country of origin. Being unemployed or not in the workforce, being unmarried, having low income and having a male general practitioner was associated with non-adherence regardless of region of origin. Living <10 years in Norway was an evident determinant of non-adherence among most but not all immigrant groups. Conclusions An increasing proportion of immigrants and low screening participation among them pose new public health challenges in Europe. Immigrants are diverse in terms of their sociodemographic attributes and screening participation. Tailored information and service delivery may be necessary to increase cancer screening among immigrants.
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Affiliation(s)
| | | | - Giske Ursin
- Department of Research, Cancer Registry of Norway, Oslo, Norway.,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ameli Tropé
- Department of Cervical Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, Oslo, Norway
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Shen SC, Lofters A, Tinmouth J, Paszat L, Rabeneck L, Glazier RH. Predictors of non-adherence to colorectal cancer screening among immigrants to Ontario, Canada: a population-based study. Prev Med 2018; 111:180-189. [PMID: 29548788 DOI: 10.1016/j.ypmed.2018.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 03/01/2018] [Accepted: 03/09/2018] [Indexed: 12/22/2022]
Abstract
Though colorectal cancer (CRC) screening rates have increased over time in Ontario, Canada, immigrants continue to have lower rates of screening. This study examines the association between non-adherence to CRC screening and immigration, socio-demographic, healthcare utilization, and primary care physician characteristics among immigrants to Ontario. This is a population-based retrospective cross-sectional study that uses healthcare administrative databases housed at the Institute for Clinical Evaluative Sciences. Our cohort comprised immigrants aged 60 to 74 years who lived in Ontario on March 31, 2015 and who had been eligible for the Ontario Health Insurance Plan for at least 10 years. The outcome was lack of adherence to CRC screening with any modality (fecal occult blood test, flexible sigmoidoscopy, colonoscopy) on March 31, 2015. Our cohort contained 182,949 immigrants. Overall 70,134 (38%) individuals were not adherent to screening. Risk of non-adherence to CRC screening was higher among immigrants who were from low (adjusted relative risk [ARR] 1.35, 95%CI 1.28-1.42) or low-middle (ARR 1.27, 95%CI 1.24-1.30, population-attributable risk [PAR] 9.8%) income countries and refugees (ARR 1.09, 95%CI 1.06-1.11). Compared to those from the United States, Australia, and New Zealand, immigrants from most other world regions, particularly Eastern Europe and Central Asia (ARR 1.28, 95%CI 1.21-1.37), had higher risks of non-adherence. Non-immigration factors such as low healthcare use and lack of primary care enrolment also increased the risk of non-adherence to screening. These findings can be used to inform future efforts to improve uptake of CRC screening among immigrant groups.
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Affiliation(s)
| | - Aisha Lofters
- Dalla Lana School of Public Health, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Jill Tinmouth
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Toronto, Ontario, Canada; Division of Gastroenterology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Lawrence Paszat
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Linda Rabeneck
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Division of Gastroenterology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Richard H Glazier
- Dalla Lana School of Public Health, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Toronto, Ontario, Canada
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Katz D, Tengekyon AJ, Kahan NR, Calderon-Margalit R. Patient and physician characteristics affect adherence to screening mammography: A population-based cohort study. PLoS One 2018; 13:e0194409. [PMID: 29584742 PMCID: PMC5870964 DOI: 10.1371/journal.pone.0194409] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 02/19/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Screening mammograms are widely recommended biennially for women between the ages of 50 and 74. Despite the benefits of screening mammograms, full adherence to recommendations falls below 75% in most developed countries. Many studies have identified individual (obesity, smoking, socio-economic status, and co-morbid conditions) and primary-care physician parameters (physician age, gender, clinic size and cost) that influence adherence, but little data exists from large population studies regarding the interaction of these individual factors. METHODS We performed a historical cohort study of 44,318 Israeli women age 56-74 using data captured from electronic medical records of a large Israeli health maintenance organization. Univariate analysis was used to examine the association between each factor and adherence (none, partial or full) with screening recommendations between 2008-2014. Multivariate analysis was used to examine the significance of these factors in combination, using binary and multinomial logistic regression. RESULTS Among 44,318 women, 42%, 43% and 15% were fully, partially and non-adherent to screening recommendations, respectively. Factors associated with inferior adherence identified in our population included: smoking, obesity, low body weight, low socio-economic status, depression, diabetes mellitus and infrequent physician visits, while, women with ischemic heart disease, female physicians, physicians between the ages of 40 and 60, and medium-sized clinics were associated with higher screening rates. Most factors remained significant in the multivariate analysis. CONCLUSIONS Both individual and primary-care physician factors contribute to adherence to mammography screening guidelines. Strategies to improve adherence and address disparities in mammography utilization will need to address these factors.
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Affiliation(s)
- Daniela Katz
- Institute of Oncology, Assaf Harofeh Medical Center, Zrifin, Israel
| | - Angela J. Tengekyon
- The Joseph H. and Belle R. Braun Hebrew University-Hadassah School of Public Health and Community Medicine, Jerusalem, Israel
| | - Natan R. Kahan
- Medical Division, Leumit Health Services, Tel-Aviv, Israel, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ronit Calderon-Margalit
- The Joseph H. and Belle R. Braun Hebrew University-Hadassah School of Public Health and Community Medicine, Jerusalem, Israel
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Wood B, Lofters A, Vahabi M. Strategies to reach marginalized women for cervical cancer screening: A qualitative study of stakeholder perspectives. ACTA ACUST UNITED AC 2018; 25:e8-e16. [PMID: 29507490 DOI: 10.3747/co.25.3851] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Self-sampling for human papillomavirus (hpv) has the potential to reach marginalized populations that are underserved for cervical cancer screening. However, before implementing an alternative screening strategy such as self-sampling for under- and never-screened women, the key processes, facilitators, and barriers to reform need to be understood. Methods A descriptive qualitative study was conducted that involved semi-structured interviews with Canadian and international cancer screening health care providers and policy-makers. Respondents were purposively selected from a list of thirty stakeholders generated through an environmental scan. The interviews were transcribed verbatim and analyzed using directed content analysis. Results Nineteen stakeholders participated in the interviews. Most respondents thought that self-sampling was an appropriate cervical screening alternative for hard-to-reach populations, as it addressed barriers to cervical screening related to various social determinants of health. All respondents emphasized that transitioning to hpv primary screening would catalyze a policy shift towards self-sampling. Clinician respondents were less enthusiastic about self-sampling strategies since that discouraged women's appointments with primary care providers, because cervical screening offered an opportunity to discuss other preventive health topics. There also was little consensus between respondents on whether the state of evidence was satisfactory to integrate a self-sampling option into policy, or whether more Canadian research was needed. Conclusion Canadian cervical cancer screening stakeholders should collaborate to identify the knowledge gaps that researchers should address and leverage the existing literature to implement tailored, patient-centred alternative cervical screening strategies. The transition to hpv primary screening would be a key first step in the broad implementation of hpv self-sampling in Canada.
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Affiliation(s)
- B Wood
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON.,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, and Department of Family and Community Medicine, University of Toronto, Toronto, ON.,Daphne Cockwell School of Nursing, Ryerson University, Co-Director, Ryerson Centre for Global Health and Health Equity, Graduate Program in Immigration and Settlement Studies, Ryerson University, Toronto, ON
| | - A Lofters
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, and Department of Family and Community Medicine, University of Toronto, Toronto, ON
| | - M Vahabi
- Daphne Cockwell School of Nursing, Ryerson University, Co-Director, Ryerson Centre for Global Health and Health Equity, Graduate Program in Immigration and Settlement Studies, Ryerson University, Toronto, ON
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Burchell AN, Kendall CE, Cheng SY, Lofters A, Cotterchio M, Bayoumi AM, Glazier RH, Antoniou T, Raboud J, Yudin MH, Loutfy M. Cervical cancer screening uptake among HIV-positive women in Ontario, Canada: A population-based retrospective cohort study. Prev Med 2018; 107:14-20. [PMID: 29197533 DOI: 10.1016/j.ypmed.2017.11.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 11/16/2017] [Accepted: 11/26/2017] [Indexed: 10/18/2022]
Abstract
Cervical cancer caused by oncogenic types of the human papillomavirus (HPV) is of concern among HIV-positive women due to impairment of immune responses required to control HPV infection. Our objectives were to describe patterns of cervical cancer screening using Pap cytology testing among HIV-positive women in Ontario, Canada from 2008 to 2013 and to identify factors associated with adequate screening. We conducted a retrospective, population-based cohort study among screen-eligible HIV-positive women using provincial administrative health data. We estimated annual proportions tested and reported these with 95% confidence intervals (CI). Next, using person-years as the unit of analysis, we identified factors associated with annual Pap testing using log-binomial regression. A total of 2271 women were followed over 10,697 person-years. In 2008, 34.0% (95%CI 31.1-37.0%) had a Pap test. By 2013, the proportion of HIV-positive women tested was 25.9% (95%CI 23.6-28.2%). Women who were most likely to undergo testing were younger, were immigrants from countries with generalized HIV epidemics, lived in the highest income neighbourhoods, had a female primary care physician, had two or more encounters per year with an infectious disease or internal medicine specialist, and had greater comorbidity. Nearly three in four HIV-positive women were under-screened despite all having universal insurance for medically-necessary services. Annual Pap testing decreased following the 2011-2013 release of new guidelines for a lengthened screen interval for average risk women and a billing disincentive. Clinic-based intervention such as physician alerts or reminders may be needed to improve screening coverage among HIV-positive women.
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Affiliation(s)
- Ann N Burchell
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
| | - Claire E Kendall
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada; C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Stephanie Y Cheng
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Aisha Lofters
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Michelle Cotterchio
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Ahmed M Bayoumi
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Richard H Glazier
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Tony Antoniou
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Janet Raboud
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Mark H Yudin
- Department of Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mona Loutfy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
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Tavasoli SM, Kane E, Chiarelli AM, Kupets R. Women's Behaviors Toward Mammogram and Pap Test: Opportunities to Increase Cervical Cancer Screening Participation Rates among Older Women. Womens Health Issues 2018; 28:42-50. [DOI: 10.1016/j.whi.2017.10.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/13/2017] [Accepted: 10/19/2017] [Indexed: 12/18/2022]
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Nguyen-Truong CKY, Hassouneh D, Lee-Lin F, Hsiao CY, Le TV, Tang J, Vu M, Truong AM. Health Care Providers’ Perspectives on Barriers and Facilitators to Cervical Cancer Screening in Vietnamese American Women. J Transcult Nurs 2017; 29:441-448. [DOI: 10.1177/1043659617745135] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Vietnamese American women (VAW) are diagnosed and die at twice the rate than White non-Hispanic American women (16.8/100,000 vs. 8.1/100,000 and 4.4/100,000 vs. 2.4/100,000, respectively). Despite efforts to increase cervical cancer (CC) screening among VAW, the participation rates are persistently low (69% to 81%). The purpose of this study was to explore health care providers’ (HCPs) perspectives on barriers and facilitators to CC screening in VAW. Method: This qualitative descriptive pilot study, used open-ended semistructured interviews with 10 HCPs. Results: The HCPs had two to 23 years treating VAW. Major barriers and facilitators identified by the HCPs were as follows: VAW’s decision making about CC screening; sexual health divide; language discordance, relying on interpreters; breaking suspicion; VAW’s exposure to health sources of CC screening; sustainable trust; and motivated health care practices. Discussion: HCPs perceived the reasons for VAW not being screened or delaying CC screening were due to their lack of knowledge, cultural barriers, language, and issues related to trust.
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Affiliation(s)
| | - Dena Hassouneh
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Frances Lee-Lin
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Chiao-Yun Hsiao
- Immigrant & Refugee Community Organization Asian Family Center, Portland, OR, USA
| | | | | | - Margret Vu
- Asian American Community, Portland, OR, USA
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Engler J, Dahlhaus A, Güthlin C. The readiness of German GPs to recommend and conduct cancer screening is associated with patient-physician gender concordance. Results of a survey. Eur J Gen Pract 2017; 23:11-19. [PMID: 27841043 PMCID: PMC5774290 DOI: 10.1080/13814788.2016.1240166] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 08/23/2016] [Accepted: 09/14/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cancer screening participation rates in Germany differ depending on patients' gender. International studies have found that patient-physician gender concordance fosters recommendation and conducting of cancer screening, and especially cancer screening for women. OBJECTIVES We aimed to ascertain whether gender concordance influences general practitioners' (GPs') rating of the usefulness of cancer screening, as well as their recommendations and readiness to conduct cancer screening in general practice in Germany. METHODS For an exploratory cross-sectional survey, 500 randomly selected GPs from all over Germany were asked to fill in a questionnaire on cancer screening in general practice between March and June 2015. We asked them to rate the usefulness of each cancer screening examination, how frequently they recommended and conducted them and whether they viewed GPs or specialists as responsible for carrying them out. We used multiple logistic regression to analyse gender effect size by calculating odds ratios. RESULTS Our study sample consisted of 139 GPs of which 65% were male. Male and female GPs did not differ significantly in their rating of the general usefulness of any of the specified cancer screening examinations. Male GPs were 2.9 to 6.8 times as likely to consider GPs responsible for recommending and conducting PSA testing and digital rectal examinations and were 3.7 to 7.9 times as likely to recommend and conduct these examinations on a regular basis. CONCLUSION Patient-physician gender concordance made it more likely that male-specific cancer screenings would be recommended and conducted, but not female-specific screenings. [Box: see text].
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Affiliation(s)
- Jennifer Engler
- Institute of General Practice, Goethe University Frankfurt/MainFrankfurtGermany
| | - Anne Dahlhaus
- Institute of General Practice, Goethe University Frankfurt/MainFrankfurtGermany
- German Cancer Research Center (DKFZ)HeidelbergGermany
- German Cancer Consortium (DKTK)HeidelbergGermany
| | - Corina Güthlin
- Institute of General Practice, Goethe University Frankfurt/MainFrankfurtGermany
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Jih J, Nguyen MP, Ly I, Tsoh JY, Le GM, Woo K, Chan E, Gildengorin G, Stewart SL, Burke A, Pasick R, McPhee SJ, Nguyen TT. The Role of Physician Recommendation in Colorectal Cancer Screening Receipt Among Immigrant Chinese Americans. J Immigr Minor Health 2017; 20:1483-1489. [PMID: 29168060 DOI: 10.1007/s10903-017-0679-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Chinese Americans have low colorectal cancer (CRC) screening rates. It is unclear whether physicians should offer all CRC screening modalities (fecal occult blood test [FOBT], sigmoidoscopy, colonoscopy) to Chinese Americans to increase screening. Seven hundred and twenty-five Chinese Americans were asked in a survey if their physician had ever recommended CRC screening and to self-report receipt and type of CRC screening. Participants whose physician had recommended all CRC screening modalities were significantly more likely to report ever having screening (adjusted odds ratio 4.29, 95% CI 1.26-14.68) and being up-to-date (4.06, 95% CI 2.13-7.74) than those who reported that their physician only recommended FOBT. Participants who received a recommendation of only one type of screening did not report a significant difference in ever having or being up-to-date for screening. A potential strategy to increase CRC screening among Chinese Americans is for clinicians to recommend all available CRC screening modalities to each patient.
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Affiliation(s)
- Jane Jih
- Asian American Research Center on Health, San Francisco, CA, USA. .,Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA. .,Division of General Internal Medicine, University of California, San Francisco, 1545 Divisadero Street, P.O. Box 0320, San Francisco, CA, 94115, USA.
| | - Minh P Nguyen
- Asian American Research Center on Health, San Francisco, CA, USA
| | - Irene Ly
- Asian American Research Center on Health, San Francisco, CA, USA
| | - Janice Y Tsoh
- Asian American Research Center on Health, San Francisco, CA, USA.,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Gem M Le
- Asian American Research Center on Health, San Francisco, CA, USA.,Division of General Internal Medicine, Zuckerberg San Francisco General Hospital/University of California, San Francisco, San Francisco, CA, USA
| | - Kent Woo
- NICOS Chinese Health Coalition, San Francisco, CA, USA
| | - Elaine Chan
- NICOS Chinese Health Coalition, San Francisco, CA, USA
| | - Ginny Gildengorin
- Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Susan L Stewart
- Division of Biostatistics, University of California, Davis, Davis, CA, USA
| | - Adam Burke
- Asian American Research Center on Health, San Francisco, CA, USA.,Department of Health Education, San Francisco State University, San Francisco, CA, USA
| | - Rena Pasick
- Asian American Research Center on Health, San Francisco, CA, USA.,Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Stephen J McPhee
- Asian American Research Center on Health, San Francisco, CA, USA.,Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Tung T Nguyen
- Asian American Research Center on Health, San Francisco, CA, USA.,Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
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Evaluation of Recall and Reminder Letters on Retention Rates in an Organized Cervical Screening Program. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:845-853. [DOI: 10.1016/j.jogc.2017.04.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/13/2017] [Accepted: 04/25/2017] [Indexed: 11/19/2022]
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Lofters AK, Vahabi M, Kim E, Ellison L, Graves E, Glazier RH. Cervical Cancer Screening among Women from Muslim-Majority Countries in Ontario, Canada. Cancer Epidemiol Biomarkers Prev 2017; 26:1493-1499. [DOI: 10.1158/1055-9965.epi-17-0323] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/06/2017] [Accepted: 07/05/2017] [Indexed: 11/16/2022] Open
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Lofters AK, Vahabi M, Prakash V, Banerjee L, Bansal P, Goel S, Dunn S. Lay health educators within primary care practices to improve cancer screening uptake for South Asian patients: challenges in quality improvement. Patient Prefer Adherence 2017; 11:495-503. [PMID: 28331296 PMCID: PMC5352230 DOI: 10.2147/ppa.s127147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cancer screening uptake is known to be low among South Asian residents of Ontario. The objective of this pilot study was to determine if lay health educators embedded within the practices of primary care providers could improve willingness to screen and cancer screening uptake for South Asian patients taking a quality improvement approach. MATERIALS AND METHODS Participating physicians selected quality improvement initiatives to use within their offices that they felt could increase willingness to screen and cancer screening uptake. They implemented initiatives, adapting as necessary, for six months. RESULTS Four primary care physicians participated in the study. All approximated that at least 60% of their patients were of South Asian ethnicity. All physicians chose to work with a preexisting lay health educator program geared toward South Asians. Health ambassadors spoke to patients in the office and telephoned patients. For all physicians, ~60% of South Asian patients who were overdue for cancer screening and who spoke directly to health ambassadors stated they were willing to be screened. One physician was able to track actual screening among contacted patients and found that screening uptake was relatively high: from 29.2% (colorectal cancer) to 44.6% (breast cancer) of patients came in for screening within six months of the first phone calls. Although physicians viewed the health ambassadors positively, they found the study to be time intensive and resource intensive, especially as this work was additional to usual clinical duties. DISCUSSION Using South Asian lay health educators embedded within primary care practices to telephone patients in their own languages showed promise in this study to increase awareness about willingness to screen and cancer screening uptake, but it was also time intensive and resource intensive with numerous challenges. Future quality improvement efforts should further develop the phone call invitation process, as well as explore how to provide infrastructure for lay health educator training and time.
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Affiliation(s)
- AK Lofters
- Department of Family and Community Medicine
- Dalla Lana School of Public Health, University of Toronto
- Department of Family and Community Medicine
- Centre for Urban Health Solutions, St Michael’s Hospital
| | - M Vahabi
- Daphne Cockwell School of Nursing, Ryerson University, Toronto
| | - V Prakash
- Screening Saves Lives Program, Canadian Cancer Society, Mississauga
| | - L Banerjee
- Wise Elephant Family Health Team, Brampton
| | - P Bansal
- Mississauga Halton Central West Regional Cancer Program, Mississauga
| | - S Goel
- Wise Elephant Family Health Team, Brampton
- Mississauga Halton Central West Regional Cancer Program, Mississauga
| | - S Dunn
- Department of Family and Community Medicine
- Dalla Lana School of Public Health, University of Toronto
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
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Lofters AK, Schuler A, Slater M, Baxter NN, Persaud N, Pinto AD, Kucharski E, Davie S, Nisenbaum R, Kiran T. Using self-reported data on the social determinants of health in primary care to identify cancer screening disparities: opportunities and challenges. BMC FAMILY PRACTICE 2017; 18:31. [PMID: 28241787 PMCID: PMC5330155 DOI: 10.1186/s12875-017-0599-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 02/09/2017] [Indexed: 12/13/2022]
Abstract
Background Data on the social determinants of health can help primary care practices target improvement efforts, yet relevant data are rarely available. Our family practice located in Toronto, Ontario routinely collects patient-level sociodemographic data via a pilot-tested survey developed by a multi-organizational steering committee. We sought to use these data to assess the relationship between the social determinants and colorectal, cervical and breast cancer screening, and to describe the opportunities and challenges of using data on social determinants from a self-administered patient survey. Methods Patients of the family practice eligible for at least one of the three cancer screening types, based on age and screening guidelines as of June 30, 2015 and who had answered at least one question on a socio-demographic survey were included in the study. We linked self-reported data from the sociodemographic survey conducted in the waiting room with patients’ electronic medical record data and cancer screening records. We created an individual-level income variable (low-income cut-off) that defined a poverty threshold and took household size into account. The sociodemographic characteristics of patients who were overdue for screening were compared to those who were up-to-date for screening for each cancer type using chi-squared tests. Results We analysed data for 5766 patients for whom we had survey data. Survey participants had significantly higher screening rates (72.9, 78.7, 74.4% for colorectal, cervical and breast cancer screening respectively) than the 13, 036 patients for whom we did not have survey data (59.2, 65.3, 58.9% respectively). Foreign-born patients were significantly more likely to be up-to-date on colorectal screening than their Canadian-born peers but showed no significant differences in breast or cervical cancer screening. We found a significant association between the low-income cut-off variable and cancer screening; neighbourhood income quintile was not significantly associated with cancer screening. Housing status was also significantly associated with colorectal, cervical and breast cancer screening. There was a large amount of missing data for the low-income cut-off variable, approximately 25% across the three cohorts. Conclusion While we were able to show that neighbourhood income might under-estimate income-related disparities in screening, individual-level income was also the most challenging variable to collect. Future work in this area should target the income disparity in cancer screening and simultaneously explore how best to collect measures of poverty. Electronic supplementary material The online version of this article (doi:10.1186/s12875-017-0599-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A K Lofters
- Department of Family & Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. .,Department of Family & Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, ON, M5G 1V7, Canada. .,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. .,Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada. .,Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada.
| | - A Schuler
- Department of Family & Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - M Slater
- Department of Family & Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - N N Baxter
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada.,Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - N Persaud
- Department of Family & Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Department of Family & Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, ON, M5G 1V7, Canada.,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - A D Pinto
- Department of Family & Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Department of Family & Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, ON, M5G 1V7, Canada.,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada
| | - E Kucharski
- Cancer Care Ontario, 620 University Avenue, Toronto, ON, M5G 2L7, Canada
| | - S Davie
- Department of Family & Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - R Nisenbaum
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada
| | - T Kiran
- Department of Family & Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Department of Family & Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, ON, M5G 1V7, Canada.,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
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Leinonen MK, Campbell S, Klungsøyr O, Lönnberg S, Hansen BT, Nygård M. Personal and provider level factors influence participation to cervical cancer screening: A retrospective register-based study of 1.3 million women in Norway. Prev Med 2017; 94:31-39. [PMID: 27894911 DOI: 10.1016/j.ypmed.2016.11.018] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/14/2016] [Accepted: 11/24/2016] [Indexed: 11/24/2022]
Abstract
High coverage is essential for an effective screening programme. Here we present screening barriers and facilitators among 1.3 million women aged 25-69years eligible for screening within the Norwegian Cervical Cancer Screening Program (NCCSP). We defined non-adherence as no screening test in 2008-2012. We divided adherent women into those screened spontaneously, and those who had a smear after receiving a reminder from the NCCSP. Explanatory variables were extracted from several nationwide registers, and modelled by modified Poisson regression. In total, 34% of women were non-adherent. 31% of native Norwegians were non-adherent, compared to 50% of immigrants. Immigrant status was a strong predictor of non-adherence, but the vast majority of non-adherent women were still native Norwegians. Higher non-adherence rates were associated with having a male general practitioner (GP), a foreign GP, a young GP, and distance to the screening site. Being unmarried, having no children, having lower socioeconomic position and region of residence predicted non-adherence and, to a smaller extent, reminded adherence to screening. In contrast, previous experience with cervical abnormalities substantially increased adherence to screening. The population-based screening programme promotes equity by recruiting women who are less likely to participate spontaneously. However, socioeconomic disparities were evident in a country with a nationwide programme and a policy of equal access to health care. Initiatives aimed at removing practical and financial barriers to equitable screening delivery and at reducing the effect of sociodemographic attributes on screening participation are needed.
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Affiliation(s)
- Maarit K Leinonen
- Department of Research, Cancer Registry of Norway, 0304 Oslo, Norway.
| | - Suzanne Campbell
- Department of Research, Cancer Registry of Norway, 0304 Oslo, Norway
| | - Ole Klungsøyr
- Department of Treatment Research, Division of Mental Health and Addiction, Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, 0424 Oslo, Norway
| | - Stefan Lönnberg
- Department of Cervical Cancer Screening, Cancer Registry of Norway, 0304 Oslo, Norway
| | - Bo T Hansen
- Department of Research, Cancer Registry of Norway, 0304 Oslo, Norway
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, 0304 Oslo, Norway
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Keshinro A, Hatzaras I, Rifkind K, Dhage S, Joseph KA. The Impact of Primary Care Providers on Patient Screening Mammography and Initial Presentation in an Underserved Clinical Setting. Ann Surg Oncol 2016; 24:692-697. [PMID: 27766557 DOI: 10.1245/s10434-016-5618-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Cancer screening is a key component of primary care, and access to regular screening mammography (SMG) is highly dependent on recommendation and referral by a primary care provider (PCP). Women with no health insurance or who are underinsured often lack access to a regular PCP and thus access to routine screening. METHODS We retrospectively reviewed the charts of 173 surgical patients diagnosed between January 2012 and December 2013. The main outcome variables were PCP status, method of cancer detection, and breast cancer stage at diagnosis. Additional variables included race, age at diagnosis, family history of breast and ovarian cancer, and medical comorbidities. RESULTS Patients with a PCP received more mammograms (SMG) compared with patients without a PCP (61 vs. 37 %; p = 0.003). The majority (73 %) of patients without a PCP presented symptomatically with a palpable mass versus 42 % of patients with a PCP. A significant difference was noted with regard to final pathologic stage of breast cancer between the two groups (p = 0.019), and Caucasian and African American patients were more likely to have locally advanced breast cancer. CONCLUSIONS Underserved patients with a PCP are more likely to present asymptomatically and at an earlier stage of breast cancer compared with patients without a PCP. Community engagement programs that build relationships with patients may help bring vulnerable patients into the healthcare system for routine screening. Moreover, PCP education regarding the subtleties of breast cancer screening guidelines and referral to a breast specialist is also critical in improving outcomes of underserved patients.
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Affiliation(s)
- Ajaratu Keshinro
- Department of Surgery, NYU Langone Medical Center, Bellevue Hospital Medical Center, New York, NY, USA
| | - Ioannis Hatzaras
- Department of Surgery, NYU Langone Medical Center, Bellevue Hospital Medical Center, New York, NY, USA
| | - Kenneth Rifkind
- Department of Surgery, NYU Langone Medical Center, NYU Lutheran Hospital, New York, NY, USA
| | - Shubhada Dhage
- Department of Surgery, NYU Langone Medical Center, Bellevue Hospital Medical Center, New York, NY, USA
| | - Kathie-Ann Joseph
- Department of Surgery, NYU Langone Medical Center, Bellevue Hospital Medical Center, New York, NY, USA.
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Hulme J, Moravac C, Ahmad F, Cleverly S, Lofters A, Ginsburg O, Dunn S. "I want to save my life": Conceptions of cervical and breast cancer screening among urban immigrant women of South Asian and Chinese origin. BMC Public Health 2016; 16:1077. [PMID: 27733161 PMCID: PMC5062908 DOI: 10.1186/s12889-016-3709-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 09/23/2016] [Indexed: 11/13/2022] Open
Abstract
Background Breast and cervical cancer screening rates remain low among immigrant women and those of low socioeconomic status. The Cancer Awareness: Ready for Education and Screening (CARES) project ran a peer-led multi-lingual educational program between 2012 and 2014 to reach under and never-screened women in Central Toronto, where breast and cervical cancer screening rates remain low. The objective of this qualitative study was to better understand how Chinese and South Asian immigrants – the largest and most under-screened immigrant groups according to national and provincial statistics - conceive of breast and cervical cancer screening. We explored their experiences with screening to date. We explicitly inquired about their perceptions of the health care system, their screening experiences with family physicians and strategies that would support screening in their communities. Methods We conducted 22 individual interviews and two focus groups in Bengali and Mandarin with participants who had attended CARES educational sessions. Transcripts were coded through an iterative constant comparative and interpretative approach. Results Themes fell into five major, overlapping domains: risk perception and concepts of preventative health and screening; health system engagement and the embedded experience with screening; fear of cancer and procedural pain; self-efficacy, obligation, and willingness to be screened; newcomer barriers and competing priorities. These domains all overlap, and contribute to screening behaviours. Immigrant women experienced a number of barriers to screening related to ‘navigating newness’, including transportation, language barriers, arrangements for time off work and childcare. Fear of screening and fear of cancer took many forms; painful or traumatic encounters with screening were described. Female gender of the provider was paramount for both groups. Newly screened South Asian women were reassured by their first encounter with screening. Some Chinese women preferred the anonymous screening options available in China. Women generally endorsed a willingness to be screened, and even offered to organize women in their community hubs to access screening. Conclusions The experience of South Asian and Chinese immigrant women suggests that under and never-screened newcomers may be effectively integrated into screening programs through existing primary care networks, cultural-group specific outreach, and expanding access to convenient community -based screening.
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Affiliation(s)
- Jennifer Hulme
- Emergency Department, University Health Network, University of Toronto, Toronto, Canada. .,Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
| | - Catherine Moravac
- Postgraduate Medical Education, University of Toronto, Toronto, Canada
| | - Farah Ahmad
- Faculty of Health, School of Health Policy and Management, York University, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Shelley Cleverly
- Postgraduate Medical Education, University of Toronto, Toronto, Canada.,Centre for Health Promotion, Department of Public Health Sciences, University of Toronto, Toronto, Canada
| | - Aisha Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada.,Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Department of Family and Community Medicine, St. Michael Hospital, Toronto, Canada
| | - Ophira Ginsburg
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - Sheila Dunn
- Women's College Research Institute, Toronto, Canada.,Women's College Hospital, Toronto, Canada
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Lofters A, Vahabi M. Self-sampling for HPV to enhance uptake of cervical cancer screening: Has the time come in Canada? CMAJ 2016; 188:853-854. [PMID: 27114490 DOI: 10.1503/cmaj.151345] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Aisha Lofters
- Centre for Research on Inner City Health (Lofters), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Department of Family and Community Medicine (Lofters), University of Toronto, Toronto, Ont.; Daphne Cockwell School of Nursing (Vahabi), Ryerson University, Toronto, Ont.
| | - Mandana Vahabi
- Centre for Research on Inner City Health (Lofters), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Department of Family and Community Medicine (Lofters), University of Toronto, Toronto, Ont.; Daphne Cockwell School of Nursing (Vahabi), Ryerson University, Toronto, Ont
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Lofters A, Guilcher S, Maulkhan N, Milligan J, Lee J. Patients living with disabilities: The need for high-quality primary care. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2016; 62:e457-e464. [PMID: 27521411 PMCID: PMC4982744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To compare the potential risk factors for lower-quality primary care, the potential markers of unmet needs in primary care, and the willingness to participate in future research among primary care patients with versus without physical disabilities. DESIGN A waiting room survey using a convenience sample. SETTING A family health team (FHT) in Kitchener-Waterloo, Ont, with a designated Mobility Clinic. PARTICIPANTS A total of 40 patients seen at the FHT Mobility Clinic and 80 patients from the general patient population of the same FHT. MAIN OUTCOME MEASURES Socioeconomic status and social capital, number of self-reported emergency department visits and hospitalizations in the preceding year, and willingness of the patients in the 2 groups to participate in future research studies. RESULTS Patients from the Mobility Clinic were more than twice as likely to be receiving benefits or social assistance (75.0% vs 32.1%, P < .001), were twice as likely to report an annual household income of less than $40000 (58.6% vs 29.2%, P = .006), and were more likely to report their health status to be fair or poor (42.5% vs 16.2%, P = .002). Half of Mobility Clinic patients had visited the emergency department at least once in the preceding year, compared with 29.7% in the general patient population (P = .027). When asked if they would be willing to provide their health card number in the future so that it could be linked to health care data for research, 82.5% of Mobility Clinic patients agreed versus 55.0% of those in the general patient population (P = .004). CONCLUSION In this study, patients with disabilities were at a social disadvantage compared with their peers without disabilities and were more likely to use the emergency department, suggesting that they had unmet health needs. Future research should continue to explore this patient population and to investigate if an interprofessional primary health care team approach focused on patients with disabilities can help to increase quality of care.
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Affiliation(s)
- Aisha Lofters
- Scientist with the Centre for Urban Health Solutions of the Li Ka Shing Knowledge Institute at St Michael's Hospital in Toronto, Ont.
| | - Sara Guilcher
- Assistant Professor with the Leslie Dan Faculty of Pharmacy at the University of Toronto
| | - Niraj Maulkhan
- Research assistant with the Centre for Family Medicine Family Health Team at the time of this research
| | - James Milligan
- Family physician with the Centre for Family Medicine Family Health Team
| | - Joseph Lee
- Family physician with the Centre for Family Medicine Family Health Team
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Voruganti T, Moineddin R, Jembere N, Elit L, Grunfeld E, Lofters AK. Comparing stage of diagnosis of cervical cancer at presentation in immigrant women and long-term residents of Ontario: a retrospective cohort study. CMAJ Open 2016; 4:E424-E430. [PMID: 27975046 PMCID: PMC5143024 DOI: 10.9778/cmajo.20160029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Globally, cervical cancer is the fourth most common cancer in women and 7th most common cancer overall. Cervical cancer is highly preventable with screening. Previous work has shown that immigrants are less likely to undergo screening than nonimmigrants in Ontario, Canada. We examined whether immigrant women are more likely to present with later stage cervical cancer than long-term residents of the province. METHODS We conducted a retrospective matched cohort study of women with cervical cancer diagnosed between 2010 and 2014 using provincial administrative health data. We compared the odds of late-stage diagnosis between immigrants and long-term residents, adjusting for socioeconomic measures, comorbidities and health care use. The outcome of interest was stage of cervical cancer diagnosis, defined as early (stage I) or late (stages II-IV). We confirmed results with a cohort of women with cancer diagnosed between 2007 and 2012. RESULTS Complete staging data were available for 218 immigrants and 1348 matched long-term residents. We found no association between immigrant status and stage at diagnosis (adjusted odds ratio [OR] 0.94, 95% confidence interval [CI] 0.63-1.39). Factors that did show significant association with late-stage diagnosis were physician characteristics, whether a woman had previously undergone screening and had visited a gynecologist in the past 3 years. These results were echoed in the 2007-2012 cohort (immigrants v. long-term residents, OR 0.94, 95% CI 0.71-1.20). INTERPRETATION Our results show that being an immigrant is not associated with late-stage diagnosis of cervical cancer in Ontario. Programs broadly aimed at immigrants may require a targeted approach to address higher-risk subgroups.
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Affiliation(s)
- Teja Voruganti
- Institute of Health Policy, Management and Evaluation (Voruganti, Moineddin, Grunfeld); Department of Family and Community Medicine (Moineddin, Grunfeld, Lofters), University of Toronto; Institute of Clinical Evaluative Sciences (Moineddin, Jembere, Lofters), Toronto, Ont.; Department of Obstetrics and Gynecology (Elit), McMaster University, Hamilton, Ont.; Ontario Institute for Cancer Research (Grunfeld), Toronto, Ont.; Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute (Lofters), St. Michaels Hospital, Toronto, Ont
| | - Rahim Moineddin
- Institute of Health Policy, Management and Evaluation (Voruganti, Moineddin, Grunfeld); Department of Family and Community Medicine (Moineddin, Grunfeld, Lofters), University of Toronto; Institute of Clinical Evaluative Sciences (Moineddin, Jembere, Lofters), Toronto, Ont.; Department of Obstetrics and Gynecology (Elit), McMaster University, Hamilton, Ont.; Ontario Institute for Cancer Research (Grunfeld), Toronto, Ont.; Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute (Lofters), St. Michaels Hospital, Toronto, Ont
| | - Nathaniel Jembere
- Institute of Health Policy, Management and Evaluation (Voruganti, Moineddin, Grunfeld); Department of Family and Community Medicine (Moineddin, Grunfeld, Lofters), University of Toronto; Institute of Clinical Evaluative Sciences (Moineddin, Jembere, Lofters), Toronto, Ont.; Department of Obstetrics and Gynecology (Elit), McMaster University, Hamilton, Ont.; Ontario Institute for Cancer Research (Grunfeld), Toronto, Ont.; Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute (Lofters), St. Michaels Hospital, Toronto, Ont
| | - Laurie Elit
- Institute of Health Policy, Management and Evaluation (Voruganti, Moineddin, Grunfeld); Department of Family and Community Medicine (Moineddin, Grunfeld, Lofters), University of Toronto; Institute of Clinical Evaluative Sciences (Moineddin, Jembere, Lofters), Toronto, Ont.; Department of Obstetrics and Gynecology (Elit), McMaster University, Hamilton, Ont.; Ontario Institute for Cancer Research (Grunfeld), Toronto, Ont.; Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute (Lofters), St. Michaels Hospital, Toronto, Ont
| | - Eva Grunfeld
- Institute of Health Policy, Management and Evaluation (Voruganti, Moineddin, Grunfeld); Department of Family and Community Medicine (Moineddin, Grunfeld, Lofters), University of Toronto; Institute of Clinical Evaluative Sciences (Moineddin, Jembere, Lofters), Toronto, Ont.; Department of Obstetrics and Gynecology (Elit), McMaster University, Hamilton, Ont.; Ontario Institute for Cancer Research (Grunfeld), Toronto, Ont.; Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute (Lofters), St. Michaels Hospital, Toronto, Ont
| | - Aisha K Lofters
- Institute of Health Policy, Management and Evaluation (Voruganti, Moineddin, Grunfeld); Department of Family and Community Medicine (Moineddin, Grunfeld, Lofters), University of Toronto; Institute of Clinical Evaluative Sciences (Moineddin, Jembere, Lofters), Toronto, Ont.; Department of Obstetrics and Gynecology (Elit), McMaster University, Hamilton, Ont.; Ontario Institute for Cancer Research (Grunfeld), Toronto, Ont.; Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute (Lofters), St. Michaels Hospital, Toronto, Ont
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49
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Vahabi M, Lofters A, Kumar M, Glazier RH. Breast cancer screening disparities among immigrant women by world region of origin: a population-based study in Ontario, Canada. Cancer Med 2016; 5:1670-86. [PMID: 27105926 PMCID: PMC4944895 DOI: 10.1002/cam4.700] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/05/2016] [Accepted: 02/08/2016] [Indexed: 12/12/2022] Open
Abstract
Rates of mammography screening for breast cancer are disproportionately low in certain subgroups including low-income and immigrant women. The purpose of the study was to examine differences in rates of appropriate breast cancer screening (i.e., screening mammography every 2 years) among Ontario immigrant women by world region of origin and explore the association between appropriate breast cancer screening among these women groups and individual and structural factors. A cohort of 183,332 screening-eligible immigrant women living in Ontario between 2010 and 2012 was created from linked databases and classified into eight world regions of origin. Appropriate screening rates were calculated for each region by age group and selected sociodemographic, immigration, and healthcare-related characteristics. The association between appropriate screening across the eight regions of origin and selected sociodemographic, immigration, and health-related characteristics was explored using multivariate Poisson regression. Screening varied by region of origin, with South Asian women (48.5%) having the lowest and Caribbean and Latin American women (63.7%) the highest cancer screening rates. Factors significantly associated with lower screening across the world regions of origin included living in the lowest income neighborhoods, having a refugee status, being a new immigrant, not having a regular physical examination, not being enrolled in a primary care patient enrollment model, having a male physician, and having an internationally trained physician. Multiple interventions entailing cross-sector collaboration, promotion of patient enrollment models, community engagement, comprehensive and intensive outreach to women, and knowledge translation and transfer to physicians should be considered to address screening disparities among immigrant population. Consideration should be given to design and delivery of culturally appropriate and easily accessible cancer screening programs targeted at high- risk immigrant subgroups, such as women of South Asian origin, refugees, and new immigrants.
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Affiliation(s)
- Mandana Vahabi
- Faculty of Community ServicesDaphne Cockwell School of NursingRyerson UniversityTorontoOntarioCanada
- Graduate Program in Immigration and Settlement StudiesRyerson UniversityTorontoOntarioCanada
- Ryerson Centre for Global Health and Health EquityTorontoOntarioCanada
| | - Aisha Lofters
- Centre for Research on Inner City HealthLi Ka Shing Knowledge InstituteSt. Michael's HospitalTorontoOntarioCanada
- Department of Family and Community MedicineUniversity of TorontoTorontoOntarioCanada
- Department of Family and Community MedicineSt. Michael HospitalTorontoOntarioCanada
- Institute for Clinical Evaluative SciencesTorontoOntarioCanada
| | - Matthew Kumar
- Institute for Clinical Evaluative SciencesTorontoOntarioCanada
| | - Richard H. Glazier
- Centre for Research on Inner City HealthLi Ka Shing Knowledge InstituteSt. Michael's HospitalTorontoOntarioCanada
- Department of Family and Community MedicineUniversity of TorontoTorontoOntarioCanada
- Department of Family and Community MedicineSt. Michael HospitalTorontoOntarioCanada
- Institute for Clinical Evaluative SciencesTorontoOntarioCanada
- Dalla, Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
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