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Marinucci N, Moy N, Koloski N, Shah A, Austin G, Russell-Bennett R, McGraw J, Dulleck U, Holtmann G. Social determinants and participation in fecal occult blood test based colorectal cancer screening: A qualitative systematic review and meta-synthesis. Health Promot J Austr 2024; 35:9-36. [PMID: 37039425 DOI: 10.1002/hpja.732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 03/07/2023] [Accepted: 04/04/2023] [Indexed: 04/12/2023] Open
Abstract
ISSUE ADDRESSED Colorectal cancer (CRC) screening through fecal occult blood testing (FOBT) has saved thousands of lives globally with multiple countries adopting comprehensive population wide screening programs. Participation rates in FOBT based CRC screening for the socially and economically disadvantaged remains low. The aim of this systematic review is to explore empirical evidence that will guide targeted interventions to improve participation rates within priority populations. METHODS PubMed, Embase, Scopus, Cinahl and PsycInfo were systematically searched from inception to 22 June 2022. Eligible studies contained qualitative evidence identifying barriers to FOBT based CRC screening for populations impacted by the social determinants of health. An inductive thematic synthesis approach was applied using grounded theory methodology, to explore descriptive themes and interpret these into higher order analytical constructs and theories. RESULTS A total of 8,501 publications were identified and screened. A total of 48 studies from 10 countries were eligible for inclusion, representing 2,232 subjects. Coding within included studies resulted in 30 key descriptive themes with a thematic frequency greater than 10%. Coded themes applied to four overarching, interconnected barriers driving inequality for priority populations: social, behavioural, economic and technical/interfaces. SO WHAT?: This study has highlighted the need for stronger patient/provider relationships to mitigate barriers to FOBT screening participation for diverse groups. Findings can assist health professionals and policy makers address the systemic exclusion of priority populations in cancer screening by moving beyond the responsibility of the individual to a focus on addressing the information asymmetry driving low value perceptions.
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Affiliation(s)
- Nicole Marinucci
- Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- University of Queensland, Faculty of Medicine, Herston, Queensland, Australia
| | - Naomi Moy
- Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Behavioural Economics, Society and Technology (BEST), Queensland University of Technology, Brisbane, Queensland, Australia
| | - Natasha Koloski
- Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- University of Queensland, Faculty of Medicine, Herston, Queensland, Australia
| | - Ayesha Shah
- Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- University of Queensland, Faculty of Medicine, Herston, Queensland, Australia
| | - Glenn Austin
- Queensland Health, Cancer Screening Unit, Herston, Queensland, Australia
| | - Rebekah Russell-Bennett
- Centre for Behavioural Economics, Society and Technology (BEST), Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jacquie McGraw
- Centre for Behavioural Economics, Society and Technology (BEST), Queensland University of Technology, Brisbane, Queensland, Australia
| | - Uwe Dulleck
- Centre for Behavioural Economics, Society and Technology (BEST), Queensland University of Technology, Brisbane, Queensland, Australia
- Crawford School of Public Policy, ANU and CESifo LMU, Munich, Australia
| | - Gerald Holtmann
- Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- University of Queensland, Faculty of Medicine, Herston, Queensland, Australia
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Buchwald DS, Bassett DR, Van Dyke ER, Harris RM, Hanson JD, Tu SP. "Sorry for laughing, but it's scary": humor and silence in discussions of Colorectal Cancer with Urban American Indians. BMC Cancer 2023; 23:1036. [PMID: 37884866 PMCID: PMC10601143 DOI: 10.1186/s12885-023-11245-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/01/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Given high rates of cancer mortality in Native communities, we examined how urban American Indian and Alaska Native elders talk about colorectal cancer (CRC) and CRC screening. METHODS We conducted seven focus groups with a total of 46 participants in two urban clinics in the Pacific Northwest to assess participant awareness, perceptions, and concerns about CRC and CRC screening. Using speech codes theory, we identified norms that govern when and how to talk about CRC in this population. RESULTS Our analyses revealed that male participants often avoided screening because they perceived it as emasculating, whereas women often avoided screening because of embarrassment and past trauma resulting from sexual abuse. Both men and women used humor to mitigate the threatening nature of discussions about CRC and CRC screening. CONCLUSIONS We offer our analytic results to assist others in developing culturally appropriate interventions to promote CRC screening among American Indians and Alaska Natives.
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Affiliation(s)
- Dedra S. Buchwald
- Institute for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Seattle, WA 98101 USA
| | - Deborah R. Bassett
- Department of Communication, University of West Florida, 11000 University Parkway, Pensacola, FL 32514 USA
| | | | - Raymond M. Harris
- Institute for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Seattle, WA 98101 USA
| | - Jessica D. Hanson
- Department of Applied Human Sciences, University of Minnesota Duluth, 1216 Ordean Court, Duluth, MN 55812 USA
| | - Shin-Ping Tu
- Division of General Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VG 23298 USA
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Lew JB, Feletto E, Worthington J, Roder D, Canuto K, Miller C, D’Onise K, Canfell K. The potential for tailored screening to reduce bowel cancer mortality for Aboriginal and Torres Strait Islander peoples in Australia: modelling study. J Cancer Policy 2022; 32:100325. [DOI: 10.1016/j.jcpo.2022.100325] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 01/28/2022] [Accepted: 02/06/2022] [Indexed: 12/13/2022]
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Hanly SD, Kanagaretnam H, Katti S, Sivapalan G, Wong TLH, Bailey J. Colorectal cancer screening: A pilot study investigating participation in and barriers to screening in rural New South Wales. Aust J Rural Health 2021; 30:291-297. [PMID: 34939716 DOI: 10.1111/ajr.12825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 10/20/2021] [Accepted: 10/29/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Sean Denis Hanly
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Harsan Kanagaretnam
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Shobhana Katti
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Gajanth Sivapalan
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Timothy Lung Hon Wong
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Jannine Bailey
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
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Mosquera I, Mendizabal N, Martín U, Bacigalupe A, Aldasoro E, Portillo I. Inequalities in participation in colorectal cancer screening programmes: a systematic review. Eur J Public Health 2021; 30:416-425. [PMID: 32361732 DOI: 10.1093/eurpub/ckz236] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is a major public health problem due to its incidence and mortality. Screening programmes help decrease its impact on the population through early detection. However, the uneven distribution of social determinants of health can cause inequalities. The aim of this study is to identify the social inequalities in the participation in CRC screening programmes. METHODS A systematic review of the literature was carried out, searching in both health and social databases for papers published since 2000 in English, Spanish, Portuguese and French. The search strategies combined terms regarding screening, CRC, participation and social inequalities. Included papers were quantitative or qualitative primary studies analyzing gender and socioeconomic inequalities in the participation in CRC screening programmes implemented by public and private health-care providers and addressing 45- to 75-year-old population. RESULTS A total of 96 studies, described in 102 articles, were included. Most were quantitative observational studies and analyzed population-based screening programmes. They were carried out mainly in the UK (n=29) and the USA (n=18). Participation in screening programmes varied from 1.1% to 82.8% using several methods. A total of 87 studies assessed participation by sex and one focussed on men, but only two provided an analysis from a gender perspective. Although men are at a higher risk of developing CRC, they generally were less likely to participate in screening programmes. Screening attendance was higher among the least deprived areas. CONCLUSIONS Gender and socioeconomic inequalities in CRC screening participation should be addressed through the design of tailored interventions with a multidimensional focus.
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Affiliation(s)
- Isabel Mosquera
- Cirugía Computacional, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain.,Department of Sociology 2, Social and Communication Sciences Faculty, University of the Basque Country UPV-EHU, Leioa, Bizkaia, Spain.,OPIK - Research Group on Social Determinants of Health and Demographic Change, Leioa, Bizkaia, Spain
| | - Nere Mendizabal
- Integración de la Prevención y Promoción de la Salud en la Práctica Clínica, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Unai Martín
- Department of Sociology 2, Social and Communication Sciences Faculty, University of the Basque Country UPV-EHU, Leioa, Bizkaia, Spain.,OPIK - Research Group on Social Determinants of Health and Demographic Change, Leioa, Bizkaia, Spain
| | - Amaia Bacigalupe
- Department of Sociology 2, Social and Communication Sciences Faculty, University of the Basque Country UPV-EHU, Leioa, Bizkaia, Spain.,OPIK - Research Group on Social Determinants of Health and Demographic Change, Leioa, Bizkaia, Spain
| | - Elena Aldasoro
- Ministry of Health of the Basque Government, Office of Public Health and Addictions, Vitoria-Gasteiz, Araba, Spain
| | - Isabel Portillo
- Cirugía Computacional, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain.,Osakidetza Basque Health Service, Colorectal Cancer Screening Programme, Bilbao, Bizkaia, Spain
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Averbach P, Ferrari AP, Toscano CM, Borges JL, Averbach M. Implementation and results of a gastrointestinal cancer screening program in an Amazon rainforest village: A descriptive study. Endosc Int Open 2021; 9:E770-E776. [PMID: 34079857 PMCID: PMC8159593 DOI: 10.1055/a-1386-2095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 01/04/2021] [Indexed: 11/22/2022] Open
Abstract
Background and study aims Gastrointestinal cancer is an important cause of death worldwide. Remote populations are especially vulnerable to these conditions due to reduced access to screening and adequate treatment. In this context, the Belterra project was designed as a pilot taskforce to deliver gastrointestinal screening to an underserved Amazonian population and to spread knowledge and practice to local health workers. This study aimed to describe the implementation and present the results of the Belterra Project. Patients and methods The project took place between October 2014 and December 2017 in Belterra, Pará, Brazil. Public-private partnerships were obtained and were essential for funding. The project required complex logistic solutions to provide gastrointestinal screening to every inhabitant between 50 and 70 years of age, including medical equipment and personal transportation to a remote area. Subjects were asked about their medical history, and received a physical examination, endoscopic examinations, and stool tests. Results Over the course of 19 expeditions, we screened 2,022 inhabitants of Belterra, aged 50 to 70 years. Five colorectal and six gastric adenocarcinomas were diagnosed, as were several lower-stage lesions. Overall, 26 % of the participants undergoing colonoscopy showed some type of colonic lesion. Conclusions Notwithstanding the geographical, cultural, and financial barriers, this study suggests that the implementation of a gastrointestinal cancer screening program for remote Brazilian populations is feasible, reaching high adherence. Although logistics is very demanding, such campaigns may be a good strategy to provide mass gastrointestinal cancer screening for underserved populations.
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Affiliation(s)
- Pedro Averbach
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | | | - Cristiana M Toscano
- Departamento de Saúde Coletiva, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Brazil
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D'Onise K, Iacobini ET, Canuto KJ. Colorectal cancer screening using faecal occult blood tests for Indigenous adults: A systematic literature review of barriers, enablers and implemented strategies. Prev Med 2020; 134:106018. [PMID: 32057956 DOI: 10.1016/j.ypmed.2020.106018] [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: 08/08/2019] [Revised: 02/02/2020] [Accepted: 02/07/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Colorectal cancer (CRC) screening using a Faecal Occult Blood Test (FOBT) is a well-established population intervention to reduce mortality and morbidity of CRC. As Indigenous people are not fully benefiting from the screening programs, a greater understanding of barriers and enablers affecting participation is needed. METHODS Searches were carried out in PubMed, Embase, Sociological Abstracts, Scopus, CINAHL, and selected websites. Both qualitative and quantitative studies related to Indigenous populations of Canada, New Zealand, Australia and the United States of America were assessed for quality and data related to FOBT were extracted and synthetised. RESULTS A total of 375 publications were identified and screened against the inclusion/exclusion criteria. Thirty-four studies were included in the review. The barriers for participation in CRC screening included the lack of culturally competent health service access, particularly access to Indigenous health service providers. Medical discrimination, long-standing distrust in Western medicine and/or health staff and screening tests were all identified as barriers for Indigenous people. There were a small number of promising interventions to improve participation, which could be considered on a broader scale to increase overall participation by Indigenous people in CRC screening. CONCLUSIONS The review identified barriers and possible enablers for Indigenous participation in the CRC screening program, some which appear to be unique to Indigenous people. Further intervention studies conducted in partnership with Indigenous communities are needed to improve participation.
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Affiliation(s)
- Katina D'Onise
- Prevention and Population Health Directorate, Wellbeing SA, Citi Centre Building, 11 Hindmarsh Square, Adelaide, South Australia, Australia. Katina.D'
| | | | - Karla Joy Canuto
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia, Australia.
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Abstract
Background: No studies have examined the frequency of thyroid screening in the Canadian population, and whether thyroid screening and medication use vary by sex, race, income, and preexisting health conditions. Methods: Using data from the 2011, 2012 cycles of the Canadian Community Health Survey, we report rates of thyroid screening among Quebec residents ≥35 (n=7024) and rates of thyroid medication use among Quebec residents ≥35 (n=16,081). We examine variations in medication use and screening by sex, age, race, immigration status, access to a regular doctor, and health conditions that have been linked to thyroid disease. Results: Of the Quebec residents ≥35, 10.3% reported taking thyroid medication and 0.4% reported that the last blood test a physician ordered was to check for a new thyroid condition. Canadian-born residents and those who identified as White reported higher medication use and screening rates, compared to immigrants and those who identified as visible minorities. Racial disparities were especially pronounced, with White Quebec residents reporting three times greater odds of thyroid screening than visible minorities. The strongest predictors of both thyroid medication use and screening were access to a regular doctor. Despite women being eight times more likely to suffer from thyroid disease, women were not significantly more likely to be screened, compared to men (odds ratio=1.38, 95% confidence interval: 0.74–2.60). Discussion: Strategies are needed to decrease disparities in thyroid screening and medication use. Interventions that target health systems (e.g., increasing physician supply), providers (continuing professional education modules about thyroid disease for family physicians), and recipients of care (multilanguage public awareness campaigns and posters at walk-in clinics that describe common symptoms of different thyroid disorders) should be implemented and tested.
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Affiliation(s)
- Kathrin Stoll
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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van Gaans D, Dent E. Issues of accessibility to health services by older Australians: a review. Public Health Rev 2018; 39:20. [PMID: 30027001 PMCID: PMC6047130 DOI: 10.1186/s40985-018-0097-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 04/18/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This review provides an in-depth investigation into the difficulties facing older Australians when accessing health care services. METHODS A literature search was conducted in December 2016 using Academic Premier to identify relevant publications. Key search terms were accessibility, health service, older people and Australia. Papers published between 1999 and 2016 were included. Statements of accessibility were extracted and then grouped using the five dimensions of accessibility by Penchansky and Thomas (1981): availability, accessibility, accommodation, affordability and acceptability. RESULTS Forty-one papers were included. Availability issues identified were inadequate health care services, particularly for culturally and linguistically diverse (CALD) populations and those residing in rural areas. Accessibility issues included difficulties accessing transport to health care services, which in turn restricted choice of appointment time. Issues of accommodation identified were long waiting times for appointments with both general practitioners and medical specialists. Affordability was a common problem, compounded by multi-morbidity requiring high health care use. Issues of acceptability centred on the role of the family, feelings of shame when receiving care from a non-family member, traditional practices and gender sensitivity. CONCLUSIONS The contribution of factors to health service accessibility varies according to an older person's geographical local and their accessibility to transport, as well as their level of multi-morbidity and cultural background. Improving access to health services could be improved by matching services to the population that they serve.
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Affiliation(s)
- Deborah van Gaans
- Centre for Population Health Research, School of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, South Australia Australia
| | - Elsa Dent
- Centre for Positive Ageing and Wellbeing, Torrens University Australia, Adelaide, South Australia Australia
- Baker Heart and Diabetes Research Institute, Melbourne, Victoria Australia
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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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Champion C, Alvarez GG, Affleck E, Kuziemsky C. A systems perspective on rural and remote colorectal cancer screening access. J Cancer Policy 2017. [DOI: 10.1016/j.jcpo.2017.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Versace VL, Forsyth AD, Vaughan R, Morrice MG, Morphett BJ. Evidence of elevated colorectal cancer and adenoma rates for regional National Bowel Cancer Screening Program participants. Aust J Rural Health 2017; 26:63-64. [PMID: 28776860 DOI: 10.1111/ajr.12365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Vincent L. Versace
- Deakin Rural Health; Deakin University Faculty of Health; Warrnambool Victoria Australia
| | - Anton D. Forsyth
- Deakin Rural Health; Deakin University Faculty of Health; Warrnambool Victoria Australia
| | - Rose Vaughan
- Department of Medicine; South West Healthcare; Warrnambool Victoria Australia
- Warrnambool Community Health; South West Healthcare; Warrnambool Victoria Australia
| | - Margie G. Morrice
- Warrnambool Community Health; South West Healthcare; Warrnambool Victoria Australia
- Life and Environmental Sciences; Deakin University; Warrnambool Victoria Australia
| | - Barry J. Morphett
- Warrnambool Clinical School; Deakin University; Warrnambool Victoria Australia
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13
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Hofmann B. Ethical issues with colorectal cancer screening-a systematic review. J Eval Clin Pract 2017; 23:631-641. [PMID: 28026076 DOI: 10.1111/jep.12690] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/16/2016] [Accepted: 11/16/2016] [Indexed: 12/26/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Colorectal cancer (CRC) screening is widely recommended and implemented. However, sometimes CRC screening is not implemented despite good evidence, and some types of CRC screening are implemented despite lack of evidence. The objective of this article is to expose and elucidate relevant ethical issues in the literature on CRC screening that are important for open and transparent deliberation on CRC screening. METHODS An axiological question-based method is used for exposing and elucidating ethical issues relevant in HTA. A literature search in MEDLINE, Embase, PsycINFO, PubMed Bioethics subset, ISI Web of Knowledge, Bioethics Literature Database (BELIT), Ethics in Medicine (ETHMED), SIBIL Base dati di bioetica, LEWI Bibliographic Database on Ethics in the Sciences and Humanities, and EUROETHICS identified 870 references of which 114 were found relevant according to title and abstract. The content of the included papers were subject to ethical analysis to highlight the ethical issues, concerns, and arguments. RESULTS A wide range of important ethical issues were identified. The main benefits are reduced relative CRC mortality rate, and potentially incidence rate, but there is no evidence of reduced absolute mortality rate. Potential harms are bleeding, perforation, false test results, overdetection, overdiagnosis, overtreatment (including unnecessary removal of polyps), and (rarely) death. Other important issues are related to autonomy and informed choice equity, justice, medicalization, and expanding disease. CONCLUSION A series of important ethical issues have been identified and need to be addressed in open and transparent deliberation on CRC screening.
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Affiliation(s)
- Bjørn Hofmann
- Department of Health Science, the Norwegian University for Science and Technology, Gjøvik, Norway.,The Centre of Medical Ethics at the University of Oslo, Norway
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Cullerton K, Gallegos D, Ashley E, Do H, Voloschenko A, Fleming M, Ramsey R, Gould T. Cancer screening education: can it change knowledge and attitudes among culturally and linguistically diverse communities in Queensland, Australia? Health Promot J Austr 2016; 27:140-147. [PMID: 27376437 DOI: 10.1071/he15116] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 04/11/2016] [Indexed: 11/23/2022] Open
Abstract
Issue addressed: Screening for cancer of the cervix, breast and bowel can reduce morbidity and mortality. Low participation rates in cancer screening have been identified among migrant communities internationally. Attempting to improve low rates of cancer screening, the Ethnic Communities Council of Queensland developed a pilot Cancer Screening Education Program for breast, bowel and cervical cancer. This study determines the impact of education sessions on knowledge, attitudes and intentions to participate in screening for culturally and linguistically diverse (CALD) communities living in Brisbane, Queensland.Methods: Seven CALD groups (Arabic-speaking, Bosnian, South Asian (including Indian and Bhutanese), Samoan and Pacific Island, Spanish-speaking, Sudanese and Vietnamese) participated in a culturally-tailored cancer screening education pilot program that was developed using the Health Belief Model. A pre- and post-education evaluation session measured changes in knowledge, attitudes and intention related to breast, bowel and cervical cancer and screening. The evaluation focussed on perceived susceptibility, perceived seriousness and the target population's beliefs about reducing risk by cancer screening.Results: There were 159 participants in the three cancer screening education sessions. Overall participants' knowledge increased, some attitudes toward participation in cancer screening became more positive and intent to participate in future screening increased (n=146).Conclusion: These results indicate the importance of developing screening approaches that address the barriers to participation among CALD communities and that a culturally-tailored education program is effective in improving knowledge, attitudes about and intentions to participate in cancer screening.So what?: It is important that culturally-tailored programs are developed in conjunction with communities to improve health outcomes.
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Affiliation(s)
- Katherine Cullerton
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Qld 4059, Australia
| | - Danielle Gallegos
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Qld 4059, Australia
| | - Ella Ashley
- Ethnic Communities Council of Queensland, 253 Boundary Street, West End, Qld 4101, Australia
| | - Hong Do
- Ethnic Communities Council of Queensland, 253 Boundary Street, West End, Qld 4101, Australia
| | - Anna Voloschenko
- Ethnic Communities Council of Queensland, 253 Boundary Street, West End, Qld 4101, Australia
| | - MaryLou Fleming
- School of Public Health and Social Work, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Qld 4059, Australia
| | - Rebecca Ramsey
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Qld 4059, Australia
| | - Trish Gould
- School of Public Health and Social Work, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Qld 4059, Australia
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Honein-AbouHaidar GN, Kastner M, Vuong V, Perrier L, Daly C, Rabeneck L, Straus S, Baxter NN. Systematic Review and Meta-study Synthesis of Qualitative Studies Evaluating Facilitators and Barriers to Participation in Colorectal Cancer Screening. Cancer Epidemiol Biomarkers Prev 2016; 25:907-17. [PMID: 27197277 DOI: 10.1158/1055-9965.epi-15-0990] [Citation(s) in RCA: 173] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 03/31/2016] [Indexed: 11/16/2022] Open
Abstract
Screening reduces the incidence, morbidity, and mortality of colorectal cancer, yet participation tends to be low. We undertook a systematic review and meta-study synthesis of qualitative studies to identify facilitators and barriers to colorectal cancer screening participation. We searched major bibliographic databases for records published in all languages from inception to February 2015. Included primary studies that elicited views and perceptions towards colorectal cancer screening were appraised for relevance and quality. We used a two-stage synthesis to create an interpretation of colorectal cancer screening decisions grounded in primary studies; a thematic analysis to group themes and systematically compare studies and a meta-synthesis to generate an expanded theory of colorectal cancer screening participation. Ninety-four studies were included. The decision to participate in colorectal cancer screening depended on an individual's awareness of colorectal cancer screening. Awareness affected views of cancer, attitudes towards colorectal cancer screening modalities, and motivation for screening. Factors mediating awareness included public education to address misconceptions, primary care physician efforts to recommend screening, and the influence of friends and family. Specific barriers to participation in populations with lower participation rates included language barriers, logistical challenges to attending screening tests, and cultural beliefs. This study identifies key barriers, facilitators, and mediators to colorectal cancer screening participation. Cancer Epidemiol Biomarkers Prev; 25(6); 907-17. ©2016 AACR.
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Affiliation(s)
| | - Monika Kastner
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Vincent Vuong
- Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Laure Perrier
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Corinne Daly
- Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | | | - Sharon Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Nancy N Baxter
- Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.
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Ward PR, Coffey C, Javanparast S, Wilson C, Meyer SB. Institutional (mis)trust in colorectal cancer screening: a qualitative study with Greek, Iranian, Anglo-Australian and Indigenous groups. Health Expect 2015; 18:2915-27. [PMID: 25271975 PMCID: PMC5810636 DOI: 10.1111/hex.12276] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2014] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Colorectal cancer (CRC) has the second highest cancer mortality rate in Australia. The Australian National Bowel Cancer Screening Program (NBCSP) aims to increase early detection of CRC by offering free Faecal Occult Blood Testing (FOBT), although uptake is low for culturally and linguistically diverse (CALD) groups. AIM OF PAPER To present data on trust and mistrust in the NBCSP by population groups with low uptake and thus to highlight areas in need of policy change. METHODS A qualitative study was undertaken in South Australia, involving interviews with 94 people from four CALD groups: Greek, Iranian, Anglo-Australian, and Indigenous peoples. RESULTS Our study highlights the complexities of institutional trust, which involves considerations of trust at interpersonal, local and national levels. In addition, trust and mistrust was found in more abstract systems such as the medical knowledge of doctors to diagnose or treat cancer or the scientific procedures in laboratories to test the FOBTs. The object of institutional (mis)trust differed between cultural groups - Anglo-Australian and Iranian groups indicated a high level of trust in the government, whereas Indigenous participants were much less trusting. CONCLUSION The level and nature of trust in the screening process varied between the CALD groups. Addressing program misconceptions, clarifying the FOBT capabilities and involving medical services in collecting and transporting the samples may increase trust in the NBCSP. However, broader and more enduring mistrust in services and institutions may need to be dealt with in order to increase trust and participation.
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Affiliation(s)
- Paul R Ward
- Discipline of Public Health, Flinders University, Adalaide, SA, Australia
| | - Cushla Coffey
- Discipline of Public Health, Flinders University, Adalaide, SA, Australia
| | - Sara Javanparast
- South Australian Community Health Research Unit, Flinders University, Adalaide, SA, Australia
| | - Carlene Wilson
- School of Medicine, Flinders University, Adalaide, SA, Australia
| | - Samantha B Meyer
- Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
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Ward PR, Coffey C, Meyer S. Trust, choice and obligation: a qualitative study of enablers of colorectal cancer screening in South Australia. SOCIOLOGY OF HEALTH & ILLNESS 2015; 37:988-1006. [PMID: 25912247 DOI: 10.1111/1467-9566.12280] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Colorectal cancer (CRC) has the second highest cancer prevalence and mortality rates in Australia. The Australian National Bowel Cancer Screening Program (NBCSP) aims to increase early detection of CRC by offering free faecal occult blood testing. The NBCSP aims to offer choice to consumers about whether or not to participate in screening. This article presents data on trust, choice and perceived obligation to participate in the NBCSP by population groups with low uptake. A qualitative study was undertaken in South Australia. We interviewed 94 people from four culturally distinct groups: Greek, Iranian, Anglo-Australian and Indigenous peoples. This article demonstrates the complexity of factors shaping the choice, or lack thereof, to participate in the NBCSP. Informed choice is based on adequate knowledge, although this varied among our participants, highlighting the need for more health education in appropriate languages. An obligation to participate was found in the Iranian and Anglo-Australian groups and resulted from an established personal relationship with the doctor, a sense of duty, the acknowledgement of government investment and appreciation. Overall, this article makes a link between trust, choice and obligation, adding to literature on the sociology of trust and medical screening and highlighting important issues in the need of a policy and practice to improve CRC screening rates.
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Affiliation(s)
- Paul R Ward
- Discipline of Public Health, Flinders University, Australia
| | - Cushla Coffey
- Discipline of Public Health, Flinders University, Australia
| | - Samantha Meyer
- School of Public Health and Health Systems, Waterloo University, Canada
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Varlow M, Stacey I, Dunlop S, Young J, Kite J, Dessaix A, McAulay C. Self-reported participation and beliefs about bowel cancer screening in New South Wales, Australia. Health Promot J Austr 2014; 25:97-103. [PMID: 25017447 DOI: 10.1071/he13102] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 04/11/2014] [Indexed: 12/28/2022] Open
Abstract
ISSUE ADDRESSED To describe self-reported bowel cancer screening participation, beliefs and attitudes in a sample of New South Wales (NSW) adults, and to identify beliefs and demographic factors associated with self-reported bowel cancer screening participation. METHODS This study used data from the International Cancer Benchmarking Partnership Module 2, a representative population-based telephone survey. Self-reported participation in and beliefs about bowel cancer screening were measured using the Awareness and Beliefs about Cancer survey of people aged 50 years and over living in NSW, Australia (n=2001). Logistic regression modelling was used to identify explanatory variables associated with bowel cancer screening participation. RESULTS Half of all women (54.1%, 95% CI: 50.8-57.4%) and two-thirds of men (65.7%, 95% CI: 61.5-69.9%) reported screening for bowel cancer within the previous 5 years. Believing that screening was only necessary when experiencing symptoms was more likely to be endorsed by people aged 65 years and over (25.5%, 95% CI: 22.2-28.7%) rather than younger (50-64 years; 16.7%, 95% CI: 13.8-19.7%), non-English-speaking migrants (35.4%, 95% CI: 26.7-44.1%) versus others (18.6%, 95% CI: 16.4-20.7%), and people in metropolitan (23.3%, 95% CI: 20.4-26.1%) versus non-metropolitan areas (16.4%, 95% CI: 12.8-20%). People who disagreed that screening was only necessary when experiencing symptoms were four times more likely to report screening participation (OR 3.96, 95% CI: 3.11-5.03). CONCLUSIONS Community education about bowel cancer screening is needed to correct misperceptions regarding screening in the absence of symptoms. Tailored strategies for older, migrant and urban communities may be beneficial. SO WHAT? Education strategies that promote the need for screening in the absence of symptoms and correct misconceptions about bowel cancer screening amongst subgroups of the NSW population may improve screening rates and decrease the burden of bowel cancer in NSW.
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Affiliation(s)
- Megan Varlow
- Cancer Institute NSW, PO Box 41, Alexandria, NSW 1435, Australia
| | - Ingrid Stacey
- Cancer Institute NSW, PO Box 41, Alexandria, NSW 1435, Australia
| | - Sally Dunlop
- Cancer Institute NSW, PO Box 41, Alexandria, NSW 1435, Australia
| | - Jane Young
- Cancer Institute NSW, PO Box 41, Alexandria, NSW 1435, Australia
| | - James Kite
- Cancer Institute NSW, PO Box 41, Alexandria, NSW 1435, Australia
| | - Anita Dessaix
- Cancer Institute NSW, PO Box 41, Alexandria, NSW 1435, Australia
| | - Claire McAulay
- Sydney School of Public Health, The University of Sydney, Edward Ford Building (A27), NSW 2006, Australia
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Russell DJ, Humphreys JS, Ward B, Chisholm M, Buykx P, McGrail M, Wakerman J. Helping policy-makers address rural health access problems. Aust J Rural Health 2014; 21:61-71. [PMID: 23586567 DOI: 10.1111/ajr.12023] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2012] [Indexed: 11/28/2022] Open
Abstract
This paper provides a comprehensive review of the key dimensions of access and their significance for the provision of primary health care and a framework that assists policy-makers to evaluate how well policy targets the dimensions of access. Access to health care can be conceptualised as the potential ease with which consumers can obtain health care at times of need. Disaggregation of the concept of access into the dimensions of availability, geography, affordability, accommodation, timeliness, acceptability and awareness allows policy-makers to identify key questions which must be addressed to ensure reasonable primary health care access for rural and remote Australians. Evaluating how well national primary health care policies target these dimensions of access helps identify policy gaps and potential inequities in ensuring access to primary health care. Effective policies must incorporate the multiple dimensions of access if they are to comprehensively and effectively address unacceptable inequities in health status and access to basic health services experienced by rural and remote Australians.
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Affiliation(s)
- Deborah J Russell
- School of Rural Health, Monash University, Centre of Research Excellence in Rural and Remote Primary Health Care, Bendigo, Victoria, Australia.
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Meyer SB, Luong TCN, Mamerow L, Ward PR. Inequities in access to healthcare: analysis of national survey data across six Asia-Pacific countries. BMC Health Serv Res 2013; 13:238. [PMID: 23816181 PMCID: PMC3734194 DOI: 10.1186/1472-6963-13-238] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 06/21/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence suggests that there is a link between inequitable access to healthcare and inequitable distribution of illness. A recent World Health Organization report stated that there is a need for research and policy to address the critical role of health services in reducing inequities and preventing future inequities. The aim of this manuscript is to highlight disparities and differences in terms of the factors that distinguish between poor and good access to healthcare across six Asia-Pacific countries: Australia, Hong Kong, Japan, South Korea, Taiwan, and Thailand. METHODS A population survey was undertaken in each country. This paper is a secondary analysis of these existing data. Data were collected in each country between 2009 and 2010. Four variables related to difficulties in access to healthcare (distance, appointment, waiting time, and cost) were analysed using binomial logistic regression to identify socio- and demographic predictors of inequity. RESULTS Consistent across the findings, poor health and low income were identified as difficulties in access. Country specific indicators were also identified. For Thailand, the poorest level of access appears to be for respondents who work within the household whereas in Taiwan, part-time work is associated with difficulties in access. Within Hong Kong, results suggest that older (above 60) and retired individuals have the poorest access and within Australia, females and married individuals are the worst off. CONCLUSION Recognition of these inequities, from a policy perspective, is essential for health sector policy decision-making. Despite the differences in political and economic climate in the countries under analysis, our findings highlight patterns of inequity which require policy responses. Our data should be used as a means of deciding the most appropriate policy response for each country which includes, rather than excludes, socially marginalised population groups. These findings should be of interest to those involved in health policy, but also in policy more generally because as we have identified, access to health care is influenced by determinants outside of the health system.
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Affiliation(s)
- Samantha B Meyer
- Discipline of Public Health, Flinders University, Sturt Road, Bedford Park, South Australia 5042, Australia
| | - Tini CN Luong
- Discipline of Public Health, Flinders University, Sturt Road, Bedford Park, South Australia 5042, Australia
| | - Loreen Mamerow
- Discipline of Public Health, Flinders University, Sturt Road, Bedford Park, South Australia 5042, Australia
| | - Paul R Ward
- Discipline of Public Health, Flinders University, Sturt Road, Bedford Park, South Australia 5042, Australia
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Javanparast S, Ward PR, Carter SM, Wilson CJ. Barriers to and facilitators of colorectal cancer screening in different population subgroups in Adelaide, South Australia. Med J Aust 2012; 196:521-3. [PMID: 22571311 DOI: 10.5694/mja11.10701] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To identify barriers to and facilitators of colorectal cancer (CRC) screening participation among different cultural subgroups in South Australia, and to describe how these might be shared or be distinct across these groups. DESIGN, PARTICIPANTS AND SETTING Qualitative study using individual interviews in Adelaide, South Australia, between July 2009 and December 2010. Participants were recruited from five culturally distinct groups in SA (Greek, Vietnamese, Iranian, Indigenous and Anglo-Australian) and included people who had participated in CRC screening and people who had not. MAIN OUTCOME MEASURES Factors that may act as barriers to or enablers of CRC screening. RESULTS We interviewed 121 people. Members of all groups expressed positive attitudes towards cancer screening. However, we also noted a lack of knowledge about bowel cancer and its screening tests across all groups, and that the tests were viewed as unpleasant. Issues that differed across groups included language barriers, fatalistic views about cancer, embarrassment, the importance of privacy, the significance of a doctor's recommendation, moral obligations, and culture-specific concerns. CONCLUSIONS This study suggests that population-based screening programs may need to be modified to facilitate access and participation among minority populations and Indigenous people if equity in screening is to be achieved.
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