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Belon AP, McKenzie E, Teare G, Nykiforuk CIJ, Nieuwendyk L, Kim MO, Lee B, Adhikari K. Effective strategies for Fecal Immunochemical Tests (FIT) programs to improve colorectal cancer screening uptake among populations with limited access to the healthcare system: a rapid review. BMC Health Serv Res 2024; 24:128. [PMID: 38263112 PMCID: PMC10807065 DOI: 10.1186/s12913-024-10573-4] [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: 07/25/2023] [Accepted: 01/06/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is one of the leading causes of cancer death globally. CRC screening can reduce the incidence and mortality of CRC. However, socially disadvantaged groups may disproportionately benefit less from screening programs due to their limited access to healthcare. This poor access to healthcare services is further aggravated by intersecting, cumulative social factors associated with their sociocultural background and living conditions. This rapid review systematically reviewed and synthesized evidence on the effectiveness of Fecal Immunochemical Test (FIT) programs in increasing CRC screening in populations who do not have a regular healthcare provider or who have limited healthcare system access. METHODS We used three databases: Ovid MEDLINE, Embase, and EBSCOhost CINAHL. We searched for systematic reviews, meta-analysis, and quantitative and mixed-methods studies focusing on effectiveness of FIT programs (request or receipt of FIT kit, completion rates of FIT screening, and participation rates in follow-up colonoscopy after FIT positive results). For evidence synthesis, deductive and inductive thematic analysis was conducted. The findings were also classified using the Cochrane Methods Equity PROGRESS-PLUS framework. The quality of the included studies was assessed. RESULTS Findings from the 25 included primary studies were organized into three intervention design-focused themes. Delivery of culturally-tailored programs (e.g., use of language and interpretive services) were effective in increasing CRC screening. Regarding the method of delivery for FIT, specific strategies combined with mail-out programs (e.g., motivational screening letter) or in-person delivery (e.g., demonstration of FIT specimen collection procedure) enhanced the success of FIT programs. The follow-up reminder theme (e.g., spaced out and live reminders) were generally effective. Additionally, we found evidence of the social determinants of health affecting FIT uptake (e.g., place of residence, race/ethnicity/culture/language, gender and/or sex). CONCLUSIONS Findings from this rapid review suggest multicomponent interventions combined with tailored strategies addressing the diverse, unique needs and priorities of the population with no regular healthcare provider or limited access to the healthcare system may be more effective in increasing FIT screening. Decision-makers and practitioners should consider equity and social factors when developing resources and coordinating efforts in the delivery and implementation of FIT screening strategies.
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Affiliation(s)
- Ana Paula Belon
- Centre for Healthy Communities, School of Public Health, University of Alberta, Edmonton, Canada
| | - Emily McKenzie
- Provincial Population and Public Health, Alberta Health Services, Calgary, Canada
- Department of Community Health Sciences, Cummings School of Medicine, University of Calgary, Calgary, Canada
- Health Evidence and Impact, Alberta Health Services, Calgary, Canada
| | - Gary Teare
- Provincial Population and Public Health, Alberta Health Services, Calgary, Canada
- Department of Community Health Sciences, Cummings School of Medicine, University of Calgary, Calgary, Canada
| | - Candace I J Nykiforuk
- Centre for Healthy Communities, School of Public Health, University of Alberta, Edmonton, Canada
| | - Laura Nieuwendyk
- Centre for Healthy Communities, School of Public Health, University of Alberta, Edmonton, Canada
| | - Minji Olivia Kim
- Centre for Healthy Communities, School of Public Health, University of Alberta, Edmonton, Canada
| | - Bernice Lee
- Centre for Healthy Communities, School of Public Health, University of Alberta, Edmonton, Canada
| | - Kamala Adhikari
- Provincial Population and Public Health, Alberta Health Services, Calgary, Canada.
- Department of Community Health Sciences, Cummings School of Medicine, University of Calgary, Calgary, Canada.
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Jessiman-Perreault G, Law J, Adhikari K, Machado AA, Moysey B, Xu L, Yang H, Scott LKA, Teare G, Li A. Geospatial analysis and participant characteristics associated with colorectal cancer screening participation in Alberta, Canada: a population-based cross-sectional study. BMC Health Serv Res 2023; 23:1454. [PMID: 38129826 PMCID: PMC10740253 DOI: 10.1186/s12913-023-10486-8] [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: 03/28/2023] [Accepted: 12/16/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is a leading cause of death in Canada and early detection can prevent deaths through screening. However, CRC screening in Alberta, Canada remains suboptimal and varies by sociodemographic and health system characteristics, as well as geographic location. This study aimed to further the understanding of these participant and health system characteristics associated with CRC screening in Alberta and identify clusters of regions with higher rates of overdue or unscreened individuals. METHODS We included Albertans aged 52 to 74 as of December 31, 2019 (index date) and we used data from administrative health data sources and linked to the Alberta Colorectal Cancer Screening Program database to determine colorectal cancer screening rates. We used multivariable multinomial logistic regression analysis to investigate the relationship between sociodemographic, health system characteristics and participation in CRC screening. We used optimized Getis-Ord Gi* hot-spot analysis to identify hot and cold-spots in overdue for and no record of CRC screening. RESULTS We included 919,939 Albertans, of which 65% were currently up to date on their CRC screening, 21% were overdue, and 14% had no record of CRC screening. Compared to Albertans who were currently up to date, those who were in older age groups, those without a usual provider of care, those who were health system non-users, and those living in more deprived areas were more likely to have no record of screening. Areas with high number of Albertans with no record of screening were concentrated in the North and Central zones. CONCLUSIONS Our study showed important variation in colorectal cancer screening participation across sociodemographic, health system and geographical characteristics and identified areas with higher proportions of individuals who have no record of screening or are under-screened in Alberta, Canada.
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Affiliation(s)
- Geneviève Jessiman-Perreault
- Provincial Population and Public Health, Alberta Health Services, Holy Cross Centre, 2210 2 St SW, Calgary, AB, T2S 3C3, Canada
| | - Jessica Law
- Provincial Population and Public Health, Alberta Health Services, Holy Cross Centre, 2210 2 St SW, Calgary, AB, T2S 3C3, Canada
| | - Kamala Adhikari
- Provincial Population and Public Health, Alberta Health Services, Holy Cross Centre, 2210 2 St SW, Calgary, AB, T2S 3C3, Canada.
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
| | - Amanda Alberga Machado
- Provincial Population and Public Health, Alberta Health Services, Holy Cross Centre, 2210 2 St SW, Calgary, AB, T2S 3C3, Canada
| | - Barbara Moysey
- Screening Programs, Provincial Population and Public Health, Alberta Health Services, Holy Cross Centre, 2210 2 St SW, Calgary, AB, T2S 3C3, Canada
| | - Linan Xu
- Screening Programs, Provincial Population and Public Health, Alberta Health Services, Holy Cross Centre, 2210 2 St SW, Calgary, AB, T2S 3C3, Canada
| | - Huiming Yang
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- Screening Programs, Provincial Population and Public Health, Alberta Health Services, Holy Cross Centre, 2210 2 St SW, Calgary, AB, T2S 3C3, Canada
| | - Lisa K Allen Scott
- Provincial Population and Public Health, Alberta Health Services, Holy Cross Centre, 2210 2 St SW, Calgary, AB, T2S 3C3, Canada
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- Department of Oncology, University of Calgary, 1331 29th Street NW, Calgary, AB, T2N 4N2, Canada
| | - Gary Teare
- Provincial Population and Public Health, Alberta Health Services, Holy Cross Centre, 2210 2 St SW, Calgary, AB, T2S 3C3, Canada
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Alvin Li
- Provincial Population and Public Health, Alberta Health Services, Holy Cross Centre, 2210 2 St SW, Calgary, AB, T2S 3C3, Canada
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