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Zhang L, Jiang S. Examining the Role of Information Behavior in Linking Cancer Risk Perception and Cancer Worry to Cancer Fatalism in China: Cross-Sectional Survey Study. J Med Internet Res 2024; 26:e49383. [PMID: 38819919 PMCID: PMC11179024 DOI: 10.2196/49383] [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: 05/26/2023] [Revised: 10/27/2023] [Accepted: 04/25/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Reducing cancer fatalism is essential because of its detrimental impact on cancer-related preventive behaviors. However, little is known about factors influencing individuals' cancer fatalism in China. OBJECTIVE With a general basis of the extended parallel process model, this study aims to examine how distinct cancer-related mental conditions (risk perception and worry) and different information behaviors (information seeking vs avoidance) become associated with cancer fatalism, with an additional assessment of the moderating effect of information usefulness. METHODS Data were drawn from the Health Information National Trends Survey in China, which was conducted in 2017 (N=2358). Structural equation modeling and bootstrapping methods were performed to test a moderated mediation model and hypothesized relationships. RESULTS The results showed that cancer risk perception and cancer worry were positively associated with online health information seeking. In addition, cancer worry was positively related to cancer information avoidance. Moreover, online health information seeking was found to reduce cancer fatalism, while cancer information avoidance was positively associated with cancer fatalism. The results also indicated that the perceived usefulness of cancer information moderated this dual-mediation pathway. CONCLUSIONS The national survey data indicate that cancer mental conditions should not be treated as homogeneous entities, given their varying functions and effects. Apart from disseminating useful cancer information to encourage individuals to adaptively cope with cancer threats, we advocate for health communication programs to reduce cancer information avoidance to alleviate fatalistic beliefs about cancer prevention.
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Affiliation(s)
- Lianshan Zhang
- School of Media and Communication, Shanghai Jiao Tong University, Shanghai, China
| | - Shaohai Jiang
- Department of Communications and New Media, National University of Singapore, Singapore, Singapore
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Schmeising-Barnes N, Waller J, Marlow LAV. Attitudes to multi-cancer early detection (MCED) blood tests for population-based screening: A qualitative study in Great Britain. Soc Sci Med 2024; 347:116762. [PMID: 38520825 DOI: 10.1016/j.socscimed.2024.116762] [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: 11/07/2023] [Revised: 01/17/2024] [Accepted: 03/05/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Trials are underway to test the clinical utility of multi-cancer early detection (MCED) blood tests for screening asymptomatic individuals. We sought to understand the acceptability of MCED blood test screening and potential barriers and facilitators to participation among the general public. METHODS We conducted eleven semi-structured online focus groups with 50-77-year-olds (n = 53) in April-November 2022. Participants were purposefully sampled to include a mix of socio-economic and ethnic backgrounds as well as people who would not want 'a blood test for cancer'. Participants were shown information about MCED blood tests. Transcripts were analysed using reflexive thematic analysis. RESULTS Participants showed enthusiasm for MCED screening. Perceived benefits included procedural familiarity and the potential to screen for many cancers. Enthusiasm was driven by beliefs that cancer is a real and increasing risk (both at population level and personally with age) and that early detection reduces treatment burden and cancer mortality. Some felt they would not want to know if they had cancer. The potential for MCED tests to raise anxiety was a concern, especially in a false-positive scenario. Participants wanted to avoid unpleasant and unnecessary procedures. The initial blood test was deemed "less invasive" than current screening tests, but potential follow-up procedures were a concern. Views on MCED screening were influenced by wider factors including dislike of uncertainty, desire for choice and control over one's health, and existing relationships with the NHS. CONCLUSION The introduction of MCED screening is likely to be appealing due to the simplicity and familiarity of the primary test procedure. Test accuracy needs to be high to facilitate acceptability and should be communicated from the outset. Some people would rather not know if they have cancer, and MCEDs will not appeal to all.
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Affiliation(s)
- Ninian Schmeising-Barnes
- Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK; Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Jo Waller
- Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK; Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Laura A V Marlow
- Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK; Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK.
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AL Naabi M, Al Zaabi A. Quantitative Evaluation of Cancer Stigma among Non-Patient Population in Oman. Asian Pac J Cancer Prev 2024; 25:1223-1229. [PMID: 38679981 PMCID: PMC11162736 DOI: 10.31557/apjcp.2024.25.4.1223] [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: 08/26/2023] [Accepted: 04/12/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Cancer is widely considered as one of the most stigmatized diseases globally, despite scientific advances in the medicine. While most existing literatures focuses on cancer stigma as perceived by patients, there has been limited research on stigma towards cancer among the non-cancer population. In 2014, Marlow et al developed and validated the "Cancer Stigma Scale" (CASS) specifically for the non-Cancer population. This study aims to quantitatively evaluate cancer stigma within the non-patient population in Oman. METHODS This is a cross-sectional study conducted in Oman. The Cancer Stigma Scale (CASS) has been used to evaluate the cancer-related stigma among the non-cancer patient population in Oman. RESULTS A total of 510 participants completed the survey of whom 57.6% were male. The personal responsibility section had the highest mean score, followed by the avoidance and financial discrimination. The lowest mean scores were observed in the danger and policy opposition sections. Female participants showed ore disagreement with cancer stigma statements compared to males. Participants who knew someone with cancer expressed more disagreement with stigma statements than those who did not know anyone with cancer. CONCLUSION This study provides a baseline measurement of cancer-related stigma among non-cancer patients in Oman, tilizing the CASS in a representative sample of the population. The results indicate generally low levels of stigma, though certain aspects are more pronounced, varying according to the participants' gender, age, and personal connections to someone with cancer.
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Affiliation(s)
| | - Adhari Al Zaabi
- Human and Clinical Anatomy, College of Medicine and Health Sciences, Muscat, Sultanate of Oman.
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Alyazidi F, Shakely D, Petzold M, Alyazidi F, Hussain-Alkhateeb L. Community perception of causes of death using verbal autopsy for diabetes mellitus in Saudi Arabia. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001690. [PMID: 38051697 PMCID: PMC10697554 DOI: 10.1371/journal.pgph.0001690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 11/06/2023] [Indexed: 12/07/2023]
Abstract
Diabetes mellitus is a serious global health issue which significantly impacts public health and socioeconomic development. Exploring how the community perceives the causes of death and their associated risk factors is crucial for public health. This study combines verbal autopsy (VA) with the Type 2 Diabetes Mellitus (T2DM) register to explore community perceptions of causes of death and associated influential factors in Makkah province, Saudi Arabia. 302 VA interviews were conducted with relatives or caregivers of deceased who died between 2018 and 2021 based on T2DM medical register from Alnoor Specialist Hospital in Makkah City, Saudi Arabia. Cause-specific mortality fractions (CSMFs) obtained from the VA using the InterVA-5 model were utilized to assess community perception. We used a multivariable logistic regression model to determine factors influencing community perceptions of causes of death. Lin's CCC with 95% CI was used to analyze the concordance for the CSMFs from verbal autopsy causes of death (VACoD) as a presumed reference standard and family-reported causes of death (FRCoD). The outcomes of this study demonstrate a generally broad spectrum of community perceived mortalities, with some critical misconceptions based on the type of death and other vital events like marital status, with an overall CCC of 0.60 (95% CI: 0.20-1.00; p = 003). The study findings demonstrate that community perception is weak if the deceased was male compared to female (aOR: 0.52; 95% CI: 0.26-1.03) and if the deceased was > = 80 years compared to 34-59 years (aOR: 0.48; 95% CI: 0.16-1.38), but it significantly improves among married compared to single (aOR: 2.13; 95% CI: 1.02-4.42). Exploring community perception of causes of death is crucial as it provides valuable insights into the community's understanding, beliefs, and concerns regarding mortality. Higher or lower community perception is attributed to how people may perceive risk factors associated with the causes of death, which can guide public health planning and interventional programs. The study findings further emphasize the need to employ robust and standardized VA methods within the routine medical services for a systemized assessment of families' reported causes of death.
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Affiliation(s)
- Faleh Alyazidi
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Public Health, College of Health Sciences at Al-Leith, Umm Al-Qura University, Al-Leith, Kingdom of Saudi Arabia
| | - Deler Shakely
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Max Petzold
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Fawaz Alyazidi
- Infectious Diseases Control Department, Executive Directorate of Preventive Medicine, Makkah Healthcare Cluster, Makkah, Kingdom of Saudi Arabia
| | - Laith Hussain-Alkhateeb
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Population Health Research Section, King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
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5
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Cavers D, Nelson M, Rostron J, Robb KA, Brown LR, Campbell C, Akram AR, Dickie G, Mackean M, van Beek EJR, Sullivan F, Steele RJ, Neilson AR, Weller D. Understanding patient barriers and facilitators to uptake of lung screening using low dose computed tomography: a mixed methods scoping review of the current literature. Respir Res 2022; 23:374. [PMID: 36564817 PMCID: PMC9789658 DOI: 10.1186/s12931-022-02255-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/17/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Targeted lung cancer screening is effective in reducing mortality by upwards of twenty percent. However, screening is not universally available and uptake is variable and socially patterned. Understanding screening behaviour is integral to designing a service that serves its population and promotes equitable uptake. We sought to review the literature to identify barriers and facilitators to screening to inform the development of a pilot lung screening study in Scotland. METHODS We used Arksey and O'Malley's scoping review methodology and PRISMA-ScR framework to identify relevant literature to meet the study aims. Qualitative, quantitative and mixed methods primary studies published between January 2000 and May 2021 were identified and reviewed by two reviewers for inclusion, using a list of search terms developed by the study team and adapted for chosen databases. RESULTS Twenty-one articles met the final inclusion criteria. Articles were published between 2003 and 2021 and came from high income countries. Following data extraction and synthesis, findings were organised into four categories: Awareness of lung screening, Enthusiasm for lung screening, Barriers to lung screening, and Facilitators or ways of promoting uptake of lung screening. Awareness of lung screening was low while enthusiasm was high. Barriers to screening included fear of a cancer diagnosis, low perceived risk of lung cancer as well as practical barriers of cost, travel and time off work. Being health conscious, provider endorsement and seeking reassurance were all identified as facilitators of screening participation. CONCLUSIONS Understanding patient reported barriers and facilitators to lung screening can help inform the implementation of future lung screening pilots and national lung screening programmes.
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Affiliation(s)
- Debbie Cavers
- Usher Institute, University of Edinburgh, Doorway 1, Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
| | - Mia Nelson
- Usher Institute, University of Edinburgh, Doorway 1, Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
| | - Jasmin Rostron
- The National Institute of Economic and Social Research, 2 Dean Trench Street, London, NW1P 3HE UK
| | - Kathryn A. Robb
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ UK
| | - Lynsey R. Brown
- School of Medicine, University of St. Andrews, North Haugh, St. Andrews, KY16 9TF UK
| | - Christine Campbell
- Usher Institute, University of Edinburgh, Doorway 1, Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
| | - Ahsan R. Akram
- MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Graeme Dickie
- Usher Institute, University of Edinburgh, Doorway 1, Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
| | - Melanie Mackean
- Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU UK
| | - Edwin J. R. van Beek
- Edinburgh Imaging, Queen’s Medical Research Institute, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4TJ UK
| | - Frank Sullivan
- School of Medicine, University of St. Andrews, North Haugh, St. Andrews, KY16 9TF UK
| | - Robert J. Steele
- School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY UK
| | - Aileen R. Neilson
- Usher Institute, University of Edinburgh, Doorway 1, Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
| | - David Weller
- Usher Institute, University of Edinburgh, Doorway 1, Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
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Khokhar MA, Gibson B, Winslow M, Owens J. 'Oral Cancer is a Punishment for my Sins': Oral Histories of Oral Cancer, Fatalism and Islamic Religious Beliefs in Pakistan. JOURNAL OF RELIGION AND HEALTH 2022; 61:4337-4351. [PMID: 35639222 DOI: 10.1007/s10943-022-01585-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/08/2022] [Indexed: 06/15/2023]
Abstract
This paper explores how Islamic religious beliefs; spiritual practices and fatalism may act as barriers to a diagnosis of oral cancer in Rawalpindi/Islamabad Pakistan. The qualitative methodology is oral history and interviews took place with fifteen women diagnosed with oral cancer and receiving treatment in hospital. The research provides a model illustrating how religiosity, fatalism and the social determinants of health exist on a continuum and influence the perspectives of women in Pakistan, contributing to their late presentation and diagnosis of oral cancer. Analysis of the patients' oral histories, suggests improved communication between medical professionals and integration of spiritual/traditional healers into the existing health care system of Pakistan which may assist in reducing oral health inequalities.
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Affiliation(s)
- Mariam A Khokhar
- Department of Health Sciences, Faculty of Sciences, University of York, ATB/220 (Area 4), Seebohm Rowntree Building, Heslington, Y010 5DD, UK.
| | - Barry Gibson
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Michelle Winslow
- The Division of Nursing and Midwifery, University of Sheffield, Sheffield, UK
| | - Janine Owens
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
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7
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Du G, Lyu H, Li X. Social class and subjective well-being in Chinese adults: The mediating role of present fatalistic time perspective. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-020-01058-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Shah SK, Narcisse MR, Hallgren E, Felix HC, McElfish PA. Assessment of Colorectal Cancer Screening Disparities in U.S. Men and Women Using a Demographically Representative Sample. CANCER RESEARCH COMMUNICATIONS 2022; 2:561-569. [PMID: 36381661 PMCID: PMC9645794 DOI: 10.1158/2767-9764.crc-22-0079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/29/2022] [Accepted: 06/09/2022] [Indexed: 06/16/2023]
Abstract
Timely receipt of colorectal cancer (CRC) screening can reduce morbidity and mortality. This is the first known study to adopt Andersen's model of health services use to identify factors associated with CRC screening among US adults. The data from National Health Interview Survey from 2019 was utilized to conduct the analyses. Multivariable logistic regression was used to separately analyze data from 7,503 age-eligible women and 6,486 age-eligible men. We found similar CRC screening levels among men (57.7%) and women (57.6%). Factors associated with higher screening odds in women were older age, married/cohabitating with a partner, Black race, >bachelor's degree, having a usual source of care, and personal cancer history. Factors associated with lower odds for women were American Indian/Alaska Native race, living in the US for ≤10 years, ≤138% federal poverty level (FPL), uninsured or having Medicare, and in fair/poor health. For men, factors associated with higher screening odds were older age, homosexuality, married/cohabitating with a partner, Black race, >high school/general educational development education, having military insurance, having a usual source of care, and personal cancer history. Factors associated with lower odds for men were being a foreign-born US resident, living in the South or Midwest, ≤138% FPL, and being uninsured or having other insurance. Despite lower screening rates in the past, Black adults show a significantly higher likelihood of CRC screening than White adults; yet, screening disparities remain in certain other groups. CRC screening efforts should continue to target groups with lower screening rates to eliminate screening disparities.
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Affiliation(s)
- Sumit K. Shah
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Marie-Rachelle Narcisse
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Emily Hallgren
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Holly C. Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
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French DP, Woof VG, Ruane H, Evans DG, Ulph F, Donnelly LS. The feasibility of implementing risk stratification into a national breast cancer screening programme: a focus group study investigating the perspectives of healthcare personnel responsible for delivery. BMC Womens Health 2022; 22:142. [PMID: 35501791 PMCID: PMC9063090 DOI: 10.1186/s12905-022-01730-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Providing women with personalized estimates of their risk of developing breast cancer, as part of routine breast cancer screening programmes, allows women at higher risk to be offered more frequent screening or drugs to reduce risk. For this to be feasible, the concept and practicalities have to be acceptable to the healthcare professionals who would put it in to practice. The present research investigated the acceptability to healthcare professionals who were responsible for the implementation of this new approach to screening in the ongoing BC-Predict study. METHODS Four focus groups were conducted with 29 healthcare professionals from a variety of professional backgrounds working within three breast screening services in north-west England. An inductive-manifest thematic analysis was conducted. RESULTS Overall, healthcare professionals viewed the implementation of personalised breast cancer risk estimation as a positive step, but discussion focused on concerns. Three major themes are presented. (1) Service constraints highlights the limited capacity within current breast services and concerns about the impact of additional workload. (2) Risk communication concerns the optimal way to convey risk to women within resource constraints. (3) Accentuating inequity discusses how risk stratification could decrease screening uptake for underserved groups. CONCLUSIONS Staff who implemented risk stratification considered it a positive addition to routine screening. They considered it essential to consider improving capacity and demands on healthcare professional time. They highlighted the need for skilled communication of risks and new pathways of care to ensure that stratification could be implemented in financially and time constrained settings without impacting negatively on women.
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Affiliation(s)
- David P French
- Division of Psychology & Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, UK.
| | - Victoria G Woof
- Division of Psychology & Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, UK
| | - Helen Ruane
- Nightingale & Prevent Breast Cancer Research Unit, Manchester University NHS Foundation Trust, Manchester, UK
| | - D Gareth Evans
- Nightingale & Prevent Breast Cancer Research Unit, Manchester University NHS Foundation Trust, Manchester, UK.,Division of Evolution and Genomic Science, Department of Genomic Medicine, University of Manchester, Manchester, UK
| | - Fiona Ulph
- Division of Psychology & Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, UK
| | - Louise S Donnelly
- Nightingale & Prevent Breast Cancer Research Unit, Manchester University NHS Foundation Trust, Manchester, UK.,Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
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Likely uptake of a future a lung cancer screening programme in Hodgkin lymphoma survivors: a questionnaire study. BMC Pulm Med 2022; 22:165. [PMID: 35484621 PMCID: PMC9052526 DOI: 10.1186/s12890-022-01959-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/19/2022] [Indexed: 11/17/2022] Open
Abstract
Background Many Hodgkin lymphoma (HL) survivors are at increased risk of subsequent malignant neoplasms (SMN), including lung cancer, due to previous treatment for HL. Lung cancer screening (LCS) detects early-stage lung cancers in ever smokers but HL survivors without a heavy smoking history are ineligible for screening. There is a rationale to develop a targeted LCS. The aim of this study was to investigate levels of willingness to undergo LCS in HL survivors, and to identify the psycho-social factors associated with screening hesitancy. Methods A postal questionnaire was sent to 281 HL survivors registered in a long-term follow-up database and at increased risk of SMNs. Demographic, lung cancer risk factors, psycho-social and LCS belief variables were measured. Multivariable logistic regression analysis was performed to determine the factors associated with lung cancer screening hesitancy, defined as those who would ‘probably’ or ‘probably not’ participate. Results The response rate to the questionnaire was 58% (n = 165). Participants were more likely to be female, older and living in a less deprived area than non-participants. Uptake (at any time) of breast and bowel cancer screening among those previously invited was 99% and 77% respectively. 159 participants were at excess risk of lung cancer. The following results refer to these 159. Around half perceived themselves to be at greater risk of lung cancer than their peers. Only 6% were eligible for lung cancer screening pilots aimed at ever smokers in the UK. 98% indicated they would probably or definitely participate in LCS were it available. Psycho-social variables associated with LCS hesitancy on multivariable analysis were male gender (OR 5.94 CI 1.64–21.44, p < 0.01), living in an area with a high index of multiple deprivation decile (deciles 6–10) (OR 8.22 CI 1.59–42.58, p < 0.05) and lower levels of self-efficacy (OR 1.64 CI 1.30–2.08 p < 0.01). Conclusion HL survivors responding to this survey were willing to participate in a future LCS programme but there was some hesitancy. A future LCS trial for HL survivors should consider the factors associated with screening hesitancy in order to minimise barriers to participation. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01959-3.
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11
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Kırca K, Kaş C. Examining Nursing Students' Perspectives on Cancer through Metaphors in Turkey. JOURNAL OF RELIGION AND HEALTH 2022; 61:1451-1468. [PMID: 35239085 DOI: 10.1007/s10943-022-01529-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 06/14/2023]
Abstract
This study was conducted to reveal the perceptions of cancer through metaphors among second-year nursing students. This study utilized descriptive phenomenology, which is a qualitative research design. In order to reveal the metaphors that each nursing student (n = 65) considered for the concept of "cancer," they were asked to complete the following sentence: "Cancer is like ……, because ……". In analyzing the data, a content analysis approach comprising coding, the identification of themes, and grouping of data according to codes and themes was used. It was found that the nursing students produced 44 different metaphors. With the groupings made from the students' perspectives on cancer, categories of "crime/punishment," "fear/anxiety/pain," "uncertainty," "uncontrollability," and "struggle/hope" were identified. In particular, the students' metaphors of "test," "fight," "unwanted friend," "love," "naughty child," "thief," and "trouble" for the concept of cancer came to the fore. It is recommended to improve clinical education to develop positive attitudes among nursing students toward cancer.
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Affiliation(s)
- Kamile Kırca
- Nursing Department, Faculty of Health Sciences, Kırıkkale University, Kırıkkale, Turkey.
| | - Canan Kaş
- Midwifery Department, Faculty of Health Sciences, Kastamonu University, Kastamonu, Turkey
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12
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Quaife SL, Brain KE, Stevens C, Kurtidu C, Janes SM, Waller J. Development and psychometric testing of the self-regulatory questionnaire for lung cancer screening (SRQ-LCS). Psychol Health 2022; 37:194-210. [PMID: 33593154 DOI: 10.1080/08870446.2021.1879806] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 01/06/2021] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Research implicates psychological factors in low uptake of lung cancer screening. We developed and psychometrically tested a standardised measure of these psychological determinants in preparation for a prospective, longitudinal cohort study of screening uptake. METHODS Leventhal's Common-Sense Model of Self-Regulation of Health and Illness provided the theoretical framework to generate the initial item pool. Items were refined during expert review and cognitive interviews which tested for face validity, redundancy, acceptability and comprehensibility. An online survey piloted the refined pool with 1500 current and former (quit ≤ 15 years) smokers aged 55-80. The response distributions, internal reliability and factor structure determined the final retained constructs. Regression analyses examined these constructs' associations with screening intention, smoking status and demographics. RESULTS The final measure included seven factor-derived subscales (consequences, personal control, treatment control, illness coherence, emotional representation, behavioural response and appraisal, risk perception) with Cronbach's alphas ranging from 0.59 to 0.91 and four single-item questions (response efficacy for smoking cessation, treatment intention, perceived stigma and lung cancer survival). Most constructs were associated with smoking status and screening intention (p's < .05). CONCLUSIONS The Self-Regulatory Questionnaire for Lung Cancer Screening (SRQ-LCS) is an acceptable, reliable and valid measure for investigating the psychological determinants of screening uptake.
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Affiliation(s)
- Samantha L Quaife
- Research Department of Behavioural Science and Health, University College London, London, UK
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Kate E Brain
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Claire Stevens
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Clara Kurtidu
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Samuel M Janes
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, UK
| | - Jo Waller
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
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13
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Young B, Robb KA. Understanding patient factors to increase uptake of cancer screening: a review. Future Oncol 2021; 17:3757-3775. [PMID: 34378403 DOI: 10.2217/fon-2020-1078] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Early detection of cancer through organized screening is a central component of population-level strategies to reduce cancer mortality. For screening programs to be effective, it is important that those invited to screening participate. However, uptake rates are suboptimal in many populations and vary between screening programs, indicating a complex combination of patient factors that require elucidation to develop evidence-based strategies to increase participation. In this review, the authors summarize individual-level (sociodemographic and psychosocial) factors associated with cancer screening uptake and evidence for the effectiveness of behavioral interventions to increase uptake. The authors reflect on current trends and future directions for behavioral cancer screening research to overcome challenges and address unmet needs in reducing cancer mortality.
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Affiliation(s)
- Ben Young
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 0XH, UK
| | - Kathryn A Robb
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 0XH, UK
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14
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Kedar A, John A, Goala S, Babu R, Tapkire R, Kannan R, Hariprasad R. Barriers and facilitators in implementing population based common cancer screening through community health workers. Ecancermedicalscience 2021; 15:1277. [PMID: 34567262 PMCID: PMC8426026 DOI: 10.3332/ecancer.2021.1277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Indexed: 11/06/2022] Open
Abstract
Population based cancer screening was initiated in India in 2016 owing to an increased burden of cancers. A feasibility health system study was done by utilising community health workers (CHWs) to conduct the cancer screening. The current study is a qualitative study to elicit the barriers and facilitators in implementing population based cancer screening through CHWs. The study was conducted at three subcentres of Dholai block of Cachar district, Assam, India and Cachar Cancer Hospital and Research Center, Silchar. The participants of the study were CHWs, master trainer nurses and women from community. Three focus group discussions (FGDs) and one in-depth interview (IDI) were conducted at the provider level and seven IDIs of women from the community. The FGDs and IDIs were audio recorded after taking verbal consent from the participants. The verbatims were prepared following translation and transcription and data analysis using ATLAS ti ver 8. The major barrier faced by the community was a lack of motivation to get screened which stemmed from various factors such as personal beliefs, attitudes and fear. The major facilitators were accessibility of tests, family support and CHWs as screening service providers. The major barriers for CHWs were difficulty in motivating the community, lack of support from supervisors and lack of motivation to work. The major facilitators were convenience of screening during home visits, empowerment, skill enhancement and teamwork. Population based cancer screening was a new concept for the community under study. Cancer screening by CHWs was well accepted by the community. Awareness generation among the community was a major factor in improving screening coverage. The study highlights that training and motivation of CHWs can improve the uptake of cancer screening services. CHWs felt empowered with the new skills imparted and were able to carry out screening.
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Affiliation(s)
- Ashwini Kedar
- National Viral Hepatitis Control Program, Ministry of Health and Family Welfare, Nirman Bhawan, Delhi 110001, India
| | - Amrita John
- Guntherstrase, 34, Duisburg, North Rhine Westphalia, 47051, Germany
| | - Subhadra Goala
- Cachar Cancer Hospital and Research Center, NS Avenue, Meherpur, Silchar 788015, Assam, India
| | - Roshni Babu
- Fogarty International Fellow, Yenepoya University, University Road Deralakatte Mangalore 575018, Karnataka 575022, India
| | - Ritesh Tapkire
- Cachar Cancer Hospital and Research Center, NS Avenue, Meherpur, Silchar 788015, Assam, India
| | - Ravi Kannan
- Cachar Cancer Hospital and Research Center, NS Avenue, Meherpur, Silchar 788015, Assam, India
| | - Roopa Hariprasad
- Division of Clinical Oncology, Indian Council of Medical Research-National Institute of Cancer Prevention & Research (ICMR-NICPR), I-7 Sector 39, Noida 201301, India
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15
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Clarke N, Kearney PM, Gallagher P, McNamara D, O'Morain CA, Sharp L. Negative emotions and cancer fatalism are independently associated with uptake of Faecal Immunochemical Test-based colorectal cancer screening: Results from a population-based study. Prev Med 2021; 145:106430. [PMID: 33482227 DOI: 10.1016/j.ypmed.2021.106430] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 01/13/2021] [Accepted: 01/16/2021] [Indexed: 12/24/2022]
Abstract
Although systematic colorectal cancer screening is efficacious, many programmes suffer from low uptake. Few behavioural or attitudinal factors have been identified as being associated with participation in colorectal cancer screening. We explored knowledge, beliefs about cancer, subjective health literacy, emotional attitudes to screening, and social influences among individuals invited to a population-based screening programme. Regression modelling of a cross-sectional survey of 2299 individuals (users and non-users) of a population-based Faecal Immunochemical Test (FIT) screening programme in Dublin was conducted. Questions were derived from previous theoretically-informed qualitative work and assessed using previously used and validated measures. The primary outcome variable was uptake status (User/Participation or Non-User/Non-participation); multivariable logistic regression was used to estimate the odds ratios (OR) for screening participation. Stronger fatalistic beliefs independently predicted lower uptake (OR = 0.94; 95% CI 0.90-0.98; P = 0.003). Those aged <65 who disagreed that "cancer can often be cured" also had lower uptake (OR = 0.43; 95% CI 0.22-0.82: P = 0.017). Agreement that the test was disgusting and tempting fate predicted lower uptake (OR = 0.16: 95% CI 0.10-0.27: p < 0.001), while the influence of a partner on decision to be screened was associated with higher uptake (OR = 1.32; 95% CI 1.15-1.50: P < 0.001). Negative cancer-related and screening-related beliefs and emotions are associated with non-participation in FIT (-based screening). Research is warranted to explore if these negative beliefs and emotions are modifiable and, if so, whether this would improve screening uptake. The association between the influence of a partner and screening participation present a challenge around improving uptake among those not in co-habiting relationships.
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Affiliation(s)
| | | | | | - Deirdre McNamara
- Department of Clinical Medicine, Trinity Centre for Health Sciences, Adelaide and Meath Hospital, Dublin, Ireland.
| | - Colm A O'Morain
- Faculty of Health Science, Trinity College Dublin, Dublin, Ireland.
| | - Linda Sharp
- Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, England, UK.
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16
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He R, Li Y. Media Exposure, Cancer Beliefs, and Cancer-Related Information-Seeking or Avoidance Behavior Patterns in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3130. [PMID: 33803594 PMCID: PMC8002949 DOI: 10.3390/ijerph18063130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/12/2021] [Accepted: 03/14/2021] [Indexed: 12/09/2022]
Abstract
This study explored the relationships between media exposure, cancer beliefs, and cancer information-seeking or information-avoidance behaviors. Based on the planned risk information-seeking model and its extended framework, two predictive models were constructed: one for cancer information seeking and the other for cancer information avoidance. A structural equation modeling strategy was applied to survey data from China HINTS 2017 (n = 3090) to compare the impact of traditional mass media and social media exposure to cancer-related information on cancer information-seeking and information-avoidance behaviors. The study findings suggest that health-related information exposure through different media channels may generate distinctive information-seeking or information-avoidance behaviors based on various cancer beliefs. Additionally, the findings indicate that social media exposure to health-related and cancer curability beliefs does not lead to cancer information avoidance; both mass media and social media exposure encourage people to seek cancer-related information. Cancer fatalism is positively associated with cancer information-seeking and avoiding intentions, suggesting that negative cancer beliefs predict seemingly contradictory yet psychologically coherent information intentions and behaviors.
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Affiliation(s)
- Rui He
- Department of Journalism, School of Humanities, Shanghai University of Finance and Economics, 100 Wudong RD, Yangpu District, Shanghai 200433, China;
| | - Yungeng Li
- School of Media and Communication, Shanghai Jiao Tong University, 800 Dongchuan RD, Minhang District, Shanghai 200240, China
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17
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Feng GC, Lin Z, Ou W, Su X, Yan Q. A Model-Based Meta-Analysis of Willingness to Participate in Cancer Screening. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2580. [PMID: 33806652 PMCID: PMC7967393 DOI: 10.3390/ijerph18052580] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/26/2021] [Accepted: 02/27/2021] [Indexed: 12/31/2022]
Abstract
Although early screening tests are beneficial for the detection and treatment of cancers, many people have failed to participate in screening tests. The present study aims to explore the theoretical underpinning of low participation in screening programs using the method of meta-analytic structural equation modeling. It was found that the health belief model is the most adopted theoretical framework. Moreover, the intended uptake of screening was positively predicted only by cues to action, health literacy, and perceived susceptibility. As a result, a health intention model, including the three significant variables, is proposed. The practical implications of the findings are that health communication campaigns should focus on enlightening and engaging the public through all necessary means to raise awareness and transfer knowledge in relation to screening procedures as well as cancers per se.
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Affiliation(s)
| | - Zhiliang Lin
- School of Literature and Media, Nanfang College of Sun Yat-sen University, Guangzhou 510970, China;
| | - Wanhua Ou
- College of Communication, Shenzhen University, Shenzhen 518600, China; (W.O.); (X.S.)
| | - Xianglin Su
- College of Communication, Shenzhen University, Shenzhen 518600, China; (W.O.); (X.S.)
| | - Qing Yan
- School of Journalism and Communication, Jinan University, Guangzhou 510610, China;
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18
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Okui T. Analysis of Predictors of Breast Cancer Screening among Japanese Women using Nationally Representative Survey Data, 2001-2013. Asian Pac J Cancer Prev 2021; 22:171-178. [PMID: 33507696 PMCID: PMC8184184 DOI: 10.31557/apjcp.2021.22.1.171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Indexed: 11/25/2022] Open
Abstract
Objective: Predictors of participation in breast cancer screening in recent years or the trend of participation rate by predictors over the years has not been investigated in Japan. In this study, we investigated predictors for participation in breast cancer screening and analyzed the trend of participation rate depending on the predictors using nationally representative survey data in Japan. Methods: The data of “Comprehensive Survey of Living Conditions” in Japan from 2001 to 2013 were used. Participation in breast cancer screening was used as an outcome. Next, as explanatory variables, we used age group, marital status, living arrangements, educational level, household income, employment status, smoking status, regular outpatient visit status, and self-rated health status. Then, the participation rate for breast cancer screening was calculated for each of the factors over the years. In addition, multivariate logistic regression analysis was conducted to analyze the association between each factor and the participation rate using data from 2010 and 2013. Results: We found that non-married women, women with lower educational level, women with low household income, self-employed or unemployed women, smokers, and women with low self-rated health status were significantly less likely to participate in breast cancer screening. Conversely, the participation rate increased for all predictor groups from 2001 to 2013, and the increase in the participation rate for never-married women was particularly evident compared with the other marital statuses. However, significant differences in the participation rate for breast cancer screening existed depending on marital status, household income, employment status, and smoking status throughout the analyzed years. Conclusion: Our findings suggest that further recommendations for breast cancer screening are particularly needed among women of low socioeconomic status and those who are self-employed or unemployed to increase the participation rate in Japan.
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Affiliation(s)
- Tasuku Okui
- Medical Information Center, Kyushu University Hospital, Fukuoka City, Japan
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19
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Dressler J, Johnsen AT, Madsen LJ, Rasmussen M, Jorgensen LN. Factors affecting patient adherence to publicly funded colorectal cancer screening programmes: a systematic review. Public Health 2020; 190:67-74. [PMID: 33360029 DOI: 10.1016/j.puhe.2020.10.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/22/2020] [Accepted: 10/29/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Colorectal cancer (CRC) is the third most common cancer. Many countries in Europe have already implemented systematic screening programmes as per the recommendations by the European Union. The impact of screening is highly dependent on participation rates. The aim of the study was to identify barriers, facilitators and modifiers to participation in systematised, stool sample-based, publicly financed CRC screening programmes. STUDY DESIGN Systematic review. METHODS A systematic search in PubMed, Embase, MEDLINE, CINAHL, Cochrane CENTRAL, Google Scholar and PsycINFO was undertaken. We included both qualitative and quantitative studies reporting on barriers and facilitators (excluding sociodemographic variables) to participation in stool sample-based CRC screening. Barriers and facilitators to participation were summarised and analysed. RESULTS The inclusion criteria were met in 21 studies. Reported barriers and facilitators were categorised into the following seven themes (examples): psychology (fear of cancer), religion (believing cancer is the will of God), logistics (not knowing how to conduct the test), health-related factors (mental health), knowledge and awareness (lack of knowledge about the test), role of the general practitioner (being supported in taking the test by the general practitioner), and environmental factors (knowing someone who has participated in a screening programme). Six studies reported that non-participation was not due to a negative attitude towards screening for CRC. CONCLUSION Many barriers to screening were found. It is important to work with peoples' fear of screening. Moreover, this review suggests that it might be possible to increase participation rates, if the population-wide awareness and knowledge of potential health benefits of CRC screening are increased and proper logistical support is provided.
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Affiliation(s)
- J Dressler
- Digestive Disease Center, Bispebjerg Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - A T Johnsen
- Institute of Psychology, University of Southern Denmark, Odense, Denmark.
| | - L J Madsen
- Digestive Disease Center, Bispebjerg Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - M Rasmussen
- Digestive Disease Center, Bispebjerg Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - L N Jorgensen
- Digestive Disease Center, Bispebjerg Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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20
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Hoeck S, van de Veerdonk W, De Brabander I, Kellen E. Does the Flemish colorectal cancer screening programme reach equity in FIT uptake? Eur J Public Health 2020; 29:1108-1114. [PMID: 30887054 DOI: 10.1093/eurpub/ckz043] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND To investigate colorectal cancer (CRC) screening rates by the faecal immunochemical test (FIT) according to sociodemographic characteristics and nationality. METHODS Men and women, aged 56-74, invited to participate in the Flemish CRC screening programme in 2013 and 2014 were included in this study. We analysed the association between CRC screening uptake and sex, age, (first and current) nationality and several proxies for socio-economic status (SES). The statistical analysis was based on descriptive analyses and logistic regression models. RESULTS A total of 1 184 426 persons were included in our analysis. The overall screening uptake was 52.3%, uptake varied by sex, age, nationality and SES. Lower participation rates were associated with the youngest and oldest age categories (56-60 and 70-74) and being male. All nationalities other than Belgian or Dutch were significantly less screened. Lower uptake of screening was also associated with several proxy's for low SES, such as having an allowance for being disabled, not being able to work, being an extended minor and having a social allowance/minimum wage. The descriptive analysis showed a 27% difference in CRC screening uptake between the (early) retired and the people entitled to a minimum wage. CONCLUSIONS There is a significant difference between screening uptake and demographic and socio-economic variables in the first 2 years of the population-based screening programme in Flanders. Based on the study results, implementing strategies to improve participation in those subgroups is needed.
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Affiliation(s)
- S Hoeck
- Centre for Cancer Detection, Bruges, Belgium.,Department of Social Epidemiology and Health Policy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - W van de Veerdonk
- Department of Social Epidemiology and Health Policy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | | | - E Kellen
- Centre for Cancer Detection, Bruges, Belgium.,University Hospital Leuven, Leuven, Belgium
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21
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Brewster R, Deb S, Pendharkar AV, Ratliff J, Li G, Desai A. The effect of socioeconomic status on age at diagnosis and overall survival in patients with intracranial meningioma. Int J Neurosci 2020; 132:413-420. [PMID: 32878534 DOI: 10.1080/00207454.2020.1818742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Intracranial meningiomas are the most common primary tumors of the central nervous system. How socioeconomic status (SES) impacts treatment access and outcomes for brain tumor subtypes is an emerging area of research. Few studies have examined the relationship between SES and meningioma survival and management with reference to relevant clinical factors, including age at diagnosis. We studied the independent effects of SES on receiving surgery and survival probability in patients with intracranial meningioma. METHODS 54,282 patients diagnosed with intracranial meningioma between 2003 and 2012 from the Surveillance, Epidemiology, and End Results (SEER) Program at the National Cancer Institute database were included. Patient SES was divided into tertiles. Patient age groups included 'older' (>65, the median patient age) and 'younger'. Multivariable linear regression and Cox proportional hazards model were used with SAS v9.4. Results were adjusted for race, sex, and tumor grade. Kaplan-Meier survival curves were constructed according to SES tertiles and age groups. RESULTS Meningioma prevalence increased with higher SES tertile. Higher SES tertile was also associated with younger age at diagnosis (OR = 0.890, p < 0.05), an increased likelihood of undergoing gross total resection (GTR) (OR = 1.112, p < 0.05), and a trend toward greater 5-year survival probability (HR = 1.773, p = 0.0531). Survival probability correlated with younger age at diagnosis (HR = 2.597, p < 0.001), but not with GTR receipt. CONCLUSION The findings from this national longitudinal study on patients with meningioma suggest that SES affects age at diagnosis and treatment access for intracranial meningiomas patients. Further studies are required to understand and address the mechanisms underlying these disparities.
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Affiliation(s)
- Ryan Brewster
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Sayantan Deb
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Arjun Vivek Pendharkar
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - John Ratliff
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Gordon Li
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Atman Desai
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
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22
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Özkan İ, Taylan S. Barriers to women’s breast cancer screening behaviors in several countries: A meta-synthesis study. Health Care Women Int 2020; 42:1013-1043. [DOI: 10.1080/07399332.2020.1814777] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- İlknur Özkan
- Kumluca Faculty of Health Sciences, İnternal Medicine Nursing Department, Akdeniz University, Kumluca, Antalya, Turkey
| | - Seçil Taylan
- Kumluca Faculty of Health Sciences, Surgical Nursing Department, Akdeniz University, Kumluca, Antalya, Turkey
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23
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Horshauge PM, Gabel P, Larsen MB, Kirkegaard P, Edwards A, Andersen B. The association between health literacy and colorectal cancer screening uptake in a publicly funded screening program in Denmark: Cross-sectional study. Prev Med Rep 2020; 19:101132. [PMID: 32551215 PMCID: PMC7287294 DOI: 10.1016/j.pmedr.2020.101132] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 05/13/2020] [Accepted: 05/23/2020] [Indexed: 02/07/2023] Open
Abstract
There are multiple reasons for not participating in colorectal cancer screening, but the role of health literacy in screening uptake is not well understood. The aims of this study were to determine the association between health literacy and colorectal cancer screening uptake and to explore whether socioeconomic and -demographic characteristics and worry and attitude variables modify this association. In a cross-sectional study, 10,030 53-74-year-old randomly selected citizens resident in Central Denmark Region received a questionnaire assessing health literacy using the European Health Literacy Survey Short Scale 16-item. Data on colorectal cancer screening uptake were obtained from the Danish Colorectal Cancer Screening database, and socioeconomic and -demographic data were linked from Statistics Denmark. The response rate was 71% (n = 7142). Odds ratio (OR) for uptake was 1.06 (95% confidence interval (CI): 0.96, 1.19) for problematic health literacy and 1.00 (95% CI: 0.87, 1.16) for inadequate health literacy, when using adequate health literacy as the reference value. The association was not modified by socioeconomic or -demographic characteristics, worry or attitude. No association was found between health literacy and colorectal cancer screening uptake. Future research needs to clarify which dimensions of health literacy may predict screening uptake and how it is best measured.
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Affiliation(s)
- Petricia Marie Horshauge
- Department of Public Health Programmes, Randers Regional Hospital, Denmark.,Department of Clinical Medicine, Aarhus University, Denmark
| | - Pernille Gabel
- Department of Public Health Programmes, Randers Regional Hospital, Denmark
| | - Mette Bach Larsen
- Department of Public Health Programmes, Randers Regional Hospital, Denmark
| | - Pia Kirkegaard
- Department of Public Health Programmes, Randers Regional Hospital, Denmark
| | - Adrian Edwards
- Department of Public Health Programmes, Randers Regional Hospital, Denmark.,Division of Population Medicine, School of Medicine, Cardiff University, UK
| | - Berit Andersen
- Department of Public Health Programmes, Randers Regional Hospital, Denmark.,Department of Clinical Medicine, Aarhus University, Denmark
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24
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Brzoska P, Aksakal T, Yilmaz-Aslan Y. Utilization of cervical cancer screening among migrants and non-migrants in Germany: results from a large-scale population survey. BMC Public Health 2020; 20:5. [PMID: 31906964 PMCID: PMC6945536 DOI: 10.1186/s12889-019-8006-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 11/27/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Studies from European and non-European countries have shown that migrants utilize cervical cancer screening less often than non-migrants. Findings from Germany are inconsistent. This can be explained by several limitations of existing investigations, comprising residual confounding and data which is restricted to only some regions of the country. Using data from a large-scale and nationwide population survey and applying the Andersen Model of Health Services Use as the theoretical framework, the aim of the present study was to examine the role that different predisposing, enabling and need factors have for the participation of migrant and non-migrant women in cervical cancer screening in Germany. METHODS We used data from the 'German Health Update 2014/2015' survey on n = 12,064 women ≥20 years of age. The outcome of interest was the participation in cancer screening (at least once in lifetime vs. no participation). The outcome was compared between the three population groups of non-migrants, migrants from EU countries and migrants from non-EU countries. We employed multivariable logistic regression to examine the role of predisposing, enabling and need factors. RESULTS Non-EU and EU migrant women reported a lower utilization of cervical cancer screening (50.1 and 52.7%, respectively) than non-migrant women (57.2%). The differences also remained evident after adjustment for predisposing, enabling and need factors. The respective adjusted odds ratios (OR) for non-EU and EU migrants were OR = 0.67 (95%-CI = 0.55-0.81) and OR = 0.80 (95%-CI = 0.66-0.97), respectively. Differences between migrants and non-migrants were particularly pronounced for younger age groups. Self-rated health was associated with participation in screening only in non-migrants, with a poorer health being indicative of a low participation in cancer screening. CONCLUSIONS The disparities identified are in line with findings from studies conducted in other countries and are indicative of different obstacles this population group encounters in the health system. Implementing patient-oriented health care through diversity-sensitive health services is necessary to support informed decision-making.
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Affiliation(s)
- Patrick Brzoska
- Health Services Research, Faculty of Health, School of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
| | - Tuğba Aksakal
- Health Services Research, Faculty of Health, School of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
- Bielefeld University, School of Public Health, Department of Epidemiology & International Public Health, 33501 Bielefeld, Germany
| | - Yüce Yilmaz-Aslan
- Bielefeld University, School of Public Health, Department of Epidemiology & International Public Health, 33501 Bielefeld, Germany
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25
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Vrinten C, Stoffel S, Dodd RH, Waller J, Lyratzopoulos Y, von Wagner C. Cancer worry frequency vs. intensity and self-reported colorectal cancer screening uptake: A population-based study. J Med Screen 2019; 26:169-178. [PMID: 31042098 PMCID: PMC6854611 DOI: 10.1177/0969141319842331] [Citation(s) in RCA: 5] [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: 07/17/2018] [Accepted: 03/15/2019] [Indexed: 12/31/2022]
Abstract
Objectives Many studies of cancer worry use items measuring frequency or intensity. Little is known about how each of these relate to cancer screening uptake. This study compared the association between worry frequency vs. intensity and colorectal cancer screening intention/uptake. Methods Across four surveys (2014–2016), we collected data from 2878 screening-eligible men and women (aged 60–70) in England. Measures included single-items assessing cancer worry frequency and intensity, and a derived combination of both. We also assessed self-reported past faecal occult blood testing uptake (ever vs. never), intention to participate when next invited (yes vs. no), and demographics. Using logistic regression, we compared a model containing sociodemographic characteristics (Model 1), with four models adding cancer worry frequency (Model 2), intensity (Model 3), both (Model 4), or the combined measure (Model 5). Results A model with cancer worry intensity and demographics (Model 3) explained significantly more variance in uptake and intention (R 2 = 0.068 and 0.062, respectively) than demographics alone (Model 1: R 2 = 0.058 and 0.042; p < 0.001), or a model with demographics and cancer worry frequency (Model 2: R 2 = 0.059 and 0.052; p < 0.001). The model was also equally as effective as models including both the frequency and intensity items (Model 4: R 2 = 0.070 n.s. and 0.062 n.s.), or using the derived combination of both (Model 5: R 2 = 0.063 n.s. and 0.053 n.s.). Conclusion A single item measure of cancer worry intensity appeared to be most parsimonious for explaining variance in colorectal cancer screening intention and uptake.
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Affiliation(s)
- Charlotte Vrinten
- Department of Behavioural Science and Health, University College London, London, UK
| | - Sandro Stoffel
- Department of Behavioural Science and Health, University College London, London, UK
| | - Rachael H Dodd
- Department of Behavioural Science and Health, University College London, London, UK
| | - Jo Waller
- Department of Behavioural Science and Health, University College London, London, UK
| | - Yoryos Lyratzopoulos
- Department of Behavioural Science and Health, University College London, London, UK
| | - Christian von Wagner
- Department of Behavioural Science and Health, University College London, London, UK
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26
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Sugisawa H, Harada K, Sugihara Y, Yanagisawa S, Shimmei M. Time perspectives as mediators of the associations between socio-economic status and health behaviours in older Japanese adults. Psychol Health 2019; 35:1000-1016. [PMID: 31698958 DOI: 10.1080/08870446.2019.1686505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: Few studies have used time perspective (TP) theory to examine the factors mediating the association between socio-economic status (SES) and health behaviours (i.e. the psychological mechanisms that underlie SES differences in health behaviours). The purpose of this study was to examine the mediating effects of TPs on the relationship between SES and health behaviours in older Japanese adults. Design: In total, 761 participants living in the Tokyo metropolitan area participated in face-to-face interviews in 2016. Outcome measures: Health behaviours were measured using three indicators: participation in exercise, healthy dietary habits and smoking status. SES was composed of educational attainment and annual income. TPs were measured using the Zimbardo Time Perspective Inventory, which consisted of five subcategories: the past-negative, past-positive, present-hedonistic, present-fatalistic and future perspectives. Results: Among these five subcategories, none mediated both SES and health behaviours. Conclusion: TPs might not contribute to the appearance of SES differences in health behaviours in older adults.
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Affiliation(s)
| | - Ken Harada
- Department of Humanities and Social Sciences, Jissen Women's University, Tokyo, Japan
| | - Yoko Sugihara
- Department of Urban Science and Policy, Tokyo Metropolitan University, Tokyo, Japan
| | - Shizuko Yanagisawa
- Department of Oral Health Science and Social Welfare, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
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Vrinten C, Gallagher A, Waller J, Marlow LAV. Cancer stigma and cancer screening attendance: a population based survey in England. BMC Cancer 2019; 19:566. [PMID: 31185949 PMCID: PMC6561035 DOI: 10.1186/s12885-019-5787-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 05/31/2019] [Indexed: 02/07/2023] Open
Abstract
Background Cancer-related stigma attracts considerable research interest, but few studies have examined stigmatisation in the healthy population. Qualitative studies suggest that stigma can discourage people from attending cancer screening. We aimed to quantify the prevalence and socio-demographic patterning of cancer stigma in the general population and to explore its association with cancer screening attendance. Methods In 2016, 1916 adults aged 18–70 years took part in home-based interviews in England. Measures assessed demographic characteristics, self-reported screening uptake for cervical (n = 681), breast (n = 326) and colorectal cancer (n = 371), and cancer stigma. Cancer stigma was measured with the validated Cancer Stigma Scale which assesses six subdomains (Severity, Personal Responsibility, Awkwardness, Avoidance, Policy Opposition, and Financial Discrimination), from which a mean score was calculated. Logistic regression analyses examined the association between cancer stigma and having been screened as recommended versus not. Results Levels of cancer stigma were low, but varied across the six subdomains. Items regarding the severity of a cancer diagnosis attracted the highest levels of agreement (30–51%), followed by statements about the acceptability of making financial decisions on the basis of a cancer diagnosis such as allowing banks to refuse a mortgage (16–31%) and policy opposition statements such as not having a responsibility to provide the best possible care for cancer patients (10–17%). A similar proportion anticipated feeling awkward around someone with cancer (10–17%). Only 8–11% agreed with personal responsibility statements, such as that a person with cancer is to blame for their condition, while 4–5% of adults anticipated avoiding someone with cancer. Stigma was significantly higher in men (p < .05) and in those from ethnic minority backgrounds (p < .001). Higher cancer stigma was associated with not being screened as recommended for all three screening programmes (cervical: adjusted OR 1.59, 95% CI 1.15–2.20; breast: adjusted OR = 1.97, 95% CI 1.17–3.32; colorectal: adjusted OR = 1.59, 95% CI 1.06–2.38). Conclusions Cancer stigma is generally low, but some aspects of stigma are more prevalent than others. Stigma is more prevalent in certain population subgroups and is negatively associated with cancer screening uptake. These benchmark findings may help track and reduce cancer stigma over time. Electronic supplementary material The online version of this article (10.1186/s12885-019-5787-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Charlotte Vrinten
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT, UK.
| | - Ailish Gallagher
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT, UK
| | - Jo Waller
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT, UK
| | - Laura A V Marlow
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT, UK
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Park CL, Cho D, Moore PJ. How does education lead to healthier behaviours? Testing the mediational roles of perceived control, health literacy and social support. Psychol Health 2018; 33:1416-1429. [DOI: 10.1080/08870446.2018.1510932] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Crystal L. Park
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Dalnim Cho
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
- Department of Health Disparities, MD Anderson Cancer Center, Unit 1440, UT MD Anderson Cancer Center, Houston, Texas, USA
| | - Philip J. Moore
- Department of Psychology, George Washington University, Washington, DC, USA
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Adapting a religious health fatalism measure for use in Muslim populations. PLoS One 2018; 13:e0206898. [PMID: 30388161 PMCID: PMC6214560 DOI: 10.1371/journal.pone.0206898] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 10/22/2018] [Indexed: 11/30/2022] Open
Abstract
Objective Fatalism has been shown to influence health behaviors and outcomes among different populations. Our study reports on the adaptation of the Religious Health Fatalism Questionnaire for a Muslim population (RHFQ-M). Design The original RHFQ wording was modified for a Muslim context and cognitively tested in 6 focus groups (FG). Items were revised by Muslim and non-Muslim healthcare researchers based on FG responses regarding the theological “accurateness” of the questions. The revised 9-item measure was administered to 58 English-speaking Muslim women (≥40 years old) recruited from two mosques in the Chicago area in order to assess psychometric properties. Main outcome measures Cronbach’s alpha and exploratory factor analyses were used to assess internal consistency and measure dimensionality, respectively. Statistical correlations with several fatalism and religiosity measures were computed to assess convergent and discriminant validity. Results After testing with an ethnically and racially diverse group of Muslims, the RHFQ-M was found to be reliable (Cronbach’s α is 0.79), comprised of two distinct underlying subscales, and is correlated with, but distinct from, other measures of fatalism and Islamic religiosity. Conclusion Our adapted measure, RHFQ-M, appears to accurately assess Islamic dimensions of fatalism and is ready for use in the health literature.
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Cullati S, von Arx M, Courvoisier DS, Sandoval JL, Manor O, Burton-Jeangros C, Bouchardy C, Guessous I. Organised population-based programmes and change in socioeconomic inequalities in mammography screening: A 1992-2012 nationwide quasi-experimental study. Prev Med 2018; 116:19-26. [PMID: 30145347 DOI: 10.1016/j.ypmed.2018.08.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 07/25/2018] [Accepted: 08/21/2018] [Indexed: 12/26/2022]
Abstract
Organised mammography screening programmes may reduce socioeconomic inequalities in breast cancer screening, but evidence is contradictory. Switzerland has no national organised mammography screening programme, but regional programmes were progressively introduced since 1999, giving the opportunity to conduct a nationwide quasi-experimental study. We examined the evolution of socioeconomic inequalities in mammography screening in Switzerland and if exposure to regional organised programmes reduced socioeconomic inequalities. Data of 10,927 women aged 50 to 70 years old were collected from the Swiss Health Interview Survey, a nationally representative cross-sectional survey repeated 5 times (1992-2012). Socioeconomic characteristics were assessed using education, income, employment status, and occupational class. Adjusted prevalence ratios of up-to-date mammography screening were estimated with Poisson regressions and weighted for sampling strategy and non-participation bias. In the absence of organised screening programmes (1992-1997), prevalence of mammography screening increased by 23% and was associated with tertiary education and working part time. During the period of progressive introduction of regionally organised programmes (2002-2012), prevalence of mammography screening increased by 19% every 5 years and was associated with exposure to regional programmes and with independent/artisan occupations. Tertiary education and working part time were no longer associated. Exposure to organised programmes did not modify socioeconomic inequalities except for employment status: not employed women benefitted more from organised programmes compared to women working full time. In conclusion, socioeconomic inequalities in mammography screening decreased over time but organised programmes did not greatly modify them, except women not employed whose prevalence passed employed women.
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Affiliation(s)
- Stéphane Cullati
- Unit of Population Epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Switzerland; Swiss NCCR "LIVES - Overcoming Vulnerability: Life Course Perspectives", University of Geneva, Switzerland; Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Switzerland; Institute of Demography and Socioeconomics, University of Geneva, Switzerland.
| | - Martina von Arx
- Institute of Demography and Socioeconomics, University of Geneva, Switzerland
| | - Delphine S Courvoisier
- Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Switzerland
| | - José Luis Sandoval
- Unit of Population Epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Switzerland; Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Switzerland
| | - Orly Manor
- School of Public Health and Community Medicine, Hebrew University-Hadassah, Israel
| | - Claudine Burton-Jeangros
- Swiss NCCR "LIVES - Overcoming Vulnerability: Life Course Perspectives", University of Geneva, Switzerland; Institute of Demography and Socioeconomics, University of Geneva, Switzerland
| | - Christine Bouchardy
- Geneva Cancer Registry, Global Health Institute, University of Geneva, Switzerland
| | - Idris Guessous
- Unit of Population Epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Switzerland; Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland
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Hall MB, Vos P. Comparison of Cancer Fatalism Among Rural Smokers and Nonsmokers. J Community Health 2018; 44:215-221. [DOI: 10.1007/s10900-018-0576-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Schütte S, Dietrich D, Montet X, Flahault A. Participation in lung cancer screening programs: are there gender and social differences? A systematic review. Public Health Rev 2018; 39:23. [PMID: 30128168 PMCID: PMC6092821 DOI: 10.1186/s40985-018-0100-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 06/06/2018] [Indexed: 11/10/2022] Open
Abstract
Lung cancer remains the leading cause of cancer mortality worldwide. A number of screening trials for early detection of lung cancer exist, using chest X-ray, low-dose computed tomography, or both. However, little is known about the socio-demographic characteristics of participants in lung cancer screening programs. As gender and socio-economic determinants are important variables to consider for successful program implementation, this review aims to characterize the participants in such programs and to investigate whether differences in representation exist across screening programs. Systematic methods were used to identify relevant studies. A search was undertaken to locate all studies published up to August 2017 assessing the socio-demographic profile of participants in lung cancer screening programs. A search strategy was developed, refined, and implemented to search in two different online databases (MEDLINE and Web of Sciences). A total of 1588 references were retrieved of which 14 were eligible for review. The results highlight differences in gender and social characteristics of participants across programs, while noting that differences may be partly explained by the various epidemiological contexts, program inclusion criteria, and socio-economic status (SES) measures collected. Most importantly, despite a well-recognized predominance of low SES among heavy smokers, people with high SES are seemingly over-represented among participants. Male participants also seem to be over-represented. These findings are important to help inform the development and implementation processes of future lung cancer screening programs, which should likely include strategies for engaging women as well as individuals with low SES and, of course, those most at risk for developing lung cancer.
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Affiliation(s)
- Stefanie Schütte
- 1Centre Virchow-Villermé for Public Health Paris-Berlin, Université Sorbonne Paris Cité, Paris, France
| | - Damien Dietrich
- 2Institute of Global Health, Faculty of Medicine, University of Geneva, 9, chemin des mines, 1202 Geneva, Switzerland.,3Radiology and Medical Informatics Department, Geneva University Hospitals, Geneva, Switzerland
| | - Xavier Montet
- 3Radiology and Medical Informatics Department, Geneva University Hospitals, Geneva, Switzerland
| | - Antoine Flahault
- 2Institute of Global Health, Faculty of Medicine, University of Geneva, 9, chemin des mines, 1202 Geneva, Switzerland
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Kiviniemi MT, Klasko-Foster LB, Erwin DO, Jandorf L. Decision-making and socioeconomic disparities in colonoscopy screening in African Americans. Health Psychol 2018; 37:481-490. [PMID: 29595298 PMCID: PMC5920714 DOI: 10.1037/hea0000603] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Socioeconomic status (SES) disparities in colorectal cancer screening are persistent. Lower education and income are both associated with lower screening rates. Both cognitive (e.g., perceived barriers) and affective (e.g., disgust, fear) decision-making constructs are known determinants of colorectal cancer screening behavior. This study tests the hypotheses that SES may be related to decision-making constructs and that this SES-decision-making construct relation may contribute to explaining the SES-screening behavior disparity. METHOD Surveys assessing perceived benefits and barriers to screening, self-efficacy, positive and negative affective associations with colonoscopy, fear of colonoscopy, colorectal cancer knowledge, past screening behavior, and demographics including education and income were completed by 2,015 African American participants ages 50 and older. Both univariable and multivariable relations of SES to decision-making constructs were examined, as were univariable and multivariable models of the indirect effect of SES on screening via decision-making constructs. RESULTS Socioeconomic status was related to both screening compliance and the decision-making constructs. Bootstrap modeling of the indirect effect showed that the total effect of the SES-screening behavior relation included an indirect effect via social cognitive decision-making constructs. CONCLUSION These findings suggest that cognitive and affective decision-making constructs account for at least some of the SES disparities in colorectal cancer screening behavior. As such, more research is needed to explore the intra individual-level influences of disparities in colorectal cancer screening. In addition, work is needed to develop effective intervention approaches to address the relation of SES to decision-making constructs. (PsycINFO Database Record
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Affiliation(s)
| | | | - Deborah O Erwin
- Office of Cancer Health Disparities Research, Roswell Park Cancer Institute
| | - Lina Jandorf
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai
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Carter-Harris L, Davis LL, Rawl SM. Lung Cancer Screening Participation: Developing a Conceptual Model to Guide Research. Res Theory Nurs Pract 2018; 30:333-352. [PMID: 28304262 DOI: 10.1891/1541-6577.30.4.333] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To describe the development of a conceptual model to guide research focused on lung cancer screening participation from the perspective of the individual in the decision-making process. METHODS Based on a comprehensive review of empirical and theoretical literature, a conceptual model was developed linking key psychological variables (stigma, medical mistrust, fatalism, worry, and fear) to the health belief model and precaution adoption process model. RESULTS Proposed model concepts have been examined in prior research of either lung or other cancer screening behavior. To date, a few studies have explored a limited number of variables that influence screening behavior in lung cancer specifically. Therefore, relationships among concepts in the model have been proposed and future research directions presented. CONCLUSION This proposed model is an initial step to support theoretically based research. As lung cancer screening becomes more widely implemented, it is critical to theoretically guide research to understand variables that may be associated with lung cancer screening participation. Findings from future research guided by the proposed conceptual model can be used to refine the model and inform tailored intervention development.
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de Klerk CM, Gupta S, Dekker E, Essink-Bot ML. Socioeconomic and ethnic inequities within organised colorectal cancer screening programmes worldwide. Gut 2018; 67:679-687. [PMID: 28073892 DOI: 10.1136/gutjnl-2016-313311] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 12/14/2016] [Accepted: 12/18/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Colorectal cancer (CRC) screening programmes can reduce CRC mortality. However, the implementation of a screening programme may create or exacerbate socioeconomic and ethnic health inequities if participation varies by subgroup. We determined which organised programmes characterise participation inequities by socioeconomic and ethnic subgroups, and assessed the variation in subgroup participation among programmes collecting group-specific data. DESIGN Employing a literature review and survey among leaders of national or regional screening programmes, this study identified published and unpublished data on participation by socioeconomic status and ethnicity. We assessed programmes offering faecal occult blood tests (FOBT) for screening. Primary outcome was screening participation rate. RESULTS Across 24 organised FOBT-screening programmes meeting the inclusion criteria, participation rates ranged from 21% to 73%. Most programmes (13/24, 54%) did not collect data on participation by socioeconomic status and ethnicity. Among the 11 programmes with data on participation by socioeconomic status, 90% (28/31 publications) reported lower participation among lower socioeconomic groups. Differences across socioeconomic gradients were moderate (66% vs 71%) to severe (35% vs 61%). Only six programmes reported participation results by ethnicity. Ethnic differences were moderate, though only limited data were available for evaluation. CONCLUSIONS Across organised CRC screening programmes worldwide, variation in participation by socioeconomic status and ethnicity is often not assessed. However, when measured, marked disparities in participation by socioeconomic status have been observed. Limited data were available to assess inequities by ethnicity. To avoid exacerbating health inequities, screening programmes should systematically monitor participation by socioeconomic status and ethnicity, and investigate and address determinants of low participation.
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Affiliation(s)
- C M de Klerk
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - S Gupta
- Division of Gastroenterology, Department of Internal Medicine, University of California San Diego, San Diego, California, USA
| | - E Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M L Essink-Bot
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Self-rated health is prospectively associated with uptake of screening for the early detection of colorectal cancer, not vice versa. Eur J Cancer Prev 2018; 25:282-7. [PMID: 26230609 DOI: 10.1097/cej.0000000000000184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Self-rated health (SRH) is a consistent predictor of mortality and other health outcomes. One of the mechanisms hypothesized to explain its validity as a predictor is that SRH affects the adoption of health behaviors. The present study examined the prospective association between SRH and performance of a recommended colorectal cancer (CRC) screening test. One thousand four hundred and seventy-six men and women aged 50-74 years, eligible for CRC screening, who had undergone the test a year before were interviewed 1-2 weeks (long interview, before testing) or 2 months (short interview, after testing) following the mailing of a test kit. Test performance was ascertained using an HMO's computerized data set. Respondents in the long interview group who rated their health as 'higher than others' performed the screening test 2 months following the invitation more than those who rated their health as similar to or lower than that of others (65.4, 61.6, and 49.1%, respectively, χ=8.02, P=0.018). At the same time, these respondents perceived the risk of CRC as significantly lower than that of those who rated their health as comparable with or lower than that of others. In a multivariate logistic regression of CRC screening behavior that included demographic and perceptual variables, age, intentions, and SRH were found to be significant predictors. Among respondents in the short interview, who tested before the interview, there was no significant association between SRH and behavior. SRH prospectively predicts uptake of CRC screening better than other perceptual variables, after accounting for demographic variables.
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Kim K, Xue QL, Walton-Moss B, Nolan MT, Han HR. Decisional balance and self-efficacy mediate the association among provider advice, health literacy and cervical cancer screening. Eur J Oncol Nurs 2017; 32:55-62. [PMID: 29353633 DOI: 10.1016/j.ejon.2017.12.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 11/30/2017] [Accepted: 12/01/2017] [Indexed: 12/28/2022]
Abstract
PURPOSE Health literacy has emerged as a potential determinant of cancer screening, yet limited literature has investigated the pathways which health literacy influences Pap tests among immigrant women who experience a higher incidence of cervical cancer. This study aimed to test a health literacy-focused sociocognitive model which proposes motivational (knowledge, decisional balance) and volitional (self-efficacy) factors mediating the association between health literacy and triennial Pap tests. METHODS Using structural equation modeling, we conducted a secondary analysis of baseline data obtained from a randomized controlled trial to promote breast and cervical cancer screenings among 560 Korean American women 21-65 years of age. They were interviewed on demographics such as education and English proficiency, provider advice, health literacy, knowledge of cervical cancer, decisional balance for Pap tests, self-efficacy, and Pap test use. RESULTS Higher health literacy predicted high level of knowledge and high decisional balance score, and greater self-efficacy and then only decisional balance and self-efficacy affected Pap tests. High level of knowledge predicted Pap tests through its impact on the decisional balance score. Receiving provider advice both directly and indirectly predicted Pap tests through high level of health literacy, high level of decisional balance and greater self-efficacy. CONCLUSIONS Findings from this study suggest possible pathways through which provider advice and health literacy affect Pap tests. Interventions targeting immigrant women with limited English proficiency should consider skill-based approaches such as health literacy training, promoting patient-provider communications and emphasizing decisional balance and self-efficacy as potentially sustainable ways of promoting Pap tests.
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Affiliation(s)
- Kyounghae Kim
- Department of Community-Public Health, School of Nursing, Johns Hopkins University, 525 N Wolfe Street, Baltimore, MD 21205, USA.
| | - Qian-Li Xue
- School of Medicine, Johns Hopkins University, 733 N Broadway, Baltimore, MD 21205, USA
| | - Benita Walton-Moss
- Department of Nursing, School of Social Work, University of Southern California, 1150 South Olive St. Suite T1100, Los Angeles, CA 90015, USA
| | - Marie T Nolan
- Department of Acute and Chronic Care, School of Nursing, Johns Hopkins University, 525 N Wolfe Street, Baltimore, MD 21205, USA
| | - Hae-Ra Han
- Department of Community-Public Health, School of Nursing, Johns Hopkins University, 525 N Wolfe Street, Baltimore, MD 21205, USA
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Agustina E, Dodd RH, Waller J, Vrinten C. Understanding middle-aged and older adults' first associations with the word "cancer": A mixed methods study in England. Psychooncology 2017; 27:309-315. [PMID: 29047225 PMCID: PMC5813269 DOI: 10.1002/pon.4569] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 10/03/2017] [Accepted: 10/04/2017] [Indexed: 12/21/2022]
Abstract
Objective Cancer is still widely feared and often associated with death. Fatalistic beliefs adversely affect help‐seeking for cancer symptoms and engagement in cancer prevention. This study aims to understand middle‐aged and older adults' first association with the word “cancer” and their relationship with sociodemographic factors, cancer fear, and cancer information avoidance. Methods We conducted a cross‐sectional survey of 1464 community‐based adults aged 50 to 70 living in England in April 2015. First associations with cancer were measured qualitatively and analysed using content analysis. We used binary logistic regression to analyse associations between the most common first association of cancer and sociodemographic characteristics, cancer fear, and cancer information avoidance. Results Cancer was most commonly associated with “death” (26%). Respondents with lower levels of education, living in the Midlands or North of England where cancer mortality is higher, or with close friends or family members with a cancer history, were more likely to associate cancer with death. Cancer fear was significantly associated with death associations, but cancer information avoidance was not. Conclusions Despite improved cancer outcomes, middle‐aged and older adults often associate cancer with death. Further efforts to decrease fatalistic associations in this age group may be needed.
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Affiliation(s)
- Edelyn Agustina
- Department of Behavioural Science and Health, UCL, London, UK
| | - Rachael H Dodd
- Department of Behavioural Science and Health, UCL, London, UK
| | - Jo Waller
- Department of Behavioural Science and Health, UCL, London, UK
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Ghanouni A, Renzi C, Waller J. A cross-sectional survey assessing factors associated with reading cancer screening information: previous screening behaviour, demographics and decision-making style. BMC Public Health 2017; 17:327. [PMID: 28420378 PMCID: PMC5395826 DOI: 10.1186/s12889-017-4224-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 04/01/2017] [Indexed: 12/03/2022] Open
Abstract
Background There is broad agreement that cancer screening invitees should know the risks and benefits of testing before deciding whether to participate. In organised screening programmes, a primary method of relaying this information is via leaflets provided at the time of invitation. Little is known about why individuals do not engage with this information. This study assessed factors associated with reading information leaflets provided by the three cancer screening programmes in England. Methods A cross-sectional survey asked screening-eligible members of the general population in England about the following predictor variables: uptake of previous screening invitations, demographic characteristics, and ‘decision-making styles’ (i.e. the extent to which participants tended to make decisions in a way that was avoidant, rational, intuitive, spontaneous, or dependent). The primary outcome measures were the amount of the leaflet that participants reported having read at their most recent invitation, for any of the three programmes for which they were eligible. Associations between these outcomes and predictor variables were assessed using binary or ordinal logistic regression. Results After exclusions, data from 275, 309, and 556 participants were analysed in relation to the breast, cervical, and bowel screening programmes, respectively. Notable relationships included associations between regularity of screening uptake and reading (more of) the information leaflets for all programmes (e.g. odds ratio: 0.16 for participants who never/very rarely attended breast screening vs. those who always attended previously; p = .009). Higher rational decision-making scores were associated with reading more of the cervical and bowel screening leaflets (OR: 1.13, p < .0005 and OR: 1.11, p = .045, respectively). Information engagement was also higher for White British participants compared with other ethnic groups for breast (OR: 3.28, p = .008) and bowel (OR: 2.58, p = .015) information; an opposite relationship was observed for older participants (OR: 0.96, p = .048; OR: 0.92, p = .029). Conclusions Interventions that increase screening uptake may also increase subsequent engagement with information. Future research could investigate how to improve engagement at initial invitations. There may also be scope to reduce barriers to accessing non-English information and alternative communication strategies may benefit participants who are less inclined to weigh up advantages and disadvantages as part of their decision-making.
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Affiliation(s)
- Alex Ghanouni
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Cristina Renzi
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Jo Waller
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London, WC1E 6BT, UK.
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Clarke N, McNamara D, Kearney PM, O'Morain CA, Shearer N, Sharp L. The role of area-level deprivation and gender in participation in population-based faecal immunochemical test (FIT) colorectal cancer screening. Prev Med 2016; 93:198-203. [PMID: 27765660 DOI: 10.1016/j.ypmed.2016.10.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 09/06/2016] [Accepted: 10/13/2016] [Indexed: 12/24/2022]
Abstract
This study aimed to investigate the effects of sex and deprivation on participation in a population-based faecal immunochemical test (FIT) colorectal cancer screening programme. The study population included 9785 individuals invited to participate in two rounds of a population-based biennial FIT-based screening programme, in a relatively deprived area of Dublin, Ireland. Explanatory variables included in the analysis were sex, deprivation category of area of residence and age (at end of screening). The primary outcome variable modelled was participation status in both rounds combined (with "participation" defined as having taken part in either or both rounds of screening). Poisson regression with a log link and robust error variance was used to estimate relative risks (RR) for participation. As a sensitivity analysis, data were stratified by screening round. In both the univariable and multivariable models deprivation was strongly associated with participation. Increasing affluence was associated with higher participation; participation was 26% higher in people resident in the most affluent compared to the most deprived areas (multivariable RR=1.26: 95% CI 1.21-1.30). Participation was significantly lower in males (multivariable RR=0.96: 95%CI 0.95-0.97) and generally increased with increasing age (trend per age group, multivariable RR=1.02: 95%CI, 1.01-1.02). No significant interactions between the explanatory variables were found. The effects of deprivation and sex were similar by screening round. Deprivation and male gender are independently associated with lower uptake of population-based FIT colorectal cancer screening, even in a relatively deprived setting. Development of evidence-based interventions to increase uptake in these disadvantaged groups is urgently required.
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Affiliation(s)
- Nicholas Clarke
- Department of Epidemiology and Public Health, University College Cork, Ireland.
| | - Deirdre McNamara
- Department of Clinical Medicine, Trinity Centre for Health Sciences, Adelaide and Meath Hospital, Dublin, Ireland.
| | - Patricia M Kearney
- Department of Epidemiology and Public Health, University College Cork, Ireland.
| | - Colm A O'Morain
- Faculty of Health Science, Trinity College Dublin, Dublin, Ireland.
| | - Nikki Shearer
- Department of Clinical Medicine, Trinity Centre for Health Sciences, Adelaide and Meath Hospital, Dublin, Ireland.
| | - Linda Sharp
- Institute of Health & Society, Newcastle University, England.
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Symonds EL, Pedersen S, Cole SR, Massolino J, Byrne D, Guy J, Backhouse P, Fraser RJ, LaPointe L, Young GP. Improving Participation in Colorectal Cancer Screening: a Randomised Controlled Trial of Sequential Offers of Faecal then Blood Based Non-Invasive Tests. Asian Pac J Cancer Prev 2016; 16:8455-60. [PMID: 26745101 DOI: 10.7314/apjcp.2015.16.18.8455] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poor participation rates are often observed in colorectal cancer (CRC) screening programs utilising faecal occult blood tests. This may be from dislike of faecal sampling, or having benign bleeding conditions that can interfere with test results. These barriers may be circumvented by offering a blood-based DNA test for screening. The aim was to determine if program participation could be increased by offering a blood test following faecal immunochemical test (FIT) non-participation. MATERIALS AND METHODS People were invited into a CRC screening study through their General Practice and randomised into control or intervention (n=600/group). Both groups were mailed a FIT (matching conventional screening programs). Participation was defined as FIT completion within 12wk. Intervention group non-participants were offered a screening blood test (methylated BCAT1/IKZF1). Overall participation was compared between the groups. RESULTS After 12wk, FIT participation was 82% and 81% in the control and intervention groups. In the intervention 96 FIT non- participants were offered the blood test - 22 completed this test and 19 completed the FIT instead. Total screening in the intervention group was greater than the control (88% vs 82%, p<0.01). Of 12 invitees who indicated that FIT was inappropriate for them (mainly due to bleeding conditions), 10 completed the blood test (83%). CONCLUSIONS Offering a blood test to FIT non-participants increased overall screening participation compared to a conventional FIT program. Blood test participation was particularly high in invitees who considered FIT to be inappropriate for them. A blood test may be a useful adjunct test within a FIT program.
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Affiliation(s)
- Erin L Symonds
- Flinders Centre for Innovation in Cancer, Bedford Park, Australia E-mail :
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Harada K, Lee S, Shimada H, Lee S, Bae S, Anan Y, Harada K, Suzuki T. Psychological predictors of participation in screening for cognitive impairment among community‐dwelling older adults. Geriatr Gerontol Int 2016; 17:1197-1204. [DOI: 10.1111/ggi.12841] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 05/05/2016] [Accepted: 05/10/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Kazuhiro Harada
- Graduate School of Human Development and Environment Kobe University Kobe Japan
- Department of Preventive Gerontology National Center for Geriatrics and Gerontology Obu Japan
| | - Sangyoon Lee
- Department of Preventive Gerontology National Center for Geriatrics and Gerontology Obu Japan
| | - Hiroyuki Shimada
- Department of Preventive Gerontology National Center for Geriatrics and Gerontology Obu Japan
| | - Sungchul Lee
- Department of Preventive Gerontology National Center for Geriatrics and Gerontology Obu Japan
| | - Seongryu Bae
- Department of Preventive Gerontology National Center for Geriatrics and Gerontology Obu Japan
| | - Yuya Anan
- Department of Preventive Gerontology National Center for Geriatrics and Gerontology Obu Japan
| | - Kenji Harada
- Department of Preventive Gerontology National Center for Geriatrics and Gerontology Obu Japan
| | - Takao Suzuki
- Institute for Gerontology J. F. Oberlin University Machida Japan
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Burón A, Posso M, Sivilla J, Grau J, Guayta R, Castells X, Castells A, Macià F. Analysis of participant satisfaction in the Barcelona colorectal cancer screening programme: Positive evaluation of the community pharmacy. GASTROENTEROLOGIA Y HEPATOLOGIA 2016; 40:265-275. [PMID: 27292268 DOI: 10.1016/j.gastrohep.2016.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 04/22/2016] [Accepted: 04/25/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Population-based bowel screening programmes with faecal occult blood (FOB) tests need to achieve high uptake rates and offer quality services. We invited participants in the Barcelona Programme to complete a satisfaction survey, in order to explore factors influencing uptake and respondents' opinion and satisfaction with each step of the screening process. MATERIAL AND METHOD Telephone survey using an ad hoc questionnaire (see annex) administered to a final sample of 1189 people: 310 non-participants in the programme (NoP), 553 participants with a negative test result (PNeg), and 326 participants with a positive result (PPos). RESULTS High scores were obtained for the clarity of the information provided by the programme (mean 8.9 on a scale 0-10), and for the accessibility and attention at the pharmacy as well as its role as the point for collection and return of FOB test cards (mean >9.3). Aspects that were not so highly rated were: preparation for the colonoscopy (41.6% reported quite a lot or a lot of discomfort), and to a lesser extent telephone accessibility (27.1% reported some difficulties). Participants also expressed concern about receiving a positive test result by telephone (78.9% reported some concern). CONCLUSIONS Respondents' opinion of the programme was positive overall, and supports the pharmacy as the point for distributing and collecting FOB test cards, as well as the role of the pharmacist in the context of the programme. Some aspects of the screening process will be reviewed in order to improve participant satisfaction and eventually increase uptake.
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Affiliation(s)
- Andrea Burón
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España; Red de investigación en servicios de salud en enfermedades crónicas (REDISSEC), España.
| | - Margarita Posso
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España
| | - Judit Sivilla
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España
| | - Jaume Grau
- Servicio de Medicina Preventiva y Epidemiología, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Rafael Guayta
- Direcció de Projectes i Recerca. Consell de Col·legis Farmacèutics de Catalunya, Barcelona, España
| | - Xavier Castells
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España; Red de investigación en servicios de salud en enfermedades crónicas (REDISSEC), España
| | - Antoni Castells
- Servicio de Gastroenterología, Hospital Clínic, IDIBAPS, CIBEREHD, Universitat de Barcelona, Barcelona, España
| | - Francesc Macià
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España; Red de investigación en servicios de salud en enfermedades crónicas (REDISSEC), España
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Field JK, Duffy SW, Baldwin DR, Brain KE, Devaraj A, Eisen T, Green BA, Holemans JA, Kavanagh T, Kerr KM, Ledson M, Lifford KJ, McRonald FE, Nair A, Page RD, Parmar MK, Rintoul RC, Screaton N, Wald NJ, Weller D, Whynes DK, Williamson PR, Yadegarfar G, Hansell DM. The UK Lung Cancer Screening Trial: a pilot randomised controlled trial of low-dose computed tomography screening for the early detection of lung cancer. Health Technol Assess 2016; 20:1-146. [PMID: 27224642 PMCID: PMC4904185 DOI: 10.3310/hta20400] [Citation(s) in RCA: 181] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Lung cancer kills more people than any other cancer in the UK (5-year survival < 13%). Early diagnosis can save lives. The USA-based National Lung Cancer Screening Trial reported a 20% relative reduction in lung cancer mortality and 6.7% all-cause mortality in low-dose computed tomography (LDCT)-screened subjects. OBJECTIVES To (1) analyse LDCT lung cancer screening in a high-risk UK population, determine optimum recruitment, screening, reading and care pathway strategies; and (2) assess the psychological consequences and the health-economic implications of screening. DESIGN A pilot randomised controlled trial comparing intervention with usual care. A population-based risk questionnaire identified individuals who were at high risk of developing lung cancer (≥ 5% over 5 years). SETTING Thoracic centres with expertise in lung cancer imaging, respiratory medicine, pathology and surgery: Liverpool Heart & Chest Hospital, Merseyside, and Papworth Hospital, Cambridgeshire. PARTICIPANTS Individuals aged 50-75 years, at high risk of lung cancer, in the primary care trusts adjacent to the centres. INTERVENTIONS A thoracic LDCT scan. Follow-up computed tomography (CT) scans as per protocol. Referral to multidisciplinary team clinics was determined by nodule size criteria. MAIN OUTCOME MEASURES Population-based recruitment based on risk stratification; management of the trial through web-based database; optimal characteristics of CT scan readers (radiologists vs. radiographers); characterisation of CT-detected nodules utilising volumetric analysis; prevalence of lung cancer at baseline; sociodemographic factors affecting participation; psychosocial measures (cancer distress, anxiety, depression, decision satisfaction); and cost-effectiveness modelling. RESULTS A total of 247,354 individuals were approached to take part in the trial; 30.7% responded positively to the screening invitation. Recruitment of participants resulted in 2028 in the CT arm and 2027 in the control arm. A total of 1994 participants underwent CT scanning: 42 participants (2.1%) were diagnosed with lung cancer; 36 out of 42 (85.7%) of the screen-detected cancers were identified as stage 1 or 2, and 35 (83.3%) underwent surgical resection as their primary treatment. Lung cancer was more common in the lowest socioeconomic group. Short-term adverse psychosocial consequences were observed in participants who were randomised to the intervention arm and in those who had a major lung abnormality detected, but these differences were modest and temporary. Rollout of screening as a service or design of a full trial would need to address issues of outreach. The health-economic analysis suggests that the intervention could be cost-effective but this needs to be confirmed using data on actual lung cancer mortality. CONCLUSIONS The UK Lung Cancer Screening (UKLS) pilot was successfully undertaken with 4055 randomised individuals. The data from the UKLS provide evidence that adds to existing data to suggest that lung cancer screening in the UK could potentially be implemented in the 60-75 years age group, selected via the Liverpool Lung Project risk model version 2 and using CT volumetry-based management protocols. FUTURE WORK The UKLS data will be pooled with the NELSON (Nederlands Leuvens Longkanker Screenings Onderzoek: Dutch-Belgian Randomised Lung Cancer Screening Trial) and other European Union trials in 2017 which will provide European mortality and cost-effectiveness data. For now, there is a clear need for mortality results from other trials and further research to identify optimal methods of implementation and delivery. Strategies for increasing uptake and providing support for underserved groups will be key to implementation. TRIAL REGISTRATION Current Controlled Trials ISRCTN78513845. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 40. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- John K Field
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - David R Baldwin
- Respiratory Medicine Unit, David Evans Research Centre, Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | - Kate E Brain
- Division of Population Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Anand Devaraj
- Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Tim Eisen
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Beverley A Green
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - John A Holemans
- Department of Radiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | - Keith M Kerr
- Department of Pathology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Martin Ledson
- Department of Respiratory Medicine, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Kate J Lifford
- Division of Population Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Fiona E McRonald
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Arjun Nair
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Richard D Page
- Department of Thoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | - Robert C Rintoul
- Department of Thoracic Oncology, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Nicholas Screaton
- Department of Radiology, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Nicholas J Wald
- Centre for Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - David Weller
- School of Clinical Sciences and Community Health, University of Edinburgh, Edinburgh, UK
| | - David K Whynes
- School of Economics, University of Nottingham, Nottingham, UK
| | - Paula R Williamson
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Ghasem Yadegarfar
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - David M Hansell
- Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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Breslau ES, Gorin SS, Edwards HM, Schonberg MA, Saiontz N, Walter LC. An Individualized Approach to Cancer Screening Decisions in Older Adults: A Multilevel Framework. J Gen Intern Med 2016; 31:539-47. [PMID: 26941042 PMCID: PMC4835387 DOI: 10.1007/s11606-016-3629-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 02/05/2016] [Accepted: 02/05/2016] [Indexed: 11/29/2022]
Abstract
Guidelines for optimal cancer screening in older adults remain unclear, particularly for adults over the age of 75. While cancer screening in older adults may benefit some in good health, it may cause unnecessary burdens in others with limited life expectancy. Thus, a systematic approach to enable individualized cancer screening decisions in older adults is needed. We suggest a framework that guides such decisions through evidence-based approaches from multiple interactions, and that involves the patient, clinician, and healthcare system. An individualized approach considers differences in disease risk rather than the chronological age of the patient. This paper presents a comprehensive framework that depicts the independent and converging levels of influences on individualized cancer screening decisions in older adults. This Individualized Decisions for Screening (IDS) framework recognizes the reality of these interrelationships, including the tensions that arise when behaviors and outcomes are valued differently at the patient, clinician, and healthcare organization levels. Person-centered approaches are essential to advancing multilevel research of individualized cancer screening decisions among older adults.
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Affiliation(s)
- Erica S Breslau
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850-9761, USA.
| | - Sherri Sheinfeld Gorin
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc., Frederick, MD, 21702, USA
- New York Physicians Against Cancer, Herbert Irving Comprehensive Cancer Center, New York, 10032, NY, USA
| | - Heather M Edwards
- Patient-Centered Outcomes Research Institute, Washington, 20036, DC, USA
| | - Mara A Schonberg
- Department of Medicine, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, 02215, MA, USA
| | - Nicole Saiontz
- Office of the Director, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, 20850-9761, MD, USA
| | - Louise C Walter
- Department of Medicine, Division of Geriatrics, University of California San Francisco and the San Francisco VA Medical Center, San Francisco, 94121, CA, USA
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46
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Tirgari B, Azzizadeh Forouzi M, Malakian L. Being Under the Umbrella of Persistent Grief: Experiences of Survivors of Bam Earthquake. Issues Ment Health Nurs 2016; 37:344-52. [PMID: 27172233 DOI: 10.3109/01612840.2016.1155004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The loss of a loved one is a highly stressful event that nearly everyone experiences. Multiple losses can leave relatives feeling overwhelmed or stuck in their grief, a phenomenon commonly referred to as bereavement overload. This study aimed to elucidate the meaning of prolonged grief from the viewpoint of the survivors of the Bam earthquake (Iran, December 2003) 11 years after the earthquake in south eastern Iran. Family members who lost loved ones in the Bam earthquake were considered potential participants. A total of 12 survivors participated in this study. The interviews were analyzed with Ricoeur's phenomenological hermeneutic method. The meaning of prolonged grief was comprehensively understood as "being under the umbrella of persistent grief." This can be divided into four themes: experiencing a divine and painful destiny, experiencing heartbreaking goodbye with loved ones, losing all hopes and dreams, and being in a state of fragile peace. The results in this study suggest survivors of the Bam earthquake grief can be moderated by adequate crisis-related coping resources such as social, cultural, and religious supports. These supports are clearly important to survivors' post-earthquake recovery.
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Affiliation(s)
- Batool Tirgari
- a Kerman Neuroscience Research Center and Neuropharmacology Institute , Kerman , Iran
| | | | - Lila Malakian
- b Bam University of Medical Sciences , School of Nursing and Midwifery , Bam , Iran
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47
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Idowu KA, Adenuga B, Otubu O, Narasimhan K, Kamara F, Hunter-Richardson F, Larbi D, Sherif ZA, Laiyemo AO. Place of birth, cancer beliefs and being current with colon cancer screening among US adults. Ann Gastroenterol 2016; 29:336-40. [PMID: 27366035 PMCID: PMC4923820 DOI: 10.20524/aog.2016.0040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/09/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Historically, studies suggested that immigrants acquire the risk of colorectal cancer (CRC) as US-born persons within the same generation. CRC risk of immigrants is largely unknown in this era of cancer screening and widespread immigration. We investigated the association of place of birth and cancer beliefs with uptake of CRC screening. METHODS The 2007 Health Information National Trends Survey was used and 4,299 respondents (weighted population size=81,896,392) who were 50 years and older (3,960 US-born and 339 foreign-born) were identified. We defined being current with CRC screening guidelines as the use of fecal occult blood test within 1 year, sigmoidoscopy within 5 years, or colonoscopy within 10 years. We compared being up-to-date with CRC screening among foreign-born versus US-born respondents. Logistic regression models were used to calculate odds ratios (OR) and 95% confidence intervals (CI). RESULTS Overall, 2,594 (63.3%) US-born and 208 (52.8%) foreign-born respondents were current with CRC screening. Foreign-born respondents were less current in unadjusted model (OR 0.65; 95% CI: 0.50-0.85) but became non-statistically significant after adjustment (OR 0.79; 95% CI: 0.51-1.24). Respondents who believed that screening finds cancer when it is easy to treat (OR 2.85; 95% CI: 1.44-3.61), those who believed that cancer can be cured when detected early (OR 1.56; 95% CI: 1.20-2.00), and those who worry about getting cancer (OR 1.34; 95% CI: 1.10-1.61) were likely to be current with CRC screening. However, respondents with fatalistic beliefs were borderline less likely to be current (OR 0.82; 95% CI: 0.65-1.04). CONCLUSION There is a need to improve education on CRC screening, particularly among foreign-born adults.
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Affiliation(s)
- Kolapo A Idowu
- Department of Community and Family Medicine (Kolapo A. Idowu, Babafemi Adenuga, Oritsetsemaye Otubu, Krishnan Narasimhan, Feremusu Kamara, Finie Hunter-Richardson), Washington DC, USA
| | - Babafemi Adenuga
- Department of Community and Family Medicine (Kolapo A. Idowu, Babafemi Adenuga, Oritsetsemaye Otubu, Krishnan Narasimhan, Feremusu Kamara, Finie Hunter-Richardson), Washington DC, USA
| | - Oritsetsemaye Otubu
- Department of Community and Family Medicine (Kolapo A. Idowu, Babafemi Adenuga, Oritsetsemaye Otubu, Krishnan Narasimhan, Feremusu Kamara, Finie Hunter-Richardson), Washington DC, USA
| | - Krishnan Narasimhan
- Department of Community and Family Medicine (Kolapo A. Idowu, Babafemi Adenuga, Oritsetsemaye Otubu, Krishnan Narasimhan, Feremusu Kamara, Finie Hunter-Richardson), Washington DC, USA
| | - Feremusu Kamara
- Department of Community and Family Medicine (Kolapo A. Idowu, Babafemi Adenuga, Oritsetsemaye Otubu, Krishnan Narasimhan, Feremusu Kamara, Finie Hunter-Richardson), Washington DC, USA
| | - Finie Hunter-Richardson
- Department of Community and Family Medicine (Kolapo A. Idowu, Babafemi Adenuga, Oritsetsemaye Otubu, Krishnan Narasimhan, Feremusu Kamara, Finie Hunter-Richardson), Washington DC, USA
| | - Daniel Larbi
- Department of Medicine (Daniel Larbi, Adeyinka O. Laiyemo), Washington DC, USA
| | - Zaki A Sherif
- Department of Biochemistry and Molecular Biology (Zaki A. Sherif), Howard University College of Medicine, Washington DC, USA
| | - Adeyinka O Laiyemo
- Department of Medicine (Daniel Larbi, Adeyinka O. Laiyemo), Washington DC, USA
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48
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Clarke N, Gallagher P, Kearney PM, McNamara D, Sharp L. Impact of gender on decisions to participate in faecal immunochemical test-based colorectal cancer screening: a qualitative study. Psychooncology 2016; 25:1456-1462. [PMID: 26864167 DOI: 10.1002/pon.4085] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 01/06/2016] [Accepted: 01/07/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Faecal immunochemical tests (FITs) are increasingly being used in population-based colorectal cancer-screening programmes. Uptake of FIT is lower in men than women; however, the reasons for this are not well understood. We aimed to explore gender differences in influences on decisions to participate in FIT screening. METHODS This is a qualitative study using in-depth face-to-face interviews of four groups of screening invitees (male and female screening users and male and female screening non-users), purposively sampled from the database of a population-based FIT screening programme. Recruitment continued until saturation was reached. Interviews were audio recorded and transcribed verbatim. Thematic analysis using the framework approach was employed with the theoretical domains framework guiding analysis. RESULTS Forty-seven screening invitees were interviewed. Six theoretical domains influenced screening uptake: 'environmental context and resources', 'beliefs about capabilities', 'beliefs about consequences', 'emotions', 'social influences' and 'knowledge'. Male non-users were often fatalistic, less knowledgeable and misinformed about cancer and FIT screening compared with other groups. Female non-users expressed negative attitudes, beliefs and emotions towards FIT screening, cancer, social influences and the medical profession and were over-confident about their health. CONCLUSIONS Negative attitudes and emotions to screening dominated non-user decision-making but differed by gender. Opportunities to improve uptake in men and women exist. Greater national discussions on the benefits of FIT screening, and development of screening materials tackling negative attitudes and beliefs while recognising male/female differences, may improve screening uptake. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Nicholas Clarke
- National Cancer Registry Ireland, Cork, Ireland.,Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Pamela Gallagher
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Patricia M Kearney
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Deirdre McNamara
- Department of Clinical Medicine, Trinity Centre for Health Sciences, Adelaide and Meath Hospital, Dublin, Ireland
| | - Linda Sharp
- National Cancer Registry Ireland, Cork, Ireland.,Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
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49
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Socioeconomic inequalities in attitudes towards cancer: an international cancer benchmarking partnership study. Eur J Cancer Prev 2016; 24:253-60. [PMID: 25734238 PMCID: PMC4372163 DOI: 10.1097/cej.0000000000000140] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Socioeconomic status (SES) differences in attitudes towards cancer have been implicated in the differential screening uptake and the timeliness of symptomatic presentation. However, the predominant emphasis of this work has been on cancer fatalism, and many studies focus on specific community subgroups. This study aimed to assess SES differences in positive and negative attitudes towards cancer in UK adults. A population-based sample of UK adults (n=6965, age≥50 years) completed the Awareness and Beliefs about Cancer scale, including six belief items: three positively framed (e.g. ‘Cancer can often be cured’) and three negatively framed (e.g. ‘A cancer diagnosis is a death sentence’). SES was indexed by education. Analyses controlled for sex, ethnicity, marital status, age, self-rated health, and cancer experience. There were few education-level differences for the positive statements, and overall agreement was high (all>90%). In contrast, there were strong differences for negative statements (all Ps<0.001). Among respondents with lower education levels, 57% agreed that ‘treatment is worse than cancer’, 27% that cancer is ‘a death sentence’ and 16% ‘would not want to know if I have cancer’. Among those with university education, the respective proportions were 34, 17 and 6%. Differences were not explained by cancer experience or health status. In conclusion, positive statements about cancer outcomes attract near-universal agreement. However, this optimistic perspective coexists alongside widespread fears about survival and treatment, especially among less-educated groups. Health education campaigns targeting socioeconomically disadvantaged groups might benefit from a focus on reducing negative attitudes, which is not necessarily achieved by promoting positive attitudes.
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50
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Brittain K, Christy SM, Rawl SM. African American patients' intent to screen for colorectal cancer: Do cultural factors, health literacy, knowledge, age and gender matter? J Health Care Poor Underserved 2016; 27:51-67. [PMID: 27182187 DOI: 10.1353/hpu.2016.0022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
African Americans have higher colorectal cancer (CRC) mortality rates. Research suggests that CRC screening interventions targeting African Americans be based upon cultural dimensions. Secondary analysis of data from African-Americans who were not up-to-date with CRC screening (n=817) was conducted to examine: 1) relationships among cultural factors (i.e., provider trust, cancer fatalism, health temporal orientation (HTO)), health literacy, and CRC knowledge; 2) age and gender differences; and 3) relationships among the variables and CRC screening intention. Provider trust, fatalism, HTO, health literacy and CRC knowledge had significant relationships among study variables. The FOBT intention model explained 43% of the variance with age and gender being significant predictors. The colonoscopy intention model explained 41% of the variance with gender being a significant predictor. Results suggest that when developing CRC interventions for African Americans, addressing cultural factors remain important, but particular attention should be given to the age and gender of the patient.
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Affiliation(s)
- Kelly Brittain
- College of Nursing, Michigan State University, East Lansing
| | - Shannon M Christy
- Department of Psychology, Purdue School of Science, Indiana University-Purdue University Indianapolis
| | - Susan M Rawl
- School of Nursing, Indiana University, Indianapolis
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