Barriers to colonoscopy in UK colorectal cancer screening programmes: Qualitative interviews with ethnic minority groups

OBJECTIVE

People from ethnic minority backgrounds are less likely to attend colonoscopy, following faecal immunochemical test screening, and are more likely to be diagnosed with colorectal cancer at an advanced stage as a result. The aim of this research was to explore the barriers and facilitators to attending colonoscopy, perceived by ethnic minority groups living in the United Kingdom.

METHODS

Semi-structured online and telephone interviews were conducted with thirty men and women of Black-African (n = 5), Black-Caribbean (n = 5), South Asian (n = 10) and White British (n = 10) descent. Participants were eligible for screening, but had not necessarily been invited for colonoscopy. All interviews were conducted in the participant's first language and were assessed using Framework-analysis, in line with a conceptual framework developed from previous interviews with healthcare professionals.

RESULTS

Five thematic groups of barriers and facilitators were developed: 'Locus of control', 'Cultural attitudes and beliefs', 'Individual beliefs, knowledge and personal experiences with colonoscopy and cancer', 'Reliance on family and friends' and 'Health concerns'. Differences were observed, between ethnic groups, for: 'Locus of control', 'Cultural attitudes and beliefs' and 'Reliance on family and friends'. Black and South Asian participants frequently described the decision to attend colonoscopy as lying with 'God' (Muslims, specifically), 'the doctor', or 'family' (Locus of control). Black and South Asian participants also reported relying on friends and family for 'language, transport and emotional support' (Reliance on family and friends). Black-African participants, specifically, described cancer as 'socially taboo' (Cultural attitudes and beliefs).

CONCLUSIONS

The results highlight several targets for culturally-tailored interventions to make colonoscopy more equitable.

Locus of Control in College Students with and Without Visual Impairments, and the Visual Characteristics that Affect It

Introduction:

According to previous research, locus of control (LOC) has a crucial role in an individual’s psychological well-being. The purpose of this study was 3-fold: (1) comparing LOC of college students with and without visual impairments while controlling for gender, educational level, and age; (2) investigating the relationship between LOC and visual characteristics in college students with visual impairments; and (3) predicting LOC of these students using their visual characteristics.

Methods:

The design of this study was causal-comparative. The statistical population included a sample of college students with and without visual impairments who were enrolled at the University of Isfahan, Iran. Fifteen of the 20 college students with visual impairments were selected through convenience sampling and amongst sighted students, 15 individuals were selected in a way that they were matched with college students with visual impairment regarding gender, educational level, and age. The Rotter Locus of Control Scale was used to measure LOC. Also, visual impairment characteristics and demographic data were collected. The results were analyzed by t-test and stepwise regression analysis.

Results:

Results indicated no significant difference between LOC of college students with and without visual impairments ( p > .05), and both groups tended to have internal LOC on average. The results indicated that adjustment to visual impairment and the recent status of visual impairment might predict the LOC of a college student who is visually impaired and explained 59.2% of its variance with this sample ( p < .005).

Discussion:

LOC of college students with visual impairments was similar to their sighted counterparts. The better adjusted the person was to his or her visual impairment and the less worsening the status of visual impairment was, the higher internal LOC he or she had.

Implications for practitioners:

Families and society can help individuals with visual impairments build their internal LOC, by teaching them how to adjust to their disability and providing them the conditions to increase their independence. At the same time, preparing them for entering university may also help them develop their sense of internal LOC.