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Lifford KJ, Grozeva D, Cannings-John R, Quinn-Scoggins H, Moriarty Y, Gjini A, Goddard M, Hepburn J, Hughes J, Moore G, Osborne K, Robling M, Townson J, Waller J, Whitelock V, Whitaker KL, Brain K. Satisfaction with remote consultations in primary care during COVID-19: a population survey of UK adults. Br J Gen Pract 2024; 74:e96-e103. [PMID: 38253548 PMCID: PMC10824329 DOI: 10.3399/bjgp.2023.0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 08/21/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Mode of access to primary care changed during the COVID-19 pandemic; remote consultations became more widespread. With remote consultations likely to continue in UK primary care, it is important to understand people's perceptions of remote consultations and identify potential resulting inequalities. AIM To assess satisfaction with remote GP consultations in the UK during the COVID-19 pandemic and identify demographic variation in satisfaction levels. DESIGN AND SETTING A cross-sectional survey from the second phase of a large UK-based study, which was conducted during the COVID-19 pandemic. METHOD In total, 1426 adults who self-reported having sought help from their doctor in the past 6 months completed an online questionnaire (February to March 2021). Items included satisfaction with remote consultations and demographic variables. Associations were analysed using multivariable regression. RESULTS A novel six-item scale of satisfaction with remote GP consultations had good psychometric properties. Participants with higher levels of education had significantly greater satisfaction with remote consultations than participants with mid-level qualifications (B = -0.82, 95% confidence interval [CI] = -1.41 to -0.23) or those with low or no qualifications (B = -1.65, 95% CI = -2.29 to -1.02). People living in Wales reported significantly higher satisfaction compared with those living in Scotland (B = -1.94, 95% CI = -3.11 to -0.78), although caution is warranted due to small group numbers. CONCLUSION These findings can inform the use and adaptation of remote consultations in primary care. Adults with lower educational levels may need additional support to improve their experience and ensure equitable care via remote consultations.
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Affiliation(s)
- Kate J Lifford
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff
| | | | | | - Harriet Quinn-Scoggins
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff
| | | | - Ardiana Gjini
- Public Health Wales; senior lecturer, Cardiff University, Cardiff
| | - Mark Goddard
- Centre for Trials Research, Cardiff University, Cardiff
| | - Julie Hepburn
- Public Involvement Community, Health and Care Research Wales Support Centre, Cardiff
| | | | - Graham Moore
- DECIPHer (Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement), School of Social Sciences, Cardiff University, Cardiff
| | | | | | - Julia Townson
- Centre for Trials Research, Cardiff University, Cardiff
| | - Jo Waller
- Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Faculty of Medicine & Dentistry, Queen Mary University of London, London; reader of cancer screening & early diagnosis, School of Cancer and Pharmaceutical Sciences, King's College London, London
| | | | | | - Kate Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff
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Smith P, Quinn-Scoggins H, Murray RL, McCutchan G, Nelson A, Moore G, Callister M, Tong H, Brain K. Barriers and facilitators to engaging in smoking cessation support among lung screening participants. Nicotine Tob Res 2023:ntad245. [PMID: 38071660 DOI: 10.1093/ntr/ntad245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Indexed: 03/01/2024]
Abstract
INTRODUCTION Embedded smoking cessation support within lung cancer screening is recommended in the UK; however, little is known about why individuals decline smoking cessation support in this setting. This study identified psychosocial factors that influence smoking cessation and quit motivation among those who declined support for quitting smoking alongside lung cancer screening. METHODS Qualitative interviews conducted between August 2019 - April 2021 with thirty adults with a smoking history, recruited from the Yorkshire Lung Screening Trial. Participants had declined smoking cessation support. Verbatim interview transcripts were thematically analysed. RESULTS Fifty percent of participants were male and the majority were from the most deprived groups. Participants reported low motivation and a variety of barriers to stopping smoking. Participants described modifiable behavioural factors that influenced their quit motivation including self-efficacy, perceived effectiveness of stop-smoking services including smoking cessation aids, risk-minimising beliefs, lack of social support, absence of positive influences on smoking and beliefs about smoking/smoking cessation. Broader contextual factors included social isolation and stigma, COVID-19 and comorbid mental and physical health conditions that deterred smoking cessation. CONCLUSIONS To encourage engagement in smoking cessation support during lung cancer screening, interventions should seek to encourage positive beliefs about the effectiveness of smoking cessation aids and increase confidence in quitting as part of supportive, person-centred care. Interventions should also acknowledge the wider social determinants of health among the lung screening-eligible population. IMPLICATIONS This study provides an in-depth understanding of the beliefs surrounding smoking and smoking cessation and further potential psychosocial factors that influence those attending lung cancer screening. Many of the barriers to smoking cessation found in the present study are similar to those outside of a lung screening setting however this work offers an understanding of potential facilitators that should be considered in future lung screening programmes.
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Affiliation(s)
- Pamela Smith
- Cardiff University, Division of Population Medicine, Heath Park, Cardiff, UK
| | | | - Rachael L Murray
- University of Nottingham, Division of Epidemiology and Public Health Clinical Sciences, Nottingham City Hospital
| | - Grace McCutchan
- Cardiff University, Division of Population Medicine, Heath Park, Cardiff, UK
| | - Annmarie Nelson
- Cardiff University, Marie Curie Research Centre, Cardiff, UK
| | - Graham Moore
- Cardiff University, School of Social Sciences, 1-3 Museum Place, Cardiff, UK
| | - Mat Callister
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Hoang Tong
- Cardiff University, Division of Population Medicine, Heath Park, Cardiff, UK
| | - Kate Brain
- Cardiff University, Division of Population Medicine, Heath Park, Cardiff, UK
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3
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Murray R, Brain K, Britton J, Lewis S, Thorley R, Baldwin D, Quaife S, Chalitsios C, Alexandris P, Crosbie P, Copeland H, Quinn-Scoggins H, McCutchan G, Rogerson S, Parrott S, Wu Q, Gabe R, Neal R, Beeken R, Callister M. PL03.03 Personalised Smoking Cessation Support in a Lung Cancer Screening Programme: The Yorkshire Enhanced Stop Smoking Study (YESS). J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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4
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Anyanwu P, Moriarty Y, McCutchan G, Grozeva D, Goddard M, Whitelock V, Cannings-John R, Quinn-Scoggins H, Hughes J, Gjini A, Hepburn J, Osborne K, Robling M, Townson J, Waller J, Whitaker KL, Brown J, Brain K, Moore G. Health behaviour change among UK adults during the pandemic: findings from the COVID-19 cancer attitudes and behaviours study. BMC Public Health 2022; 22:1437. [PMID: 35902822 PMCID: PMC9332100 DOI: 10.1186/s12889-022-13870-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND COVID-19 related lockdowns may have affected engagement in health behaviours among the UK adult population. This prospective observational study assessed socio-demographic patterning in attempts to change and maintain a range of health behaviours and changes between two time points during the pandemic. METHODS Adults aged 18 years and over (n = 4,978) were recruited using Dynata (an online market research platform) and the HealthWise Wales platform, supplemented through social media advertising. Online surveys were conducted in August/September 2020 when lockdown restrictions eased in the UK following the first major UK lockdown (survey phase 1) and in February/March 2021 during a further national lockdown (survey phase 2). Measures derived from the Cancer Awareness Measure included self-reported attempts to reduce alcohol consumption, increase fruit/vegetable consumption, increase physical activity, lose weight and reduce/stop smoking. Multivariable logistic regressions were used to assess individual health behaviour change attempts over time, adjusted for age, sex, ethnicity, employment and education. RESULTS Around half of participants in survey phase 1 reported trying to increase physical activity (n = 2607, 52.4%), increase fruit/vegetables (n = 2445, 49.1%) and lose weight (n = 2413, 48.5%), with 19.0% (n = 948) trying to reduce alcohol consumption among people who drink. Among the 738 participants who smoked, 51.5% (n = 380) were trying to reduce and 27.4% (n = 202) to stop smoking completely. Most behaviour change attempts were more common among women, younger adults and minority ethnic group participants. Efforts to reduce smoking (aOR: 0.98, 95% CI: 0.82-1.17) and stop smoking (aOR: 0.98, 95% CI: 0.80-1.20) did not differ significantly in phase 2 compared to phase 1. Similarly, changes over time in attempts to improve other health behaviours were not statistically significant: physical activity (aOR: 1.07; 95% CI: 0.99-1.16); weight loss (aOR: 0.95; 95% CI: 0.90-1.00); fruit/vegetable intake (aOR: 0.98, 95% CI: 0.91-1.06) and alcohol use (aOR: 1.32, 95% CI: 0.92-1.91). CONCLUSION A substantial proportion of participants reported attempts to change health behaviours in the initial survey phase. However, the lack of change observed over time indicated that overall motivation to engage in healthy behaviours was sustained among the UK adult population, from a period shortly after the first lockdown toward the end of the second prolonged lockdown.
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Affiliation(s)
- Philip Anyanwu
- Centre for Medical Education, School of Medicine, Cardiff University, Cardiff, UK. .,Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.
| | | | - Grace McCutchan
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Mark Goddard
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | | | - Harriet Quinn-Scoggins
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Ardiana Gjini
- Public Health Wales, Cardiff, UK.,Cardiff University, Cardiff, UK
| | - Julie Hepburn
- Public Involvement Community, Health and Care Research Wales Support Centre, Cardiff, UK
| | | | - Michael Robling
- Centre for Trials Research, Cardiff University, Cardiff, UK.,DECIPHer (Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement), School of Social Sciences, Cardiff University, Cardiff, UK
| | - Julia Townson
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Jo Waller
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | | | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
| | - Kate Brain
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Graham Moore
- DECIPHer (Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement), School of Social Sciences, Cardiff University, Cardiff, UK
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5
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Wilson R, Quinn-Scoggins H, Moriarty Y, Hughes J, Goddard M, Cannings-John R, Whitelock V, Whitaker KL, Grozeva D, Townson J, Osborne K, Smits S, Robling M, Hepburn J, Moore G, Gjini A, Brain K, Waller J. Intentions to participate in cervical and colorectal cancer screening during the COVID-19 pandemic: A mixed-methods study. Prev Med 2021; 153:106826. [PMID: 34599921 PMCID: PMC8480143 DOI: 10.1016/j.ypmed.2021.106826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/21/2021] [Accepted: 09/26/2021] [Indexed: 12/04/2022]
Abstract
Worldwide, cancer screening faced significant disruption in 2020 due to the COVID-19 pandemic. If this has led to changes in public attitudes towards screening and reduced intention to participate, there is a risk of long-term adverse impact on cancer outcomes. In this study, we examined previous participation and future intentions to take part in cervical and colorectal cancer (CRC) screening following the first national lockdown in the UK. Overall, 7543 adults were recruited to a cross-sectional online survey in August-September 2020. Logistic regression analyses were used to identify correlates of strong screening intentions among 2319 participants eligible for cervical screening and 2502 eligible for home-based CRC screening. Qualitative interviews were conducted with a sub-sample of 30 participants. Verbatim transcripts were analysed thematically. Of those eligible, 74% of survey participants intended to attend cervical screening and 84% intended to complete home-based CRC screening when next invited. Thirty percent and 19% of the cervical and CRC samples respectively said they were less likely to attend a cancer screening appointment now than before the pandemic. Previous non-participation was the strongest predictor of low intentions for cervical (aOR 26.31, 95% CI: 17.61-39.30) and CRC (aOR 67.68, 95% CI: 33.91-135.06) screening. Interview participants expressed concerns about visiting healthcare settings but were keen to participate when screening programmes resumed. Intentions to participate in future screening were high and strongly associated with previous engagement in both programmes. As screening services recover, it will be important to monitor participation and to ensure people feel safe to attend.
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Affiliation(s)
- Rebecca Wilson
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK.
| | - Harriet Quinn-Scoggins
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK.
| | - Yvonne Moriarty
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK.
| | - Jacqueline Hughes
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK.
| | - Mark Goddard
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK.
| | - Rebecca Cannings-John
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK.
| | - Victoria Whitelock
- Cancer Intelligence, Cancer Research UK, 2 Redman Place, London, E20 1JQ, UK.
| | | | - Detelina Grozeva
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK.
| | - Julia Townson
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK.
| | - Kirstie Osborne
- Cancer Intelligence, Cancer Research UK, 2 Redman Place, London, E20 1JQ, UK.
| | - Stephanie Smits
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK.
| | - Michael Robling
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK; DECIPHer (Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement), School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, UK.
| | - Julie Hepburn
- Public Involvement Community, Health and Care Research Wales Support Centre, Castlebridge 4, 15-19, Cowbridge Road East, Cardiff CF11 9AB, UK
| | - Graham Moore
- DECIPHer (Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement), School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, UK.
| | - Ardiana Gjini
- Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, UK; Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK.
| | - Kate Brain
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK.
| | - Jo Waller
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College London, Great Maze Pond, London SE1 9RT, UK.
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6
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Moriarty Y, Lau M, Sewell B, Trubey R, Quinn-Scoggins H, Owen S, Padgett L, Kolovou V, Hepburn J, Buckle P, Playle R, Townson J, Robling M, Gilbert S, Dimitropoulou P, Edwards A, Mitchell C, Matthews M, Smits S, Wood F, Neal RD, Brain K. Randomised controlled trial and economic evaluation of a targeted cancer awareness intervention for adults living in deprived areas of the UK. Br J Cancer 2021; 125:1100-1110. [PMID: 34453114 PMCID: PMC8391006 DOI: 10.1038/s41416-021-01524-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 07/06/2021] [Accepted: 08/11/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cancer outcomes are poor in socioeconomically deprived communities, with low symptom awareness contributing to prolonged help-seeking and advanced disease. Targeted cancer awareness interventions require evaluation. METHODS This is a randomised controlled trial involving adults aged 40+ years recruited in community and healthcare settings in deprived areas of South Yorkshire and South-East Wales. INTERVENTION personalised behavioural advice facilitated by a trained lay advisor. CONTROL usual care. Follow-up at two weeks and six months post-randomisation. PRIMARY OUTCOME total cancer symptom recognition score two weeks post-randomisation. RESULTS Two hundred and thirty-four participants were randomised. The difference in total symptom recognition at two weeks [adjusted mean difference (AMD) 0.6, 95% CI: -0.03, 1.17, p = 0.06] was not statistically significant. Intervention participants reported increased symptom recognition (AMD 0.8, 95% CI: 0.18, 1.37, p = 0.01) and earlier intended presentation (AMD -2.0, 95% CI: -3.02, -0.91, p < 0.001) at six months. "Lesser known" symptom recognition was higher in the intervention arm (2 weeks AMD 0.5, 95% CI: 0.03, 0.97 and six months AMD 0.7, 95% CI: 0.16, 1.17). Implementation cost per participant was £91.34, with no significant between-group differences in healthcare resource use post-intervention. CONCLUSIONS Improved symptom recognition and earlier anticipated presentation occurred at longer-term follow-up. The ABACus Health Check is a viable low-cost intervention to increase cancer awareness in socioeconomically deprived communities. CLINICAL TRIAL REGISTRATION ISRCTN16872545.
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Affiliation(s)
- Yvonne Moriarty
- Centre for Trials Research, Cardiff University, Cardiff, UK.
| | - Mandy Lau
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Bernadette Sewell
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Rob Trubey
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Harriet Quinn-Scoggins
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Louise Padgett
- Department of Health Sciences, University of York, York, UK
| | - Vasiliki Kolovou
- School of Sport & Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Julie Hepburn
- Public Involvement Community, Health and Care Research Wales Support Centre, Cardiff, UK
| | | | - Rebecca Playle
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Julia Townson
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | | | | | - Adrian Edwards
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Caroline Mitchell
- Academic Unit of Primary Medical Care, University of Sheffield, Northern General Hospital, Sheffield, UK
| | | | - Stephanie Smits
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Fiona Wood
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Richard D Neal
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Kate Brain
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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7
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McCutchan G, Weiss B, Quinn-Scoggins H, Dao A, Downs T, Deng Y, Ho H, Trung L, Emery J, Brain K. Psychosocial influences on help-seeking behaviour for cancer in low-income and lower middle-income countries: a mixed-methods systematic review. BMJ Glob Health 2021; 6:bmjgh-2020-004213. [PMID: 33531348 PMCID: PMC7868297 DOI: 10.1136/bmjgh-2020-004213] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/09/2020] [Accepted: 01/06/2021] [Indexed: 12/14/2022] Open
Abstract
Introduction Starting cancer treatment early can improve outcomes. Psychosocial factors influencing patients’ medical help-seeking decisions may be particularly important in low and lower middle-income countries (LMIC) where cancer outcomes are poor. Comprehensive review evidence is needed to understand the psychosocial influences on medical help-seeking for cancer symptoms, attendance for diagnosis and starting cancer treatment. Methods Mixed-methods systematic review registered on PROSPERO (CRD42018099057). Peer-reviewed databases were searched until April 2020 for studies assessing patient-related barriers and facilitators to medical help-seeking for cancer symptoms, diagnosis and treatment in adults (18+ years) living in LMICs. Quality of included studies was assessed using the Critical Appraisal Skills Programme tool. Data were synthesised using meta-analytic techniques, meta-ethnography or narrative synthesis as appropriate. Results Of 3963 studies identified, 64 were included. In quantitative studies, use of traditional, complementary and alternative medicine (TCAM) was associated with 3.60 higher odds of prolonged medical help-seeking (95% CI 2.06 to 5.14). Qualitative studies suggested that use of TCAM was a key barrier to medical help-seeking in LMICs, and was influenced by causal beliefs, cultural norms and a preference to avoid biomedical treatment. Women face particular barriers, such as needing family permission for help-seeking, and higher stigma for cancer treatment. Additional psychosocial barriers included: shame and stigma associated with cancer such as fear of social rejection (eg, divorce/disownment); limited knowledge of cancer and associated symptoms; and financial and access barriers associated with travel and appointments. Conclusion Due to variable quality of studies, future evaluations would benefit from using validated measures and robust study designs. The use of TCAM and gender influences appear to be important barriers to help-seeking in LMIC. Cancer awareness campaigns developed with LMIC communities need to address cultural influences on medical help-seeking behaviour.
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Affiliation(s)
- Grace McCutchan
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK .,Wales Cancer Research Centre, Cardiff University, Cardiff, UK
| | - Bahr Weiss
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Harriet Quinn-Scoggins
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.,PRIME Centre Wales, Cardiff University, Cardiff, UK
| | - Anh Dao
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Tom Downs
- Department of Acute Medicine, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, Gwynedd, UK
| | - Yunfeng Deng
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Ha Ho
- Center for Research, Information and Services in Psychology, Vietnam National University, Hanoi, Vietnam
| | - Lam Trung
- Danang Psychiatric Hospital, Da Nang, Vietnam
| | - Jon Emery
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Kate Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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8
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Kolovou V, Moriarty Y, Gilbert S, Quinn-Scoggins H, Townson J, Padgett L, Owen S, Buckle P, Edwards A, Hepburn J, Lau M, Matthews M, Mitchell C, Neal R, Playle R, Robling M, Smits S, Trubey R, Wood F, Brain K. Recruitment and retention of participants from socioeconomically deprived communities: lessons from the Awareness and Beliefs About Cancer (ABACus3) Randomised Controlled Trial. BMC Med Res Methodol 2020; 20:272. [PMID: 33148184 PMCID: PMC7641826 DOI: 10.1186/s12874-020-01149-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recruitment of research participants poses challenges in socioeconomically deprived areas. The Awareness and Beliefs About Cancer (ABACus) phase 3 Randomised Control Trial recruited adult participants from socioeconomically deprived areas using a combined healthcare/community engagement model. We report the strategies used to successfully recruit and retain our trial participant sample. METHODS Community and healthcare settings in areas of high socioeconomic deprivation were identified by lay advisors who recruited participants opportunistically or by appointment. Follow-up was done by telephone or post at 2-weeks and 6-months after recruitment, and all participants were offered financial incentives. Qualitative interviews were conducted with lay advisors regarding their experience and reflections. RESULTS The lay advisors identified and contacted 107 potential recruitment venues across South and West Yorkshire and South East Wales of which 41.1% (n = 42) were opened for recruitment. A total of 234 participants were recruited, with 91% (n = 212) retention at 2-weeks and 85% (n = 199) at 6-months. Community settings yielded 75% (n = 176) of participants. Participants had a mean age of 61.3 years and 63.3% (n = 148) were female, with 66% (n = 154) resident in the most deprived geographical areas. Lay advisors described recruitment as intensive, although engaging participants was easier in community settings. CONCLUSIONS The ABACus3 trial achieved recruitment and high retention with a population that is often "hard to reach" or entirely missed in health research. Strategies were specifically tailored to engage the venues and adult residents of highly deprived areas. Future studies recruiting adults living in the most deprived areas might benefit from community recruitment and from collaborating with local gatekeepers who are key to engagement. This study adheres to CONSORT guidelines. TRIAL REGISTRATION Retrospectively registered with ISRCTN ( http://www.isrctn.com/ISRCTN16872545 ) on 12.01.2018.
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Affiliation(s)
- Vasiliki Kolovou
- Centre for Trials Research Cardiff Metropolitan University, Cardiff, Wales, CF14 4YS, UK.
| | - Yvonne Moriarty
- Centre for Trials Research Cardiff Metropolitan University, Cardiff, Wales, CF14 4YS, UK
| | - Stephanie Gilbert
- Centre for Trials Research Cardiff Metropolitan University, Cardiff, Wales, CF14 4YS, UK
| | | | - Julia Townson
- Centre for Trials Research Cardiff Metropolitan University, Cardiff, Wales, CF14 4YS, UK
| | - Louise Padgett
- Department of Health Sciences, University of York, York, UK
| | - Sioned Owen
- Centre for Trials Research Cardiff Metropolitan University, Cardiff, Wales, CF14 4YS, UK
| | - Peter Buckle
- Centre for Trials Research Cardiff Metropolitan University, Cardiff, Wales, CF14 4YS, UK
| | - Adrian Edwards
- Centre for Trials Research Cardiff Metropolitan University, Cardiff, Wales, CF14 4YS, UK
| | - Julie Hepburn
- Lead Lay Research Partner Wales Cancer Research Centre, Cardiff, Wales, UK
| | - Mandy Lau
- Centre for Trials Research Cardiff Metropolitan University, Cardiff, Wales, CF14 4YS, UK
| | | | - Caroline Mitchell
- Academic Unit of Primary Medical Care, University of Sheffield, Sheffield, UK
| | - Richard Neal
- Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
| | - Rebecca Playle
- Centre for Trials Research Cardiff Metropolitan University, Cardiff, Wales, CF14 4YS, UK
| | - Mike Robling
- Centre for Trials Research Cardiff Metropolitan University, Cardiff, Wales, CF14 4YS, UK
| | - Stephanie Smits
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Rob Trubey
- Centre for Trials Research Cardiff Metropolitan University, Cardiff, Wales, CF14 4YS, UK
| | - Fiona Wood
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Kate Brain
- Division of Population Medicine, Cardiff University, Cardiff, UK
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McCutchan G, Brain K, Quinn-Scoggins H, Dao A, Downs T, Ho H, Lam T, Emery J, Weiss B. Psychosocial Influences on Medical Help Seeking for Cancer Symptoms and Treatment in Low- and Middle-Income Countries: A Meta-Analysis and Mixed Methods Systematic Review. JCO Glob Oncol 2020. [DOI: 10.1200/go.20.28000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Cancer disproportionately affects people living in low- and middle-income countries (LMICs), partly because of delayed medical help-seeking behavior (HSB). Our mixed-methods systematic review synthesized existing studies in LMICs to understand psychosocial influences on cancer-related medical HSB to inform the development of effective interventions to promote earlier HSB for cancer. METHODS We searched peer-reviewed literature databases for quantitative, qualitative, and mixed-methods studies exploring barriers/facilitators to medical HSB for cancer symptoms in adults living in LMICs. Study exclusion criteria were low methodologic quality, non-English language publication, non–peer-reviewed publication, and studies conducted in high-income countries. Study findings were synthesized using meta-analysis, meta-ethnography, and narrative synthesis methods, according to individual study design. RESULTS Fifty studies were included. Many studies used nonstandardized measures/designs, which increased the difficulty integrating findings. Preliminary findings indicate that the use of traditional healers is a key barrier to prompt medical HSB in LMICs. Use of traditional healers for cancer symptoms/treatment was influenced by causal beliefs about symptoms, familial pressure, ease of access, affordability, and a preference to avoid biomedical treatment, which was perceived as invasive, ineffective, and expensive. Additional psychosocial barriers included shame and stigma associated with cancer, such as fear of marital rejection/divorce; limited knowledge of cancer and associated symptoms; financial and access barriers associated with travel and appointments; and cultural barriers, such as women needing permission from the family network. CONCLUSION Such barriers as low symptom knowledge and negative beliefs about cancer are universal barriers to cancer HSB in high-income countries and LMICs, whereas the use of traditional healers and women needing permission to seek medical help seem to be unique to LMICs. Intervention developers should work with local communities to appropriately tailor cancer awareness interventions in LMICs, taking into account cultural influences on HSB. Future evaluations would benefit from using validated measures and robust study designs.
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Affiliation(s)
| | - Kate Brain
- Cardiff University, Cardiff, United Kingdom
| | | | - Anh Dao
- Vanderbilt University, Nashville, TN
| | - Tom Downs
- Ysbyty Gweynedd Hospital, Bangor, United Kingdom
| | - Ha Ho
- University of Education, Vietnam National University, Hanoi, Vietnam
| | - Trung Lam
- Danang Psychiatric Hospital, Da Nang, Vietnam
| | - Jon Emery
- University of Melbourne, Melbourne, VIC, Australia
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Moriarty Y, Townson J, Quinn-Scoggins H, Padgett L, Owen S, Smits S, Playle R, Dimitropoulou P, Sewell B, Kolovou V, Buckle P, Carter B, Edwards A, Hepburn J, Matthews M, Mitchell C, Neal RD, Robling M, Wood F, Brain K. Improving cancer symptom awareness and help-seeking among adults living in socioeconomically deprived communities in the UK using a facilitated health check: A protocol for the Awareness and Beliefs About Cancer (ABACus) Randomised Control Trial. BMC Public Health 2019; 19:285. [PMID: 30866887 PMCID: PMC6417119 DOI: 10.1186/s12889-019-6612-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 02/28/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Cancer survival is lower in socioeconomically deprived communities, partly due to low awareness of symptoms, negative beliefs and delayed help-seeking. We developed an interactive health check questionnaire facilitated by trained lay advisors. It entails 29 questions about background, lifestyle and health with tailored behaviour change advice. Personalised results are printed using a traffic light (red/amber/green) system, highlighting areas where action should be taken. This is an individually randomised control trial to test effectiveness of the health check on symptom recognition. METHODS A total 246 participants aged 40+ years will be recruited from community and healthcare settings in socioeconomically deprived areas of Yorkshire and South Wales. Participants will be randomised to receive the health check or standard care (1:1 ratio). Outcome measures include: adapted Awareness and Beliefs about Cancer (primary outcome), brief State Trait Anxiety Inventory, intentions and motivation to adopt recommended health behaviours (early symptom presentation, cancer screening and lifestyle behaviours), adapted Client Service Receipt Inventory, brief medical history/screening and demographic questionnaire at: baseline; 2-weeks; and 6-months post-randomisation. A purposive sample of intervention sessions will be audio-recorded (n = 24) and half will additionally be observed (n = 12). Semi-structured interviews will take place at 2-weeks (n = 30) and 6-months (n = 15-20) post-randomisation. The primary analysis will compare cancer symptom recognition scores between arms at 2-weeks. Secondary analysis will assess cancer beliefs, barriers/time to presentation, screening and lifestyle behaviours, anxiety and costs. A process evaluation will assess intervention fidelity, dose and contamination. The London-Surrey NHS Research Ethics Committee (Ref: 17/LO/1507) approved this trial. DISCUSSION This is a trial of a theoretically underpinned complex intervention which has undergone phase 1 and 2 development work. The findings will evaluate evidence about the effect of the health check on symptom awareness. Although there are few exclusion criteria there are limitations regarding the population we are able to reach, who may have even higher risks of late diagnosis and poor cancer prognosis. However, the health check has the potential to improve cancer symptom awareness and encourage early help-seeking behaviour in deprived populations, thereby reducing inequalities in longer term cancer outcomes. TRIAL REGISTRATION Retrospectively registered with ISRCTN (Ref: ISRCTN16872545 ) on 12.01.2018.
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Affiliation(s)
- Yvonne Moriarty
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Julia Townson
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Harriet Quinn-Scoggins
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Louise Padgett
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT UK
| | - Sioned Owen
- Tenovus Cancer Care, Gleider House, Ty-Glas Rd, Cardiff, CF14 5BD UK
| | - Stephanie Smits
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Rebecca Playle
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Polyxeni Dimitropoulou
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Bernadette Sewell
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, SA2 8PP UK
| | - Vasiliki Kolovou
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Peter Buckle
- Marie Curie Research Voices, Marie Curie, 89 Albert Embankment, London, SE1 7TP UK
| | - Ben Carter
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF UK
| | - Adrian Edwards
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Julie Hepburn
- Public Involvement Community, Health and Care Research Wales support Centre, Castlebridge 4, 15-19, Cowbridge Road East, Cardiff, CF11 9AB UK
| | - Maura Matthews
- Tenovus Cancer Care, Gleider House, Ty-Glas Rd, Cardiff, CF14 5BD UK
| | - Caroline Mitchell
- Academic Unit of Primary Medical Care, University of Sheffield, Northern General Hospital, Sheffield, S5 7AU UK
| | - Richard D Neal
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Clarendon Way, Leeds, LS2 9NL UK
| | - Michael Robling
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Fiona Wood
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Kate Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
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Nurmatov UB, Mullen S, Quinn-Scoggins H, Mann M, Kemp A. The effectiveness and cost-effectiveness of first aid interventions for burns given to caregivers of children: A systematic review. Burns 2017; 44:512-523. [PMID: 28784346 DOI: 10.1016/j.burns.2017.05.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/09/2017] [Accepted: 05/25/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES the effectiveness and cost-effectiveness of burns first-aid educational interventions given to caregivers of children. METHODS Systematic review of eligible studies from seven databases, international journals, trials repositories and contacted international experts. RESULTS Of 985 potential studies, four met the inclusion criteria. All had high risk of bias and weak global rating. Two studies identified a statistically significant increase in knowledge after of a media campaign. King et al. (41.7% vs 63.2%, p<0.0001), Skinner et al. (59% vs 40%, p=0.004). Skinner et al. also identified fewer admissions (64.4% vs 35.8%, p<0.001) and surgical procedures (25.6% vs 11.4%, p<0.001). Kua et al. identified a significant improvement in caregiver's knowledge (22.9% vs 78.3%, 95% CI 49.2, 61.4) after face-to-face education intervention. Ozyazicioglu et al. evaluated the effect of a first-aid training program and showed a reduction in use of harmful traditional methods for burns in children (29% vs 16.1%, p<0.001). No data on cost-effectiveness was identified. CONCLUSION There is a paucity of high quality research in this field and considerable heterogeneity across the included studies. Delivery and content of interventions varied. However, studies showed a positive effect on knowledge. No study evaluated the direct effect of the intervention on first aid administration. High quality clinical trials are needed.
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Affiliation(s)
- Ulugbek B Nurmatov
- Division of Population Medicine, School of Medicine, Cardiff University, CF 14 4YS, Cardiff, Wales, UK.
| | - Stephen Mullen
- Paediatric Emergency Department, University Hospitals of Wales, CF 14 4XW, Cardiff, Wales, UK; The Scar Free Foundation Centre for Children's Burns Research, CF 14 4YS, Cardiff, Wales, UK.
| | - Harriet Quinn-Scoggins
- Division of Population Medicine, School of Medicine, Cardiff University, CF 14 4YS, Cardiff, Wales, UK; The Scar Free Foundation Centre for Children's Burns Research, CF 14 4YS, Cardiff, Wales, UK.
| | - Mala Mann
- Specialist Unit for Review Evidence, Cardiff University, CF 14 4YS, Cardiff, Wales, UK.
| | - Alison Kemp
- Division of Population Medicine, School of Medicine, Cardiff University, CF 14 4YS, Cardiff, Wales, UK; The Scar Free Foundation Centre for Children's Burns Research, CF 14 4YS, Cardiff, Wales, UK.
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