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abstract
Cancer screening barriers and facilitators for under and never screened populations: A mixed methods study
Highlights
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- Significant barriers to cancer screening relate to the universal human condition of fear.
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- Significant facilitators for cancer screening are related to relationship and communication.
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- The top barriers and facilitators are consistent across the three cancers and upscale from local to provincial levels.
Background
Cancer
screening is below targets in Ontario, Canada. Our objective was to
identify and quantify the barriers and facilitators for breast, cervical
and colorectal cancer screening for under and never screened (UNS)
residents living in Ontario between 2011 and 2013.
Methods
We
used a multi-phased mixed methods study design. Results from thematic
analysis of focus group discussions with health care providers and UNS
community members were used to develop an on-line, province-wide,
cross-sectional survey to estimate the prevalence of barriers and
facilitators for the provincial population. Adjusted prevalence odds
ratios and 95% confidence intervals were estimated for UNS compared to
regularly screened participants using logistic regression.
Results
Four
focus groups were held with health service providers and sixteen with
UNS community members. Top barriers and facilitators themed around
provider-patient communication, fear and embarrassment, history of
physical or sexual abuse, social determinants of health (including low
literacy, lack of awareness, and health insurance), symptoms appearing,
and family and friends. 3075 participants completed the online survey.
Compared to regularly screened participants, UNS had significantly
higher odds of reporting: no regular health care provider; not feeling
comfortable talking about screening; or the Doctor or Nurse Practitioner
not suggesting screening. UNS also had significantly higher odds of
reporting the facilitators: the test being less scary/painful or
uncomfortable; friend/family insisting on getting screened; starting to
have symptoms; or an easier test that could be done at home.
Conclusions
Interventions addressing fear through individual, interpersonal and structural facilitators may increase cancer screening.
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