Are community‐based health worker interventions an effective approach for early diagnosis of cancer? A systematic review and meta‐analysis

Bellhouse, Sarah; McWilliams, Lorna; Firth, Joseph; Yorke, Janelle; French, David P.

doi:10.1002/pon.4575

Cited by 28 publications

(40 citation statements)

References 84 publications

(420 reference statements)

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“…In order to better understand thought processes on receipt of a written invitation, think‐aloud studies on FSS may offer a potential means to further understand the immediate barriers low uptake groups face 78 . Finally, considering efforts to optimize UK Asian ethnic groups' participation in screening, community‐based participatory research has been recognised as an important approach to consider when conducting intervention research aimed at improving screening attitude, knowledge and behaviour 79 …”

Section: Discussionmentioning

confidence: 99%

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Barriers to flexible sigmoidoscopy colorectal cancer screening in low uptake socio‐demographic groups: A systematic review

et al. 2020

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Objective: To synthesise qualitative evidence related to barriers and facilitators of flexible sigmoidoscopy screening (FSS) intention and uptake, particularly within low socio-demographic uptake groups. FSS uptake is lower amongst women, lower socioeconomic status (SES), and Asian ethnic groups within the United Kingdom (UK) and United States of America. Methods: A total of 12 168 articles were identified from searches of four databases: EMBASE, MEDLINE, PsycINFO and Web of Science. Eligibility criteria included: individuals eligible to attend FSS and empirical peer-reviewed studies that analysed qualitative data. The Critical Appraisal Skills Program tool evaluated the methodological quality of included studies, and thematic synthesis was used to analyse the data. Results: Ten qualitative studies met the inclusion criteria. Key barriers to FSS intention and uptake centred upon procedural anxieties. Women, including UK Asian women, reported shame and embarrassment, anticipated pain, perforation risk, and test preparation difficulties to elevate anxiety levels. Religious and cultural-influenced health beliefs amongst UK Asian groups were reported to inhibit FSS intention and uptake. Competing priorities, such as caring commitments, particularly impeded women's ability to attend certain FSS appointments. The review identified a knowledge gap concerning factors especially associated with FSS participation amongst lower SES groups.

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Section: Discussionmentioning

confidence: 99%

“…78 Finally, considering efforts to optimize UK Asian ethnic groups' participation in screening, community-based participatory research has been recognised as an important approach to consider when conducting intervention research aimed at improving screening attitude, knowledge and behaviour. 79…”

Section: Future Research and Clinical Implicationsmentioning

confidence: 99%

Barriers to flexible sigmoidoscopy colorectal cancer screening in low uptake socio‐demographic groups: A systematic review

et al. 2020

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“…If that lady who got the letter, she doesn't know English, she doesn't understand English that would be a worry if they got the letter first and then somebody might, on behalf of her, talk to the doctor. (Sara, 41) In some cases, rather than sending a personalised risk result directly to women's homes it was deemed more appropriate for their General Practitioner (GP) to receive this information first. Women explain that as a high-risk result is likely to cause significant worry, talking with a healthcare professional in the first instance would provide reassurance and alleviate concerns.…”

Section: Theme 3: Acceptability Of Risk Communication Strategymentioning

confidence: 99%

The introduction of risk stratified screening into the NHS breast screening Programme: views from British-Pakistani women

et al. 2020

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Background: UK national guidelines suggest women at high-risk of breast cancer should be offered more frequent screening or preventative medications. Currently, only 1 in 6 high-risk women are identified. One route to identify more high-risk women is via multifactorial risk assessment as part of the UK's NHS Breast Screening Programme (NHSBSP). As lower socioeconomic and minority ethnic populations continue to experience barriers to screening, it is important that any new service does not exacerbate issues further. To inform service development, this study explored views of women from underserved backgrounds regarding the introduction of risk stratification into the NHSBSP.Methods: Nineteen semi-structured interviews were conducted with British-Pakistani women from low socioeconomic backgrounds from East Lancashire, UK. Fourteen interviews were conducted via an interpreter.Results: Thematic analysis produced three themes. Attitudes toward risk awareness concerns the positive views women have toward the idea of receiving personalised breast cancer risk information. Anticipated barriers to accessibility emphasises the difficulties associated with women's limited English skills for accessing information, and their I.T proficiency for completing an online risk assessment questionnaire. Acceptability of risk communication strategy highlights the diversity of opinion regarding the suitability of receiving risk results via letter, with the option for support from a healthcare professional deemed essential. Conclusions:The idea of risk stratification was favourable amongst this underserved community. To avoid exacerbating inequities, this new service should provide information in multiple languages and modalities and offer women the opportunity to speak to a healthcare professional about risk. This service should also enable completion of personal risk information via paper questionnaires, as well as online.

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“…21 The concept of training non-medical professionals to assist in the screening of breast cancer is not a new one, 22 and the use of CHWs has helped to improve acceptability and increase uptake among minority and underserved groups of women in HICs such as the USA. [23][24][25] Furthermore, although CHWs have been successfully trained and deployed to help reduce the burden of maternal and child health challenges, as well as infectious and other non-communicable diseases, their role to assist in breast cancer screening in LMICs is less clear. We identified only one systematic review by Wadler et al 26 in 2011, which assessed the role of CHWs in South Africa to improve breast cancer control, 26 and are unaware of any other reviews assessing the role of CHWs across LMICs more broadly.…”

Section: Bmj Global Healthmentioning

confidence: 99%

Community health workers and early detection of breast cancer in low-income and middle-income countries: a systematic scoping review of the literature

et al. 2020

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BackgroundBreast cancer is the leading cause of female mortality in low-income and middle-income countries (LMICs). Early detection of breast cancer, either through screening or early diagnosis initiatives, led by community health workers (CHWs) has been proposed as a potential way to address the unjustly high mortality rates. We therefore document: (1) where and how CHWs are currently deployed in this role; (2) how CHWs are trained, including the content, duration and outcomes of training; and (3) the evidence on costs associated with deploying CHWs in breast cancer early detection.MethodsWe conducted a systematic scoping review and searched eight major databases, as well as the grey literature. We included original studies focusing on the role of CHWs to assist in breast cancer early detection in a country defined as a LMIC according to the World Bank.Findings16 eligible studies were identified. Several roles were identified for CHWs including awareness raising and community education (n=13); history taking (n=7); performing clinical breast examination (n=9); making onward referrals (n=7); and assisting in patient navigation and follow-up (n=4). Details surrounding training programmes were poorly reported and no studies provided a formal cost analysis.ConclusionsDespite the relative paucity of studies addressing the role of CHWs in breast cancer early detection, as well as the heterogeneity of existing studies, evidence suggests that CHWs can play a number of important roles in breast cancer early detection initiatives in LMICs. However, if they are to realise their full potential, they must be appropriately supported within the wider health system.

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Are community‐based health worker interventions an effective approach for early diagnosis of cancer? A systematic review and meta‐analysis

Cited by 28 publications

References 84 publications

Barriers to flexible sigmoidoscopy colorectal cancer screening in low uptake socio‐demographic groups: A systematic review

Barriers to flexible sigmoidoscopy colorectal cancer screening in low uptake socio‐demographic groups: A systematic review

The introduction of risk stratified screening into the NHS breast screening Programme: views from British-Pakistani women

Community health workers and early detection of breast cancer in low-income and middle-income countries: a systematic scoping review of the literature

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