Attitudes to colorectal cancer screening among ethnic minority groups in the UK

Robb, Kathryn A.; Solarin, Ijeoma; Power, Emily; Atkin, Wendy; Wardle, Jane

doi:10.1186/1471-2458-8-34

Cited by 59 publications

(76 citation statements)

References 29 publications

(26 reference statements)

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“…42,81 Our finding of low awareness of the purpose and value of bowel cancer screening across South Asian faith communities confirms previous findings. 42,55,73,75,81 A number of studies also found low knowledge and awareness of cancer and fearful perceptions of cancer in minority ethnic groups, 42,55,70,73,75,80,81 which mirrors our finding that awareness of cancer curability was perceived to be low across South Asian faith communities. Finally, we found perceived difficulties associated with the sampling and storage of faeces in order to complete the gFOBt kit, including limitations on getting help from family members owing to the personal nature of the test, which were also experienced within the majority (white European and African Caribbean) population.…”

Section: Discussionsupporting

confidence: 77%

“…42 Two studies exploring low uptake of bowel cancer screening by FS in diverse minority ethnic groups reported low knowledge and awareness of bowel cancer, anxiety about test invasiveness, fear of cancer, language difficulties, religious sensitivities and embarrassment as barriers to participation. 55,70 However, the relevance of these findings to low uptake of gFOBt is limited owing to differences in screening test procedures. Importantly, no studies have explored explanations for the differences in gFOBt uptake identified in the Muslim, Sikh and Hindu faith communities.…”

Section: Introductionmentioning

confidence: 99%

“…40,43 A study of participation in bowel cancer screening using FS (an internal examination undertaken by a medical professional) similarly found lower uptake by South Asian participants after socioeconomic status had been controlled for. 70 Inequalities are also present in the longer-established UK breast and cervical screening programmes. 40,43,69,[71][72][73] Uptake across screening programmes has consistently been lower in London than in the rest of the country, and this has in part been attributed to its diverse population.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Testing innovative strategies to reduce the social gradient in the uptake of bowel cancer screening: a programme of four qualitatively enhanced randomised controlled trials

Raine

Atkin

Wagner

et al. 2017

Programme Grants Appl Res

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Objective: To reduce socioeconomic inequalities in uptake of the NHS BCSP ’ s guaiac faecal occult blood test (gFOBt) without compromising uptake in any socioeconomic group. Design: Workstream 1 explored psychosocial determinants of non-uptake of gFOBt in focus groups and interviews. Workstream 2 developed and tested four theoretically based interventions: (1) ‘ gist ’ information, (2) a ‘ narrative ’ leaflet, (3) ‘ general practice endorsement ’ (GPE) and (4) an ‘ enhanced reminder ’ (ER). Workstream 3 comprised four national cluster randomised controlled trials (RCTs) of the cost-effectiveness of each intervention. Methods: Interventions were co-designed with user panels, user tested using interviews and focus groups, and piloted with postal questionnaires. RCTs compared ‘ usual care ’ (existing NHS BCSP invitations) with usual care plus each intervention. The four trials tested: (1) ‘ gist ’ leaflet ( n = 163,525), (2) ‘ narrative ’ leaflet ( n = 150,417), (3) GPE on the invitation letter ( n = 265,434) and (4) ER ( n = 168,480). Randomisation was based on day of mailing of the screening invitation. The Index of Multiple Deprivation (IMD) score associated with each individual ’ s home address was used as the marker of socioeconomic circumstances (SECs). Change in the socioeconomic gradient in uptake (interaction between treatment group and IMD quintile) was the primary outcome. Screening uptake was defined as the return of a gFOBt kit within 18 weeks of the invitation that led to a ‘ definitive ’ test result of either ‘ normal ’ (i.e. no further investigation required) or ‘ abnormal ’ (i.e. requiring referral for further testing). Difference in overall uptake was the secondary outcome. Results: The gist and narrative trials showed no effect on the SECs gradient or overall uptake (57.6% and 56.7%, respectively, compared with 57.3% and 58.5%, respectively, for usual care; all p -values > 0.05). GPE showed no effect on the gradient ( p = 0.5) but increased overall uptake [58.2% vs. 57.5% in usual care, odds ratio (OR) = 1.07, 95% confidence interval (CI) 1.04 to 1.10; p < 0.0001]. ER showed a significant interaction with SECs ( p = 0.005), with a stronger effect in the most deprived IMD quintile (14.1% vs. 13.3% in usual care, OR = 1.11, 95% CI 1.04 to 1.20; p = 0.003) than the least deprived (34.7% vs. 34.9% in usual care OR = 1.00, 95% CI 0.94 to 1.06; p = 0.98), and higher overall uptake (25.8% vs. 25.1% in usual care, OR = 1.07, 95% CI 1.03 to 1.11; p = 0.001). All interventions were inexpensive to provide. Limitations: In line with NHS policy, the gist and narrative leaflets supplemented rather than replaced existing NHS BCSP information. This may have undermined their effect. Conclusions: Enhanced reminder reduced the gradient and modestly increased overall uptake, whereas GPE increased overall uptake but did not reduce the gradient. Therefore, given their effectiveness and very low cost, the findings suggest that implementation of both by the NHS BCSP would be beneficial. The gist and narrative results hig...

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Section: Discussionsupporting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Testing innovative strategies to reduce the social gradient in the uptake of bowel cancer screening: a programme of four qualitatively enhanced randomised controlled trials

Raine

Atkin

Wagner

et al. 2017

Programme Grants Appl Res

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“…This finding supports previous work reporting high levels of interest in FS screening and similar levels of intentions across the main UK ethnic groups. 34 In contrast, the data on uptake showed that these positive intentions were differentially translated into behaviour. Both Black and White respondents had significantly higher attendance rates than Asians (80% versus 69% versus 54%).…”

Section: Discussionmentioning

confidence: 68%

Ethnic differences in participation in flexible sigmoidoscopy screening in the UK

et al. 2008

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Objectives The aim of the study was to examine ethnic differences in participation in colorectal cancer screening by flexible sigmoidoscopy (FS). It assessed both intentions to be screened and actual screening uptake, and considered whether demographic, health and psychosocial factors mediated the ethnic differences. The setting of this study follows a subset of participants from the UK FS Trial. Methods A postal questionnaire assessed ethnicity, demographic characteristics, health, attitudes to screening and FS screening intentions. Data on screening intentions were available for 17,333 adults aged 55 -64 years (Sample 1). Screening uptake was recorded in a subsample of 4303 respondents who were subsequently randomized to receive an invitation to screening (Sample 2). Results Screening intentions in Sample 1 were equally high across all the ethnic groups (.80% [13,724/17,042]

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“…10 One study has specifically explored barriers to FS screening in UK ethnic minority groups, adding open-ended questions to a nationwide survey of the main ethnic minority groups, known as the Ethnibus Survey. 11 While there was high interest in screening, ethnic minority groups had lower levels of CRC awareness than white British adults and embarrassment was identified as a key barrier in the ethnic minority respondents. This study provided some suggestions about barriers to FS screening but was limited by the small number of questions and relatively few respondents were within the target age range for screening.…”

Section: Introductionmentioning

confidence: 99%

Perceived barriers to flexible sigmoidoscopy screening for colorectal cancer among UK ethnic minority groups: a qualitative study

et al. 2009

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Objectives Evidence from existing UK screening programmes indicates disparities in uptake rates between UK ethnic minorities and the white majority population. The aim of this study was to explore barriers to the uptake of flexible sigmoidoscopy (FS) screening among UK ethnic minority populations. Specifically, beliefs about bowel cancer, perceived barriers to the test and ideas about ways to increase uptake were investigated. Methods Nine focus groups were conducted with a total of 53 participants from African-Caribbean, Gujarati Indian, Pakistani and white British communities. The topic guide was based on the Health Belief Model. Discussions were subject to framework analysis. Results Most participants expressed limited awareness of bowel cancer and cited this as a barrier to screening attendance. Anxiety regarding the invasiveness of the test, the bowel preparation and fear of a cancer diagnosis were common barriers across all ethnic groups. Language difficulties, failure to meet religious sensitivities and the expression of culturally influenced health beliefs were all discussed as specific barriers to uptake. Ethnically tailored health promotion and general practitioner involvement were recommended as ways of overcoming such barriers. Conclusions The study was the first attempt to qualitatively explore barriers to FS bowel cancer screening in UK ethnic minorities. Most barriers were shared by all ethnic groups but health educators should supplement approaches designed for the majority to incorporate the specific needs of individual minority groups to ensure equitable access.

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Attitudes to colorectal cancer screening among ethnic minority groups in the UK

Cited by 59 publications

References 29 publications

Testing innovative strategies to reduce the social gradient in the uptake of bowel cancer screening: a programme of four qualitatively enhanced randomised controlled trials

Testing innovative strategies to reduce the social gradient in the uptake of bowel cancer screening: a programme of four qualitatively enhanced randomised controlled trials

Ethnic differences in participation in flexible sigmoidoscopy screening in the UK

Perceived barriers to flexible sigmoidoscopy screening for colorectal cancer among UK ethnic minority groups: a qualitative study

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