Although researchers frequently experience obstacles and the phenomenon known as "gatekeeping" when attempting to conduct research amongst vulnerable populations, there is little evidence of harm to participants. On the contrary, there is evidence of benefit for participants and evidence that they are willing to participate if given the opportunity. Although well-meaning, the actions of gatekeepers are not only paternalistic, they could be further marginalising vulnerable populations by denying them the benefits to be gained from research designed to identify and begin addressing their needs.

Background: Oral cancer is a growing problem worldwide, with high incidence rates in South Asian countries. With increasing numbers of South Asian immigrants in developed countries, a possible rise in oral cancer cases is expected given the high prevalence in their source countries and the continued oral cancer risk behaviours of immigrants. The aim of this review is to synthesise existing evidence regarding knowledge, attitudes and practices of South Asian immigrants in developed countries regarding oral cancer. Methods: Five electronic databases were systematically searched to identify original, English language articles focussing on oral cancer risk knowledge, attitudes and practices of South Asian immigrants in developed countries. All studies that met the following inclusion criteria were included: conducted among South Asian immigrants in developed countries; explored at least one study outcome (knowledge or attitudes or practices); used either qualitative, quantitative or mixed methods. No restrictions were placed on the publication date, quality and setting of the study. Results: A total of 16 studies involving 4772 participants were reviewed. These studies were mainly conducted in the USA, UK, Italy and New Zealand between 1994 and 2018. Findings were categorised into themes of oral cancer knowledge, attitudes and practices. General lack of oral cancer risk knowledge (43-76%) among participants was reported. More than 50% people were found engaging in one or more oral cancer risk practices like smoking, betel quid/pan/gutka chewing. Some of the participants perceived betel quid/pan/gutka chewing habit good for their health (12-43.6%). Conclusion: This review has shown that oral cancer risk practices are prevalent among South Asian immigrants who possess limited knowledge and unfavourable attitude in this area. Culturally appropriate targeted interventions and strategies are needed to raise oral cancer awareness among South Asian communities in developed countries.

Background Oral cancer is a public health concern and is widespread in developing countries, particularly in South Asia. However, oral cancer cases are also rising in developed nations due to various factors, including smoking, viruses and increased migration from South Asia. In this context, the role of general medical practitioners (GPs) in identifying oral cancer is becoming increasingly important and, while some studies have explored their perspective about oral cancer, a synthesis of these results has not been undertaken. Objective The objective of this integrative review is to synthesize existing evidence regarding oral cancer-related knowledge, attitudes and practices of GPs in developed countries. Methods Four electronic databases were searched to identify studies focussing on the objective of this review. The inclusion criteria were: peer-reviewed English language publications; studies conducted in developed countries involving GPs; explored at least one study outcome (knowledge/attitudes/practices). No restrictions were placed on the publication date. Results A total of 21 studies involving 3409 GPs were reviewed. Most studies revealed limited knowledge of GPs about emerging risk factors, such as betel nut chewing (0.8–50%). Significant variation (7–70%) was evident in routine oral examination practices of GPs. Most GPs felt unsure about diagnosing oral cancer and many (38–94%) raised the need for further education. No study explored the specific relevance of GPs’ practices concerning South Asian immigrants. Conclusion This review suggests the need for educational programs to enhance GPs’ knowledge regarding oral cancer. Further research exploring oral cancer-related practices of GPs caring for South Asian immigrants is warranted.

The BCSBQ can be used to provide nurses with information relevant for the development of culturally sensitive breast health education programs.