Barriers and facilitators of colorectal cancer screening using the 5As framework: A systematic review of US studies

Agunwamba, Amenah A.; Zhu, Xuan; Sauver, Jennifer L. St.; Thompson, Gina; Helmueller, Leah; Rutten, Lila J. Finney

doi:10.1016/j.pmedr.2023.102353

Cited by 5 publications

(1 citation statement)

References 132 publications

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“…The framework is commonly used in healthcare research, policy, and practice to guide discussions and interventions related to improving access to healthcare services. [21] We used this framework in a qualitative study exploring ALHIV experiences and perceptions about accessing care for HTN/DM within HIV CTCs and other healthcare settings in Dar es Salaam. The evidence from this study may inform the integration of HIV/NCD care, proposing potential implementation strategies to improve care for ALHIV with comorbid conditions in Tanzania, SSA, and similar settings.…”

Section: Introductionmentioning

confidence: 99%

“I only seek treatment when I am ill”: Experiences of hypertension and diabetes care among adults living with HIV in urban, Tanzania

Ottaru,

Wood,

Butt

et al. 2023

Preprint

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Background For adults living with HIV (ALHIV) and comorbidities, access to comprehensive healthcare services is crucial to achieving optimal health outcomes. This study aims to describe lived experiences, challenges, and coping strategies for accessing care for hypertension and/or diabetes (HTN/DM) in HIV care and treatment clinics (CTCs) and other healthcare settings. Methodology We conducted in-depth interviews with 33 ALHIV with HTN (n=16), DM (n=10), and both (n=7), purposively recruited from six HIV CTCs in Dar-es-Salaam, Tanzania. Thematic content analysis was guided by the 5As framework domains (availability, accommodation, affordability, acceptability, and accessibility). Results Participants sought HTN/DM care including screening and management at non-CTC health facilities due to the limited availability of such services at HIV CTCs. However, healthcare delivery for these conditions was perceived as unaccommodating and poorly coordinated. The need to attend multiple clinic appointments for the management of HTN/DM in addition to HIV care was perceived as frustrating, time-consuming, and financially burdensome. Participants reported difficulty paying for their HTN/DM medications and non-HIV CTCs providers’ consultation costs. High costs of care and transportation, limited understanding of comorbidities, and the perceived complexity of HTN/DM care contributed to HTN/DM treatment discontinuity among ALHIV. As a means of coping, participants frequently monitored their own HTN/DM symptoms at home. When symptoms were a problem, participants utilized community pharmacies and dispensaries near their residences to check blood pressure and sugar levels and obtain medications. These approaches were preferred to seeking care at the HTN/DM care sites due to the costs. Limited education in HTN/DM management was provided at all health facilities including HIV CTCs. Participants expressed a preference for non-pharmaceutical approaches to comorbidity management such as lifestyle modification and herbal therapies because of concerns about side effects and perceived ineffectiveness of HTN/DM medications. Participants also preferred integrated care and focused health education on multimorbidity management at HIV CTCs. Conclusion Our findings highlight significant barriers to accessing HTN/DM care among ALHIV, mostly related to affordability, availability, and accessibility. Integration of NCD care into HIV CTCs, with attention to cost and other barriers, could greatly improve ALHIV health access and outcomes and align with patient preference.

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Section: Introductionmentioning

confidence: 99%

“I only seek treatment when I am ill”: Experiences of hypertension and diabetes care among adults living with HIV in urban, Tanzania

Ottaru,

Wood,

Butt

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

Optimizing tracking and completion of follow-up colonoscopy after abnormal stool tests at health systems participating in the Centers for Disease Control and Prevention’s Colorectal Cancer Control Program

Subramanian,

Tangka,

Hoover

et al. 2024

Cancer Causes Control

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“I only seek treatment when I am ill”: experiences of hypertension and diabetes care among adults living with HIV in urban Tanzania

Ottaru,

Wood,

Butt

et al. 2024

BMC Health Serv Res

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Background For adults living with HIV (ALHIV) and comorbidities, access to comprehensive healthcare services is crucial to achieving optimal health outcomes. This study aims to describe lived experiences, challenges, and coping strategies for accessing care for hypertension and/or diabetes (HTN/DM) in HIV care and treatment clinics (CTCs) and other healthcare settings. Methodology We conducted a qualitative study that employed a phenomenological approach between January and April 2022 using a semi-structured interview guide in six HIV CTCs in Dar es Salaam, Tanzania. We purposively recruited 33 ALHIV with HTN (n = 16), DM (n = 10), and both (n = 7). Thematic content analysis was guided by the 5As framework of access to care. Findings The majority of the participants were females, between the ages of 54–73, and were recruited from regional referral hospitals. HIV CTCs at regional referral hospitals had more consistent provision of HTN screening services compared to those from district hospitals and health centers. Participants sought HTN/DM care at non-CTC health facilities due to the limited availability of such services at HIV CTCs. However, healthcare delivery for these conditions was perceived as unaccommodating and poorly coordinated. The need to attend multiple clinic appointments for the management of HTN/DM in addition to HIV care was perceived as frustrating, time-consuming, and financially burdensome. High costs of care and transportation, limited understanding of comorbidities, and the perceived complexity of HTN/DM care contributed to HTN/DM treatment discontinuity. As a means of coping, participants frequently monitored their own HTN/DM symptoms at home and utilized community pharmacies and dispensaries near their residences to check blood pressure and sugar levels and obtain medications. Participants expressed a preference for non-pharmaceutical approaches to comorbidity management such as lifestyle modification (preferred by young participants) and herbal therapies (preferred by older participants) because of concerns about side effects and perceived ineffectiveness of HTN/DM medications. Participants also preferred integrated care and focused patient education on multimorbidity management at HIV CTCs. Conclusion Our findings highlight significant barriers to accessing HTN/DM care among ALHIV, mostly related to affordability, availability, and accessibility. Integration of NCD care into HIV CTCs, could greatly improve ALHIV health access and outcomes and align with patient preference.

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Barriers and facilitators of colorectal cancer screening using the 5As framework: A systematic review of US studies

Cited by 5 publications

References 132 publications

“I only seek treatment when I am ill”: Experiences of hypertension and diabetes care among adults living with HIV in urban, Tanzania

“I only seek treatment when I am ill”: Experiences of hypertension and diabetes care among adults living with HIV in urban, Tanzania

Optimizing tracking and completion of follow-up colonoscopy after abnormal stool tests at health systems participating in the Centers for Disease Control and Prevention’s Colorectal Cancer Control Program

“I only seek treatment when I am ill”: experiences of hypertension and diabetes care among adults living with HIV in urban Tanzania

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