Barriers and facilitators to participation in breast, bowel and cervical cancer screening in rural Victoria: A qualitative study

Abstract

Issue addressed: Population cancer screening rates are around 50% for the general population and even lower in rural areas. This study aimed to explore knowledge, attitudes, behaviours, motivators and barriers to breast, bowel and cervical screening participation in under-screened men and women. Methods:We used a qualitative research design. Focus groups were segmented by age, sex and screening participation. Participants were under-screened in at least one of the cancer screening programs, with separate groups for each of the programs.The discussion guides were designed around the Health Belief Model and group discussions were coded using a thematic content analysis approach.Results: Fourteen focus groups were held with 80 participants. Key themes were that the concept of cancer screening was not well understood, a low priority for preventive health behaviours, issues relating to local general practitioners (GP) and screening was unpleasant, embarrassing and/or inconvenient. A key determinant of participation in cancer screening was exposure to prompts to action, and it was evident that participants often required multiple prompts before they took action. Conclusions:Opportunities that develop attitudes to health that place disease prevention as a high priority; improve understanding of the benefit of screening in terms of early detection and treatment; improve GP availability and the patient-practitioner relationship; and the development of messages for each of the screening programs should be further explored as factors that may influence rural population screening rates.So what?: Addressing health attitudes, beliefs, knowledge, health practitioner and test-related barriers and improving messaging may increase cancer screening participation in under-screened rural populations.

Talking about health: Community ambassadors as a health promotion strategy to increase breast and bowel cancer screening in regional Australia

“…There exist a number of barriers that prevent vulnerable groups from embracing messaging from traditional modes of health communication and promotion. This includes hesitancy, ambivalence and distrust of messages delivered by authorities and a dearth of messaging that is relatable and/or delivered in ways that also account for the broader needs of the community 18 . In addition to this, vulnerable groups, often targeted for a number of interventions, risk message saturation with the potential to reduce the uptake of health messaging or result in message fatigue 24,25 …”

“…These campaigns have proven important in increasing community participation in the screening for breast, bowel and cervical cancers, albeit in some instances with only short‐term impact 17 . However, campaigns targeted towards specific populations and demographics are needed to increase screening among groups, particularly vulnerable populations, that otherwise are not reached by traditional campaigns, and present screening gaps 17,18 …”

“…Breast cancer screening rates are also lower for women that are residents of specific areas (Moe, Morwell and Churchill), women aged 70‐74 years old and women with culturally and linguistically diverse backgrounds 19 . These groups experience a range of specific circumstances that impact their relationship with health generally, and medical professionals specifically, which require consideration in approaches to public health messaging 5,18 …”

“…19 These groups experience a range of specific circumstances that impact their relationship with health generally, and medical professionals specifically, which require consideration in approaches to public health messaging. 5,18 This research contributes insights into the approaches community members identify as being effective in promoting public health messages. Through a range of in-depth interviews with high-risk members of the Latrobe community, leaders and essential service providers, this research seeks to understand the complex ways that high-risk groups in regional areas interact with health messaging about breast and bowel cancer screening.…”

“…17 However, campaigns targeted towards specific populations and demographics are needed to increase screening among groups, particularly vulnerable populations, that otherwise are not reached by traditional campaigns, and present screening gaps. 17,18 Latrobe, located in Victoria's Gippsland region, is largely representative of many regional areas, with high rates of breast and bowel cancer screening amongst the general population (Table 1), but screening rates are significantly below average amongst numerous vulnerable population groups 18,19 (Table 2). In particular, bowel cancer screening rates in the area are lower for men, people aged in their 50s, and residents of specific areas of the region (Moe and Morwell).…”