Health care system factors influencing primary healthcare workers’ engagement in national cancer screening programs: a qualitative study

Abstract

Objective: This study aimed to explore factors across the environment, organisation and care team levels of the health care system that influence the engagement of primary healthcare workers (PHCWs) in Australia's national cancer screening programs. Methods: A cross‐sectional qualitative study involving semi‐structured interviews with PHCWs – general practitioners (n=10), practices nurses (n=10), and practice managers (n=10) from settings across Australia. Transcripts were analysed using the Framework Method. Results: Two environment‐level factors were found to influence several organisation and care team level factors. Firstly, the financial structure of primary health care, impacting on practitioner: time, practice culture, screening knowledge and opportunistic conversations. Secondly, the structure of screening programs had flow‐on effects for: access to patient screening records, recall and reminder systems, and sense of program ownership. Conclusions: Encouraging more effective PHCW engagement in the screening programs requires the consideration and mitigation of overarching financial and structural barriers. Up‐to‐date and easy‐to‐use recall and reminder systems, whole‐of‐practice approaches which optimise the role of each PHCW and the identification of a ‘champion’ to drive implementation should be considered. Implications for public health: This study offers insights into what elements practice and practitioner targeted initiatives in Australia should incorporate, potentially leading to improved engagement of PHCWs and increased cancer screening participation rates.

“So, if she wasn’t aware of it, then how would everybody else out there be aware of it?”—Key Stakeholder Perspectives on the Initial Implementation of Self-Collection in Australia’s Cervical Screening Program: A Qualitative Study

“…Very limited promotion regarding the availability of self-collection to both consumers and health care providers has very likely contributed to a substantially low adoption of restricted self-collection in the first two years of the renewed program [ 33 ]. Among primary care practitioners, there appears to be the strong misconception that self-collection is inferior compared to a clinician-collected HPV samples [ 27 , 31 , 34 ] with similar findings have been documented elsewhere [ 28 , 29 , 32 ]. At the time of the policy decision in Australia (in around 2014), the early evidence suggested that, while HPV testing on a self-collected sample had a greater sensitivity than Pap testing, it was slightly inferior to HPV testing on a clinician-collected sample, because many of the studies had used HPV tests based on signal-amplification assays rather than PCR-based assays [ 35 ].…”

Factors and strategies influencing implementation of an intravenous iron intervention for antenatal anaemia: A mixed‐methods systematic review

“…35 It is well accepted that having a champion can facilitate the implementation of an EBI and lead to a positive change in the organisational culture. 49,50 Similar to the findings outlined by Mayson et al, 40 a qualitative study on barriers and facilitators experienced by nurses and physicians when implementing a PPH project found 'active programme champions' to be a facilitator and 'lack of champions' to be a barrier. The study detailed how 'successful implementation began with an active nurse champion, whose enthusiasm, commitment, and persistence of the project was evident and viewed as a successful strategy'.…”

“…The ERIC strategy with the highest level of cumulative expert endorsement was ‘identify and prepare champions’, defined as ‘individuals who dedicate themselves to supporting, marketing, and driving through an implementation, overcoming indifference or resistance that the intervention may provoke in an organisation’ 35 . It is well accepted that having a champion can facilitate the implementation of an EBI and lead to a positive change in the organisational culture 49,50 . Similar to the findings outlined by Mayson et al, 40 a qualitative study on barriers and facilitators experienced by nurses and physicians when implementing a PPH project found ‘active programme champions’ to be a facilitator and ‘lack of champions’ to be a barrier.…”

Cancer Risk Assessment Tools in Primary Care Settings: An Integrative Review

“…From advocating early detection and diagnosis to offering care during and after treatment for cancer and any concurrent disorders, primary care clinicians have essential roles to play across the cancer continuum. Evidence suggests that higher cancer screening participation rates are associated with improved primary care involvement [20,21] Thus, the role of healthcare professionals, such as oncologists, nurses, and the healthcare team, on cancer risk assessment in the primary care setting across the lifespan is crucial to ensure a care plan tailored to each patient's needs.…”