A qualitative study of barriers and enablers associated with colorectal cancer screening among Somali men in Minnesota

Effectiveness of health promotion interventions to increase faecal occult blood test uptake rates among older adults with an average-risk of colorectal cancer: A systematic review and meta-analysis

Objective

This review aims to examine the effectiveness of interventions in increasing faecal occult blood test (FOBT) uptake rates among older adults with an average-risk of colorectal cancer (CRC) and to identify essential components of such interventions based on current evidence.

Methods

Five databases were included in a systematic literature search for studies reporting randomized controlled trials (RCT) and interventions aimed at increasing FOBT uptake rates among average-risk individuals aged 50-75. Review Manager 5.4.1 was used for conducting meta-analyses and subgroup analyses.

Results

A meta-analysis of the 20 included studies demonstrated that health promotion interventions led to significant increases in FOBT uptake rates (odds ratio [OR] ​= ​1.55, 95% confidence interval (CI) ​= ​1.30-1.85; I 2 ​= ​95%). Provision of information, mailing of FOBT outreach, and reminders were identified as core components of promotion interventions to increase FOBT uptake rates. Among the different significant reminder strategies, a digital message (via text) plus telephone calls (automated and navigator-initiated) had a larger effect size than a telephone call alone. In addition, there was no significant evidence that financial incentives were associated with FOBT uptake. Most studies included a diverse mixture of components, but only a few studies utilized theoretical framework-based interventions.

Conclusions

Future studies with rigorous methodologies are warranted to examine the effectiveness and understand the mechanisms of theoretical framework-based multi-component educational programmes aimed at increasing FOBT uptake rates.

Systematic review registration

PROSPERO CRD42024520859.

"But if you don't know what my needs are, you can't help me": Health seeking experiences of older Black and Latinx cancer survivors

BACKGROUND

More research on minoritized individuals' health-seeking experiences is necessary to address disparities in cancer survivorship. To fill this critical gap in the literature, this study explored the health-seeking experiences of older Black and Latinx populations in the United States (U.S.), guided by the intersectionality framework.

METHOD

Using a qualitative descriptive design, participants were recruited from the New England region of the U.S. Inclusion criteria were: a) 50 years or older, b) Black or Latinx person or both, c) a history of cancer diagnosis, and d) could speak English or Spanish. A semi-structured interview guide was used for data collection, and data were analyzed using reflexive thematic analysis.

RESULTS

A total of 17 (4 men and 13 women) cancer survivors with a mean age of 63.9 years participated in this study. Three main themes relating to health-seeking emerged from the study: 1) views about cancer as stigmatizing or not ("Because you can see how people are staying away from you"); 2) the impact of being a Black or Latinx cancer survivor ("America is a complex one that sometimes you could be neglected"); and the impact of being an immigrant ("If I had no help, why didn't I go back to my country").

CONCLUSION

Minoritized older cancer survivors may experience what we term the triple jeopardy on health seeking due to the disabling effect of cancer, race/ethnicity, and immigration status/situation.

POLICY SUMMARY

To strengthen health-seeking and eliminate cancer health disparities, it is important to design or enhance policies that address structural inequities, including racism and xenophobia, and support community-oriented programs to reduce cancer-related stigma.

Interventions to Increase Cancer Screening Adherence Among Somali Immigrants in the US and Europe: A Systematic Review

Cancer screening rates among immigrant and refugee populations in high income countries is significantly lower than native born populations. The objective of this study is to systematically review the effectiveness of interventions to improve screening adherence for breast, cervical and colorectal cancer among Somali immigrants. A literature search was conducted for the years 2000-2021 and eight studies met eligibility criteria. The following intervention components were found to increase adherence to cervical cancer screening: home HPV test, educational workshop for women and education for general practitioners. A patient navigator intervention was found to increase screening for breast cancer. Educational workshops motivated or increased knowledge regarding cancer screening for breast, cervical and colorectal cancer. However, most of the studies had limitations due to methodology with potential for introduction of bias. Therefore, future studies comparing effectiveness of specific intervention components to reduce disparities in cancer screening among Somali immigrants and refugees are encouraged.

Barriers and facilitators of colorectal cancer screening among East African men in Minnesota: a qualitative investigation

Objective: This study aimed to explore barriers and facilitators to colorectal cancer (CRC) screening among East African men in Minnesota.Design: Six focus groups were conducted in Minneapolis and St. Paul, MN, USA. Participants were asked to describe individual and structural barriers to CRC screening, and discuss strategies that would address individual and structural barriers to screening. Audio-recorded conversations were transcribed verbatim and translated to English. The transcriptions were analyzed using a thematic analysis. Major themes that emerged on individual barriers were lack of knowledge, fear, and privacy.Results: Themes that emerged on structural barriers were distrust in the medical system, lack of health care coverage, and access to the health care system. Education, client reminders, mass media, increased clarity in communication with the provider and translator, and increased access to health care were frequently mentioned strategies to increase CRC screening in the East African community. Participants expressed favorable views toward the concept of patient navigation.Conclusion: Our findings indicate the need to develop culturally appropriate, multi-faced, intervention programs that are aimed at eliminating personal, cultural, and structural barriers.

Improving colorectal cancer screening disparities among Somali-speaking patients in an Internal Medicine Residency Clinic

Colorectal cancer (CRC) is the third-most lethal cancer in the USA, and early detection through screening is crucial for improving outcomes. However, significant disparities in access and utilisation of CRC screening exist among patients with limited English proficiency. Our Quality Improvement (QI) team developed and implemented a video, featuring a Somali-speaking physician, created with input from internal medicine (IM) residents, patient education experts and community leaders to increase the rate of CRC screening uptake within a Somali-speaking population receiving primary care within an IM Residency Clinic. The baseline proportion of average-risk Somali-speaking patients who had successfully been screened for CRC was 46.3% (63/134). The proportion of patients agreeable to undergo CRC screening was assessed monthly from the beginning of video implementation (June 2022 to December 2022). We found that this intervention corresponded with a significant increase in willingness to undergo CRC screening from 36.4% to 100% during the early stages of intervention. At the end of our measurement timeframe, the proportion of the original population fully screened for CRC was 50.7% (68/134). Implementation of the video intervention was also assessed and determined to be minimally disruptive to the clinic flow.

Exploring non-participation in colorectal cancer screening: A systematic review of qualitative studies

INTRODUCTION

Worldwide, colorectal cancer is a major public health issue. Despite the existence of screening programmes in many countries, global uptake remains low. This meta-ethnography aimed to analyse qualitative literature to explore attitudes towards colorectal cancer screening and reasons for non-participation in eligible people that do not participate when invited.

METHODS

Systematic searches were conducted in five databases in May 2021. Critical appraisal of included studies was performed using the CASP checklist for qualitative studies.

FINDINGS

Thirteen studies were included. Three main themes and eight sub-themes were developed across studies: (1) Differences in motivation, with non-participants expressing a lack of knowledge and varying levels of intention to participate but not feeling screening was personally necessary; (2) Active aversion to screening expressed by fear, discomfort, disgust or not wanting to know; and (3) Contextual barriers of the healthcare system such as practical constraints or poor relationships with healthcare professionals.

CONCLUSION

Findings suggest multiple pathways to non-participation including ambivalence, aversion to the process and consequences of screening or lack of support. Persuasive messages and prompts to action to target ambivalence, reassurance regarding the screening procedures to target negative reactions, and increased support from healthcare professionals may be beneficial in increasing screening uptake.

Barriers to Colorectal Cancer Screening in US Immigrants: A Scoping Review

INTRODUCTION

Timely colorectal cancer (CRC) screening has been shown to improve CRC-related morbidity and mortality rates. However, even with this preventative care tool, CRC screening rates remain below 70% among eligible United States (US) adults, with even lower rates among US immigrants. The aim of this scoping review is to describe the barriers to CRC screening faced by this unique and growing immigrant population and discuss possible interventions to improve screening.

METHODS

Four electronic databases were systematically searched for all original research articles related to CRC screening in US immigrants published after 2010. Following a full-text review of articles for inclusion in the final analysis, data extraction was conducted while coding descriptive themes. Thematic analysis led to the organization of this data into five themes.

RESULTS

Of the 4637 articles initially identified, 55 met inclusion criteria. Thematic analysis of the barriers to CRC screening identified five unique themes: access, knowledge, culture, trust, health perception, and beliefs. The most cited barriers were in access (financial burden and limited primary care access) and knowledge (CRC/screening knowledge).

CONCLUSIONS

US immigrants face several barriers to the receipt of CRC screening. When designing interventions to increase screening uptake among immigrants, gaps in physician and screening education, access to care, and trust need to be addressed through culturally sensitive supports. These interventions should be tailored to the specific immigrant group, since a one-size-fits approach fails to consider the heterogeneity within this population.

Heterogeneity in the Utilization of Fecal Occult Blood Testing and Colonoscopy among Migrants and Non-Migrants in Austria: Results of the Austrian Health Interview Survey

Many European studies report lower participation in colorectal cancer screening among migrants than non-migrants. A major limitation of these studies is that usually, the heterogeneity of migrants cannot be accounted for. The aim of this investigation was to examine differences in the utilization of fecal occult blood testing and colonoscopy between non-migrants and the five largest migrant groups residing in Austria using data from the Austrian Health Interview Survey 2019. The two outcomes were compared between non-migrants and migrants using multivariable logistic regression adjusted for socioeconomic and health variables. Migrants from a Yugoslav successor state (OR = 0.61; 95%-CI: 0.44–0.83), Turkish (OR = 0.35; 95%-CI: 0.22–0.55), Hungarian (OR = 0.37; 95%-CI: 0.16–0.82) and German migrants (OR = 0.70; 95%-CI: 0.51–0.98) were less likely to have used a fecal occult blood test compared to non-migrants. Participation in colonoscopy was lower among Turkish migrants (OR = 0.42; 95%-CI: 0.27–0.67) and migrants from a Yugoslav successor state (OR = 0.56; 95%-CI: 0.42–0.75) than among non-migrants. The findings are consistent with studies from other countries and highlight barriers migrants face in accessing the health care system. To address these barriers, the heterogeneity of the population must be taken into account when developing educational materials in order to promote informed decisions about whether or not to participate in colorectal cancer screening.

Somali Refugee Women's Experiences and Perceptions of Western Health Care

INTRODUCTION

The purpose of this study was to explore Somali refugee women's experiences and perceptions of Western health care in the United States. This study took place in the Midwestern region of the United States.

METHODOLOGY

This qualitative descriptive study collected data from 15 participants through in-depth interviews.

RESULTS

Six themes emerged: (a) communication and resource provision, (b) participatory decision-making, (c) provider attitudes toward cultural practices, (d) understanding the U.S. health care system, (e) resistance to Western health care and, (f) religious beliefs.

DISCUSSION AND CONCLUSION

Accounts of the women in this study ran the gamut from positive views to those that were more critical and replete with complaints about Western health care providers and the system. Somali refugee women need culturally competent health care providers who provide sensitive care, offer resources, and involve the women in decision-making about their care.

Screening Intention Prediction of Colorectal Cancer among Urban Chinese Based on the Protection Motivation Theory

Colorectal cancer poses a serious threat worldwide. Although early screening has been proved to be the most effective way to prevent and control colorectal cancer, the current situation of colorectal cancer screening remains not optimistic. The aim of this article is to apply the protection motivation theory (PMT) to examine the influencing factors on screening intention of colorectal cancer (CRC). This cross-sectional survey was launched in five communities in Wuhan, China. All the eligible urban Chinese were recruited and interviewed using paper-and-pencil questionnaires. The intention of colorectal cancer screening (CRCS) was measured using six PMT subconstructs, including perceived risk, perceived severity, fear arousal, response efficacy, response cost, and self-efficacy. Data on sociodemographic variables and knowledge of CRC were also collected. The structural equation modeling (SEM) method was used for data analysis. Among all the 569 respondents, 83.66% expressed willingness to participate in CRCS. Data of the research fit the proposed SEM model well (Chi-square/df = 2.04, GFI = 0.93, AGFI = 0.91, CFI = 0.91, IFI = 0.91, RMSEA = 0.04). Two subconstructs of PMT (response efficacy and self-efficacy) and CRC knowledge were directly and positively associated with screening intention. Age, social status, medical history, physical activity, and CRC knowledge were indirectly related to the screening intention through at least one of the two PMT subconstructs (response efficacy and self-efficacy). The findings of this study suggest the significance of enhancing response efficacy and self-efficacy in motivating urban Chinese adults to participate in CRC screening. Knowledge of CRC is significantly associated with screening intention. This study can provide useful information for the formulation and improvement of colorectal cancer screening strategies and plans.

The impact of cumulative colorectal cancer screening delays: A simulation study

OBJECTIVE

Annual fecal immunochemical tests can reduce colorectal cancer incidence and mortality. However, screening is a multi-step process and most patients do not perfectly adhere to guideline-recommended screening schedules. Our objective was to compare the reduction in colorectal cancer incidence and life-years gained based on US guideline-concordant fecal immunochemical test screening to scenarios with a range of delays.

METHOD

The Colorectal Cancer Simulated Population model for Incidence and Natural history (CRC-SPIN) microsimulation model was used to estimate the effect of systematic departures from fecal immunochemical test screening guidelines on lifetime screening benefit.

RESULTS

The combined effect of consistent modest delays in screening initiation (1 year), repeated fecal immunochemical test screening (3 months), and receipt of follow-up or surveillance colonoscopy (3 months) resulted in up to 1.3 additional colorectal cancer cases per 10,000, 0.4 additional late-stage colorectal cancer cases per 10,000 and 154.7 fewer life-years gained per 10,000. A 5-year delay in screening initiation had a larger impact on screening effectiveness than consistent small delays in repeated fecal immunochemical test screening or receipt of follow-up colonoscopy after an abnormal fecal immunochemical test. The combined effect of consistent large delays in screening initiation (5 years), repeated fecal immunochemical test screening (6 months), and receipt of follow-up or surveillance colonoscopy (6 months) resulted in up to 3.7 additional colorectal cancer cases per 10,000, 1.5 additional late-stage colorectal cancer cases per 10,000 and 612.3 fewer life-years gained per 10,000.

CONCLUSIONS

Systematic delays across the screening process can result in meaningful reductions in colorectal cancer screening effectiveness, especially for longer delays. Screening delays could drive differences in colorectal cancer incidence across patient groups with differential access to screening.

Psychosocial Correlates of Experience and Intention to Receive Colorectal Cancer Screening: A Cross-Sectional Study Among East African Men in the U.S

Cancer screening is an important approach to reducing disease burden. The rate of colorectal cancer (CRC) screening among immigrants in the U.S. is very low. Our study's aim was to examine correlates of experience with, and intention to, receive CRC screening among East African men who were up-to-date (UTD) with CRC screening (n = 64, mean age 65) and those who had never been screened or were overdue for one (NOD; n = 47, mean age 60), compared on demographic characteristics, attitudes toward cancer, psychosocial stress, and health behaviors. UTD men had significantly less emotional concerns about cancer screening and experienced significantly greater distress and lower resiliency than NOD men. However, these results were attenuated after controlling for demographic confounders. Perceived risk, trust in the medical system, and PTSD symptoms were significantly associated with an intention to undertake CRC screening in the next 12 months. These results should be used to guide efforts toward increasing CRC screening rates among immigrant communities.

A Population Health Equity Approach Reveals Persisting Disparities in Colorectal Cancer Screening in New York City South Asian Communities

To assess colorectal cancer (CRC) screening among South Asians (SAs) and explore the challenges and facilitators to CRC screening among SA subgroups in New York City (NYC). Fifty-one semi-structured in-depth interviews and surveys were conducted among SA immigrants in NYC. Qualitative results suggested challenges to CRC screening were related to socio-cultural factors, such as a lack of knowledge on CRC and CRC screening, and structural factors, such as cost and language. A physician referral was the most cited facilitator to CRC screening. Participants reported culturally and linguistically adapted education and information on CRC and CRC screening would help to overcome noted challenges. Our findings support the development of targeted, linguistically and culturally adapted campaigns for this population that facilitate access to health systems and leverage natural community assets and social support systems.