Objectives: To identify barriers to and facilitators of colorectal cancer (CRC) screening participation among different cultural subgroups in South Australia, and to describe how these might be shared or be distinct across these groups.
Design, participants and setting: Qualitative study using individual interviews in Adelaide, South Australia, between July 2009 and December 2010. Participants were recruited from five culturally distinct groups in SA (Greek, Vietnamese, Iranian, Indigenous and Anglo-Australian) and included people who had participated in CRC screening and people who had not.
Results: We interviewed 121 people. Members of all groups expressed positive attitudes towards cancer screening. However, we also noted a lack of knowledge about bowel cancer and its screening tests across all groups, and that the tests were viewed as unpleasant. Issues that differed across groups included language barriers, fatalistic views about cancer, embarrassment, the importance of privacy, the significance of a doctor’s recommendation, moral obligations, and culture-specific concerns.
Conclusions: This study suggests that population-based screening programs may need to be modified to facilitate access and participation among minority populations and Indigenous people if equity in screening is to be achieved.
- 1. Australian Institute of Health and Welfare, Australasian Association of Cancer Registries. Cancer in Australia: an overview, 2008. Canberra: AIHW, AACR, 2008. (AIHW Cat. No. CAN 42; Cancer Series No. 46.) http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442454588 (accessed Feb 2012).
- 2. Smith RA, von Eschenbach AC, Wender R, et al; ACS Prostate Cancer Advisory Committee, ACS Colorectal Cancer Advisory Committee, ACS Endometrial Cancer Advisory Committee. American Cancer Society guidelines for the early detection of cancer: update of early detection guidelines for prostate, colorectal, and endometrial cancers. CA Cancer J Clin 2001; 51: 38-75.
- 3. Australian Institute of Health and Welfare, Department of Health and Ageing. National Bowel Cancer Screening Program: annual monitoring report 2009. Canberra: AIHW, 2009. (AIHW Cat. No. CAN 45; Cancer Series No. 49.) http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442454613 (accessed Feb 2012).
- 4. Australian Institute of Health and Welfare, Department of Health and Ageing. National Bowel Cancer Screening Program monitoring report 2008. Canberra: AIHW, 2008. (AIHW Cat. No. CAN 40; Cancer Series No. 44.) http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442454594 (accessed Feb 2012).
- 5. Whynes DK, Frew EJ, Manghan CM, et al. Colorectal cancer, screening and survival: the influence of socio-economic deprivation. Public Health 2003; 117: 3 89-395.
- 6. McCaffery K, Wardle J, Nadel M, Atkin W. Socioeconomic variation in participation in colorectal cancer screening. J Med Screen 2002; 9: 104-108.
- 7. Singh SM, Paszat LF, Li C, et al. Association of socioeconomic status and receipt of colorectal cancer investigations: a population-based retrospective cohort study. CMAJ 2004; 171: 461-465.
- 8. Martini A, Javanparast S, Ward PR, et al. Colorectal cancer screening in rural and remote areas: analysis of the National Bowel Cancer Screening Program data for South Australia. Rural Remote Health 2011; 11: 1648.
- 9. UK CRC Screening Pilot Evaluation (Ethnicity) Team. Ethnicity: UK Colorectal Cancer Screening Pilot, final report. London: UK Department of Health, 2003. http://www.cancerscreening.nhs.uk/bowel/ethnicity-finalreport.pdf (accessed Feb 2012).
- 10. Jerant AF, Fenton JJ, Franks P. Determinants of racial/ethnic colorectal cancer screening disparities. Arch Intern Med 2008; 168: 1317-1324.
- 11. Goel MS, Wee CC, McCarthy EP, et al. Racial and ethnic disparities in cancer screening: the importance of foreign birth as a barrier to care. J Gen Intern Med 2003; 18: 1028-1035.
- 12. McGregor SE, Hilsden RJ, Li FX, et al. Low uptake of colorectal cancer screening 3 yr after release of national recommendations for screening. Am J Gastroenterol 2007; 102: 1727-1735.
- 13. Ko CW, Kreter W, Baldwin LM. Persistent demographic differences in colorectal cancer screening utilization despite Medicare reimbursement. BMC Gastroenterol 2005; 5: 10.
- 14. Cooper GS, Doug Kou T. Underuse of colorectal cancer screening in a cohort of Medicare beneficiaries. Cancer 2008; 112: 293-299.
- 15. Australian Government Department of Health and Ageing. The Australian Bowel Cancer Screening Pilot Program and beyond: final evaluation report. Canberra: DoHA, 2005. http://www.health.gov.au/internet/screening/publishing.nsf/Content/final-eval-cnt (accessed Feb 2012).
- 16. Javanparast SJ, Ward PR, Cole S, et al. A cross-sectional analysis of participation in National Bowel Cancer Screening Program in Adelaide by age, gender and geographical location of residence. Australasian Medical Journal [internet] 2010; 1: 141-146. http://www.amj.net.au/index.php? journal=AMJ&page=article&op=viewFile&path =198&path=498 (accessed Feb 2012).
- 17. Ward PR, Javanparast S, Matt MA, et al. Equity of colorectal cancer screening: cross-sectional analysis of the National Bowel Cancer Screening Program data for South Australia. Aust N Z J Public Health 2011; 35: 61-65.
- 18. Bastani R, Gallardo NV, Maxwell AE. Barriers to colorectal cancer screening among ethnically diverse high- and average-risk individuals. J Psychosoc Oncol 2001; 19: 65-84.
- 19. Berkowitz Z, Hawkins NA, Peipins LA, et al. Beliefs, risk perceptions, and gaps in knowledge as barriers to colorectal cancer screening in older adults. J Am Geriatr Soc 2008; 56: 307-314.
- 20. Brouse CH, Basch CE, Wolf RL, et al. Barriers to colorectal cancer screening with fecal occult blood testing in a predominantly minority urban population: a qualitative study. Am J Public Health 2003; 93: 1268-1271.
- 21. Kitto SC, Chesters J, Grbich C. Quality in qualitative research: criteria for authors and assessors in the submission and assessment of qualitative research articles for the Medical Journal of Australia. Med J Aust 2008; 188: 243-246.
- 22. MacKenzie R, Chapman S, Johnson N, et al. The newsworthiness of cancer in Australian television news. Med J Aust 2008; 189: 155-158.
- 23. Cole SR, Smith A, Wilson C, et al. An advance notification letter increases participation in colorectal cancer screening. J Med Screen 2007; 14: 73-75.
- 24. Ward PR, Javanparast S, Wilson C. Equity of bowel cancer screening: which groups have inequitable participation and what can we do about it? Aust J Prim Health 2011; 17: 334-346.
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.