title: Exploring cancer screening in the context of unmet mental health needs: a participatory pilot study.
abstract: BACKGROUND
  Cancer is the leading cause of preventable death in the Bronx, New York. Service providers in this mental health provider shortage area identified untreated mental illness as an important barrier to participation in cancer screening, a finding that supports existing literature. The Mental Health and Cancer (MHC) Connection partnership formed to investigate and address this issue.
  
  
  OBJECTIVE
  We sought to use an ecological framework to examine barriers and facilitators to obtaining mental health services in the Bronx, and to explore how lack of access to mental healthcare affects cancer screening.
  
  
  METHODS
  In this community-based participatory research (CBPR)-driven pilot study, semistructured, qualitative interviews based on an ecological framework were conducted with 37 Bronx-based service providers representing a range of professional perspectives. Data were analyzed using thematic content analysis and techniques from grounded theory.
  
  
  RESULTS
  Similar barriers and facilitators were reported for mental healthcare and cancer screening utilization across ecological levels. Providers emphasized the impact of urban poverty-related stressors on the mental health of their clients, and affirmed that mental health issues were a deterrent for cancer screening. They also recognized their own inability to connect clients effectively to cancer screening services, and rarely saw this as part of their present role.
  
  
  CONCLUSIONS
  Findings highlight how unmet mental health needs can affect cancer screening in impoverished urban contexts. Participants recommended improving linkages across healthcare and social service providers to address mental health and cancer screening needs simultaneously. Study results are being used to plan a collaborative intervention in the Bronx through the MHC Connection partnership.
authors.affiliation: Division of Community Collaboration and Implentation Science, Albert Einstein College of Medicine, Department of Epidemiology and Population Health.
authors.forename: Abigail
authors.initials: A
authors.lastname: Williams
authors.forename: Jennifer
authors.initials: J
authors.lastname: Erb-Downward
authors.forename: Emilie
authors.initials: E
authors.lastname: Bruzelius
authors.forename: Ellen
authors.initials: E
authors.lastname: O'Hara-Cicero
authors.forename: Alison
authors.initials: A
authors.lastname: Maling
authors.forename: Lauren
authors.initials: L
authors.lastname: Machin
authors.forename: Meiling
authors.initials: M
authors.lastname: Viera-Delgado
authors.forename: Pamela
authors.initials: P
authors.lastname: Valera
authors.forename: Nicole
authors.initials: N
authors.lastname: Maysonet
authors.forename: Elisa S
authors.initials: ES
authors.lastname: Weiss
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D055812:Community-Based Participatory Research / Q000458:organization & administration; D003159:Community-Institutional Relations; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000175:diagnosis*; D008605:Mental Health Services / Q000458:organization & administration*; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000175:diagnosis*; D009519:New York City; D010865:Pilot Projects; D036301:Qualitative Research; D057545:Social Stigma; D012947:Social Work / Q000458:organization & administration; D012959:Socioeconomic Factors