title: Who are the under- and never-screened for cancer in Ontario: a qualitative investigation.
abstract: BACKGROUND
  Observed breast, cervical and colon cancer screening rates are below provincial targets for the province of Ontario, Canada. The populations who are under- or never-screened for these cancers have not been described at the Ontario provincial level. Our objective was to use qualitative methods of inquiry to explore who are the never- or under-screened populations of Ontario.
  
  
  METHODS
  Qualitative data were collected from two rounds of focus group discussions conducted in four communities selected using maps of screening rates by dissemination area. The communities selected were archetypical of the Ontario context: urban, suburban, small city and rural. The first phase of focus groups was with health service providers. The second phase of focus groups was with community members from the under- and never-screened population. Guided by a grounded theory methodology, data were collected and analyzed simultaneously to enable the core and related concepts about the under- and never-screened to emerge.
  
  
  RESULTS
  The core concept that emerged from the data is that the under- and never-screened populations of Ontario are characterized by diversity. Group level characteristics of the under- and never-screened included: 1) the uninsured (e.g., Old Order Mennonites and illegal immigrants); 2) sexual abuse survivors; 3) people in crisis; 4) immigrants; 5) men; and 6) individuals accessing traditional, alternative and complementary medicine for health and wellness. Under- and never-screened could have one or multiple group characteristics.
  
  
  CONCLUSIONS
  The under- and never-screened in Ontario comprise a diversity of groups. Heterogeneity within and intersectionality among under- and never-screened groups adds complexity to cancer screening participation and program planning.
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7, Canada. dionne.gesink@utoronto.ca.
authors.forename: Dionne
authors.initials: D
authors.lastname: Gesink
authors.forename: Alanna
authors.initials: A
authors.lastname: Mihic
authors.forename: Joan
authors.initials: J
authors.lastname: Antal
authors.forename: Brooke
authors.initials: B
authors.lastname: Filsinger
authors.forename: C Sarai
authors.initials: CS
authors.lastname: Racey
authors.forename: Daniel Felipe
authors.initials: DF
authors.lastname: Perez
authors.forename: Todd
authors.initials: T
authors.lastname: Norwood
authors.forename: Farah
authors.initials: F
authors.lastname: Ahmad
authors.forename: Nancy
authors.initials: N
authors.lastname: Kreiger
authors.forename: Paul
authors.initials: P
authors.lastname: Ritvo
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000453:epidemiology / Q000517:prevention & control; D003110:Colonic Neoplasms / Q000453:epidemiology / Q000517:prevention & control; D055088:Early Detection of Cancer / Q000379:methods*; D005006:Ethnicity; D005260:Female; D006301:Health Services Needs and Demand; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000517:prevention & control; D009864:Ontario / Q000453:epidemiology; D012424:Rural Population; D014505:Urban Population; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000517:prevention & control