title: Institutional (mis)trust in colorectal cancer screening: a qualitative study with Greek, Iranian, Anglo-Australian and Indigenous groups.
abstract: BACKGROUND
  Colorectal cancer (CRC) has the second highest cancer mortality rate in Australia. The Australian National Bowel Cancer Screening Program (NBCSP) aims to increase early detection of CRC by offering free Faecal Occult Blood Testing (FOBT), although uptake is low for culturally and linguistically diverse (CALD) groups.
  
  
  OBJECTIVE
  To present data on trust and mistrust in the NBCSP by population groups with low uptake and thus to highlight areas in need of policy change.
  
  
  METHODS
  A qualitative study was undertaken in South Australia, involving interviews with 94 people from four CALD groups: Greek, Iranian, Anglo-Australian, and Indigenous peoples.
  
  
  RESULTS
  Our study highlights the complexities of institutional trust, which involves considerations of trust at interpersonal, local and national levels. In addition, trust and mistrust was found in more abstract systems such as the medical knowledge of doctors to diagnose or treat cancer or the scientific procedures in laboratories to test the FOBTs. The object of institutional (mis)trust differed between cultural groups - Anglo-Australian and Iranian groups indicated a high level of trust in the government, whereas Indigenous participants were much less trusting.
  
  
  CONCLUSIONS
  The level and nature of trust in the screening process varied between the CALD groups. Addressing program misconceptions, clarifying the FOBT capabilities and involving medical services in collecting and transporting the samples may increase trust in the NBCSP. However, broader and more enduring mistrust in services and institutions may need to be dealt with in order to increase trust and participation.
authors.affiliation: Discipline of Public Health, Flinders University, Adalaide, SA, Australia.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Ward
authors.affiliation: Discipline of Public Health, Flinders University, Adalaide, SA, Australia.
authors.forename: Cushla
authors.initials: C
authors.lastname: Coffey
authors.affiliation: South Australian Community Health Research Unit, Flinders University, Adalaide, SA, Australia.
authors.forename: Sara
authors.initials: S
authors.lastname: Javanparast
authors.affiliation: School of Medicine, Flinders University, Adalaide, SA, Australia.
authors.forename: Carlene
authors.initials: C
authors.lastname: Wilson
authors.affiliation: Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.
authors.forename: Samantha B
authors.initials: SB
authors.lastname: Meyer
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000523:psychology; D055088:Early Detection of Cancer / Q000523:psychology*; D005260:Female; D006115:Greece / Q000208:ethnology; D006801:Humans; D007407:Interviews as Topic; D007492:Iran / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D036301:Qualitative Research; D013021:South Australia; D035502:Trust / Q000523:psychology*
keywords: Australia; colorectal cancer screening; culturally and linguistically diverse groups; mistrust; qualitative; trust