title: Influences on uptake of cancer screening in mental health service users: a qualitative study.
abstract: Cancers are a leading cause of death worldwide. People with mental illness are 30 % more likely to die from cancer than the general population. One reason for this may be low uptake of nationally offered cancer screening tests by people with mental illness. We aimed to identify barriers and facilitators for breast, cervical and bowel cancer screening uptake by people with mental illness in order to inform interventions to promote equal access.
  
  
  
  The interview study was conducted in both urban and rural settings. The study was informed by the Theoretical Domains Framework, using framework analysis and triangulation across participant groups. Participants included 45 mental health service users (service users) eligible for cancer screening, 29 mental health professionals and 11 professionals involved in cancer screening.
  
  
  
  Themes emerging from the data that affected uptake included knowledge of screening programmes by both service users and healthcare providers; knowledge of, and attitudes towards, mental illness; health service-delivery factors; service users' beliefs and concerns about cancer screening, and practical issues. These are relevant to different stages of the screening process. Service users do not receive invitations to screening or cancer testing kits if they are admitted to hospital. They are not routinely invited for screening if they are not registered with a general practitioner (GP). Lack of integrated care means that mental health staff do not know if someone is overdue for a test and cancer screening is often not considered during health promotion. Barriers including information processing problems, the extent to which the screening process aggravates symptoms, poor staff client relationships and travel difficulties vary between individuals. Screening professionals are motivated to help, but may lack time or training to manage mental health needs. Reactive measures are available, but service users must request help which they may find difficult.
  
  
  
  There are specific barriers to cancer screening uptake for mental health service users that prevent equality of care. Interventions that can be personalised are needed at individual, policy and service-delivery levels. Primary and secondary care staff and policy-makers should work together to develop an integrated approach to cancer screening in this population.
authors.affiliation: Florence Nightingale Faculty of Nursing and Midwifery, King's College London, 57 Waterloo Road, London, SE1 8WA, UK.
authors.forename: Abigail
authors.initials: A
authors.lastname: Clifton
authors.affiliation: Division of Health and Social Care Research, Faculty of Life Sciences & Medicine, King's College London, Addison House, Guy's Campus, London Bridge, London, SE1 1UL, UK.
authors.forename: Caroline
authors.initials: C
authors.lastname: Burgess
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London, SE5 8AF, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Clement
authors.affiliation: Florence Nightingale Faculty of Nursing and Midwifery, King's College London, 57 Waterloo Road, London, SE1 8WA, UK.
authors.forename: Ruth
authors.initials: R
authors.lastname: Ohlsen
authors.affiliation: Faculty of Health and Life Sciences, Oxford Brookes University, Jackstraws Lane, Marston, Oxford, Oxon, OX3 0FL, UK.
authors.forename: Pras
authors.initials: P
authors.lastname: Ramluggun
authors.affiliation: Florence Nightingale Faculty of Nursing and Midwifery, King's College London, 57 Waterloo Road, London, SE1 8WA, UK.
authors.forename: Jackie
authors.initials: J
authors.lastname: Sturt
authors.affiliation: Bournemouth University and Dorset HealthCare University NHS Foundation Trust, Sentinel House, Nuffield Road, Poole, BH17 0RB, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Walters
authors.affiliation: College of Nursing, Midwifery and Healthcare, University of West London, Paragon House, Boston Manor Road, Brentford, Middlesex, TW8 9GA, UK. elizabeth.barley@uwl.ac.uk.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Barley
mesh_terms: D000328:Adult; D000368:Aged; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology*; D008603:Mental Health; D008605:Mental Health Services; D008875:Middle Aged; D009042:Motivation; D009369:Neoplasms; D010342:Patient Acceptance of Health Care; D036301:Qualitative Research
keywords: Bowel; Breast; Cancer screening; Cervical; Mental health; Preventative medicine; Public health; Qualitative research