Cancer screening barriers and facilitators for under and never screened populations: A mixed methods study.
Cancer screening is below targets in Ontario, Canada. Our objective was to identify and quantify the barriers and facilitators for breast, cervical and colorectal cancer screening for under and never screened (UNS) residents living in Ontario between 2011 and 2013.



We used a multi-phased mixed methods study design. Results from thematic analysis of focus group discussions with health care providers and UNS community members were used to develop an on-line, province-wide, cross-sectional survey to estimate the prevalence of barriers and facilitators for the provincial population. Adjusted prevalence odds ratios and 95% confidence intervals were estimated for UNS compared to regularly screened participants using logistic regression.



Four focus groups were held with health service providers and sixteen with UNS community members. Top barriers and facilitators themed around provider-patient communication, fear and embarrassment, history of physical or sexual abuse, social determinants of health (including low literacy, lack of awareness, and health insurance), symptoms appearing, and family and friends. 3075 participants completed the online survey. Compared to regularly screened participants, UNS had significantly higher odds of reporting: no regular health care provider; not feeling comfortable talking about screening; or the Doctor or Nurse Practitioner not suggesting screening. UNS also had significantly higher odds of reporting the facilitators: the test being less scary/painful or uncomfortable; friend/family insisting on getting screened; starting to have symptoms; or an easier test that could be done at home.



Interventions addressing fear through individual, interpersonal and structural facilitators may increase cancer screening.
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Electronic address: dionne.gesink@utoronto.ca.
Dionne
D
Gesink
Analytics and Informatics, Cancer Care Ontario, Toronto, Ontario, Canada.
Brooke
B
Filsinger
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Alanna
A
Mihic
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Analytics and Informatics, Cancer Care Ontario, Toronto, Ontario, Canada.
Todd A
TA
Norwood
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
C
C
Sarai Racey
School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada.
Daniel
D
Perez
Analytics and Informatics, Cancer Care Ontario, Toronto, Ontario, Canada.
Joan
J
Antal
School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada.
Paul
P
Ritvo
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Lee
L
Vernich
D000328:Adult; D000368:Aged; D002170:Canada; D003142:Communication; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000517:prevention & control / Q000523:psychology*; D011795:Surveys and Questionnaires
Barriers; Cancer screening; Communication; Facilitators; Fear; Mixed methods