title: Facilitators of and barriers to accessing clinical prevention services for the South Asian population in Surrey, British Columbia: a qualitative study.
abstract: BACKGROUND
  British Columbia falls short in uptake of recommended clinical prevention services, with even lower rates among immigrant populations. This study explored facilitators of and barriers to uptake of clinical prevention services among people from South Asia, who represent 31% of the population in Surrey, British Columbia.
  
  
  METHODS
  We used a qualitative descriptive approach and employed vignettes in a focus group setting to elicit perspectives of South Asian people on accessing clinical prevention services. Participants aged 40 years or more were recruited between October 2014 and February 2015 from health care and community settings such as older-adult housing, day programs and health education events. Letters of introduction to the study were provided in English or Punjabi or both to all potential participants. We conducted qualitative content analysis of the results.
  
  
  RESULTS
  Sixty-two South Asian adults (36 women and 26 men) aged 40-87 years participated in 1 of 8 focus groups in health care or community settings. Facilitators of and barriers to accessing clinical prevention services were noted at the patient, primary care provider and health care system levels. Facilitators at the patient level included taking ownership over one's health, health literacy and respecting the provider's advice; barriers included fear of the diagnosis, death and/or procedures, perceived low risk of disease or utility of the intervention, and side effects of procedures. Provider factors centred on a trust-based patient-provider relationship, strong communication and adequate time during visits. Health care system factors included such facilitators as processes to routinely offer prevention services as part of other health care or social services, systems that encourage prevention-oriented family practice and services at low or no cost to the patient.
  
  
  CONCLUSIONS
  Our findings validate previously identified facilitators of and barriers to accessing preventive care for immigrant populations. However, the results suggest that system-level factors influencing the duration of primary care visits may have a more salient impact on uptake of clinical prevention services in this population.
authors.affiliation: MPH practicum student, Fraser Health Authority, Surrey, BC, and MPH candidate, University of Waterloo (Majid), Waterloo, Ont.; Population Health Observatory (Douglas), Fraser Health Authority, Surrey, BC; Fraser Health Authority (Lee), Surrey, BC; Digital Emergency Medicine (Stacy, Ho) and Department of Emergency Medicine (Ho), Faculty of Medicine, University of British Columbia, and the University of British Columbia P.A. Woodward Instructional Resources Centre (Stacy, Ho), Vancouver, BC; South Asian Health Institute, Fraser Health Authority and Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia (Garg), New Westminster, BC.
authors.forename: Sanaa
authors.initials: S
authors.lastname: Majid
authors.affiliation: MPH practicum student, Fraser Health Authority, Surrey, BC, and MPH candidate, University of Waterloo (Majid), Waterloo, Ont.; Population Health Observatory (Douglas), Fraser Health Authority, Surrey, BC; Fraser Health Authority (Lee), Surrey, BC; Digital Emergency Medicine (Stacy, Ho) and Department of Emergency Medicine (Ho), Faculty of Medicine, University of British Columbia, and the University of British Columbia P.A. Woodward Instructional Resources Centre (Stacy, Ho), Vancouver, BC; South Asian Health Institute, Fraser Health Authority and Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia (Garg), New Westminster, BC.
authors.forename: Rachel
authors.initials: R
authors.lastname: Douglas
authors.affiliation: MPH practicum student, Fraser Health Authority, Surrey, BC, and MPH candidate, University of Waterloo (Majid), Waterloo, Ont.; Population Health Observatory (Douglas), Fraser Health Authority, Surrey, BC; Fraser Health Authority (Lee), Surrey, BC; Digital Emergency Medicine (Stacy, Ho) and Department of Emergency Medicine (Ho), Faculty of Medicine, University of British Columbia, and the University of British Columbia P.A. Woodward Instructional Resources Centre (Stacy, Ho), Vancouver, BC; South Asian Health Institute, Fraser Health Authority and Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia (Garg), New Westminster, BC.
authors.forename: Victoria
authors.initials: V
authors.lastname: Lee
authors.affiliation: MPH practicum student, Fraser Health Authority, Surrey, BC, and MPH candidate, University of Waterloo (Majid), Waterloo, Ont.; Population Health Observatory (Douglas), Fraser Health Authority, Surrey, BC; Fraser Health Authority (Lee), Surrey, BC; Digital Emergency Medicine (Stacy, Ho) and Department of Emergency Medicine (Ho), Faculty of Medicine, University of British Columbia, and the University of British Columbia P.A. Woodward Instructional Resources Centre (Stacy, Ho), Vancouver, BC; South Asian Health Institute, Fraser Health Authority and Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia (Garg), New Westminster, BC.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Stacy
authors.affiliation: MPH practicum student, Fraser Health Authority, Surrey, BC, and MPH candidate, University of Waterloo (Majid), Waterloo, Ont.; Population Health Observatory (Douglas), Fraser Health Authority, Surrey, BC; Fraser Health Authority (Lee), Surrey, BC; Digital Emergency Medicine (Stacy, Ho) and Department of Emergency Medicine (Ho), Faculty of Medicine, University of British Columbia, and the University of British Columbia P.A. Woodward Instructional Resources Centre (Stacy, Ho), Vancouver, BC; South Asian Health Institute, Fraser Health Authority and Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia (Garg), New Westminster, BC.
authors.forename: Arun K
authors.initials: AK
authors.lastname: Garg
authors.affiliation: MPH practicum student, Fraser Health Authority, Surrey, BC, and MPH candidate, University of Waterloo (Majid), Waterloo, Ont.; Population Health Observatory (Douglas), Fraser Health Authority, Surrey, BC; Fraser Health Authority (Lee), Surrey, BC; Digital Emergency Medicine (Stacy, Ho) and Department of Emergency Medicine (Ho), Faculty of Medicine, University of British Columbia, and the University of British Columbia P.A. Woodward Instructional Resources Centre (Stacy, Ho), Vancouver, BC; South Asian Health Institute, Fraser Health Authority and Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia (Garg), New Westminster, BC.
authors.forename: Kendall
authors.initials: K
authors.lastname: Ho