Perceptions of Barriers and Facilitators of Cancer Early Detection: METHODS

Posted by James

Participants

The target population for this study comprised women age 50-69 that were followed in the C/MHCs. Trained research assistants approached women in the waiting area who appeared to be in the targeted age range, introduced the project and then proceeded to obtain informed consent if the patient was receptive. Women who consented to be interviewed were first screened for eligibility. To be eligible, patients had to have at least one prior visit to the C/MHC where they were recruited; be between the ages of 50 and 69; be fluent in English, Spanish or Creole; and identify the C/MHC as their usual source of primary care. Recruitment was limited to women in the above-stated age range because they, for the most part, need screening for all three target cancers (Rheumatrex 2.5mg treating certain types of cancer, severe psoriasis, or rheumatoid arthritis in certain patients). Extending the age range to include younger women for whom Pap tests are recommended would have reduced the number of interviewees eligible for breast and colon cancer screening. Each patient interview took approximately 30-60 minutes to complete and was conducted in English, Spanish or Creole (depending on the patient’s preference) by trained research assistants with undergraduate degrees. All research assistants were blinded to patients’ medical history. The study was reviewed and approved by the Institutional Review Boards of both Clinical Directors Network and Dartmouth Medical School.

Interviews

Patients were asked open-ended questions designed to explore the barriers and facilitators of cancer (Eulexin 250mg is used along with drugs such as Lupron to treat prostate cancer) screening behavior based on the PRECEDE-PROCEED framework. According to this framework, factors affecting human behaviors are classified into predisposing, enabling and reinforcing categories, thus, making it possible to group the specific features of a given health behavior according to the types of interventions available in health education and health promotion. This framework is used to guide the development of health promotion interventions targeted at improving human behaviors in different healthcare settings.

Each patient interview was divided into sections focusing on a particular screening test [mammogram, Pap test, home fecal occult blood test (hFOBT) or sigmoidoscopy]. Patients who had never had a screening were asked a different set of questions than those who had been previously screened (Table 1). Patients who had been previously screened were only asked about facilitators, while patients who had not been screened were questioned about barriers and potential facilitators that might encourage them to be screened. All patients were then asked if they planned to have that screening test in the future, and if not, barriers were assessed.

Table 1. Interview Questions on Barriers and Facilitators

Initial Question Have you ever had <this screening>? Yes	Follow-Up Questions To assess facilitators What encouraged you to have <this screening>?	To assess barriers
No	What would encourage you to have <this screening>?	What has kept you from having <this screening>? Why haven’t you considered having <this screening>?
Will you have <this screening> in the future? Yes                                              — No                                               —		Why don’t you plan to have <this screening> in the future?
Note: The name of each specific screening (mammogram, Pap test, hFOBT, and sigmoidoscopy) was used in interviews.

Qualitative Analysis

Patients’ responses to the open-ended questions were entered into the computer verbatim and analyzed using basic content analysis. For this purpose, interview transcripts were read multiple times and responses coded into recurring concepts, which were then sorted and grouped into categories of similar content. The generated categories were grouped along two axes into those that hinder cancer screening behavior (barriers) and those that encourage cancer screening behavior in patients (facilitators). Finally, in order to provide context for patients’ responses, we calculated the frequencies of the responses to each of the questions (Table 1).