Perceptions of Barriers and Facilitators of Cancer Early Detection: RESULTS

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Participants

A total of 187 women were interviewed out of 457 subjects who were approached for participation in the study. Of those approached, 14% refused consent, 26% were ineligible by age, 5% were ineligible because they were transient rather than established users of the C/MHC and 14% did not show up for a scheduled interview after agreeing to participate. Most patients had received at least one of the three tests previously (178 patients had mammograms, 179 had Pap tests, 106 had hFOBTs and 35 had sigmoidoscopies). Of the 187 women interviewed, 44% were African-American, and 51% were Latina. About 39% had at least a high-school education. Of the 64 patients who provided information on their income status, 92% reported earning less than $25,000 annually. The women interviewed indicated that most prior tests were for screening rather than for diagnostic reasons, accounting for over 90% of Pap tests and mammography (161 of 179 tests and 164 of 178 tests, respectively). Seventy-seven percent of home hFOBTs (82 of 106 tests) were for screening, while 49% of sigmoidoscopies (17 of 35) were done for diagnostic reasons.

Identified Categories of Cancer Screening Behaviors

Qualitative analysis of patients’ responses revealed three major categories of cancer (Rheumatrex 2.5mg works to treat cancer and psoriasis by blocking an enzyme needed for cell growth) screening behaviors: 1) patient attitudes and beliefs, 2) social network experience and 3) accessibility of services. The themes underlying each of these categories were further subdivided into internal or external factors. Internal factors are defined as those factors that reflect a patient’s desire or motivation to seek cancer screening (inherently related to the patient’s cognition), while external factors are those factors that reflect a patient’s ability to seek cancer (Hydrea canadian is an antineoplastic used to treat certain types of cancer) screening (inherently related to the patient’s environment). As such, the categories of patient attitudes and beliefs were considered internal, while the categories of social network and accessibility of services were considered external. A taxonomy of all three categories as a compendium of issues that patients raised during the individual interviews is outlined in Table 2.

Table 2. Taxonomy of Patient Facilitators of and Barriers to Cancer Screening

Category	Facilitators	Barriers
Patients’ Attitudes and Beliefs	Personal health/cancer history Reassurance about pain Recommended for women my age Screening is routine Seeking reassurance about health Wanting to care for one’s self	Competing priorities Esthetics (don’t like idea) Fatalism Fear of cancer diagnosis Fear of pain or unpleasantness from procedure Lack of cancer screening knowledge Loss of privacy/ embarrassment Low self-efficacy for the screening procedure Perception of good health/absence of symptoms Perception of not needing the test
Social Network Experience i	Advice from family members Advice from friends Family history of cancer Information from the media Knowing someone with cancer Medical recommendation	Family discouragement Knowledge of someone harmed by test Lack of medical recommendation
Accessibility	Availability of insurance Affordability of screenings Convenient location of screening services	Cost of test Lack of transportation Language barrier

Internal Factors
Patients attitudes and beliefs as facilitators.The attitudes and beliefs identified as facilitators of cancer (Leukeran 2mg is used for treating certain cancers) screening behaviors included personal fac­tors, such as self-care, coping (wanting to take care of oneself), fear of cancer and information seeking/ reassurance. For instance, one patient wanted to care for herself because of her role as a caregiver for other family members: “I need to take care of myself, because no one can take care of me.” Another patient responded, “The kids I babysit depend on me.” For another patient, it was easy to seek cancer (Methotrexate tabletes is used to treat certain types of cancer of the breast, skin, head and neck, or lung. It is also used to treat severe psoriasis and rheumatoid arthritis) screening services, because it had become a routine practice for her: “When I turned 40, they said I should have one mammogram every year and I’ve been doing it ever since. I don’t like surprises.” Whereas for other patients, cancer screening is important to provide reassurance that they do not have cancer. One patient responded, “I wanted to know for sure if I was okay or not.”

Patients attitudes and beliefs as barriers. The attitudes and beliefs identified as barriers to cancer (Generic Casodex treating prostate cancer) screening included a lack of knowledge about cancer screening or cancer itself (patients never thought about screening or heard of screening test), a fear of cancer or pain, a perception of being healthy and not needing the test, the harmful nature of the procedure (it causes pain, radiation and cancer), low self-efficacy or not having confidence in one’s ability to carry out the test, the loss of privacy or embarrassment at having one’s pelvic organs examined, and, finally, the potential disgust associated with touching one’s stool. For instance, a patient said, “I don’t like others touching my body,” while another said, “I feel uneasy about body waste and fluid.” Regarding fear of the test procedure, severalpatients indicated that the pain associated with the procedure prevented them from doing the test, and one patient responded, “You should not do [the mammogram] too often because that is electricity.”

A significant number of patients cited a lack of symptoms as a main reason for not having the test. One patient said, “Nothing is wrong with my breasts,” and another said, “I have never felt any pains.” Others had concerns about their ability to carry out the test properly, especially the hFOBT. One patient said, “I prefer for my doctor to do it. That way I know that it was done correctly.”

External Factors
External factors were grouped into two broad categories: social network experience and accessibility of services, with social network experience playing a greater role in motivating patients to seek cancer screening. Social network experience is defined as a patient’s reliance on information about cancer screening obtained from relatives or friends, while accessibility of services is defined as those factors related to the availability of screening services to patients.