Abstract
This study conducted in Toronto, Canada, explored the perceptions of women living in homeless shelters and women with severe mental health challenges about the factors influencing their decision-making processes regarding breast and cervical cancer screening. Twenty-six in-depth qualitative interviews were conducted. The objectives of this research were (i) to provide new insights about women’s decision-making processes, (ii) to describe the barriers to and facilitators for breast and cervical cancer screening, and (iii) to offer recommendations for future outreach, education, and screening initiatives developed specifically for under/never-screened marginalized women living in urban centers. This exploratory study utilized thematic analysis to broaden our understanding about women’s decision-making processes. A constructed ontology1 was used in an attempt to understand and describe participants’ constructed realities. The epistemological framework was subjective and reflected co-created knowledge. The approach was hegemonic, values-based, and context-specific. The aim of the analysis was to focus on meanings and actions with a broader view to identify the interplay between participants’ narratives and social structures, medical praxis, and policy implications. Results from 26 qualitative interviews conducted in 2013–2014 provided insights on both positive and negative prior cancer screening experiences, the role of power and trust in women’s decision-making, and areas for improvement in health care provider/patient interactions. Outcomes of this investigation contribute to the future development of appropriately designed intervention programs for marginalized women, as well as for sensitivity training for health care providers. Tailored and effective health promotion strategies leading to life-long cancer screening behaviors among marginalized women may improve clinical outcomes, decrease treatment costs, and save lives.
Highlights
National, Provincial, and Local Breast Cancer Screening Rates in CanadaIt is estimated that in 2017 there will be 26,300 new cases of breast cancer detected in Ontario this year and that 1,950 Ontario-residing women will die from the disease
This study aims to: (i) provide new insights from highly marginalized women about their cancer screening decisions, (ii) describe the barriers and facilitators to breast and cervical cancer screening they experience, and (iii) offer recommendations for future outreach, education, and screening initiatives developed for under/never-screened marginalized women living in urban centers
The primary research question for this investigation was: (i) What factors influence breast and cervical cancer screening decisions among homeless women and women with mental health challenges residing in Toronto, Canada? Secondary research questions were (ii) What are the barriers to and facilitators for breast and cervical cancer screening among this group of women? and (iii) What recommendations can be made for future outreach, education and screening initiatives developed for under/ never-screened women living in urban centers at the individual, organizational, community, and systems levels?
Summary
It is estimated that in 2017 there will be 26,300 new cases of breast cancer detected in Ontario this year and that 1,950 Ontario-residing women will die from the disease. The number of predicted new cases and deaths in Ontario is higher than in any other Canadian province [1]. Since the advent of breast screening programs across Canada in the late 1980’s, mammogram use has increased significantly. Breast cancer prevention initiatives have largely been successful, more than one quarter of Canadian women aged 50–69 report that they have not had a mammogram in the previous 2 years [2]. Low social economic status has been associated with (i) the belief that having a mammogram is unnecessary and (ii) failure to return for subsequent breast cancer screening [3]
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