Using concept mapping in the knowledge-to-action process to compare stakeholder opinions on barriers to use of cancer screening among South Asians

Rebecca Lobb,Andrew D Pinto,Aisha Lofters

doi:10.1186/1748-5908-8-37

Abstract

BackgroundUsing the knowledge-to-action (KTA) process, this study examined barriers to use of evidence-based interventions to improve early detection of cancer among South Asians from the perspective of multiple stakeholders.MethodsIn 2011, we used concept mapping with South Asian residents, and representatives from health service and community service organizations in the region of Peel Ontario. As part of concept mapping procedures, brainstorming sessions were conducted with stakeholders (n = 53) to identify barriers to cancer screening among South Asians. Participants (n = 46) sorted barriers into groups, and rated barriers from lowest (1) to highest (6) in terms of importance for use of mammograms, Pap tests and fecal occult blood tests, and how feasible it would be to address them. Multi-dimensional scaling, cluster analysis, and descriptive statistics were used to analyze the data.ResultsA total of 45 unique barriers to use of mammograms, Pap tests, and fecal occult blood tests among South Asians were classified into seven clusters using concept mapping procedures: patient’s beliefs, fears, lack of social support; health system; limited knowledge among residents; limited knowledge among physicians; health education programs; ethno-cultural discordance with the health system; and cost. Overall, the top three ranked clusters of barriers were ‘limited knowledge among residents,’ ‘ethno-cultural discordance,’ and ‘health education programs’ across surveys. Only residents ranked ‘cost’ second in importance for fecal occult blood testing, and stakeholders from health service organizations ranked ‘limited knowledge among physicians’ third for the feasibility survey. Stakeholders from health services organizations ranked ‘limited knowledge among physicians’ fourth for all other surveys, but this cluster consistently ranked lowest among residents.ConclusionThe limited reach of cancer control programs to racial and ethnic minority groups is a critical implementation issue that requires attention. Opinions of community service and health service organizations on why this deficit in implementation occurs are fundamental to understanding the solutions because these are the settings in which evidence-based interventions are implemented. Using concept mapping within a KTA process can facilitate the engagement of multiple stakeholders in the utilization of study results and in identifying next steps for action.

Highlights

Using the knowledge-to-action (KTA) process, this study examined barriers to use of evidence-based interventions to improve early detection of cancer among South Asians from the perspective of multiple stakeholders
Self-reported recent use of mammograms (73%) and Pap tests (73%) in Ontario are similar to the country as a whole [6,7], and self-reported rates of fecal occult blood test (FOBT) use (50%) are higher in Ontario compared to other provinces [8]
The Ontario cancer screening programs have limited reach to immigrant populations compared to Canadian-born residents [9,10,11,12,13,14,15], which diminishes the effectiveness of these programs [16] and potentially leads to health inequities

Summary

Introduction

Using the knowledge-to-action (KTA) process, this study examined barriers to use of evidence-based interventions to improve early detection of cancer among South Asians from the perspective of multiple stakeholders. The Ontario cancer screening programs have limited reach to immigrant populations compared to Canadian-born residents [9,10,11,12,13,14,15], which diminishes the effectiveness of these programs [16] and potentially leads to health inequities. Lofters et al found that among immigrant groups cervical cancer screening rates were lower for South Asian immigrant women compared to Canadian-born women and immigrants who arrived before 1985, both for women aged 18 to years (adjusted rate ratio (ARR) 0.81, 95% confidence interval (CI) 0.80, 0.82) and for women aged to 66 years (ARR 0.67, 95% CI 0.65, 0.69) [22]. South Asian specific colorectal cancer screening data are not available, screening rates for colorectal cancer are lower for all immigrant groups as compared to Canadian-born residents [24]

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Discussion

Conclusion