Background Bowel cancer is common and accounts for 10% of all cancer mortality-second only to lung cancer deaths. If detected early through screening tests, mortality is significantly reduced. The NHS Bowel Cancer Screening Programme (BCSP) invites adults aged 60–74 years to carry out a home screening test biennially. The national target for test completion is 60%; completion is substantially lower (~30%) amongst South Asian populations.
Universal approaches to increase screening uptake, e.g. text reminders, are effective, but may widen health inequalities, as they tend to benefit individuals with greater agency. Strategies tailored to ethnic minority groups show promise but are poorly specified and evidence of effectiveness is lacking. Limited evidence suggests that barriers to bowel cancer screening for South Asians are complex.
The aim was to develop a community-based intervention to increase completion of the home bowel screening test in South Asians.
Methods Multi-methods comprising two stages: 1) group and individual interviews with S.Asians aged 50–74 years purposively sampled from faith-based venues in Oxfordshire (Mosques, Hindu temples and Sikh Gurdwaras), religious festivals and local community groups for maximum variation. Semi-structured interviews based on the Theoretical Domains Framework (TDF) investigated determinants of bowel screening completion. Interviews were recorded, transcribed, and analysed using framework analysis and findings mapped onto the COM-B Behaviour Change Wheel; 2) Co-production of intervention during two workshops with key stakeholders and target population. Findings from stage one were presented, feedback sought and amendments to the intervention prototype were made.
Results To-date 25 adults recruited of Indian, Pakistani and Bangladeshi ethnicity with variation in age, gender, first language, faith, compliance with bowel screening. Key barriers and TDF domains that they mapped to were: - lack of knowledge about bowel cancer and screening; lack of language, literacy and physical ability (skills) to carry out the home test; confidence to carry it out correctly (belief about capabilities); appropriate space and time to carry out the test (environmental context and resources); putting off undertaking the test (memory attention and decision processes); risk perception and fear of cancer (emotions). Enablers were: social influences from peers; goals and motivations. Data collection and workshops will be completed by May 2020.
Conclusion Early results suggest an intervention comprising education, persuasion, modelling and enablement functions could increase completion of the home test. An intervention prototype will be produced and further funding sought for intervention refinement and evaluation of early feasibility and acceptability.
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