Aisha K Lofters1,2,3,4,5,6, Natalie A Baker7,8, Andree Schuler9,10, Allison Rau8, Alison Baxter9, Nancy N Baxter11,7,12, Edward Kucharski13, Fok-Han Leung10,14, Karen Weyman10,14, Tara Kiran9,10,14,11,15,16. 1. MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. Aisha.lofters@utoronto.ca. 2. Department of Family and Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. Aisha.lofters@utoronto.ca. 3. Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada. Aisha.lofters@utoronto.ca. 4. ICES, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. Aisha.lofters@utoronto.ca. 5. Dalla Lana School of Public Health, 155 College Street, Health Science Building 6th floor, Toronto, Ontario, M5T 3M7, Canada. Aisha.lofters@utoronto.ca. 6. Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada. Aisha.lofters@utoronto.ca. 7. Dalla Lana School of Public Health, 155 College Street, Health Science Building 6th floor, Toronto, Ontario, M5T 3M7, Canada. 8. Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. 9. MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. 10. Department of Family and Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. 11. ICES, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. 12. Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. 13. Cancer Care Ontario, 620 University Avenue, Toronto, ON, M5G 2L7, Canada. 14. Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada. 15. Health Quality Ontario, 130 Bloor Street W, Toronto, ON, M5S 1N5, Canada. 16. Institute of Health Policy, Management and Evaluation, 4th Floor, 155 College St, Toronto, ON, M5T 3M6, Canada.
Abstract
BACKGROUND: In our primary care organization, we have observed income gradients in cancer screening for our patients despite outreach. We hypothesized that outreach strategies could be improved upon to be more compelling for our patients living with low income. OBJECTIVE: To use co-design to adapt our current strategies and create new strategies to improve cancer screening uptake for patients living with low income. DESIGN: An exploratory, qualitative study in two phases: interviews and focus groups. PARTICIPANTS: For interviews, we recruited 25 patient participants who were or had been overdue for cancer screening and had been identified by their provider as potentially living with low income. For subsequent focus groups, we recruited 14 patient participants, 11 of whom had participated in Phase I interviews. APPROACH: To analyse written transcripts, we took an iterative, inductive approach using content analysis and drawing on best practices in Grounded Theory methodology. Emergent themes were expanded and clarified to create a derived model of possible strategies to improve the experience of cancer screening and encourage screening uptake for patients living with low income. KEY RESULTS: Fear and competing priorities were two key barriers to cancer screening identified by patients. Patients believed that a warm and encouraging outreach approach would work best to increase cancer screening participation. Phone calls and group education were specifically suggested as potentially promising methods. However, these views were not universal; for example, women were more likely to be in favour of group education. CONCLUSIONS: We used input from patients living with low income to co-design a new approach to cancer screening in our primary care organization, an approach that could be broadly applicable to other contexts and settings. We learned from our patients that a multi-modal strategy will likely be best to maximize screening uptake.
BACKGROUND: In our primary care organization, we have observed income gradients in cancer screening for our patients despite outreach. We hypothesized that outreach strategies could be improved upon to be more compelling for our patients living with low income. OBJECTIVE: To use co-design to adapt our current strategies and create new strategies to improve cancer screening uptake for patients living with low income. DESIGN: An exploratory, qualitative study in two phases: interviews and focus groups. PARTICIPANTS: For interviews, we recruited 25 patientparticipants who were or had been overdue for cancer screening and had been identified by their provider as potentially living with low income. For subsequent focus groups, we recruited 14 patientparticipants, 11 of whom had participated in Phase I interviews. APPROACH: To analyse written transcripts, we took an iterative, inductive approach using content analysis and drawing on best practices in Grounded Theory methodology. Emergent themes were expanded and clarified to create a derived model of possible strategies to improve the experience of cancer screening and encourage screening uptake for patients living with low income. KEY RESULTS: Fear and competing priorities were two key barriers to cancer screening identified by patients. Patients believed that a warm and encouraging outreach approach would work best to increase cancer screening participation. Phone calls and group education were specifically suggested as potentially promising methods. However, these views were not universal; for example, women were more likely to be in favour of group education. CONCLUSIONS: We used input from patients living with low income to co-design a new approach to cancer screening in our primary care organization, an approach that could be broadly applicable to other contexts and settings. We learned from our patients that a multi-modal strategy will likely be best to maximize screening uptake.
Authors: Sheila F Dunn; Aisha K Lofters; Ophira M Ginsburg; Christopher A Meaney; Farah Ahmad; M Catherine Moravac; Cam Tu Janet Nguyen; Angela M Arisz Journal: Am J Prev Med Date: 2017-01-13 Impact factor: 5.043
Authors: Shixin Cindy Shen; Aisha Lofters; Jill Tinmouth; Lawrence Paszat; Linda Rabeneck; Richard H Glazier Journal: Prev Med Date: 2018-03-13 Impact factor: 4.018
Authors: Shawna V Hudson; Jeanne M Ferrante; Pamela Ohman-Strickland; Karissa A Hahn; Eric K Shaw; Jennifer Hemler; Benjamin F Crabtree Journal: J Am Board Fam Med Date: 2012 Nov-Dec Impact factor: 2.657
Authors: Aisha K Lofters; Natalie Alex Baker; Ann Marie Corrado; Andree Schuler; Allison Rau; Nancy N Baxter; Fok-Han Leung; Karen Weyman; Tara Kiran Journal: Prev Med Rep Date: 2021-10-25
Authors: A K Lofters; M A O'Brien; R Sutradhar; A D Pinto; N N Baxter; P Donnelly; R Elliott; R H Glazier; J Huizinga; R Kyle; D M Manca; M A Pietrusiak; L Rabeneck; B Riordan; P Selby; K Sivayoganathan; C Snider; N Sopcak; K Thorpe; J Tinmouth; B Wall; F Zuo; E Grunfeld; L Paszat Journal: BMC Public Health Date: 2021-08-03 Impact factor: 3.295