Determinants of cancer screenings participation in Queensland: a scoping review

Search strategy

The evidence search utilised the Joanna Briggs Institute three-stage search strategy (identifying initial keywords and analysing text words, database-specific searches and review of reference lists of identified studies).¹³ The first stage was the initial search using Mesh terms, free text search and key concept terms in PubMed and CINAHL to help identify types of studies potentially available for analysis. The titles and abstracts of texts were analysed with the retrieved articles (see Fig. 1).

The second stage involved a detailed search across the following electronic databases: MEDLINE (PubMed), CINAHL, Cochrane and ProQuest. All the identified key concept terms were combined in this second stage detailed search (cancer screening programs or mass screening OR breast screening or bowel screening OR cervical screening) AND (determinants OR barriers OR factors) AND (Queensland). The investigation was iterative and additional keywords and sources were incorporated into the search strategy.

In the third stage, reference lists of identified reports and articles were also searched for additional studies. Additional searches were also done in ResearchGate and Google Scholar. Finally, a final step was searching for grey literature in Google and databases on websites of organisations concerned with population health and cancer screening programs in Queensland, Australia (see Fig. 1).

Fig. 1. 

PRISMA flowchart. Adapted from the PRISMA guidelines (Tricco et al. 2018).⁴³

Study types

All relevant articles, including grey literature published from June 2005 to December 2021, evaluated the determinants, or described the cancer screening participation rates, in Queensland.

Study selection

The titles and abstracts of all papers identified in the electronic databases were manually assessed using the inclusion and exclusion criteria. In the next phase, all full-text articles were extracted and reviewed. The first and second authors agreed on the final list of studies deemed fit.¹³ Articles were included if they focussed on participation in the national cancer screening program and barriers to the cancer screening program in Queensland, Australia. Articles and reports published between January 2005 and December 2021 were assessed. Non-English language articles were excluded.

Charting of data

All selected studies were charted according to the evidence source, including peer-reviewed primary studies, literature reviews and grey literature. The extracted results were further mapped guided by the population (populations), concept (determinants of screening participation) and context mnemonic (prevention programs).¹³ We used Microsoft Excel to document full text selected extracts mapped by relevant characteristics such as authors, type of study, study state, sampling methods, outcomes and duration. The charting process was iterative and continually updated by the first author.

Several models of human behaviour have been used to predict health behaviour, such as screening attendance. The theory of planned behaviour and reasoned action are widely used models to predict human behaviour.^14,15 This study adopted the Integrated Model for Behavourial Change (I-Change model, see Fig. 2) to analyse the determinants of cancer screening participation.^8,16 The I-Change model assumes a behaviour change process depends on awareness, motivation and action. The process is determined by different factors such as predisposing factors (biological factors-gender, genetics), behavioural factors (lifestyles), environmental factors (social and cultural factors-policies, cultural practices) and information factors (messages, sources used and channels).^16–18 The I-Change model aims to enhance healthcare workers’ understanding of individual behaviours and provide targeted interventions and treatment plans to help alter cancer screening behaviours.

Fig. 2. 

The Integrated Behaviour Change Model.¹⁶

Studies retrieved

A total of 634 abstracts were screened, resulting in 75 full-text articles assessed for eligibility. An additional search for grey literature was conducted via organisational websites and Google search; however, no further studies were added. Table 1 shows the characteristics of the 16 papers in the review.

The studies identified many factors that may hinder or encourage people to participate in cancer screening programs. We mapped these factors according to the I-Change model. Table 2 provides an overview of the cancer screening participation determinants documented in the articles.

Predisposing factors

Most studies reported on predisposing factors associated with cancer screening participation. For the three cancer screening programs, age, ethnicity, gender and cultural beliefs displayed a relationship with the involvement in cancer screening in Queensland.^19–32 For cervical and breast screening programmes, ethnicity and women from non-English speaking background (Aboriginal and Torres Strait Islander and culturally and linguistically diverse (CALD)) were reported as determinants of lower screening uptake.^{19,21,23,25,27,28} Younger age is also a determinant of low screening participation in the state.^{19,21,25,27,30,32} Women are more likely to comply with self-sampling kits than men.^32,33 In addition, women living in rural and very remote areas in Queensland showed decreased participation rates compared to those in cities and outer regional areas.^{19,21,25,30,32}

Psychological and emotional issues that impacted non-participation in the cancer screening programs in Queensland include safety concerns, feeling of embarrassment, confidentiality and cultural beliefs.^{19–29,31–35} For cervical screening, cultural and religious beliefs were significant barriers to participation in CALD and Indigenous women.^26,31 In addition, women in rural and remote areas are disadvantaged in accessing cervical cancer screening.^19,21,25,27 Time constraints and costs were cited in two studies.^19,20 Difficulties accessing consistent health professionals was another concern, especially in rural areas in Queensland.²³

Information factors

Several studies discussed the lack of information, health promotion activities and non- general practice based invitation as contributing to low cancer screening participation and non-attendance. For example, an intervention study reported active recruitment and promotion of cancer screening programs targeting first-time screeners increased participation.³² Developing culturally appropriate health literacy information and strategies have also been identified as a key consideration, especially in Aboriginal and Torres Strait Islander people and CALD minority communities.^23,26,27 For example, Anaman-Torgbor et al.²⁶ suggested it is essential to build the competence of health professionals providing cervical screening services in African communities and provide information to address the misperceptions about cervical cancer causation and screening practices.

Awareness factors

Eleven studies discussed awareness factors, such as lack of knowledge, cultural perceptions and salience in communities, as determinants of low screening participation.^19–28,33 A community study among Indigenous women in a small regional Queensland town found that respondents reported cancer silence in the community due to a lack of information and awareness.²³ Similarly, a study among African women in Queensland found lack of knowledge about cervical cancer and their belief systems have contributed to low screening participation.²⁸ Finally, several studies reported that most women forgot their scheduled screening appointments because of long intervals. This suggested continuous active engagement of primary healthcare services, particularly in rural and remote areas, to remind women when their screening appointment is due, may improve screening participation.^22,25,30,32

Motivation factors

Fatalistic attitude, spiritual forces, culturally based factors, privacy and confidentiality, timely access to service and fear of receiving abnormal results were motivational factors discussed in six studies.^{20,22,23,29,31–33} Most Queenslanders believe it is vital to check for different types of cancer even if there are no symptoms (98% for cervical cancer, 98% for breast cancer and 80% for colorectal cancer).³³ Concerning bowel and breast cancer screening, increased knowledge was significantly associated with positive attitudes towards the possibility of screening participation in the future.²⁸ For cervical screening, privacy and confidentiality, invasiveness, embarrassment and accessing culturally sensitive services motivated social issues.^22,25,28 Fear of the screening procedure, pain associated with the examination (cervical examination), fear of the test result and negative experiences were associated with less motivation for cervical cancer screening.^{23,28,29,33–35}

Ability factors

Most studies discussed action factors. For example, the new 5-yearly national cervical screening program makes women miss appointments due to the more extended screening intervals.²⁰ Access to culturally appropriate screening services, especially for cervical screening, plain language and information and building trusting relationships with health professionals are critical factors in commencing and continuing screening.^{19–29,31,32}