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Download Thesis This electronic thesis or dissertation has been downloaded from the King’s Research Portal at https://kclpure.kcl.ac.uk/portal/ Understanding low uptake of colorectal cancer screening in South East London exploration of demographic, psychological, social and cultural factors Dharni, Nimarta Awarding institution: King's College London The copyright of this thesis rests with the author and no quotation from it or information derived from it may be published without proper acknowledgement. END USER LICENCE AGREEMENT Unless another licence is stated on the immediately following page this work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International licence. https://creativecommons.org/licenses/by-nc-nd/4.0/ You are free to copy, distribute and transmit the work Under the following conditions: Attribution: You must attribute the work in the manner specified by the author (but not in any way that suggests that they endorse you or your use of the work). Non Commercial: You may not use this work for commercial purposes. No Derivative Works - You may not alter, transform, or build upon this work. Any of these conditions can be waived if you receive permission from the author. Your fair dealings and other rights are in no way affected by the above. Take down policy If you believe that this document breaches copyright please contact [email protected] providing details, and we will remove access to the work immediately and investigate your claim. Download date: 07. Oct. 2021 This electronic theses or dissertation has been downloaded from the King’s Research Portal at https://kclpure.kcl.ac.uk/portal/ Title: Understanding low uptake of colorectal cancer screening in South East London; exploration of demographic, psychological, social and cultural factors Author: Nimarta Dharni The copyright of this thesis rests with the author and no quotation from it or information derived from it may be published without proper acknowledgement. END USER LICENSE AGREEMENT This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License. http://creativecommons.org/licenses/by-nc-nd/3.0/ You are free to: Share: to copy, distribute and transmit the work Under the following conditions: Attribution: You must attribute the work in the manner specified by the author (but not in any way that suggests that they endorse you or your use of the work). Non Commercial: You may not use this work for commercial purposes. No Derivative Works - You may not alter, transform, or build upon this work. Any of these conditions can be waived if you receive permission from the author. Your fair dealings and other rights are in no way affected by the above. Take down policy If you believe that this document breaches copyright please contact [email protected] providing details, and we will remove access to the work immediately and investigate your claim. Understanding low uptake of colorectal cancer screening in South East London; exploration of demographic, psychological, social and cultural factors Nimarta Dharni Thesis submitted for the degree of Doctor of Philosophy of the University of London King’s College London 2013 1 Abstract Colorectal Cancer (CRC) screening is offered in the UK to individuals aged 60-75 years through the faecal occult blood test (FOBt). Uptake of CRC screening is variable but particularly low in South East (SE) London, an area with high ethnic diversity and socio- economic deprivation. Reasons for this low uptake are unclear. This thesis explores the role of psychological, social and cultural factors in the low uptake of CRC screening in SE London. Mixed methods were employed where a narrative synthesis examined the beliefs of various ethnic minority and socio-economic groups about the FOBt; a qualitative study explored the beliefs of 50 people of Black African, Black Caribbean and White British backgrounds from SE London; and a prospective questionnaire study (n=507) identified the demographic and psychological predictors of screening intentions and uptake. The narrative synthesis, interview topic guide and questionnaire were underpinned by Theoretical Domains Framework (TDF; Michie et al 2005). Findings of the narrative synthesis indicated a dearth of research examining both ethnicity and SES factors together. The qualitative study highlighted many similarities in the views of participants from the three main ethnic groups after considering SES. The survey indicated intentions and participation in CRC screening were underpinned by psychological and demographic factors, where psychological factors mediated the impact of ethnic differences. Although SES was not related to screening intentions or uptake, more deprived groups were significantly less likely to make an informed choice about screening. This thesis has bridged an important gap by examining the beliefs of Black African and Black Caribbean who have been previously neglected from research. Exploration of ethnicity and SES and the integrated use of a theoretical framework are distinct strengths of this thesis. These findings can help inform the design of interventions to influence screening uptake. 2 Acknowledgements This thesis would not have been completed without the support, guidance, and assistance of many individuals. Though these acknowledgments may not prove completely exhaustive, my gratitude extends to all who have contributed to the conception and completion of this work. Firstly, I would like to thank my first supervisor, Dr Alison Wright for the time and enthusiasm she has invested in this PhD and for her interest both in the research and in my development as a researcher. I would also like to thank my second supervisor Professor David Armstrong who helped me develop a critical understanding of the conceptual issues in this thesis. I would also like to thank Professor Roger Jones who was my second supervisor before retiring and Dr Rachel Crockett for supervising me whilst Alison was on maternity leave. I would also like to acknowledge the academic support, warm friendship and inspiration that has been given to me by Helen, Sophia, Mercy and Martine, and other colleagues in the Department of Primary Care and Public Health Sciences over the last few years. It was a privilege working alongside you all and I could not have asked for a better environment in which to do a PhD. Thanks also to Dr Mark Ashworth whose assistance was invaluable in making contact with GP practices. A big thanks to my wonderful siblings Poonam, Ekta and Bhavesh for their help collecting and/or entering the data in chapter six. Your love, support, good humour has always kept me going and I am a very proud big sister. I would also like to thank my extended family and friends for cheering me on and always providing perspective when I needed it the most. I am very grateful to all the participants who contributed to this research and very generously gave their time in order to participate in interviews. Finally, I would like to thank Dr Guy-Chung-Faye and Kings College Hospital Charity for funding the research undertaken in this PhD. This thesis is dedicated to my wonderful parents, Rampal & Manjula; all that I am or hope to be, I owe to them. 3 Abbreviations BCT – Behaviour change technique CRC – Colorectal cancer FOBt – Faecal occult blood test HBM - Health Belief Model IMD Index of Multiple Deprivation SES – Socio-economic status SD – Social Deprivation SCT - Social Cognitive Theory TDF - Theoretical Domains Framework TPB – Theory of Planned Behaviour 4 Table of Contents Abstract..................................................................................................................................2 Acknowledgements................................................................................................................3 Abbreviations........................................................................................................................4 Table of Figures.....................................................................................................................10 Table of Tables......................................................................................................................11 Chapter 1 Thesis Overview..................................................................................................13 1.1 Chapter overview ............................................................................................................. 13 1.2 Background ...................................................................................................................... 13 1.3 The screening process ...................................................................................................... 14 1.4 Uptake of Screening ......................................................................................................... 16 1.5 Key research questions .................................................................................................... 18 1.6 Overview of Chapters ...................................................................................................... 18 Chapter 2 Conceptualising Ethnicity and SES..................................................................20 2.1 Chapter overview ............................................................................................................. 20 2.2 Uptake of CRC screening in the UK ................................................................................ 20 2.3 Ethnicity ..........................................................................................................................
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