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Cited by 12Global Cancer Incidence and ScreeningWomen's cancer prevention and managementPatient-Provider Communication in Healthcare

A “Tea and Cookies” Approach: Co-designing Cancer Screening Interventions with Patients Living with Low Income

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Lofters, Aisha K., Baker, Natalie A., Schuler, Andree, Rau, Allison, Baxter, Alison, Baxter, Nancy N., Kucharski, Edward, Leung, Fok-Han +2 more·2020·Journal of General Internal Medicine
DOI 10.1007/s11606-019-05400-0PMC PMC6957607
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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.

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  • Competing life demands such as other diseases, childcare responsibility, no possibility to take time off, and being busy with housework are widely cited barriers.

    “Barriers such as other diseases, responsibility of childcare, no possibility to take time off, and being busy with housework are widely cited [9,13,22,23,30].”

    From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [23]

    In Phase I: Individual Interviews (page unavailable), participants described other ailments and the demands of feeding children as competing priorities to cancer screening. The paper does not identify an inability to take time off or housework as screening barriers; its comments about work schedules and errands concern the timing of proposed group sessions. (LLM, conf=0.86)

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Authors
Lofters, A. K., Baker, N. A., Schuler, A., Rau, A., Baxter, A., Baxter, N. N., Kucharski, E., Leung, F.-H., Weyman, K., & Kiran, T.
Affiliations
  • St. Michael's Hospital (CA)
  • Cancer Care Ontario (CA)
ORCID
Venue
Journal of General Internal Medicine
Publisher
Springer Science and Business Media LLC
Published
2019-10-21
Volume
35
Issue
1
Pages
255-260
ISSN
  • 0884-8734 (ISSN-L)
  • 1525-1497
DOI
10.1007/s11606-019-05400-0
PMC
PMC6957607
OpenAlex
W2981551011
Cited by
12
References
33
Citations by year
2026: 4 · 2024: 3 · 2023: 2 · 2021: 2 · 2020: 1
FWCI
0.31
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of General Internal Medicine (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • TSpace (University of Toronto) (submittedVersion)
Funders
  • Women's College Hospital
  • University of Toronto
  • Canadian Institutes of Health Research
Topics
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
  • Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
Keywords
cancer screening, low income, co-design, patient engagement, screening outreach, screening uptake, barriers to screening, fear of cancer, competing priorities, telephone calls, group education, primary care, income gradient
MeSH terms
Female, Humans, Mass Screening, Neoplasms, Poverty, Tea, Qualitative Research, Early Detection of Cancer

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