Ward Paul R, Javanparast Sara, Wilson Carlene
Discipline of Public Health, Flinders University, Flinders University, Bedford Park, SA 5042, Australia.
Aust J Prim Health. 2011;17(4):334-46. doi: 10.1071/PY11055.
The National Bowel Cancer Screening Program (NBCSP) offers population-based screening for colorectal cancer (CRC) across Australia. The aims of this paper were to highlight the inequities in CRC screening in South Australia (SA) and the system-related barriers and enablers to CRC screening from the perspective of participants identified as having inequitable participation. First, de-identified data for the SA population of the NBCSP were statistically analysed and then mapped. Second, 117 in-depth interviews were conducted with culturally and linguistically diverse (CALD) groups, Indigenous and Anglo-Saxon Australians. Participation rates in the NBCSP were geographically and statistically significantly different (P < 0.0001) on the basis of gender (higher for women), age (higher for older people) and socioeconomic status (higher for more affluent people). The main system-related barriers were the lack of awareness of CRC or CRC screening within these groups, the problems with language due to most of the information being in English and the lack of recommendation by a doctor. This study revealed that inequity exists in the NBCSP participation in SA, and we identified both barriers and facilitators to CRC screening that require action at the level of both policy and practice. There is a large role in primary health care of both recommending CRC screening and facilitating equitable participation.
澳大利亚国家肠癌筛查项目（NBCSP）为全澳民众提供肠癌筛查服务。本文旨在突出南澳大利亚州（SA）肠癌筛查中的不公平现象，以及从被认定为参与度不公平的参与者角度来看，与系统相关的肠癌筛查障碍和促进因素。首先，对NBCSP中SA人群的匿名数据进行统计分析，然后绘制地图。其次，对文化和语言背景多元（CALD）群体、澳大利亚原住民和盎格鲁-撒克逊澳大利亚人进行了117次深入访谈。基于性别（女性较高）、年龄（老年人较高）和社会经济地位（较富裕人群较高），NBCSP的参与率在地理和统计上存在显著差异（P < 0.0001）。与系统相关的主要障碍包括这些群体对肠癌或肠癌筛查缺乏认识、由于大多数信息为英文而存在的语言问题以及缺乏医生的推荐。本研究表明，SA的NBCSP参与存在不公平现象，我们确定了肠癌筛查的障碍和促进因素，需要在政策和实践层面采取行动。在推荐肠癌筛查和促进公平参与方面，初级卫生保健发挥着重要作用。
