McCutchan Grace, Wood Fiona, Smits Stephanie, Edwards Adrian, Brain Kate
Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.
BMC Public Health. 2016 Oct 5;16(1):1052. doi: 10.1186/s12889-016-3733-2.
Socioeconomic inequalities in cancer survival can in part be explained by long patient intervals among people from deprived groups; however, the reasons for this are unclear. This qualitative study explores the actual and anticipated barriers to cancer symptom presentation in the context of socioeconomic deprivation.
Thirty participants were recruited through the International Cancer Benchmarking Partnership Welsh database (n = 20), snowball sampling (n = 8) and community partners (n = 2). Semi-structured qualitative interviews were conducted with symptomatic and asymptomatic adults over the age of 50 years, who were identified as being from a low socioeconomic group based on multiple individual and group level indicators. Transcripts were analysed using a Framework approach based on the COM-B model (Capability, Opportunity, Motivation-Behaviour).
There was evidence of poor awareness of non-specific cancer symptoms (Capability), fearful and fatalistic beliefs about cancer (Motivation), and various barriers to accessing an appointment with the family physician (Opportunity) and full disclosure of symptoms (Capability). These in combination were associated with a lengthened patient interval among participants. Social networks (Opportunity) were influential on the formation of knowledge and beliefs about cancer. Participants' behavioural and normative beliefs were usually formed and reinforced by people they knew with cancer, and such beliefs were considered to lengthen the patient interval. Discussing symptoms with a family member or friend before a visit to the family physician was the norm, and could act as a barrier or facilitator depending on the quality of advice given (Opportunity). Economic hardship meant fulfilling basic day-to-day needs such as finding money for food were prioritised over medical help seeking (Opportunity).
The complex interaction between individual characteristics and socio-environmental factors is important for understanding cancer symptom presentation behaviour, especially in the context of socioeconomic deprivation. Interventions targeted at deprived communities should take into account the wider social influences on symptom presentation behaviour.
癌症生存率方面的社会经济不平等部分可归因于贫困群体患者就诊间隔时间长；然而，其原因尚不清楚。本定性研究探讨了在社会经济贫困背景下，癌症症状呈现的实际和预期障碍。
通过国际癌症基准伙伴关系威尔士数据库招募了30名参与者（n = 20），通过滚雪球抽样招募了8名参与者，通过社区合作伙伴招募了2名参与者。对50岁以上有症状和无症状的成年人进行了半结构化定性访谈，这些人根据多个个人和群体层面指标被确定为来自低社会经济群体。使用基于COM-B模型（能力、机会、动机 - 行为）的框架方法对访谈记录进行了分析。
有证据表明对非特异性癌症症状的认识不足（能力）、对癌症的恐惧和宿命论信念（动机），以及在预约家庭医生（机会）和充分披露症状（能力）方面存在各种障碍。这些因素综合起来与参与者就诊间隔时间延长有关。社交网络（机会）对癌症知识和信念的形成有影响。参与者的行为和规范信念通常由他们认识的患癌症的人形成并强化，这些信念被认为会延长就诊间隔时间。在去看家庭医生之前与家庭成员或朋友讨论症状是常态，这可能根据所提供建议的质量起到障碍或促进作用（机会）。经济困难意味着满足基本日常需求，如筹集购买食物的钱，比寻求医疗帮助更优先（机会）。
个体特征与社会环境因素之间的复杂相互作用对于理解癌症症状呈现行为很重要，尤其是在社会经济贫困的背景下。针对贫困社区的干预措施应考虑到对症状呈现行为更广泛的社会影响。
