Camilla Rahr Tatari

Aim: This study aimed to identify barriers to cancer screening among lonely and isolated people in Denmark and to explore strategies to improve their participation. Subject and methods: The impact of loneliness and social isolation on higher mortality rates and lower cancer screening participation remains relatively unexplored. With rising loneliness worldwide, including in Denmark, understanding its influence on cancer screening is crucial. This exploratory qualitative study included individual and group interviews with 32 people experiencing loneliness or social isolation. The interviews were recorded, transcribed, and analysed using systematic text condensation. Results: Most participants had undergone cancer screening at least once, but regular participation and awareness were lacking. Participants desired more personalised communication, such as outreach and reminders from general practitioners, to enhance motivation. Pre-booked appointments were favoured. Close relationships played a crucial role in motivating screening participation, with those living alone needing extra support. While self-sampling for cervical and colorectal cancer was seen as convenient, participants preferred human interaction and guidance. Conclusion: This study reveals a paradox: high interest in cancer screening does not lead to regular participation. Enhancing social networks and providing clear, accessible information can increase participation and better integrate lonely or isolated populations into preventive healthcare.

Colorectal cancer (CRC) screening can reduce both CRC incidence and mortality, and faecal immunochemical testing (FIT)-based screening programmes are therefore now being implemented in many countries. However, social inequality in FIT-based screening participation is well documented, and initiatives to address this challenge are understudied. We explored the perceptions of CRC screening and the perceived barriers and facilitators towards FIT-based CRC screening among men visiting a drop-in centre for people with severe social problems in Denmark. The study was a qualitative interview study. Participants were sixteen men visiting a drop-in centre in Denmark. A local staff member provided supplementary information and assisted with the recruitment process. The interviews were transcribed verbatim, followed by an inductive content analysis. The men were often dealing with health and social problems, and they often had low self-esteem. At first, they stated that they did not think much about cancer and their own risk of being diagnosed with it. They argued that they had little time, energy, and resources to participating in, for example, CRC screening programmes, and barriers to participating were facts of life such as comorbidity and cognitive difficulties. Further, they were not sure how to participate, and some misunderstood the concept of screening. However, during the interviews, the main part of the participants became very keen to participate, and they suggested that in the future, they could receive regular information about cancer screening in face-to-face interactions with someone who cared and was interested in helping them. Men in a vulnerable position visiting a drop-in centre were interested in CRC screening. If we intervene in a way that meets the needs among these vulnerable citizens, it may contribute to reducing social inequality in FIT-based CRC screening programmes.

Background: Ethnic minority women are less likely to participate in cervical cancer uteri (CCU) screening compared to native women. Human Papillomavirus (HPV) self-sampling kits for CCU screening may be a potential strategy to increase participation. This study aimed to explore views and attitudes on four different types of self-sampling kits (two brushes, a first-void urine device, and a menstrual blood device) among non-Western ethnic minority women living in Denmark. Methods: The study was a social science single case study based on focus group interviews with 30 women aged 32–54 with non-Western background from a deprived area. A phenomenological approach was applied to describe the phenomenon “self-sampling” as seen from the women’s lifeworlds. The interviews were transcribed verbatim and analysed using systematic text condensation. Results: The women expressed significant interest in the possibility of using HPV self-sampling kits as an alternative to being screened by their general practitioner. They were particularly motivated to use the non-invasive self-sampling kits for CCU screening as they were deemed suitable for addressing cultural beliefs related to their bodies and virginity. The women expressed interest in the use of the invasive self-sampling kits but were cautious, primarily due to lack of confidence in correctly performing self-sampling with a brush and due to cultural beliefs. Conclusion: The use of non-invasive self-sampling kits, such as a first-void urine collection device and menstrual blood pad, represents a promising solution to overcome cultural barriers and promote greater equality in CCU screening participation among non-Western ethnic minority women.

Cancer is a major global health concern. Unfortunately, Indigenous populations such as Greenlanders living in Denmark, face significant disparities in cancer risk, incidence, diagnosis, care quality, and outcomes. In Denmark, vulnerable Greenlanders face challenges accessing cancer screening. The aim of this study was to explore their perceptions of cancer, barriers to participation in cancer screening, and potential for developing a tailored intervention. This qualitative study was based on participant observations and qualitative interviews. The sample comprised 46 participants from four distinct drop-in centres. Of these, 28 were vulnerable Greenlanders (19 women and 9 men), 9 were staff members (6 women and 3 men), and 6 were relatives (4 women and 2 men). The data were analysed through inductive content analysis. Vulnerable Greenlanders in Denmark believed they were responsible for their own health and were generally satisfied with the healthcare system. However, they found it challenging to manage their own health and many depended on support from others. Fear of cancer and death shaped their attitudes towards screening. For vulnerable Greenlanders in Denmark participation in cancer screening programmes was positively viewed for most but could be challenging. Different intervention ideas raised by the vulnerable Greenlanders, relatives and staff members could guide the development of strategies to increase participation rates.

Background: Ethnic minority women from non‐Western countries are less likely than the native women to participate in screening programmes for cervical cancer, breast cancer and colorectal cancer. This social inequality can result in loss of possibility for prevention, delayed diagnosis and treatment and, ultimately, lower chance of survival. Developing a tailored intervention might be the solution to reduce social inequalities in cancer screening, and a key feature in intervention research is to consult the target group.Objective: To explore ethnic minority women's own ideas and preferences for a cancer screening intervention and identify their attitudes to different strategies.Methods: An interview study with five focus group interviews, two group interviews with an interpreter and three individual interviews. Thirty‐seven women from 10 non‐Western countries contributed to the study. The interviews were audio‐recorded and transcribed verbatim followed by a thematic analysis.Results: According to the women, a tailored intervention should focus on knowledge in the form of face‐to‐face teaching. The women further suggested information material in their own language with a simple, positive and concrete communication strategy. They would like to be involved in an awareness strategy and share the knowledge with their network.Conclusion: Ethnic minority women were interested in a tailored intervention, and they were keen to contribute with ideas and preferences. The findings emphasized the potential of a tailored intervention with specific suggestions to the content when attempting to reduce inequality in cancer screening participation.Patient or Public Contribution: Minority women were involved in the interview study.

Background: Screening programmes for cervical cancer, breast cancer and colorectal cancer have been implemented in many Western countries to reduce cancer incidence and mortality. Ethnic minority women are less likely to participate in cancer screening than the majority population. In worst case this can result in higher incidence rates, later diagnosis and treatment and ultimately inferior survival. In this paper we explored the perceptions about cancer and perceived barriers towards cancer screening participation among ethnic minority women in a deprived area in Denmark. Methods: Interview study with ethnic minority women in a deprived area in Denmark. The interviews were transcribed verbatim followed by an inductive content analysis. Results: Cancer was perceived as a deadly disease that could not be treated. Cancer screening was perceived as only relevant if the women had symptoms. Knowledge about cancer screening was fragmented, often due to inadequate Danish language skills and there was a general mistrust in the Danish healthcare system due to perceived low medical competences in Danish doctors. There was, however, a very positive and curious attitude regarding information about the Danish cancer screening programmes and a want for more information. Conclusion: Ethnic minority women did not have sufficient knowledge about cancer and the purpose of cancer screening. Perceptions about cancer screening were characterised by openness and the study showed positive and curious attitudes towards screening participation. The findings emphasise the importance of culturally adapted interventions for ethnic minority women in attempts to reduce inequality in screening participation.

Objective: In Denmark, parents with small children have the highest contact frequency to out-of-hours (OOH) service, but reasons for OOH care use are sparsely investigated. The aim was to explore parental contact pattern to OOH services and to explore parents’ experiences with managing their children’s acute health problems. Design: A qualitative study was undertaken drawing on a phenomenological approach. We used semi-structured interviews, followed by an inductive content analysis. Nine parents with children below four years of age were recruited from a child day care centre in Aarhus, Denmark for interviews. Results: Navigation, information, parental worry and parental development appeared to have an impact on OOH services use. The parents found it easy to navigate in the health care system, but they often used the OOH service instead of their own general practitioner (GP) due to more compatible opening hours and insecurity about the urgency of symptoms. When worried about the severity, the parents sought information from e.g. the internet or the health care professionals. The first child caused more worries and insecurity due to less experience with childhood diseases and the contact frequency seemed to decrease with parental development. Conclusion: Parents’ use of the OOH service is affected by their health literacy levels, e.g. level of information, how easy they find access to their GP, how trustworthy and authorized health information is, as well as how much they worry and their parental experience. These findings must be considered when planning effective health services for young families.