218199 Barriers and facilitators to breast, cervical, and colorectal cancer screenings among lesbian, gay, bisexual, and transgender (LGBT) persons: A qualitative study and curriculum development

Monday, November 8, 2010

Rebecca Ramsey, MPH , University of Nebraska Medical Center, CityMatCH, Omaha, NE
Alicia Matthews, PhD , College of Nursing, University of Illinois at Chicago, Chicago, IL
Lisa M. Kuhns, PhD, MPH , Division of Research, Howard Brown Health Center, Chicago, IL
Objective: To identify barriers and facilitators to breast, cervical, and colorectal cancer screenings among lesbian, gay, bisexual, and transgender (LGBT) persons.

Methods: Interviews were conducted with 36 Chicago-area self-identified LGBT individuals and 12 LGBT-serving health care providers and/or medical directors. The interview guide included questions about individual-level and institutional factors (e.g., cognitive, structural, financial, and LGBT-specific) that may act as barriers to adherence to cancer screening guidelines. Interviews were audio recorded and transcribed for analysis. Data were analyzed using a framework analysis approach to systematically sift, chart and sort interview data according to key issues and themes.

Results: Participants included 16 female-identified, 8 male-identified, and 4 female-to-male transgender-identified individuals for whom the average age was 46. Barriers to cancer screening include lack of health insurance, fear of medical procedures and diagnostic findings, prior experiences of LGBT-related discrimination, mistrust in the value of cancer screenings as well as health care in general, and low prioritization of screening. Identified facilitators include encouragement of screening by providers, increased visibility of cancer-related information and educational messages in the public arena, and increased awareness of low-cost or free access to screening.

Conclusions: Study findings indicate that individual-level and institutional-level factors amenable to intervention currently serve as barriers to cancer screening among LGBT individuals. These findings will be used to adapt an existing Health Systems Navigation curriculum to the needs and experiences of LGBT persons. The curriculum will be used to enhance the cultural competency of health educators and lay patient navigators serving LGBT populations.

Learning Areas:
Assessment of individual and community needs for health education
Chronic disease management and prevention
Diversity and culture
Planning of health education strategies, interventions, and programs
Public health or related research

Learning Objectives:
1. Describe the distribution of cancer morbidity within LGBT populations. 2. Identify barriers and facilitators to breast, cervical, and colorectal cancer screening among LGBT populations 3. Identify potential points of intervention for adaptation of a Health Systems Navigation curriculum to the needs of LGBT persons.

Keywords: Cancer Screening, Minority Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I hold a MPH degree in Community Health Sciences, and I am the project coordinator for this particular research study and have knowledge of the interview process, findings, and day-to-day administration of the project.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.