Reasons for non-participation in the Northern Ireland Bowel Cancer Screening Programme: a qualitative study.

OBJECTIVES: To identify the reasons why some people do not participate in bowel cancer screening so that steps can be taken to improve informed decision-making. DESIGN: Qualitative study, using focus groups with thematic analysis of data to identify, analyse and report patterns. Transcripts were repeatedly read and inductively coded using a phenomenological perspective, and organised into key themes. SETTING: Belfast and Armagh, two areas of Northern Ireland with relatively low uptake of bowel cancer screening. PARTICIPANTS: Ten women and 18 men in three single-gender focus groups (two male and one female), each with 9-10 participants. Study participants were recruited by convenience sampling from the general public and were eligible for, but had not taken part in, the Northern Ireland Bowel Cancer Screening Programme. RESULTS: Key themes identified were fear of cancer; the test procedure; social norms; past experience of cancer and screening; lack of knowledge or understanding about bowel cancer screening; and resulting behaviour towards the test. Fear about receiving bad news and reluctance to conduct the test themselves were reactions that participants seemed willing to overcome after taking part in open discussion about the test. CONCLUSIONS: We identified barriers to participation in bowel cancer screening and used these insights to develop new materials to support delivery of the programme. Some of the issues raised have been identified in other UK settings, suggesting that knowledge about barriers, and strategies to improve uptake, may be generalisable.

Healing in places of decline: (re)imagining everyday landscapes in Hamilton, Ontario.

Ongoing interest in therapeutic landscapes has contributed noticeably to the development of a "post-medical geography of health" (Kearns, R.A., Professional Geographer 45 (1993) 139). Drawing on a variety of sources, including in-depth interviews and newspaper coverage from Hamilton, Canada, this paper explores the processes by which ordinary places are characterised as healthy or unhealthy, and investigates how health-affirming and health-denying places exist together in everyday life. We argue that it is possible for places to simultaneously hurt and heal, and that the therapeutic effect of place is largely contingent on individuals' physical and social locations. Further, we attempt to illustrate how these meanings are negotiated at a variety of different geographic scales.

Angina and socio-economic status in Ontario: how do characteristics of the county you live in influence your chance of developing heart disease?

OBJECTIVE: To assist in the development of community heart health programming and policy development, the Central West Health Planning Information Network (CWHPIN) was asked by its partners to collaborate in obtaining information that might clarify the relationships between socio-economic status (SES) and heart disease among residents of Ontario, Canada. The purpose of this component of the project was to explore, at the county level, how much of the variation in angina pectoris (angina) could be explained by SES variables. STUDY DESIGN: Linear regression modeling was used to identify key predictors of angina hospitalization rates in counties Ontario-wide. RESULTS: Results of the linear regression modeling showed that SES variables (most notably education and occupation) were key predictors of angina, even when traditional risk factors (i.e., smoking, etc.) were included in the analysis. CONCLUSION: This study demonstrates that, at the county level, socio-economic variables such as education and occupation have a significant relationship with rates of heart disease at the population level, even when including the traditional risk factors in the analysis.

Does deliberation make a difference? Results from a citizens panel study of health goals priority setting.

How to involve the public in setting health and health care priorities is a constant challenge for health system decisions. Policy maker interest in involving the public in increasingly complex and value-laden priority setting processes has led to the use of deliberative public involvement methods designed to promote discussion and debate among participants with the objective of obtaining more informed and consensual views. These methods have not been evaluated rigorously using controlled designs with pre- and post-test measurements. We examined, using a controlled design, the effects of introducing different opportunities for deliberation into a process for obtaining public input into a community health goals priority setting process. Our findings indicate that deliberation does make a difference to participant views. As more deliberation is introduced, participant views may be more amenable to change. Deliberation also offers the potential for views to become more rather than less entrenched. While we are beginning to understand the difference deliberation makes to participant views, we are still at an early stage in understanding the process through which these differences come about and what difference deliberation makes to broader outcomes such as civic competence, civic engagement and health policy decisions.