Understanding lung cancer screening participation

Background: Lung cancer is the leading cause of cancer death worldwide. There are evident health inequalities in lung cancer mortality, with those from more deprived groups more likely to be diagnosed with lung cancer and die of the disease. Understanding the factors associated with cancer screening uptake is vital to implementing an effective and efficient UK lung cancer screening programme in the future. This thesis aimed to explore the socioeconomic and psychosocial factors associated with lung cancer screening participation. Methodology: This thesis used a mixed methods approach. A systematic review, of the public perceptions and awareness of lung cancer and lung cancer screening, used an integrative methodology, exploring both quantitative and qualitative literatures. Two secondary analyses of data from an early detection of lung cancer trial were conducted (n = 11,164). The first of the two quantitative studies examined the demographic and psychosocial differences across socioeconomic groups among trial participants, while the second study looked to explore any demographic or psychosocial differences of those who were recruited to participate in the trial by their GP and those recruited via the community. Data from both studies were analysed using univariate and multivariate analyses. Finally, a qualitative study (n = 8) used semi-structured interviews to examine the barriers to attendance among people who initially arranged a lung cancer screening appointment but did not attend. Two analytic approaches were applied to the data. First, data were analysed using a thematic framework approach to generate themes, this was then followed by a theoretical framework approach using two different behavioural models (the Health Action Process Approach and the Common-Sense Model of Self-Regulation) in order to identify overlap and gaps in the models. Main Findings: The findings of these studies suggest that beliefs about lung cancer and lung cancer screening vary by socioeconomic status, with those from more deprived backgrounds more likely to report barriers to screening, less likely to perceive that their actions can impact the development of lung cancer and more likely to feel upset when they think about lung cancer. The secondary analyses highlight the need to consider how best to measure deprivation if it is to be used as a criterion in targeted cancer screening, and further consider how we optimise the way we invite high risk people to participate in lung cancer screening. Results of the secondary analyses of recruitment type in the ECLS trial indicate that community and opportunistic screening invitations encourage uptake in people from less deprived backgrounds, and therefore might not be the best method to reach those at high risk of lung cancer and living in more deprived areas. Results of the qualitative study indicate that people experience both practical and emotional barriers to attending lung cancer screening. Those who agreed to participate, but did not attend their appointment, were more likely to first cite practical barriers, such as competing priorities or ill-health. However, the reasons for not making another appointment were often more emotive, with lung cancer fear and fatalism high among non-attenders. The study also identified significant overlap between the HAPA model and CSM, particularly with regard to the role coping strategies play in a group of people who already have positive intentions. Coping planning and coping appraisal seem to be significant problem areas for non-attenders, with the time between invitation and appointment vital to whether or not they attend their appointment. Conclusions: There are sociodemographic and psychosocial factors associated with participation in lung cancer screening. It is important to identify the barriers to lung cancer screening and provide solutions if a lung cancer screening programme is to be implemented in the UK. Further work is required in order to explore the development of targeted interventions to support those at high risk of lung cancer, particularly those from more deprived groups