Improbability or impossibility? A qualitative study exploring the stakeholder’s perception of barriers homeless populations face within cancer screening.

Abstract

Background: Homeless populations are highly susceptible to cancer yet despite such high-risk cancer profiles, cancer screening uptake amongst them remains poor. Although such low rates are alarming as they may lead to a lack of timely cancer diagnosis and treatment, few studies have sought to understand what may be contributing to a lack of engagement of homeless populations with cancer screening. Despite playing a highly crucial role in the lives of those facing homelessness, stakeholders who provide such individuals with the necessary support have never been included in studies on homelessness and cancer screening. This study addresses this, exploring stakeholders understanding of the lived reality of such groups, and any barriers they may face with cancer screening.

Methods: This study adopted a qualitative research design, which made use of semi-structured interviews with eight participants. For this study, thematic analysis was chosen, and four themes were derived from the interview transcriptions after adopting the six-step coding framework by Braun and Clarke.

Results: Consistent with social-ecological models of health-seeking behaviour amongst homeless populations, this study has found that homeless populations face consistent barriers to cancer screening at the individual, peer, community, institutional and cultural levels. Such barriers were found to transcend beyond a lack of physical resources as they also include latent healthcare seeking patterns, as well as a lack of funds being invested into hospitals and homeless support services, which all come to affect the populations’ ability or willingness to screen for cancer.

Conclusion: This study has concluded that cancer screening barriers often exist or are derived from the wider health and social inequalities homeless populations face, hence, there is a pressing need to address such inequalities in conjunction with addressing the minimisation of cancer screening barriers. This study has also concluded that national screening campaigns have consistently failed to address the difficulties and challenges current screening strategies may pose to homeless populations, and that targeted cancer screening interventions that seek to include those facing homelessness in their design and plans of action are required.