Pathways to colorectal cancer screening in Hull : a complexity informed configurational approach

Morasae, Esmaeil Khedmati

September 2018

Thesis or dissertation

© 2018 Esmaeil Khedmati Morasae. All rights reserved. No part of this publication may be reproduced without the written permission of the copyright holder.

In terms of its colorectal cancer profile, Hull is among the worst cities in the UK. A considerable number of colorectal cancer cases in Hull are diagnosed in emergency departments and in their late stages. Several modalities of screening tests (e.g. Faecal Occult Blood Test (FOBT)) are offered in order to detect cancer cases in their early days of development when treatment is more feasible. However, the overall rate of screening is far from optimal and is even lower among people of lower socioeconomic status in Hull. Despite Hull having such an unacceptable profile of colorectal cancer, very few studies have investigated the reasons behind screening behaviour and its unequal distribution in Hull. This study, therefore, aimed to understand the reasons behind screening behaviour and its inequalities in this city. Unlike conventional research focusing on the impact of single psychosocial factors on screening, we used a complexity-informed configurational approach, called Qualitative Comparative Analysis (QCA), to understand the configurations of conditions that produce screening behaviour. Semi-structured interviews were conducted with 30 people from the most and least deprived neighbourhoods in Hull to gather the required data. A thematic content analysis was undertaken to discover the main themes (conditions) that were reported as the determinants of screening by participants. Various configurations of these conditions (complex solutions) were shown by QCA to be sufficient for production of outcome (screening) among the rich and poor. Interestingly, the number of configurations for production of outcome negation (lack of screening) was higher among the poor. Moreover, minimization of complex solutions showed that motivation is the most important (highly necessary and sufficient) condition influencing the screening decision in Hull, regardless of socioeconomic status. Therefore, motivation-focused interventions should be in the first line of interventions to increase screening rates and redress inequalities in this city. However, alongside specific attention to motivation and by taking a complex configurational approach, complex interventions should be designed to address the revealed configurations in each specific socioeconomic context within the city.

Business School, The University of Hull
Merali, Yasmin; Macleod, Una
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