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Ethnic differences in barriers to symptomatic presentation in primary care: A survey of women in England

Williams, Emily D., Whitaker, Katriina L., Piano, Marianne and Marlow, Laura A.V. (2019) Ethnic differences in barriers to symptomatic presentation in primary care: A survey of women in England Psycho-Oncology.

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The majority of cancers are diagnosed following a decision to access medical help for symptoms. People from ethnic minority backgrounds have longer patient intervals following identification of cancer symptoms. This study quantified ethnic differences in barriers to symptomatic presentation including culturally‐specific barriers. Correlates of barriers (e.g. migration status, health literacy and fatalism) were also explored.


A cross‐sectional survey of 720 White British, Caribbean, African, Indian, Pakistani and Bangladeshi women aged 30‐60 (n=120/group) was carried out in England. Barrier items were taken from the widely‐used Cancer Awareness Measure; additional culturally‐specific barriers to symptomatic presentation were included following qualitative work (11 in total). Migration status, health literacy and fatalism were included as correlates to help‐seeking barriers.


Ethnic minority women reported a higher number of barriers (p˂0.001, 2.6‐3.8 more than White British women). Emotional barriers were particularly prominent. Women from ethnic minority groups were more likely to report 'praying about a symptom' (p˂0.001, except Bangladeshi women) and 'using traditional remedies' (p˂0.001,except Caribbean women). Among ethnic minority women, adult migration to the UK, low health literacy and high fatalistic beliefs increased likelihood of reporting barriers to symptomatic presentation. For example, women who migrated as adults were more likely to be embarrassed (OR=1.83,CI:1.06‐3.15), worry what GP might find (OR=1.91,CI:1.12‐3.26) and be low on body vigilance (OR=4.44,CI:2.72‐7.23).


Campaigns addressing barriers to symptomatic presentation among ethnic minority women should be designed to reach low health literacy populations and include messages challenging fatalistic views. These would be valuable for reducing ethnic inequalities in cancer outcomes.

Item Type: Article
Divisions : Faculty of Health and Medical Sciences > School of Health Sciences
Authors :
Williams, Emily
Whitaker, Katriina
Piano, Marianne
Marlow, Laura A.V.
Date : 11 September 2019
DOI : 10.1002/pon.5225
Copyright Disclaimer : © 2019 John Wiley & Sons Ltd.
Uncontrolled Keywords : Cancer; Early diagnosis; Ethnicity; General practice; Symptomatic presentation; Barriers
Depositing User : Clive Harris
Date Deposited : 25 Sep 2019 13:47
Last Modified : 12 Sep 2020 02:08

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