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"Robb, Kathryn A."
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Depression and anxiety among people living with and beyond cancer: a growing clinical and research priority
by
Robb, Kathryn A.
,
Katikireddi, Srinivasa Vittal
,
Knifton, Lee
in
Adaptation, Psychological
,
Adolescent
,
Adult
2019
Background
A cancer diagnosis can have a substantial impact on mental health and wellbeing. Depression and anxiety may hinder cancer treatment and recovery, as well as quality of life and survival. We argue that more research is needed to prevent and treat co-morbid depression and anxiety among people with cancer and that it requires greater clinical priority. For background and to support our argument, we synthesise existing systematic reviews relating to cancer and common mental disorders, focusing on depression and anxiety.
We searched several electronic databases for relevant reviews on cancer, depression and anxiety from 2012 to 2019. Several areas are covered: factors that may contribute to the development of common mental disorders among people with cancer; the prevalence of depression and anxiety; and potential care and treatment options. We also make several recommendations for future research. Numerous individual, psychological, social and contextual factors potentially contribute to the development of depression and anxiety among people with cancer, as well as characteristics related to the cancer and treatment received. Compared to the general population, the prevalence of depression and anxiety is often found to be higher among people with cancer, but estimates vary due to several factors, such as the treatment setting, type of cancer and time since diagnosis. Overall, there are a lack of high-quality studies into the mental health of people with cancer following treatment and among long-term survivors, particularly for the less prevalent cancer types and younger people. Studies that focus on prevention are minimal and research covering low- and middle-income populations is limited.
Conclusion
Research is urgently needed into the possible impacts of long-term and late effects of cancer treatment on mental health and how these may be prevented, as increasing numbers of people live with and beyond cancer.
Journal Article
Effectiveness of workplace cancer screening interventions: a systematic review
by
Robb, Kathryn A.
,
Mon, Hsu Myat
,
Demou, Evangelia
in
Analysis
,
Bias
,
Biomedical and Life Sciences
2024
Introduction
Cancer cases are rising globally, with a noticeable rise in younger adults. Screening and early detection are effective in decreasing mortality. Workplaces can play a role in promoting cancer screening uptake. This systematic review investigated the effectiveness of workplace breast, lung, colorectal, and cervical cancer screening interventions, and the factors impacting their effectiveness.
Methodology
Six databases (Embase, Medline, Web of Science, CINAHL, Cochrane Library, Scopus) were searched, and cancer screening promotion and cancer screening uptake was analysed using effect direction plots. Magnitude of effectiveness (i.e., change in knowledge or screening rate) was also evaluated.
Results
In total, 13,426 articles were identified. After screening and applying the eligibility criteria, 21 articles were included in the analysis. A positive effect direction was seen for all workplace cancer screening promotion interventions. Magnitude of effectiveness for cancer screening promotion interventions resulted in a > 30% change in knowledge or screening uptake in 4/7 of breast cancer, in 3/4 of cervical cancer and 1/3 colorectal cancer screening promotion interventions. For workplace cancer screening uptake interventions, a positive effect direction was observed for the majority (18/22). Cancer screening uptake interventions showed a > 30% change in magnitude of screening rate in 4/7 breast cancer, 5/10 colorectal cancer and in 1/5 cervical cancer workplace interventions. No studies for lung cancer were eligible. Factors positively influencing effectiveness included an interest in health and previous healthcare use, while fear of cancer and embarrassment of screening negatively influenced effectiveness.
Conclusion
Workplace cancer screening promotion and uptake interventions can effectively improve cancer screening knowledge and increase uptake of screening tests.
Journal Article
The PROCAN-B study protocol: Early diagnosis of PROstate CANcer for Black men—a community-centred participatory approach in Scotland and the North-East of England
2024
Prostate cancer is the most common cancer in the UK and Black African-Caribbean men are twice as likely to develop prostate cancer as white men. These cancer inequalities need urgent tackling. Barriers to early diagnosis are complex and require complex solutions. Culturally-tailored, community-centred and participatory approaches show promise in tackling cancer inequalities. We aim to co-design a culturally appropriate intervention to tackle barriers to early diagnosis of prostate cancer for Black men in Scotland and the North-East of England using a community-centred participatory approach.
The PROCAN-B study is a mixed methods study set in Scotland and the North-East of England. A Public Involvement and Community Engagement (PICE) group (n = 12), is involved at every step of the research. Drawing on principles of the Integrated Screening Action model (I-SAM), the study has 8 objectives: 1) to explore barriers to early diagnosis of prostate cancer among Black men (45+) through focus groups (n = 12); 2) to co-design a culturally acceptable peer-led intervention to tackle barriers to early diagnosis of prostate cancer in Black men; 3) to train members of the community as 'peer-facilitators' (n = 8); 4) to deliver the intervention in each location, facilitated by peer-facilitators, with a purposive sample (n = 20) of Black men (45+); 5) to qualitatively evaluate the intervention through focus groups; 6) to refine the intervention based on qualitative feedback; 7) to pilot the refined intervention with another purposive sample (n = 40) through a cross-sectional survey pre- and post-intervention; 8) to qualitatively evaluate the refined intervention through focus groups to further refine the intervention.
Community-centred and culturally tailored interventions have potential to be effective in addressing barriers to early diagnosis of prostate cancer, and thus ultimately reduce morbidity and mortality rates through earlier diagnosis in Black communities.
Journal Article
Understanding patient barriers and facilitators to uptake of lung screening using low dose computed tomography: a mixed methods scoping review of the current literature
2022
Background
Targeted lung cancer screening is effective in reducing mortality by upwards of twenty percent. However, screening is not universally available and uptake is variable and socially patterned. Understanding screening behaviour is integral to designing a service that serves its population and promotes equitable uptake. We sought to review the literature to identify barriers and facilitators to screening to inform the development of a pilot lung screening study in Scotland.
Methods
We used Arksey and O’Malley’s scoping review methodology and PRISMA-ScR framework to identify relevant literature to meet the study aims. Qualitative, quantitative and mixed methods primary studies published between January 2000 and May 2021 were identified and reviewed by two reviewers for inclusion, using a list of search terms developed by the study team and adapted for chosen databases.
Results
Twenty-one articles met the final inclusion criteria. Articles were published between 2003 and 2021 and came from high income countries. Following data extraction and synthesis, findings were organised into four categories:
Awareness of lung screening
,
Enthusiasm for lung screening
,
Barriers to lung screening
, and
Facilitators or ways of promoting uptake of lung screening
. Awareness of lung screening was low while enthusiasm was high. Barriers to screening included fear of a cancer diagnosis, low perceived risk of lung cancer as well as practical barriers of cost, travel and time off work. Being health conscious, provider endorsement and seeking reassurance were all identified as facilitators of screening participation.
Conclusions
Understanding patient reported barriers and facilitators to lung screening can help inform the implementation of future lung screening pilots and national lung screening programmes.
Journal Article
Comparing uptake across breast, cervical and bowel screening at an individual level: a retrospective cohort study
2019
Background
We investigated demographic and clinical predictors of lower participation in bowel screening relative to breast and cervical screening.
Methods
Data linkage study of routinely collected clinical data from 430,591 women registered with general practices in the Greater Glasgow & Clyde Health Board. Participation in the screening programmes was measured by attendance at breast or cervical screening or the return of a bowel screening kit.
Results
72.6% of 159,993 women invited attended breast screening, 80.7% of 309,899 women invited attended cervical screening and 61.7% of 180,408 women invited completed bowel screening. Of the 68,324 women invited to participate in all three screening programmes during the study period, 52.1% participated in all three while 7.2% participated in none. Women who participated in breast (OR = 3.34 (3.21, 3.47),
p
< 0.001) or cervical (OR = 3.48 (3.32, 3.65),
p
< 0.001) were more likely to participate in bowel screening.
Conclusion
Participation in bowel screening was lower than breast or cervical for this population although the same demographic factors were associated with uptake, namely lower social deprivation, increasing age, low levels of comorbidity and prior non-malignant neoplasms. As women who complete breast and cervical are more likely to also complete bowel screening, interventions at these procedures to encourage bowel screening participation should be explored.
Journal Article
Barriers and facilitators to accessing healthcare for early diagnosis of prostate cancer for black men—a qualitative exploration in North-East England and Scotland
by
Nnyanzi, Lawrence Achilles
,
Murphy, Marie K.
,
Robb, Kathryn A.
in
Adult
,
African American market
,
Aged
2025
Introduction
Prostate cancer is the most commonly diagnosed cancer in men in the United Kingdom. There are substantial inequalities in prostate cancer, with Black African and Caribbean men at least twice as likely as White men to develop prostate cancer, and twice as likely to die from it. Black men need to be aware of their elevated risk, which can encourage help-seeking behaviour leading to early diagnosis. This study aimed to investigate barriers and facilitators to accessing healthcare for early diagnosis of prostate cancer for Black men.
Methods
Barriers and facilitators were explored through online focus groups with Black men (
n
= 13) from Scotland and North-East England, who formed the Public Involvement and Community Engagement group for a larger study. Purposive and snowball sampling was used. Focus groups were audio-recorded and transcribed verbatim. Data analysis was iterative. Framework analysis was used and data were mapped onto the Integrated Screening Action Model (I-SAM).
Results
Participants believed Black men lack prostate cancer knowledge. Additionally, prostate cancer communication needs to use language that Black men could identify with. Participants shared a lack of trust in healthcare providers and perspectives emerged resulting from negative healthcare experiences, including experiences of racism, as barriers to accessing healthcare for early prostate cancer diagnosis. Difficulties with accessing care, including navigating the healthcare system and making appointments, as well as cultural, social and religious factors, were reported as barriers to prostate cancer health checks. Discussing intimate and sensitive issues such as prostate cancer was perceived as difficult for Black men. The involvement of community and religious leaders, along with the collectivist characteristic of the community and the belief in staying healthy for the benefit of the family, were perceived as facilitators.
Conclusion
Barriers to accessing healthcare for early prostate cancer diagnosis are complex and multifaceted, requiring complex solutions. Asset-based, participatory, and culturally tailored interventions have the potential to be effective in addressing barriers, and thus ultimately reduce morbidity and mortality through earlier diagnosis of prostate cancer in Black communities.
Journal Article
Qualitative evaluation of a codesigned faith-based intervention for Muslim women in Scotland to encourage uptake of breast, colorectal and cervical cancer screening
by
Kotzur, Marie
,
Robb, Kathryn A.
,
Amiri, Rana
in
Adult
,
Cervical cancer
,
Colorectal Neoplasms - diagnosis
2022
ObjectivesThis pilot study aimed to evaluate the acceptability of a codesigned, culturally tailored, faith-based online intervention to increase uptake of breast, colorectal and cervical screening in Scottish Muslim women. The intervention was codesigned with Scottish Muslim women (n=10) and underpinned by the reframe, reprioritise and reform model and the behaviour change wheel.SettingThe study was conducted online, using Zoom, due to the COVID-19 pandemic.ParticipantsParticipants (n=18) taking part in the intervention and subsequently in its evaluation, were Muslim women residing in Scotland, recruited through purposive and snowball sampling from a mosque and community organisations. Participants were aged between 25 years and 54 years and of Asian and Arab ethnicity.DesignThe study’s codesigned intervention included (1) a peer-led discussion of barriers to screening, (2) a health education session led by a healthcare provider, (3) videos of Muslim women’s experiences of cancer or screening, and (4) a religious perspective on cancer screening delivered by a female religious scholar (alimah). The intervention was delivered twice online in March 2021, followed 1 week later by two focus groups, consisting of the same participants, respectively, to discuss participants’ experiences of the intervention. Focus group transcripts were analysed thematically.ResultsParticipants accepted the content and delivery of the intervention and were positive about their experience of the intervention. Participants reported their knowledge of screening had increased and shared positive views towards cancer screening. They valued the multidimensional delivery of the intervention, appreciated the faith-based perspective, and in particular liked the personal stories and input from a healthcare provider.ConclusionParticipatory and community-centred approaches can play an important role in tackling health inequalities in cancer and its screening. Despite limitations, the intervention showed potential and was positively received by participants. Feasibility testing is needed to investigate effectiveness on a larger scale in a full trial.
Journal Article
Probable COVID-19 infection is associated with subsequent poorer mental health and greater loneliness in the UK COVID-19 Mental Health and Wellbeing study
2022
The COVID-19 pandemic has been associated with psychological distress. In addition to physical effects including fatigue and cognitive impairment, contracting COVID-19 itself may also be related to subsequent negative mental health outcomes. The present study reports data from a longitudinal, national survey of the UK adult population investigating whether contracting suspected or confirmed COVID-19 at the early stages of the pandemic (March–May 2020) was associated with poorer mental health outcomes in May/June 2020, October/November 2020 and June/July 2021. A quota survey design and a sampling frame that permitted recruitment of a national sample (n = 3077) were utilised. Experience of contracting COVID-19 during the first UK lockdown was assessed along with levels of depression, anxiety, mental wellbeing and loneliness. Around 9% of participants reported contracting COVID-19 in March/May 2020 (waves 1–3) with just under 13% of the overall sample reporting COVID-19 at any one of the first three time points. Compared to those without probable COVID-19 infection, participants with probable COVID-19 had poorer mental health outcomes at follow-up with these effects lasting up to 13 months (e.g., May/June 2020:OR
depression
= 1.70,
p
< 0.001; OR
anxiety
= 1.61,
p
= 0.002; Oct/Nov 2020, OR
depression
= 1.82,
p
< 0.001; OR
anxiety
1.56,
p
= 0.013; June/July 2021, OR
depression
= 2.01,
p
< 0.001; OR
anxiety
= 1.67,
p
= 0.008). Having a pre-existing mental health condition was also associated with greater odds of having probable COVID-19 during the study (OR = 1.31,
p
= 0.016). The current study demonstrates that contracting probable COVID-19 at the early stage of the pandemic was related to long-lasting associations with mental health and the relationship between mental health status and probable COVID-19 is bidirectional.
Journal Article
How has physical distancing impacted on health and well-being during the COVID-19 pandemic? A Scottish longitudinal qualitative study
by
Kotzur, Marie
,
Robb, Kathryn A.
,
O’Connor, Rory C.
in
COVID-19
,
COVID-19 - epidemiology
,
COVID-19 - prevention & control
2022
ObjectivesThis study provides an in-depth understanding of the impact of physical distancing restrictions and other quarantining measures during the first 6 months of the COVID-19 pandemic on physical and mental health and well-being.DesignLongitudinal qualitative research using semistructured interviews at two time points (21 May to 10 June 2020 when the first restrictions were eased, and 2 to 26 August 2020 when many restrictions had been eased, but physical distancing measures remained) and framework analysis.SettingInterviews by telephone or video call in Scotland.ParticipantsThirty participants: 16 women, 93% reporting white ethnicity, 18+ years, 47% from deprived areas, 47% reported mental and/or physical health conditions.ResultsFour main themes described the impact of physical distancing restrictions on (1) health behaviours; (2) healthcare access; (3) physical health; and (4) mental health. Changes in impact over the two time points were compared. For example, health behaviours in May/June, such as reduced physical activity and increased calorie intake, appeared to improve by August. From May/June to August, an increasing number of participants expressed dissatisfaction with healthcare they received. Participants with existing physical health conditions reported continued negative impact of restrictions on their physical health. All participants reported some negative mental health impact, mostly anxiety. An increasing number reported mental health improvements in August, with those with mental health conditions or under 30 years reporting improvement most frequently.ConclusionsIn line with previous research, our participants felt able to return to prepandemic health habits. Our findings corroborate evidence of reduced preventive healthcare use and help-seeking behaviours. People with existing health conditions appear to be most vulnerable to negative mental and physical health impacts of physical distancing. These negative impacts and periods of unhealthy behaviours have potential long-term consequences, especially among already underserved groups. We recommend public health and policy strategies to mitigate long-term impacts of physical distancing.
Journal Article
A mixed-methods evaluation of a peer-led, co-produced, asset-based intervention for early diagnosis of prostate cancer for Black men: the PROCAN-B study
2025
ObjectiveTo pilot a culturally tailored, peer-led, co-produced asset-based intervention workshop to encourage early diagnosis of prostate cancer for Black men.DesignMixed-methods pilot study.SettingCommunity centres in the North-East of England and Scotland.ParticipantsThe intervention was delivered in November 2023 with Black African and Caribbean men (n=21), and again in February 2024 (n=41). Participants were highly educated and aged between 42 and 63 years. The intervention was qualitatively evaluated with 40 of the intervention participants.InterventionUnderpinned by the Integrated Screening Action Model (I-SAM), we co-produced a culturally tailored, peer-led 2-hour workshop consisting of multiple components, including small group discussions about barriers to accessing prostate cancer care, general practitioner (GP) health education, activities to facilitate effective communication with the GP and reception staff and videos with testimonials from survivors, women and religious leaders.Primary outcomesKnowledge, attitudes and intention to engage in prostate cancer testing were examined through a pre- and post-survey design. Intervention acceptability was qualitatively explored through focus groups.ResultsParticipants (n=41) reported that the workshop increased their confidence in engaging with healthcare providers to discuss prostate cancer testing (I-SAM component: psychological capability). Knowledge (I-SAM component: psychological capability: Z=4.939, p<0.001) and intention to undergo prostate cancer testing (I-SAM component: decided to act): Z=3.975, p<0.001) significantly increased post-intervention. Focus group data showed participants enjoyed the workshop and found it acceptable and informative. They particularly liked that the workshop was delivered exclusively by people who shared participants’ cultural and racial backgrounds. Culturally tailored and faith-based messages made the intervention relevant to participants and facilitated trust-building.ConclusionAsset-based strategies, focusing on community strengths, including faith-based health promotion, can promote health behaviours in a culturally and spiritually meaningful way. The PROCAN-B intervention effectively targeted components within the I-SAM and shows potential to increase prostate cancer awareness and build confidence to engage in behaviours conducive to early diagnosis. However, the sample was small, and more robust effectiveness testing is needed.
Journal Article