Perceptions of Bowel Cancer Screening Among Culturally and Linguistically Diverse (CALD) Men Living in the Nepean Blue Mountains Region

In 2017 bowel cancer was the second most diagnosed cancer in Australia and the second highest cause of cancer mortality. Bowel cancer screening (BCS), in the form of the faecal occult blood test (FOBT) is freely provided for eligible populations in Australia (ages 50-74) by the National Bowel Cancer Screening Program (NBCSP) and has proven effective in the early detection and prevention of cancer. The NBCSP is crucial to reducing mortality and improving health outcomes, however despite the known benefits of screening, participation remains sub-optimal. In New South Wales (NSW), screening rates are substantially below national averages and targets, ranking 7th of 8 states. Participation among men and culturally and linguistically diverse (CALD) populations, is particularly low. For instance, NBCSP participation in Australia has been found to be significantly lower among men from Middle Eastern, Continental Europe and Asian backgrounds compared to Australian-born men3,7. NBCSP participation in the Nepean Blue Mountains (NBM) region is similarly reported to be low, especially among men. Participation rates were lower in NBM (33.3%) compared to NSW (35.1%), ranking NBM 7th out of 10 NSW PHN regions. As a region with a high CALD population, investigating and understanding the barriers and facilitators experienced by CALD men living in the NBM region is imperative to improving NBCSP participation rates. The aim of this study was to qualitatively explore the bowel cancer screening behaviours of men from different CALD groups in the Nepean Blue Mountains (NBM) region, with the aim of identifying barriers and facilitators to participation in the NBCSP. Findings identified a number of underlying masculine beliefs, including traditional masculine traits of risk-taking, self-reliance, heterosexual self-presentation, primacy of work, control and responsibility. General barriers to participation in the NBCSP included sociocultural factors that affected access to healthcare, such as language barriers, transportation (having to visit their GP for assistance with instructions on how to do the test) as well as low education and health literacy levels. Other barriers reported were family crises, illness, and work commitments, which appeared to contribute to a lack of time to participate in the NBCSP or shifted the priority level of screening. There is an overall need to make preventative health, including bowel cancer screening a higher priority among the culturally and linguistically diverse men of the NBM region. This may be achieved through increased engagement with men through culturally specific settings and through men's groups. Policy makers should also be provided with evidence-based research such as this report to put these issues, as well as men's health in general, more highly on their agendas. Collaboration with health care professionals in primary care is also needed to ensure the same consistent messages around bowel cancer screening are being delivered and are available for all CALD men in the NBM region. Findings of the current report could also be used the help Multicultural health promotion teams develop and produce tools to reach all CALD men including those who do not interact with primary care.