Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2014

Open Access 01-12-2014 | Research article

Cancer symptom awareness and barriers to medical help seeking in Scottish adolescents: a cross-sectional study

Authors: Gill Hubbard, Iona Macmillan, Anne Canny, Liz Forbat, Richard D Neal, Ronan E O’Carroll, Sally Haw, Richard G Kyle

Published in: BMC Public Health | Issue 1/2014

Login to get access

Abstract

Background

Initiatives to promote early diagnosis include raising public awareness of signs and symptoms of cancer and addressing barriers to seeking medical help about cancer. Awareness of signs and symptoms of cancer and emotional barriers, such as, fear, worry, and embarrassment strongly influence help seeking behaviour. Whether anxiety influences seeking medical help about cancer is not known. The purpose of this study about adolescents was to examine: 1) the relationship between contextual factors and awareness of signs and symptoms of cancer and barriers (including emotional barriers) to seeking medical help, and 2) associations between anxiety and endorsed barriers to seeking medical help. Interpretation of data is informed by the common sense model of the self-regulation of health and illness.

Methods

A cross-sectional study of 2,173 Scottish adolescents (age 12/13 years) using the Cancer Awareness Measure. Socio-demographic questions were also included. Descriptive statistics were calculated and two Poisson regression models were built to determine independent predictors of: 1) the number of cancer warning signs recognized, and; 2) number of barriers to help seeking endorsed.

Results

Analysis identified that knowing someone with cancer was a significant independent predictor of recognising more cancer warning signs whereas Black and Minority Ethnic status was a significant independent predictor of recognising fewer cancer warning signs. Emotional barriers were the most commonly endorsed, followed by family, service and practical barriers. Over two thirds of adolescents were ‘worried about what the doctor would find’ and over half were ‘scared’. Higher anxiety scores, knowing more cancer warning signs and female gender were significant independent predictors of barriers to help seeking.

Conclusion

Improving cancer awareness and help seeking behaviour during adolescence may contribute to early presentation. Contextual factors (for example, ethnicity, gender, knowing someone with cancer), and emotional dimensions (for example, anxiety, fear, worry) are critical components in help seeking behaviours. The role of emotional factors indicates that public health campaigns focused on awareness and help seeking may benefit from having a more emotional focus, for example, including references to feelings, such as, fears and worries.
Appendix
Available only for authorised users
Literature
1.
Wolfe I, Macfarlane A, Donkin A, Marmot M, Viner R: Why children die: deaths in infants, children and young people in the UK. Part A. 2014, London: Royal College of Paediatrics and Child Health and National Children’s Bureau
2.
3.
4.
Richards M: The National Awareness and Early Diagnosis Initiative in England: assembling the evidence. British J Cancer. 2009, 101 (Suppl 2): S1-S4.CrossRef
5.
6.
Department of Health: Cancer Reform Strategy. 2007, London: Department of Health
7.
8.
9.
Walter F, Webster A, Scott S, Emory J: The Andersen Model of Total Patient Delay: a systematic review of its application in cancer diagnosis. J Health Serv Res Policy. 2012, 17: 110-118. 10.1258/jhsrp.2011.010113.CrossRefPubMedPubMedCentral
10.
de Nooijer J, Lechner L, De Vries H: Help seeking behaviour for cancer symptoms: perceptions of patients and general practitioners. Psychooncology. 2001, 10: 469-478. 10.1002/pon.535.CrossRefPubMed
11.
Quaife SL, Forbes LJL, Ramirez AJ, Brain KE, Donnelly C, Simon AE, Wardle J: Recognition of cancer warning signs and anticipated delay in help seeking in a population sample of adults in the UK. Br J Cancer. 2013, 110 (1): 12-18.CrossRefPubMedPubMedCentral
12.
Chapple A, Zeibland S, McPherson A: Qualitative study of men’s perceptions of why treatment delays occur in the UK for those with testicular cancer. Br J Gen Pract. 2004, 54 (498): 25-32.PubMedPubMedCentral
13.
Smith LK, Pope C, Botha JL: Patients’ help seeking experiences and delay in cancer presentation: a qualitative synthesis. Lancet. 2005, 366 (9488): 825-831. 10.1016/S0140-6736(05)67030-4.CrossRefPubMed
14.
Robb K, Stubbings S, Ramirez AJ, Macleod U, Austoker J, Waller J, Hiom S, Wardle J: Public awareness of cancer in Britain: a population-based survey of adults. Br J Cancer. 2009, 101 (Supp 2): S18-S23.CrossRefPubMedPubMedCentral
15.
Kyle RG, Forbat L, Hubbard G: Cancer awareness among adolescents in Britain: a cross-sectional study. BMC Public Health. 2012, 12: 580-10.1186/1471-2458-12-580.CrossRefPubMedPubMedCentral
16.
Rouhani P, Parmet Y, Bessell AG, Peay T, Weiss A, Kirsner RS: Knowledge, attitudes and behaviors of elementary school students regarding sun exposure and skin cancer. Pediatr Dermatol. 2009, 26: 529-35. 10.1111/j.1525-1470.2009.00908.x.CrossRefPubMed
17.
Bish A, Ramirez A, Burgess C, Hunter M: Understanding why women delay in seeking help for breast cancer symptoms. J Psychosom Res. 2005, 58: 321-326. 10.1016/j.jpsychores.2004.10.007.CrossRefPubMed
18.
Andersen BL, Cacioppo JT, Roberts DC: Delay in seeking a cancer diagnosis: Delay stages and psychophysiological comparison processes. Br J Soc Psychol. 1995, 34 (Pt 1): 33-52.CrossRefPubMed
19.
Byles JE, Redman S, Hennrikus D, Sanson-fisher RW, Dickinson J: Delay in consulting a medical practitioner about rectal bleeding. J Epidemiol Community Health. 1992, 46: 241-244. 10.1136/jech.46.3.241.CrossRefPubMedPubMedCentral
20.
Forbes LJL, Simon AE, Warburton F, Boniface D, Brain KE, Dessaix A, Donnelly C, Haynes K, Hvidberg L, Lagerlund M, Lockwood G, Tishelman C, Vedsted P, Vigmostad MN, Ramirez AJ, Wardle J, The international Cancer Benchmarking Partnership Module 2 Working Group: Differences in cancer awareness and beliefs between Australia, Canada, Denmark, Norway, Sweden and the UK (the International Cancer Benchmarking Partnership): do they contribute differences in cancer survival. Br J Cancer. 2013, 108: 292-300. 10.1038/bjc.2012.542.CrossRefPubMedPubMedCentral
21.
Sheikh I, Ogden J: The role of knowledge and beliefs in help seeking behaviour for cancer: a quantitative and qualitative approach. Patient Educ Couns. 1998, 35: 35-42. 10.1016/S0738-3991(98)00081-0.CrossRefPubMed
22.
Leventhal H: Findings and theory in the study of fear communications. Advances in Experimental Social Psychology. Edited by: Berkowitz L. 1970, New York: Academic Press, 119-186.
23.
Cameron LD, Leventhal H, Love RR: Trait anxiety, symptom perceptions, and illness-related responses among women with breast cancer in remission during a tamoxifen clinical trial. Health Psychol. 1998, 17: 459-469.CrossRefPubMed
24.
Ristvedt SL, Trinkaus KM: Psychological factors related to delay in consultation for cancer symptoms. Psychooncology. 2005, 14 (5): 339-350. 10.1002/pon.850.CrossRefPubMedPubMedCentral
25.
Hunter S, Grunfeld EA, Ramirez AJ: Help seeking intentions for breast-cancer symptoms: a comparison of the self-regulation model and the theory of planned behaviour. Br J Health Psychol. 2003, 8: 319-333. 10.1348/135910703322370888.CrossRefPubMed
26.
de Nooijer J, Lechner L, de Vries H: Social psychological correlates of paying attention to cancer symptoms and seeking medical help. Soc Sci and Med. 2003, 56 (5): 915-920. 10.1016/S0277-9536(02)00098-9.CrossRef
27.
O’Mahony M, Hegarty J: Help Seeking for Cancer Symptoms: A Review of the Literature. Oncol Nurs Forum. 2009, 36 (4): E178-E184. 10.1188/09.ONF.E178-E184.CrossRefPubMed
28.
Wyke S, Adamson J, Dixon D, Hunt K: Consultation and illness behaviour in response to symptoms: A comparison of models from different disciplinary frameworks and suggestions for future research directions. Soc Sci & Med. 2013, 86: 79-87.CrossRef
29.
Hagger MS, Orbell S: A meta-analytic review of the common-sense model of illness representations. Psychol Health. 2003, 18 (2): 141-184. 10.1080/088704403100081321.CrossRef
30.
Leventhal H, Leventhal E, Contrada RJ: Self-regulation, health and behaviour: a perceptual cognitive approach. Psychol Health. 1998, 13: 717-734. 10.1080/08870449808407425.CrossRef
31.
Leventhal H, Brissette I, Leventhal E: The Common-sense model of self-regulation of health and illness. The Self-regulation of Health and Illness Behaviour. Edited by: Cameron LD LD, Leventhal H. 2003, London and New York: Routledge, 42-65.
32.
Wearden A, Peters S: Therapeutic techniques for interventions based on Leventhal’s common sense model. B J Health Psychol. 2008, 13: 189-193. 10.1348/135910708X295613.CrossRef
33.
Gross JJ: Emotion and emotion regulation. Handbook of Personality: Theory and Research. Edited by: Pervin LA. 1999, New York: Guilford Press, 525-552.
34.
Gross JJ: Ed. Handbook of emotion regulation. 2007, New York: Guilford Press
35.
Cameron LD, Jago L: Emotion regulation interventions: A common-sense model approach. B J Health Psychol. 2008, 13: 215-221. 10.1348/135910708X288800.CrossRef
36.
Leventhal H, Meyer D, Nerenz D: The common- sense representation of illness danger. Medical Psychology. Edited by: Rachman S. 1980, New York: Pergamon Press, 7-30. Vol 2
37.
Leventhal H, Nerenz DR, Steele DJ, Baum A, Taylor SE, Singer JE: Illness representations and coping with health threats. Handbook of psychology and health. Vol IV: Social psychological aspects of health. 1984, Hillsdale NJ: Erlbaum, 219-252.
38.
Kyle RG, Macmillan I, Rauchaus P, O’Carroll R, Neal RD, Forbat L, Haw S, Hubbard G: Adolescent Cancer Education (ACE) to increase adolescent and parent cancer awareness and communication: study protocol for a cluster randomized controlled trial. Trials. 2013, 14: 286-10.1186/1745-6215-14-286.CrossRefPubMedPubMedCentral
39.
Economic and Social Research Council: ESRC Framework for Research Ethics. 2010, Swindon: ESRC
40.
CR-UK: Cancer Awareness Measure Toolkit V2.1. 2011, London: Cancer Research UK
41.
Stubbings S, Robb K, Waller J, Ramirez A, Austoker J, Macleod U, Hiom S, Wardle J: Development of a measurement tool to assess public awareness of cancer. Br J Cancer. 2009, 101: S13-S17.CrossRefPubMedPubMedCentral
42.
Zigmond AS, Snaith RP: The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983, 67: 361-370. 10.1111/j.1600-0447.1983.tb09716.x.CrossRefPubMed
43.
White D, Leach C, Sims R, Atkinson M, Cottrell D: Validation of the Hospital Anxiety and Depression Scale for use with adolescents. Br J Psychiatry. 1999, 175: 452-454. 10.1192/bjp.175.5.452.CrossRefPubMed
44.
45.
Klein J, Berry C, Felice M: The development of a testicular self- examination instructional booklet for adolescents. J Adolesc Health Care. 1990, 11: 235-9. 10.1016/0197-0070(90)90355-6.CrossRefPubMed
46.
Lechner L, Oenema A, de Nooijer J: Testicular self-examination (TSE) among Dutch young men aged 15–19: determinants of the intention to practice TSE. Health Ed Res, Theory Pract. 2002, 17: 73-84. 10.1093/her/17.1.73.CrossRef
47.
Smith S, Case L, Fern L, Waterhouse K, Vaughan K, McCabe M: Poor cancer awareness in young people in Greater Manchester advocates the need for age specific interventions to raise awareness. 2011, Liverpool: NCRI Cancer Conference, 6–9 November
48.
Ward K, Vander M, Cocke Read M, Sell M, Beech B: Testicular cancer awareness and self-examination among adolescent males in community-based youth organisations. Prev Med. 2005, 41: 386-398. 10.1016/j.ypmed.2005.02.003.CrossRefPubMed
49.
Forbes LJL, Atkins L, Thurnham A, Layburn J, Haste F, Ramirez AJ: Breast cancer awareness and barriers to symptomatic presentation among women from different ethnic groups in East London. British J Cancer. 2011, 105: 1474-1479. 10.1038/bjc.2011.406.CrossRef
50.
Waller J, Robb K, Stubbings S, Ramirez A, Macleod U, Austoker J, Hiom S, Wardle J: Awareness of cancer symptoms and anticipated help seeking among ethnic minority groups in England. British J Cancer. 2009, 101: S24-S30.CrossRef
51.
Agency NPS: Delayed Diagnosis of cancer: Thematic review. 2010, London: Royal College of General Practitioners
52.
Gulliver A, Griffiths KM, Christensen H: Perceived barriers and facilitators to mental health help seeking in young people: A systematic review. BMC Psychiatry. 2010, 10: 113-10.1186/1471-244X-10-113.CrossRefPubMedPubMedCentral
53.
Antonovsky A, Hartman H: Delay in the detection of cancer: A review of the literature. Health Educ Monogr. 1974, 2: 98-127. 10.1177/109019817400200202.CrossRef
54.
Cloninger CR, Przybeck TR, Svrakic DM, Wetzel RD: The Temperament and Character Inventory (TCI): A Guide to its Development and Use. 1994, St Louis MO: Center for Psychobiology of Personality, Washington University
55.
Spielberger CD, Gorsuch RL, Lushene RE, Vagg PR, Jacobs GA: STAI Manual for the State-Trait Anxiety Inventory. 1970, Palo Alto, CA: Consulting Psychologists Press
56.
Watson D, Pennebaker JW: Health complaints, stress, and distress: Exploring the central role of negative affectivity. Psychol Rev. 1989, 96 (2): 234-254.CrossRefPubMed
57.
Lee J, Friesen BJ, Walker JS, Colman D, Donlan WE: Youth’s help seeking intentions for ADHD and depression: Findings from a national survey. J Child Fam Stud. 2014, 23 (1): 144-156. 10.1007/s10826-012-9700-3.CrossRef
58.
Green H, McGinty A, Meltzer H, Ford T, Goodman R: Mental Health of Children And Young People In Great Britain, 2004. 2005, Basingstoke: Palgrave MacmillanCrossRef
59.
60.
Windschitl PD, Wells GL: Measuring psychological uncertainty: Verbal versus numeric methods. J Exp Psychol Appl. 1996, 2: 343-364.CrossRef
61.
Slovic P, Peters E: Risk perception and affect. Curr Dir Psychol Sci. 2006, 15: 322-325. 10.1111/j.1467-8721.2006.00461.x.CrossRef
62.
Epstein S, Lipson A, Holstein C, Huh E: Irrational reactions to negative outcomes: Evidence for two conceptual systems. J Pers Soc Psychol. 1992, 62: 328-339.CrossRefPubMed
63.
Slovic P, Peters E, Finucane ML, MacGregor DG: Affect, risk, and decision making. Health Psychol. 2005, 24: S35-S40.CrossRefPubMed
64.
Janssen E, van Osch L, Lechner L, Candel M, de Vries H: Thinking versus feeling: Differentiating between cognitive and affective components of perceived cancer risk. Psychol Health. 2012, 27 (7): 767-783. 10.1080/08870446.2011.580846.CrossRefPubMed
65.
Janssen E, van Osch L, de Vries H, Lechner L: Measuring risk perceptions of skin cancer: Reliability and validity of different operationalizations. B J Health Pscyhol. 2011, 16: 92-112. 10.1348/135910710X514120.CrossRef
66.
Dillard AJ, Ferrer RA, Ubel PA, Fagerlin A: Risk perception measures’ associations with behavior intentions, affect, and cognition following colon cancer screening messages. Health Psychol. 2012, 3: 106-113.CrossRef
67.
Lawton R, Conner M, McEachan R: Desire or reason: Predicting health behaviors from affective and cognitive attitudes. Health Psychol. 2009, 28: 56-65.CrossRefPubMed
68.
McCartney G, Collins C, Walsh D, Batty D: Accounting for Scotland’s Excess Mortality: Towards a Synthesis. 2011, Glasgow: Glasgow Centre for Population Health
69.
Gibson F, Pearce S, Eden T, Glaser A, Hooker L, Whelan J, Kelly D: Young people describe their prediagnosis cancer experience. Psychooncology. 2013, 22 (11): 2585-92. 10.1002/pon.3325.CrossRefPubMed
70.
Chen E, Matthews KA, Boyce WT: Socioeconomic differences in children’s health: how and why do these relationships change with age?. Psychol Bull. 2002, 128: 295-329.CrossRefPubMed
71.
World Health Organisation: Strengthening the health sector response to adolescent health and development. 2009, Geneva: World Health Organisation, 2-
Metadata
Title
Cancer symptom awareness and barriers to medical help seeking in Scottish adolescents: a cross-sectional study
Authors
Gill Hubbard
Iona Macmillan
Anne Canny
Liz Forbat
Richard D Neal
Ronan E O’Carroll
Sally Haw
Richard G Kyle
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2014
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-14-1117

Other articles of this Issue 1/2014

BMC Public Health 1/2014 Go to the issue

Research article

Association between physical activity, multimorbidity, self-rated health and functional limitation in the Spanish population

Research article

Evaluation of the Mercy weight estimation method in Ouelessebougou, Mali

Research article

Acceptability of self-collection sampling for HPV-DNA testing in low-resource settings: a mixed methods approach

Study protocol

Health responses to a new high-voltage power line route: design of a quasi-experimental prospective field study in the Netherlands

Research article

Effectiveness of an improved road safety policy in Ethiopia: an interrupted time series study

Research article

Assessment of psychometric properties of the Korean SF-12 v2 in the general population