Patients’ Perceived Barriers to Care May Influence Disparities within Cancer Centers

A study published in Cancer Causes & Control evaluated racial differences in individual- and geographic-level factors among patients in the catchment area, or area from which patients are drawn, of a major cancer center.

“Racial and ethnic minorities experience well-documented disparities across the cancer trajectory. However, factors underlying these disparities may vary regionally,” wrote the study authors. “The Health Belief Model (HBM) was developed to explain and predict health-related prevention and early detection behaviors, particularly uptake of health services.”

HBM was developed by the U.S. Public Health Service in the 1950s and posits that six constructs are associated with health behavior: risk susceptibility, risk severity, benefits to action, barriers to action, self-efficacy, and cues to action.

The investigators sought to “use the HBM to guide an exploration of factors that contribute to racial/ethnic health disparities in the catchment area of a large National Cancer Institute-designated Comprehensive Cancer Center in the Southeastern United States.”

To conduct this study, they evaluated data on the Community Health Needs Assessment from a single cancer center. The Community Health Needs Assessment was a triennial survey which samples adults from the cancer center’s 15 county–wide catchment area. In total, 1,189 respondents answered the survey. The racial makeup of the respondents was: non-Hispanic White (n = 887); Non-Hispanic Black (n = 78); Hispanic/Latinx (n = 185); and “other” race/ethnicity (n = 39). Racial differences were evaluated for in key HBM variables, including demographic/psychosocial information, perceived benefits/barriers to preventive health behaviors, risk perception, and health behavior outcomes.

The researchers found significant differences between races/ethnicities in information seeking behaviors, risk perception, community attributes, discrimination, and distress, even after controlling for annual household income, relationship status, and age. Black and Hispanic/Latinx patients, and patients who identified as “other” races/ethnicities, reported worse community attributes compared to White patients. These patients also reported higher levels of daily discrimination, lower health literacy, less confidence in their ability to access health information, and lower perceptions of cancer risk.

In conclusion, the authors wrote, “This analysis presents a better understanding of how HBM factors may influence health disparities in the cancer center’s catchment area. Results describe the needs of community members from racial and ethnic minority groups, which will inform future research, education, outreach, and service activities.