背景:美国的黑色素瘤死亡率在老年男性中最高,社会经济地位较低的个人(SES),和有色人种。为了更好地理解这些不平等,在北加州和南加州进行了一项定性探索性研究,以产生有关障碍和促进意识的知识,预防,以及生活在城市和半农村地区的低SES拉丁裔和非拉丁裔白人(NLW)个体中黑色素瘤的早期检测。
方法:进行了19个焦点小组(N=176名成年参与者),按种族/族裔分层(拉丁裔,低收入NLW),地理(半农村,城市),语言(英语和西班牙语)。进行了归纳和演绎主题分析,研究结果是使用社会生态模型框架组织的:个体,人际关系,社区,和卫生系统/政策水平。
结果:四个社会生态主题描述了关键因素如何影响知识,感知风险,预防行为,和黑色素瘤筛查。个体层面的研究结果表明,许多参与者对黑色素瘤并不熟悉,但他们愿意通过可信的来源学习。棕色或深色肤色被认为与皮肤癌风险较低有关。人际交往,社会关系是皮肤癌预防实践的重要影响因素。然而,对于几个拉丁裔和半农村的参与者来说,有关黑色素瘤预防的对话未与家人和同龄人进行.在社区层面,半农村参与者报告说,距离较远或缺乏前往诊所的交通是获得皮肤科护理的挑战.医疗保健系统的障碍包括皮肤科就诊和获得转诊的额外医疗保健费用的负担。
结论:不同因素影响认知水平,信仰,以及与知识相关的行为,预防,以及在低收入的拉丁裔和NLW个人以及半农村地区早期发现黑色素瘤。结果对健康教育干预有启示意义。以个人为目标的导航策略,家庭,和卫生保健机构可以促进这些社区中黑色素瘤的预防和早期发现。
Melanoma mortality rates in the US are highest among older men, individuals of lower socioeconomic status (SES), and people of color. To better understand these inequities, a qualitative exploratory study was conducted in Northern and Southern California to generate knowledge about barriers and facilitators of awareness, prevention, and early detection of melanoma in lower SES Latinx and non-Latinx White (NLW) individuals living in urban and semi-rural areas.
Nineteen focus groups were conducted (N = 176 adult participants), stratified by race/ethnicity (Latinx, low-income NLW), geography (semi-rural, urban), and language (English and Spanish). Inductive and deductive thematic analysis was conducted, and the findings were organized using the socioecological model framework: individual, interpersonal, community, and health system/policy levels.
Four socioecological themes describe how key factors affect knowledge, perceived risk, preventive behaviors, and melanoma screening. Individual level findings revealed that many participants were not familiar with melanoma, yet were willing to learn through trusted sources. Having brown or darker skin tone was perceived as being associated with lower risk for skin cancer. Interpersonally, social relationships were important influences for skin cancer prevention practice. However, for several Latinx and semi-rural participants, conversations about melanoma prevention did not occur with family and peers. At the community level, semi-rural participants reported distance or lack of transportation to a clinic as challenges for accessing dermatology care. Healthcare systems barriers included burdens of additional healthcare costs for dermatology visits and obtaining referral.
Varying factors influence the awareness levels, beliefs, and behaviors associated with knowledge, prevention, and early detection of melanoma among low-income Latinx and NLW individuals and in semi-rural areas. Results have implications for health education interventions. Navigation strategies that target individuals, families, and health care settings can promote improved prevention and early detection of melanoma in these communities.