Background: Cancers are a leading cause of death worldwide. People with mental illness are 30 % more likely to die\nfrom cancer than the general population. One reason for this may be low uptake of nationally offered cancer screening\ntests by people with mental illness. We aimed to identify barriers and facilitators for breast, cervical and bowel cancer\nscreening uptake by people with mental illness in order to inform interventions to promote equal access.\nMethods: The interview study was conducted in both urban and rural settings. The study was informed by the\nTheoretical Domains Framework, using framework analysis and triangulation across participant groups. Participants\nincluded 45 mental health service users (service users) eligible for cancer screening, 29 mental health professionals and\n11 professionals involved in cancer screening.\nResults: Themes emerging from the data that affected uptake included knowledge of screening programmes by both\nservice users and healthcare providers; knowledge of, and attitudes towards, mental illness; health service-delivery\nfactors; service users� beliefs and concerns about cancer screening, and practical issues. These are relevant to different\nstages of the screening process. Service users do not receive invitations to screening or cancer testing kits if they are\nadmitted to hospital. They are not routinely invited for screening if they are not registered with a general practitioner\n(GP). Lack of integrated care means that mental health staff do not know if someone is overdue for a test and cancer\nscreening is often not considered during health promotion. Barriers including information processing problems, the\nextent to which the screening process aggravates symptoms, poor staff client relationships and travel difficulties vary\nbetween individuals. Screening professionals are motivated to help, but may lack time or training to manage mental\nhealth needs. Reactive measures are available, but service users must request help which they may find difficult.\nConclusions: There are specific barriers to cancer screening uptake for mental health service users that prevent\nequality of care. Interventions that can be personalised are needed at individual, policy and service-delivery levels.\nPrimary and secondary care staff and policy-makers should work together to develop an integrated approach to\ncancer screening in this population.
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