Barriers and facilitators to the utilization of cancer screening services in two Arctic Indigenous communities in Canada

BACKGROUND: Indigenous communities in Canada have high age-standardized rates of cancer mortality. Remote communities in Canada's northern territories have a high proportion of Indigenous residents and disproportionately low utilization rates of screening services for breast, cervical, and colorectal cancers, which could contribute to delayed cancer diagnosis and less favourable clinical outcomes. Knowledge is limited regarding the under-utilization of cancer screening services. OBJECTIVE: This study identified factors contributing to the underutilization of breast, cervical, and colorectal cancer screening services and documented suggestions to promote utilization in remote Indigenous communities in Northwest Territories, Canada. METHODS: This qualitative study consisted of four sessions of sharing circles and two one-on-one interviews with nine healthcare professionals, eight community members including Elders, and five community leadership from two Northwest Territories communities. Data were transcribed verbatim and coded and analyzed using NVivo-10. The constant comparative method determined emergent themes. RESULTS: Data identified four themes of factors influencing the utilization of cancer screening services (socio-environmental, socio-cultural, socio-political, and personal themes), covering limited resources, limited cultural considerations, the legacy of colonial practices, and fear. Five themes regarding suggested approaches to encourage utilization were community outreach, collaboration, sustainability, cultural safety, and support for healthcare professionals. CONCLUSIONS: Factors identified to affect cancer screening service utilization and suggested approaches to improve the utilization are supported by other studies and initiatives in the region highlighting the relevance and feasibility of the findings. The findings could further inform community-based interventions for improving the utilization of cancer screening and support services in remote Indigenous communities.