Table 1 Concept mapping: community planning to reduce inequities in cancer screening

14

Fear of emotional or physical discomfort about tests (e.g. pain, invasiveness, embarrassment or reluctance to handle feces)

42

Fear of the side effects of treatment (e.g. Loss of hair, loss of weight, pain, etc.)

45

Fear of going to the test alone

43

Belief about lack of confidentiality

1

Fear of starting a discussion about cancer or cancer screening with their physician

41

Fear that cancer will be detected (i.e. Stigma, neglect by family)

9

Fear about going to hospital

13

Female patient is not able to access cancer screening unless her partner approves

12

Religious belief about modesty

24

Lack of family and friends experienced with cancer screening to endorse participation

44

Females and their health are worthless in some families

11

Patient is concerned about cost associated with specialized tests

28

Patient has difficulty accessing transportation, including cost

8

Patient experiences loss of time and wages to see the primary care provider

15

Limited knowledge about cancer screening tests

17

Limited accurate knowledge about cancer and risk factors

19

Limited knowledge about how to access tests

16

Limited knowledge about the success of cancer treatment

18

Limited knowledge about the Canadian health care system

20

Limited knowledge about using the health system when not sick

7

Patient does not prioritize cancer screening

35

Health system does not respect or accommodate the culture and traditional notions of health care among South Asians

31

Not enough primary care providers and technicians from South Asian cultures or who speak South Asian languages

34

Education programs do not offer materials that are well translated and culturally appropriate

32

Not enough female primary care providers

22

Primary care provider does not emphasize the need for cancer screening

5

Primary care provider does not equally emphasize the need for mammograms, Pap tests, and fecal occult blood tests

2

Primary care provider perceives a lower risk of cancer among South Asians

4

Primary care provider is unaware of guidelines for cancer screening

3

Primary care provider is unaware of cancer screening programs

10

Primary care provider lacks regard for patients’ personal choice about whether cancer screening should be completed

26

Primary care provider does not have financial incentive to ensure cancer screening is completed

25

Do not provide messages through multiple mediums accessed by South Asians (e.g. Newspaper, television, etc.)

33

Do not offer materials that are easy to understand (e.g. Use pictures to convey message, low reading level)

36

Do not offer endorsements from credible sources (e.g. places of worship, schools, South Asian cancer survivors)

39

Education programs sometimes deliver inconsistent messages

40

Not enough partnerships between public health departments and primary care providers to promote cancer screening

23

The health system does not have automated reminders to prompt primary care providers to talk with patients about cancer screening

21

The health system does not provide personal reminders from a credible authority (e.g. Ministry of health)

27

Patient needs to access tests by going through a physician

30

The region of Peel does not have enough test facilities in convenient locations

37

Patient has limited time to talk about cancer screening with the primary care provider

29

Patient experiences delays in getting an appointment (e.g. Long wait, inconvenient times)

38

The health system sometimes discontinues successful cancer screening programs

6

The region of Peel does not have enough primary care providers