abstract: 'Background In our primary care organization, we have observed income

  gradients in cancer screening for our patients despite outreach. We

  hypothesized that outreach strategies could be improved upon to be more

  compelling for our patients living with low income. Objective To use

  co-design to adapt our current strategies and create new strategies to

  improve cancer screening uptake for patients living with low income.

  Design An exploratory, qualitative study in two phases: interviews and

  focus groups. Participants For interviews, we recruited 25 patient

  participants who were or had been overdue for cancer screening and had

  been identified by their provider as potentially living with low income.

  For subsequent focus groups, we recruited 14 patient participants, 11 of

  whom had participated in Phase I interviews. Approach To analyse written

  transcripts, we took an iterative, inductive approach using content

  analysis and drawing on best practices in Grounded Theory methodology.

  Emergent themes were expanded and clarified to create a derived model of

  possible strategies to improve the experience of cancer screening and

  encourage screening uptake for patients living with low income. Key

  Results Fear and competing priorities were two key barriers to cancer

  screening identified by patients. Patients believed that a warm and

  encouraging outreach approach would work best to increase cancer

  screening participation. Phone calls and group education were

  specifically suggested as potentially promising methods. However, these

  views were not universal; for example, women were more likely to be in

  favour of group education. Conclusions We used input from patients

  living with low income to co-design a new approach to cancer screening

  in our primary care organization, an approach that could be broadly

  applicable to other contexts and settings. We learned from our patients

  that a multi-modal strategy will likely be best to maximize screening

  uptake.'
affiliation: 'Lofters, AK (Corresponding Author), St Michaels Hosp, Li Ka Shing Knowledge
  Inst, MAP Ctr Urban Hlth Solut, 30 Bond St, Toronto, ON M5B 1W8, Canada.

  Lofters, Aisha K.; Schuler, Andree; Baxter, Alison; Kiran, Tara, St Michaels Hosp,
  Li Ka Shing Knowledge Inst, MAP Ctr Urban Hlth Solut, 30 Bond St, Toronto, ON M5B
  1W8, Canada.

  Lofters, Aisha K.; Schuler, Andree; Leung, Fok-Han; Weyman, Karen; Kiran, Tara,
  St Michaels Hosp, Dept Family \& Community Med, Toronto, ON, Canada.

  Lofters, Aisha K.; Leung, Fok-Han; Weyman, Karen; Kiran, Tara, Univ Toronto, Dept
  Family \& Community Med, Toronto, ON, Canada.

  Lofters, Aisha K.; Baxter, Nancy N.; Kiran, Tara, ICES, Toronto, ON, Canada.

  Lofters, Aisha K.; Baker, Natalie A.; Baxter, Nancy N., Dalla Lana Sch Publ Hlth,
  Toronto, ON, Canada.

  Lofters, Aisha K., Womens Coll Hosp, Toronto, ON, Canada.

  Baker, Natalie A.; Rau, Allison, St Michaels Hosp, Li Ka Shing Knowledge Inst, Appl
  Hlth Res Ctr, Toronto, ON, Canada.

  Baxter, Nancy N., St Michaels Hosp, Li Ka Shing Knowledge Inst, Dept Surg, Toronto,
  ON, Canada.

  Kucharski, Edward, Canc Care Ontario, Toronto, ON, Canada.

  Kiran, Tara, Hlth Qual Ontario, Toronto, ON, Canada.

  Kiran, Tara, Inst Hlth Policy Management \& Evaluat, Toronto, ON, Canada.'
author: Lofters, Aisha K. and Baker, Natalie A. and Schuler, Andree and Rau, Allison
  and Baxter, Alison and Baxter, Nancy N. and Kucharski, Edward and Leung, Fok-Han
  and Weyman, Karen and Kiran, Tara
author-email: Aisha.lofters@utoronto.ca
author_list:
- family: Lofters
  given: Aisha K.
- family: Baker
  given: Natalie A.
- family: Schuler
  given: Andree
- family: Rau
  given: Allison
- family: Baxter
  given: Alison
- family: Baxter
  given: Nancy N.
- family: Kucharski
  given: Edward
- family: Leung
  given: Fok-Han
- family: Weyman
  given: Karen
- family: Kiran
  given: Tara
da: '2023-09-28'
doi: 10.1007/s11606-019-05400-0
earlyaccessdate: OCT 2019
eissn: 1525-1497
files: []
issn: 0884-8734
journal: JOURNAL OF GENERAL INTERNAL MEDICINE
keywords-plus: SERVICES; ONTARIO; CANADA; BREAST
language: English
month: JAN
number: '1'
number-of-cited-references: '36'
orcid-numbers: 'Leung, Fok-Han/0000-0001-8886-3625

  Baxter, Nancy/0000-0003-4793-4620'
pages: 255-260
papis_id: daab0c9ee075ae51b36edef8e91b7642
ref: Lofters2020teacookies
researcherid-numbers: Baxter, Nancy/E-7020-2015
times-cited: '4'
title: 'A ``Tea and Cookies″ Approach: Co-designing Cancer Screening Interventions
  with Patients Living with Low Income'
type: Article
unique-id: WOS:000491863200015
usage-count-last-180-days: '0'
usage-count-since-2013: '10'
volume: '35'
web-of-science-categories: Health Care Sciences \& Services; Medicine, General \&
  Internal
year: '2020'