Shared and Unshared Barriers to Cancer Symptom Management Among Urban and Rural American Indians

Tracy Line Itty · Felicia Schanche Hodge · Fernando Martínez

32 citations0/0 files storedThe Journal of Rural Health

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Indigenous Health, Education, and Rights Cancer survivorship and care Global Cancer Incidence and Screening

Abstract

PURPOSE: Before the end of the 20th century, American Indians (AIs) primarily resided in nonmetropolitan areas. Shifting demographic trends have led to a majority of AIs now living in urban areas, leading to new health care barriers for AIs. AIs experience the poorest survival from all cancers combined compared to all other racial groups. Identifying and classifying barriers to cancer care may facilitate supportive interventions and programs to improve access and treatment. METHODS: A 5-year cancer symptom management project targeted AIs in the Southwest. The first phase of the randomized clinical trial consisted of 13 focus groups (N = 126) of cancer patients/survivors and their caregivers. Discussions explored existing and perceived barriers and facilitators to cancer symptom management and cancer treatment. FINDINGS: Significant barriers to cancer-related care were found among urban AIs, as compared to their rural counterparts. Barriers were classified within 4 subgroups: (1) structural, (2) physical, (3) supportive, or (4) cultural. Urban AIs reported barriers that are both structural and physical (inadequate access to care and public transportation) and supportive (lack of support, resources and technology, and less access to traditional healing). Rural participants reported communication and culture barriers (language differences, illness beliefs, and low levels of cancer care knowledge), as well as unique structural, physical, and supportive barriers. CONCLUSION: It is important to identify and understand culturally and geographically influenced barriers to cancer treatment and symptom management. We provide recommendations for strategies to reduce health disparities for AIs that are appropriate to their region of residence and barrier type.

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References

2006Constructing grounded theory : a practical guide through qualitative analysis 2006Constructing Grounded Theory. A Practical Guide Through Qualitative Analysis 2004The Importance of Place of Residence: Examining Health in Rural and Nonrural Areas 2006A Nationwide Population-Based Study Identifying Health Disparities Between American Indians/Alaska Natives and the General Populations Living in Select Urban Counties 2006Barriers to Care Among American Indians in Public Health Care Programs 2002Demographic Trends in the Twentieth Century. Census 2000 Special Reports.1986Roots of the Native American Urban Experience: Relocation Policy in the 1950s

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