• Aisha K Lofters, Natalie A Baker, Andree Schuler, Allison Rau, Alison Baxter, Nancy N Baxter, Edward Kucharski, Fok-Han Leung, Karen Weyman, and Tara Kiran.
• MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. Aisha.lofters@utoronto.ca.
• J Gen Intern Med. 2020 Jan 1; 35 (1): 255260255-260.

BackgroundIn 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.ObjectiveTo use co-design to adapt our current strategies and create new strategies to improve cancer screening uptake for patients living with low income.DesignAn exploratory, qualitative study in two phases: interviews and focus groups.ParticipantsFor 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.ApproachTo 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 ResultsFear 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.ConclusionsWe 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.

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