Uptake of AAA screening in men from different -under-served groups: Preferences, enablers and barriers

Available to UK applicants only

Supervisor: Professor Matt Bown m.bown@le.ac.uk

Project:

The NHS invites men to have screening for abdominal aortic aneurysm (AAA) when they are 65. Detecting AAA early through screening has been shown to reduce the risks of men dying from AAA by half. Women rarely get AAAs and are not invited for screening.

AAA is less common in people with an African-Caribbean background and very rare in Asian people, being most common in people with white European ancestry. It is not clear whether this is because there have traditionally been differences in smoking rates -smoking is the main risk factor for AAA- between these populations, or if there are other factors such as genetic differences that protect black and Asian people from AAA.

Attendance for AAA screening is very good, with 8 out of 10 men who are invited attending for screening. However, the uptake of this screening depends on socio-economic factors; it is lower in areas of higher deprivation which is precisely where people are at the highest risk of having an AAA. This is because smoking rates and other risk factors for AAA are highest in these areas. This means those most likely to have an AAA are the least likely to attend for screening. This adds to existing social inequalities and makes screening less effective.

Whilst attendance for AAA screening has been shown to be associated with socio-economic status, it is not clear how attendance relates to ethnicity and stigma. It is well established that uptake of other adult screening programmes is different in ethically-minoritised communities, but there is very little data for AAA screening. In addition, there is no evidence on uptake of AAA screening in men from stigmatised groups such as homeless and prisoners.

The first part of the PhD will be to search through published literature on AAA and other adult screening programmes to determine how strongly ethnicity is linked to attendance for screening. This will focus on data from the UK where screening is provided free at the point of use by the NHS, but compare this to international data where other screening models exist. If available, new data from the UK AAA screening programme will be used to directly determine if attendance for AAA screening specifically is different across various ethnic groups.

The second stage of the research will work with local under-served communities to explore their views on AAA screening, and to identify ways to improve the uptake of AAA screening in different ethnically-minoritised groups and stigmatised populations. AAA screening will be discussed with people from a range of communities and backgrounds to find out what matters most to different groups of people. We will also ask these people how important it is to improve screening uptake in their communities given that AAA might be very uncommon in their populations. AAA screening will be discussed with people from a range of communities and backgrounds to find out what matters most to different groups of people. We will also ask these people how important it is to improve screening uptake in their communities given that AAA might be very uncommon in their populations.

Using the information from these discussions, and results from previous research in other screening programmes, several possible ways to improve the uptake of AAA screening will be designed. People from ethnically-minoritised communities and other under-served groups will then be asked to help choose which will work best and refine these methods to improve the uptake of AAA screening.

If feasible, a research project will be set up to test these new ways to invite people for screening in one or two regional AAA screening programmes to see which work best.

References: 

• Richards Review of Adult Screening 2019: https://www.england.nhs.uk/wp-content/uploads/2019/02/report-of-the-independent-review-of-adult-screening-programme-in-england.pdf
• Population screening: review of interventions to improve participation among underserved groups 2022: https://www.gov.uk/government/publications/population-screening-improving-participation-in-underserved-groups/population-screening-review-of-interventions-to-improve-participation-among-underserved-groups
• NIHR PHR call 2023: https://www.nihr.ac.uk/uptake-population-screening-programmes-under-served-groups 
• Salem MK, Rayt HS, Hussey G, Rafelt S, Nelson CP, Sayers RD, Naylor AR, Nasim A. Should Asian men be included in abdominal aortic aneurysm screening programmes? Eur J Vasc Endovasc Surg. 2009 Dec;38(6):748-9.