Table 1 Barriers and facilitators to anal cancer screening in MSM synthesized from all studies
Factors | Facilitators | Barriers |
|---|---|---|
Individual factors | ||
Age | Younger age [32] | |
Race | Black race [21] | Non-Hispanic Black race [32] Racialized groups [52] |
Sexual orientation | Homosexuals [59] | Heterosexual men [52], bisexual or queer [59] |
Resource | Availability of the screening test [21, 54, 57] Education from a health care provider or accept education program [36, 54] Having insurance coverage [21] Having a high annual household income [22] | Financial distress [30, 32, 42, 47, 51, 55, 57] Lack of availability of the screening test [39, 56] Lack of time for participating due to work, traffic etc. [43, 57] |
Education | More years of school [59] | Not having a college degree [32] |
Health condition | Living with HIV[21, 22, 39, 51] Self-observed, other perceived or diagnosed anal disease or physical symptoms [21, 30, 31, 45, 57] Family history of cancer[57] | Living with HIV [59] Not experiencing anal cancer symptoms [57] Mental health conditions [42] |
Health behavior | Previous history of anal cancer screening [21, 22] Higher levels of sexual activity (i.e., anal receptive sexual partners) in the previous six months [21, 31] | Not disclosed their sexual behavior with men to their primary health care provider [22] Not having anal receptive sexual intercourse [32] |
Health literacy | Greater perceived knowledge about anal cancer screening, anal cancer, HPV, vaccination and associated risk [22, 31, 37, 39, 43, 46, 57] | Lack of knowledge related HPV, anal cancer, and anal screening [32, 35, 39–45, 47, 49, 50, 55–58] Lack of awareness and concern of disease risk [35, 38–40, 42, 45, 49, 56, 57] Uncertainty about the effectiveness and possible side effect of anal cancer screening [32, 48, 52] Uncertain about their doctor’s recommendation [52] |
Psychology | Worry about getting anal cancer and being very concerned about anal cancer [21, 22, 39, 43] Less anal sex stigma [54] High tolerance for any pain experienced [43] | Stigma and discrimination [39, 41, 43, 44, 49–51, 54, 58] Psychological distress, such as anxious/fear about anal cancer screening and the finding an abnormality [32, 35, 40, 43, 44, 48, 55, 57] Feel shame or embarrassment [39, 41, 43–45, 47, 50, 57] Negative experience [47, 48] Having other health concern (i.e., living with HIV) [40] Vulnerability [48] |
Attitude | Patient willingness [44, 45, 50, 56, 57] Perceptions of self-efficacy [41, 43, 52] Safer sex fatigue [21] Reduced HIV concern [21] Not believing anal Pap tests are only necessary for people who have anal intercourse [22] Positive normative beliefs [52] Positive behavioral beliefs regarding treatment [52] Belief about HPV-related disease or HRA [43] | Not Interested in or dislike anal screening and potentially toughing faeces [32, 45, 54, 57] Sensitive nature of discussing sexual identity and sexual practices and screening itself [35, 48] Self-esteem, male affect their masculinity [44] Internalized racism [48] Connection the HRA to the Sexual Behavior “Bottom” Identity [49] |
Social support | Recommended by the healthcare provider [21, 44, 56, 57] Good communication and relationship with the healthcare provider [37, 43, 46, 48, 56] Good communication with supportive sexual partner [50] Close relationship experiences the disease of prostate cancer [49] Discussion with female friend [49] Social support [54] | Lack of recommendation from healthcare professional [40, 47, 57] |
Healthcare system factors | ||
Efficiency of the system | Improving health check-up processes [31, 50, 51, 55] Development of clear screening guideline [56, 58] | Healthcare system inefficiencies, such as the absence of a clinical routine, unclear delineation of responsibilities, weak health information system, health service not meet the specific need, ambiguous policy guidelines [38, 43, 48, 54, 58] Differences in HIV care practices [38] |
Resources | Training healthcare providers [40, 51, 56, 58] | Lack of human resources [34, 41–43, 58] Inadequate infrastructure [53, 58] Lack of funding and financial resources [38, 58] Lack of political will and commitment from the government [58] |
Dissemination | Creation of dissemination style on health education [40] | No promotion in media [34] |
Healthcare provider factors | ||
Professional | Well trained healthcare provider with adequate knowledge, expertise and good communication skill [43, 44, 48, 50] | Concern about the effectiveness and acceptability of anal screening [34, 38, 53] Lack of professional training [53] Lack of time [34, 42] |
Attitude | Non-judgment [48] | Bias, apathy and discourtesy from the doctor’s side [48, 51] Forgetting (i.e., lack of reminders) [34] Unnecessary anxiety, discomfort, embarrassment for patients [34] Low patient interest [34] |
Relationship | Good communication and relationship with the patient [43, 48, 56] | Poor communication with the patient [38, 43] |
Screen-related factors | ||
Screening method | Self-anal exams [44, 45] Preferred anal examinations to be performed only by a medical expert [35] Partner anal exams [45] Self-anal examination can be taught by the clinician [41] | Discomfort feelings from anal cancer screening [32, 33, 35, 38, 39, 43, 50, 54, 57] Inadequate physical flexibility to conduct an anal self-examination [35, 45] Concerned about hygiene before anal self-examination [35] |
Screening environment | Screening performs in familiar environment [59] Friendly environment [48] | Unfriendly therapeutic environment [50] |
Cost | Cost of screening [39, 57] Time consuming [39] | |
Convenience | Convenience of the screening method [44] | Lack of convenience of the screening [39] |