JMIR Publications

ABSTRACT

Background:

Qualitative methods can provide a valuable complement to quantitative data in community health needs assessments to gain a deeper understanding of community perspectives on needs, inequities, and potential solutions. For needs assessments focusing on a large geographic area, it is challenging to collect qualitative data from a variety of different rural and urban contexts. In 2021, a steering committee of academic and community organizations in Kentucky (KY) was formed to drive a multi-method, statewide cancer needs assessment (CNA) to identify needs and future priorities for the state.

Objective:

This article reports on the virtual focus group component of the CNA. The objectives were to: 1) document existing community resources and perceived needs across the cancer care continuum and 2) explore the impacts of social determinants of health and the needs unique among populations that experience health disparities.

Methods:

We recruited adult KY residents who were not employed in health occupations to participate in 11 virtual 60-minute focus groups, with stratified sampling to include multiple target populations and geographic areas. We based our semi-structured discussion guide on the cancer care continuum domains and additionally focused on social determinants of health, health equity, and other factors affecting cancer diagnoses and outcomes. We conducted qualitative line-by-line analysis of the session recording transcripts to identify themes.

Results:

Participants (N=51) lived in 25 different counties, including 35% from rural communities, 14% from Appalachian KY, and 31% who self-identified as a racial or ethnic minority. We identified a variety of themes representing community-perceived needs and potential solutions across the cancer care continuum, including the need for the following: 1) novel approaches to make information accessible; 2) messaging that will not be interpreted as blaming or shaming; 3) messaging from individuals who engender trust; 4) screening efforts that reach individuals where they are; 5) ways to address practical barriers for screening and treatment, such as cost and transportation; and 6) ways to increase knowledge about insurance coverage for screening and treatment. We also found emergent themes across race, ethnicity, rural/urban residence, sexual orientation/gender identity, and age. Participants pointed to a need to promote positive, culturally sensitive communication between patients and providers and to create safe care spaces, which consider ways cultural and gender norms affect cancer care, to fight stigma and improve health equity.

Conclusions:

The findings will inform future research and cancer control efforts to address KY's high cancer incidence and mortality rates. Virtual focus groups can be a valuable component of multi-method CNAs that cover a large geographic area and/or with diverse populations to capture community perceptions of cancer-related needs and solutions. Focusing on the cancer care continuum domains, social determinants of health, and unique needs of specific groups provides useful data for CNAs.