{
  "abstract": "Background Lung cancer has the highest mortality of all cancers in the UK. Targeted low-dose CT screening of asymptomatic high-risk individuals reduces mortality through early detection. However, the impact of national lung cancer screening programmes is limited by inequitable participation, particularly among those experiencing socioeconomic deprivation and with long-term tobacco dependence. Pathway navigation (PN) is an individualised approach, which employs trained navigators to guide individuals experiencing inequalities to overcome barriers to accessing healthcare, including screening. A randomised controlled trial assessed the effect of a telephone-based PN intervention on uptake of lung cancer screening by previous non-responders as part of the Yorkshire Lung Screening Trial. A mixed-methods process evaluation was conducted in parallel to understand the acceptability of the PN intervention, how it might work, barriers preventing participants from attending screening and the strategies adopted by pathway navigators.Methods For the qualitative component, in-depth, remote, semi-structured interviews were conducted with participants purposively sampled from the PN trial intervention arm. Data collection was guided by the COM-B framework and analysed thematically using the framework approach.Results Two groups were recruited based on lung cancer screening history, never responders (N=25) and previous disengagers (N=10). The PN intervention was viewed as highly acceptable across both groups. The personalised, nonjudgemental and actively empathetic approach of the PN team was described as essential in the decision to attend screening, working sometimes to facilitate arranging attendance for those already able and motivated to be screened and other times to navigate practical and emotional difficulties. Travel challenges, fear of lung cancer diagnosis and poor health were the primary barriers reported by participants. Age-related health decline, awareness of smoking as a risk factor for cancer, the perceived benefits of early detection, being reminded/prompted about screening and the offer of travel support motivated and enabled attendance.Conclusion Non-responders found telephone-based PN support to be an acceptable and supportive approach, which acted to prompt, enable or motivate their attendance through bespoke practical and emotional support. Adopting pathway navigation for non-responders within the national lung screening programme may be a potentially powerful tool to help reduce the inequality gap and maximise effectiveness.",
  "authors": [
    {
      "affiliations": [
        "Wolfson Institute of Population Health, Queen Mary University of London, London, UK"
      ],
      "name": "LG Akwa"
    },
    {
      "affiliations": [
        "Surrey City Council, Surrey, UK"
      ],
      "name": "D McInnerney"
    },
    {
      "affiliations": [
        "Wolfson Institute of Population Health, Queen Mary University of London, London, UK"
      ],
      "name": "L Mitchinson"
    },
    {
      "affiliations": [
        "Wolfson Institute of Population Health, Queen Mary University of London, London, UK"
      ],
      "name": "G Hutton"
    },
    {
      "affiliations": [
        "Leeds Institute of Health Sciences, University of Leeds, Leeds, UK"
      ],
      "name": "I Simmonds"
    },
    {
      "affiliations": [
        "Leeds Institute of Health Sciences, University of Leeds, Leeds, UK"
      ],
      "name": "N Hancock"
    },
    {
      "affiliations": [
        "Department of Research and Innovation, Leeds Teaching Hospitals NHS Trust, Leeds, UK"
      ],
      "name": "S Rogerson"
    },
    {
      "affiliations": [
        "Department of Research and Innovation, Leeds Teaching Hospitals NHS Trust, Leeds, UK"
      ],
      "name": "J Lindop"
    },
    {
      "affiliations": [
        "Wolfson Institute of Population Health, Queen Mary University of London, London, UK"
      ],
      "name": "D Vulkan"
    },
    {
      "affiliations": [
        "Leeds Institute of Health Sciences, University of Leeds, Leeds, UK"
      ],
      "name": "C Marshall"
    },
    {
      "affiliations": [
        "Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Wythenshawe, UK"
      ],
      "name": "PAJ Crosbie"
    },
    {
      "affiliations": [
        "Wolfson Institute of Population Health, Queen Mary University of London, London, UK"
      ],
      "name": "R Gabe"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK"
      ],
      "name": "MEJ Callister"
    },
    {
      "affiliations": [
        "Wolfson Institute of Population Health, Queen Mary University of London, London, UK"
      ],
      "name": "SL Quaife"
    }
  ],
  "title": "P126 Understanding the acceptability and process mechanisms of a pathway navigation intervention to engage non-responders in lung cancer screening",
  "uid": "1787504c-7a21-5498-a4e0-176564d4af62"
}