Reducing disparities among colorectal cancer screening participants by an organization at the limit of the prevention system: when field analysis and theory meet

Abstract

Social health inequalities are a strong theme in nowadays health literature. Each year, about
40 000 people are diagnosed with colorectal cancer, 17 526 died of it in 2011. Its screening allows for an early care thus significantly decreasing the mortality rate. Since 2001, French health authorities have organized colorectal cancer screening promotion for people between 50 and 74 years old, however underprivileged populations are less likely to participate.
From 2012 to 2014, we took part in a French interventional study, COLONAV. Its aim was to replicate an American program called “navigation program”. This navigation device is an intermediary function allowing access to a population whose health system cannot reach through usual promotion.
These programs design is poorly and unclearly described and it has never been studied theoretically. The in-depth study of navigators recruitment exposed/described in the literature as well as the COLONAV project, allowed the identification of contingency factors around this device design, and the foundations ensuring its efficiency. In this paper, we study this organization by focusing on the recruitment profile of navigators. This essay questions the place of this additional actor in the health promotion design. Is he/she an intermediary between a health system with a lot of dysfunctions and are those people less able to overcome them? Does it question the ability of this system to outline a modest yet new design of cancer screening programs? Working from the perspective of Grounded Theory, we used an abductive approach. The analysis of our results helped us identify theoretical tracks.
We show that the navigation device resembles the boundary organization theory developed from Peton’s work. This theoretical work helps frame thinking on how to organize an accessible screening for populations least concerned by it at present.
Navigation devices, and by extension the navigators, are a boundary organization allowing to connect and translate expectations between the different organizational actors and the target
population.
They act as intermediaries between a health system with a lot of dysfunctions and people less able to overcome them. Yet in the context of screening, their most interesting function stands upstream of the lifting of logistical barriers, in their ability to make a link between divergent objectives.