Developing an intervention to increase the receipt of oral cancer screening amongst adults with severe mental illness (SMI)

Background:

There are stark health inequalities between people with severe mental illness (SMI) and the general population.¹ SMI is a mental illness (such as schizophrenia, bipolar disorder or other related psychotic disorders) that results in substantial functional impairment. Individuals with SMI die decades earlier when compared to the general public.² Most of this inequality in mortality is related to preventable and treatable chronic conditions, such as cancer.³

Mental illness is associated with higher levels of cancer risk factors such as obesity, smoking, drinking alcohol and poor diet.⁴ People with SMI who develop cancer had higher mortality rate than those in the general population with cancer.³ This could be explained by the late detection and lower rate of uptake of cancer screening amongst this disadvantaged group of the population.³

The incidence and mortality rates of oral cancer is rising.^5-7 Most cases present late, which reduces prognosis.⁸ This is more likely to occur amongst people with SMI given the fact that disadvantaged groups bear the greatest share of the oral cancer burden.

Oral cancer should be amenable to early detection, diagnosis and treatment due to its location and easy access.⁸ This in turn can improve survival outcomes, and reduce therefore inequalities experienced by people with SMI. Primary care practitioners, in dental and medical settings, have a key role in the early diagnosis of oral malignancy.^8-11 Given the low rate of cancer screening uptake amongst people with SMI, there is a need for an intervention to increase oral cancer screening amongst this disadvantaged group. This in turn requires a better understanding of the multiple barriers and facilitators to receiving oral cancer screening from the perspectives of different stakeholders, especially the service users. Currently, very little is known regarding such barriers and facilitators.

Aims:

This study is a mixed method and trans-disciplinary (dentistry, psychiatry and public health) study that will be conducted in three stages. It aims to inform a co-produced, theory-based, multilevel interventions to increase oral cancer screening amongst people with SMI, through:

·      Exploring the views, experiences and suggestions of adults with SMI, their carers, mental health and dental care teams, and commissioners regarding the multilevel barriers and facilitators to the receipt of oral cancer screening amongst adults with SMI (Stage 1),

·      Prioritising the facilitators identified in Stage 1 and formulate consensus (Stage 2), and

·      Developing a logic model (theory of change) to explain how prioritised facilitators identified in Stage 2 could lead to an increase in the receipt of oral cancer screening amongst adults with SMI (Stage 3).Applicants need BDS or equivalent or a good health related first or public health, health psychology or behavioural science degree (minimum of a 2:1) and a relevant Master’s degree or an equivalent professional qualification.