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Understanding how rural-dwellers respond to potential cancer symptoms: A mixed methods PhD project using a community-based cohort assessing prevalence and response to potential cancer symptoms

Project Description

1. Background to the project.
Scottish people living further from key healthcare facilities have less chance of prompt cancer diagnosis and poorer cancer survival than those living closer-by[1]. This finding has been replicated world-wide. Several potential explanations have been offered for this phenomenon but the underlying mechanisms remain obscure.[2] There is, however, some evidence that rural people have lower expectations of health services, and different health behaviours from urban-dwellers[3,4]. Recent work using a cohort of people diagnosed with colorectal cancer in Northeast Scotland between 1998-1997 found that people living further from healthcare facilities were more likely to present initially to GPs with alarm, rather than more vague, symptoms suggestive of cancer[5]. Together, this evidence suggest that that people who live remotely and in rural communities may experience and react to symptoms of potential cancer differently to those living in cities and suburban areas. USEFUL is a large community-based cohort which assesses prevalence and response to potential cancer symptoms and affords enables us the unique opportunity to gain further insight into differences in the prevalence, experience of, and reaction to potential cancer symptoms of rural compared to urban populations.

2. Proposed research and techniques.
The student will work under the supervision of a health psychologist, medical statistician and academic GP, who together will provide expertise on cancer diagnosis within primary care, symptom experience and health behaviour, data-linkage and advanced statistical analysis. The student’s work will be based on the USEFUL cohort, a community-based cohort of approximately 20,000 people drawn from across the UK. Subjects in the USEFUL cohort have provided detailed information about their current experience of, and reaction to, 35 potential symptoms of cancer. The USEFUL cohort enables a unique insight into the prevalence of potential cancer symptoms within the UK population as well as how these symptoms are differentially experienced by and reacted to by people with different demographic characteristics.

The project has three stages:

First, under the direction of supervisors Fielding and Murchie the student will conduct a detailed statistical exploration of rural/urban differences in symptom prevalence, experience and reaction amongst the USEFUL cohort [6] from 20,000 UK adults. This will establish the prevalence and patterns of symptoms associated with cancer in the UK general population compare how people from rural and urban settings appraise and respond to these symptoms.

Second, under the direction of supervisor Allan the student will conduct a systematic review of the psychological mechanisms underpinning symptom experience, comparing urban and rural areas. This work will follow established systematic review methods[7] and will inform the development of a theoretical model of the potentially modifying effects of place of residence on symptom experience and response.

Third, under the direction of supervisors Allan and Murchie the student will explore the emergent model using in-depth face-to-face qualitative interviews with people affected by cancer, and health professionals, from rural environments to understand how geography may have influenced their experiences, including their perceptions and responses to their initial cancer symptoms.

This project will contribute to a developing programme of work which is seeking to build rural and urban cancer equality in Scotland. In particular the work will highlight ways in which public cancer awareness campaigns and primary care and other community-based healthcare services need to be best configured in order to best meet the needs of the most remote Scottish residents.

This project is advertised in relation to the research areas of APPLIED HEALTH SCIENCE. Formal applications can be completed online: You should apply for Degree of Doctor of Philosophy in Applied Health Science, to ensure that your application is passed to the correct person for processing.


Candidates should contact the lead supervisor to discuss the project in advance of submitting an application, as supervisors will be expected to provide a letter of support for suitable applicants. Candidates will be informed after the application deadline if they have been shortlisted for interview.

Funding Notes

This project is part of a competition funded by the Institute of Applied Health Sciences. Full funding is available to UK/EU candidates only. Overseas candidates can apply for this studentship but will have to find additional funding to cover the difference between overseas and home fees (approximately £16,625 per annum).

Candidates should have (or expect to achieve) a minimum of a First Class Honours degree in a relevant subject. Applicants with a minimum of a 2:1 Honours degree may be considered provided they have a Distinction at Masters level.


1. Campbell NC, Elliot AM, Sharp L et al. Rural factors and survival from cancer: an analysis of Scottish cancer registration. Brit J Cancer 2000;82:1863-1866.

2. Jones AP, Haynes R, Sauerzapf Vet al. Travel times to health care and survival from cancers in Northern England. Eur J Cancer 2008;44:269-274.

3. Bain NSC, Campbell NC. Treating patients with colorectal cancer in rural and urban areas: a qualitative study of the patients’ perspective. Fam Pract 2000;17:475-479.

4. Farmer J, Iversen L, Campbell NC et al. Rural/urban differences in accounts of patients’ initial decisions to consult in primary care. Health and Place 2006;12:210-221.

5. Murage P, Murchie P, Bachman M et al. Do rural patients present later to their GPs with symptomatic colorectal cancer? A cross-sectional geographical enquiry using linked data from Northern Scotland (in press with British Journal of General Practice)

6. Symptoms associated with cancer in the UK general population: understanding prevalence, patterning and response to provide an evidence base for the development of interventions to reduce time to presentation: Ongoing Research Project Funded by Cancer Research UK/NAEDI.

7. Moher D, Liberati A, Tetzlaff J et al, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6: e1000097. doi:10.1371/journal.pmed1000097

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