Irish Travellers' Cancer Awareness and Engagement With Prevention, Screening and Early Diagnosis: A Qualitative Study of Barriers and Enablers.

Abstract

Background: Irish Travellers are a distinct minority ethnic group with a long tradition of nomadism on the island of Ireland. Travellers have a significantly reduced life expectancy and experience greater health inequalities. Limited evidence describes how cancer awareness and engagement with prevention, screening and early diagnosis are shaped by structural and service contexts.

Methods: This qualitative study was undertaken as part of a larger multi-method study co-developed with the Health Service Executive, National Cancer Control Programme, National Social Inclusion Office, and Pavee Point Traveller and Roma Centre- a human rights advocacy and Irish Non-Governmental Organisation (NGO). The study aimed to understand cancer awareness and attitudes among Irish Travellers, identify barriers and enablers to cancer risk reduction behaviours and early diagnosis of cancer. In-person interviews were completed with 22 adult Irish Travellers (18 individual interviews and two group interviews with two participants each) and were transcribed verbatim and analysed using collaborative reflexive thematic analysis.

Results: Four themes described the interactions between everyday structural disadvantage, culture, privacy, fear and family roles; systems-level barriers; and Traveller-led and service-level enablers. Awareness did not always translate into an opportunity to act. Racism and discrimination, literacy barriers, living conditions, limited service choice, inaccessible communication and inflexible appointment systems constrained engagement. Pride in Traveller identity, trusted relationships, Traveller Community Health Workers, accessible information and culturally safe services supported engagement.

Conclusions: Improving cancer awareness requires more than individual behaviour change. Equitable engagement with prevention, screening and early diagnosis depends on anti-racist, accessible and flexible mainstream services developed in partnership with Travellers and their organisations. Traveller Community Health Workers are a major strength, and their expertise should be harnessed within health systems.

Patient and public contribution: The study was co-developed with Pavee Point Traveller and Roma Centre, who are represented as co-authors on the paper and were members of the study working group. They took part in all aspects of the study, including providing anti-discrimination training, recruitment, interpretation of findings, and providing lived-experience expertise throughout the drafting of the paper.