{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T15:34:22Z","timestamp":1781364862164,"version":"3.54.1"},"reference-count":51,"publisher":"Royal College of General Practitioners","issue":"720","license":[{"start":{"date-parts":[[2019,2,12]],"date-time":"2019-02-12T00:00:00Z","timestamp":1549929600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Gen Pract"],"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>COVID-19 has led to rapid changes in healthcare delivery, raising concern that these changes may exacerbate existing inequalities in patient outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To understand how patients\u2019 help-seeking experiences in primary care for colorectal cancer symptoms during COVID-19 were affected by their socioeconomic status (SES).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design and setting<\/jats:title><jats:p>Qualitative semi-structured interviews with males and females across the UK, recruited using purposive sampling by SES.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Interviews were carried out with 39 participants (20 higher SES; 19 lower SES) who contacted primary care about possible symptoms of colorectal cancer during COVID-19. Data were analysed using framework analysis followed by comparative thematic analysis to explore differences between groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Three themes were identified with differences between SES groups: 1) how people decided to seek medical help through appraisal of symptoms; 2) how people navigated services; and 3) impact of COVID-19 on how patients interacted with healthcare professionals. The lower SES group expressed uncertainty appraising symptoms and navigating services (in terms of new processes resulting from COVID-19 and worries about infection). There was also potential for increased disparity in diagnosis and management, with other methods of getting in touch (for example, email or 111) taken up more readily by higher SES patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The findings suggest that COVID-19 exacerbated disparities between higher and lower SES participants. This study raises awareness around challenges in help seeking in the context of the pandemic, which are likely to persist (post-COVID-19) as healthcare systems settle on new models of care (for example, digital). Recommendations are provided to reduce inequalities of care.<\/jats:p><\/jats:sec>","DOI":"10.3399\/bjgp.2021.0644","type":"journal-article","created":{"date-parts":[[2022,4,11]],"date-time":"2022-04-11T17:13:16Z","timestamp":1649697196000},"page":"e472-e482","source":"Crossref","is-referenced-by-count":19,"title":["Socioeconomic differences in help seeking for colorectal cancer symptoms during COVID-19: a UK-wide qualitative interview study"],"prefix":"10.3399","volume":"72","author":[{"given":"Athena","family":"Ip","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgia","family":"Black","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia","family":"Vindrola-Padros","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Taylor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Otter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madeleine","family":"Hewish","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afsana","family":"Bhuiya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Callin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Wong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Machesney","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naomi J","family":"Fulop","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cath","family":"Taylor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katriina L","family":"Whitaker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1987","published-online":{"date-parts":[[2022,3,24]]},"reference":[{"key":"2022092209350834000_72.720.e472.1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(20)30388-0"},{"key":"2022092209350834000_72.720.e472.2","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.ejca.2021.04.019","article-title":"Economic impact of avoidable cancer deaths caused by diagnostic delay during the COVID-19 pandemic: a national population-based modelling study in England, UK","volume":"152","author":"Gheorghe","year":"2021","journal-title":"Eur J Cancer"},{"key":"2022092209350834000_72.720.e472.3","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(20)30242-4"},{"key":"2022092209350834000_72.720.e472.4","unstructured":"Macmillan Cancer Support (2020) The forgotten \u2018C\u2019? The impact of Covid-19 on cancer care, https:\/\/www.macmillan.org.uk\/_images\/forgotten-c-impact-of-covid-19-on-cancer-care_tcm9-359174.pdf (accessed 12 Apr 2022)."},{"issue":"11","key":"2022092209350834000_72.720.e472.5","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.1016\/S1470-2045(19)30456-5","article-title":"Progress in cancer survival, mortality, and incidence in seven high-income countries 1995\u20132014 (ICBP SURVMARK-2): a population-based study","volume":"20","author":"Arnold","year":"2019","journal-title":"Lancet Oncol"},{"key":"2022092209350834000_72.720.e472.6","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2020-320625"},{"key":"2022092209350834000_72.720.e472.7","unstructured":"Office for National Statistics (2016) Cancer survival by stage at diagnosis for England (experimental statistics): adults diagnosed 2012, 2013 and 2014 and followed up to 2015, https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/healthandsocialcare\/conditionsanddiseases\/bulletins\/cancersurvivalbystageatdiagnosisforenglandexperimentalstatistics\/adultsdiagnosed20122013and2014andfollowedupto2015 (accessed 12 Apr 2022)."},{"issue":"4","key":"2022092209350834000_72.720.e472.8","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1016\/j.gie.2020.06.042","article-title":"Impact of COVID-19 on colorectal cancer disparities and the way forward","volume":"92","author":"Balzora","year":"2020","journal-title":"Gastrointest Endosc"},{"key":"2022092209350834000_72.720.e472.9","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1200\/EDBK_321071","article-title":"Colorectal cancer: in the pursuit of health equity","volume":"41","author":"Musselwhite","year":"2021","journal-title":"Am Soc Clin Oncol Educ Book"},{"key":"2022092209350834000_72.720.e472.10","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.canep.2017.01.007","article-title":"The relationship between ethnicity, social deprivation and late presentation of colorectal cancer","volume":"47","author":"Askari","year":"2017","journal-title":"Cancer Epidemiol"},{"key":"2022092209350834000_72.720.e472.11","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyq048"},{"key":"2022092209350834000_72.720.e472.12","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2020-214232"},{"issue":"9","key":"2022092209350834000_72.720.e472.13","doi-asserted-by":"crossref","first-page":"1396","DOI":"10.1038\/bjc.2017.295","article-title":"Persistent inequalities in 90-day colon cancer mortality: an English cohort study","volume":"117","author":"Fowler","year":"2017","journal-title":"Br J Cancer"},{"key":"2022092209350834000_72.720.e472.14","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2015.49"},{"key":"2022092209350834000_72.720.e472.15","doi-asserted-by":"publisher","DOI":"10.1038\/s41416-021-01382-1"},{"key":"2022092209350834000_72.720.e472.16","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-053095"},{"issue":"3","key":"2022092209350834000_72.720.e472.17","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/S2468-1253(21)00005-4","article-title":"Impact of the COVID-19 pandemic on the detection and management of colorectal cancer in England: a population-based study","volume":"6","author":"Morris","year":"2021","journal-title":"Lancet Gastroenterol Hepatol"},{"issue":"7","key":"2022092209350834000_72.720.e472.18","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.1111\/codi.15622","article-title":"The impact of the first peak of the COVID-19 pandemic on colorectal cancer services in England and Wales: a national survey","volume":"23","author":"Boyle","year":"2021","journal-title":"Colorectal Dis"},{"key":"2022092209350834000_72.720.e472.19","unstructured":"Public Health Scotland (2021) Cancer staging data using 2018\u20132020 DCE data \u2014 the impact of COVID-19, https:\/\/publichealthscotland.scot\/publications\/cancer-staging-data-using-2018-to-2020-dce-data-the-impact-of-covid-19\/cancer-staging-data-using-2018-to-2020-dce-data-the-impact-of-covid-19\/ (accessed 12 Apr 2022)."},{"key":"2022092209350834000_72.720.e472.20","doi-asserted-by":"crossref","unstructured":"Wanat M Hoste M Gobat N (2021) Transformation of primary care during the COVID-19 pandemic: experiences of healthcare professionals in eight European countries. Br J Gen Pract, DOI: https:\/\/doi.org\/10.3399\/BJGP.2020.1112.","DOI":"10.3399\/BJGP.2020.1112"},{"key":"2022092209350834000_72.720.e472.21","doi-asserted-by":"crossref","unstructured":"Murphy M Scott LJ Salisbury C (2021) Implementation of remote consulting in UK primary care following the COVID-19 pandemic: a mixed-methods longitudinal study. Br J Gen Pract, DOI: https:\/\/doi.org\/10.3399\/BJGP.2020.0948.","DOI":"10.21203\/rs.3.rs-94227\/v1"},{"key":"2022092209350834000_72.720.e472.22","doi-asserted-by":"crossref","unstructured":"Mroz G Papoutsi C Rushforth A Greenhalgh T (2021) Changing media depictions of remote consulting in COVID-19: analysis of UK newspapers. Br J Gen Pract, DOI: https:\/\/doi.org\/10.3399\/BJGP.2020.0967.","DOI":"10.3399\/BJGP.2020.0967"},{"key":"2022092209350834000_72.720.e472.23","doi-asserted-by":"crossref","unstructured":"Archer S Calanzani N Honey S (2021) Impact of the COVID-19 pandemic on cancer assessment in primary care: a qualitative study of GP views. BJGP Open, DOI: https:\/\/doi.org\/10.3399\/BJGPO.2021.0056.","DOI":"10.3399\/BJGPO.2021.0056"},{"key":"2022092209350834000_72.720.e472.24","doi-asserted-by":"publisher","DOI":"10.12968\/hmed.2020.0555"},{"key":"2022092209350834000_72.720.e472.25","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-6-35"},{"key":"2022092209350834000_72.720.e472.26","unstructured":"Cancer Research UK (2011) Bowel Cancer Awareness Measure (CAM), https:\/\/www.cancerresearchuk.org\/sites\/default\/files\/health_professional_bowel_cam_toolkit_version_2.1_09.02.11.pdf (accessed 12 Apr 2022)."},{"key":"2022092209350834000_72.720.e472.27","unstructured":"Bowel Cancer UK (2019) Symptoms of bowel cancer, https:\/\/www.bowelcanceruk.org.uk\/about-bowel-cancer\/symptoms\/ (accessed 12 Apr 2022)."},{"issue":"1","key":"2022092209350834000_72.720.e472.28","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1111\/bjhp.12215","article-title":"Educational differences in responses to breast cancer symptoms: a qualitative comparative study","volume":"22","author":"Marcu","year":"2017","journal-title":"Br J Health Psychol"},{"key":"2022092209350834000_72.720.e472.29","unstructured":"NHS (2021) Main symptoms of coronavirus (COVID-19), https:\/\/www.nhs.uk\/conditions\/coronavirus-covid-19\/symptoms\/main-symptoms\/#symptoms (accessed 12 Apr 2022)."},{"key":"2022092209350834000_72.720.e472.30","doi-asserted-by":"publisher","DOI":"10.1177\/1049732316654870"},{"key":"2022092209350834000_72.720.e472.31","unstructured":"UK Cancer Research (2021) Bowel cancer incidence statistics, https:\/\/www.cancerresearchuk.org\/health-professional\/cancer-statistics\/statistics-by-cancer-type\/bowel-cancer\/incidence#heading-One (accessed 12 Apr 2022)."},{"key":"2022092209350834000_72.720.e472.32","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2018-317592"},{"key":"2022092209350834000_72.720.e472.33","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-016-3846-7"},{"key":"2022092209350834000_72.720.e472.34","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6605386"},{"issue":"16","key":"2022092209350834000_72.720.e472.35","doi-asserted-by":"crossref","first-page":"2473","DOI":"10.1016\/j.ejca.2015.07.014","article-title":"Low cancer suspicion following experience of a cancer \u2018warning sign\u2019","volume":"51","author":"Whitaker","year":"2015","journal-title":"Eur J Cancer"},{"issue":"2","key":"2022092209350834000_72.720.e472.36","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1002\/pon.4557","article-title":"Is lower symptom recognition associated with socioeconomic inequalities in help-seeking for potential breast cancer symptoms?","volume":"27","author":"Davies","year":"2018","journal-title":"Psychooncology"},{"issue":"1","key":"2022092209350834000_72.720.e472.37","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1186\/1471-2407-14-581","article-title":"Cancer awareness and socio-economic position: results from a population-based study in Denmark","volume":"14","author":"Hvidberg","year":"2014","journal-title":"BMC Cancer"},{"key":"2022092209350834000_72.720.e472.38","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6605398"},{"key":"2022092209350834000_72.720.e472.39","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2014.304"},{"issue":"2","key":"2022092209350834000_72.720.e472.40","doi-asserted-by":"crossref","first-page":"48","DOI":"10.3109\/13814780309160402","article-title":"Frequent attendance, socioeconomic status and burden of ill health","volume":"9","author":"Wyke","year":"2003","journal-title":"Eur J Gen Pract"},{"key":"2022092209350834000_72.720.e472.41","doi-asserted-by":"crossref","first-page":"102179","DOI":"10.1016\/j.msksp.2020.102179","article-title":"Safety netting; best practice in the face of uncertainty","volume":"48","author":"Greenhalgh","year":"2020","journal-title":"Musculoskelet Sci Pract"},{"issue":"6","key":"2022092209350834000_72.720.e472.42","doi-asserted-by":"crossref","first-page":"e200734","DOI":"10.1001\/jamahealthforum.2020.0734","article-title":"Strategies for digital care of vulnerable patients in a COVID-19 world \u2014 keeping in touch","volume":"1","author":"Gray","year":"2020","journal-title":"JAMA Health Forum"},{"key":"2022092209350834000_72.720.e472.43","doi-asserted-by":"crossref","unstructured":"Neves AL Lawrence-Jones A Naar L (2020) Multidisciplinary teams must work together to co-develop inclusive digital primary care for older people. Br J Gen Pract, DOI: https:\/\/doi.org\/10.3399\/bjgp20X713645.","DOI":"10.3399\/bjgp20X713645"},{"key":"2022092209350834000_72.720.e472.44","unstructured":"Velasquez D Mehrotra A (2020) Ensuring the growth of telehealth during COVID-19 does not exacerbate disparities in care. Health Affairs blog, https:\/\/www.healthaffairs.org\/do\/10.1377\/forefront.20200505.591306\/full\/ (accessed 12 Apr 2022)."},{"key":"2022092209350834000_72.720.e472.45","doi-asserted-by":"crossref","first-page":"279","DOI":"10.12688\/f1000research.52392.2","article-title":"Public perception of NHS general practice during the first six months of the COVID-19 pandemic in England","volume":"10","author":"Duncan","year":"2021","journal-title":"F1000Res"},{"issue":"5","key":"2022092209350834000_72.720.e472.46","doi-asserted-by":"crossref","first-page":"e13290","DOI":"10.1111\/ecc.13290","article-title":"Cancer has not gone away: a primary care perspective to support a balanced approach for timely cancer diagnosis during COVID-19","volume":"29","author":"Helsper","year":"2020","journal-title":"Eur J Cancer Care (Engl)"},{"key":"2022092209350834000_72.720.e472.47","doi-asserted-by":"publisher","DOI":"10.1080\/13814788.2020.1798156"},{"key":"2022092209350834000_72.720.e472.48","doi-asserted-by":"publisher","DOI":"10.1111\/1468-0009.12509"},{"key":"2022092209350834000_72.720.e472.49","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n1173"},{"issue":"4","key":"2022092209350834000_72.720.e472.50","doi-asserted-by":"crossref","first-page":"zrab056","DOI":"10.1093\/bjsopen\/zrab056","article-title":"Risk of missing colorectal cancer with a COVID-adapted diagnostic pathway using quantitative faecal immunochemical testing","volume":"5","author":"Maeda","year":"2021","journal-title":"BJS Open"},{"key":"2022092209350834000_72.720.e472.51","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2020-321956"}],"container-title":["British Journal of General Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.3399\/BJGP.2021.0644","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,22]],"date-time":"2022-09-22T16:43:23Z","timestamp":1663865003000},"score":1,"resource":{"primary":{"URL":"http:\/\/bjgp.org\/lookup\/doi\/10.3399\/BJGP.2021.0644"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,24]]},"references-count":51,"journal-issue":{"issue":"720","published-online":{"date-parts":[[2022,6,30]]},"published-print":{"date-parts":[[2022,7]]}},"alternative-id":["10.3399\/BJGP.2021.0644"],"URL":"https:\/\/doi.org\/10.3399\/bjgp.2021.0644","relation":{},"ISSN":["0960-1643","1478-5242"],"issn-type":[{"value":"0960-1643","type":"print"},{"value":"1478-5242","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,24]]}}}