England’s new Targeted Lung Health Checks (TLHCs) are reaching some people far more than others, and this study will find out exactly who is being left behind and why. Lung cancer kills more people in the UK than any other cancer, and the new TLHC programme—which invites people based on age and smoking history—aims to catch tumours early. But past screening programmes have widened health inequalities, and it is not yet clear whether TLHCs will do the same. This project, based in the North East and North Cumbria, will match attendance data to detailed socio-demographic information, then model what the national impact might be if participation patterns hold. Interviews with invitees and healthcare staff will reveal the real-world barriers—transport, work schedules, fear, or mistrust—that stop people from attending. If this research succeeds, it will produce co-designed strategies to boost engagement among the groups most at risk. That could mean changes to how appointments are offered, where they are held, or how they are communicated. The goal is to ensure the new lung health programme does not simply replicate the inequalities it was designed to overcome.
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Background Conflicting evidence exists about how socio-demographic inequalities in lung cancer might be affected by the roll-out of Targeted Lung Health Checks (TLHCs) in England. Documented inequalities in cancer screening participation have informed this new programme but these past investigations have tended to adopt a univariate approach. In addition, the risk-stratified nature of TLHCs implies that patterns observed in established programmes cannot be assumed to directly translate to the new initiative. We propose a mixed-methods study based in the North East and the North Cumbria (NENC) to shed light on patterns of engagement with TLHCs and their driving forces, their likely impact on lung cancer inequalities, and collaboratively develop strategies with the potential to reduce differentials. Aims This project will: a) quantify socio-demographic variations in TLHCs attendance, cancer incidence, survival and mortality in NENC by socio-demographics and locality-based metrics (Work Package (WP) 1); b) examine barriers and facilitators to TLHC engagement driving these patterns (WP2); and c) identify strategies/interventions to address inequalities using co-design approaches (WP3). Methods Data on persons invited to the incident round of the TLHCs by age, sex and Lower Super Output Area (LSOA) will be matched to existing and novel socio-demographic indices (WP1). National data on lung cancer registrations will also be requested. We will calculate age-standardised proportions of persons attending a TLHC in NENC, alongside estimates of incidence, mortality and survival by socio-demographic characteristics. We will then use scenario modelling to estimate potential impacts of participation nationally. Semi-structured interviews (group 1: TLHC invitees; group 2: healthcare practitioners involved in TLHC delivery) will examine barriers and facilitators to uptake, as located within participants’ geographical and social-cultural contexts, and challenges and opportunities for TLHC delivery (WP2). Stakeholder workshops (public, practitioners & charities) will collaboratively identify strategies to increase TLHC engagement (WP3). How the results of this research will be used This project has potential to significantly impact cancer inequalities policy and practice via development of co-designed, research-informed, strategies to maximise engagement with TLHCs. Detailed quantitative data on engagement will provide a scaffold of information for research and policy communities, whilst high-quality qualitative data on barriers and facilitators will aid interpretation of these patterns and bring fresh perspectives to those involved in design and delivery of the TLHC programme. Imaginative and varied resources for multiple stakeholders will be co-produced in partnership with PPI representatives in order to maximise the reach and impact of the research.
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