Understanding stigma to inform public health messaging, decision-making and help-seeking for early prostate cancer diagnosis and care among Black men (DESTIGMATISE)

Research question How does stigma influence public health messaging, decision-making and help-seeking for early prostate cancer diagnosis and care among Black men in the UK? and how can this be addressed in a culturally intelligent way? Background Prostate cancer (CaP) disproportionately affects 1-in-4 Black compared with 1-in-8 White and 1-in-13 Asian men. Whilst early diagnosis enhances survival rates from CaP, evidence hints at stigma (self, public, structural) as a barrier to help-seeking for early diagnosis, treatment and post treatment care, leading to poorer prognosis. However, there is a dearth of UK-based research which specifically seeks to understand and address stigma to inform public health messaging on CaP within Black communities to improve men's engagement with cancer services. Aims and objectives The research aims to understand how stigma influences public health messaging, decision-making and early help-seeking for CaP diagnosis and care among Black men in the UK, and how this can be addressed within their communities in a culturally intelligent way to improve clinical engagement and health outcomes. Specific objectives are to: explore the meaning and negotiation of stigma related to CaP among Black men and their communities and how/where these intersect with masculinity, culture/acculturation and generational effects develop a conceptual framework to understand the influence of stigma on public health messaging, decision-making and early help-seeking for CaP diagnosis and care among Black men co-produce with Black men and their communities, innovative resources to tackle stigma as identified in objectives (i) and (ii) test the acceptability of resources co-produced in objective (iii) assess the feasibility of implementing the resources in clinical and community settings to improve patient care and engagement with cancer services Methods Research objectives will be addressed using an exploratory mixed methods sequential design involving co-production and integrated PPI. This will involve four phases: (i) mixed methods study to triangulate quantitative (survey) and qualitative (interviews/focus groups) data from adult Black men (as defined in the ONS census categories) with and/or without a CaP diagnosis and their immediate families (ii) systematic review and stakeholder engagement workshops to co-produce educational/informational resources (iii) acceptability study and (iv) feasibility study. The Framework Integrating Normative Influence on Stigma (FINIS) will theoretically underpin the study. Anticipated impact and dissemination Following NIHR guidance, a process of knowledge mobilisation will be adopted to maximise impact through rigorous and strategic engagement with an underserved patient population to co-produce and disseminate the proposed resources. At micro level, the research will benefit Black patients by providing contextual and culturally-intelligent information/educational resources to normalise CaP discussions and drive early help-seeking for cancer services. At meso level, findings will enhance cultural intelligence of clinicians in providing and delivering equitable cancer care for a culturally diverse patient population. At macro level, the research will generate significant new knowledge/outputs to support the NHS cancer strategy to improve cancer outcomes and services in England by reducing inequalities for a high risk but underserved patient population. Findings will be disseminated through academic and KE activities with Black communities and wider stakeholders.