The number of new cases of lung and bronchus cancer was 55.8 per 100,000 men and women per year. The number of deaths was 44.7 per 100,000 men and women per year. These rates are age-adjusted and based on 2010-2014 cases and deaths. Each year, more people die of lung cancer than of colon, breast, and prostate cancers combined. The knowledge that lung cancer can be successfully treated if caught early has driven a decades-long search to find an accurate and reliable screening test. National Cancer Institute's National Lung Screening Trial (NLST) found that annual screening with Low-Dose CT (LDCT) for asymptomatic patients aged 55 to 74, with a smoking history of at least 30 pack-years, and smokers who quit less than 15 years ago, had a 20% reduction in risk of death from lung cancer. Findings of this trial resulted in that LDCT becoming the gold standard of screening for lung cancer. The SEED method is a community-engaged research approach to develop conceptual models and generate patient-centered research questions. This method has been used to engage community stakeholders of Martinsville, Virginia to develop conceptual models of the factors contributing to lung cancer outcomes. In the first manuscript of this dissertation, these models which were produced by 3 different groups of stakeholders have been examined closely to explore the complexity, similarities, and differences. The models were used to produce a research agenda on the topic of factors impacting lung cancer outcomes for future researchers. A literature review was conducted by the study team on the final research agenda. The goal of this literature review was to avoid duplication of research and to focus future research on the identified gaps. The knowledge and attitudes of the health care providers and patients about lung cancer screening and the barriers in the uptake of LDCT were identified as a research gap. The design of the Martinsville lung cancer study described in the second manuscript of this dissertation responds to this identified research gap. These studies and their results shed light on the factors that impact lung cancer outcomes using a community based participatory approach. / Ph. D. / Each year, more people die of lung cancer than of colon, breast, and prostate cancers combined. Many researchers are studying to find an accurate and reliable screening test for lung cancer by testing the knowledge that if lung cancer can be successfully treated if caught early. One study that was conducted by National Cancer Institute found that annual screening with Low-Dose CT (LDCT) for patients who are 55 to 74, without any symptoms, with a smoking history of at least 30 pack-years, and smokers who quit less than 15 years ago, lowered their risk of dying from lung cancer. Findings of this study resulted in that Low-Dose CT becoming the best screening test for lung cancer. The SEED method is a research method to create conceptual models and produce research questions based on the direct feedback from patients and other stakeholders. This method has been used to engage community stakeholders of Martinsville, Virginia to develop conceptual models of the factors that impact the lung cancer outcomes in this area. In the first manuscript of this dissertation, these models have been examined closely to find their similarities and differences and to find out how complex they are. After generating the research questions by using these models, related studies were reviewed by the study team to find the gap of information on this topic. This review revealed that there is a gap of information in the knowledge and attitudes of the health care providers and patients about lung cancer screening and the barriers in using the Low-Dose CT. The design of the Martinsville lung cancer study described in the second manuscript of this dissertation is an answer to this gap of information.

Timely detection of prostate cancer (PCA) with prostate-specific antigens (PSA) and digital rectal examinations (DRE) are essential in optimizing incidence, minimizing prevalence, and reducing mortality rates. Given the low levels of participation in cancer screening, this study was conducted to examine the factors men consider when deciding whether to screen for PCA in Nigeria. A cross-sectional, online-based survey of 180 consenting Nigerian men 50 years old and older was carried out. Logistic regression analysis and descriptive statistics were used to analyze the data. Based on the data, there was a moderate positive association between the health belief model constructs and DRE/PSA screening intentions, which were statistically significant (p < 0.05). The results also demonstrated that there were no statistically significant associations between previous screening and age, previous screening and ethnicity, and previous screening and education among men in the sample (all p > 0.05). Of the 180 men surveyed, 29% (n = 53) had been screened for PCA before, while 76% (n = 137) reported no health insurance. Factors significantly associated with screening included income, insurance, and family history of PCA (all p < 0.05). Cancer fatalism, pain, and embarrassment were the most common barriers to screening reported. Focused interventions that help healthcare providers identify barriers quickly could improve screening outcomes. The implications for positive social change from this study include an increase in PCA screening, positive screening intentions, and a decrease in PCA mortality rate among men in Nigeria.

Background: Cervical cancer is the second most common cause of death from cancer among women in Kenya. Various international studies indicate that the knowledge level of cervical cancer and its predisposing and preventive measures is low among the nurses as well as general population. This study aimed to assess knowledge, practices and attitudes of nurses with regards to cervical cancer screening and preventive measures at two Nairobi hospitals in Kenya. Across-sectional quantitative descriptive study design was used. Convenience sampling method was applied and data were collected from respondents using self-administered questionnaire. About 114 nurses aged 18 years and above participated in the study. The study revealed that nurses have the information about cervical cancer, available screening tests and the purpose of screening. Nurses have the knowledge that cancer screening could detect this cancer at an early stage; however, uptake is low. Cervical screening services were hampered by barriers relating to health care institutions, nurses perception and fear of screening technique, embarrassment, stigma, social influence, financial costs and available sources of information / Health Studies / M.A. (Nursing Science)