Table 3.

Barriers to cancer screening uptake as well as follow-up and treatment in Indigenous populations

Socio-cultural and behavioural barriers	Structural barriers
Individual barriers	Access barriers
Poor knowledge and awareness of cancer and screening services	Poor coordination of services, from screening to follow-up and treatment
Low levels of health literacy	Lack of transportation
Language/literacy barriers	Distance barriers/rural residence
Low perceived risk	Frequent moving, changing address
Negative attitude	Child care commitments (family responsibilities)
Worry or fear of cancer	Inflexible clinic schedules
Fatalism regarding cancer	Lack of Indigenous staff
Low priority of screening	Difficulties negotiating/communicating with providers and organizations due to language/literacy or cultural differences
Perceived self efficacy
Lack of appropriate health information
Presence of co-morbidities	Lack of health promotion material in Indigenous languages
History of racism and distrust in medical institutions
Discomfort with mainstream services/alienating hospital environment
Absence of holistic, culturally appropriate cancer services
	Economic
	Cost of seeing a GP including transport
	Unsure of potential costs of follow-up and treatment
	Costs for travel and accommodation to hospital
	Provider-related
	Lack of understanding of cultural needs
	Poor identification of Indigenous status
	Lack of appropriate resources