What does the introduction of Lung Health Checks (LHCs) in England mean for lung cancer inequalities? A mixed methods investigation.

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.