Prostate cancer is the leading cancer in Trinidad and Tobago, accounting for 44% of male cancers (GLOBOCAN, 2020), and the Caribbean has among the highest prostate cancer mortality rates worldwide. Despite this burden, no prior study has concurrently identified barriers to prostate cancer care and tested interventions to reduce these barriers in a multiethnic Caribbean population.

 

This study aimed to identify barriers to prostate cancer care among prostate cancer participants (PCPs) and participants without prostate cancer (NPCPs) in a multiethnic sample in Trinidad and Tobago, and to develop and test interventions to reduce these barriers.

 

Following approvals from UTT, the South West Regional Health Authority, and San Fernando General Hospital Urology, 240 men (120 PCPs, 120 NPCPs) were recruited from SWRHA Urology clinics and ten conveniently selected focus groups. Participants completed the validated PIPCAD survey and semi-structured interviews. Three interventions were tested: a Prostate Cancer Awareness Workshop (PCAW), a Physical Activity Programme (PAP), and a Prostate Cancer Stigma Alleviation Plan (PCASPI). Each was tested before and after exposure in sixty PCPs and sixty NPCPs, also using a newly developed Prostate Cancer Stigma Scale (PCASS) tailored to this multiethnic context.

 

PCPs had significantly higher prostate cancer prevention and early detection behaviour, fatalism, and acculturation scores, but significantly lower PC knowledge scores, than NPCPs (all p<0.001). Qualitative analysis identified five barrier themes: knowledge-related, behavioural, culture and belief-based, ethnic and social context, and health system barriers. After the interventions, PCAW significantly improved prostate cancer knowledge scores, PAP significantly improved quality of life scores, and PCSAPI significantly reduced stigma (PCASS) scores in PCPs and NPCPs (all p<0.001).

 

This study identified multidimensional barriers to prostate cancer care in a multiethnic Trinidad and Tobago sample and demonstrated that all three tested interventions were effective in improving knowledge, physical outcomes, and reducing stigma. This newly developed PCASS is a novel contribution to Caribbean cancer research and warrants further validation regionally and internationally.

 

 

Dr Nuneaton Ramesar is a two-time graduate of The University of The West Indies (UWI), who holds a Bachelor of Medicine, a Bachelor of Surgery, and a Master of Public Health. He also holds a Master of Science with Distinction in Occupational Health, Safety, and Environment from the University of Greenwich. He worked at Port-of-Spain General Hospital, and Arima Hospital for six years from 1993, eventually opening his own general practice in Arima.

 

He diagnoses and treats a wide range of patients, conducting cancer screening, obstetric and gynaecological care, executive medicals, occupational medicals for various industries, blood tests, electrocardiography, and minor surgeries including medical aesthetic procedures.

For the past six years, Dr Ramesar has worked in the fields of public health, medical research, and occupational health, where he has developed skills in research methodology, data analysis, and ethical application.

 

In his leisure time, he enjoys reading and travelling, as well as attending conferences and seminars on the most recent trends and advancements in the medical field. He hopes that the findings of this study can direct interventions to improve care for prostate cancer patients.