Understanding the unmet needs, wellbeing, experiences of cancer care and beliefs towards cancer among ethnic Chinese immigrants in Scotland

Cheng, Lin (2026) Understanding the unmet needs, wellbeing, experiences of cancer care and beliefs towards cancer among ethnic Chinese immigrants in Scotland. PhD thesis, University of Glasgow.

Abstract

Background:
Ethnic Chinese immigrants, one of the fastest growing minority groups in the United Kingdom (UK), commonly face language, cultural, and health system navigation barriers in accessing cancer care. Consequently, this population may face a greater risk of developing and dying from cancer than the native UK population, contributing to persistent health inequalities in cancer survivorship. Despite Scotland’s new 10-year cancer strategy (2023-2033) prioritising health equality, ethnic Chinese immigrant cancer survivors and their informal caregivers remain underrepresented in research. More research is needed to inform healthcare services in Scotland to become more culturally aware and person-centred for minority groups. This project aimed to investigate the unmet needs, wellbeing, care experiences, and beliefs regarding cancer among ethnic Chinese immigrants living in Scotland.

Methods:
This theory-driven project was underpinned by the principles of person-centred care, adopted a pragmatic research paradigm, and employed a five-phases hybrid, multistage mixed-methods design. Patient and public involvement and engagement was embedded throughout the research process. Phase 1 comprised a mixed-methods systematic review, synthesising evidence on unmet needs, health-related quality of life, and cancer care experiences among Asian immigrants living in very high Human Development Index western countries. Phase 2 involved an online survey that explored unmet needs and wellbeing among ethnic Chinese immigrant patients and informal caregivers affected by cancer in Scotland. Phase 3 used semi-structured interviews to generate more in-depth understanding of the lived experiences of cancer care that were reported in Phase 2. Phase 4 consisted of a focus group with health and social care professionals to gather their perspectives on delivering care to ethnic Chinese immigrants living with cancer. To examine how public preconceptions and views about cancer might contribute to the experiences of ethnic Chinese immigrants affected by cancer, Phase 5 concluded the project with a community-based survey investigating cancer knowledge, beliefs, and intentions to engage in cancer prevention behaviours among ethnic Chinese adults without a cancer diagnosis living in the Greater Glasgow area.

Results:
Unmet information needs were consistently reported throughout this project. Ethnic Chinese immigrants affected by cancer reported that they need bilingual and culturally appropriate information, and information help to navigate the national healthcare system. The community setting was highly valued as a context for receiving cancer-related knowledge and support services. Communication challenges with healthcare professionals were reported as the main barriers for optimal cancer care experience. This challenge is extended beyond language barriers to include limited recognition of patient autonomy. Informal caregivers reported poorer health related quality of life than patients, frequently prioritising the patient’s needs above their own, and experiencing heightened strain due to the absence of extended family support after migration. Patient, informal caregivers and health and social care professionals reported cancer is often perceived as taboo within the Chinese community. Fatalistic beliefs were more common among the ethnic Chinese sample from the public, who were primarily older women and had lower levels of education. The community sample also showed reluctance to engage in cancer prevention behaviours. This appeared to be influenced by limited recognition of the importance of cancer screening, perceived difficulties in accessing healthcare, and psychological fear of screening results.

Conclusion and Recommendations:
This project identified five key areas of health inequality affecting ethnic Chinese immigrants living with cancer in Scotland: unmet information needs, difficulties navigating and accessing the healthcare system, suboptimal communication with healthcare professionals, limited support for addressing cancer-related stigma, and insufficient support for informal caregivers. This project recommends that cultural differences should be considered as a fundamental component of person-centred care, particularly in culturally diverse healthcare settings. It also recommends that Scotland’s new 10-year cancer strategy develop initiatives to address unmet information needs and strengthen policies to support the wellbeing of informal caregivers. Given the important role that community health workers could play in bridging healthcare services and ethnic Chinese communities, this project recommends exploring their role in delivering cancer-related information and promoting awareness of the importance of early detection. This aligns with the aim of Scotland’s new 10-year cancer strategy to reduce late cancer diagnosis.

• Item Type: Thesis (PhD)
• Qualification Level: Doctoral
• Subjects: J Political Science > JV Colonies and colonization. Emigration and immigration. International migration; R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer)
• Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Supervisor's Name: Kotronoulas, Professor Grigorios and Cairns, Professor Deborah
• Date of Award: 2026
• Depositing User: Theses Team
• Unique ID: glathesis:2026-86301
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 06 Nov 2026 09:59
• Last Modified: 06 Nov 2026 13:50
• Thesis DOI: 10.5525/gla.thesis.86301
• URI: https://theses.gla.ac.uk/id/eprint/86301

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