Targeting women from the Aboriginal and Torres Strait Islander, Arabic and Italian communities.

Improving breast screening experiences and uptake in under-screened groups


The North West region of Melbourne is identified as a priority area for breast cancer screening given that there are community groups within the region who do not regularly participate in breast cancer screening. The ‘Optimising Breast Screening in Melbourne’s North West project’ used Ophelia to understand the strengths and challenges associated with women’s breast screening experiences, and to generate and test solutions to key barriers to screening in the region. Of particular interest were women from the Aboriginal and Torres Strait Islander, Arabic and Italian communities.

Setting

Location: Metropolitan Melbourne    Type of organisation: Not-for-profit, government-funded program providing mammographic screening and assessment Type of intervention: Improve breast screening experiences and uptake in under-screened target groups

BreastScreen Victoria is part of the Australian national breast screening program where women aged 50-74 are invited to attend a free breast screening appointment every 2 years.

 

What was the problem?

The North West region of Melbourne is identified as a priority area for breast cancer screening given that there are community groups within the region who do not regularly participate in breast cancer screening.  The ‘Optimising Breast Screening in Melbourne’s North West project’ used Ophelia to understand the strengths and challenges associated with women’s breast screening experiences, and to generate and test solutions to key barriers to screening in the region. Of particular interest were women from the Aboriginal and Torres Strait Islander, Arabic and Italian communities.

In 2016, data on health literacy, socio-demographic status, and breast screening experience and knowledge were collected by survey from 429 women (n=133 women from the general community, n=52 Aboriginal and Torres Strait Islander women, n=71 Arabic women, n=173 Italian women). Telephone interviews were conducted with 21 of these women. Workshops were held with breast screening service providers (6 workshops), Arabic women (2 workshops) and Italian women (2 workshops) and 2 yarning circles with Aboriginal women to discuss key issues and generate ideas for solutions to improve breast screening participation and experience. Survey, interview and workshop data identified these main findings:

·         Demographic differences between the communities in employment and education status.

·         Uncomfortable screening experience was a key barrier for women to attend a future screening. Aboriginal and Torres Strait Islander women were less likely to report having a respectful experience, and Arabic women reported feeling embarrassed or ashamed. Other barriers included fear of the process and/or outcome and the attitude of screening staff.

·         Knowledge: misconceptions about screening included eligibility, benefits of screening, risk perception, and cultural/religious beliefs influenced screening intention and behaviour.

·         Health Literacy: Aboriginal and Torres Strait Islander women were less likely to have a trusted healthcare provider they could rely on, were less likely to actively manage their health and had greater difficulty understanding health information. Italian women had difficulty understanding health information. Arabic women reported difficulty in navigating the healthcare system, finding health information and understanding health information.

 

What solutions were found?                                                                                          

The interventions identified were:

1.       Develop a culturally inclusive communication strategy as follows:

a.       Have brief key messages in main community languages on the initial invitation letter.

b.      Send out reminder letters for follow-up screening in preferred language, +/- telephone reminder calls in preferred language.

c.       Develop a pictorial depiction of the breast screening process.

2.       Training for breast screening site staff in cultural awareness, safety and customer service.

3.       Train women from the community as peer health educators.

4.       Pharmacy campaigns to promote breast screening.

5.       Trial of an Aboriginal gown with artwork.

 

What was the impact?

Evaluation of the interventions is underway with the project expected to be completed by the end of 2017.  

Contact: Ophelia@deakin.edu.au

 

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