Facilitating communities to take action

Whole town strategy for access to cancer services


This project sought to use the Ophelia process to understand health literacy-related factors that may contribute to disparities in cancer diagnoses and mortality in a large rural area of Victoria, Australia. Based on findings from needs assessment, stakeholders determined the aim of their intervention would be to facilitate communities to assess their needs and develop plans to take action to improve access to local services. An organised small town cancer care strategy was identified as a method to systematically organise efforts to make cultural changes, build community capacity to participate in screening and surveillance, and promote full engagement in cancer care.

Setting

Location: Rural, North Central Victoria, Australia    Type of organisation: Department of Health, Regional Integrated Cancer Service    Type of intervention: Whole town strategy for access to cancer services

This was a collaborative project between The Department of Health-funded Grampians Integrated Cancer Services (GICS) and Deakin University. The role of GICS is to promote system integration across structural boundaries and to encourage collaborative approaches to evidence-based service development. GICS comprises clusters of hospitals and associated health services that deliver services for people with all types of cancers within a geographic area. Services include public hospitals, community-based services, general practitioners and other primary health organisations, private hospitals and supportive care services. The Department of Health commissioned the Health Systems Improvement Unit at Deakin University to work collaboratively with GICS to explore potential causes and solutions forthe high rates of cancer mortality in the Grampians region.

Problem identification

Poorer cancer outcomes have been observed in the Grampians region compared with other Victorian regions. The reasons for these poorer outcomes are unknown but it is likely that a mix of factors contribute, namely disease (e.g., type of cancer), patient (e.g., lifestyle, genetics, timing of presentation, and participation in treatment), system (e.g., treatment access and quality), and environmental (e.g., exposure to carcinogens). Higher rates of unhealthy behaviours may be indicative of lower health literacy and other social determinants of health, and of lower levels of engagement with primary and preventative care.

This project sought to use the Ophelia process to understand health literacy-related factors that may contribute to disparities in cancer diagnoses and mortality in the Grampians region. Prior to the current study, there were no data available to describe the health literacy of Grampians residents, nor the relationships between health literacy strengths and challenges, lifestyle behaviours, participation in cancer screening programs, and people’s experiences when engaging with local services.

From February to May 2015, health literacy and demographic data was collected by survey from 1,698 Grampians residents, including people with cancer, and members of the community without a cancer diagnosis. A subgroup of survey respondents also took part in phone based semi-structured interviews exploring their healthcare experiences.

What solutions were found?

This data was discussed in eight workshops across the region with consumer participants, cancer healthcare workers and general practitioners. The findings highlighted the need to provide services and regional partnerships with insights into consumer and service strengths, and the challenges community members experience when accessing and engaging with services.

Based on these findings, stakeholders determined the aim of their intervention would be to facilitate communities to assess their needs and develop plans to take action to improve access to local services. An organised small town cancer care strategy was identified as a method to systematically organise efforts to make cultural changes, build community capacity to participate in screening and surveillance, and promote full engagement in cancer care.

Impact on service and community

The overall purpose of the project is to develop and trial a model that will allow agencies that work closely with small communities to reduce cancer mortality for people with all health literacy profiles by activating community strengths. The expected outcome is to have 1) strategies that communities can employ to overcome barriers to participation in care across the cancer journey, and 2) ground work for the development of a framework to guide small town service development nationally.

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