Mobilizing Newcomers
and Immigrants to Cancer Screening Programs
Funded by Public Health Agency of Canada (PHAC) The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada (PHAC).
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Why Do This Project? Newcomer/Immigrant populations Less likely to participate in cancer screening Have later-stage cancer diagnosis (sometimes present at stage of entry
And as a result More likely to experience unfavorable outcomes from the disease 2 of 20
PHAC Cancer Program Community-Based Programming Project Solicitation Priority Removing barriers Raising awareness Promoting participation in cancer screening and early detection among underserved populations
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Project Goal
Develop, deliver and evaluate evidence-based cancer prevention and screening service delivery model Targeted to newcomer and immigrant under/never screened populations in London, Ontario Disseminate across Canada 4 of 20
Project Partners
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Project Structure PHAC SWRCP Advisory Committee Members
CCS
LIHC
CCLC Project Coordinator
Focus Group Facilitators
Iraqi PHE(2)
MLHU
SWRCP
Admin Assistant Evaluator Consultant
Arabic PHE (2)
Spanish PHE (2)
Nepalese PHE (2) 6 of 20
Project Objectives  Increase awareness about cancer risk and prevention among newcomers and immigrants  Increase participation in cancer screening among these target populations 7 of 20
Target population
Immigrant communities
Arabic
Spanish
Iraqi
Health Providers
Nepalese
Middlesex London Health Unit
PCP, Nurse practitioners and PCP office staff
OBSP
LRCP
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Project Components
Community
Bridging
project initiatives
project initiatives
1. Awareness
2. Service Capacity
Activities
Train Peer Health Educators Develop education modules (Phase 1 & 2 focus groups)
Short-Term Outcomes Intermediate Outcomes
project initiatives
3. Service Use
Deliver cultural competency training for health care workers
Inter-Agency project outcomes 4. Partnership
Promote screening facility usage Identification of promising practices
Network with partners and organizations Knowledge exchange Create sustainability plan
Deliver education modules
Develop evidence based cancer prevention and screening awareness model (MNICSP-PHAC)
Output
Long-Term Outcomes
Develop cultural competency training for health care workers
Organizational
Increased collaborations between the partnership and target groups
Increased awareness about cancer prevention among target groups
Increased knowledge about cancer screening eligibility and accessibility
Increased knowledge of challenges and barriers faced by target groups
Increased collaborations between the partnership and service providers
Stronger commitment to ongoing funding, community and partner support
Develop increased cultural competency among service providers: Reduced barriers, increased advocacy to accessing cancer screening services Positive appraisal of ICS programs by the newcomer and immigrant communities
Improve access to information, education, screening and early detection
Increased participation in and access to ICS programs among newcomers and immigrants
Sustainable Partnerships
Increase health care providers’ understanding of unique cultural needs
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Partnership and Collaborative Action Intersection of Health Care/Primary Health, Community Development and Public Health Similar goals and mandates Varying experience with target populations Shared capacity Collaborative agreement 10 of 20
The Peer Health Educator Team Respected member of target populations English language Target languages Public speaking and presentation skills Conflict resolution skills Interest in promotion of healthy behaviours Work flexible hours, evenings and weekends 11 of 20
Phased Approach to Material Development
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Iceberg Concept of Culture and Cancer in Relation to non-Visible Barriers Festivals
Clothing
Music
Food
Literature
Language
Rituals
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Community Evidence-Based Barrier Language “There are many brochures but they do not answer my questions. In our Latino culture we are more personal. I would like the information in person where I could ask in my own language. We do not want to read those and then look on websites or call that number� Spanish Participant 14 of 20
Community Evidence-Based Barrier Knowledge “If I have an abnormal pap test or if I have cervical cancer, my husband should leave me…I would be disowned by my husband. I will not go… I have 4 kids” Arabic participant “Why does the doctor ask if I have relatives with cancer? Is it because it is contagious? Could I infect others?” Nepalese participant 15 of 20
Community Evidence-based Barrier Accessibility “My mom had a medical appointment, so I had to go with her to be an interpreter. When we were in, I asked for a breast screening test – a mammogram – for my mom… …the answer was you need to book another appointment to talk about it. I do not have time and get permission…it is not easy… it is another barrier.” Spanish participant 16 of 20
Phased Approach to Material Development
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Workshops Delivered by PHEs in their language Child care offered and refreshments
Culturally-relevant/community locations Reducing cancer risk (healthy living) Breast, cervical and colorectal cancer screening programs Video – sharing personal experience in cancer screening “What increases your cancer risk” form Booking mammogram and pap test appointments and arranging – “community appointments” 18 of 20
Health Care Providers – Cultural Competency Training ABCDE Model for Cultural Competency
Acknowledgements to Toronto Hospital for Sick Children
Grand Rounds (1) and Evening Workshops (2)
Dr. Bhooma Bhayana, Schulich School of Medicine and Dentistry Dr. Jan Owen, Primary Care Lead, Southwest Regional Cancer Program Dr. Adriana Diaz, Project Coordinator 19 of 20
Next Steps Development of a Sustainability Plan “Model” Toolkit – development/dissemination Workshop Strategy for Targeted Communities Cultural Competency – build on what has been started…
Project Close-Out Documentation of Project Evaluation Report and Final Report to PHAC 20 of 20
Acknowledgements
Questions?
Linda Stobo, Program Manager Chronic Disease Prevention and Tobacco Control Middlesex-London Health Unit linda.stobo@mlhu.on.ca