Mobilizing Newcomersand 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).

Adriana Diaz, Project Coordinator, South West Regional Cancer Program

Newcomer/Immigrant populations Less likely to participate in cancer screening Have later-stage cancer diagnosis (sometimes

present at stage of entryAnd as a result More likely to experience unfavorable

outcomes from the disease

Why Do This Project?

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, OntarioDisseminate across Canada

Project Deliverables

Reduce barriers that limit access to cancer prevention/screening information and cancer screening programs

Increase awareness about cancer prevention and screening

Project Deliverables

Improve cultural safety of immigrant and newcomer cancer care experience

Promote participation of immigrants and newcomers in cancer screening and early detection

Project Structure

Advisory Committee Members

PHAC

SWRCP

CCS LIHC

SWRCP

MLHU

Focus Group Facilitators

Admin Assistant

Project Coordinator

Spanish PHE (2)

Arabic PHE (2)

IraqiPHE(2)

Evaluator Consultant

Nepalese PHE (2)

Target populati

on

Immigrant communities

Arabic Spanish Iraqi Nepalese

Health Providers

Middlesex London

Health Unit

PCP, Nurse practitioners

and PCP office staff

OBSP LRCP

PHEs “represent the intersection between risk and resilience, between institution and community, and between research and practice” (Landers & Stover, 2011, p.2198)

The Institute of Medicine (2002) recommended that PHEs be included on multidisciplinary health care teams to address issues in serving racial and ethnic populations that face chronic barriers in accessing the health care system

Peer Health Educator (PHE) Model

Roles: preventative and health education interactions with other Health Human Resource (HHR) Research and health system access and navigation

PHEs have strong ties, based on trust, respect, and mutual understanding, with the communities they serve PHEs understand the needs of their communities, mainly because they have lived and experienced those needs

Peer Health Educator (PHE) Model

Peer Health Educator TrainingTrainingOrientation to the Project

Integrated Cancer Screening/Prevention Education

Training

Focus Group Facilitation Training

Phased Approach to Material Development

Phase 1Determine

Barriers and Knowledge

Phase 2Test

Education Model

Phase 3Deliver Final

Education Product

Phased Approach to Material Development

Phase 1Determine

Barriers and Knowledge

Phase 2Test

Education Model

Phase 3Deliver Final

Education Product

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

Community Evidence-Based Barrier

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

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

Phased Approach to Material Development

Phase 1Determine

Barriers and Knowledge

Phase 2Test

Education Model

Phase 3Deliver Final

Education Product

Cultural differences among target populations necessitates

Customized presentations

Mobilizing Newcomers and Immigrants to Cancer Screening Programs

Next Steps

Develop test

materials

Focus test materials

Review & ReviseDeliver KTE

Evaluate and Refine

Phased Approach to Material Development

Phase 1Determine

Barriers and Knowledge

Phase 2Test

Education Model

Phase 3Deliver Final

Education Product

Delivered by PHEs in their language

Child care offered and refreshments

Culturally-relevant/community locations

Workshops

Reducing cancer risk (healthy living)

Breast, cervical and colorectal cancer screening programs

Workshops

Video – sharing personal experience in cancer screening

“How to reduce your risk” form

Booking mammogram and pap test appointments and arranging – “community appointments”

Workshops

Peer Health Educators ‐ Approach communities in a culturally

sensitive manner ‐ Build trust in communities‐ Deliver information in own language‐ Deliver information with understanding of

culture, traditions and behaviors‐ Find the right location

Learning Points

Use healthy living examples to help overcome fear and anxiety of cancer

Immigrant communities participate in cancer screening programs when the purpose, access to programs, and procedures are understood

Learning Points

ABCDE Model for CulturalCompetency

Acknowledgements to SickKids Hospital in Toronto

Grand Rounds LRCP (1) and Evening Workshops (2)Dr. Bhooma Bhayana, Schulich School of Medicine and

Dentistry Dr. Jan Owen, Primary Care Lead, Southwest Regional

Cancer ProgramDr. Adriana Diaz, Project Coordinator

Health Care Providers – Cultural Competency Workshops

Thank you