B14.4 Mobilizing Newcomers and Immigrants_Linda Stobo

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