FACULTY OF OTHER MEDICINE AND HEALTH CARE

Transcription

1 School Academic of something Unit of Public Health FACULTY OF OTHER MEDICINE AND HEALTH CARE Communicating breast cancer and cancer screening risks to migrants and minority ethnic women: Results of a cross-over trial using an interactive communication tool Dr. Lai Fong Chiu

2 C o m m u n ica tio n stra teg ies T arget all age groups Organise- -W om en s h ealth - aw areness day; -S p ecific h ealth session s in com m u n ities; -O n e-off session about breast health and/or screen in g Target different age groups an d tailor con ten t for g rou p in terests. T ry to access existing groups and to nurture su p p ort w ith in g rou p. P lan h ealth ed u cation con ten t w ith p articip an ts Offer one-to-one in form ation /ad vice for w om en w ho receive breast screen in g ap p oin tm en ts in g en eral p ractices or com m u n ity cen tres O ffer h om e-visits for d ifficu lt to reach g rou p s In form ation C on ten t C onsciousness-raising Body image Im provin g self-esteem, h ealth in form ation - seeking behaviour and sk ills in d ecision -m ak in g G en eral w om en s h ealth Inputs B reast aw areness B reast h ealth B reast changes B reast diseases T reatm ents M enopause H orm one R eplacem ent Therapy C ancer developm ent B reast cancer risk factors B reast aw areness B reast C ancer Screening Program m e Procedure Consequences A ssessm ent procedure Advantages and disadvantages of screening Inform ed consent B reast aw areness W o m e n 's n e e d s D evelop m en tal In form ation an d su p p ort A ssistive support language, physical and tran sp ort

3 Informed Choice For All Project Aim: to investigate, using a participatory action research approach, how the risks and benefits of breast screening are understood by both health operators and MME and lowincome women and to determine a mechanism by which risk information can be effectively communicated to facilitate informed choice

4 Studies (between 1996 present) have shown cancer risk and benefit of mammograms are not perceived accurately by women Anxiety or apathy Over-screened or refusal of screening Psychological barriers fear of cancer embarrassment Social factors impacts on families employment social life

5 Stage 1 Focus groups and literature and information review Stage 2 Preparation for Q-sorts Results of Q- sorts Stage 3 Consensus Forum Stage 4 Field Trial Lay Groups 4 BME groups (Urdu, Bengali, Chinese, African- Caribbean) 1 White group Published Scientific articles on: Breast cancers and screening Professional groups: GPs Practice nurses Public health professionals Concourse of statements : 61 (Breast) statements A total 61 individuals from target communities (Pakistani, Bengali, Chinese, African-Caribbean and low income White) and professionals were recruited. Q-sort analysis Consensus Forum Lay Panel and Professional Panel: Agreed on communication foci and frames (i.e. guidance on risks & benefits messages and how they are framed) The production of the draft of guidance and communication tool-kits A Field trial of risk communication tool-kits 10 Community Health Educators (CHE) trained and carried out 230 individual interviews Results fed into the preparation of Q- statements Results (Risk perception profiles) fed into Consensus Forum for discussion Results fed into the draft of guidance and the construction of communication Tool-kits All results fed into the writing of final report

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10 Literacy Test (REALM- 66 items) 228 women Lit. Data on literacy (ability of reading English Group 1= 117 Group 2= completed both Leaflet and IG 63 completed only IG (nonliterate in both English and Mother-tongue

11 Ethnicity Number Percentage Afro-Caribbean Bangladeshi Chinese Pakistani White Other or not given Total Number Afro-Caribbean Bangladeshi Chinese Pakistani White Education Level Number Percentage Never attended school Completed primary school Completed secondary school Number Technical college graduate University graduate Other or not given Total Never attended school Completed primary school Completed secondary school Technical college graduate University graduate

12 Mean age=55.6 yrs range 39-79

13 Wilcoxon signed-rank test; W=5939.5, p=0.24

14 (Wilcoxon test W=7043, p=0.23) Screening risk score after leaflet Screening risk score after leaflet

15 Wilcoxon Test W = , p = 0.61

16 Wilcoxon test; W=7179.5, p=0.15

17 N=228 (included everyone) Wilcoxon test, W= , p<0.001 (highly significant)

18 N=164 Only those who can both read the leaflet and play the game Wilcoxon test, W= , p<0.001 (highly significant)

19 N=164 Wilcoxon test, W= 39455, p<0.001 (highly significant) Screening risk score after game Screening risk score after game

20 N=108 N=120 Overall mean scores after Game: White=8.6 MME=7.6

21 63 participants scored=0 Overall scores White=3.8 MME=2.7

22 The Interactive Game is a far more effective tool than the leaflet to inform about risk factors and screening risks among both literate and non-literate women Leaflet was not helpful at all to low-literacy women The benefit of Game is clear for both White and MME groups

23 Literacy - Huge variations between groups and within groups Think carefully how to inform people about risks - particularly MME groups which might have cultural issues Community Health Educators' involvement is crucial for understanding and improving health literacy among MME groups

24 Thank you for listening!

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