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Cullerton, Katherine, Gallegos, Danielle, Ashley, Ella, Do, Hong,Voloschenko, Anna, Fleming, MaryLou, Ramsey, Rebecca, & Gould, Tr-ish(2016)Cancer screening education: Can it change knowledge and attitudesamong culturally and linguistically diverse communities in Queensland,Australia?Health Promotion Journal of Australia, 27 (2), pp. 140-147.

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https://doi.org/10.1071/HE15116

https://eprints.qut.edu.au/view/person/Cullerton,_Katherine.htmlhttps://eprints.qut.edu.au/view/person/Gallegos,_Danielle.htmlhttps://eprints.qut.edu.au/view/person/Fleming,_Mary-Louise.htmlhttps://eprints.qut.edu.au/view/person/Ramsey,_Rebecca.htmlhttps://eprints.qut.edu.au/view/person/Gould,_Trish.htmlhttps://eprints.qut.edu.au/view/person/Gould,_Trish.htmlhttps://eprints.qut.edu.au/96800/https://doi.org/10.1071/HE15116

1

Abstract 1

Issue addressed 2

Screening for cancer of the cervix, breast and bowel can reduce morbidity and mortality. Low 3

participation rates in cancer screening have been identified among migrants internationally. 4

Attempting to impact on low rates of cancer screening, the Ethnic Communities Council of 5

Queensland developed a pilot Cancer Screening Education Program for breast, bowel and 6

cervical cancer. This study determines the impact of education sessions on knowledge, 7

attitudes and intentions to participate in screening for culturally and linguistically diverse 8

(CALD) communities living in Brisbane, Queensland. 9

Methods 10

Seven CALD groups (Arabic-speaking, Bosnian, South Asian (including Indian and 11

Bhutanese), Samoan and Pacific Island, Spanish-speaking, Sudanese and Vietnamese) 12

participated in a culturally-tailored, cancer screening education pilot program that was 13

developed utilising the Health Belief Model. A pre and post education session evaluation 14

measured changes in knowledge, attitudes and intention related to breast, bowel and cervical 15

cancer and screening. The evaluation focused on perceived susceptibility, perceived 16

seriousness, and the target population’s beliefs about reducing risk by cancer screening. 17

Results 18

There were 159 participants in the three cancer screening sessions. Overall participants’ 19

knowledge increased; some attitudes toward participation in cancer screening became more 20

positive; and intent to participate in future screening increased (n=146). 21

Conclusion 22

These results indicate the importance of developing screening approaches that address the 23

barriers to participation among CALD communities and that a culturally tailored education 24

2

program is effective in improving knowledge, attitudes about and intentions to participate in 25

cancer screening. 26

So what 27

It’s important that culturally tailored programs are developed in conjunction with 28

communities to improve health outcomes. 29

30

Key words: breast cancer; cervical cancer; colorectal cancer; screening; ethnicity; lifestyle 31

intervention. 32

33

34

35

36

37

38

39

40

41

42

43

44

45

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48

49

3

Background 50

Cancer is costly in terms of treatment, life years lost, and the impact on the community and 51

the health system. Screening for cancer of the cervix, breast and bowel can reduce morbidity 52

and mortality (1). However, these reductions are dependent upon regular screening of the 53

eligible population. Low participation rates in cancer screening have been identified among 54

migrants in countries such as the United States and the United Kingdom (2-4). Limited 55

Australian studies have determined that people from culturally and linguistically diverse 56

(CALD) backgrounds are less likely to participate in regular cancer screening (5-9). CALD 57

populations in Australia have a higher risk of some cancers and are more likely to be 58

diagnosed late for others, screening therefore remains an imperative (10-12). Without 59

strategies to promote cancer screening among eligible populations from CALD backgrounds, 60

reductions in morbidity and mortality may not be as great for these communities, compared 61

to non-CALD groups. 62

63

In order to rectify low rates of cancer screening, there have been recommendations for the 64

development of targeted interventions to improve access to screening programs through the 65

provision of appropriate information and education. In 2010, the Federation of Ethnic 66

Communities Councils of Australia stated the importance of undertaking education 67

campaigns that provide basic information but are tailored to specific communities (13). The 68

provision of culturally-appropriate information is critical to ensure that members of CALD 69

communities can make informed decisions about their health, including choosing to 70

participate in regular screening. In response to the call for targeted interventions, The Ethnic 71

Communities Council of Queensland (ECCQ) developed a pilot Cancer Screening Education 72

Program (PCSEP) for breast, bowel and cervical cancer. 73

74

4

The PCSEP was developed in conjunction with the Queensland Cancer Screening Program, 75

after an extensive literature review and needs analysis to assess knowledge, attitudes and 76

barriers to cervical screening among CALD communities. A range of factors were identified 77

to explain the low screening participation rates, including: lack of knowledge regarding the 78

necessity to undertake screening; information materials not available in the language of 79

choice; low literacy levels; poor access to health services; cultural and religious practices; 80

embarrassment, stigma and fear and; general poor health literacy (5); (6); (7); (14); (15); (4). 81

82

As a result it was recommended that a culturally-specific education strategy be developed to 83

increase the awareness of, and participation in, cancer screening in CALD populations. While 84

the focus was initially on cervical cancer, the recommendation was to broaden the remit to 85

include breast and bowel cancers. Evidence has shown that Multicultural Health Workers 86

(MHWs) are critical to the success of cancer screening programs targeting CALD 87

communities (16), accordingly, it was decided that this program needed to be delivered by 88

trained MHWs in culturally sensitive and safe community settings. 89

The pilot module undertaken in 2012, aimed to target barriers and enablers identified by 90

people from CALD communities that were amenable to change, such as, logistics (language, 91

transport, child care, social support); not understanding the benefits of cancer screening; and 92

cultural sensitivities to screening. Subsequent evaluation of the cancer screening module 93

would determine whether it would be incorporated into the already operating Living Well 94

Multicultural Health Education Program conducted by the ECCQ. 95

96

The Queensland University of Technology (QUT) was engaged by the ECCQ to evaluate the 97

impact of the pilot cancer screening module on participants' knowledge, attitudes and 98

intention to participate in cancer screening. 99

5

100

Theoretical Framework 101

The PCSEP utilised the Health Belief Model in its conceptualisation and delivery, with the 102

focus being on perceived susceptibility, perceived seriousness, and whether the target 103

populations believed action (in this case cancer screening) could reduce the threat of cancer at 104

an acceptable cost to the individual (17). Table 1 provides a summary of the Health Belief 105

Model as it applies to the PCSEP. 106

107

108

109

The PCSEP was designed to address the various components of the Health Belief Model 110

around health behaviour, including possible reasons for non-compliance with recommended 111

cancer screening. Each session in the program was prepared by a cancer screening expert and 112

then adapted by the ECCQ MHWs for each specific community. The development and 113

modification of all the sessions involved key MHWs examining the material for 114

understanding and cultural appropriateness, and using pictorial images that were relevant to 115

the communities they were intended to address. All materials were translated into the relevant 116

language for the target communities. The MHWs were trained to deliver the education 117

sessions and were required to demonstrate their competence prior to delivering the sessions to 118

the community. Three different sessions were conducted by MHWs, one each on bowel, 119

breast and cervical cancer. This paper provides background on the development of the pilot 120

cancer screening sessions and the impact they had on knowledge, attitudes and intentions of 121

people from CALD communities across the three cancer screening types. 122

6

123

Methods 124

This study had ethics approval from the QUT Human Research Ethics Committee 125

(#1200000097). The program was delivered by MHWs recruited and trained by ECCQ. 126

127

Survey development 128

The evaluation focused on changes to participants’ knowledge, behaviours and intentions. A 129

literature review of validated survey tools examining changes in cancer screening knowledge 130

and attitudes of a range of ethnic groups was conducted. Six validated tools were examined in 131

detail (8, 18-23), and in combination with the MHWs and the objectives of the sessions, a 132

draft survey tool for each cancer type was produced. The questions are commonly used, 133

however reliability and validity have not necessarily been reported. A copy of the survey tool 134

is available from ECCQ on request. 135

136

The draft survey tools were assessed for content and face validity, in English and in the 137

languages of each identified community, by ECCQ MHWs. For face validity, the tools were 138

piloted on two community members from each ethnic group. The final pre- and post-session 139

survey tools were completed based on the feedback from the pilot, this included clarity of 140

questions and simplification of language. 141

142

Sampling 143

The pilot program was undertaken with a convenience sample of members from the ECCQ 144

Chronic Disease Program’s seven priority cultural groups; Arabic-speaking, Bosnian, South 145

Asian, Samoan and Pacific Islander, Spanish-speaking, Sudanese and Vietnamese. The 146

rationale for the selection of these groups included: the high incidence of chronic disease, 147

7

evidence of a high prevalence of risk factors compared with the rest of the population; and 148

that the participants were representative of established and emerging communities in south-149

east Queensland (24). The MHWs recruited participants through their own networks, using a 150

range of recruitment techniques that were culturally appropriate. Most recruitment was via 151

word of mouth. All participants received the same verbal and written information about the 152

survey from the MHWs. Completion of the survey was deemed to be consent. All of the 153

MHWs were female, and a majority of female participants were recruited, in particular to the 154

breast and cervical screening sessions; however, men were not excluded. The MHWs 155

collected survey information from participants aged over 18 years of age. 156

157

Data collection 158

Data were collected via quantitative interviewer-administered questionnaire. The MHWs 159

were trained in collecting and entering the evaluation data into a database. The MHWs 160

administered the survey tool immediately before and after the sessions. They went through 161

each question verbally with participants in a group, and assisted those who had difficulty 162

understanding or completing the surveys. 163

164

Variables 165

Cancer and cancer screening related knowledge 166

Knowledge was assessed on a seven point Likert scale ranging from “1 – completely 167

disagree” to “7 – completely agree” for the questions: “a person can have cancer even if they feel well”; and “the risk of getting cancer 169

increases with age”. Participants were asked if they had heard of the relevant test for the 170

respective cancer, whether they knew at what age screening should commence, and how 171

8

frequently screening should occur. Responses to the two latter questions were categorised 172

into either ‘correct response’ or ‘incorrect response’ for data analyses. 173

174

Attitudes towards cancer and cancer screening 175

Attitudes towards each of the three cancers and respective screening were measured using a 176

seven point Likert scale, asking participants how they felt about three statements where 1 was 177

“completely disagree” and 7 was “completely agree”. The statements were as follows: 178

1. Attitudes towards cancers 179

It is possible that I will get in the future; 180

I am more likely to develop than other people; and 181

Thinking about scares me. 182

2. Attitudes towards screening 183

It would help to put my mind at rest 184

It would find abnormal cells before they become cancer 185

It would reduce the risk of dying of cancer 186

187

Reasons for non-participation in screening 188

Participants who had not participated in screening were asked to indicate reasons prior to and 189

after the sessions had been delivered. Results are available for bowel and breast cancer 190

screening, but not for cervical cancer due to low numbers of participants. 191

192

Screening behaviour 193

Those who fell within the eligible age groups for screening for each respective cancer were 194

asked to indicate whether they had participated in the relevant screening process (Yes or No). 195

9

196

Data analysis 197

Data were cleaned and analysed using Statistics Package for Social Sciences (SPSS) (v.17.0) 198

database. Continuous variables were assessed for normality using Schapiro-Wilkes; none 199

were normally distributed. Subsequently continuous data were analysed using Wilcoxon-200

signed ranks test and categorical variables assessed via McNemar test. 201

202

Results 203

Participation 204

While all seven CALD groups were targeted for all of the screening sessions there was 205

mixed recruitment and participation based on the capacity of MHWs. Five pre and post 206

sessions on bowel cancer were conducted, one each for Arabic-speaking, Bhutanese, Spanish-207

speaking, Sudanese and Vietnamese participants. Prior to the session commencing, 69 208

participants completed the bowel cancer survey. The response rate for the post-session survey 209

was 92.7% (n= 64). Seven breast cancer sessions were conducted, one each for Arabic-210

speaking, Bosnian, Indian, Samoan and Pacific Islander, Spanish-speaking,, Sudanese and 211

Vietnamese communities, with 69 participants attending. The response rate to the pre- and 212

post-session surveys was 88.5% (n = 61). Two cervical cancer screening sessions were 213

conducted, one each for the Sudanese and Arabic-speaking communities. Twenty-one 214

females participated in the cervical cancer sessions. All participants completed pre- and post-215

session surveys. Only data from participants completing both pre and post questionnaires are 216

reported. Table 2 provides demographic information about participants. 217

218

219

220

10

The changes in knowledge and attitudes pre- and post-session for each type of cancer are 221

summarised in Table 3. 222

223

224

225

Knowledge about cancer and cancer screening 226

For all types of cancer, there was a significant increase (towards strongly agree) after the 227

education sessions in response to the questions ‘a person can have cancer even if they feel 228

well’ and ‘the risk of getting bowel/breast/cervical cancer increases with age’. When asked 229

about their knowledge of the Faecal Occult Blood Test (FOBT), mammogram and Pap smear 230

prior to the sessions, 56%, 22%, and 14% of participants respectively had not heard or were 231

unsure of the respective screening processes. This decreased to 23% (P < 0.01), 5% (P = 232

0.04) and 0% respectively after the sessions. 233

234

For bowel and breast cancer there was a significant increase in the number of participants 235

able to correctly identify the age at which screening should commence (46.9% pre-session vs. 236

79.7% post-session for bowel cancer, 14.8% pre-session vs. 37.7% post-session for breast 237

cancer), and for breast cancer a significant increase in the proportion of participants able to 238

identify the correct frequency with which screening should be undertaken (39.3% pre-session 239

vs. 90.2% post-session) (Table 3). Generally the Sudanese, South Asian (Indian and 240

Bhutanese) and Arabic speaking communities had the lowest levels of awareness of the 241

screening process across all three cancer types. 242

243

Attitudes towards cancer screening 244

11

There was a significant increase amongst participants (towards strongly agree) in attitudes 245

towards the possibility of developing bowel cancer in the future, that screening would help 246

put women’s minds at ease regarding breast cancer, and that screening would reduce the risk 247

of dying of cervical cancer. 248

249

Reasons for not participating in screening 250

Reasons for non-participation in bowel and cancer screening are summarised in Table 4. 251

The most common reasons for not having a mammogram before the sessions were: not being 252

at risk; not having any symptoms; fear of the examination and; not knowing where to go. 253

Among those who attended the bowel cancer sessions, significantly fewer reported not 254

participating because they had no symptoms on completion of the sessions. Among those 255

attending breast cancer sessions, significantly fewer reported not knowing where to go as a 256

barrier to screening on completion of the sessions. 257

258

Across the range of cancers, participants in the Bosnian group were more likely than other 259

participants to select I don’t feel at risk and Fear of examination. Participants in the Indian 260

and Bosnian groups were more likely than other participants to select I don’t have any 261

symptoms. In contrast, participants in the Samoan and Pacific Islander group were more 262

likely to select Lack of interest, I don’t know what to do, or I don’t know where to go. They 263

were also more likely to select It is useless because if something abnormal is found nothing 264

can be done about it. Although they were asked, the Spanish-speaking, Sudanese and 265

Vietnamese participants provided no response to this question. 266

- Insert Table 4 - 267

Reported Screening Behaviour 268

12

While not statistically significant, the proportion of eligible participants (50 years or older) 269

who reported having undertaken an FOBT decreased between sessions, from 33%, reducing 270

to 27% (P = 0.13). This was evident in most cultural groups, except for the Sudanese and 271

Bhutanese. None of the Sudanese participants reported that they had a FOBT, and this did not 272

change after the session. 273

274

There was no change in the proportion of eligible women (40 years or older) reporting that 275

they had undergone a mammogram (46%, both pre- and post-session) (P = 1.00). No 276

Samoan and Pacific Island participants reported having had a mammogram. This result was 277

consistent with the fact that all were under 30 years of age. 278

279

All participants in the cervical cancer screening sessions were within the target age range for 280

screening. Again while not statistically significant, but of clinical importance, 76% of 281

participants prior to the session, reported that they had participated in cervical cancer 282

screening, this increased to 91% after the session (P = 0.125). Of note, Sudanese participants 283

specifically reported lower rates of ever having had a Pap smear compared to the Arabic 284

speaking participants, prior to the session (55.5% vs 91.7%); this rating markedly increased 285

to 89% post education sessions, however, this was not statistically significant (P=0.24) 286

287

Intention to participate in screening 288

Prior to the sessions, when asked whether they intended to undertake a FOBT in the next 12 289

months, 25% of participants reported yes, 33% reported no, and 42% reported not sure. After 290

the sessions, the percentage of participants who were planning to undertake a FOBT in the 291

next 12 months increased to 49%, and only 20% reported that they would not undertake the 292

test. Across all cultural groups, more participants intended to have a FOBT in the next 12 293

13

months following the session. Increases ranged from 7% for Arabic-speaking to 50% for 294

Spanish-speaking participants. 295

296

With respect to screening for breast cancer, prior to the session, 30% of women from Bosnia, 297

33% from India, 40% from Spanish-speaking countries, 78% from Arabic-speaking 298

countries, and 43% from Samoa and Pacific Islands reported that they planned to have a 299

mammogram in the following twelve months. After the sessions, more Arabic-speaking 300

participants, but less Bosnian, Spanish-speaking, Indian, and Samoan and Pacific Island 301

participants planned to have a mammogram in the following twelve months, due to increased 302

knowledge about the target age. For cervical cancer screening, both pre- and post-session 303

surveys indicated that 81% of participants intended to have a Pap smear in the next 12 304

months. 305

306

Discussion 307

The evaluation results from the pilot cancer screening education sessions indicate an increase 308

in knowledge (across all sessions/cancer types), with varying improvements in attitudes 309

specific to each cancer. The overall objectives of the education sessions were to increase 310

awareness amongst the participants of the benefits of screening, increase knowledge about 311

the importance of screening and reduce anxiety. The Health Belief Model was used in the 312

sessions to address participants perceived susceptibility, disease severity and threat of, bowel, 313

breast and cervical cancers. It highlighted the perceived benefits of participating in the 314

screening programs and likely barriers to participation. In addition, the program was designed 315

to increase knowledge of the cancers, their symptoms and their risk factors. 316

317

14

The age range of participants varied across the different sessions. The majority of participants 318

were aged between 35 to 44 years, potentially reflecting a heightened fear of cancer in this 319

age group and a greater interest in general health as well as the recruitment strategies of the 320

MHWs. Most participants had been in Australia for more than six years potentially reflecting 321

a focus on personal health may only be possible once competing needs have been met (25). 322

Also, for many CALD communities, there is limited provision for early detection and health 323

screening in their countries of origin (14, 15), thus screening is an unfamiliar practice. 324

325

Overall, general knowledge about the three different cancers increased after participation in 326

the program, while a marked increase was noted in knowledge about the recommended ages 327

at which screening should take place. This is important as knowledge is a precursor for 328

changes in attitudes and intentions (17). 329

330

The attitudes towards participating in the screening procedures started out relatively positive 331

and, in most cases, remained the same after the education sessions with changes in 332

knowledge also occurring. This finding is an important step along the continuum of change 333

towards increasing the likelihood that these CALD community participants may seek the 334

opportunity to be screened with consequent earlier diagnosis. 335

336

The fatalistic approach to cancer, held by many people in CALD communities, may be able 337

to be changed. For example, some participants changed their belief that screening was futile if 338

something abnormal is found nothing can be done about it. This may be dose-related, that is, 339

the more education occurs, and the more personal stories of positive screening outcomes from 340

within the community that are communicated, the more likely it is that there will be changes 341

in attitude. Fear of the examination was still a salient factor for many cultural groups, and 342

15

indeed for the general population, this could present as a significant barrier, and needs to be 343

further investigated in relation to how it could be reduced in each community. However, in 344

the Health Behaviour Model, fear can act to promote appropriate behaviour change although 345

high levels can act as a barrier to action (26). Cultural differences in the level of fear were 346

noted and this warrants further investigation. 347

348

The education sessions identified a number of issues in relation to current behaviour and 349

intended behaviour change which have implications for practice including over-reporting, 350

health literacy and informed consent. Some of the literature indicates that members of CALD 351

groups may be less likely to provide accurate reports of their cancer screening behaviour, and 352

that over-reporting may be an issue (2). This study found a similar issue in relation to FOBT 353

and the accuracy of understanding what the test entailed. Without access to accurate 354

information, members of CALD communities may misunderstand questions about screening 355

behaviours. Therefore, reported screening behaviours in such communities should be viewed 356

with caution. 357

358

High rates of reported screening for cervical cancer (91% post sessions) may suggest that 359

women are participating in tests at the request of their General Practitioner (GP), without 360

either a clear idea of what the test is, or what the results may indicate. This raises issues about 361

the degree of autonomy and general health literacy of women from CALD communities. It 362

also raises issues regarding the responsibilities of GPs who should be providing information 363

on screening tests in the relevant languages at the appropriate level of literacy. 364

365

Intentions to engage or continue to engage in bowel and cervical cancer screening increased 366

or remained similar across all cultural groups indicating a step towards appropriate action. 367

16

There was a decrease in intention for breast cancer screening which was appropriate given the 368

younger age group of the participants. There are two approaches that could be taken to 369

increase engagement; the first is education programs targeted to those within the appropriate 370

age groups. Alternatively for CALD communities, it may be that education needs to be across 371

broad age groups to ensure active dissemination into each community. The potential for 372

dissemination via women of all ages in the community, as well as positive pressure from 373

children, spouses and other significant members of the community, should be utilised to 374

enhance participation rates. 375

Limitations 376

The number of participants from the relevant CALD communities was low and this impacted 377

on the ability to produce results that were of statistical significance. Data presented here does 378

however provide evidence of potential areas for focus in the future. The evaluation of the 379

educational sessions relied on the MHWs who ran the sessions, and collected and entered the 380

data. Even though the MHWs had some training to encourage consistency of data collection, 381

lack of consistency was an issue. The database for recording information from participants 382

was developed to reduce error, however there is still the potential that data entry errors 383

occurred. This could be overcome with a more user-friendly database that limits what can be 384

inputted and responsibility for quality assurance provided at an organisational level. 385

386

While the questions have all been derived from previous surveys and are in common use their 387

reliability and validity, in particular among the different ethnic groups, has not been 388

ascertained and this could be a limitation. Some participants noted, via feedback from 389

MHWs, that the Likert scale was confusing. It may be worthwhile investigating a pictorial 390

Likert scale or other alternatives that would be better understood by CALD participants. It 391

should also be noted due to limited time and funds the tools were not back translated into 392

17

English to ensure meaning was not lost. As a result of these limitations care needs to be taken 393

with the interpretation of data and the results should be used to generally inform the 394

development and implementation of similar programs. 395

396

By measuring knowledge and attitudes at the same time we may not have accurately 397

measured change in attitude among the participants as knowledge is a precursor for changes 398

in attitudes and intentions. 399

400

Conclusion 401

The pilot cancer screening sessions appear to have enhanced positive attitudes toward cancer 402

screening and increased intentions to participate in cancer screening among selected CALD 403

communities. The culturally-tailored sessions delivered by MHWs in the appropriate 404

languages, provided opportunities for community members to ask questions, and clarify 405

information in a culturally safe environment. This is particularly important for community 406

members with low levels of literacy. Tailoring of health information provided by health 407

professionals is crucial for the appropriate delivery of health information to CALD 408

communities. 409

410

List of Abbreviations 411

CALD: Culturally and linguistically diverse; MHW: Multicultural Health Worker; ECCQ: 412

Ethnic Communities Council of Queensland; PCSEP: pilot cancer screening education 413

program; FOBT: Faecal Occult Blood Test 414

Competing interests 415

18

The authors declare that they have no competing interests. 416

417

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491

492

493

494

495

496

497

498

499

500

501

502

503

504

505

506

507

508

509

510

511

512

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Table 1: Application of Health Belief Model (Adapted from National Cancer Institute, 2005) 513

514

Concept Definition Potential Change Strategies in Cancer Screening Education Program

Perceived susceptibility

Beliefs about the chances of getting the condition

Participant’s risk of cancer is discussed and the importance of regular cancer screening is stressed. Define populations at risk.

Perceived severity Beliefs about the seriousness of a condition and its consequences

Fear of detection of cancer is addressed in the sessions.

Perceived benefits Beliefs about the effectiveness of taking action to reduce risk or seriousness

The benefits of early detection are stressed at the sessions. Define action to take; how, where, when.

Perceived barriers Beliefs about the material and psychological costs of taking action

Issues of fatalism and embarrassment are addressed. Sessions are conducted in target community’s language.

Cues to action Factors that activate “readiness for change”

Utilising MHWs are important positive cues to action. Provide how-to information.

Self-efficacy Confidence in one’s ability to take action

The sessions use a step-by-step approach to explaining how participants can participate in cancer screening.

515

516

517

518

519

520

521

522

523

524

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Table 2: Demographics of cancer screening session participants 525

Numbers may not add up to 100% due to missing data 526

Bowel

n (%)

Breast

n (%)

Cervical

n (%)

Cultural

Group

Arabic-speaking 14 (21.9) 12 (19.7) 13 (61.9)

Bhutanese 8 (12.5) n/a n/a

Bosnian n/a 10 (16.4) n/a

Indian n/a 7 (11.5) n/a

Samoan n/a 8 (13.1) n/a

Spanish-speaking 12 (18.8) 6 (9.8) n/a

Sudanese 15 (23.4) 7 (11.5) 8 (38.1)

Vietnamese 15 (23.4) 11 (18.0) n/a

Gender Male 20 (31.3) n/a n/a

Female 44 (68.8) 61 (100) 21 (100)

Age (years) Under 35 11 (17.2) 14 (22.9) 5 (23.8)

35-64 33 (51.5) 33 (54.1) 13 (61.9)

Over 65 20 (31.3) 8 (13.1) 3 (14.2)

Time in

Australia

(years)

Less than 2 5 (8.1) 6 (9.8) 0

2-5 9 (14.1) 7 (11.5) 2 (9.5)

6-10 16 (25.0) 15 (24.6) 10 (47.6)

More than 10 32 (50.0) 32 (52.4) 9 (42.9)

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Table 3: Median pre- and post-session ratings on cancer knowledge among CALD groups in Brisbane, Australia (Median, Interquartile Range) or n(%) 527

Bowel Breast Cervical

Pre Post P -

value Pre Post p-value Pre- Post p-value

Knowledge

A person can have (bowel, breast or

cervical) cancer even if they feel

well?

7.0 (4.0 – 7.0) 7.0 (6.0 - 7.0) < 0.01 6.0 (4.0 – 7.0) 7.0 (6.0 – 7.0) 0.002 6.0 (5.5 – 7.0) 7.0 (6.0 – 7.0) 0.02

The risk of getting (bowel, breast or

cervical) cancer increases with age

7.0 (5.0 – 7.0) 7.0 (6.0 – 7.0) 0.04 6.0 (5.0 – 7.0) 7.0 (6.0 – 7.0) 0.001 6.0 (6.0 – 7.0) 6.0 (6.0 – 7.0) 0.08

Correctly identifies age at which

screening should start (%)

30 (46.9) 51 (79.7) 0.04 9 (14.8) 23 (37.7) 0.003 0 (0) 0 (0)

Identifies correct frequency for

screening (%)

20 (31.3) 15 (23.4) 0.44 24 (39.3) 55 (90.2) 0.01 15 (71.4) 18 (85.7) 0.45

Attitudes

It is possible that I will get bowel,

breast or cervical cancer in the future

4 (3.5 – 6.5) 5.0 (4.0 – 7.0) 0.05 6.0 (4.0 – 7.0) 6.0 (4.0 – 7.0) 0.51 6.0 (4.0 – 6.0) 5.0 (3.0 – 6.0) 0.70

I am more likely to develop bowel,

breast or cervical cancer than other

people

4.0 (3.0 – 5.0) 3.0 (3.0 – 6.0) 0.68 4.0 (3.0 – 6.0) 4.0 (3.0 – 6.0) 0.89 6.0 (4.0 – 6.5) 6.0 (5.0 – 7.0) 0.21

Thinking about bowel, breast or

cervical cancer scares me

6.0 (5.0 – 7.0) 6.0 (5.0 – 7.0) 0.58 6.0 (5.0 – 7.0) 7.0 (5.0 – 7.0) 0.21 4.0 (2.5 – 5.0) 4.0 (3.0 – 5.0) 0.25

Screening would help to put my mind

at rest

7.0 (6.0 – 7.0) 7.0 (6.0 – 7.0) 0.92 7.0 (6.0 – 7.0) 7.0 (6.0 – 7.0) 0.03 6.0 (6.0 – 7.0) 7.0 (6.0 – 7.0) 0.31

24

Screening would find abnormal cells

before they become cancer/so it can

be treated quickly

7.0 (6.0 – 7.0) 7.0 (7.0 – 7.0) 0.12 7.0 (6.0 – 7.0) 7.0 (6.0 – 7.0) 0.10 6.0 (6.0 – 7.0) 7.0 (6.0 – 7.0) 0.28

Screening would reduce the risk of

dying of bowel, cervical, or breast

cancer

7.0 (6.0 – 7.0) 7.0 (7.0 – 7.0) 0.13 7.0 (6.0 – 7.0) 7.0 (6.0 – 7.0) 6.0 (4.0 – 7.0) 7.0 (6.0 – 7.0) 0.007

*Median score out of a possible seven ± standard deviation 528

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Table 4. Reasons for non-participation in screening 529

Bowel (FOBT)

(n=49)*

Breast

(Mammogram)

(n=37)*

Pre % Post % P value Pre % Post %

P

value

I don’t feel at risk 8 2 0.25 19 11 0.22

I don’t have any symptoms 22 6 0.04 19 14 0.45

Fear of the examination 10 12 1.0 16 11 0.25

Lack of interest 8 12 0.73 9 0 0.13

Test being unpleasant 4 0 0.50 5 6 1.0

Not yet being of risky age 8 6 1.0 14 22 0.73

I don’t know what to do 14 8 0.51 16 6 0.13

I don’t know where to go 4 0 1.0 16 3 0.03

Lack of transport 0 0 1.0 2 0

I will leave it for God to decide 2 0 1.0 2 0 1.0

I am always busy 2 6 1.0 2 0 0.69

It is useless because if something

abnormal is found nothing can be done

about it 2 0

1.0

4 0

0.50

*Multiple responses permitted does not add up to 100% 530 531

532

533

534

535

536

MethodsThis study had ethics approval from the QUT Human Research Ethics Committee (#1200000097). The program was delivered by MHWs recruited and trained by ECCQ.Survey developmentThe evaluation focused on changes to participants’ knowledge, behaviours and intentions. A literature review of validated survey tools examining changes in cancer screening knowledge and attitudes of a range of ethnic groups was conducted. Six validat...Knowledge about cancer and cancer screening*Median score out of a possible seven ± standard deviation