Review of Aboriginal Women’s Health Check Day (AWHCD)

Programme commenced from 2009Tammy Yam

BreastScreen NSW Northern Sydney Central Coast

April 2018

BreastScreen NSW

Acknowledgements

Clients of Aboriginal Women’s Health Check Day

Members of Aboriginal Women’s Health Check Day Committee

Special thanks to:

Aunty Sue - Cultural Advisor, Macquarie University

Clinical Associate Professor Peter Shine - Director of Aboriginal Health Northern Sydney Local Health District

BreastScreen NSW

Presentation Overview Rationale - Breast Cancer/Screening Behaviour/Social Determinants

Northern Sydney Aboriginal Population (2016 Census)

Key Issues for NSLHD

Barriers for accessing breast screening

What is Aboriginal Women Health Check Day(AWHCD)?

The First AWHCD

Aboriginal Health NSLHD

Community Focused Initiative Approach

Partnerships & Consultations

Outcomes – participation/ trajectories

Conclusions

Important Take-home message

BreastScreen NSW

Rationale

• Breast cancer is the most commonly diagnosed cancer for Aboriginal and Torres Strait Islander women.1

• The disease is diagnosed at a more advanced stage and outcomes are generally poorer than in other Australians.

• Low participation rates in breast cancer screening and social determinants of health led us to confirm this poorly met health need among Aboriginal women in Northern Sydney.

1 Cancer Australia, 2015. National Aboriginal and Torres Strait Islander Cancer Framework, Cancer Australia, Surry Hills, NSW.

BreastScreen NSW

Breast Cancer

In Australia, Aboriginal and Torres Strait Islander women are:1

20% less likely to be diagnosed with breast cancer.

30% less likely to be hospitalised for breast cancer.

5-year relative survival was 81%.

1.3 times more likely to die from breast cancer.

less likely to participate screening.

1 Australian Institute of Health and Welfare & Cancer Australia 2013. Cancer in Aboriginal and Torres Strait Islander peoples of Australia: an overview. Cancer series no.78. Cat. no. CAN 75. Canberra: AIHW.

BreastScreen NSW

Screening Behaviour

• Participation in Breast Screen Australia is lower for Aboriginal and Torres Strait Islander women than for non-Aboriginal women, 37% compared with 53% in 2014-2015.1

• The lower incidence but higher mortality rates, of breast cancer in Aboriginal women could be explained partially by the lower participation in breast cancer screening.

1 Australian Institute of Health and Welfare 2017. BreastScreen Australia monitoring report 2014–2015. Cancer series no. 106. Cat. no. CAN 105. Canberra: AIHW.

BreastScreen NSW

The Social and Cultural Determinants of health

“It is important to address the social and cultural determinants of health as there are many drivers of ill health that lie outside the direct responsibility of the health sector.” Close the Gap Steering Committee1

• Aspects of the broader social environment that can influence the capacity of individuals, families and communities to engage with health care and manage their own health.2

• For Aboriginal and Torres Strait Islander people, the social and cultural determinants of health may include support from family, community and church groups, connection to culture and country, and a sense of empowerment or self-efficacy.2

1 Commonwealth of Australia 2013. National Aboriginal and Torres Strait Islander Health Plan 2013-2023, Australia, Canberra, ACT. 2 Cancer Australia, 2015. National Aboriginal and Torres Strait Islander Cancer Framework, Cancer Australia, Surry Hills, NSW.

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Northern Sydney Aboriginal Population (2016 Census)

• 3,360 people in Northern Sydney reported being Aboriginal and Torres Strait Islander.1

• 0.4% of the total Northern Sydney LHD population.

• The Aboriginal population was younger than the NSLHD population with fewer older people.

• Only 26% (approx. 319) of the female population (1,228) is aged over 45 years of age.2

1 NSLHD Australia’ First Peoples Lifecycle, Health and Wellbeing Plan. Sydney: Northern Sydney Local Health District, November 2015.2 NSLHD Aboriginal Health Services Plan 2013-2016, Sydney: Northern Sydney Local Health District, October 2013.

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Key Issues for Northern Sydney Local Health District (NSLHD)According to the NSLHD Aboriginal Health Services Plan 2013-2016:1

• The Aboriginal population within Northern Sydney is relatively small and dispersed with few specialised services.

• The community has members of the Stolen Generations (ongoing mental & emotional health concerns, combined with chronic illness).

• A significant population of people are light-skinned appearance leads to questioning by service providers of the Aboriginal identity.

• Significant numbers of Aboriginal people from outside NSLHD use services in Northern Sydney including tertiary services at Royal North Shore Hospital.

1 NSLHD Aboriginal Health Services Plan 2013-2016, Sydney: Northern Sydney Local Health District, October 2013.

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Barriers for accessing breast screening

• Effects of this low often marginalised population had led to specific barriers for Aboriginal people accessing health services.

• There were access barriers that related to perceptions of lack of cultural safety, respect and validation within mainstream health services.1

• For breast screening, it is highly likely that Aboriginal and Torres Strait Islander women in Northern Sydney are an unscreened and under screened group.

1 NSLHD Australia’ First Peoples Lifecycle, Health and Wellbeing Plan. Sydney: Northern Sydney Local Health District, November 2015.

BreastScreen NSW

What is Aboriginal Women’s Health Check Day (AWHCD) ?

“A grassroots program developed in 2009 to promote breast

screening to Aboriginal and Torres Strait Islander women in

Northern Sydney by providing a culturally appropriate

environment while supporting them to have regular health

checks to improve health and wellbeing.”

BreastScreen NSW

AWHCD Flyer - 2018

BreastScreen NSW

The First Aboriginal Women’s Health Check Day (AWHCD)

• In 2009, the first AWHCD was delivered in partnership with Northern Sydney LHD, the Aboriginal Social Planner Local Government and non-government organisations.

• A small group of 7 unscreened and under-screened Aboriginal & Torres Strait Islander women attended.

• The feedback was positive that they felt safe and comfortable about breast screening in a group-setting.

BreastScreen NSW

First AWHCD – 2009 Photo Gallery

BreastScreen NSW

Aboriginal Health NSLHD

In 2014, AWHCD is conducted twice a year and all programs are run by NSLHD Aboriginal Health service with local community input and advice.

1. Royal North Shore Community Health Centre (St Leonards)

2. Hornsby Ku-ring-gai Hospital, Bungee Bidgel Aboriginal Health Clinic (Hornsby)

Bungee Bidgel is an NSLHD Aboriginal Health Service clinic at Hornsby Hospital GP Unit. This GP service has supported the AWHCD event since 2014.

BreastScreen NSW

AWHCD Flyers (2017)

BreastScreen NSW

Community Focused Initiative Approach

• Established a trusted relationship by offering a culturally safe place for local Aboriginal women using incentives such as refreshment, pampering massage and free health promotion gifts, etc.

• The most recent event offered women a range of preventative health checks including breast screening, Paps Smear, dental checks, lung function, bladder & kidney checks and diabetes.

• Health talks were introduced - breast screening, smoking cessation, oral health, heart health & healthy food choices with practical tips preventing chronic diseases.

BreastScreen NSW

Community Focused Initiative Approach - Diagram

•Endorsement & funding from NSLHD health services

•Consultations•Partnership of health services and NGO providers

•culturally safe screening environment with incentives eg. refreshment, fried rice & massage

•introduce other health checks – Paps test

•Follow ups & referrals

•Endorsement from Elders, Aunty Sue

•culturally appropriate flyers/artworks

•word of mouth promotion, Aboriginal media etc

Cultural activities

Health check

activities

Community based

Wellbeing program

AWHCD

BreastScreen NSW

Flyers (2014)

BreastScreen NSW

Promotion A range of strategies were used to promote this initiative:

• Culturally appropriate flyers – (printed & electronic) via AWHCD members

• Word of mouth

• Aboriginal and Islander Health Worker Journal

• Koori Mail & Koori Radio

• Websites - Australian Indigenous HealthInfoNet 2015 (Yarning Places)

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Partnerships & Consultations

• AWHCD is a community network facilitated by Aboriginal Health Northern Sydney LHD with representatives from Macquarie University; Sydney North Primary Health Network; Legal Aid and NSLHD including BreastScreen NSW, Oral Health and Women’s Health Services.

• We recognise the importance of a strong partnerships between NSW Local Health Districts (LHDs) and Aboriginal Community at the local level by:

1. Work collaboratively identify women’s health needs

2. Consultation with local Aboriginal community and Aboriginal workers

BreastScreen NSW

AWHCD – 2012 Photo Gallery

BreastScreen NSW

AWHCD – 2015 Photo Gallery

BreastScreen NSW

Outcomes

• Steady increase in participation of breast cancer screening as a result of this health initiative.

• The Aboriginal and Torres Strait Islander women in Northern Sydney aged 50-69 has increased their biennial participation rate by 7.3% from 27.1% (2012-13) to 34.4% (2015-16) as shown in Figure 1.1

1 Data Source: Cancer Institute NSW Sydney April 2018

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Upward Trajectories

• NSLHD 7.3% • NSW 4.1%

BreastScreen NSW

Conclusion

Evidence suggests that the poor cancer outcomes for Aboriginal and

Torres Strait Islander people can be improved by culturally inclusive

and respective environments such as community health and well

being programs to ensure that specific barriers and needs are

addressed as well as boost breast screening participation.

BreastScreen NSW

Important take-home message:

• Building trust through partnerships. Trust takes time!

• Don’t give up, even though the turnout is small

• Who/Where are your Gatekeepers?

• Community-based well-being program is the way to go!

• Transportation is an important factor.

• Aboriginal media – Aboriginal Health Worker Journal, Koori Mail, Koori Radio & websites…

• Cool incentives - goody bags, health diaries, Aboriginal products (hand creams, massage oil, tea, hair treatment) manicure, massage, bra-fitting, raffles etc.

BreastScreen NSW

ReferencesAustralian Institute of Health and Welfare & Cancer Australia 2013. Cancer in Aboriginal and Torres Strait Islander peoples of Australia: an overview. Cancer series no.78. Cat. no. CAN 75. Canberra: AIHW.

Australian Institute of Health and Welfare 2017. BreastScreen Australia monitoring report 2014–2015. Cancer series no. 106. Cat. no. CAN 105. Canberra: AIHW.

Cancer Australia, 2015. National Aboriginal and Torres Strait Islander Cancer Framework, Cancer Australia, Surry Hills, NSW.

Cancer Institute NSW

Commonwealth of Australia 2013. National Aboriginal and Torres Strait Islander Health Plan 2013-2023, Australia, Canberra, ACT.

NSLHD Aboriginal Health Services Plan 2013-2016, Sydney: Northern Sydney Local Health District, October 2013.

NSLHD Australia’ First Peoples Lifecycle, Health and Wellbeing Plan. Sydney: Northern Sydney Local Health District, November 2015.

BreastScreen NSW

Author’s Contact

Tammy Yam

Marketing & Recruitment Officer

BreastScreen NSW NSCCLHD

Tammy.Yam@health.nsw.gov.au