Aims of the research
This research project aims to determine the acceptability and feasibility of the NBCSP’s Alternative Access Model (AAM) among the Mandarin-speaking Chinese community and primary healthcare providers who provide services to people from diverse backgrounds. The ultimate goal is to identify appropriate and tailored strategies that will optimise screening participation and increased participation rate.
How conducted?
This is a two-pronged qualitative study with the Chinese community and General Practitioner Clinics across diverse socioeconomic areas in Victoria.
Progress to date
Community arm:
- Run five in-language focus group discussions
- Facilitated five in-language co-designing workshops
- Participants: a total of 100 people, 50 males and 50 females, aged 45-74
GP clinics’ arm:
Conducted 42 semi-structured interviews with Healthcare Providers (HCPs), including Practice Managers (PMs), Practice Nurses (PNs) and General Practitioners (GPs)
Findings
Findings from working with community groups
Health and bowel health literacy
- Low health, in particular bowel health literacy (e.g. views such as ‘won’t get bowel cancer if having a healthy lifestyle’; ‘no symptoms, hence, no need to participate in screening)
- Misunderstanding the importance of the screening program verse risks of diagnostic procedure
Barriers to participation
- English language proficiency
- Self-efficacy (lack of confidence in collecting the right samples)
- Store the first sample in fridge
- Logistic challenges (e.g. posting collected samples to a lab due to no car and/or concerns about temperature)
- Anxiety and fear of knowing a positive screening result and having a cancer
Enablers to participation
- Proactive health behaviours (e.g. seeing GPs every six months or annually)
- Trust relationship with own GPs/HCPs
Awareness of AAM
- Poor or no awareness of AAM
- Acknowledged benefits of engaging with HCPs (trusted and familiar healthcare workers)
Findings from working with HCPs
Awareness of and perception on AAM
- Most HCPs interviewed were unaware of AAM due to insufficient information and training available
- Unaware of the differences/implications of distributing a once-off (from pathology) screening kit verse enrolling a patient into/providing a screening kit from the NBCSP
- Most interviewees viewed AAM as consistent with their existing responsibilities and not particularly disruptive of clinic workflows
Challenges in using AAM
- Time constraints: normal consultation leaves no space and time for promotion and distribution of NBCSP kits
- Distribution of kits from pathology was perceived as convenient and fulfilled a duty of care
- Some patients’ entrenched belief/preference of having colonoscopy verse participating in screening program
Challenges in promoting bowel cancer screening program using AAM
- Initial integration of clinical software (i.e., the software currently used by individual clinic) with the National Screening Register
- Ongoing IT support
Recommendations
- Embed screening promotion into routine checkups, health assessments, chronic health management plans and so on
- Dedicated Medicare code for screening promotion and distribution of NBCSP kits (via AAM)
- Importance of educational resources and awareness-raising initiatives
One of the outputs based on findings from the focus group discussions with communities, and interviews with healthcare providers, the research team and other stakeholders (i.e. community members and HCPs) have co-developed a multifaced resource package which includes:
- Eight factsheets in both English and Simplified Chinese addressing issues/challenges identified
- Three short videos (1-2-minute) in conversational/dialogue format with English or Simplified Chinese subtitles that promote NBCSP and encourage participation