Increasing knowledge about cancer among multicultural groups to achieve health equality
Arja Leppänen describes an innovative project to raise awareness about cancer and cancer prevention in hard-to-reach areas
The Regional Cancer Center at Stockholm-Gotland, Sweden, initiated a pilot project in Botkyrka, a multicultural and multilingual county in southern Stockholm. The goal was to increase knowledge about cancer and prevention in this community, focusing on lifestyle and self-care. Botkyrka residents originate from over 100 countries and speak 160 different languages. This community has the lowest mean income and educational level in the region. Challenges encountered in the project included issues related to language barriers, health literacy, different cultural and/or religious attitudes towards cancer, and traditions. We addressed the issue of language barriers by having local interpreters during our meetings and, in addition, translating the printed information materials into 12 different languages. In many cultures you don´t visit the doctor or hospital unless you are sick and many of them are not used to thinking “PREVENTION”.
Associations between levels of education, socioeconomic factors and cancer are well-documented and supported by scientific evidence. Population-based data from the Swedish Board of Health and Welfare show differences in attending cancer screening, cancer incidence and survivor within the Stockholm region.
One part of the project was to recruit and educate volunteers from the community to serve as Peer Advisors. Their role was to communicate with and inform their peers about health and how to reduce their risk of developing cancer. The peer advisors worked approximately three to four hours a week and interacted with their peers at schools, metro stations, market places, families, workplaces, places of worship, and in different community organizations. They reported their activities, progress and other issues to the project manager.
Before the start of the project, the peer advisors were educated for their new role. The education included lectures and seminars about the following topics: European Code Against Cancer, cancer screening, cancer biology and care, patients’ rights, motivational interviewing, etc.
A main part of this project was to arrange and conduct public information activities to raise awareness about cancer and cancer prevention. Many of these activities were arranged in collaboration with multicultural organisations that are active in the community. Our experience so far is that these information activities bring us closer to populations who we usually do not reach with other health campaigns in Swedish. The printed materials distributed in this project are based on the European Code Against Cancer, which include international pictograms, suitable for this multicultural project.
Besides an excellent collaboration between local and regional stakeholders, the involvement of non-health care professionals and a patient representative at all levels has been a driving factor for the success of the project. The peer advisors are in a unique position ability to reach populations who may be unfamiliar with the Swedish health care system and may have a low level of health literacy.
They reach out with information to groups and areas where we haven’t been able to reach before. It is important to work with peer advisors who live in and know the area, who can spread information in their native language. The fact that I, as project manager, am a cancer survivor has also been important for the project’s legitimacy. Feedback from people in the municipality demonstrated change in their health habits and life style as a result of the information received. (Eight peer advisors were offered permanent employment as a consequence of their involvement with the project.)
There are many success factors and especially the information being provided in the mother tongue and peer advisors’ local affiliation, but there have also been challenges and obstacles – cultural, financial and around the issue of how to reach out to additional municipalities. However, the positive effects of the project are so many that an implementation of peer advisors in the Stockholm-region has been approved and is now implemented on regular base in several municipalities: our plan is to implement 10-15 peer advisors in every municipality in the Stockholm region who will all be supported by a Coordinator employed by Regional Cancer Centre. In addition, many municipalities nationwide have shown interest in the work.
Arja Leppänen is process manager, Equality in Cancer Care and Patient Involvement at the Regional Cancer Centre, Stockholm Gotland, Sweden, and project manager of the Botkyrka project.