Cancer screening in CALD communities: what works to improve rates?

When it comes to cancer screening, people from culturally and linguistically diverse (CALD) backgrounds have lower participation rates than the general Australian population. Just under half of Australians who speak English at home are screened for bowel cancer each year, however, that number drops to one-third for Australians who speak a language other than English at home.

As the COVID-19 pandemic and the rise of natural disasters like flooding puts extra pressure on access to screening services, support for CALD communities is paramount. Cancer Council NSW aims to reduce the impact of cancer for CALD communities, and so it commissioned an Evidence Check from the Sax Institute on effective interventions for cancer screening rates for those groups.

The review focused on interventions for Chinese-, Vietnamese- and Arabic-speaking people as they are the largest CALD groups in Australia, and it also looked at interventions addressing tobacco smoking.

Promising ways to change behaviour

The review looked at 49 peer-reviewed studies on cancer screening behaviour and found that there was no single component that was critical for success and most interventions used a combination of components. However, these five interventions all showed promise for both Chinese and Vietnamese groups:

  • Education sessions. These included online community sessions, in person workshops, and simulated training. Most sessions lasted 1-2 hours.
  • Written information. This included presentation slides, handouts, brochures, flyers, posters, letters, booklets, and flipcharts. Information was written in the target audience’s first language and/or English.
  • Visual information. This included pictorial and graphic images that were used to support education sessions, plus infographics, videos, DVDs and comics.
  • Community health worker. A health worker would provide information and support to study participants and this mostly occurred during an education session.
  • Counselling. This intervention was provided over the phone in almost all situations and was often paired with education sessions.

Interventions such as providing the opportunity to be screened or a patient navigation service worked for one but not both groups. More research was needed to determine the efficacy of media campaigns and telephone reminders for either group. There were very few studies focused on Arabic-speaking participants, so only one intervention – the opportunity to be screened – showed promise for that group. 

There were far fewer studies on tobacco cessation available, so the only interventions deemed promising were for Chinese speakers. These interventions were: education sessions, written information, visual information, counselling, involving a family member or friend, branded merchandise and mobile messaging. Nicotine replacement therapy as an intervention was excluded from the review.

Key findings for health planners

The review authors found education was the most common component of successful interventions. Most studies reported a lack of knowledge as the main reason for low cancer screening rates or high tobacco use and found that education was a key enabler for behaviour change. However, the effectiveness of education diminished as knowledge increased and other interventions became more effective.

Another common barrier to cessation and screening was related to language, which could be successfully targeted with a native-language counsellor or patient navigation service. The authors also noted that working in partnerships with community organisations helped ensure interventions met the needs of the targeted group and were culturally appropriate.

Read the full Evidence Check here.