For Bowel Cancer Awareness Month, our Prevention and Early Detection in Health and Social Care Theme Lead Dr Claire Thompson and Sadia Begum (Senior Research Assistant) discuss their theme's research that evaluates The British Islamic Medical Association intervention, which aimed to increase awareness of the importance of bowel cancer screening among the Muslim community in Luton and Peterborough.
My name is Claire Thompson and I am the Theme Lead of the Prevention and Early Detection in Health and Social Care at ARC East of England. I am a qualitative researcher at The University of Hertfordshire and my research primarily focuses on health and social inequalities and food. Since being a part of this research theme, my interests have broadened and I have had the opportunity to work on a variety of projects including evaluating The British Islamic Medical Association (BIMA) intervention for bowel cancer screening in the Muslim community. My father suffered from bowel cancer some years ago, so when Professor Daksha Trivedi started working with the partners on this project, I was keen to get involved.
Bowel cancer is the fourth most common cancer in the UK. In most cases, it is treatable when caught early and screening tests can find the disease even before symptoms start – so by raising awareness of what bowel cancer is and, crucially, of the free screening programme offered by the NHS, we can make a real-life difference to people’s health. This is especially the case in minority communities which may face a number of barriers and challenges when accessing health services.
Encouraging bowel cancer screening in the Muslim community
"There is evidence suggesting that people from areas of high deprivation and from ethnically diverse communities are less likely to be made aware of the symptoms of bowel cancer or the importance of bowel cancer screening. They are also less likely to take part in this screening. All the above can lead to inequality when it comes to bowel cancer diagnosis and treatment."
Bowel cancer screening uptake is approximately 28% lower in people of South Asian ethnicity, compared to the general population. To increase the uptake, The British Islamic Medical Association (BIMA), a national association of British Muslim healthcare professionals, designed a culturally adapted intervention with the aim to increase awareness of the importance of bowel cancer screening among the Muslim community.
This involved a one-hour educational session delivered by a health professional from BIMA across mosques across Luton and Peterborough, where there is a high Muslim population and low uptake of bowel cancer screening. The underlying idea was that, by tailoring the intervention to the specific cultural and religious background of the target group, health professionals could make the information more accessible.
Evaluating the impact of the intervention
The evaluation aimed to explore how successful the intervention was. This is to support the idea that if we tailor the message and outreach of the screenings depending on the audience, health professionals are better able to reach people within a specific community. This, in turn, has significant implications when it comes to addressing health inequalities and increasing the success of public health initiatives.
Working in partnership with other organisations – BIMA, NHS England and NHS Improvement, local authorities, Luton Council of Mosques, cancer groups, regional clinical commissioning groups – and public and community contributors has been central to the project from the start. Initially, we held a stakeholder event to launch the study and generate ideas on possible approaches, potential barriers that we may encounter and solutions to those. As the intervention was delivered in mosques in Luton and Peterborough, its success depended on the engagement of mosque leaders and volunteers – they spread the word about the intervention, encouraged people to attend, and hosted the delivery. Peer researchers who supported data collection were recruited from the community.
"The relevance of this research lies in its engagement with the community it concerns – our project would not have been possible without the support of community contributors and partners."
Finally, we wanted to encourage people to start conversations on this important, but often maybe embarrassing or taboo subject. To achieve this, we encouraged participants to share what they learnt during the intervention with their families and friends to spread awareness within their community networks.
Our preliminary findings suggest that the intervention does improve engagement around screening and awareness of bowel cancer and cancer symptoms. At a recent focus group for those who received the intervention, a participant told us that a few weeks after he attended the session, his wife started to show symptoms. He explained that, thanks to the intervention, he was aware of the potential health issue and so encouraged his wife to go to the doctor. Further testing was needed, and she was diagnosed and treated for another type of cancer. She is now in recovery.
Researchers play a key role in engaging with target communities and finding ways to encourage involvement
Sadia Begum, our Senior Research Assistant, spoke about challenges and learnings from our project during the recent ARC East of England Showcase in Peterborough. She highlighted the importance of being aware that people from different communities can be unfamiliar with research and what it involves. That, in turn, impacts on their willingness to participate in research projects.
"It is the job that the research community do … in communicating why research is important and making it accessible for all groups."
As in all research, we did face some challenges that we anticipated such as language barriers. We had peer facilitators and researchers who spoke a range of languages used by the participants, however, this matter still at times impacted on how smooth the data collection process was. This shows the need for researchers wanting to work with diverse communities to make significant allowances for language diversity prior to data collection, both in terms of resources and funding.
Sadia also explained that if information on public health issues and research comes from trusted community sources and there is space for people to ask questions, communities are more likely to take notice and engage. Again, she highlighted the role of researchers in looking for ways to make research more inclusive: “It is a researcher’s duty to communicate why research is important and give diverse groups more opportunities to find out about it”.
We still have some data collection to complete, and we are now starting to analyse the data we have. Once the project is complete and we have published the findings, we aim to apply for additional funding to further the roll-out and evaluation of the intervention.
Overall, we hope that the intervention and its evaluation will generate evidence informing national practice in terms of better targeting specific communities and, thus, help address health inequalities. We hope that this in turn will increase bowel cancer screenings amongst the Muslim community.
The project team included:
- Daksha Trivedi (Principle Investigator)
- Claire Thompson (Theme Lead)
- Nigel Smeeton (Social Statistician)
- Sadia Begum (Senior Research Assistant)
- Emilia Tylenda (Prevention theme Research Assistant)
Beyond the University of Hertfordshire, the wider project team includes, and has included:
- Julia Varnes (Assistant Screening & Immunisation Coordinator at NHS England – East of England)
- Marimba Carr (Public Health Registrar)
- Tara Berger-Gillam (Public Health Registrar)
- Salman Waqar (GP, British Islamic Medical Association, University of Oxford)
- Joanne Freedman (Public Health Registrar
- Charlotte Cuddihy (Public Health Registrar)
- Iffat Tejani (Patient and Public Involvement (PPI) cancer survivor)