Daksha Trivedi and Claire Thompson (UH) are supporting colleagues at NHS England and Improvement, in partnership with the British Islamic Medical Association, to design and carry out an evaluation of an educational bowel cancer screening intervention in Luton and Peterborough.
Background
Inequitable access to healthcare and preventive services leads to significant, avoidable disparities in health outcomes for some groups in society, particularly ethnically diverse communities. Local health organisations are aiming to increase uptake of screening and reduce health inequalities. Luton Borough Council has a large, mobile population and Luton CCG has the lowest uptake of bowel screening in the East of England In Black, Asian and Minority Ethnic groups.
We hypothesise that culturally adapted interventions within faith institutions may improve participation in cancer screening in people with low uptake. Targeting local areas in the East of England, which has the highest proportion of Muslims (2011 census data) with a very low uptake of bowel cancer screening (e.g. Luton) has the potential to reach populations with a high risk of health inequalities. It also has the highest proportion of Muslims in the East of England.
Project Aim
We aimed to conduct a pragmatic process evaluation of the BIMA intervention in Muslim communities. We identified the objectives below:
- Assess knowledge, attitudes and behaviours to bowel cancer screening at baseline, post intervention (intervention group only) and at six-month follow-up
- Assess intention to undertake screening, as well as validated screening uptake:
- Self-reported intention to undertake screening
- Number/ proportion of participants requesting a screening KIT
- Number/ proportion of participants returning screening a screening kit
- Understand the feasibility, accessibility and acceptability of the intervention for participants
- Understand the feasibility and acceptability of recruiting and training local health professionals to deliver the intervention
- Identify barriers and facilitators that might impact uptake of cancer screening.
Project Activity
An initial BIMA promotion event, delivering educational cancer screening awareness talks by The Muslim Council of Britain involved 39 faith-based venues where 900 BIMA members participated has proved successful in triggering positive cancer screening awareness in the Muslim community.
The British Islamic Medical Association (BIMA) has developed a “faith-placed” intervention to increase awareness of cancer screening and provide information to Muslim communities. It adapts a slide-deck used by Cancer Research UK and uses it to dispel myths, provide motivation and model positive behaviour in relation to screening.
We carried out a two-group non-randomised study, using mixed methods. One group received the intervention, a culturally adapted education session discussing bowel cancer screening. The other group did not receive the intervention. We compared screening uptake, and attitudes to screening, between the two groups.
The intervention was delivered by clinicians from the community and took place at a mosque or community centre. Participants also had the option to receive the intervention virtually.
The evaluation was completed in two phases:
Phase 1:
- Surveys completed by all participants at baseline and at six-month follow up. Participants receiving the intervention will also be asked to complete a survey straight after attending the information session.
Phase 2:
- Focus groups with participants receiving the intervention
- Semi-structure interviews with those delivering the intervention
We applied for NHS ethics approval through the Integrated Research Application System (IRAS). Following a Research Ethics Committee meeting minor changes were made to the study documents. Ethical approval was granted on the 27 October 2021.
We are continuing to prepare to deliver the intervention which includes confirming the study sites and making arrangements with partners to deliver the intervention.
Next steps
- Further stakeholder engagement including identifying intervention and comparison sites, working with local Muslim faith leaders and community groups
- Finalising study tools including intervention resources (in-person and on-line delivery) and participant surveys
- Intervention delivery and evaluation started in December 2021.
Papers and resources
This project can be viewed in a case study format for easy accessibility
For more information about this research, read the ARC East of England blog
