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How can we reach non-English speakers for cancer screenings?

A behaviourally-informed conversation guide

  • Blog
  • 11th Jul 2024

Detecting cancers early typically makes them easier to treat. So it might seem like a clear choice to get a cancer screening, especially when they’re provided at no cost.

But not everyone takes advantage of screening when they’re eligible, and groups with language and cultural barriers get screened even less. Health organizations are working hard to address this disparity, which has only worsened since the COVID-19 pandemic.

East Toronto Health Partners (ETHP) uses a Community Health Ambassador (CHA) model. In this leading practice, CHAs from various East Toronto communities have culturally sensitive 1-on-1 conversations with their neighbours about free cancer screenings and follow up with them to take the next step.

ETHP partnered with BIT to enhance their CHA program with behavioural science, the study of human behaviour and how our actions are influenced by different contexts. Letters designed with behavioural principles have helped boost urgent cancer referral rates and breast cancer screenings. Low-cost interventions like these have successfully targeted broad populations. 

But ETHP’s work with BIT achieved something different. We explored what behavioural science looks like when the needs of a population—and the programs designed to serve them—are unique from those of the general public.

A guide for engaging non-English speaking communities

We created a behaviourally-informed conversation guide for CHAs to use when calling community members who speak Arabic, Bengali, Dari, Pashto, Slovak, and Urdu. 

The CHA program aims to increase screenings for breast, cervical, and colorectal cancers among these harder-to-reach groups. BIT’s guide enables ambassadors to have more productive, culturally-responsive conversations that encourage people to book a screening or complete one at home.

Behavioural barriers to cancer screenings

ETHP began by partnering with Health Commons Solution Lab on two co-design sessions where community members who speak the priority languages discussed barriers to getting cancer screenings. Some included:

  • Taboos. Cancer may cause fear or carry stigma. Some community members did not feel comfortable using the word “cancer” to avoid manifesting it in their households.
  • Screening isn’t a priority. Household decision-makers may be too busy to pay attention to preventive screenings for themselves or members of their family.
  • Word choice. Certain terms related to breast, cervical, and colorectal cancer may be off-putting because of cultural norms around modesty (e.g., words for specific body parts).

Behavioural insights applied to the guide

Our team developed the guide to address these barriers and to make it as easy as possible for CHAs to use. We used EAST (Easy, Attractive, Social, and Timely), one of BIT’s evidence-based frameworks, to apply behavioural science concepts, such as: 

1) Clear, culturally-informed language

We all have limits to the amount of information we can process. This limited cognitive bandwidth makes it hard for CHAs to simultaneously talk and search for information in the guide. It’s also a reason why community members may find it challenging to navigate the healthcare system and to follow conversations in their non-native language. 

Using clear and culturally appropriate language in the guide minimizes this cognitive load and makes conversations easier between CHAs and community members.

2) Framing screening effectively

The way something is presented influences how we interpret it. We framed information in the guide with CHAs and community members in mind, especially in explaining the value of cancer screenings. 

Community members may have had negative experiences with the health care system in the past that make them want to avoid it. They also might not see screenings as urgent, given competing priorities in their daily lives.

An illustrative example from the guide showing behavioural insights applied.

We presented content in a simple, logical, and easy-to-read way with a large font, clear guidance, and keeping each page focused on a single topic. Plus, we provided talking points to help ambassadors frame screenings in a positive light and showcase their value.

3) Leveraging social networks

If people we know (or people who are like us) do something, we’re more likely to do it too. As members of East Toronto communities themselves, CHAs are strong messengers for cancer screenings.

They’re able to relate to community members at a local level and steer them toward preventive care. The guide urges them to leverage these social connections by building rapport, emphasizing that screenings are a good way to take care of loved ones, and highlighting that getting screened is normal.

Results

ETHP implemented the guide in early 2024 and CHAs used it to shape more than 1,000 phone conversations with community members. CHAs found it to be an empowering tool:

An Urdu speaking CHA said, “The cancer screening calling script was very comprehensive and provided guidance on how to address all possible concerns in a culturally appropriate manner.  It was because of this document that our answers were always consistent, concise and clear.”

While a Pashto speaking CHA reflected, “As a Community Health Ambassador, this guide was so useful, offering tailored strategies to engage in sensitive health conversations with an appropriate tone (including cultural sensitivity). I also appreciated the relevant resources which were organized conveniently for quick access.”

Based on this success, ETHP is exploring customizing the guide for other programs, including broader community outreach to raise awareness of cancer screening, regardless of whether someone is overdue. 

Iteration is key. CHAs were able to adapt the guide in real-time based on the questions they were getting most frequently from community members. One of the lessons learned from this program more broadly was that in-person outreach may be more effective than phone calls. ETHP will explore this next.

Preventive care access for all

Health care is confusing, even more so for people who aren’t familiar with the language or services offered. This holds true even when services are free. Key barriers lie in behaviour.

Applied behavioural science can complement and maximize the reach and impact of high-touch health programs to make health care access more equitable for priority groups. Contact us here if you’d like to explore enhancing your program with behavioural insights.

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