A new study has found that using a community-codesign approach can massively increase mammography screening rates among Italian and Arabic-speaking women.
The study, published in PLOS One, tested simple but novel strategies suggested by women in the community and co-designed by Breast Screen Victoria as part of the OPtimise HEalth LIteracy and Access (Ophelia) process, developed by a team led by Distinguished Professor of Health Sciences at Swinburne’s Centre for Global Health and Equity, Professor Richard Osborne.
Women in Australia from culturally and linguistically diverse (CALD) backgrounds undergo mammography screenings less often than the general population. This study showed that a reminder phone call in the women’s preferred language (in this case Italian or Arabic) was ten times more effective in addressing this issue than the standard practice of no phone call at all.
Using Ophelia to address inequality
Ophelia was designed to give women and health professionals a voice in the research process.
“Health literacy is linked to health outcomes. People with lower health literacy are less likely to be able to find and use the healthcare they need. Ophelia was developed to address this inequality, and to test and identify new initiatives and provide organisations with a structured approach to bridge this gap. We do this by taking a people-, clinician- and organisation-centred approach to better understand how to improve our services and systems to provide all people fair access to the services they might need,” Professor Osborne explains.
“Part of Ophelia is understanding how we can produce meaningful opportunities for the community to improve their chances of health. In this instance, we were able to find a low-cost, effective, simple solution to increasing CALD women’s participation in mammography screenings” he adds.
The study, funded by the Victorian Government and delivered in partnership with BreastScreen Victoria was implemented by Prof Osborne’s research team, including Dr. Alison Beauchamp, now at the University of Melbourne.
It focused on women from Italian and Arabic-speaking backgrounds residing in north-west Melbourne—an area where increasing screenings is considered a priority. Participants consisted of a random sample of women, aged 50 to 75, from Arabic and Italian-speaking communities who were due for their mammography screening, as well as women who were under-screened.
In the first trial, women who were due for a screen were either sent routine reminder letters in English with a translated version in their preferred language—either Arabic or Italian—or they received the letter in English only (control group). In the second trial, women who were overdue for a screen either received reminder phone calls in their preferred language, or no phone call (control group).
In these controlled trials, sending letter reminders in English with translated letters in the reader’s preferred language showed no difference. However, the phone calls proved to be 10 times more effective than receiving no call at all
In her words
A trial participant from the Italian-speaking community said: “Receiving a call from an Italian-speaking woman made me feel comfortable to know what the call was about.”
Another participant said: “It was very helpful for me, and for other Italian women, when booking an appointment to be able to ask what to expect from our breast screening. Being called prompted me to book a screening.”
“Community consultation was key to our understanding of intervention strategies that would support participation in mammography screenings. The success of in-language calls means we now routinely use them to reach people eligible to screen from CALD backgrounds, and we see very good take up of our appointments as a result. It is vital that our service is accessible to everyone who’s eligible,” says BreastScreen Victoria CEO Vicki Pridmore.
“This is a remarkable, almost never seen effect. By making this simple low-cost intervention, we have the potential to significantly improve screening rates in this group of women. The Ophelia process has caught the attention of many researchers, governments and the World Health Organisation. The Ophelia process is now having impact in many countries to improve health and reduce health inequality,” Professor Osborne adds.