Pacific health groups tackle breast screening barriers

Many barriers face Pacific Island women over breast screening in New Zealand, including problems accessing transport, different languages and a lack of information and understanding.

By Kara Segedin: Pacific Media Centre

Front line health organisations like the West Fono Health Trust in Waitakere city are making progress directly in their communities by addressing the unique barriers to health care facing Pacific people in New Zealand.

Earlier this year, the West Fono Health Trust was recognised for services to breast screening by Health West PHO. It won an award for most improved practice for breast screening after being contracted by BreastScreen Waitamata Northland to bring Pacific women into the national breast and cervical screening programmes.

Soana Havili is from the community team working with cervical and breast screening.

“We contact women and give them information,” she says.

Havili says there are many barriers for Pacific Island women attending screening, including problems accessing transport, different languages and a lack of information and understanding.

“They don’t know where to go,” she says.

The team helps by offering support and assisting with bookings, transport, and assessment.

“Sometimes their husbands don’t want them to go because there is a lack of understanding,” says Havili.

“The women also don’t want to go to male doctor.”

Wider community
The trust visits Pacific Island groups and churches to bring information to the wider Pacific community.

Havili has seen an increase in the number of women coming for screening in the last year.

“If we do well now it will be much better in the future,” she says.

Pacific Island women in New Zealand continue to be over represented in statistics for breast and cervical cancer. Breast cancer is the most common cancer for Pacific Island women and has a relatively high mortality rate.

Over the past 25 years, figures from the Ministry of Health show ethnic disparities in cancer survival have increased.

In a 2004 report, the Ministry of Health said barriers to breast screening for Pacific Island women included fear, procrastination and pain, whereas a GP’s recommendation was a major motivator to get a mammogram done

Figures from the National Screening Unit (NSU) show only 50 percent eligible of Pacific Island women had mammograms in the 24 months to May 2008. To address the low rates of screening, late last year the NSU ran an ad campaign specifically targeting Pacific Island women and their communities.

The aims were to raise awareness about breast screening, increase understanding of the benefits of early detection and the importance of two-yearly screening.

Graham Bethune of the NSU says for BreastScreen Aotearoa's programme to be effective they must screen 70 percent of the eligible population.

“We are currently at 61 percent for total New Zealanders, but only 50 percent for Māori and Pacific people,” he says.

Reducing deaths
BreastScreen Aotearoa aims to reduce the number of women developing and dying from breast cancer by early diagnosis, allowing treatment to begin sooner.

The goal of their ad campaign was to encourage Māori and Pacific Island women to make appointments to have breast screenings and to show them how to do this.

A campaign that simply targeted all New Zealand women would have been unlikely to significantly increase the percentage of Māori and Pacific Island women having breast screens.

Embarrassment, a lack of understanding of the benefits and where to go all make it difficult for Pacific Island women to attend screenings.

“Many Pacific women weren’t aware it was free,” he says.

The attitudes of husbands, families and the community can be a barrier.

“The ads help get the message into all families’ living rooms,” Bethune says. “It’s on national television, it’s not hidden or secret in anyway.”

The ads could be seen on TV3, Māori Television, iwi radio stations, Nui FM radio network, Mana magazine, Tu Mai, and Spasifik. They show breast screening as an “everyday part of family health”.

While not available in other languages, their advertising material is Pacific orientated, tested with Pacific women and addressing Pacific cultural issues.

It will take 12 months to get statistics to show whether the campaign been statistically significant.

“It’s too early to say, but anecdotally it’s been really positive,” he says.

Meremana Beconici, GSL Network, worked on the advertising with the NSU. The priority audience was Māori and Pacific Island women aged 45-69 who have never been screened or who do not have regular biennial screens.

“There is a secondary target,” says Beconici.

“The family, friends and community members who support and influence these women.”

Research showed women liked straightforward messages, which removed any mysteries associated with screening. They decided to use real people, stories, and experiences.

Suzanne McNicol, marketing and communications manager of the New Zealand Breast Cancer Foundation (NZBCF), says “we do know that Pacific women are 20 per cent more like to die than other New Zealanders (excluding Māori)”.

She does not know exactly why Pacific Island women along with Māori are more like to die from breast cancer, but “part of the problem is late diagnosis”.

The foundation’s goals are that all Pacific Island women and all eligible New Zealand women attend biennial breast screening.

“Screening doesn’t stop breast cancer, but does reduce the chances of dying from the disease by 33 percent,” she says.

“We recommend all women are breast aware, this is recommended for women of all ages. They need to know what’s normal for them,” says McNicol, and seek assistance from their doctor if they notice any changes.

“They need to attend screenings. That’s the key thing that’s not getting through. We want women to know that biennial screening is free for all New Zealand residents.”

McNicol says they had difficulties reaching the Pacific community in the past because “we’ve been using one message for all women”.

Previous health campaigns have not recognised that “different communities need different communications”.

Māori and Pacific people are more receptive to aural and verbal messages and not the pages of data and reports usually supporting health campaigns.

The NZBCF has partnered with community groups, churches, health groups and schools to get information to Pacific people. They are also changing their model of health education to better target the Pacific Island audience.

Kara Segedin is a Graduate Diploma in Journalism student on the Asia-Pacific Journalism course at AUT University.

NSU ad campaign [video]