Population outreach

This section summarizes the strategies that many provinces and territories employ to improve screening participation and the screening experience for First Nations, Inuit, and/or Métis, and other equity-denied populations*.

*Note: language describing groups of people who have been and continue to be marginalized and underrepresented changes rapidly. The Partnership recognizes the changing nature of language, and uses the term “equity-denied” throughout this section for consistency.

Learn more about strategies to improve cervical screening for:

Jurisdictions work with a variety of populations to ensure programs and equitable and culturally safe. Equitable access to screening services is an element of organized screening programs (IARC). Specific communities, partners, and organizations are listed in the table below.

Specific communities, partners, and organizations

British Columbia
British Columbia is working with First Nations Health Authority and Indigenous communities.

Alberta
To improve access to screening, programs have been engaged in projects for people with low income, immigrants, and people without PCPs. In addition, data linkage with First Nations and Métis Nation is informing equity actions.

Saskatchewan

SPCC has worked with OUT Saskatoon (an organization that promotes, serves, supports, and leads 2SLGBTQ people in Saskatchewan) in writing the revised cervical guidelines and healthcare provider resources. Guidelines expected to be released in 2023.
SPCC is working with a newcomer center to support language translation of SPCC resources. The goal is to tailor resources for newcomers/immigrant communities.
Delivering cervical screening clinics targeted towards under-screened/never-screened, at-risk populations (low income, people without a PCP, recent immigrants and refugees, and racial or ethnic minorities). On-site support includes Indigenous Elders, clinicians with expertise in STI counselling and support, healthcare providers administering the Pap test, and gyneoncologists for consultation and diagnostic testing. Healthcare providers deliver cervical health education to all clients.

Manitoba

Manitoba is working with:

Newcomers
People with low income
Specific cultural groups
People with mental illness or physical disabilities
People living in Indigenous communities or remote locations

Ontario

Ontario is working with:

First Nations, Inuit, Métis and urban Indigenous communities
People with lower levels of achieved education and different categories of age, immigrant status, cervical screening history, gender identity and sexual orientation
French speaking Ontarians

New Brunswick

New Brunswick is working with:

First nations community health clinics
Women’s Equality Branch
Gender-diverse people

Nova Scotia

Using the IAP2 Engagement Spectrum, Nova Scotia is collaborating with:

Mi’kmaq First Nations
Nova Scotians of African descent
2SLGBTQIA

Prince Edward Island

Prince Edward Island is working with members of Indigenous communities and representatives of community organizations:

Lennox Island First Nation (Mi’kmaq community)
Native Council of Prince Edward Island

A report was released in April 2023 that focused on the facilitators and challenges specific populations encounter when accessing cancer screening programs. The consultation team addressed community members from PEI’s Indigenous communities and organizations since they often face inequities in accessing cancer screening programs and health care more generally.

Newfoundland and Labrador

The Cervical Screening Initiatives Program continues to work with Indigenous communities throughout the province to increase equity and access to cervical screening. Work includes:

Culturally appropriate community and education sessions by health professionals
Access to service grants and collaboration through CPAC-funded FNIM projects

Additionally, the program will seek to increase awareness and offer access to service grants to groups serving those in equity-deserving populations such as new Canadians, low-income groups, those without access to PCPs, and rural and remote communities.

Community engagement

Engagement strategies include developing educational materials and campaigns, holding focus groups, and ongoing relationship building.

Highlights in population outreach and engagement

Saskatchewan

The Saskatchewan Cancer Agency (SCA) did intentional work to align their prevention and early detection programs to maximize resources and knowledge/skills. Saskatchewan is now developing a community engagement framework. This framework will encompass the values and concepts crucial to successful engagement, and will support equitable, considerate, and appropriate engagement efforts for primary and secondary users within the population health department, and potentially throughout the SCA.

SPCC strategic engagement planning will begin once the above-mentioned framework is finalized, with an anticipated completion in 2024.

SPCC has engaged a university-based research team in Saskatchewan to survey people with lower screening participation (never screened, screened less than recommended, or under-screened). This includes a focus on persons living in northern, remote, or rural communities, and persons identifying as immigrants, Indigenous, and/or LGBTQ2S+. This will support data gathering and inform strategies to improve equitable screening, particularly the engagement planning framework identified above.

Manitoba

In addition to exploring implementation options and capacity, the HPV Self-Sample (2021–2022 CPAC-funded grant) Project sought to increase participation in eligible patients overdue for screening (no Pap test in five or more years) by offering a home-based cervical cancer screening kit. In addition to screening status, the pilot prioritized underserved populations unlikely to access healthcare services due to geographic location, language barriers, and personal concerns (history of trauma, work priorities, childcare, etc.) in the study recruitment strategies.

New Brunswick

New Brunswick Cancer Network (NBCN) has an existing communication, awareness, and marketing plan for their population-based cancer screening programs. Strategies include radio advertisement, GNB Facebook, GNB Twitter, paid Facebook and Instagram ads, digital programmatic ads on popular NB websites (Kijiji, CBC, Yahoo, and The Weather Network), digital screens in regional health authorities and Service NB centres, digital billboards in major cities (Moncton, Saint John, and Fredericton), public transit ads (Moncton, Saint John, and Fredericton areas), digital news platforms (Telegraph Journal and Acadie Nouvelle), and Google Search promotional ads.

Strategies used to identify and reduce barriers to screening participation

Alberta

Continuing discussions with the Alberta First Nations Information Governance Centre to develop an ongoing dashboard to monitor progress in decreasing disparity in cancer screening.
Determining accessibility to immigration data.
Currently using work completed by geospatial mapping, and social and material deprivation index to identify equity-deserving areas/communities.
Working with LGBTQ2S+ groups to develop inclusive screening resources.

Saskatchewan

SPCC is using geographical data to understand areas of lower participation rates, and has investigated screening participation rates in northern subpopulations (representing many Indigenous and remote groups).

SPCC is working with a university-based research team in Saskatchewan to roll out a survey on cervical cancer screening attitudes, knowledge, and barriers. The objective of this study is to survey Saskatchewan residents aged 25–69 with a cervix to assess motivations and barriers to cervical cancer screening, and explore why individuals within specific populations (e.g., those living in rural, northern areas) never screen, under-screen, or screen less than recommended.

Manitoba

The program works in consultation with community groups and organizations to ensure that all resources utilize inclusive language. Program distributes education resources that target LGBTQ2S+ individuals, which are focus tested before release. Cervical cancer screening guidelines include specific guidelines for transgender individuals and utilize inclusive language.

Ontario

Ontario Health has conducted an analysis on screening participation and follow up after an abnormal test result by two indexes (material deprivation and ethnic concentration) and by postal code region. Results are available shared via a public report that may help inform regional initiatives to address equity issues.

Engagement with Regional Cancer Programs (RCP) and work with Regional Primary Care Leads has been important in identifying equity-deserving populations within each region and tailoring recruitment strategies to ensure they are appropriate and effective.

New Brunswick

Based on feedback received through our provincial cancer screening line, GIS mapping, etc., the Cervical Cancer Prevention and Screening Program may identify equity-deserving populations or communities with barriers to screening. These include:

Low-income
Recent immigrants and refugees
Non-English and non-French speakers
People without a PCP
People with mental illness
People with physical disabilities
People who are houseless
Specific geographic areas
Federally-insured individuals (armed forces, RCMP, refugees, immigrants)
Gender-diverse

Nova Scotia

Literature scan explored potential differences in behavioural barriers experienced by the identified groups of marginalized communities.

The scan identified behaviourally informed interventions. Nova Scotia undertook qualitative research with the intention to investigate potential behavioural barriers to awareness and uptake of cancer screening. Consultations happened with seven pre-identified, historically marginalized populations/communities.

Received consistent messaging from all seven community consultations:

An adequate communications and engagement approach will require co-designed community engagement that includes trusted community members.
If trusted members of the community are not engaged, community members are likely to hesitate to participate in the program. This is especially true for groups that mistrust the healthcare system because of stigma and historical factors.

Community consultations were conducted as part of the pre-implementation work for the new lung screening program, which included the colon and cervical programs in the messaging.

Prince Edward Island

A report released in April 2023 presented the main findings from a series of consultations with community members to understand their levels of awareness, understanding, and participation in cancer screening on PEI. The study consulted with members from the growing immigrant population and members of PEI’s Indigenous communities. Health PEI selected these two populations for the study, given research results that demonstrate they often face inequities in accessing cancer screening programs and health care more generally.

Newfoundland and Labrador

The Cervical Screening Initiatives Program works with all community and health-related partners to increase equity and access to cervical screening throughout the province. Work includes public engagement sessions, social media promotion, and networking with healthcare professionals through orientation sessions. In addition, access to service grants is offered to PCPs for open-access clinics where cervical screening and necessary follow-up is provided.

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