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 colorectal 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

Yukon

Yukon ColonCheck program has been on the Oversight Committee for the Yukon First Nation Cancer Plan since 2021.

Northwest Territories

Regional wellness councils in each health region, Gwich’in Tribal Council, Inuvialuit Regional Corporation, and Yellowknives Dene First Nation.

British Columbia

First Nations Healthy Authority (FNHA) and Indigenous communities.

Alberta

Screening programs have been engaged in projects with low-income individuals, immigrants, and people without PCPs to improve access. In addition, data linkage with First Nations and Métis Nation are informing equity actions.

Saskatchewan

The SPCRC engages with Indigenous communities across Saskatchewan to provide local education relating to CRC screening (e.g., health fairs and community events).

Manitoba

Newcomers, low-income individuals, specific cultural groups, people with mental illness or physical disabilities, and people living in Indigenous communities or remote locations.

Ontario

Joint Ontario Indigenous Cancer Committee Members, Sioux Lookout First Nations Health Authority, Indigenous Services Canada, and First Nations, Inuit, Métis and urban Indigenous communities.

New Brunswick

First Nations community health clinics, Federally-insured individuals (correctional facilities), and Women’s Equality Branch/gender-diverse people.

Nova Scotia

IAP2 Engagement Spectrum collaborates with Mi’kmaq First Nations, Nova Scotians of African descent, and 2SLGBTQIA community.

Prince Edward Island

Members of Indigenous communities and representatives of community organizations (Lennox Island, Mi’kmaq community, and Native Council of Prince Edward Island).

The consultation team addressed community members from the growing immigrant population on PEI, 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 Newfoundland and Labrador Colon Screening Program continues to work with Indigenous communities throughout the province to increase equity and access to colon screening. Work includes culturally-appropriate education sessions for the community and health professionals, and collaboration through CPAC-funded FNIM projects. In addition, the program will seek to increase awareness of the importance of colon cancer screening 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.

Through the Partnership’s 2019-2022 Developing Strategies for Underscreened Populations through Community Engagement initiative, five jurisdictions (Alberta, Manitoba, New Brunswick, Newfoundland & Labrador, and Northwest Territories) engaged communities to co-develop and implement evidence-based approaches for increasing colorectal screening. Read Five key lessons learned on increasing colorectal cancer screening in Canada to learn about key lessons learned from the project and see videos highlighting successes from each jurisdiction.

Highlights in population outreach and engagement

Northwest Territories

Public engagement work was done with each health region prior to the program roll-out, and phone surveys were conducted in each region after the program was fully active.

Saskatchewan

Intentional work was done to align the prevention and early detection programs to maximize resources and knowledge/skills. Saskatchewan is now developing a Community Engagement Framework that 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 Saskatchewan Cancer Agency.

SPCRC strategic engagement plan completed in January 2024.*

New Brunswick

New Brunswick Cancer Network 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 New Brunswick websites (e.g., Kijiji, CBC, Yahoo, The Weather Network), digital screens in Regional Health Authorities and Service New Brunswick centres, digital billboards in major cities (Moncton, Saint John, and Fredericton), public transit ads (Moncton, Saint John, and Fredericton), digital news platforms (Telegraph Journal and Acadie Novelle), and Google Search promotional ads.

Nova Scotia

Nova Scotia is committed to redesigning the program to meet the needs of the highest-risk groups, thereby ensuring they meet the needs of all Nova Scotians.

_{*SK: Updated March 2024.}

Strategies used to identify and reduce barriers to screening participation

Yukon

ColonCheck Disparity Report, 2021 identified equity-deserving populations/communities in Yukon. More work is planned on this initiative.

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. Working to determine accessibility of immigration data. Work completed by geospatial mapping and social and material deprivation index is being used to identify equity-deserving areas/communities. AB is working with LGBTQ2S+ groups to develop inclusive screening resources.

Saskatchewan

Program data is being used to identify potential equity-deserving populations at the area and postal-code level. Saskatchewan is aware of inequities in screening participation rates in remote communities.

Statistics Canada census information is being used to identify the proportion of non-English speaking populations in Saskatchewan. Using this information, translated materials are being made available in select languages, targeting the reduction of barriers to screening.

Manitoba

The program works in consultation with community groups and organizations to ensure all resources use inclusive language.

Ontario

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.

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 screening participation by postal code region. Results have been shared via the Ontario Cancer Screening Performance Report 2023 that may help inform regional initiatives to address equity issues.

New Brunswick

Based on feedback received through the provincial cancer screening line, GIS mapping, etc., the colon cancer 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 co-morbidities or chronic illness
People with mental illness
People with physical disabilities
People who are houseless
Specific geographic areas
Federally-insured individuals (correctional, armed forces, RCMP, refugees, immigrants)
Gender-diverse people

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 issued in April 2023 as a community engagement study presents the main findings from a series of consultations with community members to understand their levels of awareness and understanding of, and participation in cancer screening on PEI. The objective of the study was to better understand the facilitators and challenges that some specific populations encounter with respect to accessing cancer screening programs. This study consulted with community members from the growing immigrant population on PEI, 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 Newfoundland and Labrador Colon Screening Program works with community and health-related partners to increase equity and access to colon screening throughout the province. Work includes public engagement sessions, social media promotion, and networking with healthcare professionals through orientation sessions. Additionally, the program edited program materials to aid with comprehension of successful screening kits through initiatives such as the creation of wordless test kit instructions.

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