Colorectal screening in Canada, 2023-24

Strategies to engage equity-denied populations

Methods to identify equity-denied populations or communities include leveraging geospatial mapping, census and postal code data, engagement with specific communities, and literature scans. Engagement strategies include developing educational materials and campaigns, holding focus groups, and ongoing relationship building.

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Community engagement strategies used with equity-denied populations or communities

P/T Specific community engagement strategies each jurisdiction has used with equity-denied populations or communities
YT
  • A promotion and awareness public campaign in fall 2022 targeting equity-deserving populations and communities.
  • Community visits are planned for 2023.
NT
  • Focus groups and program feedback to tailor promotional materials.
  • Social media involvement to promote the screening program locally.
NU –
BC –
AB
  • Focus groups to engage colonoscopy patients to develop virtual educational materials.
  • Collaboration with patient advisory committee to understand screening needs of the LGBTQ2S+ population.
SK
  • The SPCRC engages with Indigenous communities to provide local education relating to CRC screening (e.g., health fairs and community events).
  • The SPCRC holds regular information sessions at newcomer centres and is developing specific material for these presentations.
MB
  • Invitations, recalls, and reminders are actively sent to eligible persons.
  • ColonCheck partners with community engagement liaisons in each regional health authority in the province to provide resources for one-to-one education.
  • Grant-funded project will mail 15,000 FOBT kits to underserved populations, a great proportion of which will be sent to First Nations and Métis populations.
  • Illustrated instructions and guide to colorectal cancer screening will be used to support those challenged by written communications or language barriers.
ON
  • Regional Cancer Programs respond to issues related to screening, diagnosis, treatment and management of cancer as per regional and local needs, coordinate care across local and regional healthcare providers, and work to continually improve access to care, wait times and quality.
  • ColonCancerCheck recruited screen-eligible Ontarians of diverse groups, such as immigrants and people with lower socio-economic status, to participate in testing of correspondence letters. Findings from this letter testing informed decisions related to language in screening correspondence and other public communications.
QC –
NB
  • Federally-insured individuals (correctional facilities): building relationships with community champions, healthcare providers facilitating inmate screening participation (completion of questionnaires and health assessments).
  • First Nations community health clinics/events: building relationships with community champions, targeted education (presentations or information booths upon invitation).
  • Gender-diverse population: program staff completing online training and updating program materials to better reflect gender inclusivity
NS
  • Collaboration with Mi’kmaq First Nations, Nova Scotians of African descent, and new immigrant populations.
PE
  • Holding focus groups and key stakeholder interviews.
  • A study focused on collecting and analysing data from February to March 2023 to address a series of questions that align with two main themes: awareness and understanding, and accessibility and participation as they relate to cancer screening in PEI.
  • Collecting perspectives, experiences, and opinions from various community members, or representatives from organizations working directly with community members (e.g., immigrants, Indigenous communities). Individual community members who might be interested in participating in the consultations were approached. The consultation team invited individuals to participate in either one-on-one interviews or small group discussions.
NL
  • Collaboration with PCPs, regional networks, and community groups to share data, provide education, and promote program participation.
  • Province-wide inclusion in orientation programs for new healthcare professionals through the Better Program and Provincial Collaborative Clinics.
  • Development of wordless instructions to be used throughout the screening program.
  • Development of new social media and other program promotional and education materials to encourage participation.
  • Collaboration with, education for, and presentations to PCPs and community groups that work with new Canadians, immigrants, refugees, and low-income populations.

– No information was provided at the time data were collected.

Strategies to improve screening participation through understanding and addressing barriers

P/T Strategies used with equity-denied populations or communities to identify and reduce barriers to screening participation
YT
  • There have been a number of leadership changes within Health and Services health programs. Planning steps have required waiting for the changes to be completed.
NT
  • Direct mailing of FIT to residents without the need to go through a regular healthcare provider, as many people in NT do not have one.
  • Pictograph-based instructions to minimize language and literacy issues.
  • Feedback from community members around promotional material to help ensure it is culturally appropriate.
  • Promotional materials translated into local Indigenous languages.
NU –
BC
  • Direct engagement with community-based groups, including those serving newcomer and immigrant communities, with presentations/talks and sharing of toolkits and resources.
  • Engagement with Trans Care BC and community-based clinics to foster use of inclusive approaches to health promotion and education.
  • Targeted awareness and education campaigns that are culturally appropriate.
AB
  • Committees and focus groups are used to identify barriers to screening on a regular basis. Strategies to reduce barriers are issue dependent (e.g., animated video series in different languages to promote and educate about cancer screening). Access to healthcare providers continues to be an issue for cancer screening as a whole due to human resource constraints.
SK
  • Small group interaction has facilitated conversation and addressed questions or concerns at newcomers’ centres. The goal is to increase health literacy, while decreasing fear and misconceptions associated with CRC screening.
  • Program data is being used to identify gaps in participation rates by demographic or geographic attributes.
  • Developed and implemented key social media messages addressing the embarrassment that can be associated with completing a FIT kit, while reinforcing the importance of screening and the ease of the screening test.
MB
  • Comprehensive letter campaigns that included an insert translated in 17 languages.
  • Interpreter services, including information on available interpreter services and translated documents on most public-facing communications.
  • Cancer screening education module created for new international healthcare providers.
  • Curriculum designed for educators to use with adults with low literacy, which can be found on screening website.
  • Translated resources.
  • Focus testing with primary care advisory groups and community groups.
ON
  • The ColonCancerCheck program sends invitations to people ages 50-74 who are overdue for screening (i.e., non or infrequent responders) every 2 years.
  • On the FIT requisition, people can request to have a FIT kit sent to an alternative address.
  • Mobile coaches in two Regional Cancer Programs, North West and Hamilton Niagara Haldimand Brant, provide screening services to people who do not have a primary care provider or face barriers accessing existing screening services (due to transportation or other barriers).
  • People who have requested a FIT kit and live in rural postal codes in Ontario receive envelopes for expedited mail to support timely return of FIT kits to the lab following sample collection.
  • Newly developed program resources in the ColonCancerCheck program will include gender-neutral and inclusive language (e.g., referring to “people” as opposed to “men and women”); older materials are in the process of being updated.
  • A text version of the FIT instructions, which complies with AODA requirements, is available online and is available in 32 languages. Participants can also access the informational letter provided in mailed FIT packages online in 32 languages. A word-light version of the FIT instructions is also available to help support people with lower health literacy levels.
  • In addition to English and French, colorectal cancer screening awareness campaign materials are available in 23 languages.
QC
NB
  • Individuals without a regular healthcare provider can participate in the program without a PCP referral and care following an abnormal FIT is arranged by the program.
  • The program has on-the-phone interpreter services available for those with language barriers. Staff is fluent in French and English.
  • For those with lack of screening recommendations from healthcare provider, the colon program offers clinical practice guidelines. The program regularly communicates with healthcare providers on program updates to activities and recommendations. For those with difficulty accessing the healthcare system, the program’s screening access coordinators (nurses) will assess and arrange for program colonoscopy, including providing education for positive FIT participants. New Brunswick’s Cancer Screening Line receives and handles calls from individuals with inquiries regarding access to screening services.
  • FIT instructions and bowel preparation information sheets are developed with images and simplified language for those with low health literacy. Completion of questionnaire is also offered over the phone via the New Brunswick Cancer Screening Line.
  • For those who depend on family members, completion of questionnaires and health assessments can be done with family members over the phone with the consent of the participant.
  • As required, the program will provide bowel preparation products to those who are unable to purchase them due to low income. Completed FIT kits are returned to the provincial lab using a postage-paid envelope.
  • Recent immigrants and refugees with federally-issued health cards are invited to participate in program.
  • Program staff completing online training and will be updating screening program content for gender-diverse people. Program materials and guidelines will better reflect gender inclusivity.
NS
  • Education sessions.
PE
  • Translation of brochures for CRC screening.
NL
  • The NL Colon screening program seeks to work with community groups and organizations to reduce barriers to cancer screening.
  • The program seeks opportunities to collaborate to highlight the importance of and access to all cancer screening services in the province. Specific strategies include healthcare education and orientation sessions, social media ads, public presentations, and seeking opportunities to speak with positive colon clients about the importance of participation in other screening programs.
  • Cancer screening programs have also proposed that a nurse practitioner can help in service delivery for clients who do not have a PCP.

– No information was provided at the time data were collected.

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