Case study: Increasing bowel screening among Aboriginal and/or Torres Strait Islander community members

Bowel cancer is the second biggest cause of cancer death in Australia, yet over 90% of bowel cancers can be successfully treated if found early. Unfortunately, screening rates among Aboriginal and/or Torres Strait Islanders remain considerably lower at 23.5% compared to the national average of 42.4%.

Due to low screening rates, diagnosis often occurs when the cancer is at a late stage, which means that Indigenous Australians have a lower chance of surviving five years following a diagnosis of bowel cancer.

To close this gap, our organisation partnered with local Aboriginal Community Controlled Health Organisations (ACCHOs) to implement an innovative project aimed at increasing bowel screening participation. This project implemented the evidence-based strategy of using comedy as an effective tool for engaging with the Aboriginal community on taboo topics.

Flushed: A Kuni/Coonie Could Save Your Life bowel comedy was performed by the award-winning Aboriginal comedian Denise McGuinness in locations across Victoria in 2017/18 and continues to be performed in 2019.

The objectives of the bowel screening comedy are to:

• increase knowledge and understanding of the benefits of bowel cancer screening, and confidence to undertake the test
• encourage eligible people to undertake the bowel cancer screening test when they are due
• encourage attendees to speak to their parents/relatives about doing the bowel cancer screening test.

Five bowel screening comedies were delivered at different locations around Victoria (Mildura, Albury, Horsham, Warrnambool, and Morwell). Attendees at four of the five performances were asked to rate their current understanding before and after watching the comedy. Ratings were captured using a visual target with five rings, with the outside ring of the target representing a score of 1 ‘no understanding’ and the inside of the target representing a score of 5 ‘very good understanding.’ Gender and age were also collected.

In addition, after the performance, attendees were asked whether they intended to participate in bowel cancer screening, their confidence to undertake the test, and whether they were likely to talk to their parents or other relatives about bowel cancer screening. Participants selected ‘yes,’ ‘no’, or ‘maybe’ for each item.

Attendees at the Mildura performance were not surveyed before the show. After the show, they were asked whether their understanding of bowel cancer screening had increased (responses: ‘a lot’, ‘a little’, ‘not at all’). The other questions remained the same. Findings related to improved understanding for this group are reported separately.

Overall, the events were well attended. Of those who attended, data is available from 60 people who completed the surveys.

Improved understanding of bowel cancer screening

Albury, Horsham, Morwell, Warrnambool

Forty-three attendees rated their understanding before the comedy (average score = 3), and 41 rated their understanding after the comedy they attended (average score = 5), demonstrating improved understanding of bowel cancer screening.

When examining whether individual ratings improved as a result of watching the comedy, there was also a notable increase. Thirteen attendees (32%) scored the maximum of five, having a ‘very good understanding’ of bowel cancer screening prior to the show, which was maintained after the show. After the show, a further 18 (64%) of the remaining 28 attendees reported maximum scores and a ‘very good understanding of bowel cancer screening'. The average improvement in scores for this group was two points.

Mildura

Thirteen attendees at the Mildura performance rated their increase in understanding of bowel cancer screening. Ten of the 13 attendees (77%) reported that their understanding had increased by ‘a lot’, with one attendee reporting ‘a little’ increase and one reporting ‘no increase.’

Intention to screen and confidence to take the bowel screening test

Overall, 38 of the 57 respondents (67%) indicated that they intended to screen for bowel cancer. Those that responded ‘no’ were primarily those in the younger age groups who were not yet eligible for the national screening program. Out of the 26 who were eligible to participate in the national program (those aged 50–74) 23 respondents (88%) indicated that they intended to screen within the next 12 months after watching the comedy.

Fifty-one respondents (89%) reported that they felt confident to take the bowel screening test. Of the 26 eligible to participate in the national program, 96% felt confident to take the test after watching the comedy.

Discussing screening with parents/relatives

Overall, 44 of 55 respondents (80%) indicated that they would discuss screening with others in their family. Equally 80% of those eligible for screening also reported they would discuss screening with others. Importantly, 86% of the younger attendees aged 29 or under reported that they would discuss screening with their parents and relatives.

The bowel screening comedies targeted at Aboriginal and/or Torres Strait Islander people appear to be very effective at improving understanding of bowel cancer screening. After watching the performance, attendees were highly motivated to undertake screening, confident in how to complete the screening test, and keen to discuss screening with their families.