Increasing cervical screening in Aboriginal and/or Torres Strait Islander communities
Cervical cancer is on track to be eliminated in Australia by 2030 because of our National Human Papillomavirus (HPV) vaccination program and by women and people with a cervix participating in regular cervical screenings.
All women and people with a cervix aged 25 to 74 who have ever had a sexual partner should have a Cervical Screening Test every five years, even if they are no longer sexually active. Cervical cancer screening can help detect cervical cancer at its earliest stage.
Whilst there is limited data on the cervical screening participation rates of Aboriginal and/or Torres Strait Islander women and people with a cervix, studies suggest overall participation in cervical screening is lower than the wider Australian population.1
There are many barriers which can be linked to the lower participation rates for Aboriginal and/or Torres Strait Islander women and people with a cervix including:
- distrust of healthcare providers
- lack of culturally safe and sensitive healthcare services.
The development of culturally appropriate initiatives that engage and encourage Aboriginal and/or Torres Strait Islander communities to participate in cervical screenings is essential to address this issue. Research from Moxham and colleagues highlighted the importance of having targeted information and education for Aboriginal and/or Torres Strait Islander women on cervical screening.2 Due to specific and differing attitudes and beliefs within Aboriginal and/or Torres Strait Islander communities, involving key influencers such as community leaders or Elders in promoting these messages can play a significant role in overcoming barriers in getting a cervical screening.
This case study shares insights from Cancer Council Victoria’s projects which included collaborating with an influential community member, Madison Connors, a Yorta Yorta, Dja Dja Wurrung and Gamilaroi woman who used her meaningful artwork to convey cervical screening messages to Community. This project used art as a communications tool to encourage open discussion and helped encourage people from Aboriginal and/or Torres Strait Islander communities to book a cervical screening appointment in a culturally safe way.
Women’s Business flipchart
The Women’s Business flipchart highlighted powerful imagery of various cervical screening messages, accompanied by plain text to explain the cervical screening process. The flipchart is an educational tool to support people working within Aboriginal and/or Torres Strait Islander health with images and language which resonates more closely with this community, and addresses some of the barriers that were displayed in previous resources.
The Women’s Business flipchart also aims to build knowledge and increase confidence for health professionals to discuss cervical screening, early detection, and immunisation to community members in a culturally safe way. It uses the artwork as a story-telling method to break down barriers when discussing cervical screening within Aboriginal and/or Torres Strait Islander communities.
Cancer Council Victoria commissioned Madison Connors artist and owner of Yarli Creative to develop the artwork. The Women’s Business flipchart was co-designed in partnership with the Victorian Aboriginal Community Controlled Health Organisation (VACCHO) and key stakeholders, including eight Aboriginal women and the Ballarat and District Aboriginal Cooperative.
Sistas Get Checked cervical art show
Madison Connors’ art was also transformed into Sistas Get Checked, a touring art show which travels to Aboriginal Community Controlled Organisations and Aboriginal Gathering Places across the state. Sistas Get Checked is an art exhibition which tells the story about the importance of regular cervical screenings.
The aim of the Sistas Get Checked was to increase knowledge for Aboriginal and/or Torres Strait Islander community members on cervical screening, increase the intention to screen among people who engaged with the artwork and increase the number of cervical screens booked at the host locations.
This art show created a private, culturally safe environment for community members to have conversations with Cancer Council staff, nurses, or Aboriginal Health Workers. Attendees could share their reflections about the stories of the artwork, prompting conversations about cervical screening within their community.
Women’s Business flipchart
A preliminary evaluation was completed in 2020 for the Women’s Business flipchart. This evaluation assessed the following objectives:
- Increase in health worker’s confidence and capacity to promote and deliver cervical screening education activities to Aboriginal and/or Torres Strait Islander communities.
- Increase in community workers intention to use the Women’s Business flipchart to deliver cancer screening education activities on an ongoing basis.
- Attendance at the art show and estimated reach of the Women’s Business flipchart.
|Method||Outcomes and impact|
|The distribution of the Women’s Business flipchart was monitored from 2019- 2020. Interviews were also conducted to gain feedback about the Women’s Business flipchart.||
• During the evaluation period, 21 flipcharts were distributed and 31 were downloaded from the Cancer Screening Hub website
• The Women’s Business flipchart was the most downloaded resource on the Cancer Council Cancer Screening Resource Hub
• Results from interviews were positive with one health worker who participated in the interview stating, “I am currently very confident, but I do think [the flipchart] may help women understand what I am communicating to them better.”
Sistas Get Checked Cervical Art Show
A preliminary evaluation was also conducted in 2020 to assess the effectiveness of Sistas Get Checked. This evaluation assessed:
- Increased knowledge and understanding of cervical screening.
- Intention to screen, and intention to discuss screening with friends and family among Aboriginal and/or Torres Strait Islander communities.
|Method||Outcomes and impact|
|After viewing the Sistas Get Checked cervical art show, attendees were approached by a representative of Cancer Council Victoria and asked to complete a five-minute survey.||
• Sistas Get Checked toured two regional locations - Rumbalara Aboriginal Cooperative in Shepparton and Winda-Mara Aboriginal Cooperative in Hamilton. A total of 121 people attended the Sistas Get Checked shows.
• 95% of those who completed the survey said that they were ‘very likely’ or ‘likely’ to share the information they learnt at the Sistas Get Checked exhibition with their family and/or friends.
• When asked how likely they were to get a cervical screen next time they were due, 87% said they were ‘very likely’ or ‘likely’ to do so.
• Those who attended Sistas Get Checked responded very positively.
Below are some quotes taken from people who attended:
• “[The art] gets people talking, especially us Koorie women. We tell stories through pictures.”
• “If the art show wasn’t here, I wouldn’t have booked my cervical screen and I wouldn’t have thought about it. I’m already overdue.”
• “It is fantastic, it is relatable and done in a beautiful and cultural way”
Due to the challenges of the coronavirus pandemic, Cancer Council Victoria adapted both projects to the changing environments to maintain engagement and ensure sustainability. An example of this is converting the Women’s Business flipchart into a digital format and offering a virtual experience of Sistas Get Checked in the future.
The Women’s Business flipchart and Sistas Get Checked projects highlight the power of using art as a method of storytelling and encouraging conversations about health topics within Aboriginal and/or Torres Strait Islander communities. Both health promotion initiatives demonstrated the effectiveness of incorporating culturally appropriate methods such as art to improve knowledge and increase participation rates in cervical screening.
- Australian Institute of Health and Welfare 2019. Cervical screening in Australia 2019. Cancer series no. 123. Cat. no. CAN 124. Canberra: AIHW.
- Moxham R, Moylan P, Duniec L, Fisher T, Furestad E, Manolas P, Scott N, Oam DK, Finlay S. Knowledge, attitudes, beliefs, intentions and behaviours of Australian Indigenous women from NSW in response to the National Cervical Screening Program changes: a qualitative study. The Lancet Regional Health-Western Pacific. 2021 Aug 1;13:100195.