Connecting communities with multicultural cancer care and support

Author: Professor Reema Harrison

Addressing inequities in cancer care provision is central to the Australian Cancer Plan, with care for multicultural communities as a key focus. Service providers in highly multicultural communities have responded with expansive programs to facilitate and support cancer prevention, screening, treatment and survivorship. Whilst programs are increasingly co-designed with communities to promote user-centricity, implementation is often overlooked, leading to under-utilisation of much needed support.

The South Western Sydney Local Health District (SWSLHD) has a population of 1.2 million; 40% were born overseas and 49% speak a language other than English in the home. SWSLHD has collaborated with these communities to support the provision of cancer care by offering oncology multicultural navigators for individualised cultural and linguistic support that extends to tailored patient-reported measures. Consumers can request interpreters to support interactions so they receive cancer information in their preferred language and engage in community-based culturally appropriate prevention and support programs. However, despite the availability of these co-designed programs, they remain under-utilised.  

Even co-designed interventions are challenging to implement in complex healthcare environments. Implementation strategies to ensure that programs, services and support are known to, and utilised by providers and communities, were therefore targeted through collaborative design as part of a 4-year national project called CanEngage. A resource to support the implementation of multicultural programs and services in SWSLHD was co-designed with clinicians and Arabic-speaking consumers from the cancer service. Three central strategies were deployed in the co-design to ensure that the project targeted local implementation challenges, and would be embraced, supported and sustained by the cancer service.

Localising co-design target

Firstly, in scoping the project, interviews were conducted with consumers, clinical and multicultural health staff and leaders to determine local implementation challenges. Results from this step indicated that the implementation of programs and services was constrained by language and cultural differences and that the service would embrace a strategy to target one or more of these communities.  Arabic-speaking communities were identified as the first cohort to target, with the potential to extend to other priority cohorts within the LHD. Arabic-speaking staff engaged in this initial process and extensively contributed to the subsequent co-design.

Securing buy-in for change implementation

Secondly, our co-design group included health service decision-makers in consultation about the scope of the co-design, the nature of the output, and the resources required for the implementation strategy to be used. It was challenging to connect managerial staff with the co-design group both logistically and without disrupting the balance of power. However, consultation alongside the co-design workshops provided an avenue to gather feedback, critique, understand where and how to reach the target community and seek solutions to barriers. The final product of the co-design was a set of visual resources to be shown on waiting room screens with accompanying Arabic and English text. This was rapidly embedded into the services' existing infrastructure as an acceptable, low-cost and sustainable solution.

Local ownership of output to sustain and scale improvement

As a product of co-design between clinicians and consumers facilitated by an academic team, the resource developed in our project is owned by SWSLHD. Staff in SWSLHD have expanded the use of the slides so that they feature in welcome information packs for Arabic-speaking patients. Looking to the future, flexibility is embedded in the final product for local teams to explore and make adaptations to meet the needs of further priority communities.

Professor Reema Harrison
Cancer Institute NSW Career Development Fellow
Centre for Health Systems and Safety Research
Australian Institute of Health Innovation
Faculty of Medicine, Health and Human Sciences
Macquarie University
New South Wales, Australia

This article was submitted to the JBIEI eBulletin on behalf of the South Western Sydney CanEngage Codesign Team: Paul Gorgees, Carole Chow, Joanne Pearson, Mashreka Sarwar, Ashfaq Chauhan, Bronwyn Newman.