by Taheera Walji, practicum student, Policy & Communications

At the Prevent More to Treat Less conference, a learning session, led by Liben Gebremikael Executive Director and Dr. Onye Nnorom, Family Physician and Chronic Disease Prevention Lead of TAIBU CHC, showed how by applying a public health framework while integrating TAIBU’s Afrocentric values their Cancer Screeing program led to better engagement with the community and improved preventative cancer screening rates.

TAIBU Community Health Centre, located in the Malvern community was established in 2008 with a goal of providing primary health care and health promotion programs and services to its’ priority population, the Black Community across the GTA.

TAIBU recognizes the prevalence of anti-black racism and its’ impact on the way in which this community accesses and receives services. “We plan and develop programs and services with a specialized focus on how we can address the needs and barriers faced by this community,” explains Liben Gebremikael, Executive Director of TAIBU CHC. For this reason, TAIBU is strongly committed to promoting a discrimination-free environment which is evident in their organizational values which enforce equity, cultural competency and the utilization of an anti-oppressive framework to guide its’ staff and members on how to work alongside the community to enhance health and wellbeing.

TAIBU, which is Kiswahili for “be in good health”, stands behind its’ community members, believing that the success of a community lies within its’ inherent strengths and assets. With a wide range of culturally-appropriate clinical, health promotion and prevention programs, such as the Hypertension Management Program, Sexual Health Clinic, Diabetes Education Program, L.E.A.R.N. afterschool program and the UBUNTU Elders program, TAIBU seeks to promote “healthy, vibrant and sustainable communities, creating their own solution.”

#TAIBU Cancer Screening Program

Over the past year, TAIBU has made strides in increasing preventative cancer screening rates by applying public health frameworks, and integrating them with TAIBU’s Afrocentric values, which are equity-based and focused on the “collective.”

After determining that breast, cervical, prostate and colon cancer screening rates among TAIBU’s clients needed improvement in December 2012, staff at the centre formed a Cancer Screening Prevention Taskforce led by Dr. Onye Nnorom (MD). The Taskforce is comprised of two physicians, a physician assistant, a registered nurse and a nurse practitioner.

#The goals of the Cancer Screening Program include:

-          To obtain accurate data on screening rates in the TAIBU community and to target under-screened clients

-          To reduce barriers to preventative screening

-          To educate and empower the community for better engagement with preventative screening

#Phase I

The dual phase Cancer Screening Program has undergone Phase I, which involved internal engagement with staff using a public health PDSA framework (Plan, Do, Study, and Act), an iterative process, focusing on quality improvement in order to increase cancer screening rates.

To Plan for the initiative, the Taskforce conducted literature reviews to assess the vulnerability of the Black population for cancer risk and to identify barriers and solutions to preventative screening among Black and other racialized communities.

Liben Gebremikael comments on the importance of using a high-risk approach when working with specific populations, emphasizing that “Even though general population programs and policies are useful, there are times when specific population strategies are essential and crucial to addressing some of the barriers to health.”

The literature assessment produced significant findings from U.S.data on age-adjusted death rates of cancer, demonstrating that African Americans were more likely than all other races to die of all types of Cancer1. This provided the evidence-base that strong health disparities exist among the Black community relative to other race groups, potentially causing them to be under-screened and at increased risk for cancer death.

The review revealed that barriers to preventative screening include health education, beliefs, gender of provider/technician and provider time constraints. Promising practices unveiled include culturally-relevant educational sessions, videos, facilitating transportation, provider reminders and audits.

The next stage of the cycle, known as Doing involved a cancer screening audit to review the number of TAIBU clients overdue for screening. During this audit, the taskforce reviewed current EMR data collection practices used by frontline staff to determine if indicators used at TAIBU were valid. The audit also involved correcting clients’ EMR if charts were incorrectly marked.

The taskforce focused on providing proper provider education through a provider guideline review package, with instructions on how to enter cancer screening data into EMRs. The taskforce focused on engaging and educating TAIBU health care providers about their role in increasing screening rates.

Lastly, phase 1 addressed client barriers by identifying the nearest Ontario Breast Screening Program site, with female technicians to address the gender of provider/technician as a barrier for seeking preventative testing. TAIBU also administered a pilot call-back program based on a provider audit of patients who were overdue for screening.

By accounting for the aforementioned barriers, TAIBU was able to significantly increase the amount of FOBT and mammogram tests offered to clients. 

#Next Steps: Launch of Phase 2

Phase 2 of the program, which will beginin the winter of 2014/2015 will address community engagement to increase cancer screening rates. With a focus on community awareness through knowledge transfer and exchange sessions, TAIBU is hoping to enhance community education and engagement in a “town hall” format. This is to facilitate a two-way exchange of information, so that staff is better able to understand community barriers to screening and provide solutions to these barriers. TAIBU is also hoping to engage its’ community members using different means such as pamphlets, ethnic radio and ethnic newspapers.

With promising and innovative ideas for the future, Dr. Onye Nnorom, Family Physician and Chronic Disease Prevention Lead  says that they are “hoping for more opportunities for collaboration with Public Health. Cancer screening is a form of prevention that is commonly promoted by public health. We saw a really great pamphlet that was used by Durham Public Health to promote cancer screening and we contacted them, to let them know we wanted to modify it to make it more specific to the black community.   

Dr. Nnorom also describes the decision to involve the voices and perspectives of community members in the program, “We want to promote some of our champions – people in the community who are cancer survivors, to bring a face to their condition.”

View the short clip below as Dr. Onye Nnorom, Family Physician and Chronic Disease Prevention Lead and Liben Gebremikael, Executive Director of TAIBU CHC, describe TAIBU’s next steps for the cancer screening program.

Click below to view the workshop presentation.