Bring a friend - a peer-education program to increase participation in the cervical cancer screening program among foreign-born women

Other conference contribution, 2012

Early detection of cervical changes through gynaecological screening serves as a good protection against cervical cancer. The mortality rate from cervical cancer has declined by 60 percent during the past 40 years. Still about 80 women in the region of Västra Götaland are annually diagnosed with cervical cancer and 20-25 patients die. In the region of Västra Götaland women aged between 23-60 years are invited to Papnicolau (Pap) testing within the cervical cancer-screening program. However, in the northeast part of Gothenburg only around 60 percent of the females are taking the test. The overall percentage for the entire region was 82 percent and the regional goal is that no parish should test less than 70 percent. In northeast Gothenburg 50 percent of the residents are foreign born. Almost no effort has previously been made by Swedish healthcare to recruit foreign born women to undergo Pap smear tests. Therefore, a project group was formed in the spring of 2010. National and international research was reviewed; the barriers for foreign born women to not taking the test included lack of knowledge about why the test should be taken but also an inability to assimilate information in Swedish and, finally, unavailable childcare. Using social networks and focusing on verbal information given by friends or healthcare staff with the same cultural background could encourage more women to undergo a Pap smear test. In the northeast part of Gothenburg the so called doulas are already well established, primarily supporting new parents during pregnancy and childbirth. The doulas have the same cultural background as the parents they support. In this project, the doulas were informed by a midwife about the importance of taking Pap smear tests. They were also asked to encourage women in their surrounding communities to take the test. Having taken part of previous experiences of health promoting activities in the area also inspired the project group to use additional channels to reach the women, e.g. through local associations, radio stations and at public places. By bringing a friend whilst taking a Pap smear test the women would have emotional support, simultaneously solving the problem with unavailable childcare. The friend who accompanied the woman would be given a small gift. The project group decided to encourage the women by embracing a positive approach and with the message: “Take the test and take control of your life!” On the international women’s day in March of 2011 a seminar was held and “Bring a Friend” was introduced to politicians, officials, health care professionals, the doulas and the public. “Bring a Friend” was launched in April of 2011. At the same time leaflets and information folders were produced and translated into a number of languages. The summons to the Pap smear test to the women in northeast Gothenburg were accompanied by a leaflet with information about Pap smear in 11 different languages. During the spring and autumn the midwives and the doulas participated in various events, information was aired in the local radio and exposed in waiting rooms, newsletters and on the Internet. An interview with the doulas was conducted to investigate their experience in meeting the women. Postcards, posters, pin and monitors showing the “Bring a Friend” logotype were visible around the area and a modified bus made it possible to take a Pap smear test at strategically located places in the northeast part of the city. Between April and October of 2011 a total of 3 233 Pap smear tests had been taken. During the same period the previous year there were only 2 034 tests. Healthcare professionals noticed that groups that were known for not taking Pap smear tests now showed up. According to the doulas the women had started to spread the message in their own communities about the importance of taking the test.