How this PCN… raised cancer awareness in the Punjabi community

A cancer awareness programme in Luton aims to boost the uptake of cancer screening among the South Asian community. Dr Manraj Barhey, medical director, Dr Gayan Pererra, cancer lead and Sarah Forster, strategic manager at Medics PCN in Luton explain how it works.

At Medics PCN in Luton, one of the PCN deliverables is early cancer diagnoses. The NHS cancer screening programme in England should have been an important factor in achieving this since screening can detect problems before symptoms appear.

But when we looked at the data, we realised that the uptake in our five-practice PCN area was low across the national screening programmes.

Our first attempt to address this didn’t work well. As we investigated why it had been unsuccessful, we identified that patients from the South Asian community were particularly likely to ignore invitations to cancer screening. To address this, we launched a cancer awareness programme that included a weekend community event at the local Sikh temple.

Aims

Our aim was to boost uptake of cancer screening.  We could see from our data that it was low across the national screening programmes for breast, cervical and bowel cancers. Last year, we attempted to address this via a direct patient approach. We tried to contact the patients directly and we used a care coordinator to increase uptake.

However, this wasn’t really successful. In particular, we noted that the South Asian community had a very low uptake. This was significant because Luton is one of four places outside of London where the majority of the population is from ethnic minority groups. The Census 2021 showed that the population of Luton now has a non-white majority with 54.8% per cent of the population being non-white.

When we tried to find out why there was such reluctance to take up cancer screening opportunities, we discovered there was a lot of fear and a lack of knowledge about cancer and cancer screening. If we were to improve the uptake of cancer screening, we knew that addressing this was key. 

We needed to explain to the Punjabi community why screening is beneficial and what it involves. It was important that they understood screening tests could detect a problem early – even before they were experiencing any symptoms. And we wanted them to know that finding out about a problem early can mean that treatment is more effective. We also had to help them understand when to go to their GP with symptoms that might suggest cancer. 

In short, we needed to boost awareness. So, we arranged the cancer awareness programme at the Sikh temple.  In Luton, there has been a growth in the number of Sikhs from 2,347 in 2011 to 3,032 in 2021 –  a change of 29%.  The aim of the programme was to target a community where uptake was especially low. We sought to address their concerns and provide education and support to help them understand why cancer screening was important for their health.  

Methods

Our first attempt at addressing the low uptake was contacting patients directly about cancer screening.  At the outset, we looked at practice data to identify those individuals with low uptake and made contact with them. In the process of assessing whether or not our efforts were working, we looked at the data again.  A pattern emerged as we analysed the data – patients from the South Asian community had very low uptake.

When we learned that this community felt fearful about cancer and cancer screening, we knew addressing this was key.  Only then could we hope to see an improvement in the uptake of cancer screening. So, it was crucial to boost awareness of all cancers and cancer screening.

The awareness programme was led by the PCN’s GP cancer lead, Dr Gayan Pererra, who was helped by a dedicated care coordinator, Alex Marchidan. As clinical director, I was involved alongside both strategic and operational managers, Sarah Forster and Kristina Ceresale. In addition, we had some help from ARRS role holders, including our paramedics, social prescriber and health and well-being coach.

We sought help from local cancer support groups, including the prostate cancer support group from the hospital and a local cancer support group for South Asians.  And we involved the local public health team and its community connectors. We also asked local medics – GPs and a consultant – who could speak Punjabi to help us.

And, of course, all of this was done with the local Sikh leaders who helped us get the word out and supported us in arranging a weekend community event at the temple, Guru Nanak Gurudwara. 

Data

The PCN met the costs, which were minimal – perhaps about £300 for leaflets and banners. Everything was done voluntarily. The PCN staff who worked at the event were offered time off in lieu as it was arranged for a weekend to maximise footfall.

We ran three lectures at the local Sikh temple with about 25 to 30 patients in each and we must have had more than 200 people visit the stalls we set up.  In total, the patient footfall at the local Sikh temple was about 800 people.

Outcomes

The whole concept of organising a community event on the weekend was new to us and we found it quite a challenge. But the feedback was really positive and now other communities want us to reproduce the model in their places of worship.

One of the major benefits was getting to know our local community better. For example, we learned that there is still a lot of misinformation out there in the local communities. There is a lot of fear of cancer, which feeds the reluctance to take up screening. The men in particular were very difficult to engage. So, we realised that there is a great need for further education in our local community.

Patient feedback on the event was very positive. There were a number of patients who talked to the clinicians at the event about their concerns. I’m hoping that after the event they then went to see their GP.

Another positive outcome was the relationships with the local voluntary sector and other stakeholders. It has been very beneficial to build relationships as we worked together to achieve our aim. We now know we can do it!

And that’s good because we’ve had requests from other communities to hold similar events.

Future

We want to evaluate the results. And we plan to carry out similar cancer awareness programmes at other places of worship or where other communities meet.

The programme benefited from good publicity, which we hope will help us in the future. There was a feature on ITV Anglia, and there are several video clips available – including this one <link to video> – and many photographs.

We even achieved some global coverage when the event was featured on Punjabi news channels abroad.

Dr Manraj Barhey is medical director, Dr Gayan Pererra is cancer lead and Sarah Forster is strategic manager at Medics PCN in Luton.