1. The use of community group peer education models to reduce knowledge barriers in symptom awareness for over 50s and the Bangladeshi population in Camden Sarah Hate1 , Melanie Ridge1, Dr Lucia Grun2, Mairead Lyons1, Professor Kathy Pritchard-Jones1 1. London Cancer, 2. Camden Clinical Commissioning Group
Background
Camden Clinical Commissioning Group commissioned London Cancer to undertake a multidisciplinary intervention to reduce avoidable deaths resulting from late diagnosis of cancer. The three-year integrated programme (commenced April 2013) uses social marketing, primary care professional development, a community pharmacy campaign and cancer pathway service improvements to address delays in presentation, referral, diagnostic tests and treatment. Cancer accounts for 35% of premature deaths in Camden and the toll is disproportionately high among women and deprived communities (Camden Joint Strategic Needs Assessment 2013). The project therefore focuses on raising awareness of the most common cancers in Camden: breast, lung, bowel and cervical and encourages attendance at screening programmes.
Method 1
Six community organisations across Camden were recruited to deliver health messages to the local community focusing messages in the 50+ and Bengali communities. All organisations were trained using the one day Cancer Research UK Talk Cancer training. A two-tiered management structure was put into place, with two ‘lead partner’ community organisations managing smaller grass root organisations to deliver the work and to share resources and knowledge (as show in figure 1). Both ‘lead partners’ reported directly into London Cancer.
Method 2
Method 2 was adopted after analysis of model 1. London Cancer directly manage all six community organisations for both 50+ and Bengali target groups to reduce knowledge barriers . Clearly defined contracts, targets and goals have been set between each organisation and London Cancer, with monthly steering group meetings with the community groups and a Governance meeting between London Cancer and the CCG. More in-depth training was provided and a volunteer programme was set up.
London Cancer
Community group
London Cancer
Lead partner
Community group
Figure 2. One-tiered management structure
Results method 2
This model ran from September to March 2015
The number of conversations exceeded the targets set for 50+
Targets have been adjusted for the Bengali population, as feedback showed that conversations took longer within this population:
- 50+ : 3,005/2096 conversations
- Bengali: 1061/1000 conversations
We introduced direct communication and reporting from community groups to London Cancer, which allowed for quicker resolution of problems
Managing community groups directly enabled us to identify any gaps in knowledge and skills and put in place additional training
Figure 1. Two-tiered management structure
Results method 1
Model ran from April-August 2015
Number of target conversations for both 50+ and Bengali were not met:
- 50+: 524/ 2096 conversations at month 5
- Bengali: 385/1540 conversations at month 5
Mis-communication between organisations
Bureaucracy and repetition between both management levels
Competition between organisations, due to unstable third sector climate
CRUK Talk Cancer training assumed a certain level of pre-existing knowledge to deliver the training sessions and further training needs were identified (see model 2)
Conclusions model 2
Regular direct feedback sessions enabled programme development, especially within targeted communities
Better working relationships between all organisations through direct supervision
In depth training was put in place in order to deliver ‘quality’ health promotion messages
Conclusions model 1
PDSA cycle adopted to trial change in model
Direct interactions with community organisations enabled groups to state what did and didn’t work within their communities
Enabled rapid ‘permission’ for groups to contribute, help and adapt the peer education approach for the campaign
This model of management structure was reviewed and adapted to model 2
Next steps
Programme continued into year 3 ( financial year).
Model 2 continued after successful implementation
New RSPH accredited training programme adopted for volunteers
Target 4000 conversations
Cancer Awareness Measure surveys will be conducted January-March 2016 to measure the full impact of programme.
London Cancer are exploring opportunities to extend this programme to other areas
Contacts:
Sarah Hate, Project Manager
Melanie Ridge, Programme Lead, Early Diagnosis