Improving breast and colorectal cancer screening information through co-design with underserved groups in an urban...

Certain groups participate less in Dutch population-based breast cancer (BC) and colorectal cancer (CRC)-screening, such as people with lower socio-economic status or ethnic minorities in deprived urban areas. We aimed to investigate the perspective and underlying needs of underserved groups regarding information provision about BC- and CRC- screening, and to design novel information strategies accordingly. The ultimate aim was to reach them more effectively and support informed decision-making.

In total, 28 co-design sessions were conducted in deprived neighborhoods of Amsterdam, the Netherlands, for four backgrounds separately, i.e., Moroccan, Turkish, Surinamese, and no migrant background. We performed 16 sessions with women (N = 44; 4 sessions per group; 40-78 yrs) about BC- and CRC-screening, and 12 with men (N = 28; 3 sessions per group; 54-79 yrs) about CRC-screening. Creative assignments, summaries, and field notes were analyzed using thematic analysis.

Three overall themes were identified. First, there was very limited knowledge about BC and CRC and the idea of screening for these cancers, which made it difficult for people to relate cancer screening information in general to existing knowledge structures. Second, people were in an early stage of the decision-making process, with positive but largely uninformed attitudes towards BC- and CRC-screening. Third, although participation in cancer screening was generally considered desirable, it was not a priority in daily life. Especially people with a migrant background emphasized that invitations via post were easily missed/forgotten. Co-designed novel information strategies included group information sessions in local communities, short awareness/information flyers, and audiovisual information in multiple languages.

People from underserved populations recognized the importance of BC- and CRC-screening in taking care of their health. However, findings suggested that some key information did not come across, due to a mismatch between information content typically provided -focusing on cancer screening- and basic knowledge and information needs of the participants. Additionally, there was a mismatch between typical information delivery (i.e. post) and how participants said to handle information in their daily lives. Co-designed strategies can be utilized by screening organizations.