Step 7: Strategies for increasing culturally and linguistically diverse communities participation in cancer screening

steps This section covers the following steps:

Step 7.1 Audit barriers to cancer screening for culturally and linguistically diverse patients in your health service
Step 7.2 Implement your improvement ideas
Step 7.3 Use resources and programs designed for culturally and linguistically diverse communities
Audit table Audit barriers to cancer screening for culturally and linguistically diverse patients in your health service

The information below provides a range of suggestions on actions that can be taken to support increased participation in cancer screening by people who speak a language other than English at home.

These strategies should be used in addition to strategies described in:

  • Step 2: Use good practice strategies for increased participation in cancer screening
  • Step 3: Address Health Literacy as a barrier to screening.

Use the Action plan template to implement the actions your team decides to undertake.

Step 7.1 Audit barriers to cancer screening for culturally and linguistically diverse patients in your health service

The audit table below will support your practice to identify:

  • barriers to cancer screening for culturally and linguistically diverse (CALD) patients that exist within your practice
  • ideas for improvement that will support your practice to enable CALD patients to participate in cancer screening
Success in practice:

Success in practice:

“We are aware about breast screening and cervical screening and cancer but due to ignorance, fear and shyness, we have been postponing our tests.

“Even though we know about it, we still put our family first and ignore our own health; we forget about such tests.”

- Culturally and linguistically diverse research participants – Central Eastern Sydney Primary Health Network

Download Audit table

Audit table


Reflection questions/processes

Improvement ideas/Follow-up actions Note: Use the Action plan to implement your ideas

NSW Health’s ‘Policy on Working with Interpreters’ highlights  the importance of using professional interpreters, noting that the following:

  • Interpreting is a professional skill.
  • Health care interpreters are not only bilingual, their language and interpreting skills have been tested, they are trained in medical terminology and they operate under a strict code of professional ethics, which ensures their services are impartial and confidential.
  • The use of non-professional interpreters, such as relatives, friends, children or bilingual staff is a breach of the duty of care owed to the patient/client, and could result in legal action.
  • Bilingual staff are encouraged to deliver their service directly in their other language, if fluent, without using an interpreter, but the use of bilingual staff to interpret is inappropriate.
  • Bilingual staff need to be aware of their legal position: Basically, if interpreting is not in your job description, think carefully before you do it, and make sure that every attempt has been made to obtain a professional interpreter. If anything goes wrong, you could find yourself in court trying to explain why you considered it necessary to act outside of your job description.
  • Does your team use interpreter services, when needed?
  • Does your practice have a workflow for identifying the need for interpreters and booking interpreter services?
  • Does your policy outlining the use of interpreters act as an integral part of patient privacy and care?
  • NSW Health’s Policy on Working with Interpreters and Using interpreters: A guide for GPs are helpful guides to effectively using interpreters.
  • The Translating and Interpreting Service (TIS) is available 24 hours a day, seven days a week, and is accessible from anywhere in Australia for the cost of a local call on 131 450. For more information, visit


Does your practice have a good understanding of the health needs of the cultural groups within your practice population?

In addition to cultural background, your patients’ health and approach to health care will be influenced by the following27:

  • Migration and settlement history
  • Socioeconomic status
  • Past history
  • Personal preferences, knowledge and attitudes
  • Refugee-like experiences



  • Have you analysed your practice data (e.g. lists of under-screened patients) to understand which cultural groups are represented?
  • Does your practice routinely record ethnicity, country of birth and cancer screening status?
  • Have you worked in partnership with your PHN to understand the profile of community groups within your footprint?
  • Do you work in partnership with local community and health organisations, BreastScreen NSW service, community champions (e.g. cancer survivors and regular screeners) and PHN to:
    • understand the needs of your patients
    • build links to the community
    • support health education within the community
    • promote yourself as a health service? 
  • Cancer Institute NSW’s Multicultural Strategic Advisor can support introductions to community organisations for cancer-related health promotion activities. Contact the Institute for more information.



Does your clinical team know how to prepare for screening discussions with culturally and linguistically diverse patients?

  • The National Cervical Screening Program provides a list of questions that health professionals should ask themselves before a consultation about cervical screening with people from culturally diverse backgrounds. These questions can be used as a preparation checklist.

    Many of the questions in the list also apply when discussing bowel and breast cancer screening with culturally diverse patients.



Conscious and unconscious assumptions can interfere with open communication and provision of care.

Diversity exists between and within cultural groups.

It is important not to assume particular barriers apply to all communities or all individuals within a community.1

  • Has your team participated in cultural competency training?
  • Do you use patient feedback to inform your delivery of care?


Do promotional materials in your practice reflect your patient population?

Materials that reflect your patient demographic may improve the perceived personal relevance of health promotion messages to your patients.

  • Do you display posters and information that reflect your patients?
  • Do you provide cancer screening education resources in plain English and the first language of your patient population?
  • See Step 3 for links to multicultural cancer screening promotional materials.


Note: The barriers and improvement ideas in the audit table were guided by the following resources:

Step 7.2 Implement your improvement ideas

Use the Action plan template to:

  • document which of the improvement ideas you identified in Step 1 that your team will implement
  • plan the implementation of your ideas
  • track progress and identify follow-up actions.

Step 7.3 Use resources and programs designed for culturally and linguistically diverse communities

General resources
  • The Cancer Institute Multicultural Data App supports an improved understanding of cancer screening participation in NSW. The app includes:
    • profiles of the top 50 languages and country of birth in NSW, by geographic area and local health district
    • analysis for each language group from the top 20 languages for NSW, as relevant to bowel, breast and cervical screening programs

Contact the Cancer Institute NSW for more information.

  • NSW Health’s Policy on Working with Interpreters highlights the importance of using professional interpreters.
  • The NSW Refugee Health Service's online Translated Appointment Reminder Translation Tool allows you to translate appointment details into your client's language. The form is generated immediately for the client at the time the appointment is made. It can also be emailed.
  • RACGP’s Criterion C1.4 – Interpreter and other communication services provides guidance on:
    • ensuring a patient’s rights to understand the information and recommendations they receive from their practitioners are met
    • ensuring practitioners meet their professional obligation to communicate effectively, and to understand their patients’ health concerns.


  • Cancer Australia produces a wide range of cancer publications, including guidelines, cancer guides, reports, fact sheets and leaflets in 10 different languages.
  • The Toolkit for engaging under-screened and never-screened women in the National Cervical Screening Program outlines the barriers to screening and engagement strategies for women from culturally and linguistically diverse backgrounds, including those who have experienced female genital cutting.
  • Central and Eastern Sydney Primary Health Network worked in collaboration with South Eastern Sydney Local Health District and Advance Diversity Services to develop cancer screening resources for the CALD community using a co-design approach. The resources reinforce the message that “Taking care of yourself is the best way of looking after your family”; a message that the focus groups felt would resonate with their communities.
National Bowel Cancer Screening Program resources

The flipchart assists health and community organisations/workers to explain how bowel cancer develops, risk factors, signs and symptoms of bowel cancer, and the importance of doing a bowel screening test every two years with the National Bowel Cancer Screening Program (NBCSP) between the ages of 50–74.

The Flipchart is currently available in English, Simplified and Traditional Chinese, Arabic, Italian, Greek and Vietnamese.

The Facilitator Manual provides guidance about planning and delivering bowel screening education sessions/workshops. It includes a planning checklist, suggested content and key messages, optional activities and group discussion points.

BreastScreen NSW resources

BreastScreen NSW provides the following:

National Cervical Screening Program resources

The National Cervical Screening Program offers videos, posters and booklets in a range of languages that can be downloaded or ordered for free.