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

Barriers/enablers

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 www.tisnational.gov.au/

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.