Serom Lee_220177090

HLTH 530 Health Promotion in Practice

Health Promotion Grant Proposal
University of New England

Student Name: Serom Lee

Student Number: 220177090
Due Date: 27 May, 2019
Unit Coordinator: Dr. Zaneta Smith
Word Count: 2507
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Table of Contents
Executive summary ................................................................................................................................. 3
Organisation............................................................................................................................................ 3
Identify project Type option 1 or option 2.............................................................................................. 3
Breast and cervical cancer screening project plan ................................................................................. 4
Evidence of need..................................................................................................................................... 4
Stakeholders ........................................................................................................................................... 6
Evaluation strategies............................................................................................................................... 6
Ethics ....................................................................................................................................................... 7
Resources ................................................................................................................................................ 8
Project budget proposal ......................................................................................................................... 8
Summary ................................................................................................................................................. 8
References .............................................................................................................................................. 9
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Executive summary
This grant proposal provides a plan and evaluation of the health promotion
project proposal for older women from culturally and linguistically dynamic (CALD)
backgrounds, who are subjected to higher risk for breast and cervical cancers. The
prioritised issue identified for the group in the health promotion context underlies a
lack of culturally appropriate support structures for CALD people to access screening
services. The goal is to focus on increasing participation in cancer screening through
applying client-oriented intervention strategies. The project will be undertaken within
a 12 month timeframe with the estimated budget of $20,000. This proposal is
developed to provide evidence-based advice to local public health organisations and
health care providers. The recommendation include further research into a simple
and effective intervention to boost screening participation, improving access to
screening and increasing provider delivery of screening services. This proposal
investigates the fact that the plan has limitations. Some of the limitation include:
accurate population figures are not provided, the data source is exclusively based on
internet-based research including reports from government websites and available
research evidence from published literature and peer-reviewed journal articles.

Organisation
The following organisations including the National Breast Screening Program from
Cancer Council Australia, the National Cervical Screening Program from the
Department of health, the Department of Immigration and Citizenship, the NSW
Health Care Interpreter Service (HCIS), NSW Multicultural Health Communication
Service, NSW Ministry of Health and Cancer Australia will be participating in the
project.

Identify project Type option 1 or option 2

Option 2 is chosen based on the Information from earlier projects in the National
Breast Screening Program from Cancer Council Australia, the National Cervical
Screening Program from the Department of health, the Department of Immigration
and Citizenship, the NSW Health Care Interpreter Service (HCIS), NSW Multicultural
Health Communication Service, NSW Ministry of Health and Cancer Australia, which
denoted the worrying health issue of the relatively low cancer screening participation
rates among elderly women from CALD communities.
The health promotion grant proposal aims to raise awareness of substantially
preventable cancer and to improve breast and cervical cancer screening rates
among 50-74-year-old women in CALD communities under the South Eastern NSW
health district. Our priority population is people disadvantaged through cultural
factors as their inability to communicate or comprehend health information in English
appears to be the major contributing factor to low participation rates in cancer
screening (Healthway, 2017). Healthway (2017) highlights that the selected
population in the community is at greater risk of preventable chronic diseases and
have higher rates of unhealthy behaviour. It is important to address this indicator that
poorer prognosis and undesirable outcomes are highly attributable to late detection
of changes or delayed diagnosis (Torre, Siegel, Ward, & Jemal, 2015).
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The health promotion grant proposal aims to provide evidence on the health
education/promotion interventions on the efficacy of early screening and detection to
breast and cervical cancer screening uptake among these elderly women (Agide,
Sadeghi, Garmaroudi, & Tigabu, 2018; Coordinare- South Eastern NSW PHN,
2019b). Statistics indicate that over half of all cases of cancer could be avoided
through a combination of regular screening practice and healthy lifestyle (Colditz,
Wolin, & Gehlert, 2012; Dart, Wolin, & Colditz, 2012).
The breast and cervical cancer screening project plan attempts to develop its
foundation based on previous research. This approach takes into account lifestyle-
related risk factors, social determinant of health and most importantly,
communication barriers which can make a significant difference to the long term
health outcomes for older women from CALD backgrounds (Neuhauser & Kreps,
2008).

Breast and cervical cancer screening project plan

We plan to provide education about cancer screening by supplying publications such
as guidelines, reports, fact sheets and pamphlets in relevant languages in the
community to help people overcome barriers to services. We expect to implement
interventions with potential to increase screening uptake, eliminate disparities,
achieve health equality and improve the health of the group by the end of the project
period. In the proposed project, we will implement the intervention strategies to the
target group during a 12-month period. The ultimate goal of the project is to increase
participation in breast and cervical screening of non- English speaking older females
from CALD backgrounds in the South Eastern NSW region.
The objectives of this project are: to increase awareness of local services for the
target group requiring breast screening, by providing information interpreted in
relevant community languages, to improve the knowledge about risk factors
contributing to breast cancer and preventive measures, by providing information
interpreted in relevant community languages, to educate older females about
increased risk of breast cancer, by providing information interpreted in relevant
community languages, to improve health outcomes for the target group, by providing
information interpreted in relevant community languages, to improve culturally
appropriate support structures for older CALD women to access screening services,
to achieve a 5% increase in participation rates in breast and cervical screening, to
empower individuals and communities to compose healthier lives with better health
outcomes, to encourage individuals and communities to change their behaviour and
practice toward screening, to reduce the impact of preventable cancers, to create
supportive environments for women disadvantaged through culture and language
barriers and to empower community actions and reorient health services about the
need for older females from CALD backgrounds.

Evidence of need
Cancer causes significant health burdens (Hall et al., 2018). Screening is a primary
tool for early detection and reduction in cancer incidences and associated morbidity
and mortality (Hall et al., 2018). Breast and cervical cancer are the leading causes of
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cancer-related death in females across social-economic status levels worldwide

(Torre et al., 2015). Breast cancer is responsible for approximately 1.7 million cases
and 521,900 deaths, whereas an estimate of 527,000 people were diagnosed with
cervical cancer and 265,700 deaths occurred in 2012 (Torre et al., 2015).
Primary Health Networks (PHNs) established eight priority areas for the South
Eastern NSW health district. Cancer screening, one of the indicators, requires a
regional strategy and action to be undertaken at a practice on both a systemic and
community level (Coordinare- South Eastern NSW PHN, 2015). PHNs highlight the
importance of regular cancer screening among CALD populations, and have
developed ‘Screening Saves Lives’ videos for South-East Asian, Nepalese and
Bangladeshi communities. Print resources on cancer screening are available in
various languages (Coordinare- South Eastern NSW PHN, 2019a). Cancer Australia
(2019) supports CALD communities in ways by supplying a wide range of
publications available in ten different languages about cancers. Despite the
endeavours made, the following data shows strong evidence why the intervention
strategies for the specific group should be implemented.
Firstly, Coordinare- South Eastern NSW PHN (2019b) provides up-to-date evidence
on identified health issues for the target group. It has revealed that there is
suboptimal participation in the breast screening program and limited cancer
screening and management services available in rural locations (Coordinare- South
Eastern NSW PHN, 2019b).
Secondly, throughout the research, it is observed that little information about cancer
screening is available to people with difficulty communicating in English.
Furthermore, difficulty in accessing healthy lifestyle programs or initiatives was
identified due to a dearth of culturally appropriate support systems for CALD people
to access screening services. It raises significant health concerns among both
service providers and consumers. The two most common chronic diseases greatly
affecting females are breast and cervical cancers (Viens, Perin, Senkomago, Neri, &
Saraiya, 2017).
Thirdly, recent immigrants are less likely to get screened than others (The
Community Guide, 2017). Approximately one half of cervical cancers and one third
of breast cancers are diagnosed at a late stage among CALD communities (The
Community Guide, 2017). Kreps and Sparks (2008) point out the main reason for the
serious health disparities are due to health literacy difficulties, which are further
worsened by cultural barriers to making sense of relevant health information. Kreps
and Sparks (2008) concluded that these groups require specific communication
strategies for effectively reaching and influencing them to reduce health disparities.
A study conducted by Neuhauser and Kreps (2008) highlights literacy, cultural and
linguistic factors in health and cancer communication for diverse audiences including
low-literate, multicultural and non-English-speaking individuals. Research and
empirical evidence indicate the significance of these factors yet the literature offers
limited recommendations about better cancer communication (Neuhauser & Kreps,
2008).
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Community participative communication interventions can help people overcome

barriers to screening for cancers, increasing mammogram screening for breast
cancer and the cervical screening test instead of pap-smear for cervical cancer
(Cancer Council Australia, 2019; Department of Health, 2019; Kreps & Sparks,
2008). We aim to ensure the provision of high-quality, accessible information to aid
individuals’ decision making to raise awareness of cancer and the importance of
screening (Hall et al., 2018).
Lastly, in history the National Cervical Screening Program (NSCP) has been
introduced and implemented successfully since 1991 (Department of Health, 2019).
It is reported that both cervical cancer incidences and mortality rates have halved
since the NSCP began. However, a lower than the state average rate for screening
participation was pointed out among women from CALD backgrounds across NSW
(Cancer Institute NSW, 2018). These findings imply that only the ongoing program
with the continuous support of health professionals has a positive influence in
encouraging women to receive regular cancer screening (Australian Institute of
Health and Welfare, 2018).

Stakeholders
Organisations receiving funding allocations are responsible for the efficient and
effective delivery of activities in accordance with the obligations contained in any
funding agreement.

Organisations are also responsible for (1) ensuring they deliver on the funding
agreements or any other contractual arrangements, (2) acting in the best interest for
ensuring the project achieves the goal and value with public money, (3) maintaining
contact with the organiser and advising of any emerging issues that may impact on
the success of the project. (4) identifying, documenting and managing risks and
putting in place appropriate mitigation strategies, (5) keeping records of expenditure
of the grant funding, and (6) conducting an evaluation at the end of the project as
necessary.

Evaluation strategies
The proposed project’s success will be assessed and tracked at the conclusion of
every intervention. First, program quality and immediate program effects will be
evaluated using surveys. Videoconferences will be held among the participants at
the beginning and every three months to evaluate the progress of the project.
The Department of Immigration and Citizenship manages the estimated numbers of
the target population. The organisations are responsible for maintaining records of
the country of birth of residents in the target region, languages spoken at home (or
preferred languages), and need for interpreter assistance for all clients from the
target group. The success of the intervention will be recognised within 2 months
when more than 95% of the country of birth, languages spoken at home (or preferred
languages), and need for interpreter assistance is recorded correctly in the
databases. This individual plan will be carried on until the end of the project period.
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The Department of Health, Cancer Australia and Cancer Council Australia cooperate
to produce up-to-date information about the benefits of cancer screening within 2
months. Once a compliance benchmark for the number of different languages used
in communities is identified, the NSW Health Care Interpreter Service hires
interpreters to translate cancer screening resources into relevant community
languages. Within the first 3 months, the publications dedicated to CALD
communities are produced, being commensurate with the local CALD population
profile.
The NSW Health Care Interpreter Service and NSW Multicultural Health
Communication Service cooperate to produce publications in various forms including
education videos, printed materials such as guidelines, reports, fact sheets,
pamphlets and brochures, and posting on media channels. The next step is
dissemination of these publications to health care premises, local community
centres, churches, homes, senior centres or other settings so that target groups can
be educated and motivated to get screened. Reminders will be sent via letters,
postcards, emails, or phone messages, containing information about cancer
screening in relevant community languages. This process expects to take place at
the end of the third month and to be carried out throughout the project period.
During the process, the Feedback Survey will be implemented at the conclusion of
the brief intervention. This will measure an individual’s reaction and immediate
impact of the program on key risk factors associated with the target health
behaviours, including assessment of behavioural willingness to participate in the
cancer screenings. The measures will be collected immediately after implementation
of the program and will be monitored on a continual basis to ensure program
implementation quality.

Ethics
Each organisation involved in the project is subject to Privacy Laws to protect
confidentiality and protection of personal information (Not for profit law, 2017). Any
information collected, stored, used and disclosed is considered personal health
information under the funding agreement. The organisations will have to follow
Privacy Law obligations (Not for profit law, 2017). The organisations are also
required to comply with a set of specific Health Privacy Laws designated in New
South Wales (Not for profit law, 2017). Each applicant will be required to proclaim
their ability to comply with the 13 legally binding Australian Privacy Principles (APPs)
(Not for profit law, 2017).
As the project engages in activities for cultural purposes, organisations are entitled to
collect sensitive information without consent (Not for profit law, 2017). The general
rules for collecting information should still be applied, which is (1) to collect it by
lawful and fair means, (2) to try to collect it directly from the individual concerned,
and (3) to inform the individuals of the identity of your organisation and the purpose
of collecting the information, as well as the other notification matters listed under the
section (Not for profit law, 2017).
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Resources
Available online resources will be used throughout the project. Financial funding
constitutes $20,000 within the project period. Appropriate staff will be appointed to
each task.

Project budget proposal

The majority of funding is allocated to the supply of publications in the South Eastern
NSW region, however funding is also provided to organisations, departments and
any other service providers involved. Expenses are evenly distributed across the
twelve months. It is expected that some adjustment should be made during the
project.
Approximately $4000 will be placed in interpreting and translating information into
relevant languages in the community. Expenditure will be placed in publications and
advertising including making videos, producing printed materials such as brochures,
newsletters, letters, postcards, and a variety of media channels including posting on
social media, sending via emails and phone messages ($9,000). Dissemination of
printed materials such as brochures, newsletters, letters, and postcards is expected
to consume about $4000. $3,000 will be allocated to delivering surveys and
stationery.

Summary
Despite the government efforts to raise the awareness of elderly women to
participate in the breast and cervical cancer screening programs, the targeted
women from CALD populations remain vulnerable to serious health disparities. It is
admitted that culturally appropriate support systems for CALD people to access
screening services is limited. Hence, literacy, cultural and linguistic factors in health
and cancer communication provide strong evidence that target groups such as low-
literate, multicultural and non-English-speaking individuals are in need of services.
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References

Agide, F. D., Sadeghi, R., Garmaroudi, G., & Tigabu, B. M. (2018). A systematic
review of health promotion interventions to increase breast cancer screening
uptake: from the last 12 years. European journal of public health, 28(6), 1149-
1155. doi:10.1093/eurpub/ckx231

Australian Institute of Health and Welfare. (2018). Cervical screening in Australia.

Retrieved from https://www.aihw.gov.au/getmedia/8a26b34d-a912-4f01-b646-
dc5d0ca54f03/aihw-can-111.pdf.aspx?inline=true

Cancer Australia. (2019). Culturally and linguistically diverse services. Retrieved

from https://canceraustralia.gov.au/publications-and-resources/culturally-and-
linguistically-diverse-cald-services

Cancer Council Australia. (2019). Breast cancer screening. Retrieved from

https://www.cancer.org.au/about-cancer/early-detection/screening-
programs/breast-cancer-screening.html

Cancer Institute NSW. (2018). Breast screening participation rates by culturally and
linguistically diverse communities. Retrieved from
https://www.cancer.nsw.gov.au/cancer-plan/performance-index/breast-
screening-participation-rates-by-culturally

Colditz, G. A., Wolin, K. Y., & Gehlert, S. (2012). Applying what we know to
accelerate cancer prevention. Science Translational Medicine, 4(127), 127.
doi:10.1126/scitranslmed.3003218

Coordinare- South Eastern NSW PHN. (2015). 2015/2016 report card. Retrieved
from
https://www.coordinare.org.au/assets/Uploads/Resources/publications/Coord-
Annual-report-Final-summary-FINAL-Singlepages.pdf

Coordinare- South Eastern NSW PHN. (2019a). CALD and refugee health.
Retrieved from https://www.coordinare.org.au/for-health-
professionals/vulnerable-groups/cald-and-refugee-health/

Coordinare- South Eastern NSW PHN. (2019b). Helath priority: Prevention

initiatives. Retrieved from https://www.coordinare.org.au/assets/Main-
Site/Uploads/Resources/publications/HEALTH-PRIORITY-AREA-Prevention-
initiatives.pdf

Dart, H., Wolin, K. Y., & Colditz, G. A. (2012). Eight ways to prevent cancer: a
framework for effective prevention messages for the public. Cancer causes &
control, 23(4), 601-608. doi:10.1007/s10552-012-9924-y
Department of Health. (2019). National cervical screening program. Retrieved from
http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/
cervical-screening-1
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Hall, I. J., Tangka, F. K. L., Sabatino, S. A., Thompson, T. D., Graubard, B. I., &
Breen, N. (2018). Patterns and trends in cancer screening in the United
States. Preventing Chronic Disease, 15, E97. doi:10.5888/pcd15.170465

Healthway. (2017). Strategic Plan 2012-217. Retrieved from

https://www.healthway.wa.gov.au/wp-content/uploads/healthway-strategic-
plan-2012-2017_hr.pdf

Kreps, G. L., & Sparks, L. (2008). Meeting the health literary need of immigrant
populations. Patient Education and Counseling, 71(3), 328-332.
doi:10.1016/j.pec.2008.03.001

Neuhauser, L., & Kreps, G. L. (2008). Online cancer communication: meeting the
literacy, cultural and linguistic needs of diverse audidences. Patient Education
and Counseling, 71(3), 365-377. doi:10.1016/j.pec.2008.02.015

Not for profit law. (2017). Privacy Guide- A guide to compliance with privacy laws in
Australia. Retrieved from
https://www.nfplaw.org.au/sites/default/files/media/Privacy_Guide_Cth.pdf

The Community Guide. (2017). Cancer Screening- Ecidence-based interventions for

your community. Retrieved from
https://www.thecommunityguide.org/sites/default/files/assets/What-Works-
Factsheet-CancerScreening.pdf

Torre, L. A., Siegel, R. L., Ward, E. M., & Jemal, A. (2015). Global cancer incidence
and mortality rates and trends- An update. Cancer Epidemiology and
Prevention Biomarkers, 25(1), 16-27. doi:10.1158/1055-9965.EPI-15-0578

Viens, L., Perin, D., Senkomago, V., Neri, A., & Saraiya, M. (2017). Questions about
cervical and breast cancer screening knowledge, practice, and outcomes: A
review of demographic and health surveys. Journal of Women's Health, 26(5),
403-412. doi:10.1089/jwh.2017.6441