EQUITy in Black Adult health (EQUITA)- a randomised feasibility trial of a co-produced and faith-placed intervention to increase uptake of breast, cervical, bowel, and AAA screening in the North East of England, Leeds and Scotland

Background

Breast, bowel, cervical, and abdominal aortic aneurysm (AAA) screening saves lives. However, stark inequities in uptake of screening exist for people from ethnic minority groups. This trend is particularly alarming within the Black community, where lower screening rates put them at higher risk of death due to lack of early diagnosis and provision of effective early treatment.

These inequities need tackling urgently. Culturally tailored, community-centred and participatory approaches show promise in tackling health inequities. This 24-month study aims to examine feasibility and acceptability of a co-produced, faith-placed intervention to increase uptake of breast, bowel, cervical, and AAA screening among Black communities.

Intervention

In previous research, we worked with Muslim women to co-produce a faith-based intervention to improve uptake of breast, bowel and cervical cancer screening. This approach was subsequently tailored for early detection of prostate cancer among Black men, resulting in a peer-led, two-hour workshop. The workshop included 1) discussions on barriers to early diagnosis, 2) health education by a Black GP, 3) video testimonials from community members, 4) discussions on accessing care and asking the GP questions, 5) videos of Black women discussing health for the family, 6) perspectives from religious leaders, 7) a social component with food and music.

We will adapt this intervention in partnership with the Black community to encourage uptake of breast, cervical, bowel, and AAA screening. Methods

Underpinned by the Integrated Screening Action Model, we will conduct a mixed-methods, multicentre two-arm randomised feasibility trial with 300 Black people (female aged 25-74, male 50-74) in churches in Glasgow, North East of England, and Leeds, who are partially or not up to date with screening they are eligible for, allocated to one of two arms, per site: 1) intervention, 2) control. A process evaluation through focus groups with participants (6x n=8), Peer-facilitators (n=12), and stakeholder interviews (n=10), will allow us to identify opportunities for modification in the feasibility trial and intervention.

Expected results

An assessment of suitability of the trial’s parameters will inform development of a large-scale trial using pre-specified progression criteria and a traffic light system for evaluation of STOP-AMEND-GO criteria. To gain a preliminary indication of intervention effectiveness we will capture knowledge, attitudinal change to screening (e.g. intentions to screen at baseline and 3-month follow-up), and behavioural outcomes (e.g. NHS screening attendance at 6 months).

Anticipated impact and dissemination

Our vision is to tackle current inequities by testing the feasibility and acceptability of a co-produced, peer-led intervention to improve engagement with breast, bowel, cervical and AAA screening among Black people in the UK. We propose a rigorous feasibility and process evaluation of the first theory-driven and co-produced intervention for Black people using culturally appropriate messages that support screening for early diagnosis in this underserved group.

To maximise study impact, engagement and collaborative working with members of the community and key stakeholders provides an essential route to dissemination. A Knowledge Mobilisation plan will be developed. If warranted, we will seek further funding to test intervention effectiveness in a powered randomised controlled trial.