A community champion led breast cancer screening intervention for underserved groups

RESEARCH QUESTION:

What is the impact of an intervention package delivered through community champions on breast cancer screening (BCS) uptake in underserved populations? BACKGROUND:

Breast cancer is the most common cancer in the UK, affecting 1 in 8 women in their lifetime. Breast cancer screening (BCS) detects cancer at an earlier stage, when survival is greater, and is estimated to save 1,300 lives annually. However BCS attendance is falling, and particularly low in London (56% in 2023). There are inequalities in uptake: those from deprived areas and ethnic minority groups are less likely to attend.

AIMS:

The study aims to test the impact of a community champions intervention on BCS uptake in underserved groups and wider population. We will measure exposure to the intervention and test whether exposure is associated with more positive attitudes towards screening, we will also assess cost-effectiveness.

METHODS:

The intervention resources consist of an animated video intervention, leaflet, bus stop adverts, billboards, wallet cards and radio adverts. Resources are based on extensive work on barriers and facilitators of uptake, particularly in underserved groups, and co-designed with women from these groups and based on behavioural science frameworks. The intervention will take place in Hounslow due to our partnership with Hounslow Local Authority.

They have developed a comprehensive engagement plan to reach underserved women, leveraging existing networks to recruit community champions, including from their Community Connectors, local communities/faith groups, businesses (e.g. salons), and Health Outreach Team.

After a 6 month intervention refinement stage, we will recruit and train community champions. The intervention will take place over 6 months, with 6 month follow up. Inverse probability of treatment weighting based on the propensity score will be used to compare BCS attendance in Hounslow with a comparator group of 4 non-neighbouring London boroughs with similar past uptake levels and demographics.

The analysis will control for age, index of multiple deprivation, ethnicity, previous BCS attendance, and distance to screening site. Surveys in the community (N=500) will assess exposure to the intervention, and the effect of exposure on attitudes to BCS and intention to screen. Surveys at the screening site (N=400) will assess intervention exposure across different demographic subgroups, and which resources were encountered via which distribution channels.

We will assess cost-effectiveness of the intervention, capturing resource consequences in both diagnostic and therapeutic pathways. TIMELINES: 0-6m: intervention refinement 0-9m: ethics approvals 4-9m: community champion recruitment and training 10-15m: intervention period 16-21m: follow up period 22-31m: data access and linkage

32-39m: uptake analysis, economic analysis 37-42m: write up/output production/dissemination IMPACT/DISSEMINATION:

We will disseminate findings locally, regionally and internationally. As well as peer reviewed publications and conference presentations, we will produce an accessible intervention toolkit, including all intervention resources and a how-to guide to replicate the intervention comprising engagement plans, community champion training, and FAQs about intervention dissemination and BCS. This will be disseminated to local authorities, Cancer Alliances, and NHS England using contacts of the applicants.