Approaching a multicultural prevention in cervical cancer screening

Context

In recent years, immigrants in Piedmont have had a gradual increase. From available data at 31/12/2004, they were around 208.248 people (about 8.7% of total immigrants in Italy). Women were about half (103.009) and represent 4.6% of the regional female population and 7.2% of women living in Turin. (Source: Demographic Evolutionary Database Piedmont Region, 2004). To these, irregular people (those who have never had a residence permit) must be added (about 70,000 in Piedmont).

Objectives

Considering the lowest levels of participation in screening programmes for immigrant women than Italian women, Prevenzione Serena decided to devote part of their work to this target through a specific project for integrating immigrant women in the regional screening programme. The initiative aimed to promote the participation of these women, making targeted interventions to improve the quality of communication and the access to screening facilities.

Activities

A multidisciplinary team consisting of medical doctors, community health workers, members of associations working in the field of immigration, and cultural mediators was formed.

The working group has:

  1. analysed data on participation in cervical cancer screening for immigrant women, outlining the differences with Italian women and each specific nationality;
  2. conducted a review of scientific literature in order to analyze the main obstacles to participation of immigrant women (with particular attention to language difficulties and cultural perceptions of health and prevention) and identify possible information strategies to improve their knowledge and participation;
  3. identified, in collaboration with the Centre Regional Immigration in Piedmont, the most common languages among the immigrant population, which translate information material.

A leaflet and a poster translated into seven languages (Romanian, Russian, Arabic, Chinese, English, French and Spanish) were produced. The texts have been written trying to provide information in respect of cultural differences, taking into account the principle of informed consent, in order to give women accurate and balanced information enabling them to consciously participate in the screening programme. These communication tools have been included in a wider mass campaign with the posting on regional means of transport (buses, trams, trains).

Particular attention was given to the identification of the image of the campaign. It is represented by the profiles of four women belonging to different ethnic groups, and identified among immigrants living in Turin. The information material were disseminated in clinics, pharmacies, ISI centres, medical offices, cultural centres and associations in Piedmont.

In addition, a multilingual toll free number to give women more information about Prevenzione Serena and its organisation was arranged for a limited period (6 months).

All the initiative was welcomed by immigrant women and data analysis of cervical screening participation in the pre and post campaign period (May-November 2005 and May-November 2006), showed an increase in their adherence of 2% (from 33.9% to 35.9%).

Data on cervical screening attendance by immigrant women in Prevenzione Serena continue to be regular analysed and evaluated.