Background: Cancer is a significant health concern for LGBTIQASB+ Australians, with an estimated 7,500 new diagnoses and 23,000 survivors annually. The WA Cancer Plan 2020-25 aims to reduce cancer’s burden and acknowledges the unique needs of those in the LGBTIQASB+ community. Ongoing disparities in cancer care experienced by LGBTIQASB+ individuals lead to exclusion, lack of support, and increased distress. Discrimination in healthcare settings and a lack of LGBTIQASB+ competence among clinicians hinder cancer screening uptake, especially among trans people. There is a notable absence of LGBTIQASB+-specific information in Australian cancer support resources, with recent initiatives beginning to address this gap.

Launched in 2021, the Screening Saves Lives campaign (Figure 1) targets the WA LGBTIQASB+ community, promoting awareness and engagement in bowel, breast, and cervical cancer screenings. There were three campaign components – 1. Speak to your GP, 2. Screening eligibility criteria, and 3. Community Champions. WA LGBTIQASB+ community members were featured in campaign resources, with widespread dissemination through various LGBTIQASB+ community channels and through healthcare providers. This study aimed to evaluate the campaign and assess cancer screening knowledge, attitudes and practices in the WA LGBTIQASB+ community.

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Approach: 

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• Cross-sectional online survey using a Qualtrics online panel and promotion through community networks.

• Content and face validity testing of the survey using expert panel and community members (n=13).

• Measures: campaign awareness, behavioural change intentions, knowledge of cancer risk factors, and screening eligibility and motivations to participate.

• The target group was self-identified members of the LGBTIQASB+ community residing in WA who met the established criteria by program:

  • Cervical screening: aged 25-74 years, has a cervix, has ever been sexually active.

  • Breast screening: aged 40-74 years, has breasts or chest tissue, assigned female at birth.

  • Bowel screening: aged 50-74 years, has a bowel.

Key findings:

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• Most participants (n=433) were Australian-born, aged between 25 to 39 years, English-speaking, tertiary educated and cisgender women. Participant demographics revealed an overrepresentation of women: cisgender women (64.9%; n=281), cisgender men (22.9%; n=99), trans men (0.9%; n=4), trans women (0.5%; (n=2), and non-binary participants (6.93%; n=30). A variation of sex characteristics (intersex status) was reported by 13.2% (n=57) of participants. Interestingly, 6.9% of respondents identified as Aboriginal, Torres Strait Islander and/or both.

• Over half (56.1%; n=243) of participants recalled seeing cancer screening advertising in the past 12 months. Each SSL campaign component achieved recall rates among approximately one-third (1: 37.6%, 2: 30.3%, and 3: 27.3%) of participants, indicating successful penetration of the campaign's core messages. Campaign materials were positively received, with over 80% of respondents affirming their appeal.

• Behavioural intentions were promising, with 70% of respondents considering engaging in screening activities.

• Barriers to screening such as fear, discomfort, and embarrassment were identified across cervical, breast, and bowel cancer screenings. Gaps in knowledge about screening protocols, particularly self-collection options for cervical screening were also evident. In addition, gaps in knowledge were identified in relation to modifiable risk factors.

 

Implication and considerations:

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• Findings underscore the success of the campaign's content design and messaging strategy in resonating with the intended audience. The use of outreach strategies appeared successful with social media, GP clinics, and community events identified as effective channels. The campaign's inclusive representation of the LGBTIQSB+ community was acknowledged by most participants.

• Findings also suggested the need to include greater cultural inclusivity and representation in future campaign iterations. Future evaluation efforts should aim for broader demographic segmentation, in particular older adults and people from culturally and linguistically diverse backgrounds.

• Future efforts should demystify screening processes, address emotional and psychological barriers, and reinforce the critical role of regular screening in early detection and the facilitation of timely treatment interventions. Opportunities also exist for research and evaluation to interrogate factors relating to knowledge gaps that were identified in relation to modifiable risk factors.

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Project team:

Jonathan Hallett1 , Justine Leavy1 , Nang Phoo1 , Gemma Crawford1 , Lekey Khandu1 , Renae Hayward2 , Sonya Schultz3 , Kathleen O’Connor4

1. Collaboration for Evidence, Research and Impact in Public Health (CERIPH), School of Population Health, Curtin University, Western Australia.

2. WA Cervical Cancer Prevention Program, Women and Newborn Health Service, North Metropolitan Health Service, Western Australia.

3. BreastScreen WA, Women and Newborn Health Service, North Metropolitan Health Service, Western Australia.  

4. Cancer Network WA, North Metropolitan Health Service, Western Australia.  

 

Publications:

• Hallett, J., Leavy, J., Phoo, N., Crawford, G. & Khandu, L. (2023). Screening Saves Lives campaign: KAP assessment.  Collaboration for Evidence, Research and Impact in Public Health (CERIPH), Curtin University: Perth, Western Australia.

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For more information: 

Dr Jonathan Hallett

j.hallett@curtin.edu.au