Regular cervical screening has proven to be an effective way of preventing cervical cancer. Despite the availability of a cervical screening programme in Hong Kong, there is a gap in serving South Asian ethnic minorities due to language and cultural barriers.

To address the unmet need, The Nethersole School of Nursing at The Chinese University of Hong Kong (CUHK)’s Faculty of Medicine (CU Medicine) expanded a territory-wide programme two years ago to train a group of local South Asian women by giving them knowledge of cervical cancer and access to screening services, enabling them to become community health workers who help educate their peers. It has trained more than 50 South Asian women, who have reached out to over 1,000 people in their community, boosting screening uptake by over 75%. The programme team held an appreciation ceremony on March 24 to celebrate the interim success of the programme and to recognise the support of collaborating non-governmental organisations.

Certificates were presented to community health workers who have completed the training programme and have carried out intervention to their peers.

85% of South Asian women surveyed have never received cervical screening 

Cervical cancer is the seventh commonest cancer among females in Hong Kong, with over 500 new cases each year. Regular cervical cancer screening is effective in reducing cancer risk by up to 95%.

Professor Jojo Wong Cho-lee, Associate Professor of The Nethersole School of Nursing at CU Medicine, said, “Despite the government’s existing promotion of the importance of early detection of cervical cancer and provision of cervical screening services, their effectiveness in reaching local ethnic minorities has been limited. Out of the 1,016 South Asian women who are eligible for cervical screening that we reached out to, 85% had never been screened for cervical cancer and 15% had not been screened for more than three years.”

Train-the-trainer approach: success of the educational programme led by community health workers

This training programme is part of the Integrative Multicomponent Programme for Promoting South Asians’ Cancer Screening UpTake (IMPACT) project led by Professor Winnie So, Professor Dorothy Chan and Professor Jojo Wong of The Nethersole School of Nursing at CU Medicine. Co-funded by the Knowledge Transfer Project Fund and the Social Innovation and Entrepreneurship Development Fund in 2022, the IMPACT project consists of a community health worker training programme and a community health worker-led intervention for promoting the uptake of cervical cancer screening among Asian women.

The CUHK team collaborated with more than 40 local non-governmental organisations and South Asian community centres to recruit community health worker trainees. In total, they trained 52 women, who reached out to over 1,000 of their peers in local communities, providing information about cervical cancer and cancer screening services, assisting them in making cervical cancer screening appointments, and accompanying them to these appointments. Over 75% of the women they reached out underwent cervical cancer screening.

Professor Winnie So introduced the IMPACT project and presented the outcomes they have achieved so far. 

Professor Dorothy Chan Ngo-sheung, Assistant Professor in The Nethersole School of Nursing at CU Medicine, said, “Cultural norms were among the challenges we encountered while implementing the project. For instance, many of the Pakistani women we engaged saw a need to seek permission from their husbands to take part in the screening. This reflects a need to educate not only eligible women but also their family members about the importance and purpose of cervical cancer screening.”

 

Professor Winnie So Kwok-wei from The Nethersole School of Nursing at CU Medicine, said, “The success of the IMPACT project illustrates the huge potential and capability of social capital in promoting public health, which has yet to be fully exploited. We are delighted to see the trust relationships built between community health workers and their peers, with community health workers becoming their resources for accessing health information and cancer screening services. We are expecting a ripple effect, which can bring us even closer to our ultimate goal of reaching all eligible South Asians in Hong Kong.”

 

Based on their experience, the project team and partnering organisations made some recommendations to further enhance the dissemination of cervical cancer prevention information among local South Asian ethnic minority people.

Recommendations to further enhance the dissemination of cervical cancer prevention information among local South Asian ethnic minority people in Hong Kong

1. Allocate more resources to the training of community health workers

• The Government should consider allocating more resources to local non-governmental organisations serving ethnic minorities, allowing them to train additional staff members, who can train more South Asians to become community health workers. This would help facilitate the train-the-trainer approach to promoting cervical cancer screening among South Asian ethnic minorities in Hong Kong.

2. Strengthen community-academic-clinical partnerships to promote public health

• Collaboration between healthcare research teams, District Health Centres/General Practitioners and community organisations serving local ethnic minorities should be fostered to implement health promotion programmes, not only for South Asian ethnic minorities, but also the general public. Community organisations have the network to recruit participants for health promotion programmes; healthcare research teams can provide evidence-based training to ethnic minority community health workers and evaluate the outcomes of the programmes; and District Health Centres and General Partitioners can provide health advice and cancer screening services. Collaboration among the three parties can enable the wider dissemination of health promotion strategies to the public.

Group photo of project team members from CU Medicine's Nethersole School of Nursing, community health workers and representatives of community partners.