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Direct Health Promotion Programme Avon Breast Screening Unit Dr. S. Chakrabarthi Consultant Radiologist UH Direct Health Promotion Programme Avon Breast Screening Unit Dr. S. Chakrabarthi Consultant Radiologist UH Bristol NHS Foundation Trust

Avon Breast Screening Unit n 7 th largest screening unit in the country n Avon Breast Screening Unit n 7 th largest screening unit in the country n Screening population - 134, 000 n Every year invite - approx 44, 000 n Overall uptake rate – 74% n Lowest uptake rate – 47%

Background n Standard acceptance rate - more than 70% n Acceptance rate at Charlotte Background n Standard acceptance rate - more than 70% n Acceptance rate at Charlotte Keel - very poor historically (47. 5% in 2006) n Large number of women screened n Diverse ethnicity (estimated 50% from ethnic minority groups) n One of the most deprived practices in Avon

General vs Ethnic minority - 2006 Invited General Attended 1153 547 (47%) 97 (38%) General vs Ethnic minority - 2006 Invited General Attended 1153 547 (47%) 97 (38%) (All ladies) BME 255 (22% of total)

Caucasian vs Ethnic minority Invited Attended Caucasian 898 450 (50%) BME 255 97 (38%) Caucasian vs Ethnic minority Invited Attended Caucasian 898 450 (50%) BME 255 97 (38%)

Health Equity Audit Cycle 2. Do an equity audit 3. Identify effective local action Health Equity Audit Cycle 2. Do an equity audit 3. Identify effective local action to tackle inequalities 4. Agree local target with partners 1. Agree priorities and partners 6. Review progress and impacts against targets 5. Secure changes in investment and service delivery

Local target To achieve an attendance rate of 70% in the next round - Local target To achieve an attendance rate of 70% in the next round - 2009

Interventions n 07/02/08 : Meeting with key players – Director of ABS, GP, Link Interventions n 07/02/08 : Meeting with key players – Director of ABS, GP, Link workers, PCT n All religious and leisure centres were posted letters and followed up with at least one phone call n Educational sessions

Educational sessions Oct 2008 – Jan 2009 n Charlotte Keel Health Centre n Ethnic Educational sessions Oct 2008 – Jan 2009 n Charlotte Keel Health Centre n Ethnic minority organisations Awaz Uthaoh Bangladeshi women’s organisation n Church

Educational sessions – Who? n Consultant Radiologist n Breast Care Nurse n Health Promotion Educational sessions – Who? n Consultant Radiologist n Breast Care Nurse n Health Promotion worker - PCT

Educational sessions – What? n Greetings & Introduction n Breast Awareness – hands on Educational sessions – What? n Greetings & Introduction n Breast Awareness – hands on n Awareness of ducts - pictorial n Understanding of Breast cancer n Importance of Breast Screening n Walking the Way to Health n Posters and leaflets

Walk your way to Health n. A Bristol City Council initiative n Map by Walk your way to Health n. A Bristol City Council initiative n Map by Bristol PCT n Dedicated walk leader

Map Map

Challenges n Arranging funds for link workers from PCT n Co-ordinate activities n Inviting Challenges n Arranging funds for link workers from PCT n Co-ordinate activities n Inviting women by postcode n Accomodating the needs of all n TIME!

Re audit (Jan – Feb 2009) Questionnaires: Age Ethnic group Mode of transport Did Re audit (Jan – Feb 2009) Questionnaires: Age Ethnic group Mode of transport Did they use the walking route map? Did they attend an educational session? Would they like breast awareness sessions?

Questionnaires 63% (450 women) completed questionnaires Questionnaires 63% (450 women) completed questionnaires

2006 vs 2009 Total invited BME Caucasian BME invited((% uptake of total) Overall uptake 2006 vs 2009 Total invited BME Caucasian BME invited((% uptake of total) Overall uptake rate 2006 1153 225 50% (20%) 38% 47% 2009 1274 385 58% (30%) 50% 56%

People who would have liked an education session People who would have liked an education session

53 people (12%) walked n Black caribbean or british caribbian – 21 – 40% 53 people (12%) walked n Black caribbean or british caribbian – 21 – 40% n White British – 14 – 27% n Mixed white and Black Caribbean – 5 – 9% n Others - 13 – 24%

Key Findings n Target of 70% uptake rate not achieved n Uptake rate improved Key Findings n Target of 70% uptake rate not achieved n Uptake rate improved by 9% overall n Uptake rate improved by 12% in the ethnic minority groups n A broader health promotion programme reaching out more women is likely to make a difference

Changes in our Unit n GP Practices are offered education sessions n Sessions to Changes in our Unit n GP Practices are offered education sessions n Sessions to be run by Breast Care Nurses n Sessions to be organised by GP practices n At present offered to surgeries with uptake rate less than 60%

Thank you very much n n n Dr. L. Kutt Dr. M. Lamont Ms. Thank you very much n n n Dr. L. Kutt Dr. M. Lamont Ms. S. Clough Ms. P. Castell Ms. N. Day Staff at ABSU M. Burrell – PCT Health Promotion worker Link workers – Charlotte Keele (Mrs. Hamid) Dr. Muir – Charlotte Keele PCT Bristol City Council

Most of all Nishat! Most of all Nishat!