Breast Aware FULL Case Study.Pdf
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Breast Aware Overview Topic: This project, which was jointly funded by NHS Cancer Tameside and Glossop and Tameside Organisation: Metropolitan Borough Council (MBC), aimed to increase early cancer detection and reduce late NHS Tameside and Glossop; Tameside Metropolitan Borough Council presentations and death rates of breast cancer Location: by encouraging women aged 35 to 50 to be breast aware. Tameside (North West) Dates: Following an extensive scoping stage, a January 2008 to April 2010 strategy was developed that incorporated Website: communication, community-based and service- www.breastaware.net led initiatives. Interventions were piloted Contact: between February and April 2010 in Ashton Gideon Smith (Consultant in Public Health Hurst, which is one of the most deprived Medicine); Debbie Bishop (Head of Health communities in Tameside and has particularly Improvement) low breast cancer survival rates. Email: [email protected]; Key results [email protected] Telephone: Increased awareness of the range of breast 0161 342 3358 cancer symptoms to look out for and confidence in how to self-examine Disappointingly, the campaign did not achieve an increase in women examining their breasts at least once a month (as recommended by the NHS) 40 per cent awareness of the campaign, which made women clearer about what is normal for them and changes to look for The well-women event was the most well attended community event the Primary Care Trust/Council had ever held in the area The campaign prompted other positive health behaviours, such as exercise ShowCase │ Breast Aware 1 Care Trust (PCT) to understand and act on real insight, rather than to continue doing what had always been done, and social marketing offered a way of managing this new approach. Chosen as 1 of 10 social marketing learning In line with the rest of England, breast cancer is demonstration sites, the project received free the most common cause of death from cancer social marketing guidance from a member of amongst women in Tameside and Glossop. The NSMC team, as well as funding for Although the incidence of breast cancer in the independent outcome evaluation to be region is no higher than the national average, conducted by the London School of Hygiene survival rates are lower due, in part, to late and Tropical Medicine (LSHTM). presentation. Early detection of breast cancer can lead to simpler, more effective treatment The project was initiated by the Associate and improvement in survival rates. The NHS Director of Health Improvement, with £18,000 Breast Cancer Screening Programme provides from the public health improvement budget. free screening every 3 years to women aged However, due to absence from long-term between 50 and 70. However, breast screening illness, plus staffing shortages from uptake in NHS Tameside and Glossop restructuring within the PCT, the project lacked (NHST&G) was showing a downward trend and dedicated local resource to push it through in as at 31 March 2007, coverage of women aged the early stage. The project was subsequently 53 to 70 in NHST&G was just 61.3 per cent, picked up by the PCT cancer lead (a consultant compared to 73.8 per cent in England. in public health medicine), who was able to enlist the support of a colleague who held a Whilst breast screening programmes are an joint commissioning post across the integrated important method of detecting cancer, self- Council and PCT Health Improvement Teams. awareness and understanding of what clinical Recognising the initial funding was not signs to look for also have an important role to sufficient to scope, design and implement an play. In 1991, the Department of Health effective project, they aligned their funding pots England (DH) abandoned systematic breast for preventative activities to boost the budget self-examination and replaced it with a policy for the project to £55,000 (excluding that encourages women to be breast aware evaluation). With this funding, a social from age 18. This has been encapsulated by marketing agency was commissioned to the NHS‟s breast awareness five-point code: provide dedicated project management support and deliver the scoping and development work. 1. Know what feels normal for you 2. Look and feel 3. Know what changes to look for 4. Report any changes without delay 5. Attend full breast screening if aged 50 or over Project initiation and funding To increase early cancer detection and survival rates, NHST&G approached The NSMC to initiate a social marketing pilot project to increase breast awareness in women aged 35 to 50. There was a desire within the Primary ShowCase │ Breast Aware 2 Project aims Desk-based research was carried out in The short-term aim of the project was to summer 2008 to provide an overview and increase the number of women aged 35 to 50 analysis of existing secondary research and in Ashton Hurst ward who are aware of their what was known from the evidence base of breasts and who examine them regularly. social marketing and other work relating to breast awareness, cancer and screening. The Longer-term aims of the project were to research focused on gathering information increase: about the target audience, current UK policy and examples of good practice. However, the The speed at which women report an evidence base around breast awareness, abnormality to their GP particularly among women aged under 50, was The number of women who attend breast scant. Research that did exist suggested that screening from aged 50 breast awareness is affected by a host of The number of GPs, practice nurses and psychographic factors, including self-efficacy, community workers who routinely and confidence, body image and embarrassment. systematically inform, encourage and support women to be breast aware To establish a baseline of local knowledge, awareness and behaviour around breast Target audience awareness, LSHTM carried out a street survey The target audience was initially defined as in summer 2009 in Ashton Hurst (intervention women aged 35 to 50, living in the top 10 per area) and South Denton (comparison area), cent of deprived communities in Tameside and which had been matched for age structure, Glossop. This age group was targeted to deprivation and rural/urban mix. A face-to-face increase the possibility of early detection in questionnaire was implemented with 185 younger women who are not yet eligible for free women aged between 35 and 50 across the breast screening, and to increase interest in intervention and control areas. and uptake of breast screening once they reach 50. Late presentation is a particular issue To further explore local women‟s knowledge, amongst more deprived women. The Ashton behaviour and attitudes around breast Hurst ward was selected as the pilot area since awareness, and their barriers and motivators it is one of the most deprived communities in for being breast aware, primary research was the PCT and both breast screening uptake and conducted with women aged 35 to 50 living in breast cancer survival rates are particularly Ashton Hurst and South Denton. This involved low. 2 focus groups with 6 to 8 members of the public, and 15 women were interviewed, either individually or as part of a friendship pair. Twenty in-depth interviews were also conducted with key stakeholders (such as GPs, nurses, and a range of other health professionals and community workers) to explore if and how service improvements could Research be made to increase breast awareness. The scoping stage of the project comprised desk-based research, primary research with Insights the target audience and interviews with key The findings from the street survey and stakeholders. qualitative research were largely consistent: women were aware of the dangers of breast ShowCase │ Breast Aware 3 cancer, but few regularly examined their Having a fatalistic view breasts or felt confident they were doing it Not wanting to bother their GP correctly and knew what changes to look for, other than lumps. Nurses seemed to have an accurate understanding of what it meant to be breast While women were unlikely to visit a mobile aware and reported giving lifestyle advice, unit or stand, or attend workshops, they were including about being breast aware. GPs amenable to receiving health messages in the seemed to have a more basic understanding community from non-health professionals and and did not routinely offer lifestyle advice. in non-health settings, such as in community Health trainers also had a potential role to play centres or the workplace. Poster advertising, as they engage directly with people to offer direct mail and articles in local newspapers advice on a wide range of lifestyle issues, but were regarded as the most effective media not specifically on being breast aware. channels. Interestingly, none of the professionals The baseline survey and primary research with interviewed were spontaneously aware of the women found that although many women were breast awareness code, but were very positive aware of the dangers of breast cancer and about it when it was described to them. claimed to check their breasts, most only Although the nurses interviewed had a good checked infrequently and felt they were understanding of what it meant to be breast probably doing it incorrectly. The majority of aware and reported giving women advice about women associated breast awareness with being breast aware, most of the women finding lumps and few were aware of other involved in the research had not received changes to look out for. advice from their GP or nurse about breast awareness. Since some women worried about bothering their GP and many considered the practice nurse the most appropriate person to give breast awareness advice, nurses and community workers (rather than GPs) in particular would be encouraged to proactively provide advice and support around breast awareness.