Assistant Professor Rosie Yoon has received bridge funding from the Canadian Institutes of Health Research (CIHR) to work with the Mid-West Toronto Ontario Health Team (MWT-OHT) Open Door Program – a community-connected health care and resource program – on improving cancer screening engagement in the communities located in mid-West Toronto.
“We have the population health data that shows us there are hot spots in the city where there are disparities in health status and access to preventative care. We also know from our research, that cancer screening is much lower in some neighbourhoods relative to others, and that there are multi-faceted barriers including structural vulnerabilities that contribute to that,” says Yoon.
Co-designing to improve engagement
Her research proposal is a four-year initiative aimed at increasing cancer screening engagement within three neighbourhoods that are serviced by the Mid-West Toronto Ontario Health Team, and that have statistically lower screening rates for colorectal, breast and cervical cancers. Each neighbourhood has diverse needs Yoon says, so it is imperative that this work is co-designed with the communities, to build trust and engage them on their perspectives related to cancer screening hesitancy.
“You cannot build a program without understanding the needs of the people you are trying to reach,” says Yoon.
Through targeted focus groups, and by leveraging the Open Door Program’s model of care, Yoon’s research is working towards dismantling some of the barriers that contribute to screening hesitancy. She hopes to drive improved engagement and ultimately life-saving cancer screening.
“The beauty of the MWT- OHT Open Door Program is that it is a locally driven initiative with community health ambassadors and nurses,” says Yoon. “They are bringing health promotion and education directly to people, whether that it through food banks, shelters, or community centres. They also provide support for those needing helping just navigating the health system.”
A hyperlocal approach to care
A practicing NP, Yoon has been involved with the MWT-OHT Open Door Program since its inception in 2022. Its localized population health model is a successful initiative that came out of the pandemic when communities were looking for ways to improve COVID19 vaccination rates.
“The government realized that this type of model was successful at reaching populations with barriers to health care access, and it involved having this hyperlocal approach to healthcare,” says Yoon.
Kasia Filaber is the manager of the Open Door Program and Yoon’s research partner. She describes seeing first-hand the hesitancy around cancer screening in the community, stemming from a variety of issues, including misinformation and fear, religious or cultural beliefs, and a lack of awareness about the importance of preventative screening.
“Language is another barrier as we have a lot of newcomers in the area, computer literacy is another, or even just time, since so many of the residents are working multiple jobs. Another big one is not having access to a doctor to have the screenings done in the first place,” says Filaber.
Understanding these various drivers of cancer screening hesitancy is not enough. Yoon and Filaber want to see how the MWT-OHT Open Door program and its model of care, can respond to and co-design other methods of engagement and intervention, that go beyond traditional approaches of distributing health promotion material.
If they are successful, Yoon says, they will be able to determine how to build capacity and scale up the program to cover other areas related to cancer care, including survivorship.
Community partner Rona Abramovitch was part of the initial group Yoon consulted to develop this research proposal. Abramovitch sees this research initiative as a means of addressing inequitable outcomes in the health care system, which are not always visible.
“What excites me about this research is its genuine focus on the real-life experiences of people from a variety of cultural and socio-economic backgrounds, especially those for whom typical screening outreach methods may not work. I believe that by taking this approach, we can increase cancer screening rates and ultimately lower cancer risk in these communities,” says Abramovitch.
Community based agencies have been around for decades, and they are the natural connectors that keep communities healthy, which is why Yoon is hopeful that her research will shed a light on the impact of this model and provide opportunities to see it adapted to address many other health concerns.
“We need to take the time and energy to listen to what matters to people,” says Yoon. “That is how we will address systemic barriers and improve outcomes for the better.”