EQUITy in Black Adult health (EQUITA)- a randomised feasibility trial of a co-produced and faith-placed intervention to increase uptake of breast, cervical, bowel, and AAA screening in the North East of England, Leeds and Scotland

Background Breast, bowel, cervical, and abdominal aortic aneurysm (AAA) screening saves lives. However, stark inequities in uptake of screening exist for people from ethnic minority groups. This trend is particularly alarming within the Black community, where lower screening rates put them at higher risk of death due to lack of early diagnosis and provision of effective early treatment. These inequities need tackling urgently. Culturally tailored, community-centred and participatory approaches show promise in tackling health inequities. This 24-month study aims to examine feasibility and acceptability of a co-produced, faith-placed intervention to increase uptake of breast, bowel, cervical, and AAA screening among Black communities. Intervention In previous research, we worked with Muslim women to co-produce a faith-based intervention to improve uptake of breast, bowel and cervical cancer screening. This approach was subsequently tailored for early detection of prostate cancer among Black men, resulting in a peer-led, two-hour workshop. The workshop included 1) discussions on barriers to early diagnosis, 2) health education by a Black GP, 3) video testimonials from community members, 4) discussions on accessing care and asking the GP questions, 5) videos of Black women discussing health for the family, 6) perspectives from religious leaders, 7) a social component with food and music. We will adapt this intervention in partnership with the Black community to encourage uptake of breast, cervical, bowel, and AAA screening. Methods Underpinned by the Integrated Screening Action Model, we will conduct a mixed-methods, multicentre two-arm randomised feasibility trial with 300 Black people (female aged 25-74, male 50-74) in churches in Glasgow, North East of England, and Leeds, who are partially or not up to date with screening they are eligible for, allocated to one of two arms, per site: 1) intervention, 2) control. A process evaluation through focus groups with participants (6x n=8), Peer-facilitators (n=12), and stakeholder interviews (n=10), will allow us to identify opportunities for modification in the feasibility trial and intervention. Expected results An assessment of suitability of the trial's parameters will inform development of a large-scale trial using pre-specified progression criteria and a traffic light system for evaluation of STOP-AMEND-GO criteria. To gain a preliminary indication of intervention effectiveness we will capture knowledge, attitudinal change to screening (e.g. intentions to screen at baseline and 3-month follow-up), and behavioural outcomes (e.g. NHS screening attendance at 6 months). Anticipated impact and dissemination Our vision is to tackle current inequities by testing the feasibility and acceptability of a co-produced, peer-led intervention to improve engagement with breast, bowel, cervical and AAA screening among Black people in the UK. We propose a rigorous feasibility and process evaluation of the first theory-driven and co-produced intervention for Black people using culturally appropriate messages that support screening for early diagnosis in this underserved group. To maximise study impact, engagement and collaborative working with members of the community and key stakeholders provides an essential route to dissemination. A Knowledge Mobilisation plan will be developed. If warranted, we will seek further funding to test intervention effectiveness in a powered randomised controlled trial.

The problem and what we want to do about it: Screening tests for illnesses like breast, bowel, cervical cancer, and abdominal aortic aneurysm (AAA) can save lives. But fewer ethnic minority people go for them. This is especially true in Black African and Caribbean communities. This means Black people are more likely to find out about illnesses too late for them to be best treated and cured. There are many reasons why Black people find it difficult to take part in these screening tests. For example, they may not always know about screening. They may feel embarrassed. Or they have had bad experiences with healthcare before. Our 24-month study will try out a workshop. It aims to inform and encourage more Black people to have these life-saving tests. The workshop: We have done similar research before. We worked together with Muslim women to make a 2-hour workshop to promote breast, bowel and cervical cancer screening. That workshop worked well. Women enjoyed taking part and told us they learned about screening. They also felt more positive about screening. We then changed the workshop together with Black men. The goal was to promote early diagnosis of prostate cancer. This workshop has 7 parts: first, there are discussions about why Black people might not want to get screening. Next, a Black doctor gives an information session. Then, some Black men share personal stories about the disease and testing. After that, there is advice on how to talk to doctors. Then, church leaders share how screening fits within their religion. There is food and music to create a nice environment. We trained Black men to run the workshop. In partnership with the Black community, we will change this workshop again. This time, the focus will be on promoting breast, cervical, bowel, and AAA screening for Black men and women. What we will do: We want to know if people get screening after the new workshop. This needs a larger study, a trial. If the workshop works, it could help save lives by helping people to get screened. But we need to make sure the trial is doable. We need to see if we can change our current workshop, if we can train people to run it, if Black people want to come to it, and if they find it positive and helpful. We will try out the workshop with 300 Black people who have not gone for all their screenings (women aged 25-74, men aged 50-74). We will run the workshop in churches in Scotland, the North East of England, and Leeds. People will be split into two groups: one that tries our new workshop and another that does not. We will ask for feedback from people who take part in the workshops by talking to them in group discussions or interviews to help make the workshop better. We will also ask what they thought of taking part in the study. What we expect to find out: This study will check if our workshop works well and if any changes are necessary. We want to see if people will come to the workshop, and it helps them learn about screening. If it changes their views on it and gets more people to go for screenings. This will tell us if we should make any improvements to the workshop, and test it in a larger trial. How we expect it will work: We want to make sure more Black people go for screenings. We will do this by making a workshop for Black people, with Black people. We will share what we learn with the community and with health workers. If our results are good, we will try to get more funding to do the larger trial to test the workshop.