Integrating digital tools and community outreach to address cancer screening disparities in underserved populations in East Toronto, Canada

Background: East Toronto Health Partners (ETHP), an Ontario Health Team serves 400,000 individuals, of whom over 50% are immigrants. Significant disparities exist in cancer screening rates across ETHP's 21 neighborhoods, with rates 15-25% lower in areas with higher concentrations of immigrants and lower socioeconomic status. Barriers for underserved populations include difficulty accessing services, language constraints, lack of knowledge about the importance of screening, and cultural factors influencing health practices. Addressing misinformation and improving early cancer detection through primary care providers (PCPs) is essential for enhancing population health outcomes. However, with 70% of PCPs experiencing burnout and significant administrative burdens, preventative care often becomes deprioritized.

Approach: In 2023, East Toronto Health Partners (ETHP) collaborated with the eHealth Center of Excellence to launch Poppy-bot, a robotic process automation tool designed to work within primary care electronic medical records (EMRs). Poppy-bot identifies individuals due or overdue for cancer screening and segments them by postal code and language to enable targeted outreach. In East Toronto, Poppy has identified over 15,000 individuals eligible for cancer screening.

Flemingdon Health Centre (FHC), located in two underserved neighborhoods with lower cancer screening rates, leads a multi-agency Community Health Ambassador (CHA) program. This peer-based initiative hires local residents from equity-deserving communities to provide outreach and peer support.

Recognizing the complementary strengths of Poppy-bot and CHAs, ETHP integrated these initiatives to address cancer screening challenges and support underserved communities to get screening completed.

Culturally sensitive outreach was a priority and therefore we engaged with Health Commons Solution Lab and Behavioural Insights Team to co-design educational materials with CHAs and community members through focus groups and workshops ensuring relevance and receptiveness. Behavioral science principles, conversational receptiveness, and motivational interviewing techniques informed the development of a Cancer Screening Guide. The guide was tailored for use in in multiple languages including Arabic, Bengali, Dari, Pashto, Slovak, and Urdu. Trained CHAs used this guide to have one-on-one conversations with residents flagged by Poppy-bot, explaining the importance of screening, what to expect during the process, and how to interpret results. Access to nursing staff was also available to support CHAs in addressing concerns.

Results: This initiative demonstrated the successful integration of digital tools with community outreach to improve cancer screening rates in underserved populations. Over one month, CHAs had one-to-one conversations with over 400 individuals, addressing barriers and fostering trust. Particularly, Slovak-speaking CHAs engaged their community, resulting in 43 individuals agreeing to screenings; overcoming long-standing barriers of access and healthcare system distrust.

The team received an innovation award from MARS and the Canadian Cancer Society, funding the development of the Cancer Screening Guide. Beyond screening, CHAs identified other health-related questions and barriers, shaping future program developments and outreach strategies.

Implications: The evaluation phase includes new focus groups to refine the Cancer Screening Guide and implement improvements. Lessons from Poppy-bot's deployment are enhancing its functionality. This initiative demonstrates the value of empowering CHAs in preventive care and integrating digital tools with culturally sensitive, community-based outreach to address health inequities effectively.