Health messages reach women through netball.

How do you reach groups of South Auck land women, such as Pacific and Maori women, new Asian immigrants and women who live on the street, with information about breast and cervical screening? A public health nursing team has thought hard about what brings the community together and come up with a unique answer--netball. The Well Women's Nursing Service (WONS) has contracts to promote cervical and breast screening programmes and runs its own low cost, cervical screening service through mobile clinics. Along with the Papakura Marae, Counties Manukau Sport, BreastScreen Aotearoa, New Zealand Breast Cancer Foundation and ProCare, the nursing team organised the Tukaha Wahine Hauora Netball Tournament in October. Held at the Papakura Netball Centre, the event attracted nearly 500 entries, with over 1000 people present. The event successfully brought together the women of the Counties Manukau region--youth, mothers and grandmothers--including some of their men folk. Based on data collected on the day, 72 percent of those present were Maori, 17 percent were European, eight percent were Pacific and eight percent did not identify with any ethnicity.

Tukaha means strength and virility and WONS nurse specialist, Ruth Davy, said the tournament--the second to be organised by WONS--enabled the community to have fun and learn about screening. She believes events like this are the modern face of public health nursing. The event featured giveaways, More FM radio promotions and cash prizes, along with kete containing booklets and information about screening.

Entries included a team of women who live on the street or in boarding houses. This team benefited from the tournament in a number of ways, said Davy. "These women got a real buzz out of the tournament. They had fun, got some exercise and also information about screening. Sport is the ultimate way to get messages into these communities. We could run an education day about screening but we wouldn't get 500 people turning up."

Sisters in Health tap into communities

How did Tukaha Wahine Hauora Netball come about? WONS is trialling a "Sisters in Health" programme to reach into the Clendon and Manurewa communities with screening messages. Sisters in Health originated from a community-driven project in Ngaruawahia and also work by Auckland University researcher Sarah Lovell, which identified barriers to screening in South Auckland. The concept was adopted by WONS, Waipareira Trust and Pasifika Healthcare in the Counties Manukau region, and funded by the National Screening Unit as a project to reduce inequalities for Maori and Pacific Island women.

Thirteen "sisters"--five Pacific sisters, seven Maori and one European--were recruited and trained in format and informal settings with kete of knowledge. These women now work as ambassadors for cervical and breast screening in their communities, forming links with kohanga reo, iwi groups, schools, churches and the Counties Manukau Sports Foundation. At a hui/fono last year, Maori and Pacific women discussed the reasons women avoided screening. Maori women talked about shyness, cost, the need for whanau/iwi support, support for any ongoing colposcopy and treatment, and the need to recognise whanau and wairua. Pacific women aLso identified cost, resistance by husbands, what they saw as coercion by GPs and privacy issues. "Pacific women would go to their doctor for the 'flu and be made to have a smear," said Davy. "They would go home and tell their family that the doctor was mad. 'I went with a cough and he did a smear', they would say."

The recently released Ministry of Health cervical cancer audit has found inadequate screening coverage and evidence of ethnic disparities in screening and follow-up. Maori women, women with backgrounds of high deprivation, low incomes and low education are less likely to be regularly screened. The audit showed that twice as many Maori are diagnosed with cervical cancer and four times as many die of it. The national coverage rate for Maori in the cervical screening programme is 50.9 percent and 49.4 percent for Pacific women. The rate for Maori in the breast screening programme is 42.7 percent and 43.4 percent for Pacific women. The audit recommends that the cervical screening programme pilots and evaluates new strategies for increasing screening among Maori, low-income and older women. The sisters identified that women in the Counties Manukau area related best to health messages through sport. An introduction to Counties Manukau Sports evolved and a successful netball tournament occurred in 2003, with approximately 100 Maori and Pacific women competing. The overall success of the collaborative effort saw the development of a steering committee in 2004.

Evaluating the netball programme

WONS used the Whare Tapa Wha model of health to evaluate the event. All four aspects of this model were met, said Davy. For most of the team of women from the inner city streets, this was the first sport they had participated in since high school One woman said she had to cut down her smoking to be able to run around the court. Comments from participants were all positive, including a call for the tournament to be held every six months instead of 13. The tournament has been submitted as an entry to next year's HeaLth Innovation Awards, to be announced next June. WONS will evaluate cervical and breast screening statistics in the Counties Manukau region next year. Davy said the Sisters in Health project had taught her to take up opportunities and run with them. She believes smatter, non-governmental organisations like WONS can initiate these types of projects because they can gain the trust of communities. WONS has 25 staff and provides a mix of public and personal health. It runs mobile screening clinics, trains smear takers and carries out screening health promotion. Recently WONS set up charitable trusts for Chinese and Korean communities to assist with the growing health needs of these communities in areas such as chlamydia, the human papilloma virus, unplanned pregnancies, contraception and sexual health..