Reducing the health equity gap

“Everyone knows the saying that knowledge is power, right?”

That’s just the starting point for TMU nursing professor Mandana Vahabi. For her knowledge is more than empowering, it’s life-saving.

Vahabi was honoured with one of the university’s highest accolades for her outstanding research and scholarly work to strengthen health-care knowledge and access among vulnerable populations. She received the Knowledge Mobilization and Engagement Award at the Toronto Met Awards Gala celebrating the highest achievements of TMU staff and faculty at an in-person event on May 9.

Her research has informed municipal and national health programs to reduce health equity gaps such as disproportionate cancer screening uptake among high-risk population groups. 

“This award is an acknowledgement of those marginalized populations,” she says. “If I am able to contribute and place equitable access on the agenda, particularly with policymakers to effect decisions that benefit ‘minorities’, but who really occupy a large portion of our population, then what it demonstrates is TMU’s recognition of the importance in meeting the needs of marginalized groups. I am no one without the various stories I am able to tell.”

Reducing health inequity and expanding screening

Vahabi’s research has determined that women in lower socio-economic strata tend to screen less for cancer due to structural barriers. 

“We realize that low income women, women of colour, immigrants or refugees, women who are socially stigmatized like sex workers, women who have a history of incarceration, women who are disabled, or women who have mental health issues — these are the groups that are being under-screened,” says Vahabi.

She has focused much of her recent research on cervical cancer screening. Cervical cancer is one of the leading causes of death among women but is preventable with regular testing. 

Vahabi’s work aims to circumvent structural barriers that can include the attitudes of health-care professionals, for example, towards socially stigmatized women like sex workers. 

Immigrants and refugees face many other challenges that take up their time and concern. “Meeting employment and housing needs, and a lack of social support can all deter newcomers for whom testing becomes a low priority,” Vahabi says. 

One critical method Vahabi and her team identified in overcoming structural barriers was at-home testing (which eliminates a trip to the clinic and makes testing more accessible), the success of which has led to extended funding and pilot studies in Canada.

Cultural barriers to screening for immigrant women in Canada

For Vahabi, findings showing South Asian and sub-Saharan women as the highest risk groups for cervical cancer under-screening in Canada required a deeper investigation.

Her research into this area established the significant impact of religious affiliation and cultural orientation on cancer screening uptake among immigrant women. The findings spurred her to promote sensitive methods of testing like self-sampling kits which can be done in the privacy of the home. Her studies showed that the use of these tests, again, significantly increased screening uptake.

“What we are trying to do is provide alternative options for women to become their own agents of change,” says Vahabi. “For women to become empowered to potentially save their own lives, and maybe the lives of their sisters, mothers, daughters and friends.”

Influencing health-care policy in Canada 

Fighting cancer is a public health priority in Canada, and early detection is fundamental to this effort. Vahabi works directly with policymakers to help inform effective program planning and expand screening.

Vahabi and her team recently secured funding from the Canadian Institutes of Health Research (CIHR) to research the complexities of intersectionality in health care. The research will apply analysis of health-care accessibility for people who face multiple disadvantages and/or discriminations such as low income combined with mental health and addiction challenges. They will also identify subgroups like immigrants and refugees. 

This work will help public health authorities by informing funding strategies to better support the most vulnerable people in our society. 

Educating through filmmaking in India

The success of home testing pilot studies among South Asian immigrant women in Canada led Vahabi to perform similar studies in India where cervical cancer is the second leading cause of death for women.

“I wanted to see how effective HPV self sampling was in addressing cultural barriers versus structural ones,” says Vahabi. “I thought, ‘what about the actual country itself?’ We started in Mumbai’s rural areas where the literacy level is very low.”

Education alone was not sufficient. It also required providing information to people in a way that was culturally perceptive. “HPV is also a sexually transmitted infection, and so a stigmatized condition which requires sensitivity,” she says.

The success of this study in increasing self-testing led to support from the Indian government, and a filmmaking project.

“In South Asia, storytelling is an integral method of communication of information, and there’s a lot of use of the pictorial. I created an informative film on the importance of testing and used a scenario as close to their own lived realities so they could relate.”

Vahabi quickly realized the importance of engaging and educating men as well. “I noticed women didn’t usually make independent decisions about their own health and soon saw the need for having male partners involved in the decision-making,” she says.

The film demonstrated not only the benefits to women of getting tested and diagnosed at the earliest stage, but the benefits to men as well, most critically, safeguarding the health of their partners.

“We found afterwards that the decision was made mutually by men and women who participated in that study. That's why I consider that a success.”

Vahabi is now conducting a five-year research project across eight states in India, involving 3,000 female participants and 3,000 male participants. 

She hopes her research team will gather enough evidence to persuade the Indian government to consider alternative options that can save more womens’ lives.