Understanding the profile of community health workers in breast cancer screening education: women’s preferences and insights from a qualitative focus group study

Despite efforts to reduce disparities in breast cancer screening uptake in Flanders, certain population groups, such as women with a lower income, a lower educational attainment, women living further from screening units, and with a migration background, remain less likely to participate in the population-based mammography screening program. Community Health Workers (CHWs) are effectively involved in breast cancer screening programs in various countries to reach underserved women. In Flanders, Belgium, the involvement of CHWs in breast cancer screening programs is relatively recent. However, little is known about the preferences of the target population regarding the potential profile of a CHW in breast cancer screening education in Flanders. This study aims to explore this gap. Four focus group discussions were conducted between August and December 2023. Data were analysed using Qualitative Content Analysis to identify key categories, which were subsequently organized according to Kok et al.’s framework of CHW performance. The results emphasize the importance of the desired competencies of CHWs, including professional knowledge and expertise, personal experience in shaping competencies, effective communication skills, cultural awareness and motivational and supportive competencies. Empathy, sociability, and adaptability were identified as key attitudes for fostering trust and creating supportive relationships. Trust emerged as a central theme, where female CHWs were preferred for their ability to enhance safety and trust, especially when they had prior experience with breast cancer screening. The findings of this study provide actionable insights regarding the profile of CHWs involved in breast cancer screening education, underscoring the need for a balanced combination of attributes to address the specific preferences of the target population. By integrating the target populations’ perspectives, this research bridges gaps in existing CHW performance frameworks, offering a more comprehensive understanding of CHW performance. Recruiting CHWs with the right combination of competencies, interpersonal skills and attitudes is critical for the success of breast cancer education programs. Further research is needed to explore these findings in other contexts.