Discover how co-creating a shared decision making resource with a Kempsey Aboriginal health service is improving awareness and access to bowel cancer screening.
Bowel cancer can be treated successfully more than 90% of the time when it is found early. Bowel cancer screening looks for the invisible signs of cancer or precancerous changes, so lower screening rates among Aboriginal people can have a significant impact on their health outcomes
According to available data, 27% of eligible Aboriginal people complete bowel cancer screening compared to 43% for non-Aboriginal people.1 To help close the gap and overcome systemic barriers that prevent equal access to early screening, detection and treatment, the ACI has partnered with Durri Aboriginal Corporation Medical Service, the Cancer Institute NSW, the Dunghutti Aboriginal community in Kempsey and the University of Sydney.
Together we have developed the Dunghutti Way, a culturally safe, community-led approach to help Aboriginal people access the same opportunities for bowel cancer screening and colonoscopy as everyone else.
As part of the project, the Cancer Institute NSW coordinated and co-facilitated a workshop with Kowa Collaboration on Understanding Measuring Evaluating Learning Workshops (UMEL) practice. The Dungutti Way was adapted with permission from Kowa Collaboration.
From Finding Your Way to the Dunghutti Way
Finding Your Way is a shared decision-making resource developed by the ACI with and for Aboriginal people in 2021.2 It was first used to encourage Aboriginal people and their health professionals to have a yarn and make a shared decision about the COVID-19 vaccines.
"The resource puts the person at the centre and visually explains what goes into decision-making for an Aboriginal person, so that clinicians and healthcare workers can understand and support that process," explains Ro Stirling-Kelly, who is leading the Dunghutti Way project for the ACI.
"Finding Your Way can be used for any sort of health-related shared decision making, particularly in sensitive areas like bowel cancer."
Ro started the consultation process by having a yarn with community to learn whether support to increase bowel cancer screening was something they wanted, needed and were ready for.
Given the personal nature of the subject, tapping into networks in Kempsey that had already built trusting relationships with the Aboriginal community was key. Ro connected with Paul Morris, Chief Executive of the Durri Aboriginal Corporation Medical Service (Durri ACMS), which led to a powerful partnership between Durri ACMS, the ACI and the Aboriginal community in Kempsey.
Holding in-person and online sessions, these partners identified how Finding Your Way could be used and adapted into culturally safe and responsive shared decision making resources. This process also helped to build trust and culturally safe relationships between the Aboriginal community, Durri ACMS, the ACI and Cancer Institute NSW.
"We appreciate the ACI team letting us lead this project and yarn and consult our way," says Christa Smith, Aboriginal Health Worker with Mid North Coast Local Health District, who facilitated a womens' group that took part in the process.
A shared journey towards health equity
The co-creation approach brought together Aboriginal ways of being and the western medical system, represented as a shared canoe journey down a river.
"Community yarning sessions were particularly powerful in building trust and providing a way to co-create the resources together," says Tara Dimopoulos-Bick, Stream Lead for Design, Capability and Experiential Evidence at the ACI.
The result is the Dunghutti Way – 4 resources co-created to improve community awareness of and access to bowel cancer screening, including:
- a question prompt and complementary poster for Aboriginal people
- a lapel pin for clinicians, healthcare workers and Aboriginal leaders to prompt conversations and behaviour change by telling the story of the screening process
- a yarning aid for clinicians and healthcare workers
- a screening flow chart for clinicians and healthcare workers.
The resources reflect local language, imagery, values and priorities and feature the artwork of Aboriginal artist Belinda Coe. They were launched in early September for Durri ACMS and local NSW Health services to use, along with samples of the National Bowel Cancer Screening Program test kit to help clinicians and health professionals demystify the screening process.
Reaching more people with the Dunghutti Way
The community has shared the pride they feel that their voices and contributions to the project will make an impact and empower others to get screened and support each other.
"We encourage and support each other to be leaders and role models for our community, taking our health into our own hands," explains Aboriginal Health Practitioner AJ Hoskins, who coordinates the Durri ACMS Men’s Group.
At the men's group cultural camp in June (which followed an ACI information and awareness workshop earlier in the year), conversations around the fire included bowel cancer and screening in a culturally safe place for the men.
"The more we share and talk, the more we know and the stronger we will be, so no-one has to face things like bowel cancer alone,' says one participant.
The next step is to increase the number of services using the resources, and talk to partners about expanding to other areas on the Mid North Coast. "For the local Aboriginal community, supporting good health means people can stay on Country, age well and see their grandchildren grow," reflects Ro.
For more on the co-creation method used to produce these resources, or to discuss how you could localise them in other communities, email ACI-InSITE@health.nsw.gov.au
References
- Cancer Institute NSW. Reporting for Better Cancer Outcomes: Aboriginal People in NSW. Sydney, NSW: Cancer Institute NSW; 2024 [February 2024; cited 9 Sep 2025].
- Dimopoulos-Bick T, Follent D, Kostovski C, et al. Finding Your Way - A shared decision making resource developed by and for Aboriginal people in Australia: Perceived acceptability, usability, and feasibility. Patient Educ Couns. 2023; 115:107920. DOI: 10.1016/j.pec.2023.107920