Narrative Therapy for Trust-Building in Research
Written by Dr Katie Lowles, Communications Officer at the MCRC
Tackling Inequality in Breast Cancer Screening
Early diagnosis of breast cancer is critical for timely intervention and improved survival outcomes.
The NHS breast screening programme offers routine screening to women aged 50 to 71 and plays a vital role in the early detection of breast cancer. However, around a third of women do not attend their breast screening appointments when invited, risking delayed diagnoses and poorer outcomes.
Understanding Barriers to Access
Research shows that South Asian women are less likely than any other ethnic group to attend breast screening appointments. A 2020 study by The University of Manchester (UoM) identified several barriers among Pakistani women in East Lancashire, including:
- Language barriers
- Dependence on family members for translation
- Concerns about being examined by male healthcare professionals
These factors contribute to ongoing health disparities that urgently need to be addressed.
A Participatory Approach to Research
In response, academics working within UoM’s Faculty of Biology, Medicine and Health launched a public engagement initiative, funded by Greater Manchester Cancer Alliance, to investigate why South Asian women have lower screening uptake than other demographics. Cultural adaptation and generational influence was explored, with the aim of improving breast healthcare access for ethnically minoritised women in Greater Manchester.
Building Trust Before Gathering Data
Twenty-two women from Bangladeshi, Pakistani and Indian heritages took part in the project, which involved facilitated sessions where the research team first established connections and built trust with the participants. Only after this process did the team begin to collect data from the participants, including their knowledge of breast cancer, breast health, health-related risk behaviours, screening services and barriers to attendance.
Rather than adopting a traditional interviewer-versus-interviewee dynamic, which can alienate participants and hinder open, honest discussion, the team, led by Dr Binish Khatoon, prioritised creating a culturally sensitive, inclusive, and non-hierarchical space.
This project worked at the pace of trust, rather than data extraction. Why should a participant tell us personal information about their past and their bodies if we’re not taking the time to build a safe, culturally sensitive space?
Dr Binish Khatoon
Qualitative Methodologist, The University of Manchester
The Tree of Life Methodology
To facilitate open communication, the researchers used the Tree of Life methodology, a narrative therapy tool that helps individuals reflect on their lives. Each element of the tree is used to build a picture of an individual’s life, including heritage, strengths, abilities, significant people and challenges.
The Tree of Life method provided participants with a safe and creative way of exploring their life stories, fostering connection between the community and the researchers.
There is no community too difficult to reach; we’re just not trying hard enough.
Dr Binish Khatoon
Qualitative Methodologist, The University of Manchester
Co-Creating Meaningful Messages
Discussion points raised in these conversations were used to develop four short videos addressing key themes, including the stigma around breast screening and experiences of racism and distrust in healthcare systems.
Crucially, participants were involved at every stage, from script development to production, ensuring that stories were authentic and representative of the community. For example, actresses were selected to reflect the linguistic and cultural diversity of the group, with attention to accurate dialect representation.
Showcasing Research
The project culminated in a digital art installation exhibited at Manchester Museum’s South Asia Gallery from February to May 2025. The exhibition showcased the films, personal stories and artwork created by the women, sparking conversations about health equity and cultural inclusion in healthcare.
Ncazelo Ncube, psychologist and founder of the innovative Tree of Life methodology even visited and praised the exhibition.
Earning Trust, Not Assuming It
Dr Khatoon, who shares a cultural, linguistic and religious background with many of the participants, acknowledges the role her identity played in the success of this project, but also its limitations.
As Dr Khatoon explains, “Just because I’m from a similar community doesn’t mean I was given immediate trust or access to the truth. We still had to slow right down and gain that trust. Anyone can create a safe space for participants, regardless of their background.”
Her experience highlights a crucial point: shared identity can open doors, but it doesn’t replace the need to earn trust through humility, patience and respect.
Dr Khatoon’s Advice for Researchers:
- Work at the pace of your participants. Take the time to get to know and learn from them.
- Acknowledge your own biases. Being aware of your own assumptions helps you listen with openness, not expectation.
- Sense-check your methods. Before, during and after data collection, consult mentors or trusted colleagues to reflect on your approach and ensure it remains ethical, inclusive and effective.
Dr Binish Khatoon was highly commended for her contribution to the Tree of Life project at UoM’s Faculty of Biology, Medicine and Health’s Patient and Public Involvement and Engagement celebrations earlier this year.
This project was funded by Greater Manchester Cancer Alliance
