Background: Australia aims to eliminate cervical cancer by 2035, but barriers to cervical screening prevent us from reaching this goal. The National Cervical Screening Program in Australia incorporated HPV (Human Papillomavirus) self-collection to overcome barriers linked to clinician-collected screening and promote equitable access. This scoping review aims to map Australian evidence on the uptake and perceptions of self-collection on cervical screening participations

Methods: A systematic search of MEDLINE, CINAHL, and Scopus was conducted to identify relevant Australian studies against a criteria. Eligible studies reported on screening participation, uptake, acceptability, awareness, or participant experiences. Data was charted and synthesised using narrative analysis to identify key themes related to access, acceptability, and implementation.

Results: The search strategy yielded 21 papers reporting on 18 studies. Self-collection was widely accepted as a cervical screening test across diverse populations, including Aboriginal and Torres Strait Islander, culturally diverse groups, and never- or under-screened individuals. In several settings, such as rural areas and Indigenous communities, self-collection was associated with higher cervical screening participation. However, awareness of self-collection remains consistently low, with many studies reporting that participants were not aware of the option to self-collect.

Conclusion:

Self-collection is a widely accepted alternative to clinician-collected HPV testing and has been reported to improve cervical screening participation in Australia. However, low awareness of the self-collection remains a major barrier to accessing the test. Equitable impact will require clear health promotion and policy implementation, culturally safe communication and accessible delivery models that translate availability into meaningful participation.

Learning objectives
1. Explore how co-design can inform equity-oriented, trauma-informed oral health system redesign
2. Identify system-level drivers shaping trust, engagement, and continuity of oral healthcare

Poor oral health among people experiencing homelessness is often framed primarily as a problem of service access, with solutions focused on eligibility, referral pathways, and clinic availability. This framing overlooks how system design influences engagement, trust and continuity of care for service users.

Oral Health Victoria is undertaking a co-design project to develop new initiatives to improve oral health of people experiencing homelessness by working with people with lived experience, homelessness service providers, and oral health professionals.

Co-design workshops explored lived experience of oral healthcare, barriers and enablers to engagement, and priorities for service redesign. This phase centred lived experience alongside clinical and sector expertise to identify system-level factors shaping engagement and continuity of care (UniMelb ethics ID: 2026-32961-75094).

Participants described access as determined not only by service existence but by how systems uphold dignity, trust and safety. Reception practices, eligibility checks, rigid booking systems, stigma, unstable contact arrangements and prior experiences of judgement emerged as primary drivers of disengagement. Continuity of care was redefined from strict appointment adherence to a relationship-based process in which people feel safe to return and re-engage without shame or penalty.

These preliminary insights shifted the project focus from information provision and navigation supports towards strengthening workforce capability, embedding trauma-informed and compassionate approaches, increasing flexibility in service delivery, and prioritising trust-building. The co-design process revealed how well-intentioned systems can reproduce inequity. The next phase of the project will pilot test selected solutions informed by these findings. Improving oral health outcomes for people experiencing homelessness requires systems designed for dignity, agency and relational safety alongside accessible clinical services, and aligns with public health goals of equity, inclusion and trust.

Food insecurity (FI) is a significant public health and social issue that undermines optimal child development. However, it is difficult to tackle this problem when its extent and nature is not known. Child FI has not been robustly explored in an Australian context and objective monitoring is limited. Internationally, child-report measures of FI have been developed that capture children's unique perspectives. These tools have the potential to enhance understanding of the impacts of FI and to inform the development of child-focussed solutions. While the use of child-report measures may provide a way for children to provide their FI-related experiences, the feasibility of using these measures in settings outside research has yet to be explored. This qualitative interview study sought to explore the ethical and pragmatic considerations related to using a child-report FI measure in child centred services in Queensland, Australia. A total of seven discussion groups were conducted with practitioners (N=21) from paediatric clinical and community health services, family support services and schools. Interviews were analysed using reflexive thematic analysis. Preliminary analytical findings indicate practitioners do encounter child FI as an issue in practice with many drawing on personal resources and going beyond their formal duties to respond. However, despite many services striving to include children’s perspectives in their daily work, most do not assess FI. Current practice is dominated by concerns that discussions about FI could disrupt trust and threaten relationships, especially if formal support options are unavailable to respond to disclosures. Promisingly, schools were identified as the best setting to further explore child-centred data collection. While practitioner concerns echo those found in wider FI screening research, the promise of using structured, child-centred assessment of FI in local contexts to support more coordinated responses to this public health challenge should not be ignored.

Challenge
There is global pressure for food systems to adopt policy and practice that shifts consumer purchasing towards foods that positively impact human and planetary health. Members of the remote Aboriginal and Torres Strait Islander community food retail sector have demonstrated strong leadership in this area. A co-designed benchmarking model implemented in remote community stores to strengthen health-enabling food retail policy and practice was considered valuable by stakeholders. In 2025, the model was embedded Australia-wide through its positioning as a policy implementation strategy for The National Code of Practice for Remote Store Operations. From this presentation delegates will learn the key considerations for embedding in national policy a benchmarking approach to strengthen healthy retail practices.

Evidence
We conducted a prospective qualitative policy analysis including mapping of relevant policy, interviews with 15 national and jurisdictional policymakers and 38 implementers of the benchmarking model, and guided roundtable discussion with 47 delegates at the 2025 Benchmarking project workshop. Key considerations for whether the model can be effective in this pathway were ensuring equitable uptake of the voluntary policies within which the model is embedded, and the workforce capacity to implement it. Key actions suggested to support successful implementation included strengthening community governance of stores and industry standards, evolution in the remote food system workforce, and coordinated action and communication between and from national and jurisdictional entities.

Implications for real-word action
Even where there is political will and investment to develop responsive, supportive policy, the underlying conditions – here industry expectations, local workforce and governance – will determine the translation of policy into equitable outcomes. Voluntary policies optimise buy-in from highly motivated operators, where strong community governance and high expectations around best-practice in the industry exist. Where these are weak, voluntary policy approaches must be supported by multiple, coordinated actions to achieve uptake and impact.

Aboriginal and Torres Strait Islander Governance
The Benchmarking for Healthy Stores in Remote Aboriginal and Torres Strait Islander Communities project was co-designed in response to calls from community-controlled health organisations and remote retail store groups for benchmarking in remote stores to improve health promoting policy and practice. It was informed by decades of collaboration between researchers and Aboriginal and Torres Strait Islander-led organisations and communities, many of whom were active partners in the research. The collaborative and diverse team spread across many remote communities includes Indigenous Allied Health Australia, Arnhem Land Progress Aboriginal Corporation, Outback Stores, Sunrise Health Service, Katherine West Health Board, and Miwatj Health Aboriginal Corporations, Monash University, Menzies School of Health Research, The University of Queensland, Curtin University, and the Northern Territory Government. The Benchmarking project is governed by a steering group, executive team, and codesign working group, all comprised of Aboriginal and Torres Strait Islander and non-Indigenous researchers and representatives of partner organisations, who ensure that all research processes are culturally appropriate and meaningful, and Aboriginal and Torres Strait Islander data sovereignty principles are upheld.

Efforts to understand the Commercial Determinants of Health (CDoH) have largely focused on transnational corporations, with less attention to the practices of smaller commercial entities. Remote community stores service a population of nearly 120,000 Aboriginal and Torres Strait Islander Peoples across Australia (1). Many stores are owned by communities and managed by an elected board of local Aboriginal and Torres Strait Islander directors or owned and/or managed by community store organisations and have a commitment to promoting health. Three community store organisations, The Arnhem Land Progress Aboriginal Corporation (ALPA), Community Enterprise Queensland (CEQ) and Outback Stores operate in 40% of remote community stores in Australia (1). The aim of this study was to analyse the attributes and practices of community store organisations, as they relate to CDoH in remote Aboriginal and Torres Strait Islander communities. A document analysis was conducted to identify the attributes and practices of ALPA, CEQ and Outback Stores, using the Commercial Entities and Public Health Framework (2). Annual reports (n=31), policy documents (n=39), webpages (n=444), and social media posts (n=495) were included. Health-promoting actions and opportunities for further action were identified under six practice categories: marketing, reputation, political, supply chain, scientific, and labour. This study will inform: 1) discussions with store directors and community leaders about community aspirations for health-promoting stores; and 2) the development of a co-designed framework to further drive action to promote health and equity in remote Aboriginal and Torres Strait Islander community stores. By providing an example of how the Commercial Entities and Public Health Framework can be applied, this presentation will increase understanding of health-promoting practices in remote community stores.

References: 1. van Burgel et al 2024, Aust NZ J Public Health; 2. Lacy-Nichols et al 2023, The Lancet.

Governance: This study forms part of a broader project titled ‘A co-designed framework to drive action to promote health and equity in remote Aboriginal and Torres Strait Islander community stores’. The broader project is being conducted in collaboration with community store organisations that are governed by an all-Aboriginal board or statutory entities with boards that include Aboriginal and Torres Strait Islander members. In this study the research team were guided by an Investigator Group and a Store Advisory Group, who advised on the broader project including this study, and a Task Group who oversaw the conduct of this study. The Investigator Group and Task Group include Aboriginal and/or Torres Strait Islander members, ensuring Indigenous governance at all levels of the project. Aboriginal and Torres Strait Islander members provide guidance on the design, conduct and dissemination of this study through the lens of ensuring benefit, and minimising harm, to the community store organisations involved, and the communities that the research is conducted with. The Store Advisory Group provide guidance on engagement with the community store organisations they represent, as well as the communities that they operate in, including the Aboriginal and Torres Strait Islander board directors to whom they are accountable. The broader project acknowledges that Aboriginal and Torres Strait Islander Peoples remain the owners of any traditional knowledge arising from the project. The Multi-Institutional Agreement between Participating Institutions (The University of Queensland, Monash University, the Australian National University and Queensland University of Technology) includes clauses relating to ownership of project Intellectual Property and Indigenous Knowledge.

The extractive resource industry is a major contributor to the Northern Territory economy. There are, however, ongoing concerns about the responsibilities of the industry towards Aboriginal Peoples' health and wellbeing, with particular concern raised over damage to spiritual and cultural sites through degradation of Country. This is significant for Aboriginal People who have obligations and responsibilities over customary lands and waterways that are inherently grounded within Indigenous Knowledge Systems and recognised as fundamental to health and wellbeing outcomes. Understanding the complexities between Aboriginal Communities and the extractive resource industry and the impact on health and wellbeing requires nuance. In this study, we apply a document analysis to the corporate documents of extractive resource companies (e.g. annual reports, sustainability reports, websites, and Reconciliation Action Plans) that contain information relating to Aboriginal Peoples. Data were extracted and analysed using a framework analysis, using Carroll’s pyramid of Corporate Social Responsibility, which included economic, ethical, legal, and discretionary expectations. Twenty-nine corporate actors with Northern Territory footprints and documents relating to Aboriginal peoples were identified, including 26 that generate profit from production, distribution or resource extraction, and three peak bodies. Economic responsibilities reported included employment of Aboriginal Peoples and support for Aboriginal businesses. Legal responsibilities reported included adherence to or recognition of varying Land Rights. Ethical responsibilities included mitigating environmental impacts, mine rehabilitation, managing cultural heritage, and implementing Reconciliation Action Plans. It is important to examine what is not reported; for example a further exploration of employment responsibilities through retention rates or leadership positions; why most actors are not acknowledging land rights; and whether reporting on environmental measures and mitigations fully account for the health harms these actors produce.

Aboriginal governance structures were used to ensure that Indigenous data sovereignty principles were adhered to in the research the processes were culturally appropriate. The second author (JC) and the senior author (BC) of this publication are Larrakia/Wadjigan men. BC conceptualised and oversaw the study. JC was involved in all data extraction and analysis. This research will be published, giving recognition to these authors, including attributing their language groups as per their preferences. This case study is part of Project White-Ant (NHMRC2035579) and is led by BC and governed by a majority-Aboriginal CI team, with a separate Aboriginal-only governance working group. This desk-based study, which included no Aboriginal individuals, communities, or organisations as participants, focused entirely on industry activities through public-facing documents. The data was all from extractive resource companies and is therefore not sensitive or subject to data sovereignty principles, but it is recognised that the research may impact Aboriginal Peoples and Communities.

Safe Sleep, Shared Responsibility: Reframing SUDI prevention through Indigenous-led messaging.
Sudden unexpected death in infancy (SUDI) remains a persistent and inequitable public health issue in Aotearoa New Zealand, with around 50 babies dying each year, with early 2026 trends indicating this may rise. Māori infants remain disproportionately affected, accounting for approximately 65–70% of these deaths. While safe sleep guidance is well established, prevention messaging has often been clinically framed and poorly aligned to whānau realities, limiting trust, relevance, and consistent uptake.

In 2024, Hāpai Te Hauora, a Māori public health organisation, led a national safe sleep messaging refresh shaped by whānau and communities, ensuring those most impacted shaped how safe sleep practices were understood, communicated, and applied. What began as a messaging review quickly exposed a broader systems issue: fragmented implementation, variable workforce confidence, and messaging often perceived as judgemental. National stakeholder engagement, Expert Advisory Group input, whānau voice, and iterative testing informed a redesign of safe sleep messaging and supporting resources. Messaging was reframed away from compliance-based instruction toward a whānau-informed approach grounded in shared responsibility, practical prevention, and culturally relevant communication.

This presentation explores how a whānau-led messaging refresh became a broader systems intervention, using community-informed redesign to strengthen trust, improve workforce consistency, build capability, and support more equitable prevention delivery. It also highlights the role of community champions in reinforcing messages, supporting local delivery, and strengthening community-led prevention infrastructure. It offers a practical example of how Indigenous-led approaches can move public health beyond information provision toward prevention practice that is more trusted, scalable, and effective.

Challenge
Aboriginal and Torres Strait Islander leaders have paved the way to promote health-enabling remote food retail [1] to target the gap in health outcomes when compared to non-Indigenous Australians [2]. Evidence shows that health-enabling retail practices that provide/promote healthy food and restrict the provision/promotion of unhealthy food can improve the healthiness of customer purchases and health [3]. The learning objective/outcome for this presentation is to increase awareness of an approach that can advance the integration of health-enabling retail practices into the structures and workflows of remote stores.

Evidence
A co-designed Benchmarking strategy, used with continuous improvement, was implemented across remote stores to promote health-enabling retail. Stores completed two annual cycles of assessment, feedback, action planning, and implementation. We interviewed store directors, store owners, managers and nutritionists to explore perspectives on factors that influence implementation. Perspectives showed that Benchmarking provided additional information to guide decision making, was easily incorporated into usual practice and added accountability. The role of each implementer was key, particularly store directors for decision-making. Skill development and support from research partners and the monitoring aspect of Benchmarking were important. Key barriers included a limited nutritionist workforce, lack of time for implementers, and competition from surrounding stores.

Implications for real-word action
This study advances understanding on how Benchmarking can be utilised to facilitate the uptake of best-practice food retail for health. Ensuring the continued leadership of store directors and the collaboration of implementers is key. Suitable policy frameworks are needed to ensure adoption and commitment, with this research informing recent policy, the Australian Government’s National Code of Practice for Remote Store Operations, which may facilitate uptake of Benchmarking across remote stores.

1. Brimblecombe. Lancet Planet Health. 2020;4(10)
2. AIHW (2025). Aboriginal and Torres Strait Islander Health Performance Framework: summary report June 2025.
3. Brooker. Front Public Health. 2024;12

The Aboriginal Governance structures used to ensure that Indigenous data sovereignty principles are adhered to in the research or program development and that the processes were culturally appropriate

The Benchmarking for Healthy Stores in Remote Aboriginal and Torres Strait Islander Communities project responds to a call made by remote Aboriginal and Torres Strait Islander food retail organisations, Aboriginal and Torres Strait Islander health services and academics, for benchmarking to standardise health-enabling retail practice for the benefit of all Aboriginal communities. It is a collaborative project planned and implemented by researchers and research partners, including Aboriginal Community Controlled Health Organisations, remote food retail organisations and government agencies (the Arnhem Land Progress Aboriginal Corporation, Katherine West Health Board Aboriginal Corporation, Miwatj Health Aboriginal Corporation, Sunrise Health Service Aboriginal Corporation, Aboriginal Medical Services Association of the Northern Territory, Apunipima Cape York Health Council, Indigenous Allied Health Australia, Health and Wellbeing Queensland, Katherine West Health Board Aboriginal Corporation, Northern Territory Department of Health, and Outback Stores Pty Ltd). These organisations together with Aboriginal and Torres Strait Islander community members and store directors contributed to the co-design of the Benchmarking strategy through workshops. Three of the ten project Chief Investigators are senior Aboriginal leaders and academics. The Benchmarking project is governed by a steering group, executive team, and codesign working group, all comprised of Aboriginal and Torres Strait Islander and non-Indigenous researchers and representatives of partner organisations, who ensure that all research processes are culturally appropriate and meaningful, and Aboriginal and Torres Strait Islander data sovereignty principles are upheld.

Introduction
Prevention interventions offer opportunities for health gain for Indigenous populations, but evidence on cost-effectiveness to guide investment is limited. This systematic review synthesised global economic evidence on prevention interventions for Indigenous peoples.

Methods
Eleven databases were searched for economic evaluations of interventions targeting modifiable risk factors in Indigenous populations (2003–present). Two reviewers screened studies. Data extraction focused on methods, results and Indigenous-specific adaptations. The Drummond checklist and the Aboriginal and Torres Strait Islander Quality Appraisal Tool assessed research quality from methodological and Indigenous perspectives.

Results
Twenty-four economic evaluations were included (20 Aotearoa/New Zealand, 4 Australia) covering 20 population-based interventions (smoking n=7, diet n=6, physical activity n=4, BMI n=3) and four targeted interventions in remote communities (diet n=3, multiple risk factors n=1).
Most studies incorporated some Indigenous-specific customisations: 22 adjusted model-input parameters, 13 adapted effectiveness estimates and two customised interventions using Indigenous knowledge. None adjusted willingness-to-pay thresholds, or outcome measures, or valued cultural or community benefits. Twelve conducted equity analyses using non-Indigenous mortality and morbidity.
Fourteen population-wide evaluations reported Indigenous-specific cost-effectiveness results (8 cost-saving; 3 cost-effective; 3 not cost-effective). Eighteen of 19 showed greater per-capita health gains for Indigenous populations. Targeted interventions showed mixed results (1/4 cost-effective).
Economic evaluation methodological quality was good (7-10/10). Indigenous quality appraisal was poor (0-4/14) with limited evidence of strengths-based approaches, community consultation or Indigenous leadership/governance.

Conclusion
Although economic evaluations met technical rigour criteria, cultural appropriate reporting was not prioritised. Population-wide interventions were generally cost-effective and delivered greater Indigenous health gains. Targeted interventions had mixed results, however evaluations did not value broader benefits like food security and cultural connection.
Future economic evaluations should partner with Indigenous researchers and communities to incorporate Indigenous peoples’ priorities, values and knowledges. Such partnership will strengthen evidence quality and ensure investment decisions improve health, wellbeing and equity for Indigenous peoples.


This systematic review was conducted in partnership between Deakin Health Economics and the Deakin Murnong Health Research Mob, a team of Indigenous and non-Indigenous researchers with expertise in food and nutrition policy and the commercial determinants of Aboriginal and Torres Strait Islander health. Members contributed to study design, screening, analysis and reporting. Indigenous researchers led appraisal of included studies using the Aboriginal and Torres Strait Islander Quality Appraisal Tool, ensuring assessment through an Indigenous lens. The collaboration supported mutual learning and capacity building in both economic evaluation and Aboriginal and Torres Strait Islander health and research methods.
As a systematic review, no new data or samples were collected from Indigenous peoples. Indigenous data sovereignty principles were upheld, as the study used publicly available data only.
Findings will inform future economic evaluation within the Addressing Commercial Health determinants: Indigenous Empowerment and Voices for Equity (ACHIEVE) project. ACHIEVE brings together researchers and Aboriginal Community Controlled Health Organisations to develop solutions addressing the commercial determinants to health. Initial discussions with Indigenous researchers have occurred, with further engagement planned with stakeholders, including Aboriginal Community Controlled Health Organisations. These discussions will explore the role of economic evaluation, including frameworks and study design to better reflect Indigenous priorities, values and knowledges.