Purpose: Systems-informed health promotion initiatives have shown promise in improving child health, but results have been inconsistent, partly due to implementation challenges. Systems science may offer methods to better understand scenarios influencing implementation. We tested this approach by applying two system dynamics methods: group model building (GMB) and causal loop diagrams (CLDs), to describe relationships between factors affecting implementation progress of child health promotion actions.
Methods: This study was embedded within a health promotion initiative in regional Victoria (Australia), which used system dynamics methods to support communities in developing and implementing actions to improve child health. We facilitated a GMB workshop with each of the five community-based prevention teams, to develop a CLD mapping factors influencing implementation of their community-designed actions. Using a qualitative meta-synthesis approach, the research team integrated the five CLDs into generalised CLDs illustrating overarching system structures that influence implementation.
Results: Three generalised CLDs were developed, illustrating that implementation progress is influenced by interacting factors related to (i) the alignment of action to community values; and (ii) inter-organisational partnerships and (iii) resources available in the broader prevention system. Each CLD contains reinforcing and/or balancing feedback loops, showing how change in one factor can elicit cascading effects through the system, accelerating or slowing implementation progress. Understanding implementation using this approach can help emerge covert implementation determinants and highlight suggested areas to apply implementation strategies. For example, the first generalised CLD suggests that promoting community satisfaction of existing actions may inadvertently attract additional funding from local health services and organisations.
Conclusions: This study demonstrates how system dynamics methods can help better understand implementation progress of community-designed actions. By capturing relationships and feedback rather than static lists of barriers and enablers, system dynamics can offer richer insights to inform the design of implementation strategies.

Dementia is the leading cause of death in Australia and the second leading cause of disease burden. The latest projections suggest that prevalence will more than double to over one million people by 2065 [1]. Without a cure, a public health response to dementia is essential. With 43% of Australia’s dementia burden attributable to six modifiable risk factors, there is an opportunity to reduce risk of dementia for people of all ages [1].

Since WHO’s 2012 report Dementia: a public health priority prioritised risk reduction, Australia has seen little substantive action on dementia prevention. Despite the 2024 Lancet Commission’s clear evidence and a 33% increase people living with dementia in that time, dementia has been siloed as aged care issue[2, 3]. This has limited risk reduction, reinforced stigma, and perpetuated the myth that dementia is a normal or inevitable consequence of ageing.

Dementia Australia has mapped key efforts in dementia prevention in Australia against the WHO report and subsequent action plan. We reviewed Australia’s National Dementia Action Plan, health strategies and budget papers, comparing to WHO’s recommended actions which demonstrated limited investment in and implementation of systemic, population level strategies. There is, however, growing momentum for brain health awareness and dementia risk reduction. In this presentation we highlight public health opportunities to improve brain health, including a national brain health program, scaling existing prevention programs, addressing policy levers to reduce population-wide risk, enhancing primary care pathways, and improving the public health workforce’s capabilities.

References
1. AIHW, Dementia in Australia 2025. 2025, AIHW, Australian Government.
2. AIHW, Dementia in Australia 2012. 2012, AIHW, Australian Government.
3. Livingston, G., et al., Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. Lancet, 2024. 404(10452): p. 572-628.

Health system reforms are often evaluated using administrative and service data, yet these sources provide limited insight into how reforms are experienced by the populations they are intended to benefit. Consumer‑reported data offers a complementary perspective, particularly for understanding access, affordability, and equity in real‑world settings.

This presentation draws on findings from the Australian National Consumer Sentiment Survey (NCSS), a large, nationally representative survey conducted annually to capture consumer experiences of primary care. The NCSS has been integrated into the Monitoring and Evaluation Framework for Australia’s Strengthening Medicare reforms, enabling assessment of consumer‑reported outcomes alongside administrative and workforce data.

Results from the 2024-2025 waves show a complex picture. While some aspects of care experience appear to be improving, including perceptions of respectful and inclusive care, affordability remains the dominant barrier to access, with around half of respondents reporting at least one unmet healthcare need. Patterns of access and experience vary across population groups, with differences by financial stress, geography, and gender indicating potential risks of uneven reform impact.

Importantly, these findings are shaped by both reform initiatives and broader external factors, including cost‑of‑living pressures and workforce constraints. As such, the NCSS is not designed to attribute effectiveness to individual policy measures, but to provide early signals of system performance, identify equity risks, and inform where further, targeted evaluation is required.

This work demonstrates how consumer sentiment data can be embedded within evaluation frameworks to support policy learning and adaptive implementation. Integrating consumer‑reported insights with administrative and qualitative data strengthens the evidence base needed to translate reform into improved health outcomes at scale.

Background:
Illicit drug use among older adults (aged 45+ years) is increasing globally. Despite the growing impact on older adults, studies examining illicit drug use in this population remain limited.
Method:
Data were drawn from Wave 21 (2021) of the Household, Income and Labour Dynamics in Australia (HILDA) longitudinal cohort survey. The analysis included 7,862 participants aged 45+ years, representing a weighted population of 8,713,896 individuals. The primary outcome was any illicit drug use in the past 12 months and was coded as a binary variable (yes/no). A series of Survey-weighted logistic regression (svy: logistic) was used to examine associations between illicit drug use and a range of explanatory variables which are individual-level, lifestyle behaviours, and social and mental health factors.

Result
Illicit drug use prevalence among older adults was 42% (95% CI: 40–43). Illicit drug use was significantly higher among participants born in main English-speaking countries (aOR = 1.47; 95% CI: 1.08–1.99), in Australia (aOR = 1.47; 95% CI: 1.16–1.87), and those living in Inner Regional areas (aOR = 1.93; 95% CI: 1.07–3.47). Participants with moderate psychological distress (K10) had 1.24 times higher odds (aOR = 1.24; 95% CI: 1.03–1.50), and those with high or very high distress had 1.57 times higher odds (aOR = 1.57; 95% CI: 1.22–2.04) of reporting illicit drug use. Lower scores on the SF-36 Mental Health scale (moderate or low mental health status) were significantly associated with increased odds of illicit drug use. Those that experienced traumatic life events were more likely to report illicit drug use (aOR =1.22; 95% CI: 1.05–1.42).
Conclusion:
Illicit drug use among older adults is associated with smoking, high-risk alcohol use, psychological distress, and trauma exposure. These findings highlight the need for integrated interventions addressing both substance use and mental health.

Background: Diet affordability is a critical yet under-monitored determinant of food security. The forcible disruption of traditional food systems through colonisation, compounded by geographic isolation, high freight costs and limited retail competition, intensifies food insecurity for remote Aboriginal and Torres Strait Islander communities.

Aim: To monitor the cost and affordability of diets within Aboriginal and Torres Strait Islander households across six regions in Far North Queensland.

Methodology: Price data were collected across 35 communities over two years (2023–2024) using the Healthy Diets Australian Standardised Affordability and Pricing (HD ASAP) protocol, relative to a six-person intergenerational Aboriginal and Torres Strait Islander reference household. Cost of a healthy diet (i.e., Australian Dietary Guidelines) and habitual diet (i.e., 2012–2013 Australian Aboriginal and Torres Strait Islander Health Survey) were assessed against food stress and affordability income thresholds. Linear regression with cluster-robust standard errors examined differences across year, diet type and remoteness. As an ongoing monitoring project, data were also collected in 2025 with future data collection rounds planned.

Findings: Across all regions and both years (2023-2024), healthy diets were on average 30% cheaper than the habitual diet (p<0.05) yet still exceeded the food stress threshold for Aboriginal and Torres Strait Islander households. In 2023, healthy diets were 31% more expensive in remote regions compared to non-remote regions (p<0.05). In 2024, healthy diet costs in remote regions decreased by 24%, narrowing cost differentials between remote and non-remote Queensland. This change may potentially be associated with the 20% Queensland Remote Communities Freight Assistance Scheme implemented between the 2023 and 2024 data points.

Conclusion: While targeted fiscal interventions may reduce diet cost inequities, complex systemic drivers of food insecurity persist, underscoring the need for sustained, multi-strategic and coordinated food security action.

Abstract:
Background: Culturally and linguistically diverse (CALD) communities remain underrepresented in health research, partly due to the absence of structured, culturally responsive governance approaches. Although community advisory panels are increasingly recommended to support inclusive and equitable research, there is limited operational guidance for implementing advisory structures in CALD contexts.

Methods: We conducted a scoping-informed best-fit framework synthesis integrating evidence from Indigenous implementation science, multicultural health research, cross-cultural qualitative methodologies, and inclusive patient and public involvement frameworks. The resulting draft framework is currently being refined through a modified Delphi study involving multidisciplinary experts in public health, implementation science, multicultural health, and community engagement. Consensus criteria included median scores ≥7, ≥70% agreement, and an interquartile range ≤2.

Preliminary Results: Fifteen experts were invited, with 12 participating in Round 1 (80% response rate). Most framework items achieved strong preliminary consensus, particularly those relating to culturally responsive engagement, diverse panel representation, governance integration, structural supports, and transparent feedback mechanisms. The draft framework comprises five interconnected components: (1) Foundational Principles of Cultural Partnership; (2) Community-Centred Panel Composition and Setup; (3) Culturally Responsive Engagement and Co-Design Processes; (4) Structural Supports and Resources for Implementation; and (5) Iterative Reflexivity, Evaluation, and Knowledge Translation. Qualitative feedback highlighted the importance of avoiding tokenism, clarifying advisory authority, embedding cultural safety, and ensuring flexibility in engagement processes. Items requiring refinement are currently undergoing Round 2 re-rating and revision.

Conclusions: Preliminary findings provide strong support for a culturally responsive, implementation-focused advisory panel framework for CALD research contexts. The framework offers practical guidance to strengthen equitable community engagement, culturally safe governance, and implementation relevance in public health research. Final Delphi findings will further refine framework operationalisation and applicability across diverse community settings.

Background
Despite growing investment and increasing healthcare demand associated with chronic disease prevention, the translation of preventive approaches into routine hospital care remains fragmented and underdeveloped. Tertiary services represent a critical but underutilised setting for prevention and an opportunity to reach populations experiencing barriers to access and engagement, particularly culturally and linguistically diverse (CALD) and socioeconomically disadvantaged groups. These populations experience a disproportionate burden of chronic disease and often have lower engagement with mainstream preventive services.

Aim
This review aimed to map the characteristics of chronic disease prevention programmes embedded within tertiary healthcare and identify implementation barriers, facilitators, equity considerations and implications for programme design.

Methods
A scoping review was conducted in accordance with the PRISMA-ScR framework. MEDLINE, CINAHL and Scopus were searched for studies describing chronic disease prevention in tertiary settings. Data was extracted and synthesised using thematic analysis, with a focus on equity-related dimensions.

Results
Substantial heterogeneity was identified in programme design, delivery and reach. Most interventions focused on single diseases rather than integrated prevention across conditions. Prevention programmes largely reflected standardised models that did not adequately account for population diversity, findings suggest that engagement is influenced less by intervention content than by how programmes are delivered. Common components included multi-risk screening, lifestyle counselling, referral pathways and digital or telehealth delivery. Implementation challenges included workforce capacity, competing priorities and integration within existing workflows. Equity considerations were inconsistently reported, with limited attention to socioeconomic disadvantage, language access and health literacy.

Conclusion
Chronic disease prevention can be embedded within tertiary care; however, current approaches remain fragmented and insufficiently responsive to population diversity. Findings highlight opportunities for health services to strengthen prevention through incorporating: (1) multimodal delivery models that support flexible engagement; (2) culturally responsive and equity-embedded design and (3) integrated multi-condition approaches, providing practical direction to prevention within routine clinical care

The commercial determinants of health (CDoH) are increasingly recognised as major drivers of non-communicable disease and health inequities. However, the extent to which CDoH concepts are translated into policy action remains unclear. This study critically examined the extent to which Australian health promotion policies recognise and respond to the CDoH. We conducted a critical qualitative content analysis of 94 Australian Commonwealth, state and territory health promotion policy documents published between 2015 and 2025. Using a theory-informed a priori coding framework, we examined explicit recognition of CDoH and the nature of proposed policy responses. Eighteen policies explicitly referred to the CDoH or related concepts, all published from 2021 onwards, indicating recent but uneven policy uptake. Legislative and regulatory measures were concentrated in a small number of Commonwealth-led strategies and focused primarily on tobacco, with more limited attention to unhealthy food and alcohol. State and territory strategies relied more heavily on public awareness campaigns and administrative tools rather than direct regulation of the commercial sector. Governance protections against industry interference were largely confined to tobacco control, with no measures targeting the gambling and fossil fuels industries. Australian health promotion policies demonstrate emerging but uneven recognition of the CDoH, with limited institutionalisation through regulatory and governance measures. These findings highlight ongoing challenges in translating health promotion and CDoH frameworks into coherent, whole-of-government policy responses to address the commercial drivers of health and health inequity.

Background
The Cancer-Free Cultures (CFC) Program is led by the Ethnic Communities Council of Queensland in partnership with Cancer Council Queensland and funded by Queensland Health. The program aims to reduce inequities in cancer awareness, prevention, and screening among culturally and linguistically diverse (CALD) communities, who often face barriers to accessing screening and early detection services.
Delivered across Queensland, the program uses a community-led and culturally responsive approach. It co-designs tailored education, resources, and engagement activities to improve knowledge, access, and participation in cancer prevention and screening. A Monitoring and Evaluation Framework, developed by the Institute for Social Science Research at The University of Queensland, supports implementation tracking, outcome assessment, and continuous improvement.

Methods
The CFC Monitoring and Evaluation Framework is guided by Results Based Accountability™ (RBA), distinguishing population-level and program-level outcomes. It focuses on three questions: how much was done, how well it was done, and whether anyone is better off, to assess activities, quality, and early outcomes. As an early-stage program, monitoring occurs over 12-month cycles and tracks reach, participation, experience, partnerships, outputs, and early outcomes. Co-design and community education sessions delivered to CALD communities are central, with a focus on changes in knowledge, confidence, and awareness of cancer screening. A pre- and post-program survey was used to assess changes in knowledge, awareness, confidence, and intentions related to cancer screening.

Results
In the first year of delivery, the CFC Program delivered to Arabic-speaking, Chinese, and African community groups has demonstrated improvements across knowledge, awareness, confidence, and intentions related to cancer screening. The cancer screening types covered included bowel cancer, lung screening, skin checks, breast screening, and cervical screening.
Understanding of cancer risk factors improved among 48% of participants, while 51% demonstrated improved understanding of the benefits of screening. Awareness of screening increased across all screening types, particularly for lung screening (34% to 91%) and bowel screening (71% to 99%), with improvements also observed across skin, breast, and cervical screening. Knowledge of how to access screening services increased substantially across all screening types.
Confidence and comfort in attending screening also improved across all cancer types, with bowel screening reaching 99% for both measures. Intentions to attend screening increased across all cancer types. Overall, the findings demonstrate consistent positive change across multiple domains and contribute to the evidence base informing future culturally responsive cancer prevention and screening strategies.