OBJECTIVE:To examine and describe telehealth use and attitudes among mental health professionals in Australia and New Zealand during the initial stages of the COVID-19 pandemic.METHODS:Participants completed a brief online survey between May and July 2020. Participants were recruited via peak and professional organisations and through psychology-focused social media groups and networks. The survey examined frequency of telehealth use, reasons for non-use, telehealth modalities, prior use, attitudes towards use, plans for future use, and training, information or resource needs.RESULTS:A total of 528 professionals (85.2% female) participated in the survey, of which 98.9% reported using telehealth and 32.2% reported using telehealth exclusively. Respondents were less likely to use telehealth if they worked with clients experiencing complex issues (e.g. trauma), had more hours of weekly client contact, had a choice about whether to use telehealth or felt less positive about using technology. Respondents were more likely to hold positive views towards telehealth if they were female, had used online programmes with clients previously, were frequent telehealth users and were comfortable using technology. Participants expressed mixed views on client safety and the impact of telehealth on therapeutic process and effectiveness.CONCLUSION:Telehealth has a clear and ongoing role within mental healthcare and there is a need for strong guidance for professionals on how to manage client risk, privacy, security and adapt therapy for delivery via telehealth. In particular, there is a need for individual-, organisational-, professional- and policy-level responses to ensure that telehealth remains a viable and effective healthcare medium into the future.

From March 2020, clinical psychology postgraduate programmes began rapidly adopting telepsychology within their training clinics to support public health and reduce the spread of COVID-19. However, implementing this rapidly, safely, and effectively posed challenges to programmes, educators, supervisors, and trainees who at the time predominantly utilised inperson psychology and had limited experience with telepsychology. This paper outlines the collaboration of Australian psychology postgraduate programmes; the development of the Australian Telepsychology Collaboration's role in supporting rapid adoption; empirical evidence for the use of telepsychology in training clinics; and reflects on how clinics overcame initial technological, security, clinical, practical and competency barriers to adoption. Implications and recommendations for clinical psychology postgraduate programmes are discussed, and an emphasis is placed on the unique opportunity that psychology programmes have to contribute meaningfully to clinical and empirical telepsychology knowledge. KEY POINTS What is already known about this topic: (1) Telepsychology has been rapidly adopted and is increasingly used in psychology and psychology training programs since the pandemic. (2) Telepsychology is a way to maintain training standards and learning opportunities for postgraduate psychology trainees during times of increased social and movement restrictions. (3) There is emerging literature to support telepsychology for the types of presentations common to training clinics. What this topic adds: (1) A reflection on the security, technological, and clinical knowledge learned by postgraduate psychology training programs transitioning to telepsychology that has relevance for training providers and clinicians undertaking parallel transitions. (2) Overcoming barriers to large-scale telepsychology implementation. (3) Implications and recommendations for psychology postgraduate programmes.

Digital mental health is changing the landscape of service delivery by addressing challenges associated with traditional therapy. However, practitioners’ use of these resources remains underexamined. This study explored psychologists’ attitudes and experiences with digital mental health intervention. Taking a qualitative exploratory approach via thematic analysis, the study sought to answer the following research questions: (i) How do psychologists perceive digital mental health? and (ii ) What is their experience using digital mental health as part of routine practice? Ten practising psychologists participated in online semi-structured interviews (approximately 50 min), with interviews then transcribed verbatim. Interview data were analysed according to the six-phase approach to thematic analysis proposed by Braun and Clarke. Three themes were identified: (1) attitudes towards digital mental health; (2) use within routine practice; and (3) perspectives on an effective model for implementation. Practitioners play a major role in the design and delivery of digital mental health services. Barriers and facilitators at the practitioner-level (e.g. knowledge and competence with tools, perceptions on the utility of digital interventions) and the service-level (e.g. government support for digital health) should be considered in the future design of digital mental health resources and service delivery.

PURPOSE:Helplines are increasingly used to provide information and support for people affected by cancer, and the distress routinely associated with diagnosis and treatment is a major focus for those providing such care. Little is known, however, about how the Distress Thermometer (DT), a widely used tool for the assessment of patient/carer distress on cancer-support telephone helplines, is introduced and used in such settings.METHOD:Using the method of conversation analysis, we present a qualitative analysis of DT use in actual telephone interactions by looking closely at how particular practices shape interaction on a cancer helpline. Specifically, we examine how oncology-trained nurse call-takers used the DT, in situ, as a tool for assessing callers, as well as examining how callers responded to this brief screening tool.RESULTS:Our findings show how particular positioning of the DT in the call, and particular forms of its delivery, tend to generate brief responses from callers that avoid topicalization of distress, and tend not to be associated with referral to support services.CONCLUSIONS:Implications for successful integration of the DT as a screening tool in cancer- and other health-helpline interactions, as well as for effective training of users, are discussed.

Abstract Background Opportunities for cancer survivors’ employment can both reflect and perpetuate health inequities, as employment is an important social determinant of health. Socio‐economic and geographic disadvantage is associated with greater difficulty finding work, but little is known about work needs of Australian cancer survivors living with disadvantage. Objective This study examined survivor and health‐care professional (HCP) perspectives on barriers experienced by Australian cancer survivors experiencing disadvantage when attempting to remain at or return to work. Method Focus groups and individual interviews were held with cancer survivors (N = 15) and oncology and primary HCPs (N = 41), focusing on communities at risk of disadvantage. Participants were asked about employment barriers and facilitators in general and in the context of disadvantage. Themes were identified using framework analysis. Results Geographic and socio‐economic disadvantage resulted in specific individual‐ and system‐level barriers. These related to distance from treatment and support services and limited availability and suitability of work for survivors living with geographic disadvantage, and limited availability, security, and flexibility of work and previous unemployment for survivors living with socio‐economic disadvantage. Identified needs included system‐level changes such as public and workplace‐level education, legislative and policy changes, and better access to resources. Conclusions Cancer survivors living with disadvantage experience limited access to flexible employment opportunities and resources, further perpetuating their disadvantage. Promotion of health equity for cancer survivors living with disadvantage requires systemic changes to support attempts to remain at/return to work. Patient or public contribution This study included cancer survivors and HCPs as investigators, authors and participants.

Purpose To investigate the successful strategies of health workers who support and regularly communicate with Aboriginal and Torres Strait Islander people about cancer and its treatment. Methods Semi-structured interviews were conducted face-to face or via telephone and audio-recorded with twenty-three health professionals (medical and radiation oncologists, oncology nurses and Aboriginal Health Workers), 5 identifying as Aboriginal or Torres Strait Islander in the Northern Territory and South Australia. When data saturation was reached, thematic analysis using a bottom up, essentialist/realist approach was used. Results Six themes emerged. (1) Create a safe environment, engender trust and build rapport. This involves considering the physical environment and allowing time in interviews to establish a relationship. (2) Employ specific communication strategies to explain cancer, treatment and its side effects through language choices and employing visual aids such as drawings, metaphors and relatable analogies. (3) Obtain support from Aboriginal and Torres Strait Islander staff and patient escorts who can assist in communication. (4) Consider culture which involves collective decision making, strong connection to country and community, with cultural obligations and a unique understanding of cancer. (5) Anticipate the contextual complexities of conflicts between Western medicine and Aboriginal culture, practitioner bias and difficulty maintaining contact with patients. (6) Develop personal qualities of good communicators, including being patient-centred, showing respect, patience, empathy and honesty. Conclusion These insights will help foster more positive interactions with the health system and promote optimal outcomes for Aboriginal and Torres Strait Islander people with cancer.

Abstract Objective This study aims to explore psychologists' attitudes towards the use of video conferencing technology (VCT) to deliver therapy. Method Participants (N = 12) were recruited via opportunistic sampling either via the Australian Psychological Society website or social media. Participants (three males and nine females) were located in Queensland. They were aged between 23 and 50-years of age (mean age = 32.91, SD = 9.36), held varying levels of experience in psychology (<1 year to 12-years) and types of endorsement (e.g. provisional, general, clinical and health). A semistructured interview schedule was applied in‐person (n = 7) or via telephone (n = 5). Data were analysed using Braun and Clarke's (2006) five‐step method for assessing qualitative data in psychology. Results Results indicated that psychologists' attitudes towards VCT to deliver therapy paralleled the tri‐component definition of attitudes proposed by Breckler (1984) and Rajecki (1982 ). Subthemes reflecting these components included perceived limitations or benefits of VCT (i.e. a cognitive component), a sense of comfort when using VCT (i.e. an affective component), and a general tendency to resist or embrace VCT (i.e. a behavioural disposition). Conclusions Key barriers and facilitators identified underscore the need for training to improve knowledge and awareness of VCT, including its evidence base. Specifically, the assistance of ‘embracers’ to provide training in VCT (e.g. adapting microskills to a different medium and using technology flexibly) may also dispel negative views held by psychologists regarding VCT and its effectiveness and consequently facilitate a wider adoption of VCT throughout Australia.

e24188 Background: To enable clinicians to effectively communicate about cancer and its treatment to Aboriginal and Torres Strait (Aboriginal) people with cancer who need to make informed choices about the Western medicine offered, we sought strategies from health professionals with experience in that field. Methods: Semi-structured interviews were conducted face-to face or via telephone with the experienced health professionals and audio-recorded. Thematic analysis using a bottom up, essentialist/realist approach was employed to analyse the data, when data saturation was reached. Results: The 23 health professionals interviewed were medical and radiation oncologists, oncology nurses and Aboriginal health workers. Twelve were female, 11 were male with 5 identifying as Aboriginal. Six themes emerged. (1) Create a safe environment, engender trust and build rapport. This involves avoiding assumptions, allowing time, considering the physical environment, asking about home and family, being aware of gender issues and noting non-verbals. (2) Employ specific strategies to explain cancer, treatment and its side effects by using simple language, employing visual aids such as drawings, metaphors and relatable analogies such as trees with roots, weeds, abandoned rusty cars and blocked pipes. Use repetition and ensure alignment with patient needs. Warning about upcoming sensitive issues minimised the chance of disengagement. (3) Obtain support from those who can assist in communication. This includes interpreters, aboriginal liaison officers and health workers, and patient escorts. (4) Consider the culture which involves collective decision-making, strong connection to country and community, with cultural obligations and unique understanding of cancer which can involve curses, shame and utilise bush medicine. (5) Develop personal qualities of good communicators, including showing respect, patience, empathy, honesty, being person centred and embracing personal reflection. (6) Understand the contextual complexity of multiple languages, possible disengagement with treatment, difficulty maintaining contact with patients, conflicts between Western medicine and Aboriginal culture and late stage presentations. Be aware of practitioner bias. Conclusions: These insights will help foster more positive interactions with the health system and promote optimal outcomes for Aboriginal people with cancer and enable the creation of educational modules for inexperienced clinicians.

Indigenous Australians experience a substantially higher cancer mortality rate than non-Indigenous Australians. While cancer outcomes are improving for non-Indigenous Australians, they are worsening for Indigenous Australians. Reducing this disparity requires evidence-based and culturally-appropriate guidance. The purpose of this paper is to describe an initiative by Cancer Australia and Menzies School of Health Research (Menzies) to develop Australia’s first National Aboriginal and Torres Strait Islander Cancer Framework using a process of co-design with relevant stakeholders. The initiative was guided by three core principles: achieving policy-relevant evidence-based outcomes; engaging and maintaining trust with Indigenous Australians at every phase; and employing best-practice and appropriate research methods. Four components of research comprised the Framework development: evidence review; multifaceted stakeholder consultation and input; triangulation of findings; and direct stakeholder input in drafting and refining the Framework. The evidence review confirmed the increasing burden of cancer on Indigenous Australians, while stakeholder consultations facilitated comprehensive input from those with lived experience. The consultations revealed issues not identified in existing literature, and gave different emphases of priority, thus reinforcing the value of including stakeholder perspectives. This paper focuses primarily on documenting the methods used; findings are presented only in order to illustrate the results of the process. The published Framework is available at www.canceraustralia.gov.au; further description and analyses of findings from the consultations will be published elsewhere. The logistics inherent in large-scale consultation are considerable. However, the quality of data and the foundation for sustained partnership with stakeholders and knowledge translation vastly outweighed the challenges. The process of wide-ranging stakeholder consultation described in this paper offers a model for other areas of national and international Indigenous priority setting and policy and practice development that meets the needs of those most affected. The Framework, through the establishment of an agreed, shared and evidence-based agenda, provides guidance for jurisdictional cancer plans, optimal care pathways, and program and service planning for the multiple players across all levels of the health system.

BACKGROUND:Individual coping strategies are a fundamental element underpinning psychosocial distress.OBJECTIVE:The aim of this study was to describe coping strategies and their measurement used by survivors of breast, prostate, and/or colorectal cancer after treatment.METHODS:A search of electronic databases (PubMed, CINAHL, and PsycINFO) was conducted from January 1980 to March 2015. Data were extracted using standardized forms and included studies that explored the coping mechanisms of survivorship of breast, prostate, or colorectal cancer.RESULTS:Two thousand one hundred forty-seven studies were retrieved for potential inclusion; 19 publications met the inclusion criteria and were included in the review.CONCLUSIONS:Breast, prostate, and colorectal cancer survivors seem to use different coping strategies that varied throughout the survivorship trajectory. Breast cancer survivors highlighted the importance of accepting their diagnosis and engaging in physical activities that provided social and emotional support. Personality seemed to have a significant effect on coping for prostate cancer survivors. Colorectal cancer survivors emphasized the importance of seeking information to master self-management and return to social activities.IMPLICATIONS FOR PRACTICE:Understanding coping strategies, during the survivorship trajectories, is essential to planning contemporary care after cancer treatment. Nurses and other healthcare professionals may use this knowledge to improve quality of life and decrease distress after diagnosis.

Background: Individual coping strategies are a fundamental element underpinning psychosocial distress. Objective: The aim of this study was to describe coping strategies and their measurement used by survivors of breast, prostate, and/or colorectal cancer after treatment. Methods: A search of electronic databases (PubMed, CINAHL, and PsycINFO) was conducted from January 1980 to March 2015. Data were extracted using standardized forms and included studies that explored the coping mechanisms of survivorship of breast, prostate, or colorectal cancer. Results: Two thousand one hundred forty-seven studies were retrieved for potential inclusion; 19 publications met the inclusion criteria and were included in the review. Conclusions: Breast, prostate, and colorectal cancer survivors seem to use different coping strategies that varied throughout the survivorship trajectory. Breast cancer survivors highlighted the importance of accepting their diagnosis and engaging in physical activities that provided social and emotional support. Personality seemed to have a significant effect on coping for prostate cancer survivors. Colorectal cancer survivors emphasized the importance of seeking information to master self-management and return to social activities. Implications for Practice: Understanding coping strategies, during the survivorship trajectories, is essential to planning contemporary care after cancer treatment. Nurses and other healthcare professionals may use this knowledge to improve quality of life and decrease distress after diagnosis.

Much of the world's burden of cancer is in poor and developing countries, where there are often very limited screening, early diagnosis and treatment facilities—there is a growing awareness that significant investment in cancer control measures is required to reduce the burden and suffering in low-resource settings (Gelband et al., 2016; de Martel et al., 2012)). Prevention and screening are mainstays of improving cancer survival in poorer regions; for these efforts to be successful there needs to be investment in basic primary healthcare services, promotion of awareness of cancer symptoms, low technology approaches to screening and basic treatment facilities (López-Gómez, Malmierca, de Górgolas, & Casado, 2013). In many parts of the world cancers are predominately diagnosed at a very late stage where curative treatment is not possible; this arises from a range of financial, social and cultural barriers to acting upon cancer symptoms coupled with poor diagnostic and treatment facilities (Pati, Hussain, Chauhan, Mallick, & Nayak, 2013). In this issue of the Journal we invited a number of authors with global perspectives on cancer to describe some of the major challenges faced in reducing the burden of cancer—and to highlight new and novel approaches to reducing this burden. We begin in Sub Saharan Africa (SSA) where cancer incidence and outcomes show a typical pattern for low-resource settings, with poor survival and high mortality rates (Parkin, Bray, Ferlay, & Jemal, 2014). Kimani, Namukwaya, Grant, and Murray (2017) note the significant challenges arising from increasing rates of non-communicable diseases, especially cancer, in SSA. In SSA, the health system is geared towards the management of infectious disease, and preventive health services (including screening), are poorly developed—or indeed absent. Not surprisingly, when patients present with advanced disease, and with a lack of accessible disease-modifying treatments available, palliative care is the only viable option. However, major gaps in service provision in this area also exist; Kimani et al. (2017) provide an overview of these gaps, which include a lack of availability of basic pharmaceuticals. They also outline strategies being implemented throughout SSA utilising holistic models of palliative care, taking into account physical, psychological, cultural and spiritual factors. Their paper adds to body of research aimed at improving end of life care in SSA (Hannon et al., 2015; Harding et al., 2013; Lamas & Rosenbaum, 2012); palliative care is a significant challenge in developing countries, and often the most basic needs of people (such as pain control) are neglected. Poor palliative care can arise from poor knowledge and awareness of cancer and its long-term outcomes; the paper by Moyo (2017) highlights the often poor awareness in the community of cancer—in this case, prostate cancer in a rural Zimbabwean community. Cancer outcomes in SSA are poor, and approaches which include education, training and investment in basic health care and preventive services are needed. Olver (2017) outlines the disparities in cancer control that exist in lower and middle income countries (LMICs) compared with higher income countries. An absence of screening and prevention programmes, combined with poor access to specialist oncological training, radiotherapy and essential medicines, paints a challenging picture for the management of cancer in LMICs. The future, however, may be more optimistic; Olver outlines the key strategies required to improve prevention and treatment in LMICs. As Olver argues, while a multifaceted approach is required, the establishment of targets set by the World Health Organization and the United Nations (Wild et al., 2014), is a vital step towards improving cancer control in LMICs. Brown et al. (2017) describes the development of breast cancer diagnostic and treatment services in Malawi—one of the world's poorest countries, with very poor cancer outcomes (Msyamboza et al., 2012). Patients with breast cancer in SSA typically present with advanced disease (Kohler et al., 2017); much needs to be done to raise awareness of symptoms, prompt earlier presentation and improve treatment and diagnostic facilities. Brown et al.'s paper is an excellent example of rational planning for an affordable service in a low-resource setting; furthermore, it demonstrates the importance of local leadership if such initiatives are to be sustainable. It has long been argued that proper cancer registration is vital if cancer control efforts are to be initiated and monitored adequately (Bray et al., 2014); cancer registration enables monitoring of changes in incidence and mortality responses to cancer initiatives, prevention programmes, etc. and is a vital precursor for early diagnosis, screening and treatment initiatives. The study by Tervonen, Bray, Foliaki, and Roder (2017) highlights the importance of registration procedures, with a focus on the Pacific Islands. They outline some important local initiatives which should bolster registration efforts and underpin emerging cancer control initiatives. Cervical cancer is a major cause of mortality in developing countries, and responses are typically inadequate given the scale of the problem; in India, for example, despite high mortality rates, there are no national programmes (Mallath et al., 2014). Rupani et al.'s (2017) paper on cervical screening in a region of India highlights one approach in which high-risk women (selected from those attending STD clinics) are targeted for opportunistic screening. It is vital that we continue to promote low cost, low technology and affordable screening strategies in countries such as India; focusing on high-risk groups is a key strategy in rolling out more population-based initiatives. We urgently need more international effort targeting women's cancers—at present mortality rates are unacceptably high in poor and developing regions of the world (Ginsburg et al., 2016). Lim and Ojo (2017) add an African perspective with their excellent systematic review on barriers to cervical screening in SSA—it is a complex picture, and solutions need to incorporate cultural, societal, behavioural, financial and health system factors. Finally, Wilson and Hughes (2017) offer a discussion on the concept of the “healthy migrant effect” and elaborate upon this by discussing the increased risks of cancer that occur due to acculturation in first world countries. They describe a community based approach to reducing cancer risk, which incorporates a focus on social networking to improve cancer literacy. So, we hope you enjoy these papers in our January 2017 supplement—and we remind readers that the Journal is committed to disseminating best practice in global cancer control. We encourage more submissions in this vital area of cancer research. From all of the editorial team, we hope our readers and contributors have had an enjoyable festive season, and all the very best for 2017.

There are significant challenges for cancer control in indigenous populations in both developed and under developed countries. The decision to develop a themed section on cancer in indigenous populations is underpinned by our desire at EJCC to facilitate international dialogue so that we can understand the nature of these challenges, and to identify ways in which researchers, governments, service providers and others are responding to these challenges. Through the sharing of knowledge and experience, we hope that this themed issue will facilitate ways in which we can work together towards reducing the inequities in cancer outcomes that are so evident within indigenous communities throughout the world. In our experience as editors, we are regularly reminded of the differences in preferences for use of the term indigenous (including whether to capitalise indigenous), as well as other terms applied to identify members of an indigenous culture or cultures (e.g. Aboriginal and/or Torres Strait Islander). Thus, within this themed section, we have not attempted to edit terms applied by authors. We also trust that authors have in good faith applied terms that are consistent with the way in which cultures they work with prefer to be identified. Cancer is ubiquitous and occurs throughout the world, in developed and underdeveloped countries. A focus on cancer in underdeveloped countries will feature in a later themed section, scheduled for publication November, 2016. Here we present a collection of papers from Australia, New Zealand and Canada. These countries are described as highly developed; for example, they are ranked in the top eight countries with regard to key indices including life-expectancy, education and income (Moore et al. 2015). Despite these impressive rankings, indigenous people living in these countries experience poor health, including a high incidence of cancers with low rates of survival, and for which are potentially preventable through infection reduction and/or lifestyle change (Moore et al. 2015). As documented in a previous article published in EJCC (see Miller et al. 2012), indigenous peoples in these regions experience significantly poorer cancer outcomes than their non-indigenous counterparts. Disparities in access and outcome are relevant across the cancer continuum, and where data are available for comparison, disparities in mortality rates among indigenous populations compared with non-indigenous populations, are reported for cancers of the cervix, breast, gallbladder, lip and oropharynx, liver, lung, prostate and stomach (Miller et al. 2012). In many of these regions, these disparities are large. For example, in Australia, Aboriginal and Torres Strait Islanders experience a 30% higher mortality rate from cancer, compared with non-Indigenous Australians (Zorbas & Elston 2016). Until recently, data were relatively sparse with regard to enabling comparisons in overall cancer burden in indigenous populations in high-income countries such as Australia, the United States of America (US), Canada and New Zealand. A recent paper published in Lancet Oncology (Moore et al. 2015) suggests that among indigenous populations there is an overall lower burden of cancer in the US, similar or lower levels in Australia and Canada (Alberta, Canada), with the highest level of cancer burden indicated for New Zealand. While there are several differences in cancer incidence and patterns of cancer across these regions, generally the most commonly occurring cancers among indigenous populations in these regions include lung cancer (among men) and breast cancer (among women). However, there is a lower incidence of breast cancer among indigenous populations compared with non-indigenous populations in Alaska and New Zealand. In Canada, there is a higher incidence of colorectal cancer, and in the US, a higher incidence of prostate cancer (Moore et al. 2015). Moore et al. (2015, p. 1489) suggest that the poorer outcomes reported for indigenous populations ‘… highlight the common legacy of colonisation and its resultant political, social, environmental, and economic effects on the health of indigenous people’. Authors contributing to this themed issue also acknowledge the ongoing impact of colonisation, as well as social disadvantage and marginalisation on the health and social and emotional wellbeing of indigenous populations (Brown et al. 2016). A history of exposure to racism continues to impact negatively on the health of indigenous people, with papers in this issue continuing to highlight significant inequities in cancer outcomes for indigenous people in New Zealand (Robson & Ellison-Loschmann 2016), Canada (Beben & Muirhead 2016) and Australia (Zorbas & Elston 2016). The ability of health systems to adapt and deliver care in alignment with the needs and preferences of indigenous people continues to be a barrier (Meiklejohn et al. 2016) so does the potential to alienate patients and their families though poor communication (Brown et al. 2016; Zorbas & Elston 2016). Smoking underpins the high rates of lung and head and neck cancers. Thus, Knott et al.'s (2016) exploratory study generates a range of hypotheses regarding potential differences in the determinants of smoking that may exist among Indigenous men and women in Australia. Importantly, the study identifies a range of novel motivators for quitting among Indigenous men (e.g. sport, children) and women (e.g. body image, concern for others). While there remain significant challenges in improving cancer control outcomes for indigenous patients and families affected by cancer, there are examples reported herein whereby governments and researchers are working together with indigenous people to bring about change. Brown et al. (2016) provide an example of an approach in Australia whereby Aboriginal communities are working with policy makers, health service providers and researchers to drive change in the way data are collected and utilised. A specific focus of the CanDAD project is to drive change at the health system and service delivery levels via the integration of quantitative (registry data) and qualitative data (narratives) using methods including mapping as well as data-linkage. Zorbas and Elston (2016) report on an Australian government initiative involving the development of a Framework which identifies key priorities for improving cancer outcomes for Indigenous Australians. The Framework, developed in partnership with Menzies School of Health Research, identifies key priorities which include a focus on ensuring health services are adaptable and culturally safe. Authors suggest, for example, that the approach taken by Cancer Australia may provide the impetus for other countries to develop an approach to the development of specific priorities for indigenous populations. The papers presented here are not exhaustive of the initiatives aimed at improving cancer outcomes for indigenous populations throughout the world. There are many initiatives such as those involving grass roots advocacy in which survivors aim to both engage their communities in activities involving prevention, while also facilitating system level change. We hope in the future to publish updates of such work, and encourage others who are reading this themed section, to share their knowledge and experiences with our readers.

Despite the need to urgently reduce smoking rates among Indigenous Australians, in order to close-the-gap in life expectancy, little is known regarding how this can be achieved. This study aimed to explore whether a focus on gender specific determinants of smoking among Indigenous Australians could be identified, thus providing a potentially novel approach to underpin future efforts at intervention. A qualitative research design was employed. Eighty-two participants, comprised of 43 Indigenous women (mean age 32.15, SD, 12.47) and 39 Indigenous men (mean age 34.91, SD, 11.26), participated in one of 12 focus groups held in metropolitan, regional and rural locations in South Australia. Facilitators prompted discussion in response to the question: What is it like being a smoker these days?' Two experienced coders assessed data for themes using Attride-Stirling's (2002) method of analysis. Two global themes emerged for men and women. The first theme, It's Harder to Smoke Nowadays', encompassed sub-themes capturing changed smoking practices in response to tobacco control strategies implemented in Australia. Sub-themes of smoking in secrecy' coupled with an awareness of the effects of passive smoking' were identified among women. Among men, sub-themes that depicted tension between a desire to be a role model' and guilt about smoking' emerged. The second theme, Push and Pull Factors', identified a range of gender specific determinants of smoking. While similar reasons for smoking (pull factors') were identified in men and women (e.g. addiction, boredom, stress, pleasure, mood stabiliser), different push factors' (reasons for not wanting to smoke) emerged. For men, sport, fitness and children were identified as reasons for not wanting to smoke, whereas women identified factors such as respect for non-smokers, and body image concerns. The current findings suggest that there may be fundamental differences in the determinants of smoking (pull factors) as well as reasons for wanting to quit (push factors) between Indigenous men and women. A focus on interventions that target gender specific determinants, or motivators of smoking, offers a novel, and potentially efficacious approach to reduce smoking rates among Indigenous Australians.

ObjectiveSocially deviant and health-compromising behaviours are prevalent among adolescents living in Australia. The aim of this study was to explore from the perspectives of adolescents, and those involved in the provision of their care, potential reasons for youth delinquency and problematic drinking styles.MethodsParticipants were recruited purposively and comprised adolescents (n=16) and stakeholders (n=20), including youth mental health workers (n=7), school teachers/counsellors (n=7), and police officers (n=6). An open-ended question was used to prompt group discussion around why young people engage in deviant behaviour, including problem drinking. Responses were transcribed and analysed thematically.ResultsParticipants identified a number of factors that potentially underpin delinquent behaviour. These results were summarised within three global themes: social determinants (e.g., parenting practices), reinforcement histories (e.g., social endorsement), and individual determinants (e.g., personality traits).ConclusionMultidisciplinary interventions addressing these causes are likely to result in optimal outcomes.