Academic literature on the topic 'Community theater Australia Case studies'

In this article, Katya Johanson and Hilary Glow examine the ways in which performing arts companies and arts policy institutions perceive the needs of children as audiences. Historically, children have been promoted as arts audiences. Some of these represent an attempt to fashion the adults of the future – as audiences, citizens of a nation, or members of a specific community. Other rationales focus on the needs or rights of the child, such as educational goals or the provision of an antidote to the perceived corrupting effect of electronic entertainment. Drawing on interviews with performing arts practitioners, the authors explore some of these themes through case studies of three children's theatre companies, identifying the development of policy rationales for the support of practices directed at children which are primarily based on pedagogical principles. The case studies reveal a shift away from educational goals for children's theatre, and identify a new emphasis on the importance of valuing children's aesthetic choices, examining how these trends are enacted within the case-study organizations, and the implications of these trends for company programming. Hilary Glow is Senior Lecturer and Director of the Arts Management Program at Deakin University, Victoria. She has published articles on cultural policy and the audience experience in various journals, and in a monograph on Australian political theatre (2007). Katya Johanson lectures and researches in the School of Communication and Creative Arts at Deakin University. She has published on Australian cultural policy and on the relationship between art, politics and national identity. With Glow she is the author of a monograph on Australian indigenous performing arts (2009).

This paper explores the relationship between school music and community music in Australia. While many Australian schools and community music activities tend to exist in relative isolation from one another, a range of unique school–community collaborations can be found throughout the country. Drawing on insights from Sound Links, one of Australia's largest studies into community music, this paper explores three case studies of these unique school–community collaborations. These collaborations include a community-initiated collaboration, a school-initiated collaboration and a mutual collaboration. The author brings these collaborations to life for the reader through the words and experiences of their participants, and explores their structures, relationships, benefits, and educational and social outcomes. These descriptions feature important concepts, which could be transferred to a range of other cultural and educational settings in order to foster more vibrant school–community collaborations.

This article presents findings from an exploratory research using descriptive case studies of 12 migrant women in Western Australia. The purposive sample represents the government, academia, the private sector, community, civil society and not-for-profit organisations and is ranged in age from the late 20s to the 70s. Underpinned by theoretical frameworks of resilience and empowerment, women have shared their personal case narratives, and five case studies are presented in this paper. Our findings resonate with the vital and uncontested importance of education, the desire to be empowered, the capacity to be resilient and adaptive and the importance of giving back to the community. Key recommendations include the need for migrant women’s continued access to avenues of empowerment and furthering education. The provision of adaptive structures builds resilience and grows strong communities where women feel empowered. We propose that women migrants, through alliances and collaboration, cross borders of learning and work towards generating change and transformation.

The paper outlines the strengths, similarities and differences of metropolitan and rural community health sectors. Case studies are used to look at the history of community health in South Australia, its current status is described and some future directions are proposed. Perspectives are drawn from the authors' collective experiences. Rural and metropolitan community health services in South Australia have developed from different models since they were established in the 1970s. Rural community health services have invariably been established as entities within hospitals and health services, although metropolitan community health services have generally been established as stand alone facilities independent of the acute sector. To illustrate this, two case studies are used to demonstrate the evolution of metropolitan and rural community health services.

THIS BOOK AIMS to be a comprehensive insight into community nursing in Australia. The text largely achieves this claim and in doing so has provided one of the first texts of its type contextualised specifically at Australian community nursing issues. The book comprises 24 well organised and clear chapters around the three primary elements: the organisation of community nursing in Australia; the rapidly changing environment of community health delivery; and the specific practice elements of community nursing care. The chapters are well set out and include a focussed conclusion that really distils the essential elements. The text makes appropriate use of case studies, and scenarios add to the quality of the overall product. One area that could have been given more prominence would have been a specific chapter on issues concerning the community nursing care of Australia?s Indigenous population, as well as a chapter on community nursing approaches to stigmatised and marginalised groups. While reference is made to these groups within other chapters, it may have been more powerful had chapters been specifically written on these groups. Despite this, there is a lot to like about this Australiancentred nursing text. In addition to what you would routinely expect to find in a text on community nursing, the book includes chapters on risk management; organisation culture and organisational change; the changing professional role of community nursing; and the changing focus of research. Overall, the book is easy to read and provides an excellent overview of community nursing in Australia. Additionally, as outlined earlier in this review, the text takes the reader further than what you would expect from a book of this nature. The book would suit a wide variety of readers, from those wanting a greater understanding of the complexities of nursing in the community to nurses working in a range of community health settings.

In Australia and across the globe music participation by older people active in the community has the potential to enhance quality of life. A recent review of the literature found clear evidence of numerous benefits from participation in active music making that encompass the social, physical and psychological. This article reports on five phenomenological case studies of community singing groups comprised of older people active in the community in Melbourne, Victoria. These studies are part of a research project, Well-being and Ageing: Community, Diversity and the Arts in Victoria that began in 2008. Interview data were analysed using interpretative phenomenological analysis and are reported under three overarching themes: Social connection, A sense of well-being, and Musical engagement. For older people in these studies singing in community choirs offered opportunities for social cohesion, positive ageing, and music learning that provided a sense of personal and group fulfilment, community engagement and resilience.

Community monitoring began in Australia in the 1980s primarily as an awareness-raising tool. Since that time, the community has developed increased skills and knowledge in monitoring procedures and both the data collectors and data users are placing greater demands on community data to be accurate and reliable. With over 3,500 community groups in the field collecting data at over 5,000 sites across Australia, the Waterwatch Program has developed guidelines and tools for monitoring and data collection for the community to collect reliable, accurate and useful data. This paper will discuss how Waterwatch is providing technical support through a range of data confidence guidelines and procedures to ensure that community monitoring and community data continue to play a significant role in the protection and management of our waterways. This paper will also draw on a couple of case studies from across Australia that demonstrate community data being used by a variety of stakeholders.

This thesis explores how everyday knowledge of community development practices can inform the theorising of community development in Australia. The literature of community development offers a rich source for understanding and explaining the tensions and dilemmas of collective endeavour in context, yet arguments for particular approaches to community development can serve to evaluate practice in context. In this research, however, case studies are positioned as a source of knowledge. The power of case studies lies in their ability to portray collective action and collective action is what differentiates community development from other approaches to problems. The capacity to work in context is also pivotal to community development and case studies are adept at showcasing practice in context. The research reported in this thesis uses case studies of community development practices in the south west region of Western Australia to explore ways in which theoretical arguments for particular approaches to practice represent community development in the literature. A multiple case study design is used to establish twelve cross-case findings about how community development happens in four local communities. Each case is focused on the community development practice of a community group from the south west region of Western Australia. The thesis reports how the four community groups practice community development and then explores how the knowledge of these communities can inform the theorising of community development in the Australian context. The research found that the case studies have the potential to inform the theorising of community development in ten different ways; for example, through unsettling the idea of the bottom-up approach to community development, by identifying the ‘threat’ that context may pose to the tenets of community development, and by unmasking the imperceptibility of process. The research also highlights ways in which community development practices are storied in the literature and offers fresh insights into the obligations of the narrator of community development stories. The thesis concludes by arguing that greater integration between case studies and theoretical propositions for practice, could reinvigorate the way the literature supports and encourages community development practices in the Australian context.

Asking the question "can regional and community web portals become sustainable?" demands a foray into many different disciplines. Sociology, education, business, strategic and knowledge management, organisational theory, relationship management and current technological trends and capabilities are some of the areas on which community projects, such us the development of communities on-line, are founded.

Includes bibliographical references (leaves 259-270) Based on 18-months fieldwork, 1997-1999, in various organisations, social clubs and radio programs that were constructed by participants and 'outsiders' as an expression of a local migrant community. Attempts to answer and challenge what it means to be a Latin American in Adelaide and in what sense Latin American migrants and refugees in Adelaide can be spoken about as members of an 'ethnic/migrant community' in relation to the official multiculturalism discourse and popular representations of migrants in Australia.

In 1990 many in Colquitt, Georgia considered themselves to be a dying town due to the loss of jobs and outmigration that occurred when labor intensive farming transitioned to the machine. In response citizens brought in a theater director from Chicago who helped them launch a performance series of inclusive stories that were acted by local volunteers. The resulting series called Swamp Gravy has run from 1992 to present (2012), and has led to purported claims of community revitalization. The purpose of this study was to discover what this ongoing narrative community engagement meant to the people of Colquitt in regards to: community experiences that produced new relationships (including those between Blacks and Whites); personal empowerment; the coproduction of an emerging and diverse community identity; and institutional and economic development. Methods for this case study included narrative interviews of participants, attendees and local citizens, as well as observation of the town and the performances, and document analysis. Many participant volunteers and attendees became Swamp Gravy enthusiasts, and describe their experiences as coming out into a meaningful experience of community, which included forming relationships with diverse others (including those of a different race). The enthusiasts speak of growing into larger community responsibilities with others for the common good, and feel that ongoing and inclusive storytelling is very important to coproducing a diverse heritage that informs the future of their city. Other attendees (predominantly the business community) describe the benefits of Swamp Gravy as instrumental to having given the town recognition (identity) as an entertaining tourist attraction that exposed individual talent, boosted individual confidence, and enhanced social connectivity. Others in Colquitt were indifferent or resistive to the coming out that the performances invite. Most everyone recognizes that Swamp Gravy has attracted outside tourists which has boosted economic development, occasioned the renovation of downtown Colquitt square and the formation of institutions to continue to attract and accommodate visitors from afar. This case is theorized in terms of the emerging communicative turn in planning that juxtaposes the planner as mediator or facilitator, and stakeholders as co-producers. The findings in this case study support that the Swamp Gravy form of narrative process has some potential for guiding stakeholders to a just diversity in cities, neighborhoods and towns, and as such should be studied further. Urban planning in situations of urban renewal may be one place where utilizing this form of meaningful engagement could lead to discovery of new identities, which may both inform and motivate a just plan to be coproduced.

Australian policy contexts are promoting school transformation through teacher learning and the development of schools as professional learning communities. However, Australian practitioners have very limited contextualised research to guide their efforts in response to these policies. The researcher's involvement in a school revitalisation process provided the impetus for this research study that investigates the practitioner experience of a developing professional learning community at RI College (pseudonym for a large independent girls' school in Brisbane). This study endeavours to gain a more informed and sophisticated understanding of developing a professional learning community with the intention of 'living' this vision of RI College as a professional learning community. Praxis-oriented research questions focus on the practitioner conceptualisation of their school as a developing professional community and their experience of supporting/hindering strategies and structures. The study gives voice to this practitioner experience through the emerging participatory/co-operative research paradigm, an epistemology of participative inquiry, a research methodology of co-operative inquiry and mixed methods data collection strategies. Incorporating ten practitioner inquiries over two years, recursive cycles of action/reflection engaged practitioners as co-researchers in the collaborative reflective processes of a professional learning community while generating knowledge about the conceptualisation and supporting/hindering influences on its development. The outcomes of these first-person and second-person inquiries, together with a researcher devised online survey of teachers, were both informative and transformative in nature and led to the development of the researcher's theoretical perspectives in response to the study's research questions.;As outcomes of co-operative inquiry, these theoretical perspectives inform the researcher's future actions and offer insights into existing propositional knowledge in the field. Engagement in this practitioner inquiry research has had significant transformative outcomes for the co-researchers and has demonstrated the power of collaborative inquiry in promoting collective and individual professional learning and personal growth.

How health care is best provided remains topical, contentious, and political. Debates continue over funding allocation and the weighting placed on preventive, curative, institutional and community services. Such debates were evident in 1973 when a new Federal Labor Government began to reform Australia's health system by implementing a national Community Health Program policy. Implementation led to the establishment of community health centres and multi-disciplinary teams. Studies have generally concluded that community health centre teams have ???failed??? to achieve the goals of this policy. This study sought to answer one broad question. How was the community health program policy implemented, in what context did this event occur, what processes were used and why, and how did generalist community nurses participate? This case study of the Hunter Region, New South Wales, between 1974 and 1989, was based on data collected from four sources: over five hundred documents and archives, including relevant literature, epidemiological studies, centre records, official government and newspaper reports; 69 in-depth interviews with practitioners and administrators; and participant observation. The findings revealed that implementation was hindered by political, administrative and professional impediments. However, practitioners established and provided a broad range of relevant new services by changing the way they practised. Generalist community nurses worked with non-government, private and public organisations offering health, educational and social services. As boundary riders they filled structural holes and created social capital. Conclusions drawn were first, that context strongly influenced how public health policies were implemented and the services offered by different discipline groups. Second, teamwork would have been improved had pre-service health professional education fostered a common understanding of the aim of health care and the broader determinants of health. Third, a preventive orientation needed reinforcing via an organisational context, administrative processes, ongoing learning opportunities and leadership. Fourth, generalist community nurses??? commitment to a preventive approach was embedded in a growing understanding of people's circumstances and health problems. Finally, while policy implementation was constrained in the Hunter Region during the study period it achieved what its architects intended, that is, a broader mix of accessible services, and collaboration between organisations and groups as the boundaries that maintained their separation were bridged.

Electronic marketplaces (e-marketplaces) have been researched over many years from the study of electronic data interchange (EDI) systems to the current internet based trading platforms. Early e-marketplaces connected a buyer and supplier using proprietary systems that established a market hierarchy. The buyer was responsible for the system, established the terms of trade and the electronically enabled supplier could connect to the system. These systems were costly to build, which limited their use, and only organisations with an integrated system could use them. The web based e-marketplaces opened up the possibility of connecting many buyers and suppliers and enabling electronic transactions. The e-marketplace offers opportunities for establishing trade relationships with many organisations across the world. Business to business (B2B) e-commerce is a significant part of the Australian economy and there are opportunities to take advantage of e-marketplace trading. One of the advantages of electronic trading is the ability of the technology to deliver transaction benefits; these can have a significant impact on organisations regardless of organisational size. However, despite the potential of the e-marketplace to deliver organisational benefits there have been limited studies which consider the strategic implementation of e-marketplace trading. Organisational strategy and the implementation of strategic initiatives involve interactions between organisational structures and agents. The analytical dualism this represents complicates uncovering the fundamental causes of e-marketplace participation. Not only does the adoption of e-marketplace trading impact on the buyer and supplier organisations, it introduces the e-marketplace vendor organisation and the e-marketplace technology into the participation decision. The complexity of the interactions across organisational structures and between organisational agents and technology adoption can produce a diversity of outcomes. The philosophical underpinning of critical realism for the study is supported by the lack of understanding as to why, and in what circumstances, organisations successfully participate in e-marketplace trading. The critical realist philosophy provides the opportunity to understand the interrelationships between context, organisational structures and agents and identify the causal mechanisms involved in producing various outcomes. It allows for the development of middle level theory as existing theories are examined to explain the perceived phenomena. Large organisations operating in Western Australia are used as case studies to uncover the causal relationships between context, structures and agents that can produce successful, strategic implementation of e-marketplace participation. Existing literature in relation to e-marketplaces and IT adoption is used to develop the research questions and formulate the interview questions. The structured case methodology is used to analyse each case and relate the findings to possible explanatory theories. Context, mechanism and outcome patterns, identified in each case, are presented. Building on economic market, institutional and network theories the research identifies organising vision theory and community discourse as explanations for organisational legitimation that can circumscribe the use of e-marketplace trading. Six types of community group that influence organisational adoption of e-marketplace technology are identified. The research suggests that the influence of these groups within the organisation, the fit with organisational culture and strategic objectives can prevent or instigate change. Further, the decision making process supported by the group (or group member) is more influential in the strategic adoption of the e-marketplace than the ability of the technology to deliver efficiency or transaction processing gains. This implies that technology adoption studies should include contextual and environmental issues and practitioners should examine how much their decision making is influenced by organisational and environmental features. The thesis contributes to the discussion on organising vision theory, e-marketplace trading and business value creation. It demonstrates the application of the structured case study methodology to research that is underpinned by critical realism.

Our brand-new school, Docklands Primary School, opened in January 2021. Located in the heart of Melbourne, Australia, we are a state school for students in Foundation through to Year 6. At the time of this case study first being written, we had 255 students enrolled, but numbers continue to grow. We have a vibrant and diverse student community, with over 60% of our students speaking English as an additional language. Our students were born in 21 different countries, and there are at least thirteen different languages spoken at home. As the English and Literacy Leader, I oversee curriculum, assessment, instruction, intervention, and professional learning in those domains. Part of that foundational work has involved ensuring staff are formally trained in Sounds-Write, and that the programme is implemented with consistency and fidelity across classrooms. We teach Sounds-Write in the first three years of school (Foundation-Year 2). Students receive 30 minutes of instruction daily and planning and delivery is consistent across year level classrooms. In 2021, there were six Foundation classes, two Year 1 classes, and one Year 2 class. We are not considered a particularly advantaged or disadvantaged school, with an Index of Community Socio-Educational Advantage value close to the average of 1,000 (range of 800-1,200).

Allambie Heights Public School is located on the Northern Beaches of Sydney, New South Wales, Australia. It is a Kindergarten to Year 6 school for students aged five to twelve years. The school is “committed to the pursuit of high academic achievement in a safe, secure, and caring learning environment. The programs offered are diverse, and challenge and inspire our students. Students, parents and staff work in partnership to create a vibrant learning community. Literacy, numeracy and technology are emphasized within learning programs”. The school motto, ‘Ever Aim High’, “underpins the school’s strong belief that each child needs to be recognized for their own achievements, celebrating success [both at] a school and personal level”. As a Positive Behavior for Learning school, the school values of respect, responsibility, and resilience are key to the success of our school community. We currently have 514 students and 51 staff in our school. Four students identify as Aboriginal and Torres Strait Islander and 14% of students come from a language background other than English. The school is in a high socio-economic area with a Family Occupation and Education Index (FOEI) of 17. The school Index of Community and Socio-Educational Advantage is 1,112.

Nollamara Primary and Intensive English School (NPS) is situated seven kilometers north of the Perth Central Business District in Western Australia. Our Index of Community Socio-Educational Advantage (ICSEA) is 939 and the school caters for students from Kindergarten to Year 6. There are currently 309 students who are supported by 50 staff. NPS was opened in 1956 and an Intensive English Center (IEC), supporting newly arrived humanitarian and refugee students, commenced in 2005. The school has a diverse population (see Figure 1), and there are more than 76% of students with a language background other than English at the school, with approximately 45 language groups. The larger groups include Arabic 13%, Dinka 7%, Karen 4.5%, and Burmese, Swahili, Vietnamese, and Kirundi which combined represent 10% of the cohort. Aboriginal students make up 8% of our school community. There is a high transiency rate at NPS, approximately 51%. This is due to the students in the IEC returning to their local school after one to two years on specialist English language intervention. Many families are in temporary or rental accommodation, which impacts on student enrollment, too. The school has a full-time chaplain, school psychologist (two and a half days a week), two Aboriginal Islander Education Officers (AIEO), and two multicultural liaison officers who support students and families as well as engage local agencies. The school also provides intervention with trauma counseling, speech therapists, and occupational therapists.

Buildings are one of the highest emitters of greenhouse gases globally. To reduce the detrimental effects of buildings on the environment and recognise their potential for emissions reductions, a transition towards sustainable building solutions has been observed globally. This trend and the associated benefits have been discussed and argued for more than three decades now. However, the impacts of sustainable buildings are yet to be demonstrated at macro, meso, and micro levels in the community, as the actual versus expected performance of such buildings are still being questioned. Consequently, this entry discusses the concepts underpinning sustainable buildings outlining the drivers and practices to achieve sustainable built environment solutions from the design to operation stage using university buildings as a case study. The chapter also recommends evidence-based solutions on understanding the actual and perceived gaps to achieve expected performance using “Green Star” rated academic buildings in Australia.

The details of how a voluntary income management programme might work is outlined in the chapter. The chapter also explores other means of building financial capability, using developmental and educational models and insights from the research literature on poverty reduction. In considering alternatives to punitive forms of welfare conditionality, the chapter highlights some of the differences between New Zealand and Australia, as there are lessons which Australia could learn from the use of mentors and more empowering forms of budget support in the case of New Zealand. This chapter also revisits the mixed economy of welfare by suggesting that non-government organisations could play a more enabling role in the lives of low-income households if they were encouraged to work in ways that would promote a different set of assumptions and principles to improve economic security and community wellbeing. The links between economic security and well-being are elaborated, using the public health research that demonstrates that economic insecurity is a strong determinant of mental health. Drawing on insights from a range of studies and disciplines the chapter concludes with an argument for evidence informed social security policies, which will help to reframe questions of economic and social security.

In 1981, the National Commission on Excellence in Education identified “widespread public perception that something is seriously remiss in our educational system” (Fiske, 2008). Thirty years later, in 2011, Harvard School of Education's Pathways to Prosperity Project states “In an era in which education has never been more important to economic success, the U.S. has fallen behind many other nations in educational attainment and achievement.” Learning-centered learning is not a new concept, with roots dating back to the progressive movement of early 1900's, gaining prominence in post-modern education with Nation at Risk: The Imperative for Educational Reform. A major focus of applied learning theory in post-modern education is preparing learners for a profession, a basis for achieving economic independence. This chapter identifies higher education institutions in the United States, Australia, and Great Britain highlighting methodologies, best practices, challenges. Two community college case studies are reviewed, identifying successes and opportunities of current learning practices.

Abstract This chapter critically considers the process of claiming using empirical mixed method case studies of the enforcement of age discrimination law in the United Kingdom and Australia. Drawing on enquiry and claim statistics from statutory agencies and community legal centres, qualitative expert interviews, and a survey of advocates, the chapter considers why age discrimination claims are so infrequent, given the reported prevalence of age discrimination in employment. The chapter argues that the perceived costs of claiming far outweigh the perceived benefits. The chapter highlights the fundamental limits of relying on individual claims to address age discrimination, even at this preliminary stage of enforcement, and identifies clear gaps in enforcement, especially for younger workers.

As global agricultural production methods and supply chains have become more digitised, farmers around the world are adopting digital AgTech such as drones, Internet of Things (IoT), remote sensors, blockchain, and satellite imagery to inform their on-farm decision-making. While early adopters and technology advocates globally are spruiking and realising the benefits of digital AgTech, many Australian farmers are reluctant or unable to participate fully in the digital economy. This is an important issue, as the Australian Government has said that digital farming is essential to meeting its target of agriculture being a $100billion industry by 2030. Most studies of AgTech adoption focus on individual-level barriers, yielding well-documented issues such as access to digital connectivity, availability of AgTech suppliers, non-use of ICTs, and cost-benefit for farmers. In contrast, our project took an ‘ecosystems’ approach to study cotton farmers in the Darling Downs region in Queensland, Australia who are installing water sensors, satellite imagery, and IoT plant probes to generate data to be aggregated on a dashboard to inform decision-making. We asked our farmers to map their local ecosystem, and then set up interviewing different stakeholders (such technology providers, agronomists, and suppliers) to understand how community-level orientations to digital agriculture enabled and constrained on-farm adoption. We identified human factors of digital AgTech adoption at the macro, regional and farm levels, with a pronounced ‘data divide’ between farm and community level stakeholders within the ecosystem. This ‘data divide’ is characterised by a capability gap between the provision of the devices and software that generate data by technology companies, and the ability of farmers to manage, implement, use, and maintain them effectively and independently. In the Condamine Plains project, farmers were willing and determined to learn new, advanced digital and data literacy skills. Other farmers in different circumstances may not see value in such an undertaking or have the necessary support to take full advantage of the technologies once they are implemented. Moreover, there did not seem to be a willingness or capacity in the rest of the ecosystem to fill this gap. The work raises questions about the type and level of new, digital expertise farmers need to attain in the transition to digital farming, and what interventions are necessary to address the significant barriers to adoption and effective use that remain in rural communities. By holistically considering how macro- and micro-level factors may be combined with community-level influences, this study provides a more complete and holistic account of the contextualised factors that drive or undermine digital AgTech adoption on farms in rural communities. This report provides insights and evidence to inform strategies for rural ecosystems to transition farms to meet the requirements and opportunities of Agriculture 4.0 in Australia and abroad.

Background Australia is a multi-cultural society with increasing rates of people from culturally and linguistically diverse (CALD) backgrounds. On average, CALD groups have higher rates of tobacco use, lower participation in cancer screening programs, and poorer health outcomes than the general Australian population. Lower cancer screening and smoking cessation rates are due to differing cultural norms, health-related attitudes, and beliefs, and language barriers. Interventions can help address these potential barriers and increase tobacco cessation and cancer screening rates among CALD groups. Cancer Council NSW (CCNSW) aims to reduce the impact of cancer and improve cancer outcomes for priority populations including CALD communities. In line with this objective, CCNSW commissioned this rapid review of interventions implemented in Australia and comparable countries. Review questions This review aimed to address the following specific questions: Question 1 (Q1): What smoking cessation interventions have been proven effective in reducing or preventing smoking among culturally and linguistically diverse communities? Question 2 (Q2): What screening interventions have proven effective in increasing participation in population cancer screening programs among culturally and linguistically diverse populations? This review focused on Chinese-, Vietnamese- and Arabic-speaking people as they are the largest CALD groups in Australia and have high rates of tobacco use and poor screening adherence in NSW. Summary of methods An extensive search of peer-reviewed and grey literature published between January 2013-March 2022 identified 19 eligible studies for inclusion in the Q1 review and 49 studies for the Q2 review. The National Health and Medical Research Council (NHMRC) Levels of Evidence and Joanna Briggs Institute’s (JBI) Critical Appraisal Tools were used to assess the robustness and quality of the included studies, respectively. Key findings Findings are reported by components of an intervention overall and for each CALD group. By understanding the effectiveness of individual components, results will demonstrate key building blocks of an effective intervention. Question 1: What smoking cessation interventions have been proven effective in reducing or preventing smoking among culturally and linguistically diverse communities? Thirteen of the 19 studies were Level IV (L4) evidence, four were Level III (L3), one was Level II (L2), none were L1 (highest level of evidence) and one study’s evidence level was unable to be determined. The quality of included studies varied. Fifteen tobacco cessation intervention components were included, with most interventions involving at least three components (range 2-6). Written information (14 studies), and education sessions (10 studies) were the most common components included in an intervention. Eight of the 15 intervention components explored had promising evidence for use with Chinese-speaking participants (written information, education sessions, visual information, counselling, involving a family member or friend, nicotine replacement therapy, branded merchandise, and mobile messaging). Another two components (media campaign and telephone follow-up) had evidence aggregated across CALD groups (i.e., results for Chinese-speaking participants were combined with other CALD group(s)). No intervention component was deemed of sufficient evidence for use with Vietnamese-speaking participants and four intervention components had aggregated evidence (written information, education sessions, counselling, nicotine replacement therapy). Counselling was the only intervention component to have promising evidence for use with Arabic-speaking participants and one had mixed evidence (written information). Question 2: What screening interventions have proven effective in increasing participation in population cancer screening programs among culturally and linguistically diverse populations? Two of the 49 studies were Level I (L1) evidence, 13 L2, seven L3, 25 L4 and two studies’ level of evidence was unable to be determined. Eighteen intervention components were assessed with most interventions involving 3-4 components (range 1-6). Education sessions (32 studies), written information (23 studies) and patient navigation (10 studies) were the most common components. Seven of the 18 cancer screening intervention components had promising evidence to support their use with Vietnamese-speaking participants (education sessions, written information, patient navigation, visual information, peer/community health worker, counselling, and peer experience). The component, opportunity to be screened (e.g. mailed or handed a bowel screening test), had aggregated evidence regarding its use with Vietnamese-speaking participants. Seven intervention components (education session, written information, visual information, peer/community health worker, opportunity to be screened, counselling, and branded merchandise) also had promising evidence to support their use with Chinese-speaking participants whilst two components had mixed (patient navigation) or aggregated (media campaign) evidence. One intervention component for use with Arabic-speaking participants had promising evidence to support its use (opportunity to be screened) and eight intervention components had mixed or aggregated support (education sessions, written information, patient navigation, visual information, peer/community health worker, peer experience, media campaign, and anatomical models). Gaps in the evidence There were four noteworthy gaps in the evidence: 1. No systematic review was captured for Q1, and only two studies were randomised controlled trials. Much of the evidence is therefore based on lower level study designs, with risk of bias. 2. Many studies provided inadequate detail regarding their intervention design which impacts both the quality appraisal and how mixed finding results can be interpreted. 3. Several intervention components were found to have supportive evidence available only at the aggregate level. Further research is warranted to determine the interventions effectiveness with the individual CALD participant group only. 4. The evidence regarding the effectiveness of certain intervention components were either unknown (no studies) or insufficient (only one study) across CALD groups. This was the predominately the case for Arabic-speaking participants for both Q1 and Q2, and for Vietnamese-speaking participants for Q1. Further research is therefore warranted. Applicability Most of the intervention components included in this review are applicable for use in the Australian context, and NSW specifically. However, intervention components assessed as having insufficient, mixed, or no evidence require further research. Cancer screening and tobacco cessation interventions targeting Chinese-speaking participants were more common and therefore showed more evidence of effectiveness for the intervention components explored. There was support for cancer screening intervention components targeting Vietnamese-speaking participants but not for tobacco cessation interventions. There were few interventions implemented for Arabic-speaking participants that addressed tobacco cessation and screening adherence. Much of the evidence for Vietnamese and Arabic-speaking participants was further limited by studies co-recruiting multiple CALD groups and reporting aggregate results. Conclusion There is sound evidence for use of a range of intervention components to address tobacco cessation and cancer screening adherence among Chinese-speaking populations, and cancer screening adherence among Vietnamese-speaking populations. Evidence is lacking regarding the effectiveness of tobacco cessation interventions with Vietnamese- and Arabic-speaking participants, and cancer screening interventions for Arabic-speaking participants. More research is required to determine whether components considered effective for use in one CALD group are applicable to other CALD populations.

Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.