Education of First Nations Australians about cancer-what evidence is there around its effectiveness? A narrative review.

Poorer cancer prevention and control outcomes for First Nations Australians have resulted in a need for improved health literacy, that is their capacity as individuals to access, understand, and use information in ways that promote and maintain good health. This narrative review explores the evidence on how education programs work to improve First Nations Australians' understanding of cancer, and how this leads to more effective use of prevention, screening and treatment services. Limited to the Australian context, a bibliographic search using terms structured around four main concepts: Aboriginal, Cancer, Australia, and Intervention (health literacy, health promotion) was undertaken in May 2024 for publications from January 2000. Studies that evaluated interventions or initiatives aimed to educate (that is, to increase awareness, knowledge and influence behaviours) across the cancer journey (excluding palliative care) were included. Fourteen evaluated initiatives drawn from peer-reviewed papers, published reports and peak body case studies were included in the review. All included papers were assessed with three major areas considered important for determining the effectiveness of cancer education for First Nations Australians: 1) acceptability: delivery in a format that is acceptable to community and health services, 2) impact: having a positive impact on people's access to and understanding of the cancer pathway and/or increases intended or actual participation, and 3) viability: successfully navigating the challenges of viably implementing, sustaining and scaling up an initiative. This review highlights several factors that contribute to the effectiveness of cancer education initiatives targeting First Nations Australians: culturally tailored initiatives, co-design and consultation during development, capacity building to create supportive, trusting environments for accessible cancer education; local ownership and empowerment, integration with existing healthcare systems, flexibility and multi-pronged approaches. Challenges and areas for further efforts in developing cancer health literacy are also described. Relatively few initiatives are evaluated: most of these have focussed on screening and treatment.