Strategies to address barriers and improve bowel cancer screening participation in Indigenous populations, particularly in rural and remote communities: A scoping review.

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Participation in bowel cancer screening programs is low in Indigenous1 Australian populations, particularly in rural and remote communities. There is growing evidence of strategies to increase screening rates amongst Indigenous Australians, however, there are limited strategies specific to rural and remote communities. This review aims to identify strategies that may increase bowel cancer screening rates amongst Indigenous populations, particularly in rural and remote communities. A literature search was undertaken which included peer-reviewed qualitative and quantitative articles of any study design, and grey literature. Evidence from New Zealand, Canada, United Kingdom, and Australia were included, and descriptive numerical and thematic analyses were conducted. The identified strategies were categorised using the National Cancer Policy Board's organisational framework. Nineteen strategies were identified from 23 included articles. The most frequently used strategies were recommendation from a general practitioner, culturally appropriate education resources, and nonresponder follow up. Four strategies were specific to rural and remote communities including alternative distribution of kits and mobile screening. Thirteen strategies aim to address the Knowledge category of the framework, four address Attitudes, four address Ability, and six address Reinforcement. So What?: Several strategies are available to increase bowel cancer screening in Indigenous populations, with very few strategies specifically relating to rural and remote communities. Multiple strategies may maximise the likelihood of participation in screening amongst Indigenous Australians. Implementation may require system-level and local-level changes.