Christou et al. BMC Public Health 2010, 10:373 http://www.biomedcentral.com/1471-2458/10/373 Australia that helped to encourage screening, support families of those with cancer and help patients through their cancer journey could potentially be an effective model for facilitating Indigenous participation in bowel cancer screening while also providing assistance with follow-up tests and treatment [114]. Such community- based and community-led groups could make a signifi- cant contribution and further evaluation of their influ- ence on cancer screening behaviours would provide the evidence needed for this. Discussion and Conclusion Bowel cancer screening can provide important benefits and reduce mortality from bowel cancer. However, orga- nised nationwide screening programs such as that intro- duced in Australian may overlook the needs and beliefs of minority groups, including Indigenous Australians, given their focus on what is most cost effective for the country as a whole. Strategies and interventions at sev- eral levels are needed to improve CRC screening uptake and reduce access inequities. These range from policy and program changes to remove many of the structural barriers, to targeting individual, behavioural and attitudi- nal variables and enhancing provider knowledge and incentives. There is a need to understand the reasons behind the low participation of Indigenous and CALD groups in greater depth. Research and consultation with Indigen- ous populations is needed to elucidate the barriers most impacting on participation and to better understand what will work for Indigenous people and other minor- ity groups in Australia - to date, largely unexplored. Results from pilot studies in Queensland and Victoria investigating alternative mechanisms for delivering the screening kits to Indigenous populations will be infor- mative when available, and should shed some light on effective strategies to improve participation. However, as it is unlikely that the screening test of choice will be changed in the near future, several modifications to the current program can be made in the shorter term to enhance access to the program for Indigenous Austra- lians and are detailed in Table 6. The nature of the NBCSP may exacerbate the wide disparities in cancer outcomes that exist between Indi- genous and non-Indigenous Australians; the programme design favours participation by the majority and unin- tentionally excludes disadvantaged and remote popula- tions, perpetuating prevailing health inequities. This review provides evidence that the program needs to be modified to facilitate access to and participation by Indi- genous people and other minority populations through a more community-based, people-friendly approach, bet- ter integrated into primary health care. Modifications such as those we have described are needed, taking into Page 18 of 21 account epidemiological differences, life circumstances, and specific participation barriers experienced by Indi- genous people. Acknowledgements This work was undertaken with financial support from the Western Australian Department of Health. We thank Gloria Sutherland and Kathleen O’Connor for support to identify how the national bowel cancer screening might be improved for Indigenous people. Author details 1Centre for International Health, Curtin University of Technology, GPO Box U1987 Perth WA 6845, Australia. 2Combined Universities Centre for Rural Health, University of Western Australia PO Box 109 Geraldton WA 6531, Australia. Authors’ contributions AC undertook the literature search and other sourcing of relevant information and the initial draft of the paper. JK assisted with refinement, shaping and editing of the manuscript. 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