Engaging culturally and linguistically diverse communities to prepare for lung cancer screening implementation in Australia: a qualitative focus group study

Introduction: Lung cancer is the number one cause of cancer death worldwide, including in Australia, where more than 15,000 cases were diagnosed in 2024. The Australian National Lung Cancer Screening Programme commenced in July 2025. Unique barriers to participation in existing cancer screening programmes exist for culturally and linguistically diverse (CALD) communities. Little Australian research has engaged these communities to gauge their acceptability and readiness for the implementation of lung cancer screening (LCS). The aims were to identify barriers and enablers to LCS implementation and determine views about LCS acceptability and feasibility. Methods: Community-based participatory research principles were used to collaboratively engage CALD stakeholders. The research team worked with highly experienced programme managers, multicultural health workers and bilingual facilitators/translators (‘leaders’) who provide support and education to Arabic-speaking/Lebanese, Macedonian, Vietnamese and Italian communities. Leaders used culturally appropriate methods to recruit participants and deliver focus groups. Verbatim transcripts were analysed using a coding framework based on the Health Equity Implementation Framework. Results: Seven focus groups were conducted either face to face (n = 5) or online (n = 2) with 57 participants across New South Wales, Australia. Six groups were delivered in community languages. LCS was generally perceived as acceptable across all focus groups. Key enablers towards engagement were understanding the importance of screening for early detection, provision of interpreters and easily accessible locations. Key barriers were financial and language barriers, poor experiences with other cancer screening programmes, concerns about tobacco-related eligibility criteria and cancer-related stigma. Conclusions: This qualitative study provides crucial foundational evidence from four culturally diverse Australian communities about barriers and enablers to inform Programme implementation. The findings are highly relevant to other jurisdictions that may be preparing for LCS implementation or need to modify programmes to engage culturally diverse populations to screen. Patient or Public Contribution: Members of the public were directly involved as participants in this research. Multicultural health workers and bilingual facilitators/interpreters who work with CALD communities were involved in all phases of the study design and implementation, including recruitment, development of semi-structured focus group guide, focus group facilitation and reviewing the manuscript.