Health promotion efforts aimed at narrowing socioeconomic differences in food purchasing need to be designed and implemented with an understanding of, and a sensitivity to, the barriers to nutritional improvement that difficult life circumstances can impose.

Objective: To undertake an assessment of survey participation and non-response error in a population-based study that examined the relationship between socio-economic position and food purchasing behaviour. Design and setting: The study was conducted in Brisbane City (Australia) in 2000. The sample was selected using a stratified two-stage cluster design. Respondents were recruited using a range of strategies that attempted to maximise the involvement of persons from disadvantaged backgrounds: respondents were contacted by personal visit and data were collected using home-based face-to-face interviews; multiple callbacks on different days and at different times were used; and a financial gratuity was provided. Participants: Non-institutionalised residents of private dwellings ðn ¼ 1003Þ; located in 50 small areas that differed in their socio-economic characteristics. Results: Rates of survey participation -measured by non-contacts, exclusions, dropped cases, response rates and completions -were similar across areas, suggesting that residents of socio-economically advantaged and disadvantaged areas were equally likely to be recruited. Individual-level analysis, however, showed that respondents and non-respondents differed significantly in their sociodemographic and food purchasing characteristics: non-respondents were older, less educated and exhibited different purchasing behaviours. Misclassification bias probably accounted for the inconsistent pattern of association between the area-and individual-level results. Estimates of bias due to non-response indicated that although respondents and non-respondents were qualitatively different, the magnitude of error associated with this differential was minimal. Conclusions: Socio-economic position measured at the individual level is a strong and consistent predictor of survey non-participation. Future studies that set out to examine the relationship between socio-economic position and diet need to adopt sampling strategies and data collection methods that maximise the likelihood of recruiting participants from all points on the socio-economic spectrum, and particularly persons from disadvantaged backgrounds. Study designs that are not sensitive to the difficulties associated with recruiting a socio-economically representative sample are likely to produce biased estimates (underestimates) of socio-economic differences in the dietary outcome being investigated.

Conventional approaches to health promotion generally focus on individual risk factors and often ignore a more holistic perspective. This project adopted a culturally appropriate, holistic approach, embracing a paradigm that concentrated on the communities' cultural assets and contributed to sustainable and transferable outcomes. There is a need for appropriate evaluation tools for time-limited community engagement projects.

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Screening for cancer of the cervix, breast and bowel can reduce morbidity and mortality. Low participation rates in cancer screening have been identified among migrant communities internationally. Attempting to improve low rates of cancer screening, the Ethnic Communities Council of Queensland developed a pilot Cancer Screening Education Program for breast, bowel and cervical cancer. This study determines the impact of education sessions on knowledge, attitudes and intentions to participate in screening for culturally and linguistically diverse (CALD) communities living in Brisbane, Queensland. Seven CALD groups (Arabic-speaking, Bosnian, South Asian (including Indian and Bhutanese), Samoan and Pacific Island, Spanish-speaking, Sudanese and Vietnamese) participated in a culturally-tailored cancer screening education pilot program that was developed using the Health Belief Model. A pre- and post-education evaluation session measured changes in knowledge, attitudes and intention related to breast, bowel and cervical cancer and screening. The evaluation focussed on perceived susceptibility, perceived seriousness and the target population's beliefs about reducing risk by cancer screening. There were 159 participants in the three cancer screening education sessions. Overall participants' knowledge increased, some attitudes toward participation in cancer screening became more positive and intent to participate in future screening increased (n=146). These results indicate the importance of developing screening approaches that address the barriers to participation among CALD communities and that a culturally-tailored education program is effective in improving knowledge, attitudes about and intentions to participate in cancer screening. It is important that culturally-tailored programs are developed in conjunction with communities to improve health outcomes.