Community action for cancer prevention: Overview of the cancer action in rural towns (CART) project, Australia

This paper describes the rationale, aims, design and methods of a large-scale community action cancer prevention project, Cancer Action in Rural Towns (CART). The primary aim of the CART project is to evaluate the effectiveness of a community action program in increasing community rates of preventive and screening behaviours relating to breast, cervical, smoking-related and skin cancer. Twenty towns in rural New South Wales, Australia (population 5001-15 000) were selected for inclusion in the CART project. A matched-pairs design was used, with one town from each pair randomly allocated to either experimental or control condition. In experimental towns, community action is being promoted through established community networks and within key access-points (schools, workplaces, community organisations, health care providers, retailers and the media), to encourage uptake of cancer-related preventive and screening behaviours. Outcome evaluation includes self-report measures of adult smoking quit rates, Health Insurance Commission provider presentations data, surveys of adolescent smoking and solar protection practices, and direct observation of solar protection practices at schools and community venues. Economic evaluation includes cost-effectiveness, travel cost, and contingent valuation methods of cost analysis. Process measures for the project include media monitoring, measures of change in institutional policies, and records of CART intervention activities. The evaluation of CART will be completed by the end of 1997.