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Cameron E, Bryant J, Cashmore A, Passmore E, Oldmeadow C, Neill S, Milat A, Mitchell J, Gatt N, Macoun E, Ioannides SJ, Murray C. A mixed methods evaluation of Quit for new life, a smoking cessation initiative for women having an Aboriginal baby. BMC Health Serv Res 2023; 23:532. [PMID: 37226175 DOI: 10.1186/s12913-023-09496-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 05/03/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Quit for new life (QFNL) is a smoking cessation initiative developed to support mothers of Aboriginal babies to quit smoking during pregnancy. The state-wide initiative provides support for pregnant women and their households including free nicotine replacement therapy (NRT) and follow up cessation advice. Services are also supported to implement systems-level changes and integrate QFNL into routine care. This study aimed to evaluate: (1) models of implementation of QFNL; (2) the uptake of QFNL; (3) the impact of QFNL on smoking behaviours; and (4) stakeholder perceptions of the initiative. METHODS A mixed methods study was conducted comprising semi-structured interviews and analysis of routinely collected data. Interviews were conducted with 6 clients and 35 stakeholders involved in program implementation. Data were analysed using inductive content analysis. Aboriginal Maternal and Infant Health Service Data Collection (AMDC) records for the period July 2012-June 2015 were investigated to examine how many eligible women attended a service implementing QFNL and how many women took up a QFNL support. Smoking cessation rates were compared in women attending a service offering QFNL with women attending the same service prior to the implementation of QFNL to determine program impact. RESULTS QFNL was implemented in 70 services located in 13 LHDs across New South Wales. Over 430 staff attended QFNL training, including 101 staff in Aboriginal-identified roles. In the period July 2012-June 2015 27% (n = 1549) of eligible women attended a service implementing QFNL and 21% (n = 320) of these were recorded as taking up a QFNL support. While stakeholders shared stories of success, no statistically significant impact of QFNL on smoking cessation rates was identified (N = 3502; Odds ratio (OR) = 1.28; 95% Confidence Interval (CI) = 0.96-1.70; p-value = 0.0905). QFNL was acceptable to both clients and stakeholders, increased awareness about smoking cessation, and gave staff resources to support clients. CONCLUSION QFNL was perceived as acceptable by stakeholders and clients and provided care providers with knowledge and tangible support to offer women who presented at antenatal care as smokers, however, no statistically significant impact on rates of smoking cessation were found using the measures available.
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Affiliation(s)
- Emilie Cameron
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia.
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia.
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.
| | - Jamie Bryant
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Aaron Cashmore
- Population and Public Health Division, NSW Ministry of Health, St Leonards, NSW, 2065, Australia
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, NSW, 2006, Australia
| | - Erin Passmore
- Population and Public Health Division, NSW Ministry of Health, St Leonards, NSW, 2065, Australia
| | - Christopher Oldmeadow
- Clinical Research Design, Information and Statistical Support, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Sarah Neill
- Population and Public Health Division, NSW Ministry of Health, St Leonards, NSW, 2065, Australia
| | - Andrew Milat
- Population and Public Health Division, NSW Ministry of Health, St Leonards, NSW, 2065, Australia
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, NSW, 2006, Australia
| | - Jo Mitchell
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, NSW, 2006, Australia
- The University of New South Wales School of Medicine, UNSW, Sydney, NSW, 2052, Australia
| | - Nicole Gatt
- Drug Health Services, Aboriginal Health Education Officer, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Edwina Macoun
- Population and Public Health Division, NSW Ministry of Health, St Leonards, NSW, 2065, Australia
| | - Sally J Ioannides
- Population and Public Health Division, NSW Ministry of Health, St Leonards, NSW, 2065, Australia
- The University of New South Wales School of Medicine, UNSW, Sydney, NSW, 2052, Australia
| | - Carolyn Murray
- Population and Public Health Division, NSW Ministry of Health, St Leonards, NSW, 2065, Australia
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Pregnant Aboriginal women self-assess health risks from smoking and efficacy to quit over time using an adapted Risk Behaviour Diagnosis (RBD) Scale. J Smok Cessat 2020. [DOI: 10.1017/jsc.2020.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
AbstractIntroductionDuring pregnancy, the imperative to stop smoking becomes urgent due to health risks for mother and baby.AimExplore responses to a smoking-related, pregnancy-focused Risk Behaviour Diagnosis (RBD) Scale over time with Aboriginal1 pregnant women.MethodsSix Aboriginal Medical Services in three states recruited 22 eligible women: ⩽28 weeks' gestation, ⩾16 years old, smoked tobacco, pregnant with an Aboriginal baby. Surveys were completed at baseline (n = 22), 4-weeks (n = 16) and 12-weeks (n = 17). RBD Scale outcome measures included: perceived threat (susceptibility and severity), perceived efficacy (response and self-efficacy), fear control (avoidance), danger control (intentions to quit) and protection responses (protecting babies).ResultsAt baseline, the total mean threat scores at 4.2 (95% CI: 3.9–4.4) were higher than total mean efficacy scores at 3.9 (95% CI: 3.6–4.1). Over time there was a non-significant reduction in total mean threat and efficacy; fear control increased; danger control and protection responses remained stable. Reduction of threat and efficacy perceptions, with raised fear control responses, may indicate a blunting effect (a coping style which involves avoidance of risks).ConclusionIn 22 Aboriginal pregnant women, risk perception changed over time. A larger study is warranted to understand how Aboriginal women perceive smoking risks as the pregnancy progresses so that health messages are delivered accordingly.
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Gould GS, Holder C, Oldmeadow C, Gruppetta M. Supports Used by Aboriginal and Torres Strait Islander Women for Their Health, including Smoking Cessation, and a Baby's Health: A Cross-Sectional Survey in New South Wales, Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217766. [PMID: 33114142 PMCID: PMC7660307 DOI: 10.3390/ijerph17217766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/20/2020] [Accepted: 10/22/2020] [Indexed: 12/16/2022]
Abstract
This study explored Aboriginal and Torres Strait Islander women’s use of supports for their general health, for smoking cessation, and the health of babies or children, and analyzed the women’s predictors for seeking types of support. Aboriginal and Torres Strait Islander women were recruited for a cross-sectional survey in two regions of NSW N = 132. The 19-item survey questioned the likelihood that the participant would use the various supports for their health, to quit smoking, and for a baby or child’s health. Logistic regression analyses were performed on N = 98 with complete data. Older participants were less likely to use Facebook or the internet for their health, or the health of a child, but were more likely to consult with health professionals. Women who had quit smoking were less likely to use an app for their health compared to smokers. Women who had a child living in their household were less likely to use the internet for a child’s health. This community-based study revealed age-related differences for access to health services and differences according to smoking status. Patterns of internet and app use warrant further consideration when planning strategies to improve Aboriginal and Torres Strait Islander women and children’s health.
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Affiliation(s)
- Gillian S. Gould
- School of Medicine and Public Health, The University of Newcastle, Callaghan 2308, Australia;
- Hunter Medical Research Institute, New Lambton Heights 2305, Australia; (C.H.); (C.O.)
- Correspondence: ; Tel.: +61-40-361-5563
| | - Carl Holder
- Hunter Medical Research Institute, New Lambton Heights 2305, Australia; (C.H.); (C.O.)
| | - Christopher Oldmeadow
- Hunter Medical Research Institute, New Lambton Heights 2305, Australia; (C.H.); (C.O.)
| | - Maree Gruppetta
- School of Medicine and Public Health, The University of Newcastle, Callaghan 2308, Australia;
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General practitioner and obstetrician views on system changes to improve smoking cessation care in pregnancy in Australia: a cross-sectional survey. J Smok Cessat 2020. [DOI: 10.1017/jsc.2020.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
AbstractIntroductionSystemic barriers impacting smoking cessation in pregnant women may include nicotine replacement therapy (NRT) access and training.AimAssess general practitioner (GP) and obstetrician's agreement with system-based changes to improve the management of smoking in pregnancy; compare group responses.MethodsNational cross-sectional survey with two samples: (1) online survey emailed to a random sample of 500 GPs from Royal Australian College of General Practitioners (RACGP); (2) paper survey posted to 5571 GPs and obstetricians from Royal Australia and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). Percentages agreeing that specified changes would improve the management of smoking in pregnancy were calculated. Pairwise comparisons used Kruskal–Wallis tests (RACGP/RANZCOG GPs/obstetricians).ResultsN = 378 participated. Response rates 8.4% (N = 42; online survey) and 6% (N = 335; paper survey), respectively. Total percentages agreeing with system-based changes: 79% training, 64% oral NRT subsidy, 62% Medicare item for smoking cessation, 54% improved access to NRT patches. Within RANZCOG, more GPs (73.1%) agreed that oral NRT should be subsidised (P = 0.001) than obstetricians (53.7%).ConclusionGPs and obstetricians agreed that system changes would improve their management of smoking in pregnancy. Oral NRT subsidy was the only pairwise group difference. Subsequently, oral NRT has been subsidised; in time, this may influence prescribing and quit rates.
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McInerney C, Ibiebele I, Ford JB, Randall D, Morris JM, Meharg D, Mitchell J, Milat A, Torvaldsen S. Benefits of not smoking during pregnancy for Australian Aboriginal and Torres Strait Islander women and their babies: a retrospective cohort study using linked data. BMJ Open 2019; 9:e032763. [PMID: 31753897 PMCID: PMC6887048 DOI: 10.1136/bmjopen-2019-032763] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To provide evidence for targeted smoking cessation policy, the aim of this study was to compare pregnancy outcomes of Aboriginal mothers who reported not smoking during pregnancy with Aboriginal mothers who reported smoking during pregnancy. DESIGN Population based retrospective cohort study using linked data. SETTING New South Wales, the most populous Australian state. POPULATION 18 154 singleton babies born to 13 477 Aboriginal mothers between 2010 and 2014 were identified from routinely collected New South Wales datasets. Aboriginality was determined from birth records and from four linked datasets through an Enhanced Reporting of Aboriginality algorithm. EXPOSURE Not smoking at any time during pregnancy. MAIN OUTCOME MEASURES Unadjusted and adjusted relative risks (aRR) and 95% CIs from modified Poisson regression were used to examine associations between not smoking during pregnancy and maternal and perinatal outcomes including severe morbidity, inter-hospital transfer, perinatal death, preterm birth and small-for-gestational age. Population attributable fractions (PAFs) were calculated using adjusted relative risks. RESULTS Compared with babies born to mothers who smoked during pregnancy, babies born to non-smoking mothers had a lower risk of all adverse perinatal outcomes including perinatal death (aRR=0.58, 95% CI 0.44 to 0.76), preterm birth (aRR=0.58, 95% CI 0.53 to 0.64) and small-for-gestational age (aRR=0.35, 95% CI 0.32 to 0.39). PAFs (%) were 27% for perinatal death, 26% for preterm birth and 48% for small-for-gestational-age. Compared with women who smoked during pregnancy (n=8919), those who did not smoke (n=9235) had a lower risk of being transferred to another hospital (aRR=0.76, 95% CI 0.66 to 0.89). CONCLUSIONS Babies born to women who did not smoke during pregnancy had a lower risk of adverse perinatal outcomes. Rates of adverse outcomes among Aboriginal non-smokers were similar to those among the general population. These results quantify the proportion of adverse perinatal outcomes due to smoking and highlight why effective smoking cessation programme are urgently required for this population.
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Affiliation(s)
- Carol McInerney
- The University of Sydney Northern Clinical School, Women and Babies Research, Saint Leonards, New South Wales, Australia
- NSW Biostatistics Training Program, New South Wales Ministry of Health, North Sydney, New South Wales, Australia
| | - Ibinabo Ibiebele
- The University of Sydney Northern Clinical School, Women and Babies Research, Saint Leonards, New South Wales, Australia
- Kolling Institute, Northern Sydney Local Health District, Saint Leonards, New South Wales, Australia
| | - Jane B Ford
- The University of Sydney Northern Clinical School, Women and Babies Research, Saint Leonards, New South Wales, Australia
- Kolling Institute, Northern Sydney Local Health District, Saint Leonards, New South Wales, Australia
| | - Deborah Randall
- The University of Sydney Northern Clinical School, Women and Babies Research, Saint Leonards, New South Wales, Australia
- Kolling Institute, Northern Sydney Local Health District, Saint Leonards, New South Wales, Australia
| | - Jonathan M Morris
- The University of Sydney Northern Clinical School, Women and Babies Research, Saint Leonards, New South Wales, Australia
- Obstetrics and Gynaecology, Royal North Shore Hospital, Saint Leonards, New South Wales, Australia
| | - David Meharg
- The University of Sydney, Faculty of Health Sciences, Sydney, New South Wales, Australia
- The University of Sydney, Poche Centre for Indigenous Health, Sydney, New South Wales, Australia
| | - Jo Mitchell
- Centre for Population Health, New South Wales Ministry of Health, North Sydney, New South Wales, Australia
| | - Andrew Milat
- Centre for Epidemiology and Evidence, New South Wales Ministry of Health, North Sydney, New South Wales, Australia
| | - Siranda Torvaldsen
- The University of Sydney Northern Clinical School, Women and Babies Research, Saint Leonards, New South Wales, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Askew DA, Guy J, Lyall V, Egert S, Rogers L, Pokino LA, Manton-Williams P, Schluter PJ. A mixed methods exploratory study tackling smoking during pregnancy in an urban Aboriginal and Torres Strait Islander primary health care service. BMC Public Health 2019; 19:343. [PMID: 30909896 PMCID: PMC6434627 DOI: 10.1186/s12889-019-6660-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 03/14/2019] [Indexed: 11/06/2022] Open
Abstract
Background Pregnancy can be a time of joy and a time of significant stress. For many Aboriginal and Torres Strait Islander (hereafter, respectfully, Indigenous) women, cigarette smoking, even during pregnancy, is a socially sanctioned behavioural response to stress. Indigenous women smoke during pregnancy at higher rates than their non-Indigenous counterparts. Methods A mixed methods, exploratory study, undertaken in an urban, Indigenous primary health care service, tested the impact and acceptability of a smoking cessation intervention for women pregnant with an Indigenous baby, their significant other (SO), and their primary health care service. The intervention included case management, incentivised smoking cessation support and culturally-based art activities. Results Thirty-one pregnant women and 16 SOs participated. Nearly half attempted to quit at least once during the study, 36% (4/11) of pregnant women had quit at the 3 month assessment and two remained smoke free 1 month postpartum. Most participants self-reported a reduction in tobacco smoking. Exhaled CO confirmed this for SOs (mean reduction − 2.2 ppm/assessment wave, 95% CI: -4.0, − 0.4 ppm/assessment wave, p = 0.015) but not for pregnant women. Many participants experienced social and economic vulnerabilities, including housing and financial insecurity and physical safety concerns. Conclusions Tobacco smoking is normalised and socially sanctioned in Indigenous communities and smoking is frequently a response to the multitude of stressors and challenges that Indigenous people experience on a daily basis. Smoking cessation interventions for pregnant Indigenous women must be cognisant of the realities of their private lives where the smoking occurs, in addition to the impact of the broader societal context. Narrow definitions of success focussing only on smoking cessation ignore the psychological benefit of empowering women and facilitating positive changes in smoking behaviours. Our smoking cessation intervention supported pregnant women and their SOs to manage these stressors and challenges, thereby enabling them to develop a solid foundation from which they could address their smoking. A broad definition of success in this space is required: one that celebrates positive smoking behaviour changes in addition to cessation.
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Affiliation(s)
- Deborah A Askew
- School of Clinical Medicine, Primary Care Clinical Unit, The University of Queensland, Royal Brisbane & Women's Hospital, Level 8 Health Sciences Building, Building 16/910, Brisbane, QLD, 4029, Australia. .,Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland Health, PO Box 52, Inala, QLD, 4077, Australia.
| | - Jillian Guy
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland Health, PO Box 52, Inala, QLD, 4077, Australia
| | - Vivian Lyall
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland Health, PO Box 52, Inala, QLD, 4077, Australia
| | - Sonya Egert
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland Health, PO Box 52, Inala, QLD, 4077, Australia
| | - Lynne Rogers
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland Health, PO Box 52, Inala, QLD, 4077, Australia
| | - Leigh-Anne Pokino
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland Health, PO Box 52, Inala, QLD, 4077, Australia
| | - Peggy Manton-Williams
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland Health, PO Box 52, Inala, QLD, 4077, Australia
| | - Philip J Schluter
- School of Clinical Medicine, Primary Care Clinical Unit, The University of Queensland, Royal Brisbane & Women's Hospital, Level 8 Health Sciences Building, Building 16/910, Brisbane, QLD, 4029, Australia.,School of Health Sciences, University of Canterbury - Te Whare Wānanga o Waitaha, Private Bag 4800, Christchurch, 8140, New Zealand
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Patten CA, Koller KR, Flanagan CA, Hiratsuka VY, Hughes CA, Wolfe AW, Decker PA, Fruth K, Brockman TA, Korpela M, Gamez D, Bronars C, Murphy NJ, Hatsukami D, Benowitz NL, Thomas TK. Biomarker feedback intervention for smoking cessation among Alaska Native pregnant women: Randomized pilot study. PATIENT EDUCATION AND COUNSELING 2019; 102:528-535. [PMID: 30391300 PMCID: PMC6421103 DOI: 10.1016/j.pec.2018.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 10/09/2018] [Accepted: 10/11/2018] [Indexed: 05/16/2023]
Abstract
OBJECTIVE There is some evidence for biomarker feedback when combined with cessation counseling for reducing smoking in pregnancy. This randomized controlled pilot study evaluated feasibility and potential efficacy of a social-cognitive theory (SCT)-based biomarker feedback intervention among pregnant Alaska Native (AN) smokers. METHODS Participants were randomly assigned to receive three study calls (10-20 min each): (1) biomarker feedback intervention (n = 30) including personalized cotinine results and feedback on their baby's likely exposure to carcinogen metabolite NNAL, or (2) contact control usual care condition based on the 5As (n = 30). Assessments were conducted at baseline, post-treatment, and delivery. RESULTS High rates of treatment compliance, study retention, and treatment acceptability were observed in both groups. 7-day point prevalence smoking abstinence rates at delivery verified with urinary cotinine were the same in both study groups (20% intent-to-treat analysis, 26% per-protocol). SCT-based measures did not change differentially from baseline by study group. CONCLUSION This trial supports the feasibility and acceptability of providing biomarker feedback within the clinical care delivery system, but the intervention did not promote increased smoking cessation during pregnancy compared to usual care. PRACTICE IMPLICATIONS Efforts are needed to promote the usual care and to develop alternative biomarker feedback messaging for pregnant AN women.
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Affiliation(s)
- Christi A Patten
- Department of Psychiatry and Psychology and Behavioral Health Research Program, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA.
| | - Kathryn R Koller
- Clinical and Research Services, Division of Community Health Services, Alaska Native Tribal Health Consortium, 4000 Ambassador Dr., Anchorage, AK, 99508, USA
| | - Christie A Flanagan
- Clinical and Research Services, Division of Community Health Services, Alaska Native Tribal Health Consortium, 4000 Ambassador Dr., Anchorage, AK, 99508, USA
| | - Vanessa Y Hiratsuka
- Southcentral Foundation, Department of Obstetrics and Gynecology, Alaska Native Medical Center, 4320 Diplomacy Dr., Ste. 1800, Anchorage, AK, 99508, USA
| | - Christine A Hughes
- Department of Psychiatry and Psychology and Behavioral Health Research Program, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Abbie W Wolfe
- Clinical and Research Services, Division of Community Health Services, Alaska Native Tribal Health Consortium, 4000 Ambassador Dr., Anchorage, AK, 99508, USA
| | - Paul A Decker
- Department of Health Sciences Research, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Kristin Fruth
- Department of Health Sciences Research, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Tabetha A Brockman
- Department of Psychiatry and Psychology and Behavioral Health Research Program, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Molly Korpela
- Southcentral Foundation, Department of Obstetrics and Gynecology, Alaska Native Medical Center, 4320 Diplomacy Dr., Ste. 1800, Anchorage, AK, 99508, USA
| | - Diana Gamez
- Southcentral Foundation, Department of Obstetrics and Gynecology, Alaska Native Medical Center, 4320 Diplomacy Dr., Ste. 1800, Anchorage, AK, 99508, USA
| | - Carrie Bronars
- Department of Psychiatry and Psychology and Behavioral Health Research Program, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Neil J Murphy
- Southcentral Foundation, Department of Obstetrics and Gynecology, Alaska Native Medical Center, 4320 Diplomacy Dr., Ste. 1800, Anchorage, AK, 99508, USA
| | - Dorothy Hatsukami
- University of Minnesota, 717 Delaware St SE, Minneapolis, MN, 55414, USA
| | - Neal L Benowitz
- Departments of Medicine and Bioengineering and Therapeutic Sciences, University of California, San Francisco, 1001 Potrero Ave, SFGH 30, San Francisco, CA, 94110, USA
| | - Timothy K Thomas
- Clinical and Research Services, Division of Community Health Services, Alaska Native Tribal Health Consortium, 4000 Ambassador Dr., Anchorage, AK, 99508, USA
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Bovill M, Bar-Zeev Y, Gruppetta M, Clarke M, Nicholls K, O'Mara P, Bonevski B, Reath J, Gould G. Giri-nya-la-nha (talk together) to explore acceptability of targeted smoking cessation resources with Australian Aboriginal women. Public Health 2018; 176:149-158. [PMID: 30392971 DOI: 10.1016/j.puhe.2018.08.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 06/18/2018] [Accepted: 08/30/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To engage with health providers and Aboriginal women to understand what educational resources they want and need to support quit smoking attempts during pregnancy in order to develop a comprehensive evidence-based intervention. STUDY DESIGN Resources were developed in partnership with Aboriginal people, communities and academics with the aim to be inclusive of diverse communities. We then recruited Aboriginal women of various ages for yarning circles (focus groups) held in three Australian states to explore the acceptability of the resources and seeking further guidance as to the needs of Aboriginal women to support smoking cessation during pregnancy. METHODS Yarning circles were recorded and transcribed, and data were analysed independently by two researchers. Responses were coded using predetermined themes and further general inductive analysis for emergent themes. RESULTS Twenty-four Aboriginal women reflected on the resources they included: one pregnant woman, 15 mothers and eight elders. Predetermined themes of attraction, comprehension, cultural acceptability, graphics and layout, persuasion and self-efficacy were explored. Women suggested the following: resources need to be visually attractive and interactive to enhance self-efficacy; additional scientific content on health consequences of smoking and combining with non-pharmacological approaches to quitting. CONCLUSION Indigenous peoples prefer culturally targeted messages. However, developing effective Aboriginal health promotion requires more than a 'culturally appropriate' adaptation of mainstream resources. Consideration needs to be given to the diversity of Aboriginal communities when developing effective, evidence-based interventions. Aboriginal women are calling for innovative and interactive resources that enhance self-efficacy; the use of videos to explain medical and informational brochure content is well received. Requests for non-pharmacological cessation options were reported in New South Wales and Queensland and should be further explored.
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Affiliation(s)
- M Bovill
- School of Medicine and Public Health, University of Newcastle, NSW, Australia.
| | - Y Bar-Zeev
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
| | - M Gruppetta
- Wollotuka Institute, University of Newcastle, NSW, Australia
| | - M Clarke
- OBGYN, Clarence Specialist Clinic, Australia
| | - K Nicholls
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
| | - P O'Mara
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
| | - B Bonevski
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
| | - J Reath
- School of Medicine, Western Sydney University, Australia
| | - G Gould
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
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Bar-Zeev Y, Bovill M, Bonevski B, Gruppetta M, Reath J, Gould GS. Assessing and Validating an Educational Resource Package for Health Professionals to Improve Smoking Cessation Care in Aboriginal and Torres Strait Islander Pregnant Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E1148. [PMID: 28961160 PMCID: PMC5664649 DOI: 10.3390/ijerph14101148] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 09/18/2017] [Accepted: 09/25/2017] [Indexed: 11/16/2022]
Abstract
Australian Aboriginal pregnant women have a high smoking prevalence (45%). Health professionals lack adequate educational resources to manage smoking. Resources need to be tailored to ensure saliency, cultural-sensitivity and account for diversity of Indigenous populations. As part of an intervention to improve health professionals' smoking cessation care in Aboriginal pregnant women, a resource package was developed collaboratively with two Aboriginal Medical Services. The purpose of this study was to assess and validate this resource package. A multi-centred community-based participatory 4-step process (with three Aboriginal Medical Services from three Australian states), included: (1) Scientific review by an expert panel (2) 'Suitability of Materials' scoring by two Aboriginal Health Workers (3) Readability scores (4) Focus groups with health professionals. Content was analysed using six pre-determined themes (attraction, comprehension, self-efficacy, graphics and layout, cultural acceptability, and persuasion), with further inductive analysis for emerging themes. Suitability of Material scoring was adequate or superior. Average readability was grade 6.4 for patient resources (range 5.1-7.2), and 9.8 for health provider resources (range 8.5-10.6). Emergent themes included 'Getting the message right'; 'Engaging with family'; 'Needing visual aids'; and 'Requiring practicality under a tight timeframe'. Results were presented back to a Stakeholder and Consumer Aboriginal Advisory Panel and resources were adjusted accordingly. This process ensured materials used for the intervention were culturally responsive, evidence-based and useful. This novel formative evaluation protocol could be adapted for other Indigenous and culturally diverse interventions. The added value of this time-consuming and costly process is yet to be justified in research, and might impact the potential adaption by other projects.
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Affiliation(s)
- Yael Bar-Zeev
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2300, Australia.
| | - Michelle Bovill
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2300, Australia.
| | - Billie Bonevski
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2300, Australia.
| | - Maree Gruppetta
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2300, Australia.
| | - Jennifer Reath
- Department of General Practice, Western Sydney University, Campbelltown, NSW 2560, Australia.
| | - Gillian S Gould
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2300, Australia.
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Gould GS, Bar-Zeev Y, Bovill M, Atkins L, Gruppetta M, Clarke MJ, Bonevski B. Designing an implementation intervention with the Behaviour Change Wheel for health provider smoking cessation care for Australian Indigenous pregnant women. Implement Sci 2017; 12:114. [PMID: 28915815 PMCID: PMC5602934 DOI: 10.1186/s13012-017-0645-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 09/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Indigenous smoking rates are up to 80% among pregnant women: prevalence among pregnant Australian Indigenous women was 45% in 2014, contributing significantly to the health gap for Indigenous Australians. We aimed to develop an implementation intervention to improve smoking cessation care (SCC) for pregnant Indigenous smokers, an outcome to be achieved by training health providers at Aboriginal Medical Services (AMS) in a culturally competent approach, developed collaboratively with AMS. METHOD The Behaviour Change Wheel (BCW), incorporating the COM-B model (capability, opportunity and motivation for behavioural interventions), provided a framework for the development of the Indigenous Counselling and Nicotine (ICAN) QUIT in Pregnancy implementation intervention at provider and patient levels. We identified evidence-practice gaps through (i) systematic literature reviews, (ii) a national survey of clinicians and (iii) a qualitative study of smoking and quitting with Aboriginal mothers. We followed the three stages recommended in Michie et al.'s "Behaviour Change Wheel" guide. RESULTS Targets identified for health provider behaviour change included the following: capability (psychological capability, knowledge and skills) by training clinicians in pharmacotherapy to assist women to quit; motivation (optimism) by presenting evidence of effectiveness, and positive testimonials from patients and clinicians; and opportunity (environmental context and resources) by promoting a whole-of-service approach and structuring consultations using a flipchart and prompts. Education and training were selected as the main intervention functions. For health providers, the delivery mode was webinar, to accommodate time and location constraints, bringing the training to the services; for patients, face-to-face consultations were supported by a booklet embedded with videos to improve patients' capability, opportunity and motivation. CONCLUSIONS The ICAN QUIT in Pregnancy was an intervention to train health providers at Aboriginal Medical Services in how to implement culturally competent evidence-based practice including counselling and nicotine replacement therapy for pregnant patients who smoke. The BCW aided in scientifically and systematically informing this targeted implementation intervention based on the identified gaps in SCC by health providers. Multiple factors impact at systemic, provider, community and individual levels. This process was therefore important for defining the design and intervention components, prior to a conducting a pilot feasibility trial, then leading on to a full clinical trial.
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Affiliation(s)
- Gillian S Gould
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
| | - Yael Bar-Zeev
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Michelle Bovill
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Lou Atkins
- University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Maree Gruppetta
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Marilyn J Clarke
- Clarence Specialist Clinic, 86 Through Street, South Grafton, NSW, 2460, Australia
| | - Billie Bonevski
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
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Gould GS, Bovill M, Chiu S, Bonevski B, Oldmeadow C. Exploring an adapted Risk Behaviour Diagnosis Scale among Indigenous Australian women who had experiences of smoking during pregnancy: a cross-sectional survey in regional New South Wales, Australia. BMJ Open 2017; 7:e015054. [PMID: 28566365 PMCID: PMC5729996 DOI: 10.1136/bmjopen-2016-015054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Explore Aboriginal women's responses to an adapted Risk Behaviour Diagnosis (RBD) Scale about smoking in pregnancy. METHODS AND DESIGN An Aboriginal researcher interviewed women and completed a cross-sectional survey including 20 Likert scales. SETTING Aboriginal Community Controlled Health Services, community groups and playgroups and Aboriginal Maternity Services in regional New South Wales, Australia. PARTICIPANTS Aboriginal women (n=20) who were pregnant or gave birth in the preceding 18 months; included if they had experiences of smoking or quitting during pregnancy. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes: RBD constructs of perceived threat and perceived efficacy, dichotomised into high versus low. Women who had quit smoking, answered retrospectively. SECONDARY OUTCOME MEASURES smoking status, intentions to quit smoking (danger control), protection responses (to babies/others) and fear control responses (denial/refutation). Scales were assessed for internal consistency. A chart plotted responses from low to high efficacy and low to high threat. RESULTS RBD Scales had moderate-to-good consistency (0.67-0.89 Cronbach's alpha). Nine women had quit and 11 were smoking; 6 currently pregnant and 14 recently pregnant. Mean efficacy level 3.9 (SD=0.7); mean threat 4.3 (SD=0.7). On inspection, a scatter plot revealed a cluster of 12 women in the high efficacy-high threat quadrant-of these 11 had quit or had a high intention of quitting. Conversely, a group with low threat-low efficacy (5 women) were all smokers and had high fear control responses: of these, 4 had low protection responses. Pregnant women had a non-significant trend for higher threat and lower efficacy, than those previously pregnant. CONCLUSION Findings were consistent with a previously validated RBD Scale showing Aboriginal smokers with high efficacy-high threat had greater intentions to quit smoking. The RBD Scale could have diagnostic potential to tailor health messages. Longitudinal research required with a larger sample to explore associations with the RBD Scale and quitting.
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Affiliation(s)
- Gillian Sandra Gould
- Centre for Brain and Mental Health Research, School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, New South Wales, Australia
| | - Michelle Bovill
- Centre for Brain and Mental Health Research, School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, New South Wales, Australia
| | - Simon Chiu
- Clinical Research Design, Information Technology and Statistical Support, Hunter Medical Research Institute, 1/1 Kookaburra Circuit, New South Wales, Australia
| | - Billie Bonevski
- Centre for Brain and Mental Health Research, School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, New South Wales, Australia
| | - Christopher Oldmeadow
- Clinical Research Design, Information Technology and Statistical Support, Hunter Medical Research Institute, 1/1 Kookaburra Circuit, New South Wales, Australia
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Gould GS, Bovill M, Clarke MJ, Gruppetta M, Cadet-James Y, Bonevski B. Chronological narratives from smoking initiation through to pregnancy of Indigenous Australian women: A qualitative study. Midwifery 2017; 52:27-33. [PMID: 28570858 DOI: 10.1016/j.midw.2017.05.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 04/23/2017] [Accepted: 05/15/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE One in two Indigenous Australian pregnant women smoke, yet little is known about their trajectory of smoking. This study aimed to explore Aboriginal women's narratives from starting smoking through to pregnancy. METHODS A female Aboriginal Researcher conducted individual face-to-face interviews with 20 Aboriginal women from New South Wales, Australia. Recruitment, through Aboriginal services and community networks, continued until saturation was reached. Audio-recorded transcripts were independently open coded by two researchers, inductively analysed and reported using a three-dimensional structure of looking backwards, forwards, inwards, outwards and a sense of place, to elucidate the chronology of events, life stages, characters, environments, and turning points of the stories. RESULTS A chronology emerged from smoking initiation in childhood, coming of age, becoming pregnant, through to attempts at quitting, and relapse post-partum. Several new themes emerged: the role mothers play in women's smoking and quitting; the contribution of nausea to spontaneous quitting; depression as a barrier to quitting; and the hopes of women for their own and their children's future. The epiphany of pregnancy was a key turning point for many - including the interplay of successive pregnancies; and the intensity of expressed regret. CONCLUSIONS Aboriginal women report multiple influences in the progression of early smoking to pregnancy and beyond. Potential opportunities to intervene include: a) childhood, coming of age, pregnancy, post-natal, in-between births; b) key influencers; c) environments, and d) targeting concurrent substance use. Morning sickness appears to be a natural deterrent to continued smoking. Depression, and its relationship to smoking and quitting in Australian Indigenous pregnant women, requires further research.
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Affiliation(s)
- Gillian S Gould
- Centre for Brain and Mental Health Research, School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia.
| | - Michelle Bovill
- Centre for Brain and Mental Health Research, School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia
| | - Marilyn J Clarke
- Clarence Specialist Clinic, Through Street, South Grafton, New South Wales 2460, Australia
| | - Maree Gruppetta
- Wollotuka Institute, The University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia
| | - Yvonne Cadet-James
- Indigenous Centre, James Cook University, Townsville, Queensland 4811, Australia
| | - Billie Bonevski
- Centre for Brain and Mental Health Research, School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia
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Gould GS, Patten C, Glover M, Kira A, Jayasinghe H. Smoking in Pregnancy Among Indigenous Women in High-Income Countries: A Narrative Review. Nicotine Tob Res 2017; 19:506-517. [PMID: 28403465 PMCID: PMC5896479 DOI: 10.1093/ntr/ntw288] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 02/08/2017] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Pregnant women in socioeconomically disadvantaged circumstances, such as Indigenous women, have a high prevalence of smoking. Tobacco smoking is the most significant reversible risk factor for the health of Indigenous pregnant women and their babies. METHODS As researchers working in this specialized area, we conducted a narrative review of the literature on smoking among Indigenous pregnant women in the United States, Canada, New Zealand, and Australia. We summarize prevalence and factors influencing tobacco use, interventions, and evidence gaps for tobacco control and smoking cessation. Recommendations are made for future interventions, policy changes, and much-needed research. RESULTS Common themes emerging across the four countries reveal opportunities for cross-cultural collaborative studies and trials. These include the social-normative use of tobacco as barriers to quitting in pregnancy and the need for evaluations of interventions at the family and community level. Socioeconomic disparities underscore the importance of enhancing the implementation and reach of strategies to prevent and reduce prenatal tobacco smoking among Indigenous women. Elders and community health care providers as role models for nontobacco use could be explored. Qualitative work is needed to understand the barriers and opportunities, such as cultural strengths supporting quitting tobacco to develop more effective approaches. CONCLUSIONS Although a high-priority group, there remains a dearth of research on Indigenous women's smoking in pregnancy. Studies have assessed knowledge and attitudes to smoking in pregnancy, and small feasibility studies and a few empirical trials have been conducted. Recommendations for promising culturally appropriate cessation interventions have been made. Larger trials are warranted. IMPLICATIONS Strategies to support quitting among pregnant Indigenous women need to be multifactorial and take account of the social determinants of smoking including historical antecedents, community norms, cultural strengths, and recognition of individual and community needs. Cross-country research collaborations have the potential to leverage funding, share expertise, and strengthen approaches to tackle an important and poorly attended health disparity that has a profound impact on the entire life course for Indigenous peoples.
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Affiliation(s)
- Gillian S Gould
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Christi Patten
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Marewa Glover
- School of Public Health, College of Health, Massey University, Auckland, New Zealand
| | - Anette Kira
- Independent Researcher, Manawatu, New Zealand
| | - Harshani Jayasinghe
- University of Adelaide, Adelaide, South Australia, Australia
- Basil Hetzel Institute for Translational Health Research, Adelaide, South Australia, Australia
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