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Caro-Cañizares I, López Carpintero N, Carmona-Camacho R. The Elephant in the Room: A Systematic Review of the Application and Effects of Psychological Treatments for Pregnant Women with Dual Pathology (Mental Health and Substance-Related Disorders). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:392. [PMID: 38673305 PMCID: PMC11050033 DOI: 10.3390/ijerph21040392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/14/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024]
Abstract
PURPOSE Maternal mental health and substance use, referred to as dual pathology, represent significant concerns associated with adverse pregnancy and birth outcomes, a prevalence higher than commonly anticipated. Nonetheless, a notable dearth exists ofevidence-based treatment protocols tailored for pregnant women with dual pathology. METHODS A systematic review, adhering to the PRISMA methodology, was conducted. RESULTS Out of the 57 identified papers deemed potentially relevant, only 2were ultimately included. Given the limited number of studies assessing the efficacy of psychological interventions utilizing randomized controlled trials (RCTs) for both mental health and substance misuse, and considering the diverse objectives and measures employed, definitive conclusions regarding the effectiveness of psychological interventions in this domain prove challenging. CONCLUSIONS Maternal mental health appears to be the proverbial "elephant in the room". The development of specialized and integrated interventions stands as an imperative to effectively address this pressing issue. As elucidated in the present review, these interventions ought to be grounded in empirical evidence. Furthermore, it is essential that such interventions undergo rigorous evaluation through RCTs to ascertain their efficacy levels. Ultimately, the provision of these interventions by psychology/psychiatric professionals, both within clinical practice and the RCTs themselves, is recommended to facilitate the generalizability of the results to specialized settings.
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Affiliation(s)
- Irene Caro-Cañizares
- Facultad de Ciencias de la Salud y la Educación, Universidad a Distancia de Madrid, UDIMA, 28400 Collado Villalba, Spain
| | - Nayara López Carpintero
- Departamento de Obstetricia y Ginecología, Hospital Universitario del Tajo, 28300 Aranjuez, Spain
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Kinghorn M, Garvey G, Butler TL. Gynaecological cancer resources for Aboriginal and Torres Strait Islander women: A resource audit. Health Promot J Austr 2023. [PMID: 37883991 DOI: 10.1002/hpja.822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/04/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023] Open
Abstract
ISSUE ADDRESSED Aboriginal and Torres Strait Islander women experience considerable disparities in gynaecological cancer outcomes. Accessible and culturally appropriate health promotion resources about gynaecological cancers may support health literacy in this area. This study aimed to determine the understandability, actionability, readability, and cultural relevance of gynaecological cancer health literacy resources for Aboriginal and Torres Strait Islander consumers, families, and caregivers. METHODS We conducted a general Google search and targeted searches of Australian gynaecological cancer organisation websites in January and February 2022. Resources were assessed for understandability, actionability and cultural relevance to Aboriginal and Torres Strait Islander audiences. RESULTS We found 16 resources. The resources were generally understandable, actionable, readable, and culturally relevant, however, most resources were focused on cervical cancer prevention through vaccination and screening. Few resources focused other gynaecological cancer types or aspects of the cancer care continuum. While many resources contained elements that made them culturally relevant, areas for improvement were identified. These included: greater transparency relating to the Aboriginal and Torres Strait Islander leadership, governance, and involvement in the development of the resources as well as availability of different resource formats with an emphasis on visual aids. CONCLUSIONS This study highlighted a need for the development of resources relating to a wider range of gynaecological cancer types and different stages of the cancer care continuum for Aboriginal and Torres Strait Islander women. SO WHAT?: The development of a broader range of culturally appropriate gynaecological cancer health literacy resources, ideally developed through co-design with Aboriginal and Torres Strait Islander peoples, may contribute to addressing the disparities in gynaecological cancer outcomes for Aboriginal and Torres Strait Islander women.
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Affiliation(s)
- Mina Kinghorn
- Faculty of Medicine, The University of Queensland, School of Public Health, Herston, Queensland, Australia
| | - Gail Garvey
- Faculty of Medicine, The University of Queensland, School of Public Health, Herston, Queensland, Australia
| | - Tamara L Butler
- Faculty of Medicine, The University of Queensland, School of Public Health, Herston, Queensland, Australia
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Hosking K, De Santis T, Vintour-Cesar E, Wilson PM, Bunn L, Gurruwiwi GG, Wurrawilya S, Bukulatjpi SM, Nelson S, Ross C, Binks P, Schroder P, Davis JS, Taylor S, Connors C, Davies J. "The most culturally safe training I've ever had": the co-design of a culturally safe Managing hepatitis B training course with and for the Aboriginal health workforce of the Northern Territory of Australia. BMC Health Serv Res 2023; 23:935. [PMID: 37653370 PMCID: PMC10472722 DOI: 10.1186/s12913-023-09902-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/10/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND The Aboriginal health workforce provide responsive, culturally safe health care. We aimed to co-design a culturally safe course with and for the Aboriginal health workforce. We describe the factors which led to the successful co-design, delivery, and evaluation of the "Managing hepatitis B" course for the Aboriginal health workforce. METHODS A Participatory Action Research approach was used, involving ongoing consultation to iteratively co-design and then develop course content, materials, and evaluation tools. An Aboriginal and Torres Strait Islander research and teaching team received education in chronic hepatitis B and teaching methodologies. Pilot courses were held, in remote communities of the Northern Territory, using two-way learning and teach-back methods to further develop the course and assess acceptability and learnings. Data collection involved focus group discussions, in-class observations, reflective analysis, and use of co-designed and assessed evaluation tools. RESULTS Twenty-six participants attended the pilot courses. Aboriginal and Torres Strait Islander facilitators delivered a high proportion of the course. Evaluations demonstrated high course acceptability, cultural safety, and learnings. Key elements contributing to success and acceptability were acknowledging, respecting, and integrating cultural differences into education, delivering messaging and key concepts through an Aboriginal and Torres Strait Islander lens, using culturally appropriate approaches to learning including storytelling and visual teaching methodologies. Evaluation of culturally safe frameworks and findings from the co-design process led to the creation of a conceptual framework, underpinned by meeting people's basic needs, and offering a safe and comfortable environment to enable productive learning with attention to the following: sustenance, financial security, cultural obligations, and gender and kinship relationships. CONCLUSIONS Co-designed education for the Aboriginal health workforce must embed principles of cultural safety and meaningful community consultation to enable an increase in knowledge and empowerment. The findings of this research can be used to guide the design of future health education for First Nations health professionals and to other non-dominant cultures. The course model has been successfully transferred to other health issues in the Northern Territory.
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Affiliation(s)
- Kelly Hosking
- Northern Territory Health, Darwin, NT, Australia.
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
| | | | - Emily Vintour-Cesar
- Northern Territory Health, Darwin, NT, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | | | - Linda Bunn
- Northern Territory Health, Darwin, NT, Australia
| | - George Garambaka Gurruwiwi
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- Miwatj Aboriginal Health Corporation, Nhulunbuy, East Arnhem Land, Northern Territory, Australia
| | | | | | | | - Cheryl Ross
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Paula Binks
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Phoebe Schroder
- Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine, Sydney, NSW, Australia
| | - Joshua S Davis
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- John Hunter Hospital, Newcastle, NSW, Australia
| | - Sean Taylor
- Northern Territory Health, Darwin, NT, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | | | - Jane Davies
- Northern Territory Health, Darwin, NT, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
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Amanda R, Rana K, Saunders P, Tracy M, Bridges N, Poudel P, Arora A. Evaluation of the usability, content, readability and cultural appropriateness of online alcohol and other drugs resources for Aboriginal and Torres Strait Islander Peoples in New South Wales, Australia. BMJ Open 2023; 13:e069756. [PMID: 37164458 PMCID: PMC10174040 DOI: 10.1136/bmjopen-2022-069756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVES This study aimed to analyse the usability, content, readability and cultural appropriateness of alcohol and other drugs (AODs) resources for Aboriginal and Torres Strait Islander Peoples in New South Wales (NSW), Australia. OUTCOME MEASURES The content of 30 AOD resources for Aboriginal and Torres Strait Islander Peoples was analysed according to the following criteria: general characteristics; elements of graphical design and written communication; thoroughness and content; readability (Flesch-Kincaid grade level (FKGL), Gunning Fog index (Fog), Simplified Measure of Gobbledygook and Flesch Reading Ease); and cultural appropriateness. RESULTS Most resources displayed good usability, depicted by the use of headings and subheadings (n=27), superior writing style (n=19), relevant visuals (n=19) and use of colour support (n=30). However, some resources used at least one professional jargon (n=13), and many did not provide any peer-reviewed references (n=22). During content analysis, 12 resources were categorised into the alcohol group and 18 resources in the other drugs group. Impact of alcohol during pregnancy and breast feeding (n=12) was the most common included topics in the resources related to alcohol, while the physical impact of drugs (n=15) was the most discussed topics among the other drugs group. Based on the FKGL readability score, 83% of resources met the recommended reading grade level of 6-8 by NSW Health. Many resources (n=21) met at least half of the cultural appropriateness elements of interest. However, less than one-third were developed in collaboration with the local community (n=9), used local terms (n=5), targeted the local community (n=3), included an Aboriginal voice (n=2) and addressed the underlying cause (n=1). CONCLUSIONS Many AOD resources are developed specifically for Aboriginal and Torres Strait Islander Peoples, but their usability, content and readability differed, and they were not culturally appropriate for all communities. Development of a standardised protocol for resource development is suggested.
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Affiliation(s)
- Rebecca Amanda
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
- Health Equity Laboratory, Campbelltown, NSW, Australia
| | - Kritika Rana
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
- Health Equity Laboratory, Campbelltown, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Paul Saunders
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
- School of Medicine, Western Sydney University, Penrith, NSW, Australia
| | - Marguerite Tracy
- General Practice Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Drug Health Services, Cumberland Hospital, Western Sydney Local Health District, North Parramatta, NSW, Australia
| | - Nicole Bridges
- School of Humanities and Communication Arts, Western Sydney University, Kingswood, NSW, Australia
| | - Prakash Poudel
- Office of Research and Education, Canberra Hospital, Canberra Health Services, ACT Government, Canberra, ACT, Australia
| | - Amit Arora
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
- Health Equity Laboratory, Campbelltown, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
- Discipline of Child and Adoloscent Health, Sydney Medical School, The University of Sydney, Westmead, NSW, Australia
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, Surry Hills, NSW, Australia
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Morales-Suárez-Varela M, Peraita-Costa I, Perales-Marín A, Llopis-Morales A, Llopis-González A. Risk of Gestational Diabetes Due to Maternal and Partner Smoking. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020925. [PMID: 35055745 PMCID: PMC8775944 DOI: 10.3390/ijerph19020925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/27/2022]
Abstract
Pregnant women are among the most vulnerable to environmental exposure to tobacco smoke (EET); which has been linked to problems in the mothers’ health; one of the most frequent is gestational diabetes (GD). For this reason, there are specific interventions and prevention strategies designed to reduce this exposure risk. However, currently, they are mostly aimed only at aiding the pregnant women with smoking cessation during pregnancy and do not assess or address the risk from passive exposure due to partner smoking. The aim of this work is to study the exposure to EET of pregnant women considering active and passive smoking and to evaluate its effect on the development of GD. This is an observational case-control study within a retrospective cohort of pregnant women. Information on smoking habits was obtained from both personal interviews and recorded medical history. In total, 16.2% of mothers and 28.3% of partners declared having been active smokers during pregnancy; 36.5% of the women presented EET during pregnancy when both active and passive smoking were considered. After adjustments, the association with the EET and GD of the mother was (aOR 1.10 95% CI: 0.64–1.92); for the EET of the partner, it was (aOR 1.66 95% CI: 1.01–2.77); for both partners, it was (aOR 1.82 95% CI: 1.15–2.89), adjusted by the mother’s age and body mass index. There is a lack of education regarding the effects of passive exposure to tobacco smoke. It is essential that pregnant women and their partners are educated on the risks of active and passive smoking; this could improve the effectiveness of other GD prevention strategies.
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Affiliation(s)
- María Morales-Suárez-Varela
- Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, 46100 Burjassot, Spain; (I.P.-C.); (A.L.-M.); (A.L.-G.)
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-96-3544951
| | - Isabel Peraita-Costa
- Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, 46100 Burjassot, Spain; (I.P.-C.); (A.L.-M.); (A.L.-G.)
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Alfredo Perales-Marín
- Department of Obstetrics, La Fe University Polytechnic Hospital, 46026 Valencia, Spain;
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, 46010 Valencia, Spain
| | - Agustín Llopis-Morales
- Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, 46100 Burjassot, Spain; (I.P.-C.); (A.L.-M.); (A.L.-G.)
| | - Agustín Llopis-González
- Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, 46100 Burjassot, Spain; (I.P.-C.); (A.L.-M.); (A.L.-G.)
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
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Kennedy M, Kumar R, Ryan NM, Bennett J, La Hera Fuentes G, Gould GS. Codeveloping a multibehavioural mobile phone app to enhance social and emotional well-being and reduce health risks among Aboriginal and Torres Strait Islander women during preconception and pregnancy: a three-phased mixed-methods study. BMJ Open 2021; 11:e052545. [PMID: 34819285 PMCID: PMC8614130 DOI: 10.1136/bmjopen-2021-052545] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Describe the development and pretest of a prototype multibehavioural change app MAMA-EMPOWER. DESIGN Mixed-methods study reporting three phases: (1) contextual enquiry included stakeholder engagement and qualitative interviews with Aboriginal women, (2) value specification included user-workshop with an Aboriginal researcher, community members and experts, (3) codesign with Aboriginal researchers and community members, followed by a pretest of the app with Aboriginal women, and feedback from qualitative interviews and the user-Mobile Application Rating Scale (U-MARS) survey tool. SETTINGS Aboriginal women and communities in urban and regional New South Wales, Australia. PARTICIPANTS Phase 1: interviews, 8 Aboriginal women. Phase 2: workshop, 6 Aboriginal women. Phase 3: app trial, 16 Aboriginal women. U-MARS, 5 Aboriginal women. RESULTS Phase 1 interviews revealed three themes: current app use, desired app characteristics and implementation. Phase 2 workshop provided guidance for the user experience. Phase 3 app trial assessed all content areas. The highest ratings were for information (mean score of 3.80 out of 5, SD=0.77) and aesthetics (mean score of 3.87 with SD of 0.74), while functionality, engagement and subjective quality had lower scores. Qualitative interviews revealed the acceptability of the app, however, functionality was problematic. CONCLUSIONS Developing a mobile phone app, particularly in an Aboriginal community setting, requires extensive consultation, negotiation and design work. Using a strong theoretical foundation of behavioural change technique's coupled with the consultative approach has added rigour to this process. Using phone apps to implement behavioural interventions in Aboriginal community settings remains a new area for investigation. In the next iteration of the app, we aim to find better ways to personalise the content to women's needs, then ensure full functionality before conducting a larger trial. We predict the process of development will be of interest to other health researchers and practitioners.
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Affiliation(s)
- Michelle Kennedy
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Ratika Kumar
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Nicole M Ryan
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Jessica Bennett
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Gina La Hera Fuentes
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Gillian Sandra Gould
- Faculty of Health, Southern Cross University, Lismore, New South Wales, Australia
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Abidi FB, Laing L, Cooper S, Coleman T, Campbell KA. Experts' Views on Behaviour Change Techniques for Smoking Cessation in Pregnancy: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217729. [PMID: 33105804 PMCID: PMC7660064 DOI: 10.3390/ijerph17217729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 11/16/2022]
Abstract
Smoking during pregnancy is a global health problem which has devastating health implications. Behavioural support is an important part of smoking cessation support for pregnant women. Research has identified barriers and facilitators (B&Fs) and effective behaviour change techniques (BCTs) to aid women's quit attempts. However, the extent to which and how these BCTs are used in practice is unclear. The research aimed to establish experts' views on how behavioural support can be optimised and techniques operationalised in clinical practice, by identifying ways to address known B&Fs for smoking cessation in pregnancy. A focus group discussion took place with six experts, which highlighted how BCTs can be used in practice to support women in their quit attempts. A thematic analysis was conducted to elicit overarching themes. Five themes were found: involving the family, empowering women, using incentives to boost motivation, using practical techniques to help women with their quit attempts and managing expectations about nicotine replacement therapy. Empowering women to make their own decisions and encouraging small positive changes in smoking habits, using visual aids (e.g., growth charts) to inform women of the harms of smoking to the baby and treating families holistically were deemed important.
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Bovill M, Chamberlain C, Bar-Zeev Y, Gruppetta M, Gould GS. Ngu-ng-gi-la-nha (to exchange) knowledge. How is Aboriginal and Torres Strait Islander people's empowerment being upheld and reported in smoking cessation interventions during pregnancy: a systematic review. Aust J Prim Health 2020; 25:395-401. [PMID: 31586502 DOI: 10.1071/py18186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 08/01/2019] [Indexed: 11/23/2022]
Abstract
Smoking during pregnancy is a national priority to improve Aboriginal health. Empowerment approaches underpin the priorities set by the government to improve Aboriginal health and wellbeing; however, empowerment is seldom evaluated within interventions for Aboriginal people. Literature was searched to April 2018 and data was extracted using an assessment tool with domains of individual and community empowerment in smoking cessation during pregnancy studies with Aboriginal women. Three interventions were found in published and grey literature. Elements of individual empowerment were embedded in all interventions. Interventions considered barriers for Aboriginal women to quit smoking and areas for capacity building. Interventions used health education resources. There was limited reporting of community empowerment domains. Aboriginal ethics and capacity building was the only criterium addressed by all studies. Interventions are incorporating individual empowerment, but seldom report community empowerment. The development of reporting guidelines or extensions of current guidelines would be beneficial to set a consistently high standard reporting across Aboriginal health interventions, similar to the work conducted to develop the extension of Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Equity (PRISMA-E) for health equity in systematic review reporting. Reporting empowerment domains would reflect the government priority of empowerment to improve Aboriginal health, as well as enhancing knowledge translation into practice.
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Affiliation(s)
- Michelle Bovill
- The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; and Corresponding author.
| | - Catherine Chamberlain
- Judith Lumley Centre, La Trobe University, Level 3, George Singer Building, Bundoora, Vic. 3086, Australia; and Murdoch Children's Research Institute, Flemington Road, Parkville, Vic. 3052, Australia; and School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Yael Bar-Zeev
- The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Maree Gruppetta
- The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Gillian S Gould
- The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
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9
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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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Gould GS, Havard A, Lim LL, Kumar R. Exposure to Tobacco, Environmental Tobacco Smoke and Nicotine in Pregnancy: A Pragmatic Overview of Reviews of Maternal and Child Outcomes, Effectiveness of Interventions and Barriers and Facilitators to Quitting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2034. [PMID: 32204415 PMCID: PMC7142582 DOI: 10.3390/ijerph17062034] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 03/13/2020] [Accepted: 03/14/2020] [Indexed: 12/15/2022]
Abstract
The aim of this review of reviews was to collate the latest evidence from systematic reviews about the maternal and child health outcomes of being exposed to tobacco and nicotine during pregnancy; the effectiveness of interventions designed to reduce these exposures, and barriers to and facilitators of smoking cessation during pregnancy. Two databases were searched to obtain systematic reviews published from 2010 to 2019. Pertinent data from 76 articles were summarized using a narrative synthesis (PROSPERO reference: CRD42018085896). Exposure to smoke or tobacco in other forms during pregnancy is associated with an increased risk of obstetric complications and adverse health outcomes for children exposed in-utero. Counselling interventions are modestly effective, while incentive-based interventions appear to substantially increase smoking cessation. Nicotine replacement therapy is effective during pregnancy but the evidence is not conclusive. Predictors and barriers to smoking cessation in pregnancy are also discussed. Smoking during pregnancy poses substantial risk to mother's and child's health. Psychosocial interventions and nicotine replacement therapy (NRT) appear to be effective in helping pregnant women quit smoking. Barriers to smoking cessation must be identified and steps taken to eradicate them in order to reduce smoking among pregnant women. More research is needed on smoking cessation medications and e-cigarettes.
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Affiliation(s)
- Gillian S. Gould
- School of Medicine and Public Health, The University of Newcastle, Callaghan 2308, Australia; (L.L.L.); (R.K.)
| | - Alys Havard
- Centre for Big Data Research in Health, UNSW Sydney, Sydney NSW 2052, Australia;
| | - Ling Li Lim
- School of Medicine and Public Health, The University of Newcastle, Callaghan 2308, Australia; (L.L.L.); (R.K.)
| | | | - Ratika Kumar
- School of Medicine and Public Health, The University of Newcastle, Callaghan 2308, Australia; (L.L.L.); (R.K.)
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11
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Bar-Zeev Y, Bovill M, Bonevski B, Gruppetta M, Oldmeadow C, Palazzi K, Atkins L, Reath J, Gould GS. Improving smoking cessation care in pregnancy at Aboriginal Medical Services: 'ICAN QUIT in Pregnancy' step-wedge cluster randomised study. BMJ Open 2019; 9:e025293. [PMID: 31167863 PMCID: PMC6561434 DOI: 10.1136/bmjopen-2018-025293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES This study aimed to examine the impact of the 'ICAN QUIT in Pregnancy' intervention on individual health providers (HPs) smoking cessation care (SCC) knowledge, attitudes and practices in general, and specifically regarding nicotine replacement therapy (NRT) prescription. DESIGN Step-wedge clustered randomised controlled study. HPs answered a preintervention and 1-6 months postintervention survey. SETTING Six Aboriginal Medical Services (AMSs) in three states of Australia. PARTICIPANTS All HPs were invited to participate. Of 93 eligible, 50 consented (54%), 45 completed the presurvey (90%) and 20 the post (40%). INTERVENTION Included three 1-hour webinar sessions, educational resource package and free oral NRT. OUTCOMES HPs knowledge was measured using two composite scores-one from all 24 true/false statements, and one from 12 NRT-specific statements. Self-assessment of 22 attitudes to providing SCC were measured using a five-point Likert scale (Strongly disagree to Strongly agree). Two composite mean scores were calculated-one for 15 general SCC attitudes, and one for 7 NRT-specific attitudes. Self-reported provision of SCC components was measured on a five-point Likert scale (Never to Always). Feasibility outcomes, and data collected on the service and patient level are reported elsewhere. RESULTS Mean knowledge composite scores improved from pre to post (78% vs 84% correct, difference 5.95, 95% CI 1.57 to 10.32). Mean NRT-specific knowledge composite score also improved (68% vs 79% correct, difference 9.9, 95% CI 3.66 to 16.14). Mean attitude composite score improved (3.65 (SD 0.4) to 3.87 (SD 0.4), difference 0.23, 95% CI 0.05 to 0.41). Mean NRT-specific attitudes composite score also improved (3.37 (SD 0.6) to 3.64 (SD 0.7), difference 0.36, 95% CI 0.13 to 0.6). Self-reported practices were unchanged, including prescribing NRT. CONCLUSIONS A multicomponent culturally sensitive intervention in AMSs was feasible, and might improve HPs provision of SCC to pregnant Aboriginal women. Changes in NRT prescription rates may require additional intensive measures. TRIAL REGISTRATION NUMBER ACTRN 12616001603404; Results.
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Affiliation(s)
- Yael Bar-Zeev
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Michelle Bovill
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Billie Bonevski
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Maree Gruppetta
- Wollotuka Institute, University of Newcastle, Callaghan, New South Wales, Australia
| | - Christopher Oldmeadow
- Clinical Research Design, Information Technology and Statistical Support (CReDITSS) Unit, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Kerrin Palazzi
- Clinical Research Design, Information Technology and Statistical Support (CReDITSS) Unit, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Louise Atkins
- UCL Centre for Behaviour Change, University College London, London, UK
| | - Jennifer Reath
- School of Medicine, Western Sydney University, Penrith South DC, New South Wales, Australia
| | - Gillian Sandra Gould
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
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Gould GS, Bovill M, Pollock L, Bonevski B, Gruppetta M, Atkins L, Carson-Chahhoud K, Boydell KM, Gribbin GR, Oldmeadow C, Hall A, Bar-Zeev Y, Bar-Zeev Y. Feasibility and acceptability of Indigenous Counselling and Nicotine (ICAN) QUIT in Pregnancy multicomponent implementation intervention and study design for Australian Indigenous pregnant women: A pilot cluster randomised step-wedge trial. Addict Behav 2019; 90:176-190. [PMID: 30412909 DOI: 10.1016/j.addbeh.2018.10.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/22/2018] [Accepted: 10/25/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Many health providers (HPs) lack knowledge, confidence, optimism and skills in addressing smoking with pregnant women. This study aimed to explore the feasibility and acceptability of a) a co-designed multi-component intervention for HPs at Aboriginal Medical Services (AMSs) in culturally-targeted pregnancy-specific smoking cessation care and b) the study design. METHODS Using a randomised step-wedge cluster design, the Indigenous Counselling And Nicotine (ICAN) QUIT in Pregnancy Trial was evaluated across six AMSs in three Australian states. HPs were provided educational resource packages including live interactive webinars, treatment manuals, patient resources, carbon monoxide (CO) meters, and oral Nicotine Replacement Therapy (NRT). Feasibility was assessed through recruitment and retention rates of both pregnant women (12-weeks) and HPs (end of study) as well as the potential to improve women's quit rates. Qualitative interviews with staff post-trial explored acceptability of the intervention and study, based on capability, opportunity and motivation from the Behaviour Change Wheel. RESULTS Pregnant women (n = 22; 47% (95% CI: 32%, 63%) eligible) and HPs (n = 50; 54% (95% CI: 44%, 64%) eligible) were recruited over 6 months with retention rates of 77% (95% CI: 57%, 90%) and 40% (95% CI: 28%, 54%) respectively. Self-reported 12-week 7-day point-prevalence abstinence was 13.6% (n = 3) and validated abstinent with CO readings ≤6 ppm. Staff interviewed regarding intervention implementation highlighted the importance of provision and use of resources, including training materials, patient resources, CO meters and oral NRT. Resources helped increase capability and opportunity, restructure the environment, and provided social comparison and modelling. Staff were motivated by greater engagement with pregnant women and seeing the women's reductions in CO readings. Having the intervention at the AMSs improved organisational capacity to engage with pregnant women. Staff reported changes to their routine practice that were potentially sustainable. Recommendations for improvement to the implementation of the intervention and research included reducing training length and the tasks related to conducting the study. CONCLUSION ICAN QUIT in Pregnancy was a pilot study with the ability to enrol Indigenous women. It was feasible to implement and acceptable to most staff of the AMSs in three states, with modifications recommended. Smoking in pregnancy is a key challenge for Indigenous health. The intervention needs to be evaluated through a methodologically rigorous fully-powered study to determine the efficacy of outcomes for women. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry, ACTRN12616001603404. Registered 21 November 2016 - retrospectively registered, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371778.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Yael Bar-Zeev
- University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia.
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Gould GS, Stevenson L, Bovill M, Oliva D, Keen J, Dimer L, Gruppetta M. "Building strength in coming together": A mixed methods study using the arts to explore smoking with staff working in Indigenous tobacco control. Health Promot J Austr 2018; 29:293-303. [PMID: 29858555 DOI: 10.1002/hpja.178] [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: 11/06/2017] [Accepted: 05/28/2018] [Indexed: 11/05/2022] Open
Abstract
ISSUE ADDRESSED Tobacco is a major risk factor contributing to Indigenous health disparities. Art may be a powerful and transformative tool to enable health providers to develop targeted messages for tobacco control. METHODS Indigenous and non-Indigenous staff, working in Indigenous tobacco control, attended a 2-hour workshop, and were led through a process to create individual artworks. Participants completed surveys before and after the workshop. Scales compared understandings of how art can be used in tobacco control, and the likelihood of utilising arts in future programs. Three pairs of Indigenous and non-Indigenous researchers analysed the artworks, using the Four Frames (New South Wales Board of Studies), explored themes, and developed a model. RESULTS Nineteen participants completed both surveys; 17 artworks were analysed. Pre- to post-workshop increases in "understanding" about the use of arts (P < 0.00001) for tobacco control, and "likelihood" of use of arts in the next 6 months (P < 0.006) were significant. Participants expressed personal and professional benefits from the workshop. Artworks demonstrated themes of optimism, the strength of family and culture, smoking as a barrier, resilience, recovery and urgency. CONCLUSIONS The workshop increased the understanding and likelihood of using the arts for tobacco control. Artworks revealed contemporary challenges impacting on equity; health staff expressed optimism for being engaged in their work. SO WHAT?: The Framework Convention for Tobacco Control supports novel techniques to increase the reach and relevance of health messages for diverse populations. This study successfully demonstrated how a novel, positively framed art-based technique proved to be advantageous for health professionals, working in an area of Indigenous tobacco control, where behavioural change can be complex.
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Affiliation(s)
- Gillian S Gould
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Leah Stevenson
- College of Public Health, Medicine and Veterinary Science, James Cook University, Cairns, QLD, Australia
| | - Michelle Bovill
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Dora Oliva
- Australian Council on Smoking and Health, Subiaco, WA, Australia
| | - Jennifer Keen
- Quitline Aboriginal Liaison Team, Government of Western Australia Mental Health Commission, Perth, WA, Australia
| | - Lyn Dimer
- Aboriginal Health, National Heart Foundation, Subiaco, WA, Australia
| | - Maree Gruppetta
- Wollotuka Institute, University of Newcastle, Callaghan, NSW, Australia
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Why Are New Tobacco Control Interventions Needed? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040658. [PMID: 29614798 PMCID: PMC5923700 DOI: 10.3390/ijerph15040658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 11/17/2022]
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