A mixed methods exploratory study tackling smoking during pregnancy in an urban Aboriginal and Torres Strait Islander primary health care service

Abstract

BackgroundPregnancy 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.MethodsA 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.ResultsThirty-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.ConclusionsTobacco 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.

“They Were Willing to Work with Me and Not Pressure Me”: A Qualitative Investigation into the Features of Value of a Smoking Cessation in Pregnancy Program for Aboriginal and Torres Strait Islander Women

“…From this foundation, programs that recognize and support self-agency, foster supportive relationships at the family and community level, and facilitate non-judgmental access to the available resources and organizations to ameliorate the immediate impact of the social and structural determinants of health are likely to be effective, particularly when combined with smoking cessation support tailored to each individual's needs [4,8,20,24]. Underpinned by this understanding, a holistic multifaceted smoking cessation in pregnancy program, the Empowering Strong Families (ESF) 4077 program, was developed and implemented in an urban Aboriginal and Torres Strait Islander community in Brisbane, Australia [25].…”

“…Thirty-one pregnant women and 16 significant others participated in ESF. The acceptability and impact of the ESF intervention were determined through a mixed methods, exploratory study reported in detail elsewhere [25]. Over one-third of pregnant women (36% (4/11)) had quit at the three-month assessment, with two remaining smoke free one month postpartum.…”

“…Over one-third of pregnant women (36% (4/11)) had quit at the three-month assessment, with two remaining smoke free one month postpartum. Nearly half the participants reported a quit attempt during the program, nearly all reported a reduction in the number of cigarettes smoked, and participants and health professionals all reported high levels of satisfaction with the intervention [25].…”

“…While the positive outcomes of ESF demonstrate its promising capacity for addressing Aboriginal and Torres Strait Islander women's tobacco use during pregnancy [25], understanding the core features of the program that contributed to its success and enabled the program to be positively received by ESF participants and health professionals, would enable replication of the program in other settings. Therefore, this exploratory research aimed to identify the features of value (FOV) of the ESF program, as experienced by ESF participants, case managers and COE healthcare professionals, thereby providing critical insights for the development of similar projects in other locations.…”

The Power of Authenticity and Cultural Safety at the Intersection of Healthcare and Child Protection

“…A family that encounters culturally competent professionals and goes on to develop a sense of trust and cultural safety may be more likely to engage with the range of support services offered (Askew et al 2019). Until mainstream health services prioritize First Nations culture in strategy and organizational processes (such as through the NSW Health Services Cultural Engagement Self-Assessment Tool), First Nations peoples will be "still waiting for trust" (Herring et al 2013) in the interface between child protection and healthcare systems.…”