Improving smoking cessation care in pregnancy at Aboriginal Medical Services: ‘ICAN QUIT in Pregnancy’ step-wedge cluster randomised study

Abstract

ObjectivesThis 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.DesignStep-wedge clustered randomised controlled study. HPs answered a preintervention and 1–6 months postintervention survey.SettingSix Aboriginal Medical Services (AMSs) in three states of Australia.ParticipantsAll HPs were invited to participate. Of 93 eligible, 50 consented (54%), 45 completed the presurvey (90%) and 20 the post (40%).InterventionIncluded three 1-hour webinar sessions, educational resource package and free oral NRT.OutcomesHPs 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.ResultsMean 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.ConclusionsA 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 numberACTRN 12616001603404; Results.

Feasibility of Audio-Recording Consultations with Pregnant Australian Indigenous Women to Assess Use of Smoking Cessation Behaviour Change Techniques

“…The study was a nested feasibility study within a larger intervention trial-the Indigenous Counselling and Nicotine (ICAN) Quit in Pregnancy [13][14][15]. The ICAN Quit in Pregnancy trial is aimed at testing the feasibility of an intervention to improve HP smoking cessation care with pregnant Aboriginal and Torres Strait Islander women who smoke in partnership with Aboriginal Medical Services [13][14][15]. The intervention included an educational resource package, webinar training, and free nicotine replacement therapy.…”

“…The research facilitator coordinated all of the ICAN Quit in Pregnancy trial components within the service, including recruiting patients, conducting the surveys and evaluations, and collecting the feasibility data. A full description of the ICAN Quit in Pregnancy trial methodology and results has been previously published, including adherence to the CONSORT guidelines [13][14][15].…”

Pregnant Aboriginal women self-assess health risks from smoking and efficacy to quit over time using an adapted Risk Behaviour Diagnosis (RBD) Scale

“…The trial protocol has been published (Bar-Zeev et al, 2017). The feasibility and acceptability outcomes as the primary aims of the study, and outcomes for the secondary aims (health provider demographics and outcomes, and women's demographics, nicotine dependence, medication use and smoking cessation outcomes) were reported elsewhere (Bar-Zeev et al, 2019;Bovill et al, 2020;Gould et al, 2018).…”

Feasibility of audio-recording consultations with pregnant Australian Indigenous women to assess use of smoking cessation behaviour change techniques

“…Design: Nested feasibility study within a larger intervention trial -The Indigenous Counselling and Nicotine (ICAN) Quit in Pregnancy. (13)(14)(15) The ICAN Quit in Pregnancy trial aimed to test the feasibility of an intervention to improve HPs smoking cessation care with pregnant Aboriginal and Torres Strait Islander women who smoke in partnership with Aboriginal Medical Services. [13][14][15] As part of the ICAN Quit in Pregnancy trial, both HPs and pregnant women were recruited and followed (November 2016 to September 2017).…”

“…A full description of the ICAN Quit in Pregnancy trial methodology and results has been previously published, including adherence to the CONSORT guidelines. (13)(14)(15) Aboriginal Advisory Panel: The ICAN Quit in Pregnancy trial was developed collaboratively with two Aboriginal Medical Services. (16) A Stakeholder and Consumer Aboriginal Advisory Panel guided the development and implementation of this study to ensure Aboriginal community ownership and cultural sensitivity; At least one member from each Aboriginal Medical Service was invited to participate on this panel.…”