Knowledge, attitudes and other factors associated with assessment of tobacco smoking among pregnant Aboriginal women by health care providers: a cross-sectional survey

Abstract

BackgroundAs with many Indigenous peoples, smoking rates among Aboriginal Australians are considerably higher than those of the non-Indigenous population. Approximately 50% of Indigenous women smoke during pregnancy, a time when women are more motivated to quit. Antenatal care providers are potentially important change agents for reducing the harms associated with smoking, yet little is known about their knowledge, attitudes or skills, or the factors associated with providing smoking cessation advice.MethodsThis paper aimed to explore the knowledge and attitudes of health care providers caring for pregnant Australian Aboriginal women with regard to smoking risks and cessation; and to identify factors associated with self-reported assessment of smoking. A cross-sectional survey was undertaken with 127 staff providing antenatal care to Aboriginal women from two jurisdictions: the Northern Territory and New South Wales, Australia. Measures included respondents' estimate of the prevalence of smoking among pregnant women; optimal and actual assessment of smoking status; knowledge of risks associated with antenatal smoking; knowledge of smoking cessation; attitudes to providing cessation advice to pregnant women; and perceived barriers and motivators for cessation for pregnant women.ResultsThe median provider estimate of the smoking prevalence was 69% (95%CI: 60,70). The majority of respondents considered assessment of smoking status to be integral to antenatal care and a professional responsibility. Most (79%) indicated that they assess smoking status in 100% of clients. Knowledge of risks was generally good, but knowledge of cessation was poor. Factors independently associated with assessing smoking status among all women were: employer service type (p = 0.025); cessation knowledge score (p = 0.011); and disagreeing with the statement that giving advice is not worth it given the low level of success (p = 0.011).ConclusionsAddressing knowledge of smoking risks and cessation counselling is a priority and should improve both confidence and ability, and increase the frequency and effectiveness of counselling. The health system must provide supports to providers through appropriate policy and resourcing, to enable them to address this issue.

Getting over the shock: taking action on Indigenous maternal smoking

“…In Australia, knowledge of cessation strategies is poor among Australian antenatal health providers caring for Indigenous women (Passey et al 2012b). Some health workers considered it not worthwhile to offer cessation advice to Indigenous pregnant women due to low perceived success (Passey et al 2012b). Preliminary findings from Australian GPs working in Indigenous health show a similar lack of optimism and inadequate follow up (Gould et al 2015e).…”

“…UK general practitioners (GPs) reported safety concerns and low confidence in prescribing NRT, despite the majority agreeing that NRT was safer than smoking when pregnant (Herbert et al 2005). In Australia, knowledge of cessation strategies is poor among Australian antenatal health providers caring for Indigenous women (Passey et al 2012b). Some health workers considered it not worthwhile to offer cessation advice to Indigenous pregnant women due to low perceived success (Passey et al 2012b).…”

“…Several studies draw attention to the barriers for Indigenous pregnant smokers to receiving evidence-based therapies (Passey et al 2012b;Gould et al 2013b;Passey et al 2013;. Barriers that are largely remediable and should be targeted strenuously include lack of knowledge and expertise by clinicians, lack of access to culturally appropriate programs and lack of access to subsidised oral and combination forms of NRT for pregnant women.…”

A Pragmatic Guide for Smoking Cessation Counselling and the Initiation of Nicotine Replacement Therapy for Pregnant Aboriginal and Torres Strait Islander Smokers

“…Price et al report the majority of US obstetricians in their study did not prescribe NRT because of a lack of confidence and lack of smoking cessation training (Price, Jordan & Dake, 2006). In Australia healthcare providers who have better knowledge about NRT were more likely also to assess smoking status in pregnant Aboriginal and Torres Strait Islander clients (Passey, D'Este & Sanson-Fisher, 2012).…”

Gebelikte Sigara Kullanımı ve İlişkili Faktörler

“…[24][25][26] Avustralya'da yapılan bir araştırmada ise gebe aborjin kadınlarda sigara bağımlılığının ortalama %69 olduğu görülmüştür. 27 Amerika Birleşik Devletleri (ABD) Halk Sağlığı Servisi'ne göre ABD'deki bütün gebe kadınların sigarayı bırakması durumunda ölü doğumlarda %11 ve yenidoğan ölümlerinde %5 azalma olacağı tahmin edilmektedir. 4 Bu çalışmada gebe kadınlarda sigara kullanımı ve etkileyen faktörlerin incelenmesi amaçlanmıştır.…”