“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

Abstract

With tobacco commonly used for stress relief, smoking cessation during pregnancy can present challenges for women facing stressful circumstances. This can be pronounced for Aboriginal and Torres Strait Islander women who experience disproportionately high smoking rates during pregnancy and also have a greater intersection of stressors from social disadvantage, institutional racism and trauma. To contribute understandings into how women can be best supported at this time, this study identified the features of value of an Aboriginal and Torres Strait Islander pregnancy smoking cessation program that addressed the contexts of women’s lives in culturally affirming and strength-based ways. A narrative methodology using a yarning approach was used to interview 7 pregnant women, 6 significant others, 3 case managers, and 4 healthcare professionals. Data were analyzed using thematic analysis, guided by an Indigenist research practice of deep and reflexive researcher listening. Features of value included: relationship-based care, holistic wraparound care, flexibility, individualized care, and culturally orientated care. Combined, they enabled highly relevant and responsive women-centered, trauma-informed, and harm-reducing smoking cessation support that was well received by participants, who achieved promising smoking changes, including cessation. This approach strongly departs from standard practices and provides a blueprint for meaningful support for pregnant women experiencing vulnerabilities.

Decolonising qualitative research with respectful, reciprocal, and responsible research practice: a narrative review of the application of Yarning method in qualitative Aboriginal and Torres Strait Islander health research

“…Publications reported using varied sampling approaches including convenient sampling, [ 41 ] and opportunistic sampling [ 42 ], usually through routine health care [ 27 , 41 , 51 , 58 , 67 ]. However most papers reported purposeful sampling , [ 27 – 29 , 34 , 39 , 47 , 48 , 55 , 56 , 59 – 61 , 68 ] including through key community Elders and representatives [ 33 , 50 , 69 ].…”

“…A commitment to our critical reflexivity for how we listened to and analyzed participants’ stories was pivotal to this process, as was mindfulness of the local, national, and historical contexts within which participants’ stories were being shared. (Lyall, Guy et al 2020 [ 41 ]) Although critiques of Yarning point to difficulty in establishing rigor due to the inherent “messiness” of gathered data, these limitations are based on perspectives from Eurocentric epistemological priorities which can be offset by establishing Indigenous epistemological foundations and engaging an appropriate cultural lens to analysis. (Murrup-Stewart, Whyman et al 2021 [ 54 ]) 5.…”

“…Overall, the absence of Aboriginal and Torres Strait Islander involvement in the collection of data was frequently not addressed by publications. Eighteen publications did not report whether or not there were Aboriginal and/or Torres Strait Islander involvement in data collection [ 28 , 31 , 32 , 34 , 36 , 37 , 41 , 46 , 47 , 52 – 54 , 58 , 62 , 66 , 69 , 70 , 72 ]. For the most part, these publications did not identify who was responsible for conducting the Yarning circles.…”

Improving interagency service integration of the Australian Nurse Family Partnership Program for First Nations women and babies: a qualitative study

“…First Nations families often prefer to use ACCHSs as they improved access barriers, are culturally safe, promote self-determination and agency, and are focused on working towards and supporting healthy communities [ 6 , 53 ]. It is well documented that First Nations people prefer to engage in relationship-based programs, where they can feel safe to trust and safe to disclose with service providers who are non-judgemental, flexible and trustworthy [ 54 , 55 ]; which is important for First Nations people due to the overrepresentation in health inequalities and children in out of home care [ 1 , 37 ]. Individual relationships are possible when the clients have access to the same care provider over time, commonly referred to as ‘continuity of carer’ [ 56 , 57 ].…”

Factors Associated with Smoke-Free Pregnancy among Aboriginal and Torres Strait Women and Their Experience of Quitting Smoking in Pregnancy: A Mixed Method Cross-Sectional Study

“…Aboriginal women appreciate initiatives that recognise and respect their agency [ 43 ] and enable ownership of their own smoking cessation journey [ 37 ]. Engagement of Indigenous health workers appears to be a key element in effective SCC among First Nation peoples in high-income countries with histories of colonisation [ 36 ].…”