Smoking cessation support strategies for Aboriginal and Torres Strait Islander women of reproductive age: findings from the Which Way? study.

OBJECTIVE: To identify smoking cessation support strategies that resonate with Aboriginal and Torres Strait Islander women. DESIGN, SETTING AND PARTICIPANTS: A national cross-sectional survey of Aboriginal and Torres Strait Islander women aged 16-49 years who were smokers or ex-smokers was conducted online during the period July to October 2020. MAIN OUTCOME MEASURES: Preferred strategies, providers and locations for smoking cessation support. RESULTS: Among a total of 428 women who participated in the survey, group-based support and holistic support were the most preferred strategies (preferred by 31.8% and 22.2% of women, respectively). Use of an Aboriginal health service was positively associated with choosing holistic support programs (prevalence ratio, 1.14 [95% CI, ≥ 1.00-1.28]). Women with high or moderate nicotine dependency were more likely to consider group-based support to be helpful (prevalence ratio, 1.13 [95% CI, ≥ 1.00-1.27]) than those with low nicotine dependency. The most preferred providers for smoking cessation support were Aboriginal health workers (64.3%). Most women (73.4%) preferred face-to-face support at an Aboriginal health service, 38.8% preferred online support and 34.8% preferred phone support. A higher percentage of older women (≥ 35 years) preferred online or phone support (prevalence ratio, 1.70 [95% CI, 1.03-2.80]) compared with younger women (16-20 years). Use of an Aboriginal health service was positively associated with preference for an Aboriginal health worker (prevalence ratio, 1.35 [95% CI, 1.12-1.62]), and receiving face-to-face support at an Aboriginal health service (prevalence ratio, 1.28 [95% CI, 1.10-1.49]). CONCLUSION: Aboriginal and Torres Strait Islander women prefer a range of cessation supports, with most women preferring group support and holistic approaches. Cessation supports that resonated with women varied by age, remoteness, nicotine dependence, and whether participants used an Aboriginal health service. Women want support to quit smoking from the Aboriginal health workers at their Aboriginal health service, at their health care providers and in their community. Comprehensive, multifaceted supports are required. Online support and phone-based support are also preferred by some women, which helps to increase accessibility. Appropriate models of care - including sufficient funding for Aboriginal health services and Aboriginal health workers - are required and should be developed in partnership with communities to implement meaningful and culturally safe cessation care. This research demonstrates the need for and importance of multifaceted, comprehensive cessation support strategies.

Exploring experiences and perceptions of Aboriginal and Torres Strait Islander peoples readmitted to hospital with chronic disease in New South Wales, Australia: a qualitative study.

Objective This study explored the experiences and perceptions of unplanned hospital readmissions from the perspective of Aboriginal and Torres Strait Islander peoples with chronic disease. Method We conducted semi-structured interviews with Aboriginal and Torres Strait Islander patients readmitted to hospital with chronic disease. Interviews covered perceptions of avoidable readmissions, experiences of health care, medications and carer support. Inductive thematic analysis was used to code and analyse the data. Results Fifteen patients with multiple chronic diseases were interviewed. Several participants believed their readmission was unavoidable due to their poor health, while others considered their readmission was avoidable due to perceived health professional and system failures. Enablers to chronic disease management included the importance of continuity of care and strong family networks, although a few participants struggled with isolation. Four themes emerged as barriers: poor communication from health professionals; low levels of health literacy and adherence to chronic disease management; poor access to community services; and health risk behaviours. Conclusions The participants in our study identified complex and interacting patient-, environmental-, encounter- and organisational-level factors as contributing to chronic disease management and unplanned readmissions. Our findings suggest systemic failures remain in access to basic services and access to culturally appropriate care. Family support and continuity of care were valued by participants. What is known about the topic? Aboriginal and Torres Strait Islander peoples with chronic diseases are more likely to be readmitted to hospital compared with non-Aboriginal people. Unplanned readmissions are associated with high health system costs, as well as poorer quality of life and psychological distress for the patient. What does this paper add? This paper describes the experiences and perceptions of unplanned readmissions by Aboriginal and Torres Strait Islander peoples with chronic disease. Our findings suggest systemic failures exist in access to basic services for a safe and secure living environment, and access to culturally appropriate care that is delivered in a manner which promotes health literacy and self-management capacity. What are the implications for practitioners? Practitioners and policy makers should consider involving family members in discharge planning and other medical care, and funding for Aboriginal and Torres Strait Islander health and community services to enhance transport, care coordination, culturally appropriate disability and housing services, and health promotion.

Building an Indigenous-Led Evidence Base for Smoking Cessation Care among Aboriginal and Torres Strait Islander Women during Pregnancy and Beyond: Research Protocol for the Which Way? Project.

Strong and healthy futures for Aboriginal and Torres Strait Islander people requires engagement in meaningful decision making which is supported by evidence-based approaches. While a significant number of research publications state the research is co-designed, few describe the research process in relation to Indigenous ethical values. Improving the health and wellbeing of Aboriginal and Torres Strait Islander mothers and babies is crucial to the continuation of the oldest living culture in the world. Developing meaningful supports to empower Aboriginal and Torres Strait Islander mothers to quit smoking during pregnancy is paramount to addressing a range of health and wellbeing outcomes. Aboriginal and Torres Strait Islander women have called for non-pharmacological approaches to smoking cessation during pregnancy. We describe a culturally responsive research protocol that has been co-designed and is co-owned with urban and regional Aboriginal communities in New South Wales. The project has been developed in line with the AH&MRC's (Aboriginal Health & Medical Research Council) updated guidelines for ethical research with Aboriginal and Torres Strait Islander communities. Ethics approvals have been granted by AH&MRC #14541662 University of Newcastle HREC H-2020-0092 and the Local Health District ethics committee 2020/ETH02095. Results will be disseminated through peer reviewed articles, community reports, infographics, and online social media content.