The effectiveness of internet-based group behavioural interventions on lifestyle modifications: A systematic review.

OBJECTIVES: To examine the effectiveness of internet-based group interventions incorporating social support elements in addressing behaviours related to smoking, nutrition, alcohol consumption, physical activity, and obesity. METHODS: A literature search was undertaken in six databases from inception to April 2024. Articles were eligible if they reported on group-based online interventions targeting smoking, nutrition, alcohol consumption, physical activity, and obesity, and included interactive features aimed at promoting social engagement and support. Two reviewers independently screened and assessed the quality of articles using Joanna Briggs Institute Critical Appraisal tools. A narrative analysis was used to synthesize and interpret the data to understand the effects of online interventions on lifestyle modifications. RESULTS: A total of 4063 citations underwent screening, resulting in 32 articles being deemed eligible and included in this review. Most studies examined physical activity (n = 14), followed by obesity (n = 7) and smoking (n = 6), Most studies were conducted in the USA (n = 14) and Australia (n = 11). Websites were the most utilised mode of intervention delivery (n = 11), followed by Facebook (n = 7) and mobile apps (n = 5). Group-based internet interventions were effective in improving smoking cessation, increasing physical activity and addressing obesity. However, there is insufficient data to determine their effect on promoting healthy nutrition and reducing alcohol intake. CONCLUSION: Group-based interventions delivered on the internet are effective in changing various health behaviours. This approach can offer large scale and cost-effective means to deliver behavioural interventions. However, the long-term effects and strategies for maintaining the behaviour changes are lacking, underscoring the need for further research.

Koori Quit Pack: A feasibility study of a multi-component mailout smoking cessation support for Aboriginal and Torres Strait Islander people: "I would recommend it to anybody. It's just so much easier".

INTRODUCTION: Smoking is the leading cause of preventable death among Aboriginal and Torres Strait Islander people. The Koori1 Quit Pack study aimed to assess the feasibility of a multi-component mailout smoking cessation intervention to reduce smoking among Aboriginal and Torres Strait Islander people. METHODS: A non-randomised, single-group feasibility study conducted among Aboriginal and Torres Strait Islander people who reported current smoking. The intervention package included information pamphlets and resources on quitting, referral offer to Aboriginal Quitline and optional free Nicotine Replacement Therapies (NRT). Follow-up was conducted at 2-weeks, 6-weeks, 10-weeks and 6-months post recruitment. Feasibility outcomes were recruitment and retention rates, uptake of intervention components and smoking abstinence at 6-week follow-up (primary end point). Cessation outcomes were analysed using both a complete case analysis and intention-to-treat approach. RESULTS: 165 participants were recruited, 111 (67.3%), 79 (47.9%), 59 (35.8%), and 94 (57%) participants completed the 2-week, 6-week, 10-week, and 6-month follow-up. At 10-week follow-up, 40.7% of participants used pamphlets and booklets, 13.6% used Quitline and > 90% used NRT. At 6-week follow-up, 87.3% reported a quit attempt and 46.8% sustained quitting. 46.8% were continuously smoke-free at the 6-week timepoint. The complete case analysis and the intention-to-treat analysis at 6-month shows a 7-day self-reported point prevalence abstinence of 34% and 19.4% respectively. CONCLUSION: The Koori Quit Pack mailout smoking cessation program was feasible to support Aboriginal and Torres Strait Islander people. The intervention resulted in a high smoking cessation rate and should be upscaled, implemented and evaluated nationally. IMPLICATIONS: Aboriginal and Torres Strait Islander people are disproportionately impacted by tobacco related harms, however the majority want to quit or wish they never took up smoking. Mailout cessation support is feasible, overcomes access barriers to evidence-based support and increases quitting success. We recommend a national mailout smoking cessation program is implemented for, and by Aboriginal and Torres Strait Islander people to accelerate declines in smoking prevalence to eliminate tobacco related death and disease.

"It's changed my life. I'm not smoking anymore. I don't want to smoke anymore": exploring the acceptability of mailout smoking cessation support for and by Aboriginal and Torres Strait Islander people.

INTRODUCTION: Aboriginal and Torres Strait Islander people want to quit smoking. There is global evidence of combination Nicotine Replacement Therapy (c-NRT) alongside behavioural support as best practice approach to smoking cessation care. However, there is limited adherence and acceptability research regarding NRT and behavioural supports for Aboriginal and Torres Strait Islander people. Similarly, there is limited research on what is considered culturally appropriate and safe support for Aboriginal and Torres Strait Islander people to quit smoking. METHODS: This Aboriginal-led qualitative study explored the acceptability of the Koori Quit Pack. Aboriginal and Torres Strait Islander participants shared experiences of quitting with the mailout c-NRT program and behavioural cessation support through Yarning. Reflexive thematic analysis was used to develop themes. RESULTS: Aboriginal and Torres Strait Islander people are motivated to quit smoking and have accessed cessation supports from health professionals. However, the support(s) received are not always appropriate or culturally safe. The Koori Quit Pack was deemed acceptable and useful for smoking cessation. Having access to smoking cessation care and knowledge of c-NRT helped people quit smoking, and support others to quit too. CONCLUSION: A combination of NRT products alongside culturally responsive behavioural support(s), delivered through a mailout package was a beneficial strategy to help Aboriginal and Torres Strait Islander people quit smoking. National implementation of such a package could assist to accelerate reductions in tobacco use, helping meet national smoking reduction targets and improve health outcomes. IMPLICATIONS: Cessation supports offered to Aboriginal and Torres Strait Islander people are not always culturally-safe or effectively delivered. The Koori Quit Pack provided Aboriginal and Torres Strait Islander people with culturally-safe smoking cessation support delivered for and by Aboriginal and Torres Strait Islander people, demonstrating mailout smoking cessation supports as acceptable and highly valued. Mailout support eliminates accessibility barriers to cessation care while providing tools and knowledge to quit can lead to smoke-free behaviours among individuals and communities. Country-wide availability of this program can accelerate reductions in tobacco use, helping meet national targets and improve health outcomes consistent with the National Tobacco Strategy and the WHO Framework Convention on Tobacco Control.

Aboriginal and Torres Strait Islander people who smoke and want to quit - a cohort profile from the Koori Quit Pack study.

INTRODUCTION: Reducing the prevalence of smoking is a national priority, however there is limited evidence on what smoking cessation supports are utilised, accessible, and effective among Aboriginal and Torres Strait Islander people. This paper describes a cohort profile of Aboriginal and Torres Strait Islander people who smoke and want to quit to inform tailored smoking cessation interventions. METHOD: Aboriginal and Torres Strait Islander people residing in New South Wales (NSW), Australian Capital Territory (ACT), and Victoria, who were smokers wanting to quit, were recruited through health services and online advertisements from May to October 2022. Descriptive and inferential statistics were used to summarise participant characteristics and explore factors associated with previous use and adherence to Nicotine Replacement Therapy (NRT) and intention to use Quitline services. RESULTS: 165 participants were recruited. Almost all (93.9%) had made at least one previous quit attempt, and 40.6% had used behavioural support. The majority believed NRT was safe (80.6%), effective (70.3%) and tried NRT previously (89%). Preferred forms of NRT for current quit attempts were nicotine patches (85.5%) and inhalers (69.7%). Intention to use Quitline was found to be higher among participants aged 31-45 years compared to participants under 30 years (AOR=3.12, 95%CI, 1.01-9.76). CONCLUSION: Aboriginal and Torres Strait Islander people are highly motivated to be smoke-free. However, efforts to enhance access and adherence to cessation supports are needed. The rapid recruitment and interest in the mailout cessation support should be scaled up to support Aboriginal and Torres Strait Islander peoples to quit. IMPLICATIONS: The Australian Government has recently launched a national tobacco strategy which includes targets for reducing smoking prevalence to less than 27% among Aboriginal and Torres Strait Islander peoples. In order to meet these targets Aboriginal and Torres Strait Islander people who smoke and want to quit should have access to culturally safe and responsive support. We found that Aboriginal and Torres Strait Islander people have made quit attempt, accessed evidence-based smoking cessation care, and have positive attitudes towards NRT. However, acknowledging relapse, further evidence is required to understand the factors associated with sustained quitting.

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.

BACKGROUND: Indigenous academics have advocated for the use and validity of Indigenous methodologies and methods to centre Indigenous ways of knowing, being and doing in research. Yarning is the most reported Indigenous method used in Aboriginal and Torres Strait Islander qualitative health research. Despite this, there has been no critical analysis of how Yarning methods are applied to research conduct and particularly how they privilege Indigenous peoples. OBJECTIVE: To investigate how researchers are applying Yarning method to health research and examine the role of Aboriginal and Torres Strait Islander researchers in the Yarning process as reported in health publications. DESIGN: Narrative review of qualitative studies. DATA SOURCES: Lowitja Institute LitSearch January 2008 to December 2021 to access all literature reporting on Aboriginal and Torres Strait Islander health research in the PubMed database. A subset of extracted data was used for this review to focus on qualitative publications that reported using Yarning methods. METHODS: Thematic analysis was conducted using hybrid of inductive and deductive coding. Initial analysis involved independent coding by two authors, with checking by a third member. Once codes were developed and agreed, the remaining publications were coded and checked by a third team member. RESULTS: Forty-six publications were included for review. Yarning was considered a culturally safe data collection process that privileges Indigenous knowledge systems. Details of the Yarning processes and team positioning were vague. Some publications offered a more comprehensive description of the research team, positioning and demonstrated reflexive practice. Training and experience in both qualitative and Indigenous methods were often not reported. Only 11 publications reported being Aboriginal and/or Torres Strait Islander led. Half the publications reported Aboriginal and Torres Strait Islander involvement in data collection, and 24 reported involvement in analysis. Details regarding the role and involvement of study reference or advisory groups were limited. CONCLUSION: Aboriginal and Torres Strait Islander people should be at the forefront of Indigenous research. While Yarning method has been identified as a legitimate research method to decolonising research practice, it must be followed and reported accurately. Researcher reflexivity and positioning, and Aboriginal and Torres Strait Islander ownership, stewardship and custodianship of data collected were significantly under detailed in the publications included in our review. Journals and other establishments should review their processes to ensure necessary details are reported in publications and engage Indigenous Editors and peer reviewers to uphold respectful, reciprocal, responsible and ethical research practice.

Exploring the Reported Strengths and Limitations of Aboriginal and Torres Strait Islander Health Research: A Narrative Review of Intervention Studies.

High quality intervention research is needed to inform evidence-based practice and policy for Aboriginal and Torres Strait Islander communities. We searched for studies published from 2008-2020 in the PubMed database. A narrative review of intervention literature was conducted, where we identified researcher reported strengths and limitations of their research practice. A total of 240 studies met inclusion criteria which were categorised as evaluations, trials, pilot interventions or implementation studies. Reported strengths included community engagement and partnerships; sample qualities; Aboriginal and Torres Strait Islander involvement in research; culturally appropriate and safe research practice; capacity building efforts; providing resources or reducing costs for services and communities; understanding local culture and context; and appropriate timelines for completion. Reported limitations included difficulties achieving the target sample size; inadequate time; insufficient funding and resources; limited capacity of health workers and services; and inadequate community involvement and communication issues. This review highlights that community consultation and leadership coupled with appropriate time and funding, enables Aboriginal and Torres Strait Islander health intervention research to be conducted. These factors can enable effective intervention research, and consequently can help improve health and wellbeing outcomes for Aboriginal and Torres Strait Islander people.

"It Needs a Full-Time Dedicated Person to Do This Job in Our Local Communities with Our Aboriginal Health Services"-Aboriginal and Torres Strait Islander Health Workers and Practitioners Perspectives on Supporting Smoking Cessation during Pregnancy.

BACKGROUND: Aboriginal and Torres Strait Islander women deserve improved smoking cessation support. Aboriginal health workers (AHW) and practitioners (AHP) can be central to the provision of culturally safe smoking cessation care (SCC). The objective of this study is to explore attitudes and the perceived role of AHWs/AHPs toward providing SCC to Aboriginal and Torres Strait Islander pregnant women. METHOD: A mixed-method study using quantitative and qualitative data was conducted among AHW/AHPs in 2021 across Australia. Descriptive and analytical statistics were used to characterise AHWs'/AHPs' attitudes towards SCC and to evaluate the factors associated with perceptions of who is best placed to provide SCC. RESULTS: From the total AHW/AHP workforce, 21.2% (223) completed the survey. Less than half (48.4%) believed that AHW/AHP were best placed to provide SCC for pregnant women. The majority believed that group-based supports (82.5%) and cultural support programs (63.7%) were the best strategies to support Aboriginal and Torres Strait Islander pregnant women to quit smoking. CONCLUSION: This study highlights the need to enhance SCC offered to Aboriginal and Torres Strait Islander pregnant women. A targeted workforce dedicated to smoking cessation should be resourced, including funding, standardised training, and ongoing SCC support tailored to Aboriginal and Torres Strait Islander pregnant women.