FOR centuries, Aboriginal and/or Torres Strait Islander People (henceforth called Indigenous, acknowledging diversity) have been yarning with each other, utilising collective knowledge to solve complex problems.
Through the iSISTAQUIT (implementing Supporting Indigenous Smokers to Assist Quitting) program, we are training and empowering health providers to start a chat with pregnant women who smoke tobacco to encourage them to quit smoking, and empowering Indigenous women to connect with health services that are trained and ready to assist.
All health providers understand the importance of quitting smoking, especially during pregnancy. Quitting smoking in pregnancy not only improves infant health outcomes such as birth weight and gestational age it also improves the health and wellbeing of the woman, her family and the entire community. Most Indigenous pregnant women want to quit smoking but may not get enough culturally appropriate guidance, resources and support from health providers.
It is not that health providers lack motivation to provide smoking cessation assistance. The issue is that Australian GPs and other health care workers who provide care to pregnant women often find themselves ill-equipped to provide smoking cessation care to Indigenous pregnant mums. In a study of 378 GPs and obstetricians, more than 75% agreed that training would help them provide better smoking cessation care in pregnancy. Barriers to helping pregnant Indigenous women quit smoking include not being trained in culturally appropriate methods of providing smoking cessation counselling, lack of appropriate resources, low knowledge and confidence in prescribing or recommending nicotine replacement therapy, and a scarcity of time to engage in an in-depth conversation about smoking and quitting.
We, through iSISTAQUIT, are trying to change this.
The iSISTAQUIT project
iSISTAQUIT is an evidence-based smoking cessation training program currently funded by the Australian Department of Health, as part of the Tackling Indigenous Smoking Program. It was co-developed over the past 7 years through several rounds of co-design and community testing. In its present form, it is a short – just 4 hours – online, self-paced module-based training that can be completed from a computer or a hand-held device such as a tablet or a mobile phone.
On completion of the training, the trainee can opt for continued professional development points and/or request resources such as nicotine replacement therapy, carbon monoxide breath monitor, information booklets, treatment manual, patient flip charts, My Journey booklet, and posters to display around their practice or health service. The treatment manual provides detailed guidance on approaching smoking cessation in pregnant Indigenous women including the ABCD approach (ask, brief advice, cessation support, and discuss psychosocial context).
iSISTAQUIT also offers ABCD templates for medical practice software to guide the consultation and record important patient information in the electronic medical record. Resources such as patient flip charts (with pictures) make the counselling process more systematic and intuitive. The My Journey booklet is a co-designed (with women and community) resource that can be given to women to map and plan their quit journey. Along with easy-to-understand quitting information, the booklet has distraction methods (eg, colouring activities) and built-in augmented reality videos (QR codes that can be scanned to play videos).
We are currently implementing iSISTAQUIT in more than 30 Aboriginal and mainstream health services in Australia.
Recently, iSISTAQUIT started a #smokefreesistahood social media campaign to engage women, community, and health providers on social media platforms to become involved with iSISTAQUIT.
This campaign aims at building a community of support for Indigenous women who are, or are thinking of, embarking on a quit journey. A major feature of this social media campaign is a series of videos that highlights the barriers facing pregnant women in accessing smoking cessation care within the health system. Indigenous communities, especially young women, are avid social media users and the #smokefreesistahood campaign is likely to produce engagement and awareness about smoking in pregnancy across the community.
The campaign’s main slogan — “Change starts with a chat” — calls upon health providers to initiate a yarn about smoking with pregnant Indigenous women.
iSISTAQUIT scale-up: going national
The iSISTAQUIT scale-up project received $1.8 million in funding in 2021 to scale up the implementation of iSISTAQUIT training to 100 health services, hospitals, GP practices, pharmacies, dental practices and other health delivery systems across Australia.
This phase will take the learnings from our earlier research and try to find the best way to implement the training in different health contexts in Australia. We will work closely with health providers, managers, policymakers, and community members to build a training delivery and implementation model that empowers health providers and health services to best serve pregnant Indigenous women.
Dr Ratika Kumar is a Research Fellow at Southern Cross University.
Ms Rebecca Hyland (Kamilaroi) is Senior Projects Manager iSISTAQUIT projects at Southern Cross University.
Professor Gillian Gould is Professor of Health Equity at Southern Cross University.
The iSISTAQUIT project is currently funded by the Department of Health with new funding from GACD/NHMRC.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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