Tobacco control practices among Aboriginal health professionals in Western Australia

Abstract

Smoking among Aboriginal people is extremely widespread (50 v. 17% of the general population). Aboriginal Health Workers (AHW) are at the vanguard of tackling this problem but many themselves smoke and little is known of their knowledge, attitudes and practices regarding smoking cessation. Structured telephone interviews were conducted with 36 AHW, including 31% current smokers, 31% ex-smokers and 38% non-smokers, to assess their current smoking cessation practices and knowledge of health risks, nicotine dependence, cessation strategies and pharmacotherapies. AHW considered diabetes, alcohol use and heart disease more problematic than smoking among Aboriginal people. Fear of appearing hypocritical stopped many who smoke from discussing smoking cessation with clients but also stopped some non-smoking AHW whose colleagues or family smoked. Cultural concerns about telling others ‘what to do’ was also a major impediment. Knowledge of the health effects of smoking was good, but knowledge of appropriate advice around cessation pharmacotherapies was suboptimal. AHW trained in smoking cessation were more knowledgeable and active in smoking cessation, but most AHW had received no training, despite being keen to do so. Specific smoking cessation training is sought and appears needed by AHW, particularly in the areas of brief interventions, motivational interviewing, dependence assessment and pharmacotherapies.

Barriers and facilitators for health professionals referring Aboriginal and Torres Strait Islander tobacco smokers to the Quitline

“…It should be clarified to health professionals that making a referral to the Quitline call‐back service removes cost burden from clients. Another barrier was low client motivation to quit, which is similar to the findings of Pilkington et al 9 This demonstrates the importance of developing a health workforce trained in techniques to build motivation for behaviour change.…”

“…Health professionals’ provision of cessation interventions may be influenced by beliefs about capabilities to address smoking, 4,5 perceived client receptiveness to intervention, 5,6 beliefs about effectiveness of intervention, 4 and health professional smoking status 6 . High smoking prevalence among health professionals working with Aboriginal and Torres Strait Islander clients has been identified as a barrier to discussing tobacco, 7,8 as has perceiving cessation as a low priority and concern for cultural sensitivities 9 . However, previous studies have not focused upon referrals to Quitline or facilitators for interventions.…”

Characterising the Smoking Status and Quit Smoking Behaviour of Aboriginal Health Workers in South Australia

“…These factors have previously been highlighted as impeding research involving AHWs [5]. To overcome this difficulty, repeated contact with health services was made to attain up-to-date lists of AHWs.…”

A review of the barriers preventing Indigenous Health Workers delivering tobacco interventions to their communities

“…It is widely recognised that IHWs are best placed to address tobacco issues in their communities 10 . It is also reported that IHWs are the frontline workers in a critical role to provide health information and education to the community 11 . Therefore it is imperative that IHWs are skilled and confident to deliver tobacco information and/or quit support in order to adequately address very high and persistent rates of smoking.…”

“…Some of the peer‐reviewed literature expresses a view that smoking by IHWs is a barrier for them to provide tobacco information and quit support to the community generally and to individual smokers 10–17 . However, the literature providing evidence to supporting this view has not been systematically reviewed.…”