Can we improve how health providers support smoking cessation in Aboriginal and Torres Strait Islander pregnant women? - a pilot study

The intervention will include webinar training, an educational resources package, provision of Oral Nicotine Replacement Therapy, implementation support, and audit and feedback. The duration of the total intervention will be 9 months in all sites. 1. Webinar training: Three 60 minutes (total 180 minutes) training sessions will be provided to all health providers in participating sites. In cases of staff turnover webinar training is repeated as required. Sessions will be delivered by 2 physicians, one a general practitioner and the other a public health physician, both tobacco treatment specialists. Attendance of staff members in all of the webinar sessions will be monitored through a specific form. Training Sessions: Session 1: Background on smoking in pregnancy and relevance to vulnerable subgroups including the Indigenous context – health risks/psychosocial/environmental/cultural. Non-confrontational history taking. Engagement of vulnerable pregnant smokers. Assessment of smoking in Indigenous and vulnerable women - nicotine dependence and motivation. Assessing socio-cultural aspects and environmental smoking. Culturally competent care - importance and content. Non-didactic counselling styles. Concept and benefit of ‘teachable moments’. Session 2: ABCD approach – Ask-Brief advice-Cessation medications-Discuss psychosocial context. Behaviour change techniques (BCTs) successful in pregnancy, e.g. goal setting, setting a quit date, problems solving, and boosting self-efficacy. How to tailor advice to the client. Interventions of differing intensity - brief to intensive. Involving the family in smoking management and smoke-free environments. Supportive counselling and follow up. Psychosocial support. Use of optimised resources. Referral mechanisms. Ancillary resources available: Quitline, on-line and mobile phone apps. Session 3: Using NRT in pregnancy, initiating NRT, and how to advise about NRT - NRT algorithm for pregnancy – step-wise titration. Dosage management, side-effects, indications/contra-indications, promoting adherence, recording outcomes. Use of the CO meter as a motivational tool, and for monitoring and validating abstinence. Advising re cannabis and e-cigarettes. 2. Educational package resources: Services will receive targeted educational resources including a provider training manual, provider desktop guide, a flipchart and patient booklet to guide patient education. These resources are based on a published pragmatic guide for the management of smoking in Indigenous pregnant women, and were developed collaboratively with two Aboriginal Medical Services and a Stakeholder and Consumer Aboriginal Advisory Panel. They were also put through a stringent 4 step evaluation process that included an expert panel and focus groups with health providers and community female members from three additional Aboriginal Medical Services in three states (NSW, SA, QLD). 3. Provision of free Oral NRT: Oral forms of NRT are not currently subsidised on Australian Government Schemes, so will be supplied as part of this study.. An oral NRT voucher system will be arranged, redeemable by arrangement at a local pharmacy or through the participating service, thus enabling an open-label free supply of oral NRT. The provision of Oral NRT will be monitored through a voucher system. 4. Implementation support comprised of three site visits and weekly telephone calls from the research team. 5. Audit and feedback - We will analyse the data acquired after 1 month and each service will receive information comparing its work to the other de-identified services in the study. This will be done in line with guidance from the research team on ways to improved provider practices.