Designing an implementation intervention with the Behaviour Change Wheel for health provider smoking cessation care for Australian Indigenous pregnant women

Gillian S Gould,Maree Gruppetta,Lou Atkins,Billie Bonevski,Michelle Bovill,Yael Bar-Zeev,Marilyn J Clarke

doi:10.1186/s13012-017-0645-1

Gillian S Gould, Maree Gruppetta + Show 5 more

Open Access

https://doi.org/10.1186/s13012-017-0645-1

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Abstract

BackgroundIndigenous smoking rates are up to 80% among pregnant women: prevalence among pregnant Australian Indigenous women was 45% in 2014, contributing significantly to the health gap for Indigenous Australians. We aimed to develop an implementation intervention to improve smoking cessation care (SCC) for pregnant Indigenous smokers, an outcome to be achieved by training health providers at Aboriginal Medical Services (AMS) in a culturally competent approach, developed collaboratively with AMS.MethodThe Behaviour Change Wheel (BCW), incorporating the COM-B model (capability, opportunity and motivation for behavioural interventions), provided a framework for the development of the Indigenous Counselling and Nicotine (ICAN) QUIT in Pregnancy implementation intervention at provider and patient levels. We identified evidence-practice gaps through (i) systematic literature reviews, (ii) a national survey of clinicians and (iii) a qualitative study of smoking and quitting with Aboriginal mothers. We followed the three stages recommended in Michie et al.’s “Behaviour Change Wheel” guide.ResultsTargets identified for health provider behaviour change included the following: capability (psychological capability, knowledge and skills) by training clinicians in pharmacotherapy to assist women to quit; motivation (optimism) by presenting evidence of effectiveness, and positive testimonials from patients and clinicians; and opportunity (environmental context and resources) by promoting a whole-of-service approach and structuring consultations using a flipchart and prompts. Education and training were selected as the main intervention functions. For health providers, the delivery mode was webinar, to accommodate time and location constraints, bringing the training to the services; for patients, face-to-face consultations were supported by a booklet embedded with videos to improve patients’ capability, opportunity and motivation.ConclusionsThe ICAN QUIT in Pregnancy was an intervention to train health providers at Aboriginal Medical Services in how to implement culturally competent evidence-based practice including counselling and nicotine replacement therapy for pregnant patients who smoke. The BCW aided in scientifically and systematically informing this targeted implementation intervention based on the identified gaps in SCC by health providers. Multiple factors impact at systemic, provider, community and individual levels. This process was therefore important for defining the design and intervention components, prior to a conducting a pilot feasibility trial, then leading on to a full clinical trial.

Highlights

The Behaviour Change Wheel (BCW) aided in scientifically and systematically informing this targeted implementation intervention based on the identified gaps in smoking cessation care (SCC) by health providers
The challenge was to implement what is known to be effective for smoking cessation care (SCC) during pregnancy, into the context of health providers working with Indigenous women served by Aboriginal Community Controlled Health Services (ACCHS)
Design and setting The aim of this study was to describe (1) how implementation and intervention components for the Indigenous Counselling and Nicotine (ICAN) QUIT in Pregnancy were developed for health provider and patient behaviour change based on the Theoretical Domains Framework (TDF) and BCW and (2) comment on the translation of current evidence from smoking cessation care during pregnancy in conjunction with Indigenous researchers and an Aboriginal community advisory panel, and relevant to an Indigenous context

Summary

Introduction

Indigenous smoking rates are up to 80% among pregnant women: prevalence among pregnant Australian Indigenous women was 45% in 2014, contributing significantly to the health gap for Indigenous Australians. Implementation science is the study of the methods to promote the systematic uptake of evidence-based practice into routine care to improve the quality and effectiveness of health services [1] In this case, the challenge was to implement what is known to be effective for smoking cessation care (SCC) during pregnancy, into the context of health providers working with Indigenous women served by Aboriginal Community Controlled Health Services (ACCHS). Tobacco smoking has become a norm and a social lubricant in many and diverse Australian Indigenous communities [2] Despite these factors, more Indigenous smokers want to quit smoking than their general population counterparts but are less likely to succeed [6, 7].

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