Abstract
Aboriginal Australians, including Aboriginal Health Workers (AHWs), smoke at rates double the non-Aboriginal population. This study utilized concept mapping methodology to identify and prioritize culturally relevant strategies to promote smoking cessation in AHWs. Stakeholder participants included AHWs, other health service employees and tobacco control personnel. Smoking cessation strategies (n = 74) were brainstormed using 34 interviews, 3 focus groups and a stakeholder workshop. Stakeholders sorted strategies into meaningful groups and rated them on perceived importance and feasibility. A concept map was developed using multi-dimensional scaling and hierarchical cluster analyses. Ten unique clusters of smoking cessation strategies were depicted that targeted individuals, family and peers, community, workplace and public policy. Smoking cessation resources and services were represented in addition to broader strategies addressing social and environmental stressors that perpetuate smoking and make quitting difficult. The perceived importance and feasibility of clusters were rated differently by participants working in health services that were government-coordinated compared with community-controlled. For health service workers within vulnerable populations, these findings clearly implicate a need for contextualized strategies that mitigate social and environmental stressors in addition to conventional strategies for tobacco control. The concept map is being applied in knowledge translation to guide development of smoking cessation programs for AHWs.
Highlights
Aboriginal Health Workers (AHWs) work within a variety of health and community settings as primary care practitioners responsible for providing comprehensive health care to Aboriginal clients— including smoking cessation services [5]
The Concept Map highlights that stakeholders perceive the promotion of smoking cessation in AHWS as requiring initiatives targeted at individual AHWs (n 1⁄4 3 clusters) as well as strategies targeted at their family and peer network (n 1⁄4 1 cluster), the community (n 1⁄4 1 cluster), the workplace (n 1⁄4 3 clusters) and public policy (n 1⁄4 2 clusters)
This study demonstrates that stakeholders envisage smoking cessation program for AHWs should include established tobacco control activities in conjunction with Aboriginal-specific tobacco control measures as well as broader strategies that address social and environmental stressors
Summary
Aboriginal Health Workers (AHWs) work within a variety of health and community settings as primary care practitioners responsible for providing comprehensive health care to Aboriginal clients— including smoking cessation services [5]. Stakeholder consultations with Aboriginal community members and health staff illustrate that largely orthodox, evidence-based tobacco control strategies are not always viewed as relevant or applicable to local Aboriginal communities [12]. It is unclear if smoking cessation programs for AHWs should draw on proven tobacco control activities, or unique approaches tailored to cultural needs. The aim of this study was to identify and prioritize stakeholder-relevant strategies to promote smoking cessation in AHWs and create a visual framework depicting stakeholder conceptions of culturally relevant smoking cessation programs for AHWs. A structured process was needed to elucidate the contextual factors that make quitting difficult for AHWs, and identify culturally relevant targeted strategies that could enable AHWs to quit smoking. Concept mapping was a suitable method by which to identify and prioritize smoking cessation strategies for AHWs because it involves inclusive participatory processes that derive tangible stakeholder-relevant outputs for immediate application in program planning
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