“They Were Willing to Work with Me and Not Pressure Me”: A Qualitative Investigation into the Features of Value of a Smoking Cessation in Pregnancy Program for Aboriginal and Torres Strait Islander Women

Vivian Lyall,Leigh-Anne Pokino,Lynne Rogers,Sonya Egert,Jillian Guy,Deborah Askew

doi:10.3390/ijerph18010049

Abstract

With tobacco commonly used for stress relief, smoking cessation during pregnancy can present challenges for women facing stressful circumstances. This can be pronounced for Aboriginal and Torres Strait Islander women who experience disproportionately high smoking rates during pregnancy and also have a greater intersection of stressors from social disadvantage, institutional racism and trauma. To contribute understandings into how women can be best supported at this time, this study identified the features of value of an Aboriginal and Torres Strait Islander pregnancy smoking cessation program that addressed the contexts of women’s lives in culturally affirming and strength-based ways. A narrative methodology using a yarning approach was used to interview 7 pregnant women, 6 significant others, 3 case managers, and 4 healthcare professionals. Data were analyzed using thematic analysis, guided by an Indigenist research practice of deep and reflexive researcher listening. Features of value included: relationship-based care, holistic wraparound care, flexibility, individualized care, and culturally orientated care. Combined, they enabled highly relevant and responsive women-centered, trauma-informed, and harm-reducing smoking cessation support that was well received by participants, who achieved promising smoking changes, including cessation. This approach strongly departs from standard practices and provides a blueprint for meaningful support for pregnant women experiencing vulnerabilities.

Highlights

For women who smoke tobacco, pregnancy can present an immediate motivation to pursue smoking cessation
We review how the features of value (FOV) fostered the program’s acceptability; created a foundation for smoking reduction or cessation through contextualized support; and in doing so, reoriented the way smoking cessation support was provided with participants
Given the promising nature of the program in supporting positive smoking behavioral changes among its participants, the FOV identified in this study provide critical insights for how smoking cessation programs can support pregnant Indigenous women in safe, pragmatic and effective ways

Summary

Introduction

For women who smoke tobacco, pregnancy can present an immediate motivation to pursue smoking cessation. Seeking support to address tobacco dependency at this time can be complex due to common experiences of external judgement and internal shame for potential harms imposed on their baby [1,2]. Islander women, intersecting social and structural barriers to their health and wellbeing during pregnancy, including systemic racism, impose additional challenges that can render the goal of cessation seemingly unrealistic or of lower priority, despite a desire to quit and knowledge of the adverse effects of tobacco smoking on their baby [1,3,4]. Tobacco smoking during pregnancy is one of the most important and modifiable risk factors leading to the unacceptable disparity in Indigenous maternal and infant health outcomes internationally [5].

Methods

Discussion

Conclusion