The project aims are:
- A decrease in smoking prevalence amongst Aboriginal people living in far western NSW
- An increase in the number of quit attempts made by Aboriginal people living in far western NSW
- An increase in staff confidence and willingness to routinely deliver brief interventions related to smoking
- An increase in staff and community knowledge about the harmful effects of smoking and appropriate use of the pharmacotherapies for treatment
Organisation or Department
Maari Ma Health Aboriginal Corporation
New South Wales
The Smokers Program commenced in 2005. It is currently implemented at seven health services across far western NSW. The program is ongoing. As it is implemented by local staff rather than specialised workers, it is highly sustainable.
OATSIH funds the program with funds primarily going towards the provision of subsidised NRT for clients and the purchase of CO monitors (smokerlyzers) for case managers to use as a clinical tool.
In 2010 the program was awarded funding through the Australian Government's Indigenous Tobacco Control Initiative to assist it's continuation.
The Smokers Program is a 12-week program that consists of weekly sessions with a dedicated case manager.
The clients are divided into two groups: Healthy Start with an Aboriginal maternal infant health focus and Keeping Well from school age up. This makes the case management specialised and service delivery is more effective so that clients can receive a variety of support in conjunction with the program.
All community members are eligible to participate but there is a particular focus on recruiting Aboriginal people into the program.
The sessions provide an opportunity for the client to have a trained professional support them through their quit attempt. Carbon monoxide monitoring is a key component of the Smokers Program and allows staff to adjust the person's treatment according to the CO measurements recorded.
Treatment can include nicotine replacement therapy (NRT) or prescribed medications (varenicline or buproprion).
NRT is heavily subsidised with clients paying a token amount for the products.
If at the end of the 12-weeks a client is not ready to discharge themselves from the Smokers Program, they can continue having weekly sessions with the case manager.
All staff implementing the Smokers Program have completed internal training based on the latest evidence in smoking cessation. Staff also have the opportunity to participate in external training with the majority of staff having participated in the NSW SmokeCheck training. Many others have completed training through NSW Health whilst others have completed the Certificate level course 'Nicotine dependency and smoking cessation' through the University of Sydney.
Ongoing training is provided through regular internal training updates and videoconference sessions with the University of Sydney. A visiting smoking cessation specialist attends quarterly for 3 days, providing specialist consulting and education sessions. In addition the same specialist is available for monthly teleconference or videoconference sessions.
The Smokers Program workers are also involved in community health promotion by providing screening through CO testing, providing information about the health risks associated with tobacco and promoting the Smoker's Program at community events such as Mental Health Month, World No Tobacco Day, Youth Week and NAIDOC week. They have also run information sessions at local correctional facilities and to year 10 and 11 students at two of their Outreach secondary schools. This promotion will continue as the program is looking to work with more schools, sporting clubs, at community dinners and other community groups such as the "Wings" Youth program.
Maari Ma developed the Smokers Program with assistance from staff at NSW Health (Elayne Mitchell and Tracey Greenburg) and the University of Sydney (Renee Bittoun). The program is delivered by staff from Maari Ma and Greater Western Area Health Service (GWAHS) at six GWAHS facilities and one Maari Ma facility in the communities of Balranald, Broken Hill, Dareton, Ivanhoe, Menindee, Tibooburra and Wilcannia.
What in particular helped the project?
- Incorporation of the Smokers Program into the core duties of local health service staff. There are no specialised tobacco workers; the local RNs and AHWs case manage the Smokers Program clients. Clients are generally assigned to staff according to their other health conditions. For example, a chronic disease client will have the same case manager for smoking and chronic disease management; a pregnant mum will see the midwife for her Smokers Program sessions.
- Continuous training updates for staff to keep up with the latest evidence and to keep smoking cessation 'on the agenda'.
What in particular didn't work so well?
- A high client drop-out rate in the first 2-3 weeks makes it difficult to keep staff morale up. High staff turnover at some sites means continuity of service delivery can be impaired. Sites without a full complement of staff often have to use a waiting list system to prioritise people into the Smokers Program.
- A dedicated tobacco cessation officer would be beneficial to keep smoking cessation 'on the agenda'. Whilst a strength of the Smoker Program is that it is implemented by local staff, a full-time person employed as a 'champion' for smoking cessation would ensure that the Smokers Program continues to be updated and that the staff are well supported.
Summary of Findings and Recommendations
To the end of 2009, there had been 444 quit attempts made across the region by 328 people (136 Aboriginal people). 24% of these people (n=78) are now ex-smokers and have been for a minimum period of at least 6 months.
The Smokers Program is being evaluated with funding from a NSW Health Promotion Demonstration Grant and is entitled 'Paakantji Kiira-Muuku'. The evaluation commenced in late-2007 and is due to be completed at the end of 2010. It is an action-research model that has seen the Smokers Program evolve over the three years of the evaluation process. Staff interviews and focus groups, community focus groups and client surveys provided valuable information to enhance and improve the Smokers Program as problems were identified. Medical record audits showed increases in the provision of smoking education, brief intervention and recommendations to join the Smokers Program. Program data collection showed the number of quit attempts being made and the proportion who completed the program. Current smoking status data showed the total proportion of participants who are now ex-smokers.
The findings will be contained in a report to be completed later this year.
Project Resources and Publications
No formal publications are available as yet. The final report will be submitted to NSW Health (the funders of the evaluation) in February 2011 and a final report will be available after this time. Papers for publication are currently being prepared but have not yet been submitted.
Project Leader Tobacco Control
Primary Care Specialist Services
Maari Ma Health Aboriginal Corporation
PO Box 339
Broken Hill, NSW 2880
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