IntroductionLong-term measures to reduce tobacco consumption in Australia have had differential effectsin the population. The prevalence of smoking in Aboriginal peoples is currently more thandouble that of the non-Aboriginal population. Aboriginal Health Workers are responsible forproviding primary health care to Aboriginal clients including smoking cessation programs.However, Aboriginal Health Workers are frequently smokers themselves, and their smokingundermines the smoking cessation services they deliver to Aboriginal clients. Anunderstanding of the barriers to quitting smoking experienced by Aboriginal Health Workersis needed to design culturally relevant smoking cessation programs. Once smoking is reducedin Aboriginal Health Workers, they may then be able to support Aboriginal clients to quitsmoking.
Methods:
We undertook a fundamental qualitative description study underpinned by social ecologicaltheory. The research was participatory, and academic researchers worked in partnership withpersonnel from the local Aboriginal health council. The barriers Aboriginal Health Workersexperience in relation to quitting smoking were explored in 34 semi-structured interviews(with 23 Aboriginal Health Workers and 11 other health staff) and 3 focus groups (n = 17 participants) with key informants. Content analysis was performed on transcribed text andinterview notes.
Results:
Aboriginal Health Workers spoke of burdensome stress and grief which made them unable toprioritise quitting smoking. They lacked knowledge about quitting and access to culturallyrelevant quitting resources. Interpersonal obstacles included a social pressure to smoke, socialexclusion when quitting, and few role models. In many workplaces, smoking was part oforganisational culture and there were challenges to implementation of Smokefree policy.Respondents identified inadequate funding of tobacco programs and a lack of Smokefreepublic spaces as policy level barriers. The normalisation of smoking in Aboriginal societywas an overarching challenge to quitting.
Conclusions:
Aboriginal Health Workers experience multilevel barriers to quitting smoking that includepersonal, social, cultural and environmental factors. Multidimensional smoking cessationprograms are needed that reduce the stress and burden for Aboriginal Health Workers;provide access to culturally relevant quitting resources; and address the prevailingnormalisation of smoking in the family, workplace and community.