Posted: June 13th, 2015

Topic: research proposal in public health

ASSIGNMENT 3 – RESEARCH PROPOSAL Outline a research plan that is designed to investigate the public health issue that you have chosen in relation to your research question or hypothesis that you generated in assignment 1.   As part of the research plan the target population should be described, sample size and sampling technique discussed, a research design offered, ethical considerations should be outlined, etc.     [2,500 words] Assessment criteria • Present a clear and concise research proposal as well as the rationale for this plan.   • Conform to accepted academic standards, including appropriate referencing • Clearly written with accurate spelling and grammar. Must have well constructed sentences and paragraphs

 

 

 

This is assignment one

 

Although Australia is considered a world leader in tobacco control ,

this success not extended to Indigenous Australians  who continue to

experience significant morbidity and mortality related to smoking

.current estimates indicate that more than fifty percent of indigenous

Australians are regular smokers more than twice the rate of non

indigenous Australians, so this issue considered as  great challenge

to public health to deal the with it .   Stead et al. (2001) reported

that a poorly resourced and stressful environment, strong

community norms, isolation, and limited opportunities for respite

and recreation appear to combine to encourage smoking and

discourage cessation.  

.despite high prevalence rates in indigenous areas there is a little

research evidence about the effectiveness of tobacco health

promotions interventions in indigenous people , studies that have

been conducted have reported a variable impact and for most part are

limited by small samples non- experimental  research design .in

contrast , there is an extensive literature that examine the

effectiveness of a wide range of tobacco control interventions to

reduce the prevalence of tobacco uses among other  population. So

in this chapter I will try to find out the  answer for a research

question     ( why thus public health interventions for indigenous Australians not work ?) ) In this chapter I will review the recent

studies on tobacco control interventions and then look at the barriers

which interfere with intervention  success, in the first part I will show

the aim and overview of my research , then in second part I will

present the finding of my literature review , at the end  I will define or

refine my search question and knowledge gap , after I define search

question and knowledge gap I can detect the aim and objectives of

further study.

 

Significance of my literature review

 

– increase of morbidity and mortality rate in indigenous communities

due to high prevalence of tobacco uses is considered a major public

health problem for Australian authority

 

– increase of smoking prevalence in indigenous communities more

than fifty percent and two time more than other population without

perfect interventions until now

 

– increase percent of cancer cases in indigenous communities which

is related to tobacco uses

 

– ethical role of the the scientific research to investigate and high

light the problem especially if it’s related to social determinants, and

inequities in the society.

 

Search method

The purpose of this literature review is to investigate clear

prospectives on moderate effect of interventions  for tobacco control

inside Indigenous Australian communities , and look into the

barriers which cause high prevalence of smoking to indigenous

Australians , secondly  and during my review of literature , the

knowledge gap would be identified , finally to a certain the feasibility

of future study.studies between 2010- 2015 were included to stand on

last researches , the relevance articles can be reviewed by searching

Reference lists of Primary articles .I searched inside public health

databases in CINAHL,SCOPUS, PUBMED, Medline,  find @ flinders

(I used it because it, s a new and rich source and related to public

health) Based on the following terms, smoking cessation, tobacco

control, Interventions interventions strategies, my search was

restricted on articles and literature between 2010- 2015.search

strategies on data bases  as in scopus were as (” smoking cessation

” or “tobacco control “) and (“indigenous people” or “aboriginal

Australians”) and (“interventions” or “control”), studies were

included if it, s related barriers to interventions , and if it’s related to

causes of prevalence,  if the studies related to social determinants

of health were included also 

Key words. Smoking cessation, tobacco control, Interventions,

nicotine replacement, 

 

counselling , interventions strategies, smoking prevalence, smoking

cessation ,barriers, indigenous Australians, aboriginal Australians

 

 

Review of literature

 

Review of literature on different smoking cessation interventions as

(counselling, nicotine replacement therapy, others) (30, 10,,16,21,32,31,)

,26)

 

Studies indicate less effective of  of interventions as brief advice and

nicotine patches when delivered in primary care of low intensity when

implemented (evidence based study)(30).(26)  on the other hand 

primary care interventions as brief advice and pharmaceutical

quitting aid are effective for indigenous Australians when available

and accessible, were perceived as important and effective strategies

to help people quit ( qualitative study)(32), study also indicate ineffective of unmodified quit program (32)

 

Another Study used mass media  and anti tobacco interventions  for

tobacco control indicate  culturally targeted messages were

preferred. ((Study used systemic review of qualitative and qualitative

methods and narrative synthesis (10), 

 

other  review of literature  on study  runs out different studies on

nicotine replacement in indigenous Australians indicate a low level of

success  was achieved by program participants this indicated by (

quantitative data)(16), on the other hand qualitative data indicate rich

account of people experiences in the programme , these could be

used to develop more effective programs( the study used a mixed

methodology approach Contains qualitative and qualitative data

collect ( Johnson, O now uegbt buzi..e) (16) 

 

Other study used systemic review of academic literature and reports

from government and non government agencies published between 2001 – 2007 provides evidence that face to face counselling or quit

 

support using in conjunction with nicotine replacement therapy is

likely to increase quit rates .(31),

 

Review of literature on a study on potential effectiveness of specific

anti – smoking  mass media among indigenous Australians smokers ,

this study indicate that mainstream anti smoking advertisements are

likely to be as motivating for indigenous smokers and there are few

very few differences in motivational response to emotive mainstream 

anti smoking  advertisement between indigenous Australians and non

indigenous smokers , the result of this study highlight that the

balance between what will be effective in the population as a whole

and indigenous need to be struck, and this balance could be easily ACHIEVE (21)

 

One study (systemic review) (30)indicate some factors which were

interfere with efficiency of interventions which related also to

inequities between these communities and other population as low

socio – economic status , normality of use of tobacco , culture uses ,

low health services(30) so I will review the literature on thesis Barriers

which prevent a good interventions in indigenous Australians. 

 

Review of literature on socio-economic factors

 

Review of literature look for socio economic factors as a barrier to

quit smoking has indicated in study used analysed data from 2002

(national aboriginal survey) it indicated the poorest and  the most

socially disadvantaged are the least likely to be non smokers (22).

 

And any cessation programs must be ecologically so they can

addressee unique social and environmental influences that perpetual

smoking and create barriers to cessation in addition to providing

tobacco specific resources and services (8)

 

Stress

 

Studies show that stress as a barriers to quitting smoking as in this

review which derived from reflections within an Aboriginal medical

services and makes recommendations for interventions development

it concludes that achieving smoking cessation among indigenous

people is made significantly more complex because of multiple life

stressors experienced ( method of study depended on cessation

counselling session and dispensation of free nicotine replacement

)the result of study indicate chronic and current life stressors were

noted to be the main barriers to smoking cessation described by

participants (28) . Another study indicate the effect of stress as a

greatest barriers preventing AHWS (Australian health workers

interventions) from quitting smoking it include also personal tobacco

use and lack of professional development are important barriers to

AHWS providing quit smoking program and support to community

members as these barriers are a dressed  and AHWS feel comfortable

talking with the community numbers and referring to or providing

quit smoking programme it can be expected that the high rates of

smoking  and tobacco related illness and death with  indigenous

community will decrease (25)

 

Social context

 

Study on social context of indigenous people indicate colonisation

and the introduction of tobacco , with separate indigenous social

networks , stress lives , importance of maintaining relationships with

extended family and community network , young girls use smoking to

attain status and as away of asserting  aboriginal identity and group

membership , away of belonging , not of rebelling , the result support

the importance of a dressing contextual factors in any strategies

aimed at preventing  smoking initiation or support cessation , it’s

critically to acknowledge aboriginal identity and culture as a source

of empowerment and to recognize the role of persistent

marginalization in contributing to high prevalence and entitling of

smoking (20,23)(18).Other study indicate the need to change social

normative belief around smoking , Intervention should be effectively

delivered in both the school and family environments , smoke free

home , anti smoking socialisation behaviour.(qualitative study) (12)

 

Another study indicate influence of social networks , that impact on

tobacco  use and the extend to which smoking behaviours transcend 

network with indigenous community in fact this help to improve multi

– component tobacco control strategies. I will mention the role of

social networks in health services to indigenous Australians (13)

 

 

Health services to indigenous Australians 

 

Health services shortage in indigenous Australians community

consider an other aspect of Inequities , study that provide either

quantitative or qualitative description of self reported perceived

barriers to quitting smoking indicate lack of support from health and

other service providers (32) and there is a need to community level and

social network level interventions are priority area for the future

smoking cessation, Intervention within vulnerable group(a) 32,8),

and there is a need to participation with employee view of workplace

on smoking reduction(5)(7,,2,15). Other study Indicate that

indigenous Australians callers received significantly fewer call backs

than non indigenous callers and we’re significantly less likely to sit a

quit date . (7), other study indicate interventions targeted at

particular health problem are best integrated with usual primary

health care and more fund for local control of Planning and

implementation , and worker professional development. (15)(Study

use lessons from BOABS smoking).another study review of the

barriers preventing indigenous health workers delivered tobacco

interventions to their communities providing that there remain

potential barriers faced by  IHWS (indigenous health workers

interventions) that may undermine efforts to reduce indigenous

smoking , overcoming these barriers and assisting it to quit smoking

may provide an opportunity to address high rates of smoking in

indigenous communities .further research is required with balance

between descriptive research to address it (databases were searched

for publications that examine IHWS smoking status or quit support

programme for IHWS .studies were categorized as reviews and

commentaries , Intervention s studies or descriptive research (27)

 

Result of another study  show that community organizations as(

SCsos ) have potential as setting for reaching high  number of

smokers experience financial and social disadvantage, more over the

result show that some organisations may be receptive to integrating

smoking cessation support (2).the study also suggest that (sCsos)

are a potential important setting for researching smokers who

experience various forms of disadvantage, tobacco control

advantages should work with (sCsos for future developed

comprehensive smoke free policies. 

 

The most commonly used strategies give to most clients included

emotional support and encouragement, referral to telephone , quit

line , and provision of written information , these are largely low cost

strategies , where resources can be obtained by sCsos  from health

department free of charge , amplifying these activities  could have

positive health impact at minimal cost. (2)

 

Review of literature shows that some organisations may be receptive

to integrating smoking cessation support , another study in low

social group indicate efficacy of a client centred service ,

caseworker-delivered cessation support interventions at increasingly rate in socially disadvantage population (3)

 

Knowledge gap

 

Review of literature as in (30,26,16) especially on counselling and

nicotine replacement therapy , indicate less effectiveness of interventions when studies runs on quantitative base

Review of literature on studies as in (32, 10,16,31, 3,21,)

Indicate better results when studies based on qualitative methods

So there is a knowledge gap within the interventions held on

quantitative way , so any future studies should be qualitative in

nature estimates the specificity of indigenous people and

understanding the social context for these communities, and

any further interventions should be comprehensive interventions

 

Aims and objectives

 

– there is a need for greater investment in research to build the body

of evidence on interventions that are likely to be effective in

increasing motivation to quit among indigenous communities and in

challenging the cultural acceptance of smoking across indigenous communities as a whole .(31)

– the identification of community strength can provide a powerful

starting point for effective and empowering health promotion practice (33)

– eliminating the causes of Inequities between indigenous people and

other Australians is important element if we really look for effective cessation

– any further studies should look for culture context inside

indigenous community and qualitative approach should be followed

 

Conclusion

There is a clear need for more indigenous -specific research dissemination research targeting the uptake of secondary prevention and to establish reliable and valid measure for indigenous specific health care delivery in order to determine which dissemination strategies is effective in indigenous health care setting and programs

The majority of studies suggesting that improving health care providers, knowledge and skills is a focus of current efforts to achieve best interventions to indigenous Australians. (6)

There was a major lack of research on evaluation of tobacco interventions.which should be appropriate and effective for indigenous Australians (11)

 

References

References

 

1) Bond, C., Brough, M., Spurling, G., & Hayman, N. (2012). It had to be my choice Indigenous smoking cessation and negotiations of risk, resistance and resilience. Health, Risk & Society, 14(6), 565-581.

2) Bonevski, B., OBrien, J., Frost, S., Yiow, L., Oakes, W., & Barker, D. (2013). Novel setting for addressing tobacco-related disparities: A survey of community welfare organization smoking policies, practices and attitudes. Health Education Research, 28(1), (46)-(57.)

3) Bonevski, Billie, Paul, Christine, D’Este, Catherine, Sanson-Fisher, Robert, West, Robert, Girgis, Afaf, . . . Carter, Robert. (2011). RCT of a client-centred, caseworker-delivered smoking cessation intervention for a socially disadvantaged population.(Study protocol)(Report). BMC Public Health, 11, 70.

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6) Carroll, C., Rick, J., Leaviss, J., Fishwick, D., & Booth, A. (2013). A qualitative evidence synthesis of employees’ views of workplace smoking reduction or cessation interventions. BMC PUBLIC HEALTH, 13, 1095

6) Clifford, A., Jackson Pulver, Richmond, Shakeshaft, & Ivers. (2009). Disseminating best-evidence health-care to Indigenous health-care settings and programs in Australia: Identifying the gaps. Health Promotion International, 24(4), 404-415.

7) Cosh, S., Maksimovic, L., Ettridge, K., Copley, D., & Bowden, J. (n.d.). Aboriginal and Torres Strait Islander utilisation of the Quitline service for smoking cessation in South Australia. Australian Journal hof Primary Health, 19(2), 113-118.

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9) Doyle, Michael, Butler, Tony, & Stevens, Clare. (2011). The National Summit on Tobacco Smoking in Prison: Australian National University, Canberra, August 2010 – an Aboriginal Perspective. Aboriginal and Islander Health Worker Journal, 35(3), 10-12.

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15) Marley, Julia V., Kitaura, Tracey, Atkinson, David, Metcalf, Sue, Maguire, Graeme P., & Gray, Dennis. (2014). Clinical trials in a remote Aboriginal setting: Lessons from the BOABS smoking cessation study.(Research article)(Be Our Ally Beat Smoking)(Report). BMC Public Health, 14, 579.

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17) Passey, Megan E., Gale, Jennifer T., & Sanson-Fisher, Robert W. (2011). “It’s almost expected”: Rural Australian Aboriginal women’s reflections on smoking initiation and maintenance: A qualitative study.(Research article)(Report). BMC Women’s Health, 11, 55.

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20)Stevenson, L., Bohanna, I., Robertson, J., & Clough, A. (2013). Aboriginal people in remote communities in Arnhem Land (Northern Territory) restrict their smoking in some environments: Implications for developing and implementing interventions to reduce exposure to environmental tobacco smoke. Drug and Alcohol Review, 32(6), 627-630.

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23)Thomas, D. (2012). Changes in smoking intensity among Aboriginal and Torres Strait Islander people, 1994-2008. The Medical Journal of Australia, 197(9), 503-6.

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Initial. 2015. epidemiology. master. flinders.

 

 

25) Mark, Andy, McLeod, Iris, Booker, Julie, & Ardler, Craig. (2005). Aboriginal Health Worker Smoking: A Barrier to Lower Community Smoking Rates? Aboriginal and Islander Health Worker Journal, 29(5), 22-26.

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28) DiGiacomo, M., Davidson, P., Davison, J., Moore, L., & Abbott, P. (2007). Stressful life events, resources, and access: Key considerations in quitting smoking at an Aboriginal Medical Service. Australian and New Zealand Journal of Public Health, 31(2), 174-176.Health, 13, 879.

 

29) Power, Jennifer, Grealy, Claire, & Rintoul, Duncan. (2009). Tobacco interventions for Indigenous Australians: A review of current evidence. Health Promotion Journal of Australia, 20(3), 186-194.

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31) Power, Jennifer, Grealy, Claire, & Rintoul, Duncan. (2009). Tobacco interventions for Indigenous Australians: A review of current evidence. Health Promotion Journal of Australia,20(3), 186-194.

32) Johnston, Vanessa, & Thomas, David P. (2010). What works in Indigenous tobacco control?: The perceptions of remote Indigenous community members and health staff. Health Promotion Journal of Australia, 21(1), 45-50.

33) Brough, Mark, Bond, Chelsea, & Hunt, Julian. (2004). Strong in the city: Towards a strength-based approach in Indigenous health promotion. Health Promotion Journal of Australia, 15(3), 215-220.

34) Twyman, L., Bonevski, B., Paul, C., & Bryant, J. (2014). Perceived barriers to smoking cessation in selected vulnerable groups: A systematic review of the qualitative and quantitative literature. BMJ Open, 4(12), E006414.

 

 

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