Marley Julia V, Kitaura Tracey, Atkinson David, Metcalf Sue, Maguire Graeme P, Gray Dennis
The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Terrace, PO Box 1377, Broome, WA 6725, Australia.
BMC Public Health. 2014 Jun 10;14:579. doi: 10.1186/1471-2458-14-579.
There is limited evidence regarding the best approaches to helping Indigenous Australians to stop smoking. The composite analysis of the only two smoking cessation randomised controlled trials (RCTs) investigating this suggests that one-on-one extra support delivered by and provided to Indigenous Australians in a primary health care setting appears to be more effective than usual care in encouraging smoking cessation. This paper describes the lessons learnt from one of these studies, the Be Our Ally Beat Smoking (BOABS) Study, and how to develop and implement an integrated smoking cessation program.
Qualitative study using data collected from multiple documentary sources related to the BOABS Study. As the project neared completion the research team participated in four workshops to review and conduct thematic analyses of these documents.
Challenges we encountered during the relatively complex BOABS Study included recruiting sufficient number of participants; managing the project in two distant locations and ensuring high quality work across both sites; providing appropriate training and support to Aboriginal researchers; significant staff absences, staff shortages and high workforce turnover; determining where and how the project fitted in the clinics and consequent siloing of the Aboriginal researchers relating to the requirements of RCTs; resistance to change, and maintaining organisational commitment and priority for the project. The results of this study also demonstrated the importance of local Aboriginal ownership, commitment, participation and control. This included knowledge of local communities, the flexibility to adapt interventions to local settings and circumstances, and taking sufficient time to allow this to occur.
The keys to the success of the BOABS Study were local development, ownership and participation, worker professional development and support, and operating within a framework of cultural safety. There were difficulties associated with the BOABS Study being an RCT, and many of these are shared with stand-alone programs. Interventions targeted at particular health problems are best integrated with usual primary health care. Research to investigate complex interventions in Indigenous health should not be limited to randomised clinical trials and funding needs to reflect the additional, but necessary, cost of providing for local control of planning and implementation.
关于帮助澳大利亚原住民戒烟的最佳方法，证据有限。对仅有的两项调查此事的戒烟随机对照试验（RCT）进行的综合分析表明，在初级卫生保健环境中，由澳大利亚原住民提供并为其提供的一对一额外支持，在鼓励戒烟方面似乎比常规护理更有效。本文描述了从其中一项研究——“成为我们的盟友，战胜吸烟”（BOABS）研究中吸取的经验教训，以及如何制定和实施综合戒烟计划。
采用定性研究方法，使用从与BOABS研究相关的多个文献来源收集的数据。随着项目接近尾声，研究团队参加了四个研讨会，对这些文件进行审查和主题分析。
在相对复杂的BOABS研究过程中，我们遇到的挑战包括招募足够数量的参与者；在两个偏远地点管理项目并确保两个地点的工作质量都很高；为原住民研究人员提供适当的培训和支持；大量员工缺勤、人员短缺和高劳动力周转率；确定项目在诊所中的位置和方式以及随之而来的与随机对照试验要求相关的原住民研究人员的孤立；对变革的抵制，以及维持组织对该项目的承诺和优先级。这项研究的结果还证明了当地原住民所有权、承诺、参与和控制的重要性。这包括对当地社区的了解、根据当地情况和环境调整干预措施的灵活性，以及花足够的时间来实现这一点。
BOABS研究成功的关键在于当地的发展、所有权和参与、工作人员的专业发展和支持，以及在文化安全的框架内运作。作为一项随机对照试验，BOABS研究存在一些困难，其中许多困难也是独立项目所共有的。针对特定健康问题的干预措施最好与常规初级卫生保健相结合。调查原住民健康复杂干预措施的研究不应局限于随机临床试验，资金需要反映出为当地规划和实施控制提供额外但必要的成本。
