Designing Indigenous Counseling and Nicotine (ICAN) QUIT in pregnancy program with the Behavior Change Wheel: Improving health provider smoking cessation care for Indigenous pregnant women

Background: In Australia, smoking rates among pregnant Indigenous women are 47%, and slow to decline. Previous strategies in this population suffered from design challenges. Aims: To develop an intervention to meet the needs of the target population, and improve culturally-competent smoking cessation care (SCC) for pregnant Indigenous smokers, by training providers at Aboriginal Medical Services. The behavior change wheel (BCW) – a parsimonious model governing capability, opportunity and motivation for behavioral interventions – provided a theoretical framework for the Indigenous Counselling and Nicotine (ICAN)QUIT in Pregnancy development. Methods: We identified evidence-practice gaps through: two systematic literature reviews on provider attitudes and interventions for SCC in pregnancy; a national survey of clinicians; and gathering stories of smoking and quitting from Aboriginal mothers. These studies facilitated the development of this targeted intervention. Results: Areas identified for performance improvement included: capability (psychological skills), motivation (optimism), and opportunity (resources/time). Using the BCW, we targeted: capability by training clinicians in pharmacotherapy to assist women to quit; opportunity by structuring the consultation using a flipchart and prompts, and using a whole-of-service approach; and optimism for success by presenting recent evidence, and positive testimonials from patients and clinicians. Webinar brings the training to the services to accommodate time and location constraints, and diversify responsibilities to providers other than clinicians. A Stakeholder and Consumer Aboriginal Advisory Panel was consulted on developing intervention materials. Conclusions: The formative development of ICAN QUIT in Pregnancy demonstrates how it is uniquely designed to improve the implementation of SCC for expectant mothers attending Aboriginal Medical Services. Training was designed to improve gaps identified from several robust studies, and includes improved counseling skills and pharmacotherapy management. The intervention has implications for reducing the risk of cancer from tobacco exposures to mother and child.