ICAN Quit in pregnancy: A multi-component intervention for smoking cessation care among pregnant Indigenous Australian women

Significance: Smoking prevalence in Indigenous Australian pregnant women is high at 43%. Health providers (HPs) in Australia lack knowledge and skills in addressing smoking with pregnant women. This study explored the feasibility and impact of a co-designed multi-component intervention at Aboriginal Medical Services (AMS) in culturally-targeted pregnancy-specific smoking cessation care (SCC).
Methods: Indigenous Counselling and Nicotine (ICAN) Quit In Pregnancy was developed in 2 phases. The intervention, developed collaboratively with AMS included resources for HPs webinar training and a Flipchart to guide the consultation using evidence-based SCC; and pregnant women: booklets with embedded augmented reality videos. Free oral NRT and carbon monoxide meters were to be supplied. After pre-testing the resources, a feasibility step-wedge randomised trial was conducted in 6 services. We collected data at service-level (numbers of pregnant smokers attending services, NRT patch prescriptions, oral NRT dispensed, HPs trained), HP-level (changes in knowledge, attitudes, practices) and patient-level (quit attempts, quit rates).
Results: Pregnant women (n=22; 47% eligible) and HPs (n=50; 54% eligible) were recruited over 6 months; retention rates of 77% and 40% respectively. At 12 weeks, self-reported 7 day point-prevalence biochemically-validated abstinence (of all women pre and post) was 13.6% (n=3); 41% (9/22) made a quit attempt. Service-level data revealed only one service increased NRT patch prescriptions, but 55% (12/22) of all women were offered oral NRT. HPs improved scores of general (p=0.011), and NRT-specific (p=0.004) knowledge; general attitude (p=0.017) and NRT-specific attitude (p=0.005). Self-reported practices were unchanged, including prescribing NRT.
Conclusion: A culturally sensitive intervention in AMS can have an impact on service provision, HP knowledge and attitudes about smoking in pregnancy, and potentially practices of offering NRT. Other considerations to strengthen the approach will be discussed.