title: Aboriginal health workers experience multilevel barriers to quitting smoking: a qualitative study.
abstract: BACKGROUND
  Long-term measures to reduce tobacco consumption in Australia have had differential effects in the population. The prevalence of smoking in Aboriginal peoples is currently more than double that of the non-Aboriginal population. Aboriginal Health Workers are responsible for providing primary health care to Aboriginal clients including smoking cessation programs. However, Aboriginal Health Workers are frequently smokers themselves, and their smoking undermines the smoking cessation services they deliver to Aboriginal clients. An understanding of the barriers to quitting smoking experienced by Aboriginal Health Workers is needed to design culturally relevant smoking cessation programs. Once smoking is reduced in Aboriginal Health Workers, they may then be able to support Aboriginal clients to quit smoking.
  
  
  METHODS
  We undertook a fundamental qualitative description study underpinned by social ecological theory. The research was participatory, and academic researchers worked in partnership with personnel from the local Aboriginal health council. The barriers Aboriginal Health Workers experience 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 and interview notes.
  
  
  RESULTS
  Aboriginal Health Workers spoke of burdensome stress and grief which made them unable to prioritise quitting smoking. They lacked knowledge about quitting and access to culturally relevant quitting resources. Interpersonal obstacles included a social pressure to smoke, social exclusion when quitting, and few role models. In many workplaces, smoking was part of organisational culture and there were challenges to implementation of Smokefree policy. Respondents identified inadequate funding of tobacco programs and a lack of Smokefree public spaces as policy level barriers. The normalisation of smoking in Aboriginal society was an overarching challenge to quitting.
  
  
  CONCLUSIONS
  Aboriginal Health Workers experience multilevel barriers to quitting smoking that include personal, social, cultural and environmental factors. Multidimensional smoking cessation programs are needed that reduce the stress and burden for Aboriginal Health Workers; provide access to culturally relevant quitting resources; and address the prevailing normalisation of smoking in the family, workplace and community.
authors.affiliation: University of South Australia, Sansom Institute for Health Research, Social Epidemiology and Evaluation Research Group, GPO Box 2471, IPC: CEA-01, Adelaide, South Australia, 5001, Australia.
authors.forename: Anna P
authors.initials: AP
authors.lastname: Dawson
authors.forename: Margaret
authors.initials: M
authors.lastname: Cargo
authors.forename: Harold
authors.initials: H
authors.lastname: Stewart
authors.forename: Alwin
authors.initials: A
authors.lastname: Chong
authors.forename: Mark
authors.initials: M
authors.lastname: Daniel
mesh_terms: D054521:Cultural Competency; D003695:Delivery of Health Care / Q000208:ethnology / Q000379:methods; D005260:Female; D017144:Focus Groups; D006291:Health Policy; D054624:Health Status Disparities; D006280:Health Workforce / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D016540:Smoking Cessation / Q000208:ethnology* / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data