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Providing the evidence base to reduce harmful AOD use in
Aboriginal and Torres Strait Islander communities
When planning a program to address a health problem such as smoking it is important to be able to clearly identify the problem. Once you have described the problem, you will need to develop a strategy to address the issue based on local needs.
There is good evidence that programs work better when different activities are part of a multi-component approach to tackling smoking. This page outlines ways of planning a program that includes both community and individual approaches to smoking cessation programs. It includes strategies to map community strengths, develop partnerships, and build workforce capacity. This page also describes how the TIS Programme can be seen as part of a larger preventive health care system.
It is important to clearly identify and describe the problem that needs to be addressed by asking questions such as:
To find out more about the current smoking problem in your region you will need to draw on local knowledge about smoking. Some of this information can be found from sources such as:
If you are not sure where to begin with planning, a good starting point are the following resources developed by the Aboriginal Health and Medical Research Council of NSW (AH&MRC). They are designed to help Aboriginal Community Controlled Health Services (ACCHSs) in NSW reduce tobacco use among their clients:
Another useful set of planning resources that can help you to set goals and objectives can be found here:
Once you have clearly described the problem to be addressed in your region, you will need to develop a strategy that will allow you to tackle the issue locally. Tackling Indigenous Smoking (TIS) funded activities are expected to use a range of evidence-based activities (multi-component) and take a systems focused approach (looking at all aspects of the problem and all of the support services available for the local population) to tackling smoking. You should also think about any TIS activities you have already carried out locally and what difference they have made to community awareness of smoking matters.
There is good evidence that programs to reduce smoking work better when they focus on community as well as individual change.
Box 1: What is ‘cold turkey’?
Going cold turkey is when someone stops smoking abruptly, without any build up such as cutting down first. Often when people go cold turkey they try to quit using willpower alone. Trying to quit like this without any support can be very difficult, but with planning does work for some people. It is important to support anyone who wants to go cold turkey to plan their quit attempt by setting a quit date, and showing them how to use tips and tricks to make quitting easier. For more information on going cold turkey go to: how to quit smoking cold turkey
The different activities within a multi-component approach for TIS could include:
It is important that the activities chosen during the planning stage are evidence based, like those described under Activities that work. However, projects will be most effective when teams are able to develop successful partnerships with other health teams and programs (e.g. ‘drugs and alcohol’, ‘mums and bubs’), as well as with community organisations (e.g. social services, schools). This creates a network of care, which connects participants wanting to quit to a service or organisation where they can then access individual cessation support. Box 2 gives more tips on networking.
Box 2: Networking tips
Hot tip: Network all sorts of people…
All organisations have networks. Often you can get the support of another organization to give you access to their network. This isn’t exactly a partnership - it’s more of a helping hand to put you in touch with a group of people you would not normally be able to access, but who are on your side.
Having access to other networks can really help put together a project to potential participants. The important thing is to respect confidentiality and privacy in gaining access to other people’s networks.
If you don’t have a network you can tap into, think about running a workshop as the basis for establishing a network with other local health workers, who might be interested in health promotion and tobacco control.
Source: material adapted from Kruger K, McMillan N, Russ P and Smallwood H (2007) Talkin’ up good air: Australian Indigenous tobacco control resource kit. Melbourne: Centre for Excellence in Indigenous Tobacco Control .
Other factors that have been found to be important for the success of multi-component programs for Aboriginal and Torres Strait Islander people include:
Box 3: Tips on involving the community in your project
Hot tip: Walk, walk, walk…
Think about ways to include people in your tobacco control project or program:
Source: material adapted from Kruger K, McMillan N, Russ P and Smallwood H (2007);Talkin’ up good air: Australian Indigenous tobacco control resource kit. Melbourne: Centre for Excellence in Indigenous Tobacco Control .
Different models and approaches can be used to develop health promotion projects. Below we describe one approach that has worked well for organisations developing TIS projects in Aboriginal and Torres Strait Islander communities. However you might want to consider other public health models such as PRECEDE-PROCEED that also emphasizes community involvement in a project (see Box 4).
Box 4: PRECEDE-PROCEED model
This model believes health promotion should be community-based, and that planning and implementing a project needs everyone in the community – from policy makers to community members - to work together from the start of the project.
In PRECEDE-PROCEED you begin with the desired outcomes, then work out what activities you need to put in place to achieve these results. PRECEDE (the planning stage) has four phases:
Phase 1: Identify the desired result
Phase 2: Identify and set health and community priorities by working out the behaviours, lifestyles, and/or environmental factors relevant to this issue
Phase 3: Identify predisposing, enabling, and reinforcing factors that affect the priorities set in Phase 2
Phase 4: Identify administrative and policy factors that influence what can be implemented
PROCEED (the implementation and evaluation stage) also has four phases:
Phase 5: Implementation – designing and conducting the project activities
Phase 6: Process evaluation. Are you doing the activities you planned to do?
Phase 7: Impact evaluation. Is the project having an impact on your target population?
Phase 8: Outcome evaluation. Is the project leading to the desired outcome?
You can find out more about this and other models for developing health promotion projects on the Community tool box website.
 This material is used with permission from the Commonwealth of Australia. Talkin’ up good air contains materials that were contributed by Quit Victoria (Anti-Cancer Council of Victoria), Apunipima Cape York Health Council, National Heart Foundation of Australia (NSW Division), Council of Social Services of New South Wales and Queensland Health and which remain their property.
Figure 1: Factors that influence smoking
Taking a systems approach to developing a TIS regional tobacco control program is useful because tobacco use is a complex problem made up of many different factors. Examples of the kinds of factors relevant to smoking are shown in Figure 1. The systems approach reminds us that a complex problem is like a jigsaw puzzle – if you don’t have all the parts you can’t see the whole picture. It is a reminder that everything works together - for example the different TIS activities, relationships between community organisations and individuals in the community - so you need to consider all parts of the problem in order to effect change.
Questions to ask when planning a program:
Figure 2: A systems approach to health (adapted from Centers for Disease Control and Prevention)
A systems approach also provides a useful way of thinking about health care services. The TIS Programme can be seen as part of a larger preventive health care system, all connected in different ways such as through referral pathways, and client appointments (see Figure 2). One of the important challenges for TIS is to map out the system and make connections between the different parts e.g. connecting the Aboriginal and Torres Strait Islander Health Worker with the smoking cessation nurse/counsellor.
An example of how the systems approach has been used to develop a Tobacco Control Project for Aboriginal Australians can be found here on the Australian Prevention Partnership Centre website.
A helpful way to taking a systems approach is to work through three steps:
One really good way to start working out your systems, and identifying resources, is asset mapping. This approach is very flexible and can easily be adapted to particular community needs. One of its main advantages is that it takes a strengths based approach to mapping systems. By identifying the strengths and resources of your community (assets) in relation to TIS, you can help to uncover solutions. Once community strengths and resources are recognised and mapped out, you can think more clearly about how to build on these assets to address community needs in relation to TIS.
Figure 3: Assett mapping
The three main stages of asset mapping are shown in Figure 3:
An easy step-by-step guide to carrying out community asset mapping from the Centre for Health Policy Research at UCLA shows you how to:
The guide suggests using a street map for the final step of this mapping process, which can be a useful way of thinking about how health services are placed geographically. Another way of approaching the mapping process is to think about how the different systems (the potential partners, groups, individuals) are already connected, and where connections need to be built. There are many ways of doing this:
Step-by-step guides and other practical resources for finding out how to do asset mapping can be found here:
Partnerships are an essential part of ensuring that these systems are strongly connected. Depending on the results of your asset mapping, these may include partnerships with:
You may have existing partnerships that you can build on to make the program a success, or you may have to start afresh.
One strategy for developing committed, productive partnerships is a model called the Three learning frames:
Figure 4: Three learning frames
Read more about:
Finally, it is essential to make sure you have the capability and capacity to undertake your planned program.
Box 5: What are workforce capacity and capability?
Workforce capacity means how much the workforce can do. Capacity is determined partly by how many staff or volunteers are working for you, and their availability to perform particular tasks (e.g. TIS activities). However it is not just about ‘bodies on the ground’ – capacity is also determined by staff and stakeholder performance, engagement, motivation and effort.
Workforce capability means what the workforce can do, the skills and knowledge workers have, including things such as the ability to be innovative.
Building capability involves:
Figure: 5: Capacity for tobacco control
Building capacity is not just about numbers of staff. It is also about finding ways to achieve outcomes. Building your organisation’s capacity for supporting TIS can be developed through:
Having commitment from leaders within the community and your organisation to reduce the level of smoking in your organisation and the region will encourage more smoke free spaces and smoke free events.
Bailie R, Griffin J, Laycock A, Kelaher M, McNeair T, Percival N and Schierhout G (2013). Sentinel sites evaluation: final report. Report prepared by Menzies School of Health Research for the Australian Government Department of Health and Ageing, Canberra.
This report provides an evaluation of the Indigenous Chronic Disease Package (ICDP), a federal government initiative designed to improve the capacity of primary health care services to more effectively prevent and manage chronic disease among Indigenous populations.
Cargo M, Marks E, Brimblecombe J, Scarlett M, Maypilama E, Dhurrkay JG, & Daniel, M (2011) Integrating an ecological approach into an Aboriginal community-based chronic disease prevention program: a longitudinal process evaluation. BMC Public Health, 11(1), 299 doi: 10.1186/1471-2458-11-299
This article reports the extent to which an ecological approach was integrated into an Aboriginal community-based cardiovascular disease (CVD) and type 2 diabetes prevention program, across three-intervention years.
Kothari A, Edwards N, Yanicki S, Hansen-Ketchum P & Kennedy MA, (2007). Socioecological models: strengthening intervention research in tobacco control. Drogues, santé et société, 6(1 Suppl 3), iii1-iii24.
This article explains how socioecological concepts are relevant to programs that use multi-level interventions and policy changes to tackle tobacco control.
Lee A, Lucas K, Campbell M A & Sarin J (2016) Continuing to lift the burden: using a continuous quality improvement approach to advance Aboriginal tobacco resistance and control. Public Health Research and Practice, Volume 26(5):e2651662
Thomas D (2015) Talking About The Smokes. Medical Journal of Australia;202 Supplement(10).