Question

Discuss the evaluation approach and methods you would use for determining the impact and outcomes of a stop-smoking program in an Indigenous Australian community. Please give the answer in a minimum 200 words.

Answer 1

Indigenous people throughout the world suffer a higher burden of disease than their non-indigenous counterparts contributing to disproportionate rates of disability.A significant proportion of this disability can be attributed to the adverse effect of smoking.

Health disparities in indigenous peoples may reflect a lack of consideration of historical, social, and cultural contexts in the design and delivery of research and services. Approaches to addressing high smoking rates should be relevant and appropriate to the needs and preferences of indigenous populations. To counter mistrust engendered by a history of colonization, relationships with indigenous communities should incorporate collaboration and mutually respectful partnership, including engaging with the community at all stages of the research process and enabling their meaningful involvement to ensure culturally safe practices . Rather than impose non-indigenous perspectives and methods on Indigenous people, it is necessary to acknowledge and act with genuine consideration of their beliefs and cultures. For example, the indigenous concept of health entails physical, mental, spiritual and emotional elements, reflecting both the individual and community, and is linked to political, economic, social and cultural aspects . Strategies incorporating holistic approaches are more likely to promote engagement of indigenous people and be acceptable to them. Embracing this shift from mono-cultural health systems, that marginalize indigenous people, to intercultural health systems, will foster balance, reciprocity, and practice in which different cultures are valued and incorporated

High cessation rates are traditionally indicators of a ‘successful’ intervention and can impact continued funding of programs, however, other outcomes are important in establishing efficacy in indigenous populations. Given patient, provider, and system-related barriers to access, improving availability and acceptability of programs is an effective strategy to increase community engagement in smoking cessation and other health promotion programs. People from racial and ethnic groups have been found to use effective treatments less often and have lower success rates, despite wanting to quit . Furthermore, people with higher stress levels and who live with smokers have lower abstinence rates Given that multiple quit attempts are indicators of eventual cessation, providing support for these quit attempts is likely to improve cessation rates in the long term. Enabling access further supports the normalization of quitting smoking as more individuals make quit attempts and diffuse the experience throughout the community. Efficacy may also be demonstrated by capacity built within the indigenous health workforce and the development and strengthening of relationships with non-indigenous partners.