Clinical trials in a remote Aboriginal setting: lessons from the BOABS smoking cessation study
There is limited evidence regarding the best approaches to helping Indigenous Australians to stop smoking. The composite analysis of the only two smoking cessation randomised controlled trials (RCTs) investigating this suggests that one-on-one extra support delivered by and provided to Indigenous Au...
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Published in | BMC public health Vol. 14; no. 1; p. 579 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
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BioMed Central Ltd
10.06.2014
BioMed Central |
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Abstract | There is limited evidence regarding the best approaches to helping Indigenous Australians to stop smoking. The composite analysis of the only two smoking cessation randomised controlled trials (RCTs) investigating this suggests that one-on-one extra support delivered by and provided to Indigenous Australians in a primary health care setting appears to be more effective than usual care in encouraging smoking cessation. This paper describes the lessons learnt from one of these studies, the Be Our Ally Beat Smoking (BOABS) Study, and how to develop and implement an integrated smoking cessation program.
Qualitative study using data collected from multiple documentary sources related to the BOABS Study. As the project neared completion the research team participated in four workshops to review and conduct thematic analyses of these documents.
Challenges we encountered during the relatively complex BOABS Study included recruiting sufficient number of participants; managing the project in two distant locations and ensuring high quality work across both sites; providing appropriate training and support to Aboriginal researchers; significant staff absences, staff shortages and high workforce turnover; determining where and how the project fitted in the clinics and consequent siloing of the Aboriginal researchers relating to the requirements of RCTs; resistance to change, and maintaining organisational commitment and priority for the project. The results of this study also demonstrated the importance of local Aboriginal ownership, commitment, participation and control. This included knowledge of local communities, the flexibility to adapt interventions to local settings and circumstances, and taking sufficient time to allow this to occur.
The keys to the success of the BOABS Study were local development, ownership and participation, worker professional development and support, and operating within a framework of cultural safety. There were difficulties associated with the BOABS Study being an RCT, and many of these are shared with stand-alone programs. Interventions targeted at particular health problems are best integrated with usual primary health care. Research to investigate complex interventions in Indigenous health should not be limited to randomised clinical trials and funding needs to reflect the additional, but necessary, cost of providing for local control of planning and implementation. |
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AbstractList | Background: There is limited evidence regarding the best approaches to helping Indigenous Australians to stop smoking. The composite analysis of the only two smoking cessation randomised controlled trials (RCTs) investigating this suggests that one-on-one extra support delivered by and provided to Indigenous Australians in a primary health care setting appears to be more effective than usual care in encouraging smoking cessation. This paper describes the lessons learnt from one of these studies, the Be Our Ally Beat Smoking (BOABS) Study, and how to develop and implement an integrated smoking cessation program. Methods: Qualitative study using data collected from multiple documentary sources related to the BOABS Study. As the project neared completion the research team participated in four workshops to review and conduct thematic analyses of these documents. Results: Challenges we encountered during the relatively complex BOABS Study included recruiting sufficient number of participants; managing the project in two distant locations and ensuring high quality work across both sites; providing appropriate training and support to Aboriginal researchers; significant staff absences, staff shortages and high workforce turnover; determining where and how the project fitted in the clinics and consequent siloing of the Aboriginal researchers relating to the requirements of RCTs; resistance to change, and maintaining organisational commitment and priority for the project. The results of this study also demonstrated the importance of local Aboriginal ownership, commitment, participation and control. This included knowledge of local communities, the flexibility to adapt interventions to local settings and circumstances, and taking sufficient time to allow this to occur. Conclusions: The keys to the success of the BOABS Study were local development, ownership and participation, worker professional development and support, and operating within a framework of cultural safety. There were difficulties associated with the BOABS Study being an RCT, and many of these are shared with stand-alone programs. Interventions targeted at particular health problems are best integrated with usual primary health care. Research to investigate complex interventions in Indigenous health should not be limited to randomised clinical trials and funding needs to reflect the additional, but necessary, cost of providing for local control of planning and implementation. Doc number: 579 Abstract Background: There is limited evidence regarding the best approaches to helping Indigenous Australians to stop smoking. The composite analysis of the only two smoking cessation randomised controlled trials (RCTs) investigating this suggests that one-on-one extra support delivered by and provided to Indigenous Australians in a primary health care setting appears to be more effective than usual care in encouraging smoking cessation. This paper describes the lessons learnt from one of these studies, the Be Our Ally Beat Smoking (BOABS) Study, and how to develop and implement an integrated smoking cessation program. Methods: Qualitative study using data collected from multiple documentary sources related to the BOABS Study. As the project neared completion the research team participated in four workshops to review and conduct thematic analyses of these documents. Results: Challenges we encountered during the relatively complex BOABS Study included recruiting sufficient number of participants; managing the project in two distant locations and ensuring high quality work across both sites; providing appropriate training and support to Aboriginal researchers; significant staff absences, staff shortages and high workforce turnover; determining where and how the project fitted in the clinics and consequent siloing of the Aboriginal researchers relating to the requirements of RCTs; resistance to change, and maintaining organisational commitment and priority for the project. The results of this study also demonstrated the importance of local Aboriginal ownership, commitment, participation and control. This included knowledge of local communities, the flexibility to adapt interventions to local settings and circumstances, and taking sufficient time to allow this to occur. Conclusions: The keys to the success of the BOABS Study were local development, ownership and participation, worker professional development and support, and operating within a framework of cultural safety. There were difficulties associated with the BOABS Study being an RCT, and many of these are shared with stand-alone programs. Interventions targeted at particular health problems are best integrated with usual primary health care. Research to investigate complex interventions in Indigenous health should not be limited to randomised clinical trials and funding needs to reflect the additional, but necessary, cost of providing for local control of planning and implementation. BACKGROUNDThere is limited evidence regarding the best approaches to helping Indigenous Australians to stop smoking. The composite analysis of the only two smoking cessation randomised controlled trials (RCTs) investigating this suggests that one-on-one extra support delivered by and provided to Indigenous Australians in a primary health care setting appears to be more effective than usual care in encouraging smoking cessation. This paper describes the lessons learnt from one of these studies, the Be Our Ally Beat Smoking (BOABS) Study, and how to develop and implement an integrated smoking cessation program.METHODSQualitative study using data collected from multiple documentary sources related to the BOABS Study. As the project neared completion the research team participated in four workshops to review and conduct thematic analyses of these documents.RESULTSChallenges we encountered during the relatively complex BOABS Study included recruiting sufficient number of participants; managing the project in two distant locations and ensuring high quality work across both sites; providing appropriate training and support to Aboriginal researchers; significant staff absences, staff shortages and high workforce turnover; determining where and how the project fitted in the clinics and consequent siloing of the Aboriginal researchers relating to the requirements of RCTs; resistance to change, and maintaining organisational commitment and priority for the project. The results of this study also demonstrated the importance of local Aboriginal ownership, commitment, participation and control. This included knowledge of local communities, the flexibility to adapt interventions to local settings and circumstances, and taking sufficient time to allow this to occur.CONCLUSIONSThe keys to the success of the BOABS Study were local development, ownership and participation, worker professional development and support, and operating within a framework of cultural safety. There were difficulties associated with the BOABS Study being an RCT, and many of these are shared with stand-alone programs. Interventions targeted at particular health problems are best integrated with usual primary health care. Research to investigate complex interventions in Indigenous health should not be limited to randomised clinical trials and funding needs to reflect the additional, but necessary, cost of providing for local control of planning and implementation. There is limited evidence regarding the best approaches to helping Indigenous Australians to stop smoking. The composite analysis of the only two smoking cessation randomised controlled trials (RCTs) investigating this suggests that one-on-one extra support delivered by and provided to Indigenous Australians in a primary health care setting appears to be more effective than usual care in encouraging smoking cessation. This paper describes the lessons learnt from one of these studies, the Be Our Ally Beat Smoking (BOABS) Study, and how to develop and implement an integrated smoking cessation program. Qualitative study using data collected from multiple documentary sources related to the BOABS Study. As the project neared completion the research team participated in four workshops to review and conduct thematic analyses of these documents. Challenges we encountered during the relatively complex BOABS Study included recruiting sufficient number of participants; managing the project in two distant locations and ensuring high quality work across both sites; providing appropriate training and support to Aboriginal researchers; significant staff absences, staff shortages and high workforce turnover; determining where and how the project fitted in the clinics and consequent siloing of the Aboriginal researchers relating to the requirements of RCTs; resistance to change, and maintaining organisational commitment and priority for the project. The results of this study also demonstrated the importance of local Aboriginal ownership, commitment, participation and control. This included knowledge of local communities, the flexibility to adapt interventions to local settings and circumstances, and taking sufficient time to allow this to occur. The keys to the success of the BOABS Study were local development, ownership and participation, worker professional development and support, and operating within a framework of cultural safety. There were difficulties associated with the BOABS Study being an RCT, and many of these are shared with stand-alone programs. Interventions targeted at particular health problems are best integrated with usual primary health care. Research to investigate complex interventions in Indigenous health should not be limited to randomised clinical trials and funding needs to reflect the additional, but necessary, cost of providing for local control of planning and implementation. There is limited evidence regarding the best approaches to helping Indigenous Australians to stop smoking. The composite analysis of the only two smoking cessation randomised controlled trials (RCTs) investigating this suggests that one-on-one extra support delivered by and provided to Indigenous Australians in a primary health care setting appears to be more effective than usual care in encouraging smoking cessation. This paper describes the lessons learnt from one of these studies, the Be Our Ally Beat Smoking (BOABS) Study, and how to develop and implement an integrated smoking cessation program. Qualitative study using data collected from multiple documentary sources related to the BOABS Study. As the project neared completion the research team participated in four workshops to review and conduct thematic analyses of these documents. Challenges we encountered during the relatively complex BOABS Study included recruiting sufficient number of participants; managing the project in two distant locations and ensuring high quality work across both sites; providing appropriate training and support to Aboriginal researchers; significant staff absences, staff shortages and high workforce turnover; determining where and how the project fitted in the clinics and consequent siloing of the Aboriginal researchers relating to the requirements of RCTs; resistance to change, and maintaining organisational commitment and priority for the project. The results of this study also demonstrated the importance of local Aboriginal ownership, commitment, participation and control. This included knowledge of local communities, the flexibility to adapt interventions to local settings and circumstances, and taking sufficient time to allow this to occur. The keys to the success of the BOABS Study were local development, ownership and participation, worker professional development and support, and operating within a framework of cultural safety. There were difficulties associated with the BOABS Study being an RCT, and many of these are shared with stand-alone programs. Interventions targeted at particular health problems are best integrated with usual primary health care. Research to investigate complex interventions in Indigenous health should not be limited to randomised clinical trials and funding needs to reflect the additional, but necessary, cost of providing for local control of planning and implementation. Background There is limited evidence regarding the best approaches to helping Indigenous Australians to stop smoking. The composite analysis of the only two smoking cessation randomised controlled trials (RCTs) investigating this suggests that one-on-one extra support delivered by and provided to Indigenous Australians in a primary health care setting appears to be more effective than usual care in encouraging smoking cessation. This paper describes the lessons learnt from one of these studies, the Be Our Ally Beat Smoking (BOABS) Study, and how to develop and implement an integrated smoking cessation program. Methods Qualitative study using data collected from multiple documentary sources related to the BOABS Study. As the project neared completion the research team participated in four workshops to review and conduct thematic analyses of these documents. Results Challenges we encountered during the relatively complex BOABS Study included recruiting sufficient number of participants; managing the project in two distant locations and ensuring high quality work across both sites; providing appropriate training and support to Aboriginal researchers; significant staff absences, staff shortages and high workforce turnover; determining where and how the project fitted in the clinics and consequent siloing of the Aboriginal researchers relating to the requirements of RCTs; resistance to change, and maintaining organisational commitment and priority for the project. The results of this study also demonstrated the importance of local Aboriginal ownership, commitment, participation and control. This included knowledge of local communities, the flexibility to adapt interventions to local settings and circumstances, and taking sufficient time to allow this to occur. Conclusions The keys to the success of the BOABS Study were local development, ownership and participation, worker professional development and support, and operating within a framework of cultural safety. There were difficulties associated with the BOABS Study being an RCT, and many of these are shared with stand-alone programs. Interventions targeted at particular health problems are best integrated with usual primary health care. Research to investigate complex interventions in Indigenous health should not be limited to randomised clinical trials and funding needs to reflect the additional, but necessary, cost of providing for local control of planning and implementation. Keywords: Indigenous, Aboriginal, Torres Strait Islander, Smoking cessation, Be Our Ally Beat Smoking (BOABS) study, Qualitative, Randomised controlled trial |
ArticleNumber | 579 |
Audience | Academic |
Author | Maguire, Graeme P Gray, Dennis Marley, Julia V Atkinson, David Kitaura, Tracey Metcalf, Sue |
AuthorAffiliation | 2 Kimberley Aboriginal Medical Services Council, 12 Napier Terrace, PO Box 1377, Broome, Western Australia 6725, Australia 1 The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Terrace, PO Box 1377, Broome, WA 6725, Australia 3 Derby Aboriginal Health Service, 1 Stanley Street, PO Box 1155, Derby, Western Australia 6728, Australia 6 National Drug Institute, Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia 5 Baker IDI, Alice Springs, Northern Territory 0871, Australia 4 School of Medicine and Dentistry, James Cook University, Cairns, Queensland 4870, Australia |
AuthorAffiliation_xml | – name: 3 Derby Aboriginal Health Service, 1 Stanley Street, PO Box 1155, Derby, Western Australia 6728, Australia – name: 5 Baker IDI, Alice Springs, Northern Territory 0871, Australia – name: 6 National Drug Institute, Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia – name: 1 The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Terrace, PO Box 1377, Broome, WA 6725, Australia – name: 4 School of Medicine and Dentistry, James Cook University, Cairns, Queensland 4870, Australia – name: 2 Kimberley Aboriginal Medical Services Council, 12 Napier Terrace, PO Box 1377, Broome, Western Australia 6725, Australia |
Author_xml | – sequence: 1 givenname: Julia V surname: Marley fullname: Marley, Julia V email: Julia.Marley@rcswa.edu.au organization: The Rural Clinical School of Western Australia, The University of Western Australia, 12 Napier Terrace, PO Box 1377, Broome, WA 6725, Australia. Julia.Marley@rcswa.edu.au – sequence: 2 givenname: Tracey surname: Kitaura fullname: Kitaura, Tracey – sequence: 3 givenname: David surname: Atkinson fullname: Atkinson, David – sequence: 4 givenname: Sue surname: Metcalf fullname: Metcalf, Sue – sequence: 5 givenname: Graeme P surname: Maguire fullname: Maguire, Graeme P – sequence: 6 givenname: Dennis surname: Gray fullname: Gray, Dennis |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/24912949$$D View this record in MEDLINE/PubMed |
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Aboriginal Social and Economic Impact Assessment of the Ord River Irrigation Project year: 2004 ident: 6698_CR22 contributor: fullname: F Skyring – volume-title: Scoping study of health promotion tools for Aboriginal and Torres Strait Islander people year: 2012 ident: 6698_CR29 contributor: fullname: M Wise – volume-title: Indigenous Participation in Australian Economies II Historical engagements and current enterprise year: 2012 ident: 6698_CR19 contributor: fullname: F Skyring – volume: 197 start-page: 503 issue: 9 year: 2012 ident: 6698_CR1 publication-title: Med J Aust doi: 10.5694/mja12.10558 contributor: fullname: DP Thomas – volume: 15 start-page: 280 issue: 4 year: 2006 ident: 6698_CR36 publication-title: Tob Control doi: 10.1136/tc.2005.015487 contributor: fullname: JF Etter – volume-title: The impact of tobacco smoking and alcohol consumption on Aboriginal mortality and hospitalisation in Western Australia: 1983–1991 year: 1994 ident: 6698_CR4 contributor: fullname: E Unwin – volume: 197 start-page: 404 issue: 7 year: 2012 ident: 6698_CR10 publication-title: Med J Aust doi: 10.5694/mja12.10275 contributor: fullname: JV Marley – volume: 15 start-page: 67 issue: 1 year: 2003 ident: 6698_CR33 publication-title: J Int Dev doi: 10.1002/jid.966 contributor: fullname: V Oliveira-Cruz – volume: 193 start-page: 516 issue: 9 year: 2010 ident: 6698_CR9 publication-title: Med J Aust doi: 10.5694/j.1326-5377.2010.tb04035.x contributor: fullname: JV Marley – volume-title: (Kununurra) Big River. Aboriginal Cultural Values of the Ord River and Wetlands year: 2003 ident: 6698_CR23 contributor: fullname: K Barber – ident: 6698_CR26 – volume-title: The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples year: 2005 ident: 6698_CR3 contributor: fullname: D Trewin – volume-title: Aboriginal Primary Health Care: An Evidenced-based Approach year: 2008 ident: 6698_CR35 contributor: fullname: S Couzos – volume-title: Aboriginal Primary Health Care year: 2008 ident: 6698_CR13 contributor: fullname: RB Murray – volume: 197 start-page: 16 issue: 1 year: 2012 ident: 6698_CR31 publication-title: Med J Aust doi: 10.5694/mja11.11642 contributor: fullname: LM Jamieson – volume-title: Nyikina and Mangala Mardoowarra Wila Booroo: Natural and Cultural Heritage Plan. Providing information to plan for and manage activities on Nyikina and Mangala country while protecting culture and the environment year: 2011 ident: 6698_CR20 contributor: fullname: J Watson – volume: 65 start-page: 582 year: 2011 ident: 6698_CR28 publication-title: J Epidemiol Community Health doi: 10.1136/jech.2008.082602 contributor: fullname: CP Bonell – volume: 176 start-page: 248 year: 2002 ident: 6698_CR16 publication-title: Med J Aust doi: 10.5694/j.1326-5377.2002.tb04398.x contributor: fullname: K Jamrozik – volume: 12 start-page: 232 issue: 1 year: 2012 ident: 6698_CR6 publication-title: BMC Public Health doi: 10.1186/1471-2458-12-232 contributor: fullname: JV Marley – volume: 11 start-page: 299 year: 2011 ident: 6698_CR30 publication-title: BMC Public Health doi: 10.1186/1471-2458-11-299 contributor: fullname: M Cargo – volume-title: Aboriginal Population Profiles for Development Planning in the Northern East Kimberley. Research monograph no. 23. Centre for Aboriginal Economic Policy Research year: 2003 ident: 6698_CR24 contributor: fullname: J Taylor – volume-title: Note for Guidance on Good Clinical Practice (CPMP/ICH/135/95 − Annotated with TGA comments) year: 2000 ident: 6698_CR25 contributor: fullname: Therapeutic Goods Administration – volume: 29 start-page: S4 issue: Suppl 1 year: 2006 ident: 6698_CR2 publication-title: Diabetes Care doi: 10.2337/diacare.29.s1.06.s4 contributor: fullname: American Diabetes Association – volume: 182 start-page: 514 issue: 10 year: 2005 ident: 6698_CR12 publication-title: Med J Aust doi: 10.5694/j.1326-5377.2005.tb00017.x contributor: fullname: KS Panaretto |
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Snippet | There is limited evidence regarding the best approaches to helping Indigenous Australians to stop smoking. The composite analysis of the only two smoking... Background There is limited evidence regarding the best approaches to helping Indigenous Australians to stop smoking. The composite analysis of the only two... Doc number: 579 Abstract Background: There is limited evidence regarding the best approaches to helping Indigenous Australians to stop smoking. The composite... BACKGROUNDThere is limited evidence regarding the best approaches to helping Indigenous Australians to stop smoking. The composite analysis of the only two... Background: There is limited evidence regarding the best approaches to helping Indigenous Australians to stop smoking. The composite analysis of the only two... BACKGROUND: There is limited evidence regarding the best approaches to helping Indigenous Australians to stop smoking. The composite analysis of the only two... |
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SubjectTerms | Australia Clinical trials Computer software industry Councils Diaries Health aspects Health Promotion Health services Health Services, Indigenous Humans Intervention Medical research Meetings Native Hawaiian or Other Pacific Islander Native peoples Outcome and Process Assessment, Health Care Randomized Controlled Trials as Topic Rural Population Smoking - ethnology Smoking cessation Smoking Cessation - methods Smoking Prevention Social aspects Studies Tobacco |
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Title | Clinical trials in a remote Aboriginal setting: lessons from the BOABS smoking cessation study |
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