A mixed methods evaluation of Quit for new life, a smoking cessation initiative for women having an Aboriginal baby.

BACKGROUND: Quit for new life (QFNL) is a smoking cessation initiative developed to support mothers of Aboriginal babies to quit smoking during pregnancy. The state-wide initiative provides support for pregnant women and their households including free nicotine replacement therapy (NRT) and follow up cessation advice. Services are also supported to implement systems-level changes and integrate QFNL into routine care. This study aimed to evaluate: (1) models of implementation of QFNL; (2) the uptake of QFNL; (3) the impact of QFNL on smoking behaviours; and (4) stakeholder perceptions of the initiative. METHODS: A mixed methods study was conducted comprising semi-structured interviews and analysis of routinely collected data. Interviews were conducted with 6 clients and 35 stakeholders involved in program implementation. Data were analysed using inductive content analysis. Aboriginal Maternal and Infant Health Service Data Collection (AMDC) records for the period July 2012-June 2015 were investigated to examine how many eligible women attended a service implementing QFNL and how many women took up a QFNL support. Smoking cessation rates were compared in women attending a service offering QFNL with women attending the same service prior to the implementation of QFNL to determine program impact. RESULTS: QFNL was implemented in 70 services located in 13 LHDs across New South Wales. Over 430 staff attended QFNL training, including 101 staff in Aboriginal-identified roles. In the period July 2012-June 2015 27% (n = 1549) of eligible women attended a service implementing QFNL and 21% (n = 320) of these were recorded as taking up a QFNL support. While stakeholders shared stories of success, no statistically significant impact of QFNL on smoking cessation rates was identified (N = 3502; Odds ratio (OR) = 1.28; 95% Confidence Interval (CI) = 0.96-1.70; p-value = 0.0905). QFNL was acceptable to both clients and stakeholders, increased awareness about smoking cessation, and gave staff resources to support clients. CONCLUSION: QFNL was perceived as acceptable by stakeholders and clients and provided care providers with knowledge and tangible support to offer women who presented at antenatal care as smokers, however, no statistically significant impact on rates of smoking cessation were found using the measures available.

Development of a multiple risk factor Brief Health Check for workplaces.

Health promotion in workplace settings has been prioritised to reduce chronic disease risk factors, both in Australia and internationally. This paper describes the design of a health risk assessment tool, the Brief Health Check (BHC). The BHC is one of two components of Get Healthy at Work, a state government-funded health promotion program for New South Wales workplaces. Policy imperatives required scaled-up delivery in the absence of a full pre-implementation summative evaluation. Translational formative evaluation was adapted to design an evidence based health risk assessment tool, a process for referring workers to healthy lifestyle programs, and a process for general practitioners to help workers mitigate their risk of chronic disease, independently of the workplace. The tool had good feasibility and acceptance, but barriers included business organisational issues (including the time taken to facilitate the health checks) and some scepticism among workers about the motivation of businesses and the absence of measurements other than waist circumference. A cluster nonrandomised trial showed no benefit of a modest incentive for participation. A significant proportion of workers were identified as being at risk of chronic disease, and many received an appropriate referral to an evidence based program. More work to improve uptake of referrals will increase the public health impact of the BHC.

Research evidence can successfully inform policy and practice: insights from the development of the NSW Health Breastfeeding Policy.

Strengthening the bridge between research and policy has been identified as a priority if evidence-based policy is to become the norm. However, current understanding of the research-policy interface is limited. A recent policy in NSW was the first evidence-based directive with specific actions to promote and support breastfeeding within a state health system in Australia. This paper explores the development of this policy, highlighting the factors that facilitated the incorporation of research evidence into the policy. The funding of a research centre to support NSW Health policy and workforce development was significant to the process. The existing organisational linkage ensured that the research evidence was identified, synthesised and effectively communicated, with the needs of the research users in mind and within a clear framework to guide action. The research evidence was not only strong, but also relevant with regard to prevailing political interests. The process was strengthened by the commitment of key researchers and policy makers to breastfeeding. Other types of evidence were considered, including the expert opinions of senior service providers regarding the capacity to act on the research evidence.