Academic literature on the topic 'Torres Stait Islander woman'

Smoking prevalence of pregnant Aboriginal and Torres Strait Islander women is quadruple that of pregnant women in the Australian population, and is associated with significant adverse outcomes in pregnancy. While cessation is a priority, there is as yet little evidence for effective interventions. This paper provides a pragmatic approach to addressing the complexities of smoking in pregnant Aboriginal and Torres Strait Islander peoples and informs clinicians about the initiation of nicotine replacement therapy (NRT) in pregnancy. Experts agree that nicotine replacement is safer than continuing to smoke in pregnancy. Although a pharmacotherapy-free attempt is initially recommended, if abstinence is not able to be achieved in the first few days, the women should be offered an accelerated option of NRT starting with oral forms and then, if required, progressing to nicotine patch or combined oral and transdermal therapy. Support should be offered for at least 12 weeks and post-partum. Offering counselling and cessation support to partners and family is also important, as is linking the woman in with appropriate social and community support and Aboriginal specific services. As long as oral forms of NRT are not included in the Pharmaceutical Benefit Scheme for Aboriginal and Torres Strait Islander women a significant and inequitable barrier will remain.

This review summarized literature about knowledge, attitudes, and beliefs of Aboriginal and Torres Strait Islander women from Australia who smoke during pregnancy, then examined the extent that existing health promotion materials and media messages aligned with evidence on smoking cessation for pregnant Aboriginal and Torres Strait Islander women. Knowledge, attitudes, and beliefs of pregnant Aboriginal women who smoke tobacco were identified in the literature. Health promotion campaigns were retrieved from a grey literature search with keywords and social and professional networks. Key themes from peer-reviewed papers were compared against the content of health promotion campaigns using the Aboriginal Social and Emotional Wellbeing Model, the Behavior Change Wheel and thematic analysis. Eleven empirical studies and 17 campaigns were included. Empirical studies highlighted women sought holistic care that incorporated nicotine replacement therapy, engaged with their family and community and the potential for education about smoking cessation to empower a woman. Health promotion campaigns had a strong focus on ‘engagement with family and community’, ‘knowledge of risks of smoking,’ ‘giving up vs cutting down’ and ‘culture in language and arts’. There were similarities and variances in the key themes in the research evidence and promotion materials. Topics highly aligned included risks from smoking and quitting related issues.

During some stage in their lives many Torres Strait Islanders, especially women will migrate to Australia in order to further their education, employment and training (Warrior, 1997). This paper focuses on a recent that I carried out among Torres Strait Islander women living on the mainland. The purpose of the survey is to indicate how Torres Strait Islander women are maintaining their identity whilst living on the mainland. To show these results, first the Torres Strait Islanders will be discussed generally to give an overview of their identity, then briefly Torres Strait Islanders on the mainland will be discussed. The paper will then conclude which the results from the survey conducted.

The first recorded Aboriginal person to graduate with an undergraduate qualification from any Australian university was Aboriginal woman Margaret Williams-Weir in 1959 ( Melbourne University, 2018 ). Williams-Weir graduated with a Diploma in Education. There have now been six decades of graduating Indigenous Australian women in the discipline of education, and many other disciplines. In this article, we explore Indigenous women’s presence in higher education through the narratives of our lives as Aboriginal women within education and the lives of other Indigenous women, noting their achievements and challenges. We acknowledge that while the number of Aboriginal and Torres Strait Islander women participating in university study and becoming engaged in education as a discipline at undergraduate and postgraduate levels has increased, we are still significantly underrepresented. Similarly, while we have seen increases in Indigenous university staff within the education discipline, the employment of Indigenous academics has not reached parity with non-Indigenous academics levels and too few are employed in the professoriate and in senior management positions. We will show how we would not have been able to develop our education careers within higher education without the bridges built by those like Dr Williams-Weir and others who went before us. We will share how we have worked to establish the footings for those Indigenous women who will follow us and others. In this way, we work within the context that is for the now and the future.

Background Digital health offers a fresh avenue to address health disparities experienced by Aboriginal and Torres Strait Islanders. Despite the scant evidence about how Aboriginal and Torres Strait Islanders access and use health technology, the Australian government has prioritised research that uses technology to enable people to manage their health and promote better health outcomes. Older Aboriginal and Torres Strait Islander women are cultural leaders in their communities, enabling them to provide valuable insights about the safety and efficacy of health care messaging. However, no research has engaged older Aboriginal and Torres Strait Islander, women as partners in digital health research. Objective This paper provides a protocol for co-designed translational research that privileges older Aboriginal & Torres Strait Islander women’s cultural expertise to design and test a framework for accessible, culturally safe and feasible digital health technologies. Methods This mixed-methods research project will use the collective impact approach, a user-centred, co-design methodology and yarning circles, a recognised Indigenous research methodology. A series of yarning circles with three different communities will elucidate enablers and barriers to access health information; co-create a framework clarifying what works and does not work for digital health promotion in their communities; and test the framework by co-creating three digital health information programs. Conclusions Privileging the cultural expertise of older Aboriginal and Torres Strait Islander women will provide a novel perspective and vital guidance that end users and developers can trust and rely upon to create and evaluate culturally safe and efficacious digital health promotion programs.

The Australian National Aboriginal and Torres Strait Islander Women’s Health Strategy was developed to reflect the health priorities of Aboriginal and Torres Strait Islander women, as identified by Aboriginal and Torres Strait Islander women themselves. This article describes the process used by the Australian Women’s Health Network to develop the strategy. The women involved in the research used the talking circle method and engaged with Aboriginal and Torres Strait Islander women through a process referred to as ‘talkin’ up’, where women ‘talk back’ to one another about issues that matter to them. In this article, we describe the power of the talkin’ up process, as a way for Aboriginal and Torres Strait Islander women to identify their own issues, discuss them in context and talk in a culturally safe environment. The strategy which emerged from this process is an accurate reflection of the issues that are important to Australian Indigenous women and highlights the improvements needed in Aboriginal and Torres Strait Islander women’s health to strengthen and underpin women’s health, Indigeneity and their sense of well-being as Aboriginal and Torres Strait Islander women.

Objectives: To determine the accuracy of routine identification of Aboriginal and Torres Strait Islander womenconfining at King George V (KGV) Hospital, located in Sydney, Australia.Design: Interviewer-administered survey.Participants: Consecutive sample of women who delivered live, well infants from May to July 1999.Main Outcome Measure: Comparison of hospital documentation compared with confidential self-disclosureof Aboriginal or Torres Strait Islander status to a female Aboriginal health professional.Results: Of 536 women in our sample, 29 (5%) self-disclosed as being Aboriginal or Torres Strait Islander.Only 10 of these were identified as Aboriginal or Torres Strait Islander in hospital records (p<0.001). While specificity as determined by us was 100%, sensitivity was low (34.5%). Those Aboriginal and Torres Strait Islander women referred by another organisation were significantly more likely than those who self-referred to the hospital to be correctly identified (p=0.011). Only 1% of non-Aboriginal women indicated they would have objected to an explicit question by staff about their Aboriginal or Torres Strait Islander status.Conclusions: Routine identification significantly under-represents Aboriginal or Torres Strait Islander women giving birth at an urban obstetric hospital. We recommend the development and use of a sensitive but also specific series of questions to ensure women always are given the opportunity to disclose their status, especially as few women appear to mind such questions.

AbstractTobacco smoking perpetuates the disadvantages experienced by Aboriginal and Torres Strait Islander people in Australia. Tobacco smoking is a risk factor for poor maternal and infant outcomes in pregnancy. Over half of Aboriginal and Torres Strait Islander women smoke during pregnancy and few successfully quit. Aboriginal and Torres Strait Islander women face many intrinsic barriers to quitting such as low socioeconomic disadvantage and patterns of use in family networks. There are also several extrinsic hurdles surrounding current practice guidelines and policy that may limit success in reducing smoking rates among Aboriginal and Torres Strait Islander women during pregnancy: the use of the Stages of Change (SOC) model; delay in the use of nicotine replacement therapy (NRT); and the absence of subsidised intermittent NRT. A more proactive approach towards smoking cessation for pregnant Aboriginal and Torres Strait Islander women may be necessary, including moving away from the SOC model approach and subsidised provision of intermittent NRT. Comprehensive programs that take into account the family network and wider social context are also recommended.

Background: Aboriginal and Torres Strait Islander women deserve improved smoking cessation support. Aboriginal health workers (AHW) and practitioners (AHP) can be central to the provision of culturally safe smoking cessation care (SCC). The objective of this study is to explore attitudes and the perceived role of AHWs/AHPs toward providing SCC to Aboriginal and Torres Strait Islander pregnant women. Method: A mixed-method study using quantitative and qualitative data was conducted among AHW/AHPs in 2021 across Australia. Descriptive and analytical statistics were used to characterise AHWs’/AHPs’ attitudes towards SCC and to evaluate the factors associated with perceptions of who is best placed to provide SCC. Results: From the total AHW/AHP workforce, 21.2% (223) completed the survey. Less than half (48.4%) believed that AHW/AHP were best placed to provide SCC for pregnant women. The majority believed that group-based supports (82.5%) and cultural support programs (63.7%) were the best strategies to support Aboriginal and Torres Strait Islander pregnant women to quit smoking. Conclusion: This study highlights the need to enhance SCC offered to Aboriginal and Torres Strait Islander pregnant women. A targeted workforce dedicated to smoking cessation should be resourced, including funding, standardised training, and ongoing SCC support tailored to Aboriginal and Torres Strait Islander pregnant women.

This exegesis examines the context of my studio work submitted for the degree of Doctor of Visual Art at Griffith University in 2004. My art practice reflects my identity, which is complex and many-stranded, but at its core is my identity as a 21st century woman of Torres Strait Islander descent. I also acknowledge multiple heritages and, like many of my contemporaries, I am a descendant of those two thirds of the Torres Strait population who now live on the Australian mainland. Having been born and brought up on the mainland also means that I am connected to, and have been affected by, wider Australian Indigenous issues, particularly those resulting from the alienation and dislocation which stem from colonialism. Therefore, as I draw from both traditional and contemporary modes and theory to explore the appropriateness of my art practice, this exegesis centres on the question: What constitutes culturally appropriate practice for me as a contemporary Torres Strait Island woman?

This exegesis examines the context of my studio work submitted for the degree of Doctor of Visual Art at Griffith University in 2004. My art practice reflects my identity, which is complex and many-stranded, but at its core is my identity as a 21st century woman of Torres Strait Islander descent. I also acknowledge multiple heritages and, like many of my contemporaries, I am a descendant of those two thirds of the Torres Strait population who now live on the Australian mainland. Having been born and brought up on the mainland also means that I am connected to, and have been affected by, wider Australian Indigenous issues, particularly those resulting from the alienation and dislocation which stem from colonialism. Therefore, as I draw from both traditional and contemporary modes and theory to explore the appropriateness of my art practice, this exegesis centres on the question: What constitutes culturally appropriate practice for me as a contemporary Torres Strait Island woman?
Thesis (Professional Doctorate)
Doctor of Visual Arts (DVA)
Queensland College of Art
Full Text

This thesis explores the physical activity experiences of Aboriginal and Torres Strait Islander mothers from a health promotion viewpoint, in which the determinants of physical activity can be understood. Although regarded as highly inactive subgroup of the population, little is known about the influence the determinants of health have on Aboriginal and Torres Strait Islander mothers’ physical activity participation. Therefore it is difficult to understand how future interventions could be developed to improve physical activity levels and probably explains why so few exist. The central argument of this thesis was that standardised, ‘one size fits all’ approaches, targeted at the majority are ineffective if they did not address the needs of specific groups and populations. Physical inactivity is a serious public health issue for all Australians, in particular the Aboriginal and Torres Strait Islander population, who suffer the greatest burden of disease. Hence, efforts to close the gap are needed by promoting physical activity, which is noted as the second most modifiable risk factor to chronic disease. In order to do this a comprehensive understanding of the factors that influence participation is needed. Whilst limited information that documented the physical activity determinants of Aboriginal and Torres Strait Islander mothers was available, the influences of the broader determinants were examined. The World Health Organization’s social determinants of health were used as framework to understand the various influences that impacted Aboriginal and Torres Strait Islander women’s lives. The purpose of this initial investigation was to contextualise physical activity behaviour. At this point however, it was discovered that the evidence base of the broader Australian maternal population was also relatively small. Therefore, pilot work was conducted to strengthen the knowledge and approach that would be taken in the main study.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Public Health
Griffith Health
Full Text

This dissertation examines the published and unpublished work to date by Australian author Eleanor Dark (1901-1985). It discusses quite divergent aspects of Dark's work, ranging from her engagement with modernist writing styles to her interest in ecology and, in so doing, offers quite diverse perspetives on Australian women's writing in the 1930s, 1940s, and 1950s. In this discussion, I consider Dark as a transitional author who deployed differing narrative modes, from realism to modernism, but also as an itnellectual writer who undertakes an ideological enquiry into her vision of an Australian 'nation.' In this study, I trace the ways in which Dark's writing has been eclipsed by a confluence of political machinations, literary critical strategies and, so some extent, the perceptions permitted by Dark herself. The dissertation calls attention to the tensions and ambivalences associated with creative aspiration in a period of accelerating change. In this examination certain feminist and cultural studies stragegies take precedence. The study endeavours to extend existing Dark criticism by focussing on the connections between, on the one hand, her varied writing techniques and thematic interests and, on the other, the wider perspectives of a newly-constituted nation's engagement with modernity.

Research Doctorate - Doctor of Philosophy (PhD)
After decades of discrimination and deprivation, Australia’s Aboriginal and Torres Strait Islander population faces social circumstances and health status which resemble that of a third world population group. With a wide range of health risk factors and morbidities among this population, a logical place to begin tackling the health problems is at the beginning of life. With increasing recognition of the influence of the intrauterine environment upon health, not only during infancy but into adulthood, improving health during pregnancy offers substantial benefit for present and future generations. The poor health of Aboriginal and Torres Strait Islander Australians is deeply ingrained in social deprivation, poor mental well-being, and an array of modifiable risk factors. Smoking is one risk factor at the centre of this complex web. Smoking is often accompanied by, or used as relief in, stressful situations associated with socioeconomic status, mental health, illness, and other addictions. In order to determine the most appropriate way to tackle the smoking issue among Aboriginal and Torres Strait Islander women, a series of studies were conducted. Initial literature reviews found limited evidence derived from methodologically rigorous studies in mainstream populations, and even less evidence for Aboriginal and Torres Strait Islander, or other Indigenous groups. Exploration of the knowledge and attitudes of these women in relation to antenatal smoking was conducted to identify the most appropriate targets for intervention. The findings from extensive background studies were drawn upon to design an intervention which aimed to be culturally appropriate for Aboriginal and Torres Strait Islander women, providing intensive support to assist these women to quit smoking during their pregnancy. Pilot data from the resulting intervention is presented in Chapter 8 of this Thesis. The social network among Aboriginal and Torres Strait Islander communities appears to play a central role in the behaviour of individuals. With an array of risk factors and influences found not only in the individuals surrounding women, but in their socioeconomic circumstances and overall environment, it may be that the most important approach for achieving health and behaviour change among this population is the mobilisation of social support and efforts to intervene with multiple elements of that environment.

Research Doctorate - Doctor of Philosophy (PhD)
After decades of discrimination and deprivation, Australia’s Aboriginal and Torres Strait Islander population faces social circumstances and health status which resemble that of a third world population group. With a wide range of health risk factors and morbidities among this population, a logical place to begin tackling the health problems is at the beginning of life. With increasing recognition of the influence of the intrauterine environment upon health, not only during infancy but into adulthood, improving health during pregnancy offers substantial benefit for present and future generations. The poor health of Aboriginal and Torres Strait Islander Australians is deeply ingrained in social deprivation, poor mental well-being, and an array of modifiable risk factors. Smoking is one risk factor at the centre of this complex web. Smoking is often accompanied by, or used as relief in, stressful situations associated with socioeconomic status, mental health, illness, and other addictions. In order to determine the most appropriate way to tackle the smoking issue among Aboriginal and Torres Strait Islander women, a series of studies were conducted. Initial literature reviews found limited evidence derived from methodologically rigorous studies in mainstream populations, and even less evidence for Aboriginal and Torres Strait Islander, or other Indigenous groups. Exploration of the knowledge and attitudes of these women in relation to antenatal smoking was conducted to identify the most appropriate targets for intervention. The findings from extensive background studies were drawn upon to design an intervention which aimed to be culturally appropriate for Aboriginal and Torres Strait Islander women, providing intensive support to assist these women to quit smoking during their pregnancy. Pilot data from the resulting intervention is presented in Chapter 8 of this Thesis. The social network among Aboriginal and Torres Strait Islander communities appears to play a central role in the behaviour of individuals. With an array of risk factors and influences found not only in the individuals surrounding women, but in their socioeconomic circumstances and overall environment, it may be that the most important approach for achieving health and behaviour change among this population is the mobilisation of social support and efforts to intervene with multiple elements of that environment.

The aim of this thesis was to document the distribution of mammographic parenchymal patterns (MPPs) for Australian Aboriginal and Torres Strait Islander women attending BreastScreen New South Wales North Coast (BSNSWNC); to profile breast cancer risk as it relates to breast density; and to explore the correlations among MPPs, age and breast length as described by the posterior nipple line (PNL). The PNL criterion is defined as a reference line drawn from the nipple at right angles to the anterior aspect of the pectoral muscle contour or to the back of the image whichever comes first (Spuur et al. 2011).

Research Doctorate - Doctor of Philosophy (PhD)
This thesis by publication is a body of work containing an introduction, six papers and a closing chapter with conclusions and recommendations for future practice, policy and research. All papers explore the area of concern being smoking during pregnancy among Aboriginal and Torres Strait Islander women, with a focus on how expectant mothers can be empowered to quit smoking. At the time of submission of this thesis, three of the six papers have been published or accepted for publication in peer-reviewed journals and the other three are under review.

Research Doctorate - Doctor of Philosophy (PhD)
Globally, tobacco use is the leading cause of morbidity and mortality, causing an annual death rate of seven million people. In Australia, tobacco use is responsible for 9% of the total burden of disease. Smoking during pregnancy remains a significant public health problem for specific population groups, causing miscarriage, stillbirth, low birth weight and more. Psychosocial interventions such as behavioural counselling have been shown to be effective. Clinical guidelines in Australia recommend using the 5As approach: Ask about smoking status, Advise briefly to quit, Assess nicotine dependence and motivation to quit, Assist as needed (including behavioural counselling and nicotine replacement therapy [NRT] if required), and Arrange follow-up and referral to smoking cessation support services. NRT is recommended if the woman is unable to quit using only behavioural counselling, with oral NRT considered as first line. Aboriginal and Torres Strait Islander pregnant women have the highest smoking rates in Australia at 43%, facing multiple barriers to quitting smoking, including lack of adequate support from health providers. Health providers also face many barriers to support pregnant women to quit smoking, on an individual and systematic organisational level. To date, very few interventions have tried to improve health providers’ management of smoking with Aboriginal and Torres Strait Islander pregnant women. Those that have either did not use rigorous research methods or suffered from multiple implementation challenges. The aim of this thesis was to explore health providers’ practices regarding smoking cessation care during pregnancy, barriers to the provision of smoking cessation care and methods for improving health providers’ care, and to test an evidence-based behaviour change intervention to improve health providers’ provision of smoking cessation care to pregnant Aboriginal and Torres Strait Islander women. Papers one to five explore health providers’ provision of smoking cessation care during pregnancy in general. Some data for Aboriginal and Torres Strait Islander pregnant women who smoke is also presented. The results of the first five studies were used to refine the development of a multi-component pilot intervention: the Indigenous Counselling and Nicotine (ICAN) QUIT in Pregnancy intervention for implementation in Aboriginal medical services. Papers six to eight explore the development of the intervention resources, the intervention protocol and the effect of this intervention on health providers’ smoking cessation care. Three related theoretical frameworks were drawn on throughout the research: the Theoretical Domains Framework (TDF), Behaviour Change Wheel (BCW) and the COM-B (Capability, Opportunity, Motivation–Behaviour) model for behaviour change. Paper one, “Opportunities Missed: A Cross-Sectional Survey of the Provision of Smoking Cessation Care to Pregnant Women by Australian General Practitioners and Obstetricians”, presents the results of a national cross-sectional survey of 378 general practitioners (GPs) and obstetricians about their knowledge, attitudes and practices providing smoking cessation care to pregnant women. Data from this survey revealed low levels of provision of several smoking cessation care components (“Assess”, “Assist” and “Arrange”), with only 15.6% of GPs and obstetricians reporting “often and/or always” performing all of the recommended 5As. Specifically, GPs and obstetricians reported that they lacked time, resources and confidence in their ability to prescribe NRT during pregnancy, and lacked optimism that their intervention would be effective. Paper two, “Clinician Factors Associated with Prescribing Nicotine Replacement Therapy in Pregnancy: A Cross-Sectional Survey of Australian Obstetricians and General Practitioners”, reports the results from the same cross-sectional survey mentioned in paper one, exploring GPs’ and obstetricians’ NRT prescribing rates and factors that might influence this. Overall, 25% of GPs and obstetricians reported “never” prescribing NRT, with nearly 50% reporting they would “never” prescribe combination NRT (NRT patch plus an oral NRT). GPs had higher odds of prescribing NRT compared to obstetricians. Other factors that significantly increased the odds of NRT prescription were reading the Royal Australian College of General Practitioners (RACGP) guidelines, confidence in their ability to prescribe NRT and viewing NRT as safe, effective and with good patient adherence. Paper three, “Overcoming Challenges to Treating Smoking during Pregnancy – A Qualitative Analysis of Australian General Practitioners’ Barriers and Facilitators”, reports on semi-structured qualitative interviews that were conducted with 19 GPs, aiming to explore their management of smoking during pregnancy in greater depth and what would enable them to improve their smoking cessation support to pregnant women. GPs were recruited from the cross-sectional survey participants and from those attending a national GP conference. Participants reported they lacked communication skills to provide pregnant patients adequate support for quitting, focusing on providing information on smoking harms and discussing treatment options only with patients who reported an interest in quitting. Lack of time, NRT cost, previous negative experiences with NRT and safety concerns, being unfamiliar with the Quitline process and uncertainty over its suitability (specifically for Aboriginal and Torres Strait Islander peoples) were all perceived as additional challenges. Participants reported needing clear detailed guidelines, with visual resources they could use to discuss treatment options with patients. Paper four, “Nicotine Replacement Therapy for Smoking Cessation in Pregnancy – A Narrative Review”, provides an overview of the current guidelines regarding NRT use in pregnancy, while considering the existing evidence base on NRT safety, efficacy and effectiveness during pregnancy. Animal models show that nicotine is harmful to the foetus, especially for brain and lung development, but human studies have not found any harmful effects on foetal and pregnancy outcomes. Previous studies have used NRT doses that might have been too low and not have adequately accounted for the higher nicotine metabolism during pregnancy, and thus not sufficiently treating withdrawal symptoms. Nonetheless, studies of efficacy and effectiveness in the real world suggest that NRT use during pregnancy increases smoking cessation rates. Current national clinical guidelines from Australia, the United Kingdom, New Zealand and Canada recommend that if women are unable to quit smoking with behavioural interventions alone, they should be offered NRT in addition to behavioural counselling. The guidelines also impose many restrictions on NRT prescription during pregnancy and do not provide practical detailed guidance on when to initiate NRT and how to titrate the dosage. Pragmatic suggestions for clinical practice are made, including an approach for initiating and titrating NRT dosage during pregnancy and for discussing the risks versus benefits of using NRT in pregnancy with the pregnant patient and her partner. Paper five, “Improving Health Providers’ Smoking Cessation Care in Pregnancy: A Systematic Review and Meta-Analysis”, reviews the data from all published interventions aimed to improve health providers’ smoking cessation care during pregnancy. To be included, the intervention studies needed to collect data on the health providers’ performance. Overall, 16 studies describing 14 interventions were included – 10 used a quasi-experimental design (pre–post), with only six studies using a randomised controlled trial (RCT) design. Using the Cochrane Effective Practice of Care (EPOC) taxonomy of intervention components, the review found that the median number of intervention components reported by studies was two (range 1–6). The most common intervention components used were training (93%, n=13), educational resources (64%, n=9) and reminders (57%, n=8). Studies used a variety of outcome measures, with different data collection methods (such as self-report through survey, women’s report on the health providers’ care, audit of medical records or recordings of medical consultations), affecting the ability to synthesise the data. Specifically, the “Assist” or “Provide smoking cessation support” component of care was ill defined with vast variability between studies. Meta-analysis of the different smoking cessation care components (according to the 5As) showed a small significant increase in the provision of all smoking cessation care components. The review suggests that use of a behaviour change theory to guide intervention development, and inclusion of audit and feedback, increases the likelihood of intervention effectiveness in improving health providers’ provision of certain smoking cessation care components. Paper six, “Assessing and Validating an Educational Resource Package for Health Professionals to Improve Smoking Cessation Care in Aboriginal and Torres Strait Islander Pregnant Women”, describes a multi-centre community-based participatory research study. This study aimed to assess a collaboratively developed educational resource package to aid health providers’ smoking cessation care in pregnant Aboriginal and Torres Strait Islander women. A panel of eight experts with complementary expertise provided input and suggestions to aid simplicity and usefulness of the resources. Staff members from three Aboriginal medical services in New South Wales (NSW), Queensland (Qld) and South Australia (SA) scored each of the patients’ resources using the “Suitability of Material” scoring method, finding that all received adequate or superior scoring. Average readability was grade 6.4 for patient resources (range 5.1–7.2; equivalent to ages 10–13 years) and 9.8 for health provider resources (range 8.5–10.6; equivalent to ages 13–16 years). Content analysis from focus groups with health providers from the three Aboriginal medical services revealed four themes including “Getting the message right”, “Engaging with family”, “Needing visual aids” and “Requiring practicality under a tight timeframe”. Results were presented back to a Stakeholder and Consumer Aboriginal Advisory Panel (SCAAP), and resources were adjusted accordingly for inclusion in the ICAN QUIT in Pregnancy multi-component intervention. Paper seven, “The Indigenous Counselling and Nicotine (ICAN) QUIT in Pregnancy Pilot Study Protocol: A Feasibility Step-Wedge Cluster Randomized Trial to Improve Health Providers’ Management of Smoking during Pregnancy”, describes the protocol of a step-wedge cluster randomised pilot study: the ICAN QUIT in Pregnancy intervention. This protocol described an intervention aiming to improve health providers’ provision of evidence-based, culturally responsive smoking cessation care to pregnant Aboriginal and Torres Strait Islander smokers. Six Aboriginal medical services were randomised into three clusters for implementation. Clusters received the intervention staggered by one month. The intervention included a three-hour training webinar for health providers, educational resource packages for health providers and pregnant women, free oral NRT for pregnant women and audit and feedback on health providers’ performance. Health providers would complete a cross-sectional survey pre training and post training. Health providers’ outcomes would include changes in self-reported knowledge, attitudes and practices after receiving the intervention. Paper eight, “Improving Smoking Cessation Care in Pregnancy at Aboriginal Medical Services: ICAN QUIT in Pregnancy Step-Wedge Cluster Randomized Pilot Study”, presents the pilot study outcomes of changes in health providers’ knowledge, attitudes and practices. Of 93 eligible health providers, 50 consented to the trial (54%), 45 completed the pre-intervention survey (90%) and 20 completed the post-intervention survey (40%). About 42% (n=39) of health providers participated in the webinar training. Health providers’ knowledge was measured using two composite scores – one calculated using all 24 true/false statements and the other derived from 12 NRT-specific statements. Mean knowledge composite scores improved significantly from pre to post (78% vs 84% correct, p=0.011). The mean NRT-specific knowledge composite score also improved significantly (68% vs 79% correct, p=0.004). Self-assessment of 24 attitudes to providing smoking cessation care was measured using a 5-point Likert scale (Strongly Disagree to Strongly Agree). Two composite mean scores were calculated –one for 15 general smoking cessation care attitudes and the other for seven NRT-specific attitudes. The mean attitude composite score improved significantly (3.65 [SD 0.4] to 3.87 [SD 0.4]; p=0.017). The mean NRT-specific attitudes composite score also improved significantly (3.37 [SD 0.6] to 3.64 [SD 0.7]; p=0.005). Self-reported provision of smoking cessation care components was measured on a 5-point Likert scale (Never to Always); none of the practices improved significantly, including the prescribing of NRT. In summary, increasing health providers’ provision of smoking cessation care to pregnant Aboriginal and Torres Strait Islander women is a significant priority in Australia. This body of work highlights that currently, health providers are lacking in their provision of smoking cessation care, specifically in their support for pregnant Aboriginal and Torres Strait Islander women to quit smoking. Particularly, the provision of the “Assist” smoking cessation component was low, including the prescription of NRT. Multiple barriers exist and include lack of knowledge, skills (especially communication skills), time, resources and lack of optimism. Guidelines do not provide clear guidance, including the optimal timing for initiating NRT and titrating the dosage. The pilot intervention tested within this thesis showed promising initial results, with health providers significantly improving their knowledge and attitudes, although this did not translate into improved practices. Several strategies might enhance the effectiveness of the intervention and should be tested in a larger and adequately powered trial. The complex nature of tobacco smoking, and considering its historical and social context in Aboriginal communities, suggests that wider and more intensive interventions are needed.

This chapter details the life and career of Lexine Solomon. She released her first solo album in 2002 when in her mid-forties, celebrating her own identity as an Indigenous Torres Strait Islander woman living in mainland Australia. She engages her singing voice and her lyrics to articulate and express agency, empowerment, and celebration. With a combination of newly self-composed songs and covers, Solomon is specifically involved with reclaiming and documenting the women in her family, and with encouraging and enabling women in positions of marginality, particularly Torres Strait Islander and Aboriginal women. As singer, facilitator, manager, and producer, her multifaceted vocal career involves touring nationally and internationally to perform and run workshops.

This chapter maps women’s engagement with different aspects of law over time in response to intimate partner violence (IPV). It considers the variety of legal systems women interact with at different points on their journeys, including immigration law, the child protection system, criminal law and police, civil protection order processes, and family law. The chapter identifies differences in engagements linked to women’s intersecting identities. In particular, it considers the different legal journeys experienced by migrant women, especially those who have insecure migration status, and Aboriginal and Torres Strait Islander women. The chapter explores how the law itself is sometimes used by an abusive partner as a form of nonphysical abuse to extend IPV after separation.