Identifying and Integrating Behavior Change Techniques Into an Indigenous-Led Group-Based Smoking and Vaping Cessation Program for Women During Pregnancy and the Perinatal Period: Upholding Indigenous Knowledges and Rights in Research.

Abstract

Introduction: There is an urgent need for community-led and embedded smoking and vaping cessation programs developed for and by Indigenous people to address the disproportionate tobacco-related harms stemming from colonization. This article describes the development of an Indigenous-led program for Aboriginal and Torres Strait Islander women during pregnancy and the perinatal period, drawing on Indigenous knowledges to prioritize and integrate behavior change techniques (BCTs).

Methods: A systematic process involving four steps was implemented to uphold Indigenous knowledges, rights and self-determination in program co-creation. First, we identified and prioritized BCTs that are important and meaningful to Aboriginal and Torres Strait Islander people, and identified effective BCTs from existing published literature. These steps informed a collective program development process of iterative development, reflection, and feedback to weave BCTs in the final program.

Results: The BCT domains prioritized by Aboriginal and Torres Strait Islander people included natural consequences, antecedents, goals and planning, social support and comparison of outcomes. Twenty-four BCTs across fifteen domains were identified from the peer-reviewed literature. The final program incorporates fifteen behavior change domains and 60 unique individual BCTs.

Conclusions: The Which Way? Women's Group-based Smoking and Vaping Cessation Program was co-created with Aboriginal and Torres Strait Islander women and community partners, drawing on the knowledges and wisdom of Aboriginal and Torres Strait Islander people and BCTs. The effectiveness of the program will be tested in a hybrid-Type 1 implementation trial.

Implications: This article reports a novel co-creation process led by Aboriginal and Torres Strait Islander women in partnership with community to develop a smoking and vaping cessation program for women during the pregnancy and perinatal period. In detailing the development process used, this work upholds Indigenous rights to self-determination as outlined in the World Health Organization Framework Convention on Tobacco Control. Our transparent reporting upholds Indigenous ethics and provides valuable insights to inform the development of other interventions aimed at supporting Indigenous women and communities in empowering smoke and vape-free generations.