research proposal in public heath

research proposal in public heath

ASSIGNMENT 3 – RESEARCH PROPOSAL Outline a research plan that is designed to investigate the public health issue that you have chosen in relation to your research question or hypothesis that you generated in assignment 1. As part of the research plan the target population should be described, sample size and sampling technique discussed, a research design offered, ethical considerations should be outlined, etc. [2,500 words] Assessment criteria • Present a clear and concise research proposal as well as the rationale for this plan. • Conform to accepted academic standards, including appropriate referencing • Clearly written with accurate spelling and grammar. Must have well constructed sentences and paragraphs
This is assignment one
Although Australia is considered a world leader in tobacco control ,
this success not extended to Indigenous Australians who continue to
experience significant morbidity and mortality related to smoking
.current estimates indicate that more than fifty percent of indigenous
Australians are regular smokers more than twice the rate of non
indigenous Australians, so this issue considered as great challenge
to public health to deal the with it . Stead et al. (2001) reported
that a poorly resourced and stressful environment, strong
community norms, isolation, and limited opportunities for respite
and recreation appear to combine to encourage smoking and
discourage cessation.
.despite high prevalence rates in indigenous areas there is a little
research evidence about the effectiveness of tobacco health
promotions interventions in indigenous people , studies that have
been conducted have reported a variable impact and for most part are
limited by small samples non- experimental research design .in
contrast , there is an extensive literature that examine the
effectiveness of a wide range of tobacco control interventions to
reduce the prevalence of tobacco uses among other population. So
in this chapter I will try to find out the answer for a research
question ( why thus public health interventions for indigenous Australians not work ?) ) In this chapter I will review the recent
studies on tobacco control interventions and then look at the barriers
which interfere with intervention success, in the first part I will show
the aim and overview of my research , then in second part I will
present the finding of my literature review , at the end I will define or
refine my search question and knowledge gap , after I define search
question and knowledge gap I can detect the aim and objectives of
further study.
Significance of my literature review
– increase of morbidity and mortality rate in indigenous communities
due to high prevalence of tobacco uses is considered a major public
health problem for Australian authority
– increase of smoking prevalence in indigenous communities more
than fifty percent and two time more than other population without
perfect interventions until now
– increase percent of cancer cases in indigenous communities which
is related to tobacco uses
– ethical role of the the scientific research to investigate and high
light the problem especially if it’s related to social determinants, and
inequities in the society.
Search method
The purpose of this literature review is to investigate clear
prospectives on moderate effect of interventions for tobacco control
inside Indigenous Australian communities , and look into the
barriers which cause high prevalence of smoking to indigenous
Australians , secondly and during my review of literature , the
knowledge gap would be identified , finally to a certain the feasibility
of future study.studies between 2010- 2015 were included to stand on
last researches , the relevance articles can be reviewed by searching
Reference lists of Primary articles .I searched inside public health
databases in CINAHL,SCOPUS, PUBMED, Medline, find @ flinders
(I used it because it, s a new and rich source and related to public
health) Based on the following terms, smoking cessation, tobacco
control, Interventions interventions strategies, my search was
restricted on articles and literature between 2010-
strategies on data bases as in scopus were as (” smoking cessation
” or “tobacco control “) and (“indigenous people” or “aboriginal
Australians”) and (“interventions” or “control”), studies were
included if it, s related barriers to interventions , and if it’s related to
causes of prevalence, if the studies related to social determinants
of health were included also
Key words. Smoking cessation, tobacco control, Interventions,
nicotine replacement,
counselling , interventions strategies, smoking prevalence, smoking
cessation ,barriers, indigenous Australians, aboriginal Australians
Review of literature
Review of literature on different smoking cessation interventions as
(counselling, nicotine replacement therapy, others) (30, 10,,16,21,32,31,)
Studies indicate less effective of of interventions as brief advice and
nicotine patches when delivered in primary care of low intensity when
implemented (evidence based study)(30).(26) on the other hand
primary care interventions as brief advice and pharmaceutical
quitting aid are effective for indigenous Australians when available
and accessible, were perceived as important and effective strategies
to help people quit ( qualitative study)(32), study also indicate ineffective of unmodified quit program (32)
Another Study used mass media and anti tobacco interventions for
tobacco control indicate culturally targeted messages were
preferred. ((Study used systemic review of qualitative and qualitative
methods and narrative synthesis (10),
other review of literature on study runs out different studies on
nicotine replacement in indigenous Australians indicate a low level of
success was achieved by program participants this indicated by (
quantitative data)(16), on the other hand qualitative data indicate rich
account of people experiences in the programme , these could be
used to develop more effective programs( the study used a mixed
methodology approach Contains qualitative and qualitative data
collect ( Johnson, O now uegbt buzi..e) (16)
Other study used systemic review of academic literature and reports
from government and non government agencies published between 2001 – 2007 provides evidence that face to face counselling or quit
support using in conjunction with nicotine replacement therapy is
likely to increase quit rates .(31),
Review of literature on a study on potential effectiveness of specific
anti – smoking mass media among indigenous Australians smokers ,
this study indicate that mainstream anti smoking advertisements are
likely to be as motivating for indigenous smokers and there are few
very few differences in motivational response to emotive mainstream
anti smoking advertisement between indigenous Australians and non
indigenous smokers , the result of this study highlight that the
balance between what will be effective in the population as a whole
and indigenous need to be struck, and this balance could be easily ACHIEVE (21)
One study (systemic review) (30)indicate some factors which were
interfere with efficiency of interventions which related also to
inequities between these communities and other population as low
socio – economic status , normality of use of tobacco , culture uses ,
low health services(30) so I will review the literature on thesis Barriers
which prevent a good interventions in indigenous Australians.
Review of literature on socio-economic factors
Review of literature look for socio economic factors as a barrier to
quit smoking has indicated in study used analysed data from 2002
(national aboriginal survey) it indicated the poorest and the most
socially disadvantaged are the least likely to be non smokers (22).
And any cessation programs must be ecologically so they can
addressee unique social and environmental influences that perpetual
smoking and create barriers to cessation in addition to providing
tobacco specific resources and services (8)
Studies show that stress as a barriers to quitting smoking as in this
review which derived from reflections within an Aboriginal medical
services and makes recommendations for interventions development
it concludes that achieving smoking cessation among indigenous
people is made significantly more complex because of multiple life
stressors experienced ( method of study depended on cessation
counselling session and dispensation of free nicotine replacement
)the result of study indicate chronic and current life stressors were
noted to be the main barriers to smoking cessation described by
participants (28) . Another study indicate the effect of stress as a
greatest barriers preventing AHWS (Australian health workers
interventions) from quitting smoking it include also personal tobacco
use and lack of professional development are important barriers to
AHWS providing quit smoking program and support to community
members as these barriers are a dressed and AHWS feel comfortable
talking with the community numbers and referring to or providing
quit smoking programme it can be expected that the high rates of
smoking and tobacco related illness and death with indigenous
community will decrease (25)
Social context
Study on social context of indigenous people indicate colonisation
and the introduction of tobacco , with separate indigenous social
networks , stress lives , importance of maintaining relationships with
extended family and community network , young girls use smoking to
attain status and as away of asserting aboriginal identity and group
membership , away of belonging , not of rebelling , the result support
the importance of a dressing contextual factors in any strategies
aimed at preventing smoking initiation or support cessation , it’s
critically to acknowledge aboriginal identity and culture as a source
of empowerment and to recognize the role of persistent
marginalization in contributing to high prevalence and entitling of
smoking (20,23)(18).Other study indicate the need to change social
normative belief around smoking , Intervention should be effectively
delivered in both the school and family environments , smoke free
home , anti smoking socialisation behaviour.(qualitative study) (12)
Another study indicate influence of social networks , that impact on
tobacco use and the extend to which smoking behaviours transcend
network with indigenous community in fact this help to improve multi
– component tobacco control strategies. I will mention the role of
social networks in health services to indigenous Australians (13)
Health services to indigenous Australians
Health services shortage in indigenous Australians community
consider an other aspect of Inequities , study that provide either
quantitative or qualitative description of self reported perceived
barriers to quitting smoking indicate lack of support from health and
other service providers (32) and there is a need to community level and
social network level interventions are priority area for the future
smoking cessation, Intervention within vulnerable group(a) 32,8),
and there is a need to participation with employee view of workplace
on smoking reduction(5)(7,,2,15). Other study Indicate that
indigenous Australians callers received significantly fewer call backs
than non indigenous callers and we’re significantly less likely to sit a
quit date . (7), other study indicate interventions targeted at
particular health problem are best integrated with usual primary
health care and more fund for local control of Planning and
implementation , and worker professional development. (15)(Study
use lessons from BOABS smoking).another study review of the
barriers preventing indigenous health workers delivered tobacco
interventions to their communities providing that there remain
potential barriers faced by IHWS (indigenous health workers
interventions) that may undermine efforts to reduce indigenous
smoking , overcoming these barriers and assisting it to quit smoking
may provide an opportunity to address high rates of smoking in
indigenous communities .further research is required with balance
between descriptive research to address it (databases were searched
for publications that examine IHWS smoking status or quit support
programme for IHWS .studies were categorized as reviews and
commentaries , Intervention s studies or descriptive research (27)
Result of another study show that community organizations as(
SCsos ) have potential as setting for reaching high number of
smokers experience financial and social disadvantage, more over the
result show that some organisations may be receptive to integrating
smoking cessation support (2).the study also suggest that (sCsos)
are a potential important setting for researching smokers who
experience various forms of disadvantage, tobacco control
advantages should work with (sCsos for future developed
comprehensive smoke free policies.
The most commonly used strategies give to most clients included
emotional support and encouragement, referral to telephone , quit
line , and provision of written information , these are largely low cost
strategies , where resources can be obtained by sCsos from health
department free of charge , amplifying these activities could have
positive health impact at minimal cost. (2)
Review of literature shows that some organisations may be receptive
to integrating smoking cessation support , another study in low
social group indicate efficacy of a client centred service ,
caseworker-delivered cessation support interventions at increasingly rate in socially disadvantage population (3)
Knowledge gap
Review of literature as in (30,26,16) especially on counselling and
nicotine replacement therapy , indicate less effectiveness of interventions when studies runs on quantitative base
Review of literature on studies as in (32, 10,16,31, 3,21,)
Indicate better results when studies based on qualitative methods
So there is a knowledge gap within the interventions held on
quantitative way , so any future studies should be qualitative in
nature estimates the specificity of indigenous people and
understanding the social context for these communities, and
any further interventions should be comprehensive interventions
Aims and objectives
– there is a need for greater investment in research to build the body
of evidence on interventions that are likely to be effective in
increasing motivation to quit among indigenous communities and in
challenging the cultural acceptance of smoking across indigenous communities as a whole .(31)
– the identification of community strength can provide a powerful
starting point for effective and empowering health promotion practice (33)

– eliminating the causes of Inequities between indigenous people and
other Australians is important element if we really look for effective cessation
– any further studies should look for culture context inside
indigenous community and qualitative approach should be followed
There is a clear need for more indigenous -specific research dissemination research targeting the uptake of secondary prevention and to establish reliable and valid measure for indigenous specific health care delivery in order to determine which dissemination strategies is effective in indigenous health care setting and programs
The majority of studies suggesting that improving health care providers, knowledge and skills is a focus of current efforts to achieve best interventions to indigenous Australians. (6)
There was a major lack of research on evaluation of tobacco interventions.which should be appropriate and effective for indigenous Australians (11)
1) Bond, C., Brough, M., Spurling, G., & Hayman, N. (2012). It had to be my choice Indigenous smoking cessation and negotiations of risk, resistance and resilience. Health, Risk & Society, 14(6), 565-581.
2) Bonevski, B., OBrien, J., Frost, S., Yiow, L., Oakes, W., & Barker, D. (2013). Novel setting for addressing tobacco-related disparities: A survey of community welfare organization smoking policies, practices and attitudes. Health Education Research, 28(1), (46)-(57.)
3) Bonevski, Billie, Paul, Christine, D’Este, Catherine, Sanson-Fisher, Robert, West, Robert, Girgis, Afaf, . . . Carter, Robert. (2011). RCT of a client-centred, caseworker-delivered smoking cessation intervention for a socially disadvantaged population.(Study protocol)(Report). BMC Public Health, 11, 70.
4) 5Campbell, S., Bohanna, I., McKeown-Young, D., Esterman, A., Cadet-James, Y., & McDermott, R. (2014). Evaluation of a community-based tobacco control intervention in five remote north Queensland Indigenous communities. International Journal of Health Promotion and Education, 52(2), 78-89.
6) Carroll, C., Rick, J., Leaviss, J., Fishwick, D., & Booth, A. (2013). A qualitative evidence synthesis of employees’ views of workplace smoking reduction or cessation interventions. BMC PUBLIC HEALTH, 13, 1095
6) Clifford, A., Jackson Pulver, Richmond, Shakeshaft, & Ivers. (2009). Disseminating best-evidence health-care to Indigenous health-care settings and programs in Australia: Identifying the gaps. Health Promotion International, 24(4), 404-415.
7) Cosh, S., Maksimovic, L., Ettridge, K., Copley, D., & Bowden, J. (n.d.). Aboriginal and Torres Strait Islander utilisation of the Quitline service for smoking cessation in South Australia. Australian Journal hof Primary Health, 19(2), 113-118.
8) Dawson, A., Cargo, M., Stewart, H., Chong, A., & Daniel, M. (2013). Identifying multi-level culturally appropriate smoking cessation strategies for Aboriginal health staff: A concept mapping approach. Health Education Research, 28(1), 31-45.
9) Doyle, Michael, Butler, Tony, & Stevens, Clare. (2011). The National Summit on Tobacco Smoking in Prison: Australian National University, Canberra, August 2010 – an Aboriginal Perspective. Aboriginal and Islander Health Worker Journal, 35(3), 10-12.
10) Gould, G., McEwen, A., Watters, T., Clough, A., & Van der Zwan, R. (2013). Should anti-tobacco media messages be culturally targeted for Indigenous populations? A systematic review and narrative synthesis. Tobacco Control, 22(4), E7.
11) Ivers, R. (2003). A review of tobacco interventions for Indigenous Australians. AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, 27(3), 294-299.
12) Johnston, Vanessa, Westphal, Darren W., Earnshaw, Cyan, & Thomas, David P. (2012). Starting to smoke: A qualitative study of the experiences of Australian indigenous youth.(Research article)(Report). BMC Public Health, 12, 963.
13)Maddox, Raglan, Davey, Rachel, Cochrane, Tom, Lovett, Ray, & Van der Sterren, Anke. (2013). Study protocol – Indigenous Australian social networks and the impact on smoking policy and programs in Australia: Protocol for a mixed-method prospective study.(Study protocol)(Clinical report). BMC Public Health, 13, 879.
14) Marley, J., Atkinson, J., Kitaura, D., Nelson, T., Gray, C., Metcalf, D., & Maguire, S. (2014). The Be Our Ally Beat Smoking (BOABS) study, a randomised controlled trial of an intensive smoking cessation intervention in a remote aboriginal Australian health care setting. BMC PUBLIC HEALTH, 14, 32.
15) Marley, Julia V., Kitaura, Tracey, Atkinson, David, Metcalf, Sue, Maguire, Graeme P., & Gray, Dennis. (2014). Clinical trials in a remote Aboriginal setting: Lessons from the BOABS smoking cessation study.(Research article)(Be Our Ally Beat Smoking)(Report). BMC Public Health, 14, 579.
16) Mikhailovich, Katja, & Morrison, Paul. (2008). An Evaluation of a Smoking Cessation Program for Special Populations in Australia. Journal of Smoking Cessation, 3(1), 50-56.
17) Passey, Megan E., Gale, Jennifer T., & Sanson-Fisher, Robert W. (2011). “It’s almost expected”: Rural Australian Aboriginal women’s reflections on smoking initiation and maintenance: A qualitative study.(Research article)(Report). BMC Women’s Health, 11, 55.
18)Robertson, Jan A., Conigrave, Katherine M., Ivers, Rowena, Usher, Kim, & Clough, Alan R. (2012). Translation of tobacco policy into practice in disadvantaged and marginalized subpopulations: A study of challenges and opportunities in remote Australian Indigenous communities.(Research)(Report). Health Research Policy and Systems, 10, 23.
19)Smoking cessation in indigenous populations of Australia, New Zealand, Canada, and the United States: Elements of effective interventions. (2011). International Journal of Environmental Research and Public Health, 8(2), 388.
20)Stevenson, L., Bohanna, I., Robertson, J., & Clough, A. (2013). Aboriginal people in remote communities in Arnhem Land (Northern Territory) restrict their smoking in some environments: Implications for developing and implementing interventions to reduce exposure to environmental tobacco smoke. Drug and Alcohol Review, 32(6), 627-630.
21) Stewart, H., Bowden, J., Bayly, M., Sharplin, G., Durkin, S., Miller, C., . . . Wakefield, M. (2011). Potential effectiveness of specific anti-smoking mass media advertisements among Australian Indigenous smokers. Health Education Research, 26(6), 961-975.
22)Thomas, D., Briggs, D., Anderson, V., & Cunningham, I. (n.d.). The social determinants of being an Indigenous non-smoker. AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, 32(2), 110-116.
23)Thomas, D. (2012). Changes in smoking intensity among Aboriginal and Torres Strait Islander people, 1994-2008. The Medical Journal of Australia, 197(9), 503-6.
24) Thompson-Evans, T., Glover, M., & Walker, N. (n.d.). Cytisine’s potential to be used as a traditional healing method to help indigenous people stop smoking: A qualitative study with MÄ�ori. NICOTINE & TOBACCO RESEARCH, 13(5), 3
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25) Mark, Andy, McLeod, Iris, Booker, Julie, & Ardler, Craig. (2005). Aboriginal Health Worker Smoking: A Barrier to Lower Community Smoking Rates? Aboriginal and Islander Health Worker Journal, 29(5), 22-26.
26) Ivers, R. (2003). A study of the use of free nicotine patches by Indigenous people. ACT: Public Health Association of Australia.
27) Thompson, M., Robertson, J., & Clough, A. (2011). A review of the barriers preventing Indigenous Health Workers delivering tobacco interventions to their communities. Australian and New Zealand Journal of Public Health, 35(1), 47-53.
28) DiGiacomo, M., Davidson, P., Davison, J., Moore, L., & Abbott, P. (2007). Stressful life events, resources, and access: Key considerations in quitting smoking at an Aboriginal Medical Service. Australian and New Zealand Journal of Public Health, 31(2), 174-176.Health, 13, 879.
29) Power, Jennifer, Grealy, Claire, & Rintoul, Duncan. (2009). Tobacco interventions for Indigenous Australians: A review of current evidence. Health Promotion Journal of Australia, 20(3), 186-194.
30) Ivers, R. (2004). An evidence-based approach to planning tobacco interventions for Aboriginal people. Drug and Alcohol Review, 2004, Vol.23(1), P.5-9, 23(1), 5-9.
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31) Power, Jennifer, Grealy, Claire, & Rintoul, Duncan. (2009). Tobacco interventions for Indigenous Australians: A review of current evidence. Health Promotion Journal of Australia,20(3), 186-194.
32) Johnston, Vanessa, & Thomas, David P. (2010). What works in Indigenous tobacco control?: The perceptions of remote Indigenous community members and health staff. Health Promotion Journal of Australia, 21(1), 45-50.
33) Brough, Mark, Bond, Chelsea, & Hunt, Julian. (2004). Strong in the city: Towards a strength-based approach in Indigenous health promotion. Health Promotion Journal of Australia, 15(3), 215-220.
34) Twyman, L., Bonevski, B., Paul, C., & Bryant, J. (2014). Perceived barriers to smoking cessation in selected vulnerable groups: A systematic review of the qualitative and quantitative literature. BMJ Open, 4(12), E006414.
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