Research Literacy for Health Practice: Intervention Funding Report

This report critically appraises a research paper by Ober and Roche (1997) focusing on research literacy in health practice, specifically examining harm reduction strategies to address high smoking rates among Aboriginal Australians. The report provides an overview of the study's methods, including a literature search of relevant articles from databases like Medline and PubMed, and evaluates the quality of the research using the CASP systematic review checklist. It explores the characteristics of smoking, motivators, and Aboriginal perspectives on smoking, alongside the application of harm reduction approaches. The report also includes a literature review of recent studies on harm reduction, analyzing their findings and assessing the efficacy of proposed interventions. The report concludes by evaluating the potential of the intervention for public health and whether it should be funded, emphasizing the need for tailored strategies and the importance of addressing systemic barriers to improve outcomes.

0Running head: RESEARCH LITERACY FOR HEALTH PRACTICE
Research literacy for health practice
Name of the student:
Name of the University:
Author’s note

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Introduction:
Aboriginal Australians experience great health disparity compared to non-indigenous
Australians and tobacco smoking is the most preventable cause of ill health and death among
them. High rate of smoking has increased the risk of coronary heart disease, cancer and other
heart disease in aboriginal Australians. According to the 2014-15 National Statistics on
Indigenous smoking, about 39% Aboriginal people above 15 years are daily smokers
(Department of Health | Tackling Indigenous Smoking (TIS) - National Statistics, 2017).
Although there is a decline in the number of the people smoking, however there is increase in the
proportion of people who have never smoked. Considering the deleterious effect of smoking on
health and life expectancy gaps of aboriginal people, there is a need to find preventive strategies
to reduce the smoking rate. Ober and Roche (1997) explored the potential of harm reduction
principle to address smoking prevalence among Aboriginal and Torres Strait Islanders. The study
gave an overview about the characteristics of smoking, motivator for uptake of smoking, the
aboriginal perspective on smoking and the application of harm reduction approaches to prevent
smoking. The purpose of this report is to critically appraise the research paper and evaluate
whether the intervention proposed should be funded or not. The efficacy of the intervention is
understood from review of other relevant research work and the use of CASP tool for appraisal
of article further denotes the strength and weakness of the intervention for public health.
Search strategy:
Ober and Roche (1997) proposed harm reduction approach to prevent smoking among
aboriginal Australians. To further understand the effectiveness of harm reduction approach in
preventing smoking, reviewing current research work related to the topic is necessary. This

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would help to determine whether this intervention can be applied for the target group or not. The
main criteria for searching the articles were that it should not be more than 10 years old and they
should cover the topic of harm reduction approach for preventing smoking. Another inclusion
criterion was that all research articles should be in English language. The articles were mainly
searched from the databases like Medline, CINAHL, PubMed, Cochrane library and Goggle
Scholar. The key search terms used for the literature search included ‘Harm reduction principle
for aboriginal people’, ‘use of harm reduction principle for smoking prevention, ‘impact of harm
reduction approach on reducing smoking rate’ and ‘efficacy of harm reduction approach for
reducing smoking rate in Aboriginal and Torres Strait Islander people’. Population based studies
which used health promotion approach as a health promotion method were also include for
literature review.
Literature search
Author and date Aim of the study Key findings
Kozlowski (2015) The research used harm-
reduction approach to analyse
the prospects of nicotine
reeducating strategy in
eliminating use of cigarette
The research gave the indication
that although complexity in
tobacco industry may hijack the
harm reduction approach, however
using appropriate resources and
policy related changes can
increase the benefits of nicotine
maintaining harm reduction
strategies
Chamberlain et al. 2017 The aim was to synthesize Limited indigenous specific

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evidence regarding reducing
tobacco consumption among
indigenous people
evidence for smoking prevention
and continuation of effective
intervention was urgently needed
Gould et al. (2016) It used behavioral change
wheel and application of the
harm reduction approach to
support indigenous women to
quit smoking
The review of harm reduction and
quitting strategies in indigenous
population revealed that
educational and social marketing
approach can promote use of
nicotine reduction therapy in
indigenous women. Systematic
barrier to evidence bases cessation
methods must also be addressed
Minichiello et al. (2016) The aim was to identify
effective strategies to reduce
commercial tobacco use in
indigenous communities
globally
The systematic review revealed
that myriads of activities were
implemented to reduce harm of
tobacco use in indigenous people
however comprehensive and
tailored intervention was needed
to change initiation, consumption
and smoking rate
Fraser et al. (2015) Assessment of harm reduction
approach of smoking using e-
cigarettes for long-term
replacements for smoking and
improving quitting rates
The assessment of real world
effectiveness of harm reduction
intervention showed that
anticipated effects were low and to
increase the efficacy, people who
are using the product must be

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targeted. The research outcome
will help to determine whether
harm reduction strategies can
accelerate of the slow rate of
decline in smoking prevalence or
not
Critical appraisal:
The quality of research study is evaluated by means of the CASP systematic review
checklist and the main results from the critical appraisal are as follows:
Screening question:
1. Addressing clear focused question
While reviewing a research paper, the significance of the study is understood from clear
statement regarding research question. A clear research questions is one, which clearly specified
the intervention, the population and outcome considered in the research. In the study done by
Ober and Roche (1997), the main research question is understood from reviewing the method
abstract section. The main aim of the opinion paper was to explore the potential of harm
reduction principle (intervention) in preventing smoking (outcome) among Aboriginal and
Torres Strait Islander people (population studied). The main rational for research in this area was
the poor health status of indigenous Australians and lack of application of the harm minimization
framework till then.

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2. Reviewing the right type of paper
To gain better insight regarding the impact of harm minimization approach for smoking
prevention in indigenous Australian, Ober and Roche (1997) reviewed research papers that
discussed about the smoking prevalence in aboriginal Australians, association of smoking with
poor health, awareness among the Aboriginal people about the detrimental effects of smoking,
characteristics of smoking and harm reduction strategies for smoking. Hence, all the evidence
were related to the research question and were contributing to the research objective. Best studies
were taken which were addressing key themes related to the topic. In addition, most of the papers
were survey or reports related to the topic, however there was lack of randomized controlled
study in the research paper. As the researched mainly aimed to evaluate the impact of harm
minimization approach as an intervention, inclusion of randomized controlled study would have
enhanced the validity and credibility of the research work. This is because randomized controlled
trial comes in top of the research study hierarchy when the aim to test or evaluate a new
intervention (Palinkas et al. 2015). Therefore, taking RCT papers related to the topics would
have enhances the objectivity of the paper.
Detailed question:
3. Inclusion of important and relevant studies:
As mentioned above, Ober and Roche (1997) took relevant studies related to the topic. All
sorts of paper related to indigenous Australians were included in the opinion piece. For instance,
information were covered from survey data, report of the Tobacco Control Summit Working
Group, qualitative studies and quantitative studies. One major limitation is selecting the papers
was that there was not a single RCT studies, however reviewing RCT studies related to the

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research question was critical to truly understand the efficacy of harm reduction approach. A
well conducted RCT studies might have provided most convincing evidence related to the
research question because such studies mainly evaluates whether an intervention can work for a
group or not by comparing it with the control group. Such method of research gives wider
answers such factors influencing the intervention and the mechanism by which an intervention
can bring change in outcome (Palinkas et al. 2015). Impellizzeri and Bizzini (2012) have also
confirmed that best evidence can be gathered by reading RCTs, systematic review and meta-
analysis. RCT is also the highest level of study design that can enhance the quality of research
data.
4. Assessment of the quality of the included studies:
The main responsibility of author, while conducting systematic review is that they must
consider the rigor of the study while including them for analysis. Considering this is important
because lack of rigor affects the study results. However, in the study by Ober and Roche (1997),
assessment of the quality of the included studies was completely missing. This was mainly
because it was not completely a systematic review, although the author reviewed other studies,
however it was mainly done to develop an opinion piece. However, very few systematic review
papers is found were the author assess the quality of the included studies. For instance, in a
systematic review of school based interventions to prevent smoking in girls, the consideration
regarding quality assessment and inclusion of RCT was found. This was found from the
inclusion criteria of the review, which was to include studies with children below 18 years and
studies comparing outcome of interventions such as randomized trials and other trials. Secondly,
quality assessment was done by extracting place of study, study design, intervention content,
duration of intervention and duration follow up. All this were reflective of rigor in the study.

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Additional considerations for quality assessment were also found as criteria was also developed
for judging the risk of biasness in the included articles (de Kleijn et al. 2015).
5. Treatment of the results of the review:
Ober and Roche (1997) gave detailed idea about the results of different studies, however the
variations or similarity in the research article was not separately discussed by the researcher. For
instance, results from Household survey among Aboriginal and Torres Strait Islander was
presented. Another survey gave indication of high smoking rate in Aboriginal health workers.
Secondly, the analysis of studies regarding awareness of harmful effects of smoking among
indigenous people gave idea about the underestimation of risk associated with smoking and high
awareness regarding passive smoking. Furthermore, different types of interventions implemented
as part of harm reduction approach was also presented. Hence, analysis of variation in results
was missing. In contrast to the above study, de Kleijn et al. (2015) focused on variations and
similarity in research too. This was done by considering risk of detection bias in the studies too.
The researcher specified the studies, which had high or low risk of detection bias.
6. Overall results of the review:
The main intention of Ober and Roche (1997) was to explore the effectiveness of harm
reduction principle in preventing smoking in Aboriginal and Torres Strait Islander people. The
bottom line results of the review were listed down by use of appropriate headings. For instance,
the literature search on characteristics of smoking, reinforcers, public health strategies,
perspective of aboriginals on health and harm reduction approaches to drugs were searched and
evaluated. The main outcome in each areas were as follows:
 The elements of harm reductions were determined

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 Information was provided regarding the four main harm reduction approach used till
date to prevent smoking. This included reducing recruitment, increasing cessation,
reducing risk associated with active smoking and reducing passive smoking (Ober
and Roche 1997).
 Among the above four approaches, increasing cessation was considered as difficult
to be achieved because of lifestyle stressors and lifestyle priorities in Aboriginal and
Torres Strait Islanders. Wood et al. (2008) also supported the fact by stating that high
smoking rates in family and friends, difficult life circumstances and smoking acted as
barrier to cessation even in pregnant women in the indigenous group.
 Other three approaches were found effective for application in the target group.
 To bring changes in beneficial outcomes such as morbidity, decreased health care
cost, increased cessation and decrease harm to passive smokers, results finally gave
many recommendation (Ober and Roche 1997). This was to improve the efficacy of
the harm reduction approach by giving smoking related training to Aboriginal health
workers and using wider and flexible approach to bring positive change. For
instance, Fagerström and Bridgman (2014) gave the recommendation that new
products needs to be developed so that they can compete with cigarettes. Regular and
safer nicotine alternative can encourage people to shift to those product and it will
ultimately bring positive outcome for public health.
7. Preciseness of the results
The preciseness of the result is low for the article because of no consideration for the quality
of the study. The result outcome was presented only in the form of opinion, which lacked
analysis of variation or gap in each outcome. However, the only direction given by this study

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was that wider approach and consideration of wider outcome variable is needed to enhance the
effectiveness of harm reduction approach. Hence, the research presented the need for more work
to increase the efficacy of the approach specifically for indigenous people.
8. Application of the results to the local population
The outcome of the study mainly proposed using wider approach to improve the
effectiveness of harm reduction approach for smoking prevention. Hence, the application of the
results for the local population is still low because the impact of no specific interventions were
tested for reducing smoking rate in Aboriginal people. The researcher also showed very limited
application of harm reduction approaches in the wider community. For instance, Purcell et al.
(2015) has given direction regarding approaches that can be taken for the local population. This
includes continue mass media campaigns, strengthening social policies to educate indigenous
people about signs of smoking, investing in tailored approach to support disadvantages smokers
to quit and give more priority to adult smokers.
9. Consideration of important outcomes:
One strength of the study by Ober and Roche (1997) was that all important outcomes that
might trigger improvement in smoking rate was considered. For instance, the researcher
indicated about using harm reduction approaches for beneficial outcomes like decreasing
mortality and morbidity rate, reducing harm to passive users, increasing cessation rate and
preventing health cost associated with risk of diseases due to smoking. Hence, this was an
important observation and this would provided guidance regarding policy related changes and
health promotional activities needed to address each intervention.
10. Values of the research in terms of harms and cost:

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For exploring the impact of harm reduction for smoking prevention in aboriginal people, the
researcher had to spend enough time in reviewing relevant studies. Although the cost involved in
conducting the study was low, however effort put on reviewing relevant articles proved to be
beneficial because it proved the positive impact of harm reduction approach and also gave the
direction to further strengthen the approach for smoking prevention in specific population group.
Conclusion
The report brought into attention the issue of smoking prevalence in Aboriginal and
Torres Strait Islander and critically analyzed the efficacy of harm reduction approach by the use
of CASP tool. As the article was published in 1997, it has been found by reviewing the article
that harm reduction approach remained untapped by that time. Hence, the opinion piece gave
extensive information regarding perception of aboriginal people regarding risk of smoking and
the approaches used as part of harm reduction technique. The study proved that harm reduction
approach is effective in reducing rate, however wider application was not seen. Limitation were
also found in the paper because quality of the paper were not assesses and variations in results of
different research work were not analyzed. However, the information from the study was useful
in giving a direction to enhance harm reduction approach. This mainly included using a wider
perspective and flexible tailored approach to target aboriginal people and implement policy
changes which is acceptable for the community. Finding appropriate nicotine replacement that
would control smoking is also needed.

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Reference
Chamberlain, C., Perlen, S., Brennan, S., Rychetnik, L., Thomas, D., Maddox, R., Alam, N.,
Banks, E., Wilson, A. and Eades, S., 2017. Evidence for a comprehensive approach to
Aboriginal tobacco control to maintain the decline in smoking: an overview of reviews
among Indigenous peoples. Systematic reviews, 6(1), p.135.
de Kleijn, M.J., Farmer, M.M., Booth, M., Motala, A., Smith, A., Sherman, S., Assendelft, W.J.
and Shekelle, P., 2015. Systematic review of school-based interventions to prevent
smoking for girls. Systematic reviews, 4(1), p.109.
Department of Health | Tackling Indigenous Smoking (TIS) - National Statistics. 2017.
Health.gov.au. [online] Available at:
http://www.health.gov.au/internet/main/publishing.nsf/content/indigenous-tis-statistics
[Accessed 13 Sep. 2017].
Fagerström, K.O. and Bridgman, K., 2014. Tobacco harm reduction: the need for new products
that can compete with cigarettes. Addictive behaviors, 39(3), pp.507-511.
Fraser, D., Borland, R. and Gartner, C., 2015. Protocol for a randomised pragmatic policy trial of
nicotine products for quitting or long-term substitution in smokers. BMC public
health, 15(1), p.1026.
Gould, G.S., Cadet-James, Y. and Clough, A.R., 2016. Getting over the shock: taking action on
Indigenous maternal smoking. Australian journal of primary health, 22(4), pp.276-282.

12RESEARCH LITERACY FOR HEALTH PRACTICE
Impellizzeri, F.M. and Bizzini, M., 2012. Systematic review and meta‐analysis: A
primer. International journal of sports physical therapy, 7(5), p.493.
Kozlowski, L.T., 2015. Prospects for a nicotine-reduction strategy in the cigarette endgame:
alternative tobacco harm reduction scenarios. International Journal of Drug
Policy, 26(6), pp.543-547.
Minichiello, A., Lefkowitz, A.R., Firestone, M., Smylie, J.K. and Schwartz, R., 2016. Effective
strategies to reduce commercial tobacco use in Indigenous communities globally: a
systematic review. BMC public health, 16(1), p.21.
Ober, C. and Roche, A.M., 1997. Rethinking smoking among Aboriginal Australians: the harm
minimisation-abstinence conundrum. Health Promotion Journal of Australia: Official
Journal of Australian Association of Health Promotion Professionals, 7(2), p.128.
Palinkas, L.A., Horwitz, S.M., Green, C.A., Wisdom, J.P., Duan, N. and Hoagwood, K., 2015.
Purposeful sampling for qualitative data collection and analysis in mixed method
implementation research. Administration and Policy in Mental Health and Mental Health
Services Research, 42(5), pp.533-544.
Purcell, K.R., O'Rourke, K. and Rivis, M., 2015. Tobacco control approaches and inequity—how
far have we come and where are we going?. Health promotion
international, 30(suppl_2), pp.ii89-ii101.
Wood, L., France, K., Hunt, K., Eades, S. and Slack-Smith, L., 2008. Indigenous women and
smoking during pregnancy: knowledge, cultural contexts and barriers to cessation. Social
science & medicine, 66(11), pp.2378-2389.

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Appendix
List of articles reviewed as part of literature search
Chamberlain, C., Perlen, S., Brennan, S., Rychetnik, L., Thomas, D., Maddox, R., Alam, N.,
Banks, E., Wilson, A. and Eades, S., 2017. Evidence for a comprehensive approach to
Aboriginal tobacco control to maintain the decline in smoking: an overview of reviews
among Indigenous peoples. Systematic reviews, 6(1), p.135.
Fraser, D., Borland, R. and Gartner, C., 2015. Protocol for a randomised pragmatic policy trial of
nicotine products for quitting or long-term substitution in smokers. BMC public
health, 15(1), p.1026.
Gould, G.S., Cadet-James, Y. and Clough, A.R., 2016. Getting over the shock: taking action on
Indigenous maternal smoking. Australian journal of primary health, 22(4), pp.276-282.
Kozlowski, L.T., 2015. Prospects for a nicotine-reduction strategy in the cigarette endgame:
alternative tobacco harm reduction scenarios. International Journal of Drug
Policy, 26(6), pp.543-547.
Minichiello, A., Lefkowitz, A.R., Firestone, M., Smylie, J.K. and Schwartz, R., 2016. Effective
strategies to reduce commercial tobacco use in Indigenous communities globally: a
systematic review. BMC public health, 16(1), p.21.