Three key insights from the Tackling Indigenous Smoking (TIS) preliminary evaluation
The national Tackling Indigenous Smoking (TIS) program is a population-health initiative designed ‘to improve the health of Aboriginal and Torres Strait Islander peoples through local population specific efforts to reduce harm from tobacco.’
The grants program is primarily implemented by Aboriginal community-controlled health services (ACCHOs) in ways that suit their communities – from urban to rural and remote settings across Australia.
In 2014 we worked with Nunkuwarrin Yunti (Nunk), an ACCHO based in northern Adelaide, to design a social marketing campaign funded under the TIS program, aimed at preventing the uptake of smoking by young Aboriginal people in the Adelaide region. We supported Nunkuwarrin Yunti to build on the success of their award-winning ‘re-write your story’ campaign with the youth-focused ‘Don’t let your dreams go up in smokes’ – utilising behavioural insights and positive strength-based messaging in online, social media, traditional media and in local events.
Preliminary results from the campaign were positive, however, it’s sustainable and longer-term behaviour change that will show real impact. We have continued to assist Nunkuwarrin Yunti with communicating and monitoring their broader TIS programs, so we were interested to see the recent release of the preliminary evaluation (covering year one) of the TIS program, produced by the Cultural and Indigenous Research Centre Australia (circa) and recently released by the Department of Health.
The report is extremely comprehensive, but we’ve pulled out a few high-level insights on factors impacting the success of the program so far:
Locally-driven, culturally appropriate messages and actions are key to engaging communities.
The evaluation report noted that there had been an increase in grant recipients involving the community in design and planning. There has also been an increased level of community support for TIS activities and ownership for local solutions across the sites.
Local, place-based and culturally relevant social marketing campaigns resonated much better with communities than mainstream campaigns. Many had local faces and places at the centre of the campaigns, making them more relevant for their communities. And rather than wholly concentrating on negative aspects of smoking, more successful campaigns used and promoting a strength-based approach with positive stories and emphasis on making healthy choices.
The report also noted that community events attended by or hosted by the TIS team were well attended and a successful way to engage communities. More evidence of community support for the program was seen by the “proactivity of local community and Elders in advocating for tobacco control”. For local education and awareness raising events and activities, this was recognised as key to the messages resonating with target audiences.
Progress is being made on gathering data and reporting on outcomes but analysing, translating and presenting it in a meaningful way is still a challenge.
The evaluation noted that grant recipients demonstrated a willingness to focus on outcomes and that generally they had an increased confidence and capability to obtain data. However, there have been challenges in analysing and measuring the impact of data, particularly for social marketing campaigns that have less tangible ways of measuring outcomes for people. Some sites are demonstrating a commitment to collecting data on awareness, and influences on motivations and attempts to quit. Although, interpreting and translating this data into ‘a meaningful story’ has been more difficult for some.
Grant recipients were generally confident in collecting data and committed to building the evidence base, however it was challenging for some remote recipients because of the context of low literacy levels in the community. Other challenges included the need for better and more consistent systems to support data collection, services recording data in different databases, and an occasional unwillingness to share data. Many organisations also found that they had limited capacity to evaluate and incorporate data into performance reports regularly and link outcomes relevant to their activities with the overall objectives of the national TIS framework.
Increased capacity building for organisations, including support for partnerships and collaboration is important to the overall success of the program.
Many grant recipients reported strengthened internal processes over the initial period. This has allowed organisations to extend the reach of their activities. However, at many sites, there are ongoing issues with staff retention and consistency of activity due to funding uncertainty and the use of short-term contracts under the new TIS program.
There was also an ‘increase in reported collaboration and partnerships leading to wider regional focus as well as a wider community approach to tobacco reduction’. Funded organisations recognised the value of partnerships to support their activities and integrate them into services and enhance referral processes. However, many also wanted increased support from the program to develop external partnerships and “leverage relationships through the distribution and promotion of relevant resources”.
The evaluation report recommends a multi-faceted health promotion approach – for example using social marketing, community education, quit support groups, nutrition and physical activity programs together. A systems approach with an understanding of the connections and referral pathways that ensures the TIS program is part of the larger preventative health care system. This integrated approach would seem to ensure the behaviour change is both holistic and sustained in communities.