Papers by Michelle L Smith
This paper describes two phases of a community-directed intervention to address strongyloidiasis ... more This paper describes two phases of a community-directed intervention to address strongyloidiasis in the remote Aboriginal community of Woorabinda in central Queensland, Australia. The first phase provides the narrative of a community-driven 'treat-and-test' mass drug administration (MDA) intervention that was co-designed by the Community Health Service and the community. The second phase is a description of the re-engagement of the community in order to disseminate the key factors for success in the previous MDA for Strongyloides stercoralis, as this information was not shared or captured in the first phase. During the first phase in 2004, there was a high prevalence of strongyloidiasis (12% faecal examination, 30% serology; n = 944 community members tested) that resulted in increased morbidity and at least one death in the community. Between 2004–2005, the community worked in partnership with the Community Health Service to implement a S. stercoralis control program, where all of the residents were treated with oral ivermectin, and repeat doses were given for those with positive S. stercoralis serology. The community also developed their own health promotion campaign using locally-made resources targeting relevant environmental health problems and concerns. Ninety-two percent of the community residents participated in the program, and the prevalence of strongyloidiasis at the time of the 'treat-and-test' intervention was 16.6% [95% confidence interval 14.2–19.3]. The cure rate after two doses of ivermectin was 79.8%, based on pre-serology and post-serology tests. The purpose of this paper is to highlight the importance of local Aboriginal leadership and governance and a high level of community involvement in this successful mass drug administration program to address S. stercoralis. The commitment required of these leaders was demanding, and involved intense work over a period of several months. Apart from controlling strongyloidiasis, the community also takes pride in having developed and implemented this program. This appears to be the first community-directed S. stercoralis control program in Australia, and is an important part of the national story of controlling infectious diseases in Indigenous communities.
PURPOSE/OBJECTIVES:
To explore the influence of lung cancer diagnosis on interpersonal dynamics i... more PURPOSE/OBJECTIVES:
To explore the influence of lung cancer diagnosis on interpersonal dynamics in families in which one or more members continue to smoke following diagnosis.
RESEARCH APPROACH:
Descriptive, qualitative.
SETTING:
Three cancer care sites in western Canada.
PARTICIPANTS:
16 participants from 8 family dyads.
METHODOLOGIC APPROACH:
Patients with lung cancer receiving treatment and immediate family members were recruited to participate in individual or conjoint semistructured interviews. Thematic analysis was conducted on transcribed interviews.
MAIN RESEARCH VARIABLES:
Intrafamily interaction patterns, smoking and smoking cessation, lung cancer diagnosis.
FINDINGS:
Following diagnosis, patients with lung cancer experienced considerable distress as they struggled to understand family members' continued smoking. Patient orientations to family members who smoked included preserving relationships (maintaining harmony and connection with family members took priority over directly intervening with smokers) and risking relationships (patients repeatedly confronted family members about continued smoking to influence their cessation despite the impact on relationships). Neither pattern was successful in engaging relatives in smoking reduction or cessation, and the risking relationships approach resulted in conflict and strained family relationships.
CONCLUSIONS:
The findings provide additional support for examining family dynamics related to tobacco reduction and cessation as well as directions for future research.
INTERPRETATION:
Nurses should encourage tobacco reduction as a supportive intervention for patients with lung cancer and their families to eliminate smoking-related distress.
Although individuals who are diagnosed with smoking-related disorders are offered smoking cessati... more Although individuals who are diagnosed with smoking-related disorders are offered smoking cessation programs, little attention has been directed toward reducing tobacco use among healthy relatives who smoke. The purpose of this article is to report smoking relatives' responses to a family member's diagnosis of lung disease, their constructions of smoking in this context, and their interaction patterns with the patient. Interviews with 11 family members where there was a diagnosis of lung cancer and 3 family members where there was another serious smoking-related diagnosis were analyzed. Family members used two strategies to support their continued smoking: distancing themselves from the diagnosis and taking the position that smoking cessation needed to be internally motivated by the " right reason " and initiated at the " right time " to anticipate success. The few participants who chose to quit, did so in support of their ill family member. The findings provide direction for intervening with family members who smoke.
Background: Young adults remain the earliest legal target for the tobacco industry. Against this,... more Background: Young adults remain the earliest legal target for the tobacco industry. Against this, the existence of smoking policies would appear to offer some protection to students on campus. However, little research has been conducted into the outcomes of such policies from a student perspective. Methods: The authors conducted 8 focus groups at 4 selected Canadian undergraduate campuses to investigate student perceptions and behaviors resulting from campus smoking policies. Results: Results indicated that student smoking behaviors are minimally impacted by campus smoking policies due to seriously compromised implementation and enforcement. Conclusions: These findings imply that the presence of campus smoking policies and claims of “smoke-free” campuses should not be misinterpreted as achievement and without renewed focus and adequate tobacco control infrastructure, it will remain possible for young adults to initiate and maintain tobacco smoking on campus.
Thirty per cent of school districts in British Columbia do not ban smoking outright on school gro... more Thirty per cent of school districts in British Columbia do not ban smoking outright on school grounds, and in several instances, smoking is permitted in smoking pits, regardless of school district policy. While there is evidence to suggest that enforcing a tobacco-free environment for students does reduce adolescent smoking rates, the concomitant safety and discipline problems it creates for school staff and administration are demanding and complex, and may override concerns regarding student smoking. This study uses a qualitative approach to explore the meanings that students place on tobacco control policy and the impact that these meanings have on their own smoking behaviours. We found that students were surprised and concerned that smoking was permitted on school property and that it negatively impacted their own tobacco prevention/control/cessation attempts.
The college years occur during the stage of life when many people develop permanent smoking habit... more The college years occur during the stage of life when many people develop permanent smoking habits, and approximately one-third go on to become addicted smokers. The 18–24 year demographic that makes up the majority of undergraduate attendees represents the earliest years that the tobacco industry now can legally attempt to lure new customers into smoking. This research investigated the ways in which university tobacco control policies are developed , introduced to students, faculty and staff and how they are implemented and enforced. Findings show that tobacco control initiatives at Canadian undergraduate universities face a wide range of challenges including a lack of dedicated and consistent tobacco control personnel , ownership issues, funding, enforcement and monitoring dilemmas. Participants also reported that the layout and geographic location of the campus can result in difficulties in implementation. Consequently, it appears that there may be a growing, although inadvertent , tolerance for smoking on Canadian campuses.
PLOS Neglected Tropical Diseases, 2014
Background: Strongyloides stercoralis infects human hosts mainly through skin contact with contam... more Background: Strongyloides stercoralis infects human hosts mainly through skin contact with contaminated soil. The result is strongyloidiasis, a parasitic disease, with a unique cycle of auto-infection causing a variety of symptoms and signs, with possible fatality from hyper-infection. Australian Indigenous community members, often living in rural and remote settings, are exposed to and infected with S. stercoralis. The aim of this review is to determine barriers to control of strongyloidiasis. The purpose is to contribute to the development of initiatives for prevention, early detection and effective treatment of strongyloidiasis.
Aboriginal Policy Studies, 2018
The objective of this paper is to document the knowledge and experiences of healthcare profession... more The objective of this paper is to document the knowledge and experiences of healthcare professionals and researchers in Australia about the barriers to controlling Strongyloides stercoralis in Australian Indigenous communities. Qualitative research methods were used to conduct in-depth semi-structured interviews, which were digitally recorded, transcribed, and participant-checked. Data were thematically analysed to identify significant themes. Five major themes were identified:
1) Barriers to health/treatment;
2) Access to healthcare;
3) Policy;
4) Learning opportunity; and
5) Ideas for intervention.
The findings suggest that Australian Indigenous communities will continue to suffer increased morbidity and mortality due to a lack of control or prevention of Strongyloides stercoralis. Issues such as institutional racism, improvements to health promotion, education, socioeconomic determinants, and health care system policy and procedures need to be addressed. This study identifies several direct implications for Indigenous health:
The need for increased knowledge and understanding of the risks to health for Indigenous community members;
The need for prevention policy development for neglected tropical diseases in Indigenous communities;
The need for increased knowledge and understanding of the treatment, diagnosis, and healthcare access concerning Strongyloides stercoralis for health professionals and policymakers who work within Indigenous health;
The need to raise awareness of systematic institutional racism in the control and prevention of neglected tropical diseases in Indigenous communities; and
The need for a health promotion framework that can provide the basis for multiple-level interventions to control and prevent Strongyloides in Indigenous communities.
In Canada, cultural safety is emerging as a theoretical and practice lens to orient health care s... more In Canada, cultural safety is emerging as a theoretical and practice lens to orient health care services to meet the needs of Aboriginal people. Evidence suggests Aboriginal peoples’ encounters with health care are commonly negative, and there is concern that these experiences can contribute to further adverse health outcomes. In this article, we report findings based on participatory action research drawing on Indigenous methods. Our project goal was to interrogate practices within one hospital to see whether and how cultural safety for Aboriginal patients could be improved. Interviews with Aboriginal patients who had accessed hospital services were conducted and responses were collated into narrative summaries. Using interlocking analysis, findings revealed a number of processes operating to produce adverse health outcomes. One significant outcome is the production of structural violence that reproduces experiences of institutional trauma. Positive culturally safe experiences, less reported, were described as interpersonal interactions with feelings visibility and therefore, treatment as a “human being”.
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Papers by Michelle L Smith
To explore the influence of lung cancer diagnosis on interpersonal dynamics in families in which one or more members continue to smoke following diagnosis.
RESEARCH APPROACH:
Descriptive, qualitative.
SETTING:
Three cancer care sites in western Canada.
PARTICIPANTS:
16 participants from 8 family dyads.
METHODOLOGIC APPROACH:
Patients with lung cancer receiving treatment and immediate family members were recruited to participate in individual or conjoint semistructured interviews. Thematic analysis was conducted on transcribed interviews.
MAIN RESEARCH VARIABLES:
Intrafamily interaction patterns, smoking and smoking cessation, lung cancer diagnosis.
FINDINGS:
Following diagnosis, patients with lung cancer experienced considerable distress as they struggled to understand family members' continued smoking. Patient orientations to family members who smoked included preserving relationships (maintaining harmony and connection with family members took priority over directly intervening with smokers) and risking relationships (patients repeatedly confronted family members about continued smoking to influence their cessation despite the impact on relationships). Neither pattern was successful in engaging relatives in smoking reduction or cessation, and the risking relationships approach resulted in conflict and strained family relationships.
CONCLUSIONS:
The findings provide additional support for examining family dynamics related to tobacco reduction and cessation as well as directions for future research.
INTERPRETATION:
Nurses should encourage tobacco reduction as a supportive intervention for patients with lung cancer and their families to eliminate smoking-related distress.
1) Barriers to health/treatment;
2) Access to healthcare;
3) Policy;
4) Learning opportunity; and
5) Ideas for intervention.
The findings suggest that Australian Indigenous communities will continue to suffer increased morbidity and mortality due to a lack of control or prevention of Strongyloides stercoralis. Issues such as institutional racism, improvements to health promotion, education, socioeconomic determinants, and health care system policy and procedures need to be addressed. This study identifies several direct implications for Indigenous health:
The need for increased knowledge and understanding of the risks to health for Indigenous community members;
The need for prevention policy development for neglected tropical diseases in Indigenous communities;
The need for increased knowledge and understanding of the treatment, diagnosis, and healthcare access concerning Strongyloides stercoralis for health professionals and policymakers who work within Indigenous health;
The need to raise awareness of systematic institutional racism in the control and prevention of neglected tropical diseases in Indigenous communities; and
The need for a health promotion framework that can provide the basis for multiple-level interventions to control and prevent Strongyloides in Indigenous communities.
To explore the influence of lung cancer diagnosis on interpersonal dynamics in families in which one or more members continue to smoke following diagnosis.
RESEARCH APPROACH:
Descriptive, qualitative.
SETTING:
Three cancer care sites in western Canada.
PARTICIPANTS:
16 participants from 8 family dyads.
METHODOLOGIC APPROACH:
Patients with lung cancer receiving treatment and immediate family members were recruited to participate in individual or conjoint semistructured interviews. Thematic analysis was conducted on transcribed interviews.
MAIN RESEARCH VARIABLES:
Intrafamily interaction patterns, smoking and smoking cessation, lung cancer diagnosis.
FINDINGS:
Following diagnosis, patients with lung cancer experienced considerable distress as they struggled to understand family members' continued smoking. Patient orientations to family members who smoked included preserving relationships (maintaining harmony and connection with family members took priority over directly intervening with smokers) and risking relationships (patients repeatedly confronted family members about continued smoking to influence their cessation despite the impact on relationships). Neither pattern was successful in engaging relatives in smoking reduction or cessation, and the risking relationships approach resulted in conflict and strained family relationships.
CONCLUSIONS:
The findings provide additional support for examining family dynamics related to tobacco reduction and cessation as well as directions for future research.
INTERPRETATION:
Nurses should encourage tobacco reduction as a supportive intervention for patients with lung cancer and their families to eliminate smoking-related distress.
1) Barriers to health/treatment;
2) Access to healthcare;
3) Policy;
4) Learning opportunity; and
5) Ideas for intervention.
The findings suggest that Australian Indigenous communities will continue to suffer increased morbidity and mortality due to a lack of control or prevention of Strongyloides stercoralis. Issues such as institutional racism, improvements to health promotion, education, socioeconomic determinants, and health care system policy and procedures need to be addressed. This study identifies several direct implications for Indigenous health:
The need for increased knowledge and understanding of the risks to health for Indigenous community members;
The need for prevention policy development for neglected tropical diseases in Indigenous communities;
The need for increased knowledge and understanding of the treatment, diagnosis, and healthcare access concerning Strongyloides stercoralis for health professionals and policymakers who work within Indigenous health;
The need to raise awareness of systematic institutional racism in the control and prevention of neglected tropical diseases in Indigenous communities; and
The need for a health promotion framework that can provide the basis for multiple-level interventions to control and prevent Strongyloides in Indigenous communities.