Mrs Michelle Bovill
Casual Research Assistant
School of Medicine and Public Health
Circling around the burning issues: a cultural approach to an Indigenous health issue
Michelle Bovill is investigating culturally responsive approaches to empower Aboriginal women to quit smoking during pregnancy.
Not many researchers could claim a one hundred percent agreement rate for their first health care study.
It is an especially extraordinary claim when the people involved belong to a group who can experience unique barriers to accessing quality health care.
Wiradjuri woman, PhD candidate, and Heart Foundation Australia Indigenous Scholarship recipient Michelle Bovill has done just that.
Michelle’s wildly successful study, exploring health care delivery to Aboriginal women during pregnancy in smoking cessation support, has informed the ICAN Quit in Pregnancy intervention program, now underway, with plans for further expansion.
Just don’t credit Michelle with the knowledge uncovered during her work.
“My research is about working with Aboriginal women and capturing their voices in the research space to develop interventions that are empowering and supportive for them,” Michelle says.
“It’s not my research, I’m just writing it.”
“This research belongs to the women sharing their stories.”
The truth about compliance
With extensive experience in youth work, community development, and out-of-home care, Michelle has a practical understanding of the power of support services delivered in a culturally responsive, person-centered manner.
Whilst listening to the stories of Aboriginal women, identifying supports, and attempting to uncover barriers to them accessing or accepting smoking cessation support during pregnancy, Michelle made a startling discovery.
“It turns out that a lot of health providers are telling Aboriginal women to reduce smoking in pregnancy, instead of telling them to quit,” Michelle says.
“And these women are reducing smoking, so they are actually following the advice of their health care providers.”
“The messages in medical services in general is that reducing is a good thing,” Michelle explains.
“With this research we are trying to change that line, we do not talk about reducing at all.”
“Ideally, we want to change this message and ensure every Aboriginal woman is given the means and motivation to choose to cease smoking during pregnancy.”
Barriers and supports
Health care providers themselves offered feedback that telling people what to do may impact negatively on rapport building, or that Aboriginal mums ‘just don’t want to talk about quitting’.
With statistics suggesting a large percentage of Aboriginal health care workers themselves smoke, Michelle suspects avoiding feelings of hypocrisy is also a motivator to not broach the topic.
Michelle collaborated with two Aboriginal Medical services, and her circle of pregnant mother advisors, to develop resources and educational material for both Aboriginal health services and the women being offered support by them.
For the pregnant women, the intervention program is interactive, ongoing, and informative.
For health services, a webinar training approach looks to build skills in workers.
“We want to build capacity of health care providers so they feel confident to say it is best to quit and we can make a plan to support you so you are not alone.”
“It can be a difficult subject to deal with, but in the end, health workers just needs the right training to deliver the right message.”
The program is currently being piloted in six Aboriginal Community controlled health services across three states.
It will examine whether culturally-appropriate training helps providers use evidence-based behaviour change techniques to help pregnant women quit, compared to using their standard model of care.
“Within the intervention I am specifically measuring the growth and empowerment of Aboriginal women through their pregnancy, to see if there is any change in growth and empowerment through being offered smoking cessation support,” Michelle says.
“To date, Aboriginal health care research is all deficit focused, when the reality in this case is that they're doing what the doctors are telling them to do, so let’s stop stating the prevalence and collaborate for better support strategies” Michelle says.
“So not only do we need to improve processes to improve outcomes, but we need to correct the narrative as well.”
Thanks to recent funding from the NHMRC, the team will soon roll out the ICAN QUIT program in collaboration with around 30 Aboriginal health care services around the nation.
Building interventions that work
Michelle admits to sometimes being challenged to find what she believes to be the right balance between academic tradition and authenticity in her representation of Aboriginal women’s voices.
Nonetheless, her recent paper “Collective and negotiated design for a clinical trial addressing smoking cessation supports for Aboriginal and Torres Strait Islander mothers in NSW, SA and Qld - developing a pilot study” was accepted for publication by the Australian Journal of Primary Health with minimal edits.
The paper describes the process of developing an intervention collaboratively with Aboriginal and Torres Strait Islander people and communities that evolved from the stories shared by Aboriginal women during her initial study.
Although Michelle’s approach of working with individuals and communities instead of at them seems like common sense in the new age of person centered care, it is a new experience for many participants.
“Some of our communities get a bit shocked,” she notes.
“I have implemented this process where we don't do consultation, we do ongoing conversations, and transparency is everything.”
Michelle believes it is essential for Aboriginal researchers to share information about successfully working in collaboration with Aboriginal people to uphold Aboriginal rights and ethics practice.
“Maintaining a constant back and forth conversation with these mums might be the long way to do it, but it’s the only way that interventions will work.”
“And if we build any intervention with respect, reciprocity, and trust in mind, anyone would be better supported.”
“Particularly anyone in a vulnerable population group who can feel they are not being judged, and that someone is there to genuinely give a damn about them.”
Michelle Bovill is investigating culturally responsive approaches to empower Aboriginal women to quit smoking during pregnancy.
Michelle is a proud Wiradjuri woman who has grown up on Worimi country.
Her PhD in Aboriginal Health addresses ‘Culturally responsive approaches for the empowerment of Aboriginal and Torres Strait Islander women in smoking cessation care’. Michelle’s work utilises Indigenous methodologies within the health research space to privilege the voices of Aboriginal and Torres Strait Islander women to develop culturally responsive interventions to reduce the prevalence of maternal smoking during pregnancy.
Michelle has a BA in Arts and MA in Social Science and has worked across the Hunter New England area as an artist, community development practitioner and social worker.
- Master of Social Science, University of Newcastle
- Bachelor of Arts, University of Newcastle
- Bachelor of Arts (Honours), University of Newcastle
- Graduate Certificate in Social Science, University of Newcastle
- Aboriginal Health
- Indigenous Methodologies
- Qualitative Research
- Smoking Cessation
Fields of Research
|111701||Aboriginal and Torres Strait Islander Health||100|
|Title||Organisation / Department|
|Casual Academic||University of Newcastle
Indigenous Education and Research
For publications that are currently unpublished or in-press, details are shown in italics.
Journal article (7 outputs)
Bovill M, Gruppetta M, Cadet-James Y, Clarke M, Bonevski B, Gould GS, 'Wula (Voices) of Aboriginal women on barriers to accepting smoking cessation support during pregnancy: Findings from a qualitative study', Women and Birth, 31 10-16 (2018) [C1]
© 2017 Australian College of Midwives Aim: To gather Aboriginal women's stories of smoking and becoming pregnant to identify the barriers in accepting smoking cessation suppo... [more]
© 2017 Australian College of Midwives Aim: To gather Aboriginal women's stories of smoking and becoming pregnant to identify the barriers in accepting smoking cessation support during pregnancy. Methods: Qualitative data were collected through use of yarning methodology between August 2015 and January 2016 by an Aboriginal Researcher with experience in social and community services. A short on-line survey was used to collect quantitative data. Interviews only recorded the therapeutic yarning process, which ranged from 9 to 45 min duration, averaging 30 min. Audio-recorded interviews were transcribed and independently coded. A general inductive analysis was used to determine emergent themes. Results: Twenty Aboriginal women between 17¿38 years of age, who were pregnant or recently given birth, living in the Hunter New England (HNE) area took part. Eleven women were still smoking; nine had quit. Most were highly aware of the implications of smoking for their babies. Major themes identified for accepting support were: ambivalence towards a need for support, health professional advice, reduction in smoking, and attitudes to Nicotine Replacement Therapy (NRT). Women reported being advised to cut down, rather than to quit; reducing consumption may be a barrier to accepting NRT. Women recommended enhanced clinical support and Aboriginal community engagement in cessation care. Discussion/conclusions: Aboriginal women in the HNE area reported quitting or reducing their cigarette intake during pregnancy. Health Professionals working with Aboriginal women during pregnancy should give consistent messages to quit smoking completely, and offer increased, ongoing and extensive smoking cessation support to Aboriginal mothers. Clinical practices could partner with Aboriginal communities to support the delivery of smoking cessation services.
Bovill M, Bar Zeev Y, Gruppetta M, O'Mara P, Cowling B, Gould GS, 'Collective and negotiated design for a clinical trial addressing
smoking cessation supports for Aboriginal and Torres Strait Islander
mothers in NSW, SA and Qld ¿ developing a pilot study', Australian Journal of Primary Health, 23 497-503 (2017) [C1]
Gould GS, Bovill M, Chiu S, Bonevski B, Oldmeadow C, 'Exploring an adapted Risk Behaviour Diagnosis Scale among Indigenous Australian women who had experiences of smoking during pregnancy: a cross-sectional survey in regional New South Wales, Australia', BMJ OPEN, 7 (2017) [C1]
Gould GS, Bar-Zeev Y, Bovill M, Atkins L, Gruppetta M, Clarke MJ, Bonevski B, 'Designing an implementation intervention with the Behaviour Change Wheel for health provider smoking cessation care for Australian Indigenous pregnant women.', Implementation science : IS, 12 (2017) [C1]
Gould GS, Bovill M, Clarke MJ, Gruppetta M, Cadet-James Y, Bonevski B, 'Chronological narratives from smoking initiation through to pregnancy of Indigenous Australian women: A qualitative study', Midwifery, 52 27-33 (2017) [C1]
© 2017 Objective One in two Indigenous Australian pregnant women smoke, yet little is known about their trajectory of smoking. This study aimed to explore Aboriginal women's ... [more]
© 2017 Objective One in two Indigenous Australian pregnant women smoke, yet little is known about their trajectory of smoking. This study aimed to explore Aboriginal women's narratives from starting smoking through to pregnancy. Methods A female Aboriginal Researcher conducted individual face-to-face interviews with 20 Aboriginal women from New South Wales, Australia. Recruitment, through Aboriginal services and community networks, continued until saturation was reached. Audio-recorded transcripts were independently open coded by two researchers, inductively analysed and reported using a three-dimensional structure of looking backwards, forwards, inwards, outwards and a sense of place, to elucidate the chronology of events, life stages, characters, environments, and turning points of the stories. Results A chronology emerged from smoking initiation in childhood, coming of age, becoming pregnant, through to attempts at quitting, and relapse post-partum. Several new themes emerged: the role mothers play in women's smoking and quitting; the contribution of nausea to spontaneous quitting; depression as a barrier to quitting; and the hopes of women for their own and their children's future. The epiphany of pregnancy was a key turning point for many ¿ including the interplay of successive pregnancies; and the intensity of expressed regret. Conclusions Aboriginal women report multiple influences in the progression of early smoking to pregnancy and beyond. Potential opportunities to intervene include: a) childhood, coming of age, pregnancy, post-natal, in-between births; b) key influencers; c) environments, and d) targeting concurrent substance use. Morning sickness appears to be a natural deterrent to continued smoking. Depression, and its relationship to smoking and quitting in Australian Indigenous pregnant women, requires further research.
Bar-Zeev Y, Bovill M, Bonevski B, Gruppetta M, Reath J, Gould GS, 'Assessing and Validating an Educational Resource Package for Health Professionals to Improve Smoking Cessation Care in Aboriginal and Torres Strait Islander Pregnant Women.', International journal of environmental research and public health, 14 (2017) [C1]
|Show 4 more journal articles|
Conference (11 outputs)
Bovill M, Bar-Zeev Y, Bonevski B, Gruppetta M, Palazzi K, Oldmeadow C, Gould G, 'The Growth and Empowerment Measure Among Aboriginal Pregnant Women Recruited for Ican Quit in Pregnancy', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY (2017)
Bovill M, Gruppetta M, Clarke M, Bonevski B, Gould G, ''Wula': Voice of Aboriginal women on barriers to seeking and accepting smoking cessation support during pregnancy; findings from a qualitative study in Hunter New England district, New South Wales.', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, HMRI (2016)
Bovill MA, Gould G, 'World Indigenous Cancer Conference', "Our Smoking and Smoke-Free Stories" by Aboriginal Women, Brisbane (2016)
Bar Zeev Y, Bovill M, Bonevski B, Gould G, 'INDIGENOUS COUNSELLING AND NICOTINE (ICAN) QUIT IN PREGNANCY - DEVELOPING AN EVIDENCE-BASED INTERVENTION FOR SMOKING CESSATION FOR INDIGENOUS PREGNANT WOMEN', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY (2015) [E3]
|Show 8 more conferences|
ICAN QUIT in Pregnancy 2015 - 2017
December 5, 2016