Miscommunication and misperceptions between health staff and Indigenous carers about raising smoking cessation in a paediatric ward in Australia: a qualitative study

Abstract

Background: Reducing second-hand smoke (SHS) exposure among Indigenous children is an important public health priority in Australia. Parents and family members can be supported to quit smoking during a child's hospital admission. However, communication with Indigenous patients is often a problem for health staff in Australia. Aim: This paper examines the barriers and enablers in communication between health staff and Indigenous carers of paediatric patients in a hospital, about advice to help reduce exposure of children to SHS and child tobacco-related illnesses. Methods: This paper describes findings generated about miscommunication from a broader project analysing smoking cessation interaction between non-Indigenous health staff and Indigenous carers, recruited from a paediatric ward of a regional hospital servicing remote Indigenous communities in the Northern Territory. A constructivist grounded theory with multiphase case study design and semi-structured interviews was used. Transcripts were analysed using line-by-line coding. Results: Health staff and carers had different perceptions about raising the issue of smoking. Health staff lacked confidence to talk about smoking and questioned the cultural appropriateness of doing so. In contrast, carers expected to talk about smoking while in the hospital, and perceived it as part of a caring and protective relationship by health staff. English being a second language for carers was considered a significant communication barrier by staff; carers, however, felt that health staff needed to modify their communication styles such as slowing down their speech. Health staff had possible misperceptions about carers lack of response to messages, which they interpreted as carers not being interested in SHS messages. This led to health staff dropping the subject, when, in fact, carers were struggling with health workers communication styles. Conclusions: Health staff and carers perceive discussion around smoking differently. Cross-cultural communication education may empower staff to provide effective smoking cessation interventions in this setting. Impact statement: Reducing exposure to second-hand smoke (SHS) among Indigenous children is a significant public health priority. Improving communication between health staff will help ensure the optimal provision of smoking cessation support to carers.