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Background: Smoking prevalence remains high in Aboriginal and Torres Strait Islander Peoples. Indigenous peoples in countries colonised by Western nations prefer culturally-targeted anti-tobacco messages, yet only recently have messages been tailored for Australian Aboriginal and Torres Strait Islander Peoples. We conducted a national survey to determine how messages are being developed for Indigenous tobacco control. Method: Forty-seven telephone interviews were conducted with 44 of 53 eligible organisations. Twenty-two Aboriginal Medical Services (AMSs), 13 Government Organisations (GOs), four Universities and eight non-government organisations (NGOs) participated. Questions included targeting and theoretical approaches, community consultation, messages types and design, campaign types, cultural challenges, recommended actions, resources developed, pre-tests and evaluation. Findings: Responses were scored according to core components, and message features. Total scores (mean 10.9 ±SD 2.7) were not associated with organisation type. A community-orientated, bottom-up approach was popular (47%), 55% used a theoretical framework, 87% used a positive benefit appeal; 38% used threat messages, 72% conducted a pre-test and 53% evaluated programs. Cultural sensitivity for message development was divided into superficial (images, language, demographics) and deep structure (socio-cultural). AMSs were significantly more likely to report using more deep structures in message tailoring than NGOs (p<.05) and GOs (p<0.05). A non-linear principal component analysis revealed two dimensions accounting for 53% of the variation in findings. These dimensions were called "cultural understanding" and "rigour". Over 50% of the organisations had experienced cultural challenges in message development included issues raised due to the diversity of Aboriginal and/or Torres Strait Islander cultures for example with the use of Indigenous artwork, language, and stereotypes. Conflicts and delays caused some issues with program management; and the choice and use of role models was sometimes problematic. Conclusion: Features associated with successful anti-tobacco campaigns are reported by organisations Australia-wide for Aboriginal and Torres Strait Islander communities. This study has provided new insight into the current development of anti-tobacco messages in Australia by coupling the use of both cultural understanding and rigour to enable the growth of evidence based practice. Ideally tailoring should include theoretical, behavioural and cultural aspects with Indigenous advisors, to effect cessation. Superficial structures assist message 'fit'. Deep structures, significantly used by AMSs, are centrally processed and influence message salience. We recommend refinement of evaluation, pre-empting cultural challenges, and synergy by partnerships to achieve the goal of closing the gap on Indigenous health caused by tobacco smoking.

Abstract Background Smoking rates in Australian Aboriginal and Torres Strait Islander peoples remain high, with limited impact of government measures for many subgroups. The aim of this cross-sectional study was to investigate differences in organisational practice for developing anti-tobacco messages for these target populations. Methods Telephone interviews were conducted with 47 organisation representatives using a structured questionnaire based on health communication and health promotion frameworks. Responses were coded into phases of message development, message types (educational, threat, positive or advocacy), target groups, message recommendations, and evaluations undertaken. Cultural sensitivity for message development was divided into surface structure (use of images, language, demographics) and deep structure (use of socio-cultural values). A categorical principal component analysis explored the key dimensions of the findings and their component relationships. Results Among organisations interviewed, a community-orientated, bottom-up approach for developing anti-tobacco messages was reported by 47% (n = 24); 55% based message development on a theoretical framework; 87% used a positive benefit appeal; 38% used threat messages. More Aboriginal Medical Services (AMSs) targeted youth (p < 0.005) and advised smokers to quit (p < 0.05) than other types of organisations. AMSs were significantly more likely to report using deep structure in tailoring messages compared with non-government (p < 0.05) and government organisations (p < 0.05). Organisations that were oriented to the general population were more likely to evaluate their programs (p < 0.05). A two-dimensional non-linear principal component analysis extracted components interpreted as "cultural understanding" (bottom-up, community-based approaches, deep structures) and "rigour" (theoretical frameworks, and planned/completed evaluations), and accounted for 53% of the variability in the data. Conclusion Message features, associated with successful campaigns in other populations, are starting to be used for Aboriginal and Torres Strait Islander peoples. A model is proposed to facilitate the development of targeted anti-tobacco messages for Aboriginal and Torres Strait Islander peoples. Organisations could consider incorporating both components of cultural understanding-rigour to enable the growth of evidence-based practice.

Background Smoking rates in Australian Aboriginal and Torres Strait Islander peoples remain high, with limited impact of government measures for many subgroups. The aim of this cross-sectional study was to investigate differences in organisational practice for developing anti-tobacco messages for these target populations. Methods Telephone interviews were conducted with 47 organisation representatives using a structured questionnaire based on health communication and health promotion frameworks. Responses were coded into phases of message development, message types (educational, threat, positive or advocacy), target groups, message recommendations, and evaluations undertaken. Cultural sensitivity for message development was divided into surface structure (use of images, language, demographics) and deep structure (use of socio-cultural values). A categorical principal component analysis explored the key dimensions of the findings and their component relationships. Results Among organisations interviewed, a community-orientated, bottom-up approach for developing anti-tobacco messages was reported by 47% (n = 24); 55% based message development on a theoretical framework; 87% used a positive benefit appeal; 38% used threat messages. More Aboriginal Medical Services (AMSs) targeted youth (p < 0.005) and advised smokers to quit (p < 0.05) than other types of organisations. AMSs were significantly more likely to report using deep structure in tailoring messages compared with non-government (p < 0.05) and government organisations (p < 0.05). Organisations that were oriented to the general population were more likely to evaluate their programs (p < 0.05). A two-dimensional non-linear principal component analysis extracted components interpreted as "cultural understanding" (bottom-up, community-based approaches, deep structures) and "rigour" (theoretical frameworks, and planned/completed evaluations), and accounted for 53% of the variability in the data. Conclusion Message features, associated with ...