Reducing maternal smoking using Indigenous knowledge, practices, and online technologies.

Maternal smoking increases adverse risks for both the mother's pregnancy and the unborn child and remains disproportionately high among some Indigenous peoples. Decreasing smoking among pregnant Indigenous women has been identified as a health priority in New Zealand because of wide inequities in smoking-related harms. Using pre- and post-intervention questionnaires, this feasibility study assessed the acceptability and potential efficacy of a novel cessation program designed for Indigenous women by Indigenous experts utilizing traditional knowledge and practice. COVID-19 lockdowns displaced program delivery to online teaching videos, social media and a smartphone app using augmented reality. The target population comprised adult (≥22 years) women who self-identified as Māori, were in the first or second trimester, and currently smoked and wanted to quit. Based on the response to our advertisements (>500 individuals) and the short period of time (<2 weeks) it took to recruit participants, the program appeared to be acceptable. Furthermore, it achieved high retention (20/24 (83%) women remained at the 16-week follow-up), and facilitated maintenance of high motivation to stop smoking. By the end of the program, 9/20 (45%) of participants reported not smoking. A consistently mentioned value of the program was that it increased the participants' knowledge of Māori culture, particularly about pregnancy, birthing, and post-natal support. This study supports the potential for traditional knowledge and healing methods alongside contemporary communication tools such as mobile apps and augmented reality to increase the attractiveness and reach of smoking cessation programs for pregnant Indigenous women, even if delivered online.