‘It’s how we can all work and learn together’: iSISTAQUIT's mission to Close the Gap

16 Mar 2023

iSISTAQUIT is an evidence-based smoking cessation project for pregnant Aboriginal and Torres Strait Islander women. (Supplied: iSISTAQUIT)

Since 2007, the Close the Gap social justice campaign has been striving to close the gap in long-term health outcomes and life expectancy between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians. 

Close the Gap inspired the launch of the Australian government’s Closing the Gap strategy in 2008, which aims to improve key socioeconomic targets, including health and wellbeing, by 2031.

While there have been improvements in early education and Year 12 attainment since 2008, there has been a lack of progress in achieving equality in life expectancy. Additionally, cancer mortality rates have worsened and First Nations Australians have a 50% chance of surviving cancer at least 5 years after diagnosis compared to 65% for non-Indigenous Australians.

This makes National Close the Gap Day ever more important as an opportunity to raise awareness of the need for health equality and to acknowledge the efforts of organisations and individuals that are working towards this vision. 


iSISTAQUIT has been 7 years in the making. iSISTAQUIT was developed by Cure Cancer alumna Professor Gillian Gould, a GP researcher with a refugee background, alongside Aboriginal and Torres Strait Islander experts and communities. 

The evidence-based smoking cessation project addresses the high rates of tobacco smoking among pregnant Aboriginal and Torres Strait Islander women – 44% compared to 12% for other pregnant non-Indigenous Australians.  

“We know that smoking is a major contributor to the health gap and that it is the main risk factor for low birth weight. We want to continue working towards Outcome 1 [of the 2023 Closing the Gap Implementation Plan], where Aboriginal and Torres Strait Islander people enjoy long and healthy lives, and Outcome 2, which is improving birthweight,” Prof Gould said. 

The iSISTAQUIT team is based at Southern Cross University and includes both Aboriginal and Torres Strait Islander and non-Indigenous investigators and research staff. (Supplied: Rebecca Hyland)

“We have such an enormous opportunity to learn from Aboriginal and Torres Strait Islander people about their community needs and primary prevention initiatives that can be targeted and designed by mob for mob within local communities.”

The iSISTAQUIT team is based at Southern Cross University and includes both Aboriginal and Torres Strait Islander and non-Indigenous investigators and research staff such as Rebecca Hyland, a proud Kamilaroi woman who is the Senior Research Project Manager.  

“Our women are strong, resilient, motivated, and capable of quitting smoking. So, it is supporting health professionals to provide the best possible care to our pregnant Aboriginal and Torres Strait Islander women,” Hyland said. 

Rebecca Hyland is the Senior Research Project Manager of iSISTAQUIT. (Supplied: Rebecca Hyland)

iSISTAQUIT provides self-paced, culturally appropriate training to health professionals that has been co-designed and developed with Aboriginal and Torres Strait Islander peoples. 

“We have found by undertaking the iSISTAQUIT training, health professionals feel they have gained the time and resources to confidently provide smoking cessation care,” Prof Gould said. 

“It’s also about a shift in attitudes; the training builds optimism and skills to provide the best possible culturally appropriate smoking cessation care to pregnant Aboriginal and Torres Strait Islander women,” she continued.

“Change starts with a chat,” Hyland said. 

“By health professionals completing the training, they can be equipped with providing a culturally safe smoking cessation model of care. Ultimately, they could be saving a life.”


iSISTAQUIT is the product of Prof Gould’s 17 years of expertise as a GP and Tobacco Treatment Specialist who has obtained numerous degrees including in arts therapy. 

Most importantly, it is proof of what can be achieved through building “meaningful, ongoing partnerships with Aboriginal and Torres Strait Islander Community Controlled Health Services, communities and peoples who are leading and paving the way in closing the gap.”

Prof Gillian Gould leads iSISTAQUIT and was a Cure Cancer grant recipient in 2017. (Supplied: Prof Gillian Gould)

In 2016, Prof Gould led a pilot project called ICAN QUIT in Pregnancy that she had co-designed in consultation with Aboriginal and Torres Strait Islander communities - this was the first rendition of what later became iSISTAQUIT. 

ICAN QUIT in Pregnancy assessed the feasibility and acceptability of a culturally appropriate training intervention for health providers. It involved “hearing from Aboriginal women, their stories, what their needs were, what they weren't getting, and that they wanted to quit smoking, but they just weren't getting the help”. It was also the first study in Australia to focus on Aboriginal and Torres Strait Islander smoking during pregnancy that involves 3 different states and settings. 

When she was funded by Cure Cancer and co-funded by Cancer Australia and the Can Too Foundation in 2017, Prof Gould was interested in undertaking an in-depth analysis of Behaviour Change Techniques (BCTs) to identify the ‘essential active ingredients’ or strategies that effectively change pregnant Aboriginal and Torres Strait Islander women’s smoking behaviours.

It was “the first time any resources for Aboriginal people have been analysed in this way”. She was awarded Cure Cancer Researcher of the Year Runner Up in 2018, 2019 and 2020 for her efforts.

Prof Gould’s Cure Cancer-funded research would then be used to support the next phase of her ICAN QUIT in Pregnancy research, which had been renamed to SISTAQUIT (’Supporting Indigenous Smokers to Assist Quitting’). This clinical trial compared smoking cessation outcomes between one group of health providers who have undergone culturally competent training with another group of health providers who have not. 

The iSISTAQUIT at the 2022 National Aboriginal Community Controlled Health Organisation (NACCHO) Conference. (Image via Twitter)

After receiving funding from the Department of Health and Aged Care, SISTAQUIT was renamed iSISTAQUIT (‘implementing Supporting Indigenous Smokers to Assist Quitting’), which is currently in the process of scaling up nationally. It has already been implemented in 25 health services and aims to scale up to 100 more health services across the continent.

“Now we're looking at how to get this into standard care and we want to look at the best way to implement the training so that it becomes sustainable and both health providers and patients can reap the benefits,” Prof Gould said. 

“Some of our results show that after the training, health professionals felt they had more time, more confidence, more optimism, and more resources. This is a big shift; we've designed this [training model] to deliberately increase optimism.”


According to Prof Gillian Gould, “there’s always a personal story” behind initiatives like iSISTAQUIT. 

Her experience of being a second-generation refugee from Eastern Europe has informed much of her work – as has the ways in which smoking was a part of her upbringing. 

“I feel like I was born into smoke in a way. I was born with a congenital heart defect and I’ve wondered whether that was linked to my mother smoking. Sometimes, my school sandwiches would taste funny and I would find ash in them,” she said. 

iSISTAQUIT is currently in the process of scaling up nationally. (Supplied: iSISTAQUIT)

“My mum [eventually] gave up smoking because she was diagnosed with cancer. My sister was also a long-term smoker and her kids were both smokers. So, family contexts are important because it does go down that generational pathway.

“Sometimes when you get into something, you don't know why you're getting into it, but because of my background, I just wasn’t conscious of it. I just thought, ‘Yeah, I'd love to help,’ and I actually really love working with smokers to help them quit smoking.”

For Rebecca Hyland, it was her personal story of quitting smoking that spurred her entry into the smoking cessation space. 

“I wanted to be free of the smokes, which were such a health burden, a financial burden, and in my family, a generational burden. I lost too many of my people to chronic disease that was related to smoking, and I had to break that cycle for my family,” she shared. 

“On my journey, I was fortunate to work in different regional cities and remote Aboriginal communities. I took that time to learn from my people, but also saw firsthand the health inequalities that we face every single day, yet the absolute strength and resilience of our people.

"The solutions to long term health outcomes are already within our communities, within our people. The community engagement work is paramount and that's what drives change from that grassroots level, and informs the work that we can all do together.”

iSISTAQUIT is taking interest from health services across Australia to partner with as they move into the next phase of the project. Interested health providers can contact them at iSISTAQUIT@scu.edu.au and/or participate in a brief survey to help them evaluate their social media campaign.