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McNeil D, Elliott SA, Wong A, Kromm S, Bialy L, Montesanti S, Purificati-Fuñe A, Juul S, Roach P, Bromely J, Tailfeathers E, Amyotte M, Oster RT. Indigenous maternal and infant outcomes and women's experiences of midwifery care: A mixed-methods systematic review. Birth 2024. [PMID: 38898696 DOI: 10.1111/birt.12841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/16/2024] [Accepted: 05/02/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND The impact of midwifery, and especially Indigenous midwifery, care for Indigenous women and communities has not been comprehensively reviewed. To address this knowledge gap, we conducted a mixed-methods systematic review to understand Indigenous maternal and infant outcomes and women's' experiences with midwifery care. METHODS We searched nine databases to identify primary studies reporting on midwifery and Indigenous maternal and infant birth outcomes and experiences, published in English since 2000. We synthesized quantitative and qualitative outcome data using a convergent segregated mixed-methods approach and used a mixed-methods appraisal tool (MMAT) to assess the methodological quality of included studies. The Aboriginal and Torres Strait Islander Quality Appraisal Tool (ATSI QAT) was used to appraise the inclusion of Indigenous perspectives in the evidence. RESULTS Out of 3044 records, we included 35 individual studies with 55% (19 studies) reporting on maternal and infant health outcomes. Comparative studies (n = 13) showed no significant differences in mortality rates but identified reduced preterm births, earlier prenatal care, and an increased number of prenatal visits for Indigenous women receiving midwifery care. Quality of care studies indicated a preference for midwifery care among Indigenous women. Sixteen qualitative studies highlighted three key findings - culturally safe care, holistic care, and improved access to care. The majority of studies were of high methodological quality (91% met ≥80% criteria), while only 14% of studies were considered to have appropriately included Indigenous perspectives. CONCLUSION This review demonstrates the value of midwifery care for Indigenous women, providing evidence to support policy recommendations promoting midwifery care as a physically and culturally safe model for Indigenous women and families.
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Affiliation(s)
- Deborah McNeil
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Maternal Newborn Child & Youth Strategic Clinical Network™, Alberta Health Services, Edmonton, Alberta, Canada
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Sarah A Elliott
- Alberta Research Centre for Health Evidence, Department of Pediatrics, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Angie Wong
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Indigenous Wellness Core, Alberta Health Services, Edmonton, Alberta, Canada
| | - Seija Kromm
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Maternal Newborn Child & Youth Strategic Clinical Network™, Alberta Health Services, Edmonton, Alberta, Canada
| | - Liza Bialy
- Alberta Research Centre for Health Evidence, Department of Pediatrics, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Stephanie Montesanti
- School of Public Health, College of Health Sciences, Edmonton, Alberta, Canada
- Centre for Healthy Communities, School of Public Health, College of Health Sciences, Edmonton, Alberta, Canada
| | - Adam Purificati-Fuñe
- Department of Agricultural, Food & Nutritional Sciences, Faculty of Agricultural, Life & Environmental Sciences, College of Natural & Applied Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Sonje Juul
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Pamela Roach
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jackie Bromely
- Awo Taan Healing Lodge Society, Calgary, Alberta, Canada
| | | | - Maddie Amyotte
- ihkapaskwa Indigenous Wellness Collective, Fort McMurray, Alberta, Canada
| | - Richard T Oster
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Indigenous Wellness Core, Alberta Health Services, Edmonton, Alberta, Canada
- School of Public Health, College of Health Sciences, Edmonton, Alberta, Canada
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Austin EE, Carrigan A, Holden N, Grigg S, Maka K, Clay-Williams R, Hibbert PD, Loy G, Braithwaite J. Birang Daruganora: what do Aboriginal and Torres Strait Islander communities need in a new hospital? A qualitative study. BMJ Open 2024; 14:e078658. [PMID: 38760038 PMCID: PMC11103206 DOI: 10.1136/bmjopen-2023-078658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 04/22/2024] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVES To elicit the Aboriginal community's cultural and healthcare needs and views about six prominent and emerging models of care, to inform the development of a new hospital. DESIGN Cross-sectional qualitative study co-designed and co-implemented by Aboriginal team members. SETTING Western Sydney, New South Wales, Australia. PARTICIPANTS Aboriginal and Torres Strait Islander healthcare providers (n=2) and community members (n=18) aged between 21 and 60+ years participated in yarning circles (20 participants; 14 female, 6 male). RESULTS Handwritten notes from yarning circles were inductively analysed to synthesise the cultural and healthcare needs of providers and community members in relation to a new hospital and six models of care. Three primary themes emerged in relation to future hospitals. These were 'culturally responsive spaces', 'culturally responsive systems' and 'culturally responsive models of care'. Strengths (eg, comfort, reduced waiting time, holistic care), barriers (eg, logistics, accessibility, literacy) and enablers (eg, patient navigator role, communication pathways, streamlined processes) were identified for each of the six models of care. CONCLUSIONS Aboriginal and Torres Strait Islander community members and providers are invested in the co-creation of an innovative, well-integrated hospital that meets the needs of the community. Common themes of respect and recognition, relationships and partnering, and capacity building emerged as important consumer and provider considerations when developing and evaluating care services. Participants supported a range of models citing concerns about accessibility and choice when discussing evidence-based models of care.
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Affiliation(s)
- Elizabeth E Austin
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Ann Carrigan
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Narelle Holden
- Western Sydney Local Health District, Wentworthville, New South Wales, Australia
| | - Shai Grigg
- Western Sydney Local Health District, Wentworthville, New South Wales, Australia
| | - Katherine Maka
- Western Sydney Local Health District, Wentworthville, New South Wales, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Peter D Hibbert
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Graeme Loy
- Western Sydney Local Health District, Wentworthville, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Roe Y, Allen J, Haora P, Hickey S, Briggs M, Wilkes L, Nelson C, Watego K, Coddington R, Ireland S, Kruske S, Gao Y, Kildea S. Enabling the context for Aboriginal and Torres Strait Islander Community Controlled Birthing on Country services: Participatory action research. Women Birth 2024; 37:368-378. [PMID: 38097448 DOI: 10.1016/j.wombi.2023.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/24/2023] [Accepted: 11/24/2023] [Indexed: 03/05/2024]
Abstract
PROBLEM Establishment of Birthing on Country services owned and governed by Aboriginal and Torres Strait Islander Community Controlled Health Services has been slow. BACKGROUND Birthing on Country services have demonstrated health and cost benefits and require redesign of maternity care. During the Building On Our Strengths feasibility study, use of endorsed midwives and licensing of birth centres has proven difficult. QUESTION What prevents Community Controlled Health Services from implementing Birthing on Country services in Queensland and New South Wales? METHODS Participatory action research identified implementation barriers. We conducted iterative document analysis of instruments to inform government lobbying through synthesis of policy, economic, social, technological, legal, and environmental factors. FINDINGS Through cycles of participatory action research, we analysed 17 documents: 1) policy barriers prevent Community Controlled Health Services from employing endorsed midwives to provide intrapartum care in public hospitals; 2) economic barriers include lack of sustainable funding stream and inadequate Medicare-billing for endorsed midwives; and 3) legal barriers require a medical practitioner in a birth centre. While social barriers (e.g., colonisation, medicalisation) underpin regulations, these were beyond the scope; technological and environmental barriers were not identified. DISCUSSION Findings are consistent with the literature on barriers to midwifery practice. Recommendations include a national audit of barriers to Birthing on Country services including healthcare practice insurance, and development of a funding stream. Additionally, private maternity facility regulation must align with evidence on safe birth centre operation. CONCLUSION Government can address barriers to scale-up of Aboriginal and Torres Strait Islander Community Controlled Birthing on Country services.
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Affiliation(s)
- Yvette Roe
- Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, Australia
| | - Jyai Allen
- Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, Australia.
| | - Penny Haora
- Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, Australia
| | - Sophie Hickey
- Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, Australia
| | - Melanie Briggs
- Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, Australia; Waminda South Coast Women's Health and Welfare Aboriginal Corporation, Nowra, Australia
| | - Liz Wilkes
- Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, Australia; My Midwives, Brisbane, Australia
| | - Carmel Nelson
- Institute for Urban Indigenous Health, Brisbane, Australia
| | - Kristie Watego
- Institute for Urban Indigenous Health, Brisbane, Australia
| | - Rebecca Coddington
- Waminda South Coast Women's Health and Welfare Aboriginal Corporation, Nowra, Australia
| | - Sarah Ireland
- Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, Australia
| | - Sue Kruske
- Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, Australia
| | - Yu Gao
- Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, Australia
| | - Sue Kildea
- Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, Australia
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Brown K, Cotaru C, Binks M. A retrospective, longitudinal cohort study of trends and risk factors for preterm birth in the Northern Territory, Australia. BMC Pregnancy Childbirth 2024; 24:33. [PMID: 38182975 PMCID: PMC10768210 DOI: 10.1186/s12884-023-06164-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 11/29/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Preterm birth (PTB) is the single most important cause of perinatal mortality and morbidity in high income countries. In Australia, 8.6% of babies are born preterm but substantial variability exists between States and Territories. Previous reports suggest PTB rates are highest in the Northern Territory (NT), but comprehensive analysis of trends and risk factors are lacking in this region. The objective of this study was to characterise temporal trends in PTB among First Nations and non-First Nations mothers in the Top End of the NT over a 10-year period and to identify perinatal factors associated with the risk of PTB. METHODS This was a retrospective population-based cohort study of all births in the Top End of the NT over the 10-year period from January 1st, 2008, to December 31st, 2017. We described maternal characteristics, obstetric complications, birth characteristics and annual trends in PTB. The association between the characteristics and the risk of PTB was determined using univariate and multivariate generalised linear models producing crude risk ratios (cRR) and adjusted risk ratios (aRR). Data were analysed overall, in First Nations and non-First Nations women. RESULTS During the decade ending in 2017, annual rates of PTB in the Top End of the NT remained consistently close to 10% of all live births. However, First Nations women experienced more than twice the risk of PTB (16%) compared to other women (7%). Leading risk factors for PTB among First Nations women as compared to other women included premature rupture of membranes (RR 12.33; 95% CI 11.78, 12.90), multiple pregnancy (RR 7.24; 95% CI 6.68, 7.83), antepartum haemorrhage (RR 4.36; 95% CI 3.93, 4.84) and pre-existing diabetes (RR 4.18; 95% CI 3.67, 4.76). CONCLUSIONS First Nations women experience some of the highest PTB rates globally. Addressing specific pregnancy complications provides avenues for intervention, but the story is complex and deeper exploration is warranted. A holistic approach that also acknowledges the influence of socio-demographic influences, such as remote dwelling and disadvantage on disease burden, will be required to improve perinatal outcomes.
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Affiliation(s)
- Kiarna Brown
- Menzies School of Health Research, Royal Darwin Hospital, Building 58, John Matthews Building, Tiwi, NT, 0810, Australia.
- Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, NT, Australia.
| | - Carina Cotaru
- Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, NT, Australia
| | - Michael Binks
- Menzies School of Health Research, Royal Darwin Hospital, Building 58, John Matthews Building, Tiwi, NT, 0810, Australia
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Strobel NA, Chamberlain C, Campbell SK, Shields L, Bainbridge RG, Adams C, Edmond KM, Marriott R, McCalman J. Family-centred interventions for Indigenous early childhood well-being by primary healthcare services. Cochrane Database Syst Rev 2022; 12:CD012463. [PMID: 36511823 PMCID: PMC9746601 DOI: 10.1002/14651858.cd012463.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Primary healthcare, particularly Indigenous-led services, are well placed to deliver services that reflect the needs of Indigenous children and their families. Important characteristics identified by families for primary health care include services that support families, accommodate sociocultural needs, recognise extended family child-rearing practices, and Indigenous ways of knowing and doing business. Indigenous family-centred care interventions have been developed and implemented within primary healthcare services to plan, implement, and support the care of children, immediate and extended family and the home environment. The delivery of family-centred interventions can be through environmental, communication, educational, counselling, and family support approaches. OBJECTIVES To evaluate the benefits and harms of family-centred interventions delivered by primary healthcare services in Canada, Australia, New Zealand, and the USA on a range of physical, psychosocial, and behavioural outcomes of Indigenous children (aged from conception to less than five years), parents, and families. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 22 September 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs), cluster RCTs, quasi-RCTs, controlled before-after studies, and interrupted time series of family-centred care interventions that included Indigenous children aged less than five years from Canada, Australia, New Zealand, and the USA. Interventions were included if they met the assessment criteria for family-centred interventions and were delivered in primary health care. Comparison interventions could include usual maternal and child health care or one form of family-centred intervention versus another. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. overall health and well-being, 2. psychological health and emotional behaviour of children, 3. physical health and developmental health outcomes of children, 4. family health-enhancing lifestyle or behaviour outcomes, 5. psychological health of parent/carer. 6. adverse events or harms. Our secondary outcomes were 7. parenting knowledge and awareness, 8. family evaluation of care, 9. service access and utilisation, 10. family-centredness of consultation processes, and 11. economic costs and outcomes associated with the interventions. We used GRADE to assess the certainty of the evidence for our primary outcomes. MAIN RESULTS We included nine RCTs and two cluster-RCTs that investigated the effect of family-centred care interventions delivered by primary healthcare services for Indigenous early child well-being. There were 1270 mother-child dyads and 1924 children aged less than five years recruited. Seven studies were from the USA, two from New Zealand, one from Canada, and one delivered in both Australia and New Zealand. The focus of interventions varied and included three studies focused on early childhood caries; three on childhood obesity; two on child behavioural problems; and one each on negative parenting patterns, child acute respiratory illness, and sudden unexpected death in infancy. Family-centred education was the most common type of intervention delivered. Three studies compared family-centred care to usual care and seven studies provided some 'minimal' intervention to families such as education in the form of pamphlets or newsletters. One study provided a minimal intervention during the child's first 24 months and then the family-centred care intervention for one year. No studies had low or unclear risk of bias across all domains. All studies had a high risk of bias for the blinding of participants and personnel domain. Family-centred care may improve overall health and well-being of Indigenous children and their families, but the evidence was very uncertain. The pooled effect estimate from 11 studies suggests that family-centred care improved the overall health and well-being of Indigenous children and their families compared no family-centred care (standardised mean difference (SMD) 0.14, 95% confidence interval (CI) 0.03 to 0.24; 2386 participants). We are very uncertain whether family-centred care compared to no family-centred care improves the psychological health and emotional behaviour of children as measured by the Infant Toddler Social Emotional Assessment (ITSEA) (Competence domain) (mean difference (MD) 0.04, 95% CI -0.03 to 0.11; 2 studies, 384 participants). We assessed the evidence as being very uncertain about the effect of family-centred care on physical health and developmental health outcomes of children. Pooled data from eight trials on physical health and developmental outcomes found there was little to no difference between the intervention and the control groups (SMD 0.13, 95% CI -0.00 to 0.26; 1961 participants). The evidence is also very unclear whether family-centred care improved family-enhancing lifestyle and behaviours outcomes. Nine studies measured family health-enhancing lifestyle and behaviours and pooled analysis found there was little to no difference between groups (SMD 0.16, 95% CI -0.06 to 0.39; 1969 participants; very low-certainty evidence). There was very low-certainty evidence of little to no difference for the psychological health of parents and carers when they participated in family-centred care compared to any control group (SMD 0.10, 95% CI -0.03 to 0.22; 5 studies, 975 parents/carers). Two studies stated that there were no adverse events as a result of the intervention. No additional data were provided. No studies reported from the health service providers perspective or on outcomes for family's evaluation of care or family-centredness of consultation processes. AUTHORS' CONCLUSIONS There is some evidence to suggest that family-centred care delivered by primary healthcare services improves the overall health and well-being of Indigenous children, parents, and families. However, due to lack of data, there was not enough evidence to determine whether specific outcomes such as child health and development improved as a result of family-centred interventions. Seven of the 11 studies delivered family-centred education interventions. Seven studies were from the USA and centred on two particular trials, the 'Healthy Children, Strong Families' and 'Family Spirit' trials. As the evidence is very low certainty for all outcomes, further high-quality trials are needed to provide robust evidence for the use of family-centred care interventions for Indigenous children aged less than five years.
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Affiliation(s)
- Natalie A Strobel
- Kurongkurl Katitjin, Edith Cowan University, Mount Lawley, Australia
- Medical School, The University of Western Australia, Perth, Australia
| | - Catherine Chamberlain
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Sandra K Campbell
- College of Nursing & Midwifery, Charles Darwin University, Darwin, Australia
| | - Linda Shields
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Roxanne G Bainbridge
- School of Human Health and Social Sciences, Central Queensland University, Cairns, Australia
| | - Claire Adams
- Kurongkurl Katitjin, Edith Cowan University, Mount Lawley, Australia
| | - Karen M Edmond
- Department of Women and Children's Health, King's College London, London, UK
| | - Rhonda Marriott
- Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Murdoch, Australia
| | - Janya McCalman
- School of Human Health and Social Sciences, Central Queensland University, Cairns, Australia
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Sivertsen N, Deverix J, Gregoric C, Grant J. A call for culture-centred care: exploring health workers' perspectives of positive care experiences and culturally responsive care provision to Aboriginal women and their infants in mainstream health in South Australia. Health Res Policy Syst 2022; 20:132. [PMID: 36510198 PMCID: PMC9743671 DOI: 10.1186/s12961-022-00936-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 11/09/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Aboriginal women and their infants experience significant disadvantage in health outcomes compared to their non-Aboriginal counterparts. Access to timely, effective, and appropriate maternal and child health care can contribute to reducing these existing health disparities. This research sought to explore factors that contribute to continuity of care for Aboriginal women and their infants living in metropolitan South Australia. This paper reports on the perspectives of health care workers in mainstream health services from the antenatal period to the end of an infants' second birthday. It explores health workers' perspectives of what contributes to positive care experiences and satisfaction with care provided to Aboriginal women and their infants in mainstream health. METHODS Eight focus groups were held with 52 health professionals. Participants included Aboriginal Cultural Child and Family Support Consultants (n = 7), Aboriginal Maternal Infant Care Workers (n = 3), Midwives (n = 3) and Child and Family Nurses (n = 39). Data was inductively coded and thematically analysed. RESULTS Three key themes emerged: the system takes priority, culture is not central in approaches to care, and 'we've got to be allowed to do it in a different way'. CONCLUSIONS This research highlights a lack of continuity of care for Aboriginal families accessing mainstream health services from the antenatal period through to an infants' first 1000 days of life. This research has implications for communities, and it calls for strategies to enhance continuity, and healthcare services to provide appropriate and culturally safe care. Findings will inform and guide future changes to improve continuity of care for Aboriginal families and infants in the first 1000 days.
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Affiliation(s)
- Nina Sivertsen
- grid.1014.40000 0004 0367 2697Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA 5001 Australia ,grid.10919.300000000122595234Department of Health and Care Sciences, UiT Arctic University of Norway, Campus Hammerfest/Kautokeino, Tromsø, Norway
| | - Janiene Deverix
- grid.431036.3Child and Family Health Service, Women’s Children’s Health Network, 295 South Terrace, Adelaide, SA 5000 Australia
| | - Carolyn Gregoric
- grid.1014.40000 0004 0367 2697Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA 5001 Australia
| | - Julian Grant
- grid.1037.50000 0004 0368 0777School of Nursing, Midwifery and Indigenous Health, Charles Sturt University, Panorama Ave, Bathurst, NSW 2795 Australia
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Kildea S, Roe Y. Utilising the RISE Framework to implement birthing services for First Nations families. Women Birth 2022; 35:521-523. [DOI: 10.1016/j.wombi.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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8
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McLachlan HL, Newton M, McLardie-Hore FE, McCalman P, Jackomos M, Bundle G, Kildea S, Chamberlain C, Browne J, Ryan J, Freemantle J, Shafiei T, Jacobs SE, Oats J, Blow N, Ferguson K, Gold L, Watkins J, Dell M, Read K, Hyde R, Matthews R, Forster DA. Translating evidence into practice: Implementing culturally safe continuity of midwifery care for First Nations women in three maternity services in Victoria, Australia. EClinicalMedicine 2022; 47:101415. [PMID: 35747161 PMCID: PMC9142789 DOI: 10.1016/j.eclinm.2022.101415] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Strategies to improve outcomes for Australian First Nations mothers and babies are urgently needed. Caseload midwifery, where women have midwife-led continuity throughout pregnancy, labour, birth and the early postnatal period, is associated with substantially better perinatal health outcomes, but few First Nations women receive it. We assessed the capacity of four maternity services in Victoria, Australia, to implement, embed, and sustain a culturally responsive caseload midwifery service. METHODS A prospective, non-randomised research translational study design was used. Site specific culturally responsive caseload models were developed by site working groups in partnership with their First Nations health units and the Victorian Aboriginal Community Controlled Health Organisation. The primary outcome was to increase the proportion of women having a First Nations baby proactively offered and receiving caseload midwifery as measured before and after programme implementation. The study was conducted in Melbourne, Australia. Data collection commenced at the Royal Women's Hospital on 06/03/2017, Joan Kirner Women's and Children's Hospital 01/10/2017 and Mercy Hospital for Women 16/04/2018, with data collection completed at all sites on 31/12/2020. FINDINGS The model was successfully implemented in three major metropolitan maternity services between 2017 and 2020. Prior to this, over a similar timeframe, only 5.8% of First Nations women (n = 34) had ever received caseload midwifery at the three sites combined. Of 844 women offered the model, 90% (n = 758) accepted it, of whom 89% (n = 663) received it. Another 40 women received standard caseload. Factors including ongoing staffing crises, prevented the fourth site, in regional Victoria, implementing the model. INTERPRETATION Key enablers included co-design of the study and programme implementation with First Nations people, staff cultural competency training, identification of First Nations women (and babies), and regular engagement between caseload midwives and First Nations hospital and community teams. Further work should include a focus on addressing cultural and workforce barriers to implementation of culturally responsive caseload midwifery in regional areas. FUNDING Partnership Grant (# 1110640), Australian National Health and Medical Research Council and La Trobe University.
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Affiliation(s)
- Helen L. McLachlan
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia
- Corresponding author at: Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia.
| | - Michelle Newton
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia
| | - Fiona E. McLardie-Hore
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia
- The Royal Women's Hospital, Parkville, Victoria 3052, Australia
| | - Pamela McCalman
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia
- The Royal Women's Hospital, Parkville, Victoria 3052, Australia
| | - Marika Jackomos
- Mercy Hospital for Women, Heidelberg, Victoria 3084, Australia
| | - Gina Bundle
- The Royal Women's Hospital, Parkville, Victoria 3052, Australia
| | - Sue Kildea
- Molly Wardaguga Research Centre, School of Nursing and Midwifery, Charles Darwin University, Alice Springs 0870, Australia
| | - Catherine Chamberlain
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria 3053, Australia
- Ngangk Yira: Murdoch University Research Centre for Aboriginal Health and Social Equity, Murdoch, Western Australia 6150, Australia
- The Lowitja Institute, Carlton, Victoria 3053, Australia
| | - Jennifer Browne
- Deakin University Institute for Health Transformation, Geelong, Victoria 3220, Australia
- Victorian Aboriginal Community Controlled Health Organisation, Collingwood, Victoria 3066, Australia
| | - Jenny Ryan
- The Royal Women's Hospital, Parkville, Victoria 3052, Australia
| | - Jane Freemantle
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria 3053, Australia
- Rural Health Academic Centre, The University of Melbourne, Shepparton, Victoria 3630, Australia
| | - Touran Shafiei
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia
| | - Susan E. Jacobs
- The Royal Women's Hospital, Parkville, Victoria 3052, Australia
- Murdoch Children's Research Institute, University of Melbourne, Parkville, Victoria 3052, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria 3052, Australia
| | - Jeremy Oats
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria 3053, Australia
| | - Ngaree Blow
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria 3053, Australia
| | - Karyn Ferguson
- Rural Health Academic Centre, The University of Melbourne, Shepparton, Victoria 3630, Australia
| | - Lisa Gold
- Deakin University Institute for Health Transformation, Geelong, Victoria 3220, Australia
| | - Jacqueline Watkins
- Joan Kirner Hospital, Western Health St Albans, Victoria 3021, Australia
| | - Maree Dell
- Joan Kirner Hospital, Western Health St Albans, Victoria 3021, Australia
| | - Kim Read
- Goulburn Valley Health, Shepparton, Victoria 3644, Australia
| | - Rebecca Hyde
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia
- The Royal Women's Hospital, Parkville, Victoria 3052, Australia
| | - Robyn Matthews
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia
- The Royal Women's Hospital, Parkville, Victoria 3052, Australia
| | - Della A. Forster
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia
- The Royal Women's Hospital, Parkville, Victoria 3052, Australia
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9
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Karger S, Bull C, Enticott J, Callander E. Correction to: Options for improving low birthweight and prematurity birth outcomes of Indigenous and culturally and linguistically diverse infants: A systematic review of the literature using the social-ecological model. BMC Pregnancy Childbirth 2022; 22:352. [PMID: 35461234 PMCID: PMC9034577 DOI: 10.1186/s12884-022-04599-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Shae Karger
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia.
| | - Claudia Bull
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC, Australia
| | - Joanne Enticott
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia.,Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC, Australia
| | - Emily Callander
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia.,Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC, Australia
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10
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Options for improving low birthweight and prematurity birth outcomes of indigenous and culturally and linguistically diverse infants: a systematic review of the literature using the social-ecological model. BMC Pregnancy Childbirth 2022; 22:3. [PMID: 34979997 PMCID: PMC8722221 DOI: 10.1186/s12884-021-04307-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prematurity and low birthweight are more prevalent among Indigenous and Culturally and Linguistically Diverse infants. METHODS To conduct a systematic review that used the social-ecological model to identify interventions for reducing low birthweight and prematurity among Indigenous or CALD infants. Scopus, PubMed, CINAHL, and Medline electronic databases were searched. Studies included those published in English between 2010 and 2021, conducted in high-income countries, and reported quantitative results from clinical trials, randomized controlled trials, case-control studies or cohort studies targeting a reduction in preterm birth or low birthweight among Indigenous or CALD infants. Studies were categorized according to the level of the social-ecological model they addressed. FINDINGS Nine studies were identified that met the inclusion criteria. Six of these studies reported interventions targeting the organizational level of the social-ecological model. Three studies targeted the policy, community, and interpersonal levels, respectively. Seven studies presented statistically significant reductions in preterm birth or low birthweight among Indigenous or CALD infants. These interventions targeted the policy (n = 1), community (n = 1), interpersonal (n = 1) and organizational (n = 4) levels of the social-ecological model. INTERPRETATION Few interventions across high-income countries target the improvement of low birthweight and prematurity birth outcomes among Indigenous or CALD infants. No level of the social-ecological model was found to be more effective than another for improving these outcomes.
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11
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Bradford BF, Wilson AN, Portela A, McConville F, Fernandez Turienzo C, Homer CSE. Midwifery continuity of care: A scoping review of where, how, by whom and for whom? PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000935. [PMID: 36962588 PMCID: PMC10021789 DOI: 10.1371/journal.pgph.0000935] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/05/2022] [Indexed: 11/07/2022]
Abstract
Systems of care that provide midwifery care and services through a continuity of care model have positive health outcomes for women and newborns. We conducted a scoping review to understand the global implementation of these models, asking the questions: where, how, by whom and for whom are midwifery continuity of care models implemented? Using a scoping review framework, we searched electronic and grey literature databases for reports in any language between January 2012 and January 2022, which described current and recent trials, implementation or scaling-up of midwifery continuity of care studies or initiatives in high-, middle- and low-income countries. After screening, 175 reports were included, the majority (157, 90%) from high-income countries (HICs) and fewer (18, 10%) from low- to middle-income countries (LMICs). There were 163 unique studies including eight (4.9%) randomised or quasi-randomised trials, 58 (38.5%) qualitative, 53 (32.7%) quantitative (cohort, cross sectional, descriptive, observational), 31 (19.0%) survey studies, and three (1.9%) health economics analyses. There were 10 practice-based accounts that did not include research. Midwives led almost all continuity of care models. In HICs, the most dominant model was where small groups of midwives provided care for designated women, across the antenatal, childbirth and postnatal care continuum. This was mostly known as caseload midwifery or midwifery group practice. There was more diversity of models in low- to middle-income countries. Of the 175 initiatives described, 31 (18%) were implemented for women, newborns and families from priority or vulnerable communities. With the exception of New Zealand, no countries have managed to scale-up continuity of midwifery care at a national level. Further implementation studies are needed to support countries planning to transition to midwifery continuity of care models in all countries to determine optimal model types and strategies to achieve sustainable scale-up at a national level.
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Affiliation(s)
- Billie F Bradford
- Maternal, Child, and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- Mater Research, University of Queensland, Brisbane, Queensland, Australia
| | - Alyce N Wilson
- Maternal, Child, and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Anayda Portela
- Department of Maternal, Newborn, Child, and Adolescent Health, World Health Organisation, Geneva, Switzerland
| | - Fran McConville
- Department of Maternal, Newborn, Child, and Adolescent Health, World Health Organisation, Geneva, Switzerland
| | | | - Caroline S E Homer
- Maternal, Child, and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
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12
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Beks H, Walsh SM, Binder MJ, Jones M, Versace VL. Contribution of nurse leaders to rural and remote health research in Australia: A non-systematic scoping review. Collegian 2021. [DOI: 10.1016/j.colegn.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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Fernandez Turienzo C, Rayment-Jones H, Roe Y, Silverio SA, Coxon K, Shennan AH, Sandall J. A realist review to explore how midwifery continuity of care may influence preterm birth in pregnant women. Birth 2021; 48:375-388. [PMID: 33749001 DOI: 10.1111/birt.12547] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Midwifery continuity of care models are the only health system intervention associated with both a reduction in preterm birth (PTB) and an improvement in perinatal survival; however, questions remain about the mechanisms by which such positive outcomes are achieved. We aimed to uncover theories of change by which we can postulate how and why continuity of midwifery care models might affect PTB. METHODS We followed Pawson's guidance for conducting a realist review and performed a comprehensive search to identify existing literature exploring the impact of continuity models on PTB in all pregnant women. A realist methodology was used to uncover the context (C), mechanisms (M), and outcomes (O) and to develop a group of CMO configurations to illuminate middle-range theories. RESULTS Eleven papers were included from a wide variety of settings in the United Kingdom, Australia, and the United States. The majority of study participants had low socioeconomic status or social risk factors and received diverse models of midwifery continuity of care. Three themes-woman-midwife partnership, maternity pathways and processes, and system resources-encompassed ten CMO configurations. Building relationships, trust, confidence, and advocacy resulted in women feeling safer, less stressed, and more secure and respected, and encouraged them to access and engage in antenatal care with more opportunities for early prevention and diagnosis of complications, which facilitated effective management when compliance to guidelines was ensured. Organizational infrastructure, innovative partnerships, and robust community systems are crucial to overcome barriers, address women's complex needs, ensure quality of care, and reduce PTB risk. CONCLUSIONS Pregnant women living in different contexts in the United Kingdom, Australia, and the United States at low and mixed risk of complications and with low socioeconomic status or social risk factors experienced continuity models in similar ways, and similar underlying mechanisms may have influenced PTB outcomes. Further research is required to understand how continuity models may influence behavioral change, physiological stress levels, ethnic disparities in PTB and care coordination, and navigation of health services.
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Affiliation(s)
| | - Hannah Rayment-Jones
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Yvette Roe
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane, Qld, Australia
| | - Sergio A Silverio
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Kirstie Coxon
- Department of Midwifery, Kingston University and St. George's, University of London, London, UK
| | - Andrew H Shennan
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Jane Sandall
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, London, UK
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14
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Ireland S, Maypilama EḺ, Roe Y, Lowell A, Kildea S. Caring for Mum On Country: Exploring the transferability of the Birthing On Country RISE framework in a remote multilingual Northern Australian context. Women Birth 2021; 34:487-492. [DOI: 10.1016/j.wombi.2020.09.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 11/26/2022]
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15
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Brown K, Langston-Cox A, Unger HW. A better start to life: Risk factors for, and prevention of, preterm birth in Australian First Nations women - A narrative review. Int J Gynaecol Obstet 2021; 155:260-267. [PMID: 34455588 DOI: 10.1002/ijgo.13907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 08/05/2021] [Accepted: 08/27/2021] [Indexed: 11/08/2022]
Abstract
The unacceptable discrepancies in health outcomes between First Nations and non-Indigenous Australians begin at birth. Preterm birth (birth before 37 completed weeks of gestation) is a major contributor to adverse short- and long-term health outcomes and mortality. Australian First Nations infants are more commonly born too early. No tangible reductions in preterm births have been made in First Nations communities. Factors contributing to high preterm birth rates in Australian First Nations infants are reviewed and interventions to reduce preterm birth in Australian First Nations women are discussed. More must be done to ensure Australian First Nations infants get a better start to life. This can only be achieved with ongoing and improved research in partnership with Australian First Nations peoples.
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Affiliation(s)
- Kiarna Brown
- Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Annie Langston-Cox
- Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Holger W Unger
- Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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16
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Kirkham R, King S, Graham S, Boyle J, Whitbread C, Skinner T, Rumbold A, Maple-Brown L. ‘No sugar’, ‘no junk food’, ‘do more exercise’ – moving beyond simple messages to improve the health of Aboriginal women with Hyperglycaemia in Pregnancy in the Northern Territory – A phenomenological study. Women Birth 2020; 34:578-584. [DOI: 10.1016/j.wombi.2020.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/02/2020] [Accepted: 10/02/2020] [Indexed: 10/23/2022]
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17
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Aboriginal and Torres Strait Islander family access to continuity of health care services in the first 1000 days of life: a systematic review of the literature. BMC Health Serv Res 2020; 20:829. [PMID: 32883268 PMCID: PMC7469361 DOI: 10.1186/s12913-020-05673-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/20/2020] [Indexed: 01/07/2023] Open
Abstract
Background Aboriginal women and their infants experience significant disadvantage in health outcomes compared to their non-Aboriginal counterparts. Access to timely, effective and appropriate maternal and child healthcare can contribute to reducing these existing health disparities. However, accessing mainstream healthcare services often results in high levels of fear and anxiety, and low attendance at subsequent appointments among Aboriginal women, due to inefficient communication, poor service coordination and a lack of continuity of care. Methods This integrative literature review sought to explore factors that contribute to continuity of care and consider service features that contribute to positive care experiences and satisfaction with care received by Aboriginal women and their infants. In total, 28 studies were included in the review and were thematically analysed using Braun and Clarke’s six steps of thematic analysis. This was followed by a collaborative, computer-assisted qualitative analysis, which resulted in the emergence of five key themes: lack of continuity of care, impact of lack of continuity of care, continuity of care interventions, impact of continuity of care interventions, and strategies to improve continuity of care. Results Most studies focused on health services in rural or remote Aboriginal communities and there was a lack of documented evidence of continuity of care (or lack thereof) for Aboriginal women living and birthing in regional and metropolitan areas. The majority of studies focused explicitly on continuity of care during the antenatal, birthing and immediate postnatal period, with only two studies considering continuity through to an infant’s first 1000 days. Conclusion The review highlights a lack of studies exploring continuity of care for Aboriginal families from the antenatal period through to an infants’ first 1000 days of life. Included studies identified a lack of continuity in the antenatal, peri- and postnatal periods in both regional and metropolitan settings. This, along with identified strategies for enhancing continuity, have implications for communities, and healthcare services to provide appropriate and culturally safe care. It also marks an urgent need to incorporate and extend continuity of care and carer through to the first 1000 days for successful maternal and infant health outcomes for Aboriginal peoples.
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18
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Kildea S, Hickey S, Barclay L, Kruske S, Nelson C, Sherwood J, Allen J, Gao Y, Blackman R, Roe YL. Implementing Birthing on Country services for Aboriginal and Torres Strait Islander families: RISE Framework. Women Birth 2019; 32:466-475. [DOI: 10.1016/j.wombi.2019.06.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 06/14/2019] [Accepted: 06/15/2019] [Indexed: 01/31/2023]
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19
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Hartz DL, Blain J, Caplice S, Allende T, Anderson S, Hall B, McGrath L, Williams K, Jarman H, Tracy SK. Evaluation of an Australian Aboriginal model of maternity care: The Malabar Community Midwifery Link Service. Women Birth 2019; 32:427-436. [DOI: 10.1016/j.wombi.2019.07.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 07/05/2019] [Accepted: 07/05/2019] [Indexed: 11/30/2022]
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20
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McHugh L, Binks MJ, Gao Y, Andrews RM, Ware RS, Snelling T, Kildea S. Influenza vaccination in pregnancy among a group of remote dwelling Aboriginal and Torres Strait Islander mothers in the Northern Territory: The 1+1 Healthy Start to Life study. ACTA ACUST UNITED AC 2019; 43. [PMID: 31426733 DOI: 10.33321/cdi.2019.43.33] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Remote-living Aboriginal and Torres Strait Islander women experience a higher burden of influenza infection during pregnancy than any other Australian women. Despite recommendations of inactivated influenza vaccination (IIV) in pregnancy, uptake and safety data are scarce for this population. We examined uptake of IIV in pregnancy and report adverse birth outcomes amongst a predominantly unvaccinated group of remote-living Aboriginal and Torres Strait Islander women from the Northern Territory (NT), using data from the 1+1 Healthy Start to Life study. Data were deterministically linked with the NT Immunisation Register to ascertain IIV exposure in pregnant women during 2003-2006 and 2009-2011 inclusive. Overall, IIV uptake in pregnancy was 3% (n=20/697 pregnancies); 0% (0/414) pre-influenza A(H1N1)pdm09 and 7% (20/293) post-influenza A(H1N1)pdm09 (2009-2011). Vaccine uptake was poor in this cohort and it is unclear at what stage this policy failure occurred. Women with known comorbidities and/or high risk factors were not targeted for vaccination. Much larger study participant numbers are required to validate between group comparisons but there was no clinically nor statistically significant difference in median gestational ages (38 weeks for both groups), mean infant birthweights (3,001 g unvaccinated vs 3,175 g IIV vaccinated), nor birth outcomes between the few women who received IIV in pregnancy and those who did not. There were no stillbirths in women who received an IIV in pregnancy.
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Affiliation(s)
- Lisa McHugh
- Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia
| | - Michael J Binks
- Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia
| | - Yu Gao
- Mater Midwifery Research Unit - University of Queensland, Women's Health and Newborn Services (Maternity) Mater Health Service; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia
| | - Ross M Andrews
- Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia; Applied Epidemiology Program, National Centre for Epidemiology & Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Tom Snelling
- Infectious Disease Implementation Research, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia; Perth Children's Hospital, Perth, Western Australia, Australia; Curtin University, School of Public Health, Perth, Western Australia, Australia
| | - Sue Kildea
- Mater Research Institute - University of Queensland, Women's Health and Newborn Services (Maternity) Mater Health Service; School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia
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21
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Spangaro J, Herring S, Koziol-McLain J, Rutherford A, Zwi AB. 'Yarn about it': Aboriginal Australian women's perceptions of the impact of routine enquiry for intimate partner violence. CULTURE, HEALTH & SEXUALITY 2019; 21:789-806. [PMID: 30600775 DOI: 10.1080/13691058.2018.1519117] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 08/30/2018] [Indexed: 06/09/2023]
Abstract
Aboriginal women globally are disproportionately affected by intimate partner violence (IPV) and face additional barriers to help-seeking. It is crucial that interventions for IPV are made safe for Indigenous women, given inflated rates of statutory intervention and widespread institutional racism. As part of a larger study of antenatal IPV screening, we interviewed 12 Aboriginal Australian women about the perceived impact of an antenatal IPV routine enquiry intervention. Seven women reported positive impact, and five women reported the absence of positive impact. Qualitative comparative analysis was used to map pathways to perceived impact. Cultural safety - the practice of countering tendencies in health care that undermine safety - was a key condition for positive impact. Others included: (i) continuity of care; (ii) asking about abuse without judgement and with care; and (iii) support and validation. Absence of these factors also typified pathways for nil positive impact. Naming the abuse, a sense of connection, unburdening, taking steps to safety and enabling informed care were all reported benefits. Two women reported explicitly negative impacts: one noted a sense of intrusion, and the other, disengagement from the health service. Interventions for IPV have the potential to benefit Indigenous women where cultural safety is prioritised.
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Affiliation(s)
- Jo Spangaro
- a School of Social Sciences, UNSW Sydney , New South Wales , Australia
| | - Sigrid Herring
- b NSW Education Centre Against Violence New South Wales , Australia
| | - Jane Koziol-McLain
- c Centre for Interdisciplinary Trauma Research, Auckland University of Technology , Auckland , New Zealand
| | - Alison Rutherford
- d School of Public Health and Community Medicine , UNSW Sydney , New South Wales , Australia
| | - Anthony B Zwi
- a School of Social Sciences, UNSW Sydney , New South Wales , Australia
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22
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Lattof SR, Tunçalp Ö, Moran AC, Bucagu M, Chou D, Diaz T, Gülmezoglu AM. Developing measures for WHO recommendations on antenatal care for a positive pregnancy experience: a conceptual framework and scoping review. BMJ Open 2019; 9:e024130. [PMID: 31023748 PMCID: PMC6502222 DOI: 10.1136/bmjopen-2018-024130] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES In response to the newest WHO recommendations on routine antenatal care (ANC) for pregnant women and adolescent girls, this paper identifies the literature on existing ANC measures, presents a conceptual framework for quality ANC, maps existing measures to specific WHO recommendations, identifies gaps where new measures are needed to monitor the implementation and impact of routine ANC and prioritises measures for capture. METHODS We conducted searches in four databases and five websites. Searches and application of inclusion/exclusion criteria followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow approach for scoping reviews. Data were extracted on measure information, methodology, methodological work and implementation. We adapted and refined a conceptual framework for routine ANC based on these measures. RESULTS This scoping review uncovered 58 resources describing 46 existing measures that align with WHO recommendations and good clinical practices for ANC. Of the 42 WHO-recommended ANC interventions and four good clinical practices included in this scoping review, only 14 WHO-recommended interventions and three established good clinical practices could potentially be measured immediately using existing measures. Recommendations addressing the integration of ANC with allied fields are likelier to have existing measures than recommendations that focus on maternal health. When mapped to our conceptual framework, existing measures prioritise content of care and health systems; measures for girls' and women's experiences of care are notably lacking. Available data sources for non-existent measures are currently limited. CONCLUSION Our research updates prior efforts to develop comprehensive measures of quality ANC and raises awareness of the need to better assess experiences of ANC. Given the inadequate number and distribution of existing ANC measures across the quality of care conceptual framework domains, new standardised measures are required to assess quality of routine ANC. Girls' and women's voices deserve greater acknowledgement when measuring the quality and delivery of ANC.
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Affiliation(s)
- Samantha R Lattof
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Özge Tunçalp
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Allisyn C Moran
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Maurice Bucagu
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Doris Chou
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Theresa Diaz
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Ahmet Metin Gülmezoglu
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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23
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Context-sensitive antibiotic optimization: a qualitative interviews study of a remote Australian hospital setting. J Hosp Infect 2018; 100:265-269. [PMID: 29890182 DOI: 10.1016/j.jhin.2018.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 06/04/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Antibiotic optimization is an urgent international issue. Regulatory frameworks, including the requirement to have a functioning antimicrobial stewardship (AMS) programme, are now ubiquitous across the hospital sector nationally and internationally. However, healthcare is ultimately delivered in a diverse range of institutional settings and social contexts. There is emerging evidence that implementation of antibiotic optimization strategies may be inappropriate or even counterproductive to attempts to optimize in atypical healthcare settings. AIM To document the experiences and perspectives of clinical staff in a remote healthcare setting in Australia with respect to antimicrobial use, and strategies for optimization in that environment. METHODS Semi-structured qualitative interviews were conducted with 30 healthcare professionals, including doctors, nurses and pharmacists, from a remote hospital in Queensland, Australia. FINDINGS Four themes were identified from the analysis as key challenges to antibiotic optimization: (i) AMS as externally driven, and local knowledge sidelined; (ii) perceptions of heightened local population risks, treatment failure and the subsequent pressure to over-use of antimicrobials; (iii) interprofessional relationship dynamics including medical hierarchical structures perceived as a barrier to AMS; (iv) a clinical workforce dominated by transient locum staff and other process issues were perceived as significant barriers. CONCLUSION The perceptions of healthcare professionals in this site lead to the conclusion that antimicrobial regulations and practice improvement strategies more generally are unlikely to succeed if they fail to accommodate and respect the context of care, the resource and structural constraints of the setting, and the specificities of particular populations (and subsequent clinical 'know-how').
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Felton-Busch C, Larkins S. Remote dwelling Aboriginal Australian women and birthing: A critical review of literature. Women Birth 2018; 32:6-15. [PMID: 29887507 DOI: 10.1016/j.wombi.2018.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 04/19/2018] [Accepted: 05/17/2018] [Indexed: 11/16/2022]
Abstract
PROBLEM Australian Aboriginal women's aspirations for birthing on country (having our babies born on our traditional land) are increasingly being reported in Australian scholarly and policy literature. However given the paucity of publications authored by Aboriginal Australians from remote areas of Australia, how well can the current knowledge base in Australia inform the development of culturally appropriate maternity services for our communities? OBJECTIVE The aim of this literature review is to critically analyse the policy documents informing maternity services policy and scholarly literature on the birthing experiences (including the provision of maternity services) of Aboriginal Australian women from remote communities from an Indigenous standpoint. METHOD Policy documents and scholarly literature were critically analysed to identify who the authors were, their background, approaches and perspectives; and emergent themes. A further analysis of the literature drew on Fairclough's ideas on discourse, power and hegemony. FINDINGS A critical discourse analysis of this literature exposed how these texts are ideologically shaped to give voice (and power) to the medical fraternity, maternity care services practitioners and policy makers (whose knowledge is valued) while simultaneously silencing the voices of Aboriginal Australians that pose a challenge to that power. CONCLUSION This critical review of current literature highlights the importance of ongoing critique of maternity services policy and practice discourse necessary to combat western medical hegemony that maintains the disenfranchisement of Aboriginal Australians.
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Affiliation(s)
- Catrina Felton-Busch
- Mount Isa Centre for Rural & Remote Health, Division of Tropical Health & Medicine, James Cook University, P.O. Box 2572, Mount Isa, Queensland, 4825, Australia.
| | - Sarah Larkins
- College of Medicine & Dentistry, Division of Tropical Health & Medicine, James Cook University, Townsville, Queensland, 4811, Australia
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Kildea S, Simcock G, Liu A, Elgbeili G, Laplante DP, Kahler A, Austin MP, Tracy S, Kruske S, Tracy M, O'Hara MW, King S. Continuity of midwifery carer moderates the effects of prenatal maternal stress on postnatal maternal wellbeing: the Queensland flood study. Arch Womens Ment Health 2018; 21:203-214. [PMID: 28956168 DOI: 10.1007/s00737-017-0781-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 09/19/2017] [Indexed: 01/05/2023]
Abstract
Poor postnatal mental health is a major public health issue, and risk factors include experiencing adverse life events during pregnancy. We assessed whether midwifery group practice, compared to standard hospital care, would protect women from the negative impact of a sudden-onset flood on postnatal depression and anxiety. Women either received midwifery group practice care in pregnancy, in which they were allocated a primary midwife who provided continuity of care, or they received standard hospital care provided by various on-call and rostered medical staff. Women were pregnant when a sudden-onset flood severely affected Queensland, Australia, in January 2011. Women completed questionnaires on their flood-related hardship (objective stress), emotional reactions (subjective stress), and cognitive appraisal of the impact of the flood. Self-report assessments of the women's depression and anxiety were obtained during pregnancy, at 6 weeks and 6 months postnatally. Controlling for all main effects, regression analyses at 6 weeks postpartum showed a significant interaction between maternity care type and objective flood-related hardship and subjective stress, such that depression scores increased with increasing objective and subjective stress with standard care, but not with midwifery group practice (continuity), indicating a buffering effect of continuity of midwifery carer. Similar results were found for anxiety scores at 6 weeks, but only with subjective stress. The benefits of midwifery continuity of carer in pregnancy extend beyond a more positive birth experience and better birthing and infant outcomes, to mitigating the effects of high levels of stress experienced by women in the context of a natural disaster on postnatal mental health.
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Affiliation(s)
- Sue Kildea
- Mater Research, Brisbane, QLD, Australia.,The University of Queensland, Brisbane, QLD, Australia
| | | | - Aihua Liu
- Douglas Mental Health University Institute, Verdun, Quebec, H4H, 1R3, Montreal, QC, Canada
| | - Guillaume Elgbeili
- Douglas Mental Health University Institute, Verdun, Quebec, H4H, 1R3, Montreal, QC, Canada
| | - David P Laplante
- Douglas Mental Health University Institute, Verdun, Quebec, H4H, 1R3, Montreal, QC, Canada
| | - Adele Kahler
- The University of Queensland, Brisbane, QLD, Australia
| | | | | | - Sue Kruske
- The University of Queensland, Brisbane, QLD, Australia.,Institute of Urban Indigenous Health, Bowen Hills, Queensland, Australia
| | - Mark Tracy
- Sydney University, Sydney, NSW, Australia
| | - Michael W O'Hara
- Institute of Urban Indigenous Health, Bowen Hills, Queensland, Australia.,Psychological and Brain Sciences, The University of Iowa, Iowa City, IA, USA
| | - Suzanne King
- Douglas Mental Health University Institute, Verdun, Quebec, H4H, 1R3, Montreal, QC, Canada. .,McGill University, Montreal, QC, Canada.
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26
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Kildea SV, Gao Y, Rolfe M, Boyle J, Tracy S, Barclay LM. Risk factors for preterm, low birthweight and small for gestational age births among Aboriginal women from remote communities in Northern Australia. Women Birth 2017; 30:398-405. [PMID: 28377142 DOI: 10.1016/j.wombi.2017.03.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 03/08/2017] [Accepted: 03/09/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To identify the risk factors for preterm birth, low birthweight and small for gestational age babies among remote-dwelling Aboriginal women. METHODS The study included 713 singleton births from two large remote Aboriginal communities in Northern Territory, Australia in 2004-2006 (retrospective cohort) and 2009-2011 (prospective cohort). Demographic, pregnancy characteristics, labour and birth outcomes were described. Multivariate logistic regression analysis was conducted and adjusted odds ratios were reported. RESULTS The preterm birth rate was 19.4%, low birthweight rate was 17.4% and small for gestational age rate was 16.3%. Risk factors for preterm birth were teenage motherhood, previous preterm birth, smoker status not recorded, inadequate antenatal visits, having pregnancy-induced hypertension, antepartum haemorrhage or placental complications. After adjusting for gender and birth gestation, the only significant risk factor for low birthweight was first time mother. The only significant risk factor for small for gestational age baby was women having their first baby. CONCLUSIONS Rates of these events are high and have changed little over time. Some risk factors are modifiable and treatable but need early, high quality, culturally responsive women centred care delivered in the remote communities themselves. A different approach is recommended.
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Affiliation(s)
- Sue V Kildea
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Qld 4010, Australia; Mater Research Institute - The University of Queensland, Brisbane, Qld 4101, Australia.
| | - Yu Gao
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Qld 4010, Australia; Mater Research Institute - The University of Queensland, Brisbane, Qld 4101, Australia
| | - Margaret Rolfe
- University Centre for Rural Health North Coast, Sydney Medical School, University of Sydney, Lismore, NSW 2480, Australia
| | - Jacqueline Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sally Tracy
- School of Nursing, University of Sydney, Sydney, NSW 2050, Australia
| | - Lesley M Barclay
- University Centre for Rural Health North Coast, Sydney Medical School, University of Sydney, Lismore, NSW 2480, Australia
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Josif CM, Kruske S, Kildea SV, Barclay LM. The quality of health services provided to remote dwelling aboriginal infants in the top end of northern Australia following health system changes: a qualitative analysis. BMC Pediatr 2017; 17:93. [PMID: 28359332 PMCID: PMC5374585 DOI: 10.1186/s12887-017-0849-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 03/24/2017] [Indexed: 11/17/2022] Open
Abstract
Background In Australia the health outcomes of remote dwelling Aboriginal infants are comparable to infants in developing countries. This research investigates service quality, from the clinicians’ perspective and as observed and recorded by the researcher, in two large Aboriginal communities in the Top End of northern Australia following health system changes. Methods Data were collected from semi-structured interviews with 25 clinicians providing or managing child health services in the two study sites. Thirty hours of participant observation was undertaken in the ‘baby-rooms’ at the two remote health centres between June and December 2012. The interview and observational data, as well as field notes were integrated and analysed thematically to explore clinicians’ perspectives of service delivery to infants in the remote health centres. Results A range of factors affecting the quality of care, mostly identified before health system changes were instigated, persisted. These factors included ineffective service delivery, inadequate staffing and culturally unsafe practices. The six themes identified in the data: ‘very adhoc’, ‘swallowed by acute’, ‘going under’, ‘a flux’, ‘a huge barrier’ and ‘them and us’ illustrate how these factors continue, and when combined portray a ‘very chaotic system’. Conclusion Service providers perceived service provision and quality to be inadequate, despite health system changes. Further work is urgently needed to improve the quality, cultural responsiveness and effectiveness of services to this population. Electronic supplementary material The online version of this article (doi:10.1186/s12887-017-0849-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cathryn M Josif
- University Centre for Rural Health Sydney School of Public Health, University of Sydney, Sydney, NSW, 2480, Australia.
| | - Sue Kruske
- School of Nursing Midwifery and Social Work, The University of Queensland (UQ), Brisbane, 4010, Australia
| | - Sue V Kildea
- School of Nursing Midwifery and Social Work, The University of Queensland (UQ), Brisbane, 4010, Australia
| | - Lesley M Barclay
- University Centre for Rural Health Sydney School of Public Health, University of Sydney, Sydney, NSW, 2480, Australia
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28
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Vermeiden T, Stekelenburg J. Maternity Waiting Homes as Part of an Integrated Program for Maternal and Neonatal Health Improvements: Women's Lives Are Worth Saving. J Midwifery Womens Health 2017; 62:151-154. [PMID: 28371115 DOI: 10.1111/jmwh.12618] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 02/10/2017] [Indexed: 11/29/2022]
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Kildea S, Tracy S, Sherwood J, Magick‐Dennis F, Barclay L. Improving maternity services for Indigenous women in Australia: moving from policy to practice. Med J Aust 2016; 205:374-379. [DOI: 10.5694/mja16.00854] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 08/25/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Sue Kildea
- Midwifery Research Unit, Mater Medical Research Institute, Brisbane, QLD
- University of Queensland, Brisbane, QLD
| | - Sally Tracy
- Midwifery and Women's Health Research Unit, The University of Sydney, Sydney, NSW
| | - Juanita Sherwood
- National Centre for Cultural Competence, The University of Sydney, Sydney, NSW
| | | | - Lesley Barclay
- Centre for Rural Health, The University of Sydney, Lismore, NSW
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Spangaro J, Herring S, Koziol-Mclain J, Rutherford A, Frail MA, Zwi AB. 'They aren't really black fellas but they are easy to talk to': Factors which influence Australian Aboriginal women's decision to disclose intimate partner violence during pregnancy. Midwifery 2016; 41:79-88. [PMID: 27551857 DOI: 10.1016/j.midw.2016.08.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 08/04/2016] [Accepted: 08/05/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES intimate partner violence is a significant global health problem but remains largely hidden. Understanding decisions about whether or not to disclose violence in response to routine enquiry in health settings can inform safe and responsive systems. Elevated rates of violence and systematic disadvantage found among Indigenous women globally, can impact on their decisions to disclose violence. This study aimed to test, among Indigenous women, a model for decisions on whether to disclose intimate partner violence in the context of antenatal routine screening. DESIGN we employed Qualitative Configurative Analysis, a method developed for the social sciences to study complex phenomena with intermediate sample sizes. Data were drawn from single semi- structured interviews with Indigenous women 28+ weeks pregnant attending antenatal care. Interviews addressed decisions to disclose recent intimate partner violence in the context of routine enquiry during the antenatal care. Interview transcripts were binary coded for conditions identified a priori from the model being tested and also from themes identified within the current study and analysed using Qualitative Configurative Analysis to determine causal conditions for the outcome of disclosure or non-disclosure of violence experienced. SETTINGS five Aboriginal and Maternal Infant Health Services (two urban and three regional), and one mainstream hospital, in New South Wales, Australia. PARTICIPANTS indigenous women who had experienced partner violence in the previous year and who had been asked about this as part of an antenatal booking-in visit. Of the 12 participants six had elected to disclose their experience of violence to the midwife, and six had chosen not to do so. FINDINGS pathways to disclosure and non-disclosure were mapped using Qualitative Configurative Analysis. Conditions relevant to decisions to disclose were similar to the conditions for non-Aboriginal women found in our earlier study. Unique to Aboriginal women's decisions to disclose abuse was cultural safety. Cultural safety included elements we titled: Borrowed trust, Build the relationship first, Come at it slowly and People like me are here. The absence of cultural safety Its absence was also a factor in decisions not to disclose experiences of violence by this group of women. KEY CONCLUSIONS cultural safety was central to Indigenous women's decision to disclose violence and processes for creating safety are identified. Other forms of safety which influenced disclosure included: safety from detection by the abuser; safety from shame; and safety from institutional control. Disclosure was promoted by direct asking by the midwife and a perception of care. Non-disclosure was associated with a lack of care and a lack of all four types of safety. Experiences of institutional racism were associated with Indigenous women's perceived risk of control by others, particularly child protection services. IMPLICATIONS FOR PRACTICE policies to ask abuse questions at first visits and models where continuity of care is not maintained, are problematic for Aboriginal women, among whom relationship building is important as is ample warning about questions to be asked. Strategies are needed to build cultural safety to counter widespread racism and promote safe opportunities for Indigenous women to disclose intimate partner violence and receive support. Elements of cultural safety are necessary for vulnerable or marginalised populations to fully utilise available health services.
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Affiliation(s)
- Jo Spangaro
- School of Social Sciences, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Sigrid Herring
- NSW Education Centre Against Violence, Locked Bag 7118, Parramatta BC, NSW 2150, Australia.
| | - Jane Koziol-Mclain
- Centre for Interdisciplinary Trauma Research, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand.
| | - Alison Rutherford
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Mary-Anne Frail
- School of Social Sciences, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Anthony B Zwi
- School of Social Sciences, University of New South Wales, Sydney, NSW 2052, Australia.
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Allen J, Kildea S, Stapleton H. How optimal caseload midwifery can modify predictors for preterm birth in young women: Integrated findings from a mixed methods study. Midwifery 2016; 41:30-38. [PMID: 27498186 DOI: 10.1016/j.midw.2016.07.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 06/06/2016] [Accepted: 07/15/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE to identify possible mechanisms by which caseload midwifery reduces preterm birth for young childbearing women. DESIGN a mixed methods triangulation, convergence design was used to answer the research question 'How does the way maternity care is provided affect the health and well-being of young women and their babies?' The project generated quantitative and qualitative findings which were collected and analysed concurrently then separately analysed and published. The research design enabled integration of the quantitative and qualitative findings for further interpretation through a critical pragmatic lens. SETTING a tertiary maternity hospital in Australia providing care to approximately 500 pregnant young women (aged 21 years or less) each year. Three distinct models of care were offered: caseload midwifery, young women's clinic, and standard 'fragmented' care. PARTICIPANTS a cohort study included data from 1971 young women and babies during 2008-2012. An ethnographic study included analysis of focus group interviews with four caseload midwives in the young women's midwifery group practice; as well as ten pregnant and postnatal young women receiving caseload midwifery care. FINDINGS integrated analysis of the quantitative and qualitative findings suggested particular features in the model of care which facilitated young women turning up for antenatal care (at an earlier gestation and more frequently) and buying in to the process (disclosing risks, engaging in self-care activities and accepting referrals for assistance). We conceptualised that Optimal Caseload Midwifery promotes Synergistic Health Engagement between midwife and the young woman. KEY CONCLUSIONS optimal Caseload Midwifery (which includes midwives with specific personal attributes and philosophical commitments, along with appropriate institutional infrastructure and support) facilitates midwives and young clients to develop trusting relationships and engage in maternity care. Health engagement can modify predictors for preterm birth that are common amongst pregnant adolescents by promoting earlier maternity booking, sufficient antenatal care, greater emotional resilience, ideal gestational weight gain, less smoking/drug use, and fewer untreated genito-urinary infections. IMPLICATIONS FOR PRACTICE the institutional infrastructure and managerial support for caseload midwifery should value and prioritise the philosophical commitments and personal attributes required to optimise the model. Furthermore the location of visits, between appointment access to primary midwife, and back-up system should be organised to optimise the midwife-woman relationship in order to promote the young woman's engagement with maternity care.
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Affiliation(s)
- J Allen
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Mater Research Institute - University of Queensland and School of Nursing and Midwifery University of Queensland, Level 2, Aubigny Place, Mater Health Services, Raymond Terrace, South Brisbane, QLD 4101, Australia.
| | - S Kildea
- Mater Research Institute - University of Queensland and School of Nursing and Midwifery University of Queensland, Level 1, Aubigny Place, Mater Health Services, South Brisbane, QLD 4101, Australia.
| | - H Stapleton
- Mater Research Institute - University of Queensland and School of Nursing and Midwifery University of Queensland, Level 2, Aubigny Place, Mater Health Services, South Brisbane, QLD 4101, Australia.
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