Māori and Pasifika perceptions of their local maternity care in Logan, Australia

Drivers of the Australian Health System towards Health Care for All: A Scoping Review and Qualitative Synthesis

Background

Australia has made significant progress towards universal access to primary health care (PHC) services. However, disparities in the utilisation of health services and health status remain challenges in achieving the global target of universal health coverage (UHC). This scoping review aimed at synthesizing the drivers of PHC services towards UHC in Australia.

Methods

We conducted a scoping review of the literature published from 1 January 2010 to 30 July 2021 in three databases: PubMed, Scopus, and Embase. Search terms were identified under four themes: health services, Australia, UHC, and successes or challenges. Data were analysed using an inductive thematic analysis approach. Drivers (facilitators and barriers) of PHC services were explained by employing a multilevel framework that included the proximal level (at the level of users and providers), intermediate level (organisational and community level), and distal level (macrosystem or distal/structural level).

Results

A total of 114 studies were included in the review. Australia has recorded several successes in increased utilisation of PHC services, resulting in an overall improvement in health status. However, challenges remain in poor access and high unmet needs of health services among disadvantaged/priority populations (e.g., immigrants and Indigenous groups), those with chronic illnesses (multiple chronic conditions), and those living in rural and remote areas. Several drivers have contributed in access to and utilisation of health services (especially among priority populations)operating at multilevel health systems, such as proximal level drivers (health literacy, users' language, access to health facilities, providers' behaviours, quantity and competency of health workforce, and service provision at health facilities), intermediate drivers (community engagement, health programs, planning and monitoring, and funding), and distal (structural) drivers (socioeconomic disparities and discriminations).

Conclusion

Australia has had several successes towards UHC. However, access to health services poses significant challenges among specific priority populations and rural residents. To achieve universality and equity of health services, health system efforts (supply- and demand-side policies, programs and service interventions) are required to be implemented in multilevel health systems. Implementation of targeted health policy and program approaches are needed to provide comprehensive PHC and address the effects of structural disparities.

Health engagement: a systematic review of tools modifiable for use with vulnerable pregnant women

OBJECTIVE

To examine available health engagement tools suitable to, or modifiable for, vulnerable pregnant populations.

DESIGN

Systematic review.

ELIGIBILITY CRITERIA

Original studies of tool development and validation related to health engagement, with abstract available in English, published between 2000 and 2022, sampling people receiving outpatient healthcare including pregnant women.

DATA SOURCES

CINAHL Complete, Medline, EMBASE and PubMed were searched in April 2022.

RISK OF BIAS

Study quality was independently assessed by two reviewers using an adapted COSMIN risk of bias quality appraisal checklist. Tools were also mapped against the Synergistic Health Engagement model, which centres on women's buy-in to maternity care.

INCLUDED STUDIES

Nineteen studies were included from Canada, Germany, Italy, the Netherlands, Sweden, the UK and the USA. Four tools were used with pregnant populations, two tools with vulnerable non-pregnant populations, six tools measured patient-provider relationship, four measured patient activation, and three tools measured both relationship and activation.

RESULTS

Tools that measured engagement in maternity care assessed some of the following constructs: communication or information sharing, woman-centred care, health guidance, shared decision-making, sufficient time, availability, provider attributes, discriminatory or respectful care. None of the maternity engagement tools assessed the key construct of buy-in. While non-maternity health engagement tools measured some elements of buy-in (self-care, feeling hopeful about treatment), other elements (disclosing risks to healthcare providers and acting on health advice), which are significant for vulnerable populations, were rarely measured.

CONCLUSIONS AND IMPLICATIONS

Health engagement is hypothesised as the mechanism by which midwifery-led care reduces the risk of perinatal morbidity for vulnerable women. To test this hypothesis, a new assessment tool is required that addresses all the relevant constructs of the Synergistic Health Engagement model, developed for and psychometrically assessed in the target group.

PROSPERO REGISTRATION NUMBER

CRD42020214102.

Child rearing and parenting programs among First Nations' populations in high-income countries: a bibliometric review

Objectives We set out to examine the volume, scope and quality of research related to First Nations peoples' perceptions of, and experiences with, child rearing and/or parenting programs. Methods We systematically reviewed the literature published between 2000 and 2020. Sixty-eight studies identified through electronic databases and references lists met inclusion criteria. Results The study found an 8% increase in publications in the field each year (P -value = 0.002), mostly conducted in Australia with Aboriginal and Torres Strait Islander people (n  = 29, 41%). Scope included positive and negative experiences relating to: parenting from adult (n  = 19 studies) and teenager (n  = 4) perspectives; and pregnancy, antenatal and postnatal care from the perspective of adults (n  = 23) and teenagers (n  = 2). Descriptive studies included qualitative (n  = 40; 58%), quantitative (n  = 8, 12%) or mixed methods (n  = 7, 10%). Thirteen experimental studies reported the development, acceptability and/or effectiveness of programs (19%), of which three met the Cochrane Effective Practice and Organisation of Care design criteria. Conclusions Despite an overall increase in volume, research efforts do not demonstrate a clear scientific progression. Further methodologically rigorous studies examining child rearing and/or parenting programs developed in collaboration with First Nations populations are needed.

The needs of Pacific families affected by age-related cognitive impairment in New Zealand: interviews with providers from health-care organisations

INTRODUCTION Pacific populations in New Zealand are aging, but little is known in the health-care environment about their experiences with cognitive impairment. AIM The aim was to explore the needs of Pacific peoples affected by age-related cognitive decline from the perspectives of health-care providers. METHODS Six health-care service providers from organisations focused on Pacific patients were interviewed to determine services available to aged Pacific peoples, access, and whether they met Pacific people's needs. RESULTS Three areas of concern were identified by all participants: access to services; getting a diagnosis; and communication and language. Many experienced a lack of information and poor access to services. Diagnosis of cognitive impairment was frequently made difficult by inconsistent access to general practitioners in lower socio-economic areas. Communication was hindered by poor access to information in Pacific languages. DISCUSSION Common themes noted by all participating health-care providers indicated the needs of aged Pacific people experiencing cognitive decline were often not being met.

Exploring the value and acceptability of an antenatal and postnatal midwifery continuity of care model to women and midwives, using the Quality Maternal Newborn Care Framework

BACKGROUND

Having a known midwife throughout pregnancy, birth and the early parenting period improves outcomes for mothers and babies. In Australia, midwifery continuity of care has been recommended in all states, territories and nationally although uptake has been slow. Several barriers exist to implementing midwifery continuity of care models and some maternity services have responded by introducing modified models of continuity of care. An antenatal and postnatal continuity of care model without intrapartum care is one example of a modified model of care that has been introduced by health services.

OBJECTIVES

The aim of this study was to explore the value and acceptability of an antenatal and postnatal midwifery program to women, midwives and obstetricians prior to implementation of the model at one hospital in Metropolitan Sydney, Australia.

METHODS

A qualitative descriptive methodology was undertaken to discover the value and acceptability to the implementation of the model. Data was collected via focus groups and one to one interviews from the service users (pregnant women and two partners) and service providers (midwives and obstetricians). We also collected demographic data to demonstrate the diversity of the setting. The Quality Maternal Newborn Care (QMNC) Framework was used to guide the focus groups and analyse the data.

FINDINGS

Four themes emerged from the data that were named feeling safe and connected, having more quality time and being confident, having a sense of community and respecting cultural diversity. The findings were analysed through the lens of the quality components of the QMNC framework. The final findings demonstrate the value and acceptability of implementing this model of care from women's, midwives and obstetrician's perspective.

CONCLUSIONS/IMPLICATIONS

Providing midwifery continuity of care through the antenatal and postnatal period without intrapartum care, is being implemented in Australia without any research. Using the QMNC framework is a useful way to explore the qualities of a new emerging service and the values and acceptability of this model of care for service providers and service users.