Health and well-being of urban Aboriginal and Torres Strait Islander women at their first antenatal visit: A cross-sectional study

Information-seeking in first visit pregnant women in Khayelitsha, South Africa

Background

The quality of the decisions made by women during pregnancy, especially their first visit, depends on their health needs, their health-seeking behaviour and the type of information available to them.

Aim

This study describes the health education needs, information barriers and health information-seeking behaviour of pregnant women on their first visit to antenatal clinics in a low-income setting in the Western Cape.

Setting

The setting was two antenatal facilities in Khayelitsha Health District facilities in South Africa.

Methods

A quantitative descriptive survey was conducted. A systematic random sample of 261 antenatal first visit attendees between May and July 2016 was selected. Data were collected using a researcher-administered questionnaire and was analysed using descriptive statistics, 95% confidence intervals and non-parametric tests.

Results

The response rate of the study was 92% (n = 240). Pregnant women attending an antenatal clinic for the first time reported high information needs with low health information-seeking behaviours and high information barriers. Doctors, nurses (2.2, ±1.0), family and friends (2.0, ±0.6) were the most frequently used sources of health information, while watching television or listening to the radio (1.5, ±0.9) were the least used sources of health information. Having a medical diagnosis (p < 0.001) and being of an advanced maternal age (p = 0.005) were predictive of higher health-seeking behaviour. The reliance on passively receiving information from health sources may indicate low levels of health literacy and its inverse relationship to health promoting behaviours which should be the subject of further investigation.

A mixed methods exploratory study tackling smoking during pregnancy in an urban Aboriginal and Torres Strait Islander primary health care service

Background

Pregnancy can be a time of joy and a time of significant stress. For many Aboriginal and Torres Strait Islander (hereafter, respectfully, Indigenous) women, cigarette smoking, even during pregnancy, is a socially sanctioned behavioural response to stress. Indigenous women smoke during pregnancy at higher rates than their non-Indigenous counterparts.

Methods

A mixed methods, exploratory study, undertaken in an urban, Indigenous primary health care service, tested the impact and acceptability of a smoking cessation intervention for women pregnant with an Indigenous baby, their significant other (SO), and their primary health care service. The intervention included case management, incentivised smoking cessation support and culturally-based art activities.

Results

Thirty-one pregnant women and 16 SOs participated. Nearly half attempted to quit at least once during the study, 36% (4/11) of pregnant women had quit at the 3 month assessment and two remained smoke free 1 month postpartum. Most participants self-reported a reduction in tobacco smoking. Exhaled CO confirmed this for SOs (mean reduction − 2.2 ppm/assessment wave, 95% CI: -4.0, − 0.4 ppm/assessment wave, p = 0.015) but not for pregnant women. Many participants experienced social and economic vulnerabilities, including housing and financial insecurity and physical safety concerns.

Conclusions

Tobacco smoking is normalised and socially sanctioned in Indigenous communities and smoking is frequently a response to the multitude of stressors and challenges that Indigenous people experience on a daily basis. Smoking cessation interventions for pregnant Indigenous women must be cognisant of the realities of their private lives where the smoking occurs, in addition to the impact of the broader societal context. Narrow definitions of success focussing only on smoking cessation ignore the psychological benefit of empowering women and facilitating positive changes in smoking behaviours. Our smoking cessation intervention supported pregnant women and their SOs to manage these stressors and challenges, thereby enabling them to develop a solid foundation from which they could address their smoking. A broad definition of success in this space is required: one that celebrates positive smoking behaviour changes in addition to cessation.

Prevalence of chlamydia, gonorrhoea, syphilis and trichomonas in Aboriginal and Torres Strait Islander Australians: a systematic review and meta-analysis

Higher notification rates of sexually transmissible infections (STIs) are reported among Aboriginal and Torres Strait Islander (Aboriginal) compared with non-Aboriginal people in Australia. The aim of this study is to estimate the pooled prevalence of chlamydia, gonorrhoea, syphilis and trichomonas among Aboriginal people in Australia by sex, age-group, setting (clinic vs population/community-based) and population group [adults, pregnant females, young people (12-29 years) and prisoners]. The databases Medline, PubMed and Web of Science were searched in May 2015. A meta-analysis was conducted to estimate the pooled prevalence of the four STIs in Aboriginal people and if possible, by gender, age-group, setting and population group. A total of 46 studies were included. The pooled prevalence was 11.2% (95%CI: 9.4-13.0%) for chlamydia (36 studies), 12.5% (95%CI: 10.5-14.6%) for gonorrhoea (28 studies), 16.8% (95%CI: 11.0-22.6%) for syphilis (13 studies) and 22.6% (95%CI: 18.5-26.7%) for trichomonas (11 studies); however, there was significant heterogeneity between studies (I(2) <97.5%, P<0.01). In the subgroup analysis, a higher pooled prevalence occurred in females than males for chlamydia (12.7% vs 7.7%) and gonorrhoea (10.7% vs 8.1%). The prevalence of chlamydia was 12.4% in clinic-based compared with 4.3% in population-based studies. The highest pooled prevalence by population group was among pregnant females (16.8%) and young people (16.2%) for chlamydia, pregnant females (25.2%) for trichomonas; and young people for gonorrhoea (11.9%). This review highlights the need to decrease the prevalence of STIs among Aboriginal people through community-based programs that target asymptomatic young people.

"It puts a human face on the researched"--A qualitative evaluation of an Indigenous health research governance model

OBJECTIVE

To describe the Inala Aboriginal and Torres Strait Islander Community Jury for Health Research, and evaluate its usefulness as a model of Indigenous research governance within an urban Indigenous primary health care service from the perspectives of jury members and researchers.

METHODS

Informed by a phenomenological approach and using narrative inquiry, a focus group was conducted with jury members and key informant interviews were undertaken with researchers who had presented to the Community Jury in its first year of operation.

RESULTS

The jury was a site of identity work for researchers and jury members, providing an opportunity to observe and affirm community cultural protocols. Although researchers and jury members had differing levels of research literacy, the jury processes enabled respectful communication and relationships to form, which positively influenced research practice, community aspirations and clinical care.

DISCUSSION

The jury processes facilitated transformative research practice among researchers and resulted in transference of power from researchers to the jury members, to the mutual benefit of both.

CONCLUSION

Ethical Indigenous health research practice requires an engagement with Indigenous peoples and knowledge at the research governance level, not simply as subjects or objects of research.