Teaching vulval anatomy in the twenty-first century: The Australian experience

Anatomy has often been regarded as an immutable discipline where everything that needs to be known is known. This article focuses on the teaching of vulval anatomy, the diversification of gender in contemporary society, and the increasing popularity of the Female Genital Cosmetic Surgery (FGCS) industry. The binary language and singular structural arrangements contained in lectures and chapters on "female genital anatomy" are nowadays rendered exclusive and incomplete. A series of 31 semi-structured interviews with Australian anatomy teachers identified barriers and facilitators for teaching vulval anatomy to contemporary student cohorts. Barriers included lack of connection to contemporary clinical practice, time and technical difficulty involved in regularly updating online presentations, the crowded curriculum, personal sensitivity to teaching vulval anatomy, and reluctance to introduce inclusive terminology. Facilitators included lived experience, regular use of social media, and institutional initiatives toward inclusivity including the support of queer colleagues.

Health care support following miscarriage in Australia: a qualitative study. How can we do better?

Miscarriage occurs in one in four pregnancies in Australia and commonly results in adverse psychosocial sequelae, such as clinically significant levels of depression and anxiety. Women also commonly report a lack of support, understanding and acknowledgement of their loss. Research has shown that poor health care support experiences serve to exacerbate adverse psychosocial outcomes. This study explored the support experiences of women affected by miscarriage and their views on what support is needed, when it is needed and who should provide it, as well as their recommendations for improvement. Sixteen Australian women were purposively sampled to participate in qualitative semi-structured interviews. Interview data was analysed using content analysis. Approximately half the women reported positive experiences with healthcare providers, but, despite this, almost all pointed to areas where support was lacking. Insensitive comments and lack of emotional awareness were common. Participants suggested areas for increased clinician support, including mentioning the possibility of miscarriage earlier in routine pregnancies, offering more information before and at the time of miscarriage, providing emotionally sensitive care and offering follow up and psychological support. Women wanted healthcare providers to be proactive in offering support, information and emotionally sensitive care at the time of miscarriage, rather than having to seek it out themselves. Suggestions to improve support after miscarriage included mentioning the possibility of miscarriage earlier, offering more information about miscarriage and psychological support options.

Alcohol availability and prevalent Chlamydia trachomatis in young Australians: a multi-level analysis

Background Prevalence of sexually transmissible infections (STIs) has been associated with availability of alcohol. This paper investigates potential associations between prevalent cases of chlamydia in young people in Australia and the availability of alcohol within their local area, defined as postcode of residence. Methods Alcohol availability was determined at the postcode level using liquor licensing data, classified as total number of licences, number of 'take-away' licences and number of licenses by population. Participant data were drawn from a survey targeting Australians aged 16-29years in rural and regional Australia, capturing demographic details including postcode of residence, indicators of sexual behaviour including condom use and chlamydia test results. Mixed-effects logistic regression was used to examine potential associations between first, alcohol availability and chlamydia, and second, between condom use and chlamydia. Results We found little evidence of associations between alcohol availability and chlamydia in either unadjusted or adjusted models. After adjusting for alcohol availability, we observed significant associations between inconsistent condom use and chlamydia prevalence, whether alcohol availability was measured as total number (adjusted odds ratio (AOR) 2.20; 95% confidence interval (CI) 1.20, 3.70), number of take-away licenses (AOR 2.19; 95% CI1.30, 3.69) or licenses per 1000 population (AOR 2.19; 95% CI 1.30, 3.68). Conclusion Little evidence of association between alcohol availability and chlamydia at the postcode level was found. Further research is required to determine appropriate measures of 'local area' and how characteristics thereof may impact on sexual health.

Whose role is it? Primary care and the provision of emotional support for women experiencing miscarriage: a pilot qualitative Australian study

Miscarriage can cause significant psychological morbidity. Women frequently report dissatisfaction with healthcare professionals' support following miscarriage. This pilot study aimed to explore the views and practices of GPs in providing emotional support to women experiencing miscarriage. Eight GPs participated in semi-structured interviews. GPs considered women's physical care their top priority at the time of miscarriage; however, acknowledged miscarriage could result in significant emotional sequelae. Most GPs felt it was their role to provide emotional support, including expressing empathy, listening and normalising miscarriage to mitigate guilt and self-blame. GPs preferred an individualised approach to emotional support and mostly offered follow-up appointments if a patient requested it or was considered 'high risk' for mental health issues. Some GPs believed miscarriage support was within the scope of primary care practice; however, others felt it was the role of social networks and pregnancy loss support organisations. GPs identified several structural and external barriers that precluded enhanced emotional support. Further tools and resources to enhance support care may be of benefit to some GPs. The feasibility of GPs providing follow-up support remains uncertain. Further research is required to determine whether support is best placed within primary care or better served through external organisations.

What is the anatomical basis of labiaplasty? A review of normative datasets for female genital anatomy

BACKGROUND

Despite increasing numbers of labiaplasties being performed, there is little quantitative information on normal labial diversity to guide medical education, patient education and surgical treatment.

AIM

This scoping review will determine what is known in the published literature about the anatomical basis of normal for labia and female genital cosmetic surgery (FCGS).

MATERIALS AND METHODS

The scoping review identified ten population-based studies that recorded labial dimensions by searching three electronic databases utilising a Preferred Reporting Items for Systematic Reviews and Meta-Analyses search strategy. Strict inclusion and exclusion criteria were applied and then reference lists were scrutinised until no further articles that met the criteria were located.

RESULTS

These studies showed significant variation in labial length (range 5-100 mm) and width (range 1-60 mm). Labia minora were wider in pre-menopausal women than in post-menopausal women, protruding labia minora were more common than not, and asymmetry between right and left labia was common. Variation in recruitment, inclusion and exclusion criteria, and measurement did not allow for summation of the data sets.

CONCLUSION

This information could usefully be added to medical textbooks and teaching to ensure that medical graduates are sufficiently informed about normal variation in female genital anatomy to assess and advise women seeking FGCS.

Using electronic communication technologies for improving syphilis partner notification in Chile: healthcare providers' perspectives - a qualitative case study

Background Partner notification (PN) in Australia has been studied and improved in recent decades. International researchers have highlighted the use of electronic communication technologies to assist PN (Internet partner notification or IPN). Using the Australian experience as an example, the aim of this study is to explore clinicians' perspectives on the use of specialised websites, such as Let them know, to facilitate PN in the Chilean context.

METHODS

Semi-structured interviews were conducted with healthcare providers (HCPs) in 14 primary health care centres and six sexual health units located at two regional Health Services, as well as with key informants from different backgrounds. Interviews were transcribed verbatim and QSR International's NVivo 11 PRO Software was used for cross-case thematic analysis, which followed an inductive approach. Selected quotes were translated from Spanish to English. Codes and themes were reviewed by the research team.

RESULTS

Most participants were unaware of IPN and demonstrated interest. Many agreed this could be a feasible strategy considering the high use of mobile technologies and the Internet in Chile. Participants' primary concerns around this approach were confidentiality, privacy and efficacy, given the local cultural context. The use of a counsellor to offer professional support and guidance was identified as essential to strengthen PN in Chile.

CONCLUSION

The use of IPN could be an alternative PN strategy for Chile. However, the involvement of local staff and further research to explore patients' perceptions and preferences will be essential in tailoring interventions.

The need for improved emotional support: A pilot online survey of Australian women's access to healthcare services and support at the time of miscarriage

PROBLEM

Women need improved emotional support from healthcare professionals following miscarriage.

BACKGROUND

Significant psychological morbidity can result following miscarriage and may be exacerbated by poor support experiences. Women frequently report high levels of dissatisfaction with healthcare support at this time.

AIM

This study was developed to pilot a survey aimed at exploring women's access to healthcare services and support at the time of miscarriage.

METHODS

Women over 18 years, residing in Australia, who had experienced a miscarriage in the past two years completed a 29-item online survey.

FINDINGS

A total of 399 women completed the survey. Two key findings arose: 1) More than half of women (59%) were not offered any information about miscarriage or pregnancy loss support organisations or referral/access to counselling services at the time of miscarriage, despite almost all reporting they would have liked various forms of support from items listed 2) More than half (57%) did not receive follow up care, or emotional support at this time, beyond being asked how they were coping emotionally. Other findings showed 3) Women accessed various healthcare services at the time of miscarriage and 4) Women often saw a general practitioner at the time of miscarriage despite having a private obstetrician.

CONCLUSION

There is clear mismatch between the support women want at the time of miscarriage and the care they receive from healthcare professionals. Despite considerable structural barriers, it seems likely there is scope within healthcare professionals' usual practice for improved support care through simple measures such as increased acknowledgement, information provision and referral to existing support services.

A Digital Pornography Literacy Resource Co-Designed With Vulnerable Young People: Development of "The Gist"

BACKGROUND

The impact of viewing pornography at a young age on the sexual health of subgroups of young people is an important public health issue. However, the topic is complex and extremely sensitive, and best practices for research and harm reduction are yet to be defined. Drawing on cross-disciplinary approaches, such as co-design, is one way to achieve a better understanding of the issue among vulnerable young people and to create needs-based and evidence-informed digital resources to promote pornography literacy.

OBJECTIVE

The objective of this study was to co-design a relevant, usable, and acceptable digital prototype to address the pornography literacy needs of vulnerable young people.

METHODS

In total, 17 young people aged between 14 and 23 years who were engaged in youth services programs or alternative education programs were recruited to participate in 4 co-design workshops with a multidisciplinary design team.

RESULTS

Although the participants could identify problems with pornography and critique its messages, they lacked the information to understand alternative healthy attitudes and behaviors. A digital resource that provides detailed and practical information about sex, sexual ethics, and relationships may help vulnerable young people to identify and contrast with any problematic messages they receive from both pornography and society. Embedding this information with pornography literacy messages may be a more effective way of addressing underlying attitudes. Acknowledging information-seeking patterns and leveraging user interaction patterns from commonly used digital platforms among users may enhance engagement with resources. Importantly, digital platforms are perceived among this group as a source of anonymous secondary information but would not be organically accessed among this group without face-to-face conversations as an access point.

CONCLUSIONS

This paper highlights the potential for pornography literacy to be embedded within real and practical information about having sex, navigating sexuality, and healthy relationships. The study findings include important recommendations for the conceptualization of digital pornography literacy programs and opportunities for cross-disciplinary co-design research to address complex and emerging health issues.

A descriptive analysis of young women's pornography use: a tale of exploration and harm

Background Despite viewing less often than young men, young women view pornography. This study used an online survey to describe young women's pornography use and their reflections on the influence of this use.

METHODS

Young Australian women (15-29 years) were recruited via Facebook to complete an online survey in 2016. Respondents who had ever viewed pornography (n = 491) were asked 10 closed-ended questions related to their exposure to pornography and an open-ended question: 'How has pornography influenced your life?'. Quantitative responses were descriptively analysed. Qualitative responses were thematically analysed using a descriptive qualitative approach.

RESULTS

Most respondents (89%) watched pornography alone for sexual arousal and openly reflected on the influence of their own use. Two overarching themes were identified across qualitative data. The first, exploration, included positive sub-themes of safety, independence, normalisation of sexuality and diversity in body type. The second, harm, included negative sub-themes related to conditioning, comparison and dependency. Themes were identified separately among two discrete groups, but were also described concurrently among a third group of (mostly older) respondents who experienced pornography both as a place for exploration and as a potential source of harm.

CONCLUSION

Young women watch pornography and have positive, negative and mixed experiences that they link to their own viewing. Future research must provide a safe space for young women to be honest regarding their pornography use to ensure that their perspectives are heard and understood.

A Health Education Website Developed to Meet Young People's Information Needs About Web-Based Pornography and Sharing of Sexually Explicit Imagery (SCOPE): Usability Study

BACKGROUND

Although we know that many young people watch online pornography and engage in sexting, there is limited literature examining their needs in relation to information on these highly sensitive and complex issues. Online resources exist; however, we can find no evidence of any of them having been formally tested for usability within the target population.

OBJECTIVE

This study aimed to test the usability of a resource about online pornography and sexting among young people.

METHODS

Semistructured interviews were conducted with 17 participants aged 15 to 29 years.

RESULTS

We found that the SCOPE resource was perceived as trustworthy and credible because of its evidence-based content, nonjudgmental tone, and balanced perspectives. Multimedia and video content enhanced the layout and usability of the resource; however, content relevance could be improved by targeting age and developmental stages. Participants identified resource sections such as Real Stories from young people as relevant and engaging. However, they raised issues with the translation of formative research findings relating to these stories into their final presentation.

CONCLUSIONS

Our findings suggest that young people prefer online resources about complex issues, such as online pornography and sexting, if they are balanced in content and tone. Most importantly, in the context of responding to complex and sensitive issues such as these, co-design methods can ensure that young people are central to the development of resources and avoid gaps in translating research into practice. In the context of limited literature focusing on the usability of online resources about these topics, this paper provides important insights for public health practitioners working in this emerging space.

'There was just no-one there to acknowledge that it happened to me as well': A qualitative study of male partner's experience of miscarriage

Miscarriage occurs in up to one in four pregnancies and can be a devastating event affecting both men and women. Unfortunately, the male partner’s experience of miscarriage is seldom researched, particularly within Australia. This qualitative study involved semi-structured telephone interviews with 10 Australian men, whose partners miscarried between three months and ten years ago. Participants were recruited through professional networks and support organisations. Interviews explored men’s general miscarriage experience and the support received or lacking from both healthcare providers and social networks. Online health seeking behaviour and opinions on online support were also discussed. Data was transcribed verbatim and analysed thematically. Most men described feeling significant grief following miscarriage and felt that there was little acknowledgment of their loss, both from healthcare providers and within their social networks. Feelings of sadness, devastation, powerlessness, fear, shock and a loss of identity were common. All men felt their primary role at the time of miscarriage was to support their partner. Most men did not want to burden their partner with their emotions or grief, and struggled to find people within their social networks to talk to about their loss, leading to feelings of isolation. Overall participants felt there was inadequate support offered to men affected by miscarriage. Men wanted information, informed professionals to talk to and male-orientated support networks. A website was one mechanism suggested by men which could adequately contribute to information and support needs during this time. Men are often greatly affected by miscarriage and yet there is all too often little acknowledgement or support available to them at this time. Men affected by miscarriage want and need further support, including reputable, Australian based information and resources tailored their needs.

"It's just one of those things people don't seem to talk about..." women's experiences of social support following miscarriage: a qualitative study

Background

Miscarriage is a common event which is estimated to occur in approximately one in four confirmed pregnancies (Collins et al, Grief Matters Aust J Grief Bereave_ 17:44, 2014, St John et al, Aust J Adv Nurs_ 23:8, 2006). Social networks play an important role in supporting women following this event and positive support experiences can play a role in buffering women’s experiences of grief, loss and psychological distress following miscarriage (Rowlands et al, J Reprod Infant Psychol_ 28:274–86, 2010, Stratton et al, Aust New Zeal J Obstet Gynaecol_ 48:5–11).

Methods

Women were recruited through existing networks known to the researcher, miscarriage support organisations and snowball sampling methods. Fifteen women living in Australia completed semi-structured interviews either in person or by telephone regarding their experiences of social support following miscarriage, and their recommendations for how this could be improved.

Results

Women reported both positive and negative social support experiences following miscarriage. Women’s partners were identified as their central support figures for most women in this study, and women also identified other women who had previously experienced miscarriage as helpful and supportive. Conversely, women also expressed they felt there was a vast silence surrounding miscarriage, with others being commonly uncomfortable discussing the event leading to feelings of loneliness and isolation. Many women also felt the societal tradition of not disclosing pregnancy until after the first trimester contributed to the stigma surrounding miscarriage, and lead to poorer support experiences.

Conclusions

Raising awareness of the psychological impact of miscarriage appears imperative to assist the community to support women experiencing this loss, as well as reducing the secret and hidden nature of the experience. The recommendations provided may assist well-meaning friends and family in providing appropriate support for their loved ones experiencing miscarriage. Yet as many people in the wider community are uncomfortable with others’ grief, providing the recommended supports in the context of miscarriage would likely remain highly challenging.

Health professionals' roles and practices in supporting women experiencing miscarriage: A qualitative study

BACKGROUND

Miscarriage can result in significant psychological morbidity. Research suggests health professionals play a role in shaping women's experience of miscarriage.

AIMS

This study explored the views and practices of Australian health professionals in caring for women experiencing miscarriage.

MATERIALS AND METHODS

Twelve health professionals from disciplines including medicine, midwifery and sonography were purposively sampled. Semi-structured interviews were recorded, transcribed and subjected to thematic analysis.

RESULTS

Participants acknowledged miscarriage is often a distressing event associated with feelings of grief and failure. They believed women who conceived through in vitro fertilisation, had experienced multiple miscarriages, or had a pre-existing mental illness were likely to experience more distress than others. Despite limited training, participants generally felt competent in their abilities to provide emotional support. They viewed their role largely as guilt-mitigation, which they achieved by stressing the frequency of miscarriage and emphasising that women were not at fault. Follow-up practices varied, and where they did occur, focused on physical recovery. Generally, participants relied on women to express the need for further support. Participants reported that time and resource issues, compassion fatigue and a need for self-protection restricted their abilities to provide better support care.

CONCLUSIONS

There are discrepancies between the emotional support health professionals think women want and are able to provide, and the support women would like. This exploratory study suggests the need for further investigation into provision of improved health professional support for women.

Women view key sexual behaviours as the trigger for the onset and recurrence of bacterial vaginosis

BACKGROUND

Bacterial vaginosis (BV) affects a third of women of reproductive age in the US and there is increasing evidence to suggest it may be sexually transmitted. This study aimed to extend and validate the findings of our earlier smaller qualitative study by exploring in detail women's views and experiences of the triggering factors associated with BV onset and recurrence.

METHODS

Women aged 20-49, who had experienced one or more symptomatic episode of BV within 6 months, were opportunistically recruited to complete a 38-item questionnaire on their experience of BV.

RESULTS

103 women completed the questionnaire. Women were significantly more likely to report sexual than lifestyle factors triggered BV onset and recurrence (p<0.001). The top 3 factors women attributed to both BV onset and recurrence were identical-and all sexual. They included, in order: 1) unprotected sex; 2) sex with a new male partner; and 3) sex in general. The main lifestyle factors nominated included stress, diet, menstruation and the use of feminine hygiene products. While many women felt their BV had been transmitted through sexual contact (54%) and developed as a result of sexual activity (59%), few considered BV a sexually transmitted infection (STI) (10%). Despite this 57% felt partners should also be treated for BV.

CONCLUSION

These data concur with our earlier qualitative findings that women believe BV is triggered by sexual activity. While many women felt BV was sexually transmitted and supported partner treatment, they did not consider BV an STI. This contradiction is likely due to information conveyed to women based on current guidelines. In the absence of highly effective BV treatments, this study highlights the need for guidelines to indicate there is scientific uncertainty around the pathogenesis of BV and to contain clear health messages regarding the evidence for practices shown to be associated with a reduced risk of BV (i.e. consistent condom use.

GPs perspectives on prescribing intrauterine contraceptive devices

BACKGROUND

Globally, 14% of women use intrauterine contraceptive devices (IUCDs) for prevention of unplanned pregnancy. In Australia, the use of IUCDs is negligible at METHODS: GPs participated in qualitative interviews in February-May 2016, exploring their knowledge, attitudes and practice around IUCDs. Data were thematically analysed.

RESULTS

Overall, 17 GPs were interviewed. They identified key barriers to prescription of IUCDs as misconceptions brought to the consultation, lack of current GP inserters, and issues in referral of patients for insertion.

DISCUSSION

Barriers to prescribing IUCDs create challenges for women in accessing all available contraceptive options. Potential solutions to increase IUCD uptake might include local directories of GP inserters and targeted promotion of IUCD use. Increased GP training is necessary to expand the number of current GP inserters.

General practitioners' knowledge and management of dry mouth - A qualitative study

BACKGROUND

Dry mouth (xerostomia) is common and can have significant consequences for a patient's general and oral health. Multiple medications may compromise the flow and quality of saliva.

OBJECTIVE

This study explored general practitioners' (GPs') perceptions, knowledge and management of dry mouth, and whether consideration of oral health influences prescribing patterns.

METHODS

Semi-structured interviews with 20 GPs in Melbourne, Victoria, were audiotaped, transcribed and analysed.

RESULTS

GPs who participated in the study were aware of dry mouth, but diagnosed it infrequently. They had limited knowledge about the oral health implications and management of dry mouth, with some offering potentially harmful advice. Some participants reported that dry mouth would influence their prescribing, but few referred patients to dentists for management.

DISCUSSION

Dry mouth is not on GPs' radar, and patients are rarely questioned about this during routine medical examinations. GPs in this study would welcome additional information to enhance patients' oral health and patient resources on dry mouth.

Better than nothing? Patient-delivered partner therapy and partner notification for chlamydia: the views of Australian general practitioners

Background

Genital chlamydia is the most commonly notified sexually transmissible infection (STI) in Australia and worldwide and can have serious reproductive health outcomes. Partner notification, testing and treatment are important facets of chlamydia control. Traditional methods of partner notification are not reaching enough partners to effectively control transmission of chlamydia. Patient-delivered partner therapy (PDPT) has been shown to improve the treatment of sexual partners. In Australia, General Practitioners (GPs) are responsible for the bulk of chlamydia testing, diagnosis, treatment and follow up. This study aimed to determine the views and practices of Australian general practitioners (GPs) in relation to partner notification and PDPT for chlamydia and explored GPs' perceptions of their patients' barriers to notifying partners of a chlamydia diagnosis.

Methods

In-depth, semi-structured telephone interviews were conducted with 40 general practitioners (GPs) from rural, regional and urban Australia from November 2006 to March 2007. Topics covered: GPs' current practice and views about partner notification, perceived barriers and useful supports, previous use of and views regarding PDPT.

Transcripts were imported into NVivo7 and subjected to thematic analysis. Data saturation was reached after 32 interviews had been completed.

Results

Perceived barriers to patients telling partners (patient referral) included: stigma; age and cultural background; casual or long-term relationship, ongoing relationship or not. Barriers to GPs undertaking partner notification (provider referral) included: lack of time and staff; lack of contact details; uncertainty about the legality of contacting partners and whether this constitutes breach of patient confidentiality; and feeling both personally uncomfortable and inadequately trained to contact someone who is not their patient. GPs were divided on the use of PDPT - many felt concerned that it is not best clinical practice but many also felt that it is better than nothing.

GPs identified the following factors which they considered would facilitate partner notification: clear clinical guidelines; a legal framework around partner notification; a formal chlamydia screening program; financial incentives; education and practical support for health professionals, and raising awareness of chlamydia in the community, in particular amongst young people.

Conclusions

GPs reported some partners do not seek medical treatment even after they are notified of being a sexual contact of a patient with chlamydia. More routine use of PDPT may help address this issue however GPs in this study had negative attitudes to the use of PDPT. Appropriate guidelines and legislation may make the use of PDPT more acceptable to Australian GPs.

Young pregnant women's views on the acceptability of screening for chlamydia as part of routine antenatal care

Background

In pregnancy, untreated chlamydia infection has been associated with adverse outcomes for both mother and infant. Like most women, pregnant women infected with chlamydia do not report genital symptoms, and are therefore unlikely to be aware of their infection. The aim of this study was to determine the acceptability of screening pregnant women aged 16-25 years for chlamydia as part of routine antenatal care.

Methods

As part of a larger prospective, cross-sectional study of pregnant women aged 16-25 years attending antenatal services across Melbourne, Australia, 100 women were invited to participate in a face-to-face, semi structured interview on the acceptability of screening for chlamydia during pregnancy. Women infected with chlamydia were oversampled (n = 31).

Results

Women had low levels of awareness of chlamydia before the test, retained relatively little knowledge after the test and commonly had misconceptions around chlamydia transmission, testing and sequelae. Women indicated a high level of acceptance and support for chlamydia screening, expressing their willingness to undertake whatever care was necessary to ensure the health of their baby. There was a strong preference for urine testing over other methods of specimen collection. Women questioned why testing was not already conducted alongside other antenatal STI screening tests, particularly in view of the risks chlamydia poses to the baby. Women who tested positive for chlamydia had mixed reactions, however, most felt relief and gratitude at having had chlamydia detected and reported high levels of partner support.

Conclusions

Chlamydia screening as part of routine antenatal care was considered highly acceptable among young pregnant women who recognized the benefits of screening and strongly supported its implementation as part of routine antenatal care. The acceptability of screening is important to the uptake of chlamydia screening in future antenatal screening strategies.

Telling partners about chlamydia: how acceptable are the new technologies?

Background

Partner notification is accepted as a vital component in the control of chlamydia. However, in reality, many sexual partners of individuals diagnosed with chlamydia are never informed of their risk. The newer technologies of email and SMS have been used as a means of improving partner notification rates. This study explored the use and acceptability of different partner notification methods to help inform the development of strategies and resources to increase the number of partners notified.

Methods

Semi-structured telephone interviews were conducted with 40 people who were recently diagnosed with chlamydia from three sexual health centres and two general practices across three Australian jurisdictions.

Results

Most participants chose to contact their partners either in person (56%) or by phone (44%). Only 17% chose email or SMS. Participants viewed face-to-face as the "gold standard" in partner notification because it demonstrated caring, respect and courage. Telephone contact, while considered insensitive by some, was often valued because it was quick, convenient and less confronting. Email was often seen as less personal while SMS was generally considered the least acceptable method for telling partners. There was also concern that emails and SMS could be misunderstood, not taken seriously or shown to others. Despite these, email and SMS were seen to be appropriate and useful in some circumstances. Letters, both from the patients or from their doctor, were viewed more favourably but were seldom used.

Conclusion

These findings suggest that many people diagnosed with chlamydia are reluctant to use the new technologies for partner notification, except in specific circumstances, and our efforts in developing partner notification resources may best be focused on giving patients the skills and confidence for personal interaction.

Incentive payments to general practitioners aimed at increasing opportunistic testing of young women for chlamydia: a pilot cluster randomised controlled trial

BACKGROUND

Financial incentives have been used for many years internationally to improve quality of care in general practice. The aim of this pilot study was to determine if offering general practitioners (GP) a small incentive payment per test would increase chlamydia testing in women aged 16 to 24 years, attending general practice.

METHODS

General practice clinics (n = 12) across Victoria, Australia, were cluster randomized to receive either a $AUD5 payment per chlamydia test or no payment for testing 16 to 24 year old women for chlamydia. Data were collected on the number of chlamydia tests and patient consultations undertaken by each GP over two time periods: 12 month pre-trial and 6 month trial period. The impact of the intervention was assessed using a mixed effects logistic regression model, accommodating for clustering at GP level.

RESULTS

Testing increased from 6.2% (95% CI: 4.2, 8.4) to 8.8% (95% CI: 4.8, 13.0) (p = 0.1) in the control group and from 11.5% (95% CI: 4.6, 18.5) to 13.4% (95% CI: 9.5, 17.5) (p = 0.4) in the intervention group. Overall, the intervention did not result in a significant increase in chlamydia testing in general practice. The odds ratio for an increase in testing in the intervention group compared to the control group was 0.9 (95% CI: 0.6, 1.2). Major barriers to increased chlamydia testing reported by GPs included a lack of time, difficulty in remembering to offer testing and a lack of patient awareness around testing.

CONCLUSIONS

A small financial incentive alone did not increase chlamydia testing among young women attending general practice. It is possible small incentive payments in conjunction with reminder and feedback systems may be effective, as may higher financial incentive payments. Further research is required to determine if financial incentives can increase testing in Australian general practice, the type and level of financial scheme required and whether incentives needs to be part of a multi-faceted package.

TRIAL REGISTRATION

Australian New Zealand Clinical Trial Registry ACTRN12608000499381.

Nursing outside hospitals: the working experience of community nurses. Educational characteristics and job perceptions

The community nursing practice research project reports the results of a mailed questionnaire survey of nurses employed outside hospitals and nursing homes in Victoria in 1985. Two 10 per cent random samples stratified across practice areas were selected from listings of community nurses providing detailed employment information to the Victorian Nursing Council. An 84 per cent response rate was obtained from these listings yielding 689 responses. This paper reports that part of the study relevant to job entry, job satisfaction, job mobility and perceived career options as well as educational preparation. One half of community nurses entered community nursing after five years of hospital experience. The major reasons for choosing employment in community health nursing were its conditions of work, its autonomy and a dissatisfaction with hospital nursing, rather than a specific orientation to community nursing. These can be appreciated in terms of competing demands by the nurse's family life and her sense of growing professional maturity. Job satisfaction was high, with 87 per cent of nurses in the study population being satisfied or very satisfied. Only one quarter considered opportunities for career advancement to exist in their practice area. In the event only one fifth of nurses regarded promotion as important. The high levels of job satisfaction and the low importance attached to promotion are explicable given the nature of female employment and dissatisfaction with hospital nursing. Despite this high level of job satisfaction, one third of nurses believed they would not be nursing in five years time. Less than one third of nurses felt there was adequate opportunity for advancement in their practice area.(ABSTRACT TRUNCATED AT 250 WORDS)

Conversant or clueless? Chlamydia-related knowledge and practice of general practitioners in Western Australia

Background

A survey of Western Australia's general practitioners' (GPs') knowledge and practices relating to genital chlamydia infection was conducted in mid-2005, prior to a multi-media campaign which encouraged 15–24 year olds to seek chlamydia testing through their general practitioner (GP). The survey aimed to raise GPs' awareness of chlamydia in preparation for the campaign and to establish a baseline measure of their chlamydia-related knowledge and practices.

Methods

All 2038 GPs registered on the Australian Medical Publishing Company's database as practising in Western Australia were sent a survey which covered clinical features of chlamydia, investigations, treatment and public health issues; 576 (29%) responded.

Results

Most GPs were aware of chlamydia being common in the 20–24 year old age group, but less than half were aware that it is common in 15–19 year olds. GPs missed many opportunities for chlamydia testing in patients likely to be at risk of STIs, largely because they thought the patient would be embarrassed. It is of concern that public health responsibilities in relation to chlamydia, ie notification and contact tracing, were not undertaken by all GPs.

Conclusion

Australia is currently piloting chlamydia screening. For this to be successful, GPs will need to maintain current knowledge and clinical suspicion about chlamydia, and be comfortable in asking and receiving information about sexual behaviours. Only then will GPs have a significant impact on curbing Australia's ever-increasing rates of chlamydia.

Outcomes of an educational activity with Victorian GPs aimed at improving knowledge and practices in relation to sexually transmissible diseases

OBJECTIVE

To measure the effect of a simple educational strategy for general practitioners (GPs) on their knowledge and self-reported practice in relation to sexually transmissible disease (STD) management.

METHOD

In 1995, we surveyed 520 Victorian GPs; 444 (85%) responded. A sub-sample of 242 was sent an educational package in relation to STD management that required them to reflect on their performance in the survey in relation to that of the sample as a whole. Two months after they had received the package, a brief follow-up questionnaire, using a selection of questions from the first survey, was sent to these GPs.

RESULTS

Practitioners showed statistically significant improvements in knowledge and self-reported practice for four of the six outcomes that were examined.

CONCLUSION

A relatively simple educational package for GPs had a high participation rate and resulted in improvements in knowledge and self-reported practice that could contribute to increased STD case finding in the general practice setting.

IMPLICATIONS

The key to enabling GPs to make a greater contribution to improved STD control is to encourage them to be more active in diagnosing and treating asymptomatic disease. For asymptomatic patients, sexual history-taking and selective screening are important skills but there are barriers to their implementation in the general practice setting. A key objective of GP educational programs in relation to STDs is to increase their likelihood of taking a sexual history and the significant increase in this measure for the whole sample was encouraging.

Attitudes to taking a sexual history in general practice in Victoria, Australia

OBJECTIVE

To examine general practitioners' (GPs') attitudes towards taking a sexual history.

METHODS

Questions on sexual history taking were included in a random survey on the STD knowledge, attitudes, and practices of 600 GPs practising in Victoria, Australia.

RESULTS

Most GPs commonly asked patients about safe sex (79%), number of sex partners (63%), and injecting drug use (60%) while fewer asked about recent overseas travel (50%) and sex with sex workers (31%). GPs who performed sexual health consultations daily or weekly identified barriers to sexual history taking to be of less concern than those who performed such consultations infrequently. Most GPs (92%) would take a sexual history from a man presenting as the sexual contact of an infected partner, but less than a third would do so for a patient routinely requesting the contraceptive pill (28%), a Papanicolaou (Pap) smear (30%), or advice about immunisation before overseas travel (30%). Female GPs were significantly more likely than male GPs to take a sexual history in those clinical situations involving a female patient and also to perceive these patients as experiencing less embarrassment.

CONCLUSIONS

This study highlights both the lack of opportunistic sexual history taking and the main barriers to sexual history taking in general practice in Victoria, Australia. The importance of educating both patients and GPs about sexual history taking are discussed.

Sexually transmissible diseases--knowledge and practices of general practitioners in Victoria, Australia

OBJECTIVE

To examine knowledge and practices in relation to sexually transmissible diseases (STDs) of general practitioners (GPs) in Victoria, Australia.

METHOD

A questionnaire was distributed to 520 Victorian GPs randomly selected from the Australian Medical Publishing Company (AMPCo) database of Australian medical practitioners.

RESULTS

A response rate of 85% was obtained. While sexual health consultations were common for Victorian GPs, STD caseloads were generally low. Knowledge of clinical features of symptomatic STDs and of important STD epidemiology was generally good although there was a lower awareness of the asymptomatic nature of the most prevalent STDs in Victoria. Diagnostic tests were generally selected appropriately although many GPs did not perform the gold standard combination of tests required for adequate differential diagnosis. Level of STD STD knowledge was related to frequency of advising about safe sex, diagnosing STDs, and younger practitioner age. Attendance at any of a number of postgraduate courses of relevance to the management of STDs was not related to better STD knowledge overall.

CONCLUSIONS

Prevention and detection of STDs in general practice involve risk assessment and screening of asymptomatic patients as well as effective treatment of symptomatic patients and their contacts. Results presented here suggest that GPs have good knowledge and use appropriate investigations for patients presenting with symptoms of an STD. The low levels of awareness of the asymptomatic nature of many STDs and other particular aspects of STD knowledge and practice should be addressed in undergraduate and postgraduate medical education programmes.

Nursing outside hospitals: the working experience of community nurses: job characteristics

The Community Nursing Project reports the results of a mailed questionnaire survey of the working and educational experience of 689 nurses employed outside hospitals and nursing homes in Victoria in 1985. This paper reports that part of the study relevant to their practice settings, job titles, job content and working conditions. Confusion about titles for community nurses was evident given that subjects offered 281 separate job titles. A title with the general form 'Community Nurse--specialist designation' was acceptable to 88% of nurses. Eighteen (of 57) job activities were identified that were performed at least weekly by four of the six principal practice areas. Therefore while the concept of the generic community nurse is a meaningful one, it is only so when the differences in job content across practice areas are acknowledged. Medical clinic nurses however do not conform to this general pattern. Seventy-nine per cent of the nurses currently had a job description. However, only 45% had a statement of job conditions, 26% had a formal job orientation, 24% worked overtime unrewarded by payment or time in lieu and only 59% could reschedule their work times. These figures varied greatly between practice areas. It is suggested that the concept of the community nurse--specialist designation be promoted. Specifically this could be done by the adoption of this title and the development of appropriate post-basic educational courses. While these conclusions have most relevance for Australia, they will also be of interest to nurses of other countries where an increasing emphasis on primary health care has resulted in an expansion of community nursing practice.

Factors affecting the selection of doctor of first contact in the western region of Melbourne: an interview study of parents of sick children

An interview study investigating attitudinal and other factors influencing the selection of primary medical care (PMC) is described. It focuses on parents of sick children, excluding those with trauma or medical/surgical emergencies, and was conducted in part of the Western Region (WR) of Melbourne in late 1983, the period immediately prior to the introduction of Medicare. It is based on a cross-sectional survey of in-hours attenders of eight general practices (GP), the Western Region Community Health Centre (WRCHC), the general clinic of the casualty departments at the Western General Hospital (WGH), and the Royal Children's Hospital (RCH), a teaching hospital outside the region. The most commonly stated reasons for attendance at services generally were 'closeness to home/work', 'recommendation' and 'good service'. 'Cheap/economic reasons' were given less frequently overall than the above reasons. There were however some differences in reasons given by attenders at different places of care. 'Cheap/economic reasons' was offered significantly more often and 'recommendation' significantly less often by WGH attenders compared with other attenders. 'Specialists available' and 'dissatisfaction with other doctors' was offered significantly more frequently and 'close to home' and 'no other doctor' significantly less frequently by RCH attenders than other attenders. Health insurance status did not differ significantly at the different places of care. Attenders of the RCH were significantly more knowledgeable about community health centres than GP or WGH attenders. Non-GP attenders had more often used other than their current place of care for treatment in the recent past than GP attenders had.(ABSTRACT TRUNCATED AT 250 WORDS)