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Bittleston H, Hocking JS, Temple-Smith M, Sanci L, Goller JL, Coombe J. What sexual and reproductive health issues do young people want to discuss with a doctor, and why haven't they done so? Findings from an online survey. Sex Reprod Healthc 2024; 40:100966. [PMID: 38522395 DOI: 10.1016/j.srhc.2024.100966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/28/2024] [Accepted: 03/19/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE Young people are a priority group for sexual and reproductive health (SRH) care. We considered which SRH topics young Australians want to discuss with a general practitioner (GP) and explored barriers they encounter to discussing these issues. METHODS We conducted an online survey (2nd May - 21st June 2022) of Australians aged 16-29 years. Participants were asked to identify from a list of SRH topics which they wanted to discuss, but never had, with a GP. Those who selected any topic/s (with 'undiscussed SRH issues') were asked a free-text follow-up question about what prevented them from discussing issues. We explored characteristics associated with having undiscussed issues using multivariate logistic regression. Free-text comments were analysed using content analysis. RESULTS A total of 1887 people completed relevant survey questions. Most (67.1 %) were women and 48.5 % were heterosexual. Two-thirds (67.0 %) had a usual GP. Nearly half (45.6 %) had undiscussed issues. Most commonly, women wanted to discuss cervical screening and sexual problems, and men wanted to discuss sexual problems and STIs. Participants who were male, older, heterosexual, and with a usual GP were least likely to have undiscussed issues. Barriers to accessing care for SRH were identified from free-text comments, including discomfort, lack of opportunity, fear of negative outcomes, low priority of SRH issues, and perceptions about the role and expertise of GPs. CONCLUSIONS Many young people would welcome more preventative SRH care. Young people may be reassured that all issues, including sexual difficulties and dysfunction, are appropriate to discuss with a GP.
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Affiliation(s)
- H Bittleston
- Centre for Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health, Melbourne, Australia.
| | - J S Hocking
- Centre for Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health, Melbourne, Australia
| | - M Temple-Smith
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - L Sanci
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - J L Goller
- Centre for Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health, Melbourne, Australia
| | - J Coombe
- Centre for Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health, Melbourne, Australia
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Bourchier L, Temple-Smith M, Hocking J, Bittleston H, Malta S. Engaging older Australians in sexual health research: SHAPE2 survey recruitment and sample. Sex Health 2024; 21:NULL. [PMID: 38071758 DOI: 10.1071/sh23116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/14/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Sexual health research rarely includes older age groups and the sexual health needs of older Australians are not well understood. Older adults are online in increasing numbers; however, internet surveys involving samples of older adults and sensitive topics remain uncommon. In 2021, we developed an online survey to explore the sexual health needs of Australians aged 60+years. We describe here survey recruitment and sample obtained, comparing it with national population data (Australian Bureau of Statistics) and the sample of the similar 'Sex, Age and Me' study from 2015. METHODS We recruited 1470 people with a staggered three-phase strategy: (1) emails to organisations and community groups; (2) paid Facebook advertising; and (3) passive recruitment. Half (50.6%) found out about the study via an organisation or group and just over a third (35.7%) from Facebook. RESULTS The sample was equally balanced between men (49.9%) and women (49.7%) (0.4% other gender identities). Participants were aged 60-92years (median 69years) with all Australian States/Territories represented. Facebook recruits were younger, more likely to be working rather than retired, and more likely to live outside a major city, than those recruited by other means. CONCLUSIONS Using the recruitment methods described, we successfully obtained a diverse and fairly representative sample of older Australians within the constraints of a convenience sample and on a modest budget. This research sheds light on ways to engage an under-served demographic in sexual health research. Our experience shows that many older adults are amenable to recruitment for online sexual health surveys using the approaches outlined.
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Affiliation(s)
- Louise Bourchier
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Vic., Australia
| | - Meredith Temple-Smith
- Department of General Practice and Primary Care, University of Melbourne, Melbourne, Vic., Australia
| | - Jane Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Vic., Australia
| | - Helen Bittleston
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Vic., Australia
| | - Sue Malta
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Vic., Australia
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Bittleston H, Hocking JS, Coombe J, Temple-Smith M, Goller JL. Young Australians' receptiveness to discussing sexual health with a general practitioner. Aust J Prim Health 2023; 29:587-595. [PMID: 37614041 DOI: 10.1071/py23083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/24/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Most sexual health care in Australia is provided through general practice. However, many young Australians experience barriers to accessing sexual health care. This research examines young Australians' receptiveness to discussing sexual health with a general practitioner (GP). METHODS We conducted an anonymous online sexual health survey (open 2 May to 21 June 2022). Anyone living in Australia aged 16-29years was eligible to participate. Participants were recruited via social media and asked whether they agreed with five statements exploring their receptivity to discussing sexual health with GPs. We explored characteristics associated with responses using multivariable logistic regression. RESULTS Among 1915 participants, 69.3% were cisgender women, with a median age of 20years; 48.5% were heterosexual. Approximately one-fifth agreed they might not tell a GP the whole truth about their sexual history, would be worried about confidentiality when discussing their sexual history and would be too embarrassed to see their usual GP if they thought they had a sexually transmitted infection. Over half (55.8%) agreed they would be comfortable with a GP bringing up sexual health in an unrelated consultation, but 39.6% would be nervous to bring up sexual health in case they needed an intimate examination. Multivariate regression identified several characteristics associated with responses. Notably, having a school-based sex education and a usual GP were factors associated with increased receptivity to discussing sexual health. CONCLUSIONS Young Australians were generally open to discussing sexual health with a GP. School-based sex education and GP-patient relationships are key to promoting sexual health among young people.
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Affiliation(s)
- Helen Bittleston
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Vic. 3010, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Vic. 3010, Australia
| | - Jacqueline Coombe
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Vic. 3010, Australia
| | - Meredith Temple-Smith
- Department of General Practice, The University of Melbourne, Carlton, Vic. 3010, Australia
| | - Jane L Goller
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Vic. 3010, Australia
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4
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Caddy C, Temple-Smith M, Coombe J. Who does what? Reproductive responsibilities between heterosexual partners. Cult Health Sex 2023; 25:1640-1658. [PMID: 36752653 DOI: 10.1080/13691058.2023.2173800] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
Managing fertility and sexual and reproductive health across the life course is associated with numerous responsibilities disproportionately experienced by women. This extends beyond dealing with the physical side effects of contraception and can include the emotional burden of planning conception and the financial cost of accessing health services. This scoping review aimed to map how reproductive responsibilities were defined and negotiated (if at all) between heterosexual casual and long-term partners during any reproductive life event. Original research in high-income countries published from 2015 onwards was sourced from Medline (Ovid), CINAHL and Scopus. In studies that focused on pregnancy prevention and abortion decision making, men felt conflict in their desire to be actively engaged while not wanting to impede their partner's agency and bodily autonomy. Studies identified multiple barriers to engaging in reproductive work including the lack of acceptable male-controlled contraception, poor sexual health knowledge, financial constraints, and the feminisation of family planning services. Traditional gender roles further shaped men's involvement in both pregnancy prevention and conception work. Despite this, studies reveal nuanced ways of sharing responsibilities - such as companionship during birth and abortion, ensuring contraception is used correctly during intercourse, and sharing the costs of reproductive health care.
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Affiliation(s)
- Cassandra Caddy
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Jacqueline Coombe
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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5
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Bilardi JE, Temple-Smith M. We know all too well the significant psychological impact of miscarriage and recurrent miscarriage: so where is the support? Fertil Steril 2023; 120:937-939. [PMID: 37648144 DOI: 10.1016/j.fertnstert.2023.08.951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/01/2023]
Abstract
Miscarriage and recurrent miscarriage affect a significant proportion of every population with research consistently showing it results in profound and often prolonged psychological impacts. Despite the serious psychological impacts, support for miscarriage remains grossly inadequate. There are many ways to ameliorate the impact of these losses, which are not difficult, expensive, or time consuming. At a basic level, people want and need acknowledgment and validation of their grief and loss and greater information provision at the time of loss. A clear discrepancy also exists between the bereavement care offered by health care providers and the care wanted and needed by those affected, that must be addressed as a matter of urgency. At a health care system level, the collection of national miscarriage data must begin, to allow for a true understanding of the socioeconomic cost of miscarriage and the burden of early pregnancy loss on individuals, families, and our social systems. Furthermore, to direct research funding appropriately, establishing national research funding priorities for miscarriage support, as they have in the United Kingdom, is vital in assisting researchers and other key stakeholders to effectively target research in areas that are likely to have the greatest public health benefit. Consumers, health practitioners, and policymakers could achieve a lot for many with just a little commitment to change.
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Affiliation(s)
- Jade E Bilardi
- Central Clinical School, Monash University, Melbourne, VIC, Australia; Department of General Practice, University of Melbourne, Parkville, VIC, Australia; Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC, Australia.
| | - Meredith Temple-Smith
- Department of General Practice, University of Melbourne, Parkville, VIC, Australia; Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC, Australia
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Bittleston H, Goller JL, Temple-Smith M, Coombe J, Hocking JS. How Much Do Young Australians Know About Syphilis Compared With Chlamydia and Gonorrhea? Findings From an Online Survey. Sex Transm Dis 2023; 50:575-582. [PMID: 37227384 DOI: 10.1097/olq.0000000000001834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND There is increased heterosexual transmission of syphilis in Australia, an infection with severe outcomes. Australian policy emphasizes increasing sexually transmissible infection knowledge/awareness. However, little is known about young Australians' perceptions and knowledge of syphilis. METHODS Our online sexual health survey was open May 2 to June 21, 2022, to 16- to 29-year-olds in Australia. We asked participants if they were aware of syphilis, their personal risk perception, and perceived severity of infection and compared with results for chlamydia/gonorrhea. Multivariable and multinomial logistic regressions were used to assess characteristics associated with outcomes. We measured sexually transmissible infection knowledge using 10 true/false statements (5 syphilis, 5 chlamydia/gonorrhea). RESULTS Among 2018 participants (69.1% women, 48.9% heterosexual), 91.3% had heard of syphilis (vs. 97.2% for chlamydia and 93.3% for gonorrhea). Older (25-29 years; adjusted odds ratio [aOR], 2.4; 95% confidence interval [CI], 1.4-4.4) and gay/lesbian (aOR, 2.8; 95% CI, 1.4-5.3) respondents were more likely to have heard of syphilis, as were those who were non-Aboriginal, sexually active, and with a school-based sex education. Syphilis knowledge was lower than chlamydia/gonorrhea knowledge ( P < 0.001). More than half (59.7%) perceived syphilis to have serious health impacts (vs. 36.4% for chlamydia and 42.3% for gonorrhea). Older respondents were more likely (25-29 years; aOR 2.1; 95% CI, 1.6-2.8), and gay/lesbian respondents less likely (aOR, 0.7; 95% CI, 0.6-1.0) to perceive syphilis to have serious health impacts. One-fifth of sexually active participants were unsure of their risk of syphilis. CONCLUSIONS Most young Australians are aware of syphilis, but few have comprehensive knowledge about the infection relative to chlamydia/gonorrhea. Considering increasing heterosexual transmission, syphilis health promotion campaigns should expand their focus.
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Affiliation(s)
- Helen Bittleston
- From the Centre for Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health
| | - Jane L Goller
- From the Centre for Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health
| | - Meredith Temple-Smith
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
| | - Jacqueline Coombe
- From the Centre for Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health
| | - Jane S Hocking
- From the Centre for Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health
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7
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Hocking JS, Watson C, Chondros P, Sawyer SM, Ride J, Temple-Smith M, Boyle D, Skinner R, Patton GC, Lim MSC, Pirkis J, Johnson C, Newton S, Wardley A, Blashki G, Guy R, Dalziel K, Sanci L. Will a fee-for-service payment for a young people's health assessment in general practice increase the detection of health risk behaviours and health conditions? Protocol for a cluster randomised controlled trial (RAd Health Trial). BMJ Open 2023; 13:e074154. [PMID: 37586870 PMCID: PMC10432627 DOI: 10.1136/bmjopen-2023-074154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/27/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION Adolescence is a period of major transition in physical, cognitive, social and emotional development, and the peak time for the onset of mental health conditions, substance use disorders and sexual and reproductive health risks. Prevention and treatment during this time can improve health and well-being now and into the future. However, despite clinical guidelines recommending annual preventive health assessments for young people, health professionals cite lack of consultation time and adequate funding as key barriers. This trial aims to determine whether a specific fee-for-service ('rebate payment') for a young person's health assessment, is effective and cost-effective at increasing the detection and management of health risk behaviours and conditions among young people. METHODS AND ANALYSIS This cluster randomised controlled trial will be conducted in Australian general practice. 42 general practices (clusters) will be randomly allocated 1:1 to either an intervention arm where general practitioners receive a rebate payment for each annual health assessment undertaken for 14-24-year-olds during a 2 year study period, or a control arm (no rebate). The rebate amount will be based on the Medical Benefits Schedule (Australia's list of health professional services subsidised by the Australian Government) currently available for similar age-based assessments. Our primary outcome will be the annual rate of risk behaviours and health conditions recorded in the patient electronic health record (eg, alcohol/drug use, sexual activity and mental health issues). Secondary outcomes include the annual rate of patient management activities related to health risks and conditions identified (eg, contraception prescribed, sexually transmitted infection tests ordered). A process evaluation will assess acceptability, adoption, fidelity and sustainability of the rebate; an economic evaluation will assess its cost-effectiveness. Analyses will be intention-to-treat. ETHICS AND DISSEMINATION Ethics approval has been obtained from University of Melbourne Human and Research Ethics Committee (2022-23435-29990-3). Findings will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12622000114741.
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Affiliation(s)
- Jane S Hocking
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Cathy Watson
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Patty Chondros
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Susan M Sawyer
- Centre for Adolescent Health, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jemimah Ride
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Health Economics Group, Monash University, Melbourne, Victoria, Australia
| | - Meredith Temple-Smith
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Douglas Boyle
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rachel Skinner
- University of Sydney, Sydney, New South Wales, Australia
| | - George C Patton
- Centre for Adolescent Health, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Megan S C Lim
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jane Pirkis
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Caroline Johnson
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sara Newton
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Amelia Wardley
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Grant Blashki
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Rebecca Guy
- Sexual Health Program, The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Kim Dalziel
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lena Sanci
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
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8
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Power A, Tuteja A, Mascarenhas L, Temple-Smith M. A qualitative exploration of obtaining informed consent in medical consultations with Burma-born women. Aust J Prim Health 2023; 29:284-291. [PMID: 36442078 DOI: 10.1071/py22138] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/07/2022] [Indexed: 07/20/2023]
Abstract
BACKGROUND Conciliatory attitudes, respect for medical professionals and avoidance of being direct can make health consultations with Burma-born patients difficult to navigate. Coupled with linguistic barriers, this may make the sensitive nature of many women's health consultations challenging. Little is known about current practices for obtaining informed consent in this context. The objectives of this study were to explore current practices, barriers and strategies to obtaining informed consent in medical consultations with women born in Burma. METHODS Purposive and snowball sampling was used to recruit health practitioners (n =15, 2 male, 13 female) of different ages, years of professional experience, and country of origin, from clinics in Victoria that see a high volume of Burma-born patients. Thirty to sixty minute semi-structured interviews were conducted with four general practitioners, eight nurses and three interpreters, and de-identified audio recordings were transcribed for inductive thematic analysis. RESULTS Five key themes were generated: (1) cultural cognisance; (2) influence of community; (3) skilful navigation of communication; (4) favourable consultation attributes; and (5) individual tailoring of consent conversations. Differing cultural expectations, and linguistic and educational barriers, were highlighted as challenges to obtaining informed consent, whereas thoughtful utilisation of non-verbal communication, and intentional customisation of consent conversations were identified as facilitators. CONCLUSION The findings of this study provide practical ways to optimise the informed consent process within the Australian primary healthcare context, and reinforce that accepted Western-based practices for obtaining informed consent are not a 'one-size-fits-all' process.
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Affiliation(s)
- Anna Power
- Department of General Practice, University of Melbourne, Parkville, Vic. 3010, Australia; and The Royal Australian College of General Practitioners, East Melbourne, Vic. 3002, Australia
| | - Amita Tuteja
- Department of General Practice, University of Melbourne, Parkville, Vic. 3010, Australia
| | - Lester Mascarenhas
- Department of General Practice, University of Melbourne, Parkville, Vic. 3010, Australia; and Utopia Refugee and Asylum Seeker Health, Hoppers Crossing, Vic. 3029, Australia
| | - Meredith Temple-Smith
- Department of General Practice, University of Melbourne, Parkville, Vic. 3010, Australia
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9
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Duns G, Temple-Smith M, Katz D. Role of men's sexual and reproductive health clinics in decreasing health inequalities. Aust J Gen Pract 2023; 52:435-436. [PMID: 37423237 DOI: 10.31128/ajgp-01-23-6677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Affiliation(s)
- Glenn Duns
- MDCM, MPH, FRACGP, General Practitioner, Men@s Health Melbourne, Melbourne, Vic; Senior Fellow, University of Melbourne, Department of General Practice, Melbourne, Vic; Chair, General Practice Advisory Group, Healthy Male, Melbourne, Vic
| | - Meredith Temple-Smith
- BSc, MPH, DHSc, Deputy Head, Director of Research Training, Department of General Practice, University of Melbourne, Parkville, Vic
| | - Darren Katz
- Darren Katz MBBS, FRACS (Urology), Medical@Director, Men@s Health Melbourne, Melbourne,@Vic; Leader, Urological Society Australia and New@Zealand Andrology Special Advisory Group, Sydney,@NSW; Clinical Associate Professor, Department of@Surgery, The University of Melbourne, Melbourne,@Vic; Director, Sexual Medicine, Male Infertility@Microsurgery and Andrology Fellowship, Melbourne,@Vic; Chair, Integrated Cancer Service MDM@(Gippsland Region), Traralgon, Vic; Clinical Leader,@Western Health Andrology, Melbourne, Vic
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10
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Bilardi J, Webb A, Trieu VH, Sharp G, McIntosh J, Temple-Smith M. Miscarriage Australia: the use of a human centered design approach to design and develop a website for those affected by miscarriage. Front Public Health 2023; 11:1128768. [PMID: 37250069 PMCID: PMC10213628 DOI: 10.3389/fpubh.2023.1128768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/06/2023] [Indexed: 05/31/2023] Open
Abstract
Background Past research has shown that Australians affected by miscarriage want a website specific to both miscarriage and their local region that is accessible, comprehensive, evidence-based and informed by experts. The aim of this study was to design, develop and evaluate the Miscarriage Australia website using human centered design. Methods A four stage human centered design approach was used to develop the Miscarriage Australia website which aimed to: (1) Understand the issue and why users need a website; (2) Define users' specific needs; (3) Design solutions to meet those needs; and (4) Evaluate the design by testing with end users. Across the four stages, various types of data and data analysis were developed and utilized including interviews, desktop research, development of personas and tone of voice, followed by usability testing. Process and content were guided by designers, developers and an expert advisory committee of key stakeholders. Results Analysis and synthesis of user research across Stages 1 and Stage 2 found 11 key themes pertaining to user's miscarriage experiences and support needs. Using the themes, common experiences, goals, motivations and behaviors of users were identified and similar user types grouped and used to inform the development of two personas. Using the personas and user research findings, design elements (Stage 3) including the "tone of voice guidelines" were developed recommending the Miscarriage Australia website be calm, empathetic, hopeful and authoritative. The tone of voice guidelines guided branding and over 100 pages of content was informed by the research team and reviewed by a 13-member Expert Clinical Advisory Committee over two rounds to ensure it was evidence based and reflected best practice. Using a contextual inquiry approach, usability testing was undertaken with 8 end users to test a low fidelity mockup and high-fidelity prototype of the website. Overall, end users reported the website was highly acceptable in terms of the design, content, layout, language and terminology, describing it in line with the intended tone of voice. Users reported the website was easy to use and navigate and provided useful and appropriate content and resources. Minor areas for improvement included slight changes to specific images, improved links for navigating sections, and a title change to one section heading. Conclusion The Miscarriage Australia website was successfully implemented and commended by users as meeting their needs. As a result of using human centered design, the Miscarriage Australia website provides an ideal template or blueprint on how to develop a successful and useful digital resource for users, particularly around sensitive women's health issues.
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Affiliation(s)
- Jade Bilardi
- Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Amy Webb
- Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
| | - Van-Hau Trieu
- Department of Information Systems and Business Analytics, Deakin University, Melbourne, VIC, Australia
| | - Gemma Sharp
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Jennifer McIntosh
- Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
- HumaniSE Lab, Faculty of Information Technology, Monash University, Melbourne, VIC, Australia
- School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Meredith Temple-Smith
- Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
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11
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Goller JL, Coombe J, Temple-Smith M, Bittleston H, Sanci L, Guy R, Fairley C, Regan D, Carvalho N, Simpson J, Donovan B, Tomnay J, Chen MY, Estcourt C, Roeske L, Hawkes D, Saville M, Hocking JS. Management of Chlamydia Cases in Australia (MoCCA): protocol for a non-randomised implementation and feasibility trial. BMJ Open 2022; 12:e067488. [PMID: 36600435 PMCID: PMC9772683 DOI: 10.1136/bmjopen-2022-067488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The sexually transmitted infection chlamydia can cause significant complications, particularly among people with female reproductive organs. Optimal management includes timely and appropriate treatment, notifying and treating sexual partners, timely retesting for reinfection and detecting complications including pelvic inflammatory disease (PID). In Australia, mainstream primary care (general practice) is where most chlamydia infections are diagnosed, making it a key setting for optimising chlamydia management. High reinfection and low retesting rates suggest partner notification and retesting are not uniformly provided. The Management of Chlamydia Cases in Australia (MoCCA) study seeks to address gaps in chlamydia management in Australian general practice through implementing interventions shown to improve chlamydia management in specialist services. MoCCA will focus on improving retesting, partner management (including patient-delivered partner therapy) and PID diagnosis. METHODS AND ANALYSIS MoCCA is a non-randomised implementation and feasibility trial aiming to determine how best to implement interventions to support general practice in delivering best practice chlamydia management. Our method is guided by the Consolidated Framework for Implementation Research and the Normalisation Process Theory. MoCCA interventions include a website, flow charts, fact sheets, mailed specimen kits and autofills to streamline chlamydia consultation documentation. We aim to recruit 20 general practices across three Australian states (Victoria, New South Wales, Queensland) through which we will implement the interventions over 12-18 months. Mixed methods involving qualitative and quantitative data collection and analyses (observation, interviews, surveys) from staff and patients will be undertaken to explore our intervention implementation, acceptability and uptake. Deidentified general practice and laboratory data will be used to measure pre-post chlamydia testing, retesting, reinfection and PID rates, and to estimate MoCCA intervention costs. Our findings will guide scale-up plans for Australian general practice. ETHICS AND DISSEMINATION Ethics approval was obtained from The University of Melbourne Human Research Ethics Committee (Ethics ID: 22665). Findings will be disseminated via conference presentations, peer-reviewed publications and study reports.
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Affiliation(s)
- Jane L Goller
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Jacqueline Coombe
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Meredith Temple-Smith
- Department of General Practice, The University of Melbourne, Parkville, Victoria, Australia
| | - Helen Bittleston
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Lena Sanci
- Department of General Practice, The University of Melbourne, Parkville, Victoria, Australia
| | - Rebecca Guy
- Sexual Health Program, The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Christopher Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - David Regan
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Natalie Carvalho
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Julie Simpson
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Basil Donovan
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Sexual Health Centre, Sydney, New South Wales, Australia
| | - Jane Tomnay
- Centre for Excellence in Rural Sexual Health, Department of Rural Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Claudia Estcourt
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Lara Roeske
- Royal Australian College of General Practitioners, East Melbourne, Victoria, Australia
| | - David Hawkes
- VCS Pathology, Australian Centre for the Prevention of Cervical Cancer, Carlton, Victoria, Australia
| | - Marion Saville
- Australian Centre for the Prevention of Cervical Cancer, Carlton, Victoria, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
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12
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Liu W, Lim MSY, Williams H, Temple-Smith M. Contraceptive decision making among Chinese international students in Melbourne: findings from a qualitative investigation. Cult Health Sex 2022:1-16. [PMID: 36036162 DOI: 10.1080/13691058.2022.2112084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
Compared to their non-Chinese peers in Australia, Chinese international students have very low rates of effective contraceptive use and this combined with other factors impacts unintended pregnancy rates. There is limited research exploring Chinese international students in Australia's decision-making with respect to contraceptive choices. In early 2020, 26 individual semi-structured interviews were conducted with 18-25-year-old Chinese international students to explore factors influencing their contraceptive choices. Using both deductive and inductive analysis, seven primary themes were identified. Of note was the identification of the strongly expressed cultural value of (ài xī, cherishing). Cherishing was used to describe the promotion of self-protection and the protection of loved ones from any negative outcomes related to contraceptive methods. Findings suggest that cherishing has an important role to play in Chinese students' decision-making around contraception. In particular, notions of cherishing may make it difficult for Chinese international students to accept and trust the advantages of hormonal contraceptives. Moreover, the confusing and inconsistent terminology students use to describe contraceptive options may hamper their ability to access effective forms of contraception in Australia.
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Affiliation(s)
- Wen Liu
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Madeleine S Y Lim
- Department of General Practice, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Henrietta Williams
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Meredith Temple-Smith
- Department of General Practice, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
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13
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Bittleston H, Goller JL, Temple-Smith M, Hocking JS, Coombe J. Telehealth for sexual and reproductive health issues: a qualitative study of experiences of accessing care during COVID-19. Sex Health 2022; 19:473-478. [PMID: 35732464 DOI: 10.1071/sh22098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/01/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Medicare, the health insurance system underpinning free healthcare in Australia, introduced free telehealth items in 2020 in response to the coronavirus disease 2019 (COVID-19) pandemic. Their uptake among healthcare providers was significant, including among general practitioners and sexual health services. Here, we report people's experiences of accessing sexual and reproductive health (SRH)-related care via telehealth collected as part of a survey exploring the impact of COVID on SRH health. METHODS This study utilises qualitative data from two online surveys conducted in 2020. Surveys were advertised through social media and professional and personal networks. Anyone aged≥18years and living in Australia was eligible to participate. Respondents were asked whether they accessed care for their SRH via telehealth. A free-text question asking for further detail about their experience was analysed using content analysis. RESULTS A total of 114/1070 respondents (10.7%) accessed healthcare services via telehealth for SRH-related reasons within the previous 4weeks. Three themes were identified from 78 free-text comments: (1) accessibility and convenience of telehealth; (2) appropriateness of telehealth for SRH issues; and (3) connecting and communicating with clinicians via telehealth. Respondents had a wide range of experiences. Telehealth improved access to services for some participants, and it was appropriate for some, but not all SRH issues. Difficulties connecting with clinicians on both an interpersonal and technical level was a key barrier to a satisfactory patient experience. CONCLUSIONS Telehealth can offer a viable alternative to face-to-face care, providing patients can overcome key connection and communication barriers.
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Affiliation(s)
- Helen Bittleston
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Vic., Australia
| | - Jane L Goller
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Vic., Australia
| | | | - Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Vic., Australia
| | - Jacqueline Coombe
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Vic., Australia
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14
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Coombe J, Goller J, Bittleston H, Bateson D, Bourne C, O'Donnell H, Tomnay J, Temple-Smith M, Hocking JS. Patient-delivered partner therapy: One option for management of sexual partner(s) of a patient diagnosed with a chlamydia infection. Aust J Gen Pract 2022; 51:425-429. [PMID: 35637588 DOI: 10.31128/ajgp-07-21-6066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chlamydia is the most commonly diagnosed bacterial sexually transmissible infection (STI) in Australia. Partner management is key to reducing transmission and a cornerstone of best practice chlamydia management. While most patients will opt for telling their partner(s) themselves, patient-delivered partner therapy (PDPT) offers an alternative way to inform and treat partners where usual management is inappropriate or unlikely to be undertaken. Guidelines for PDPT vary across Australia. Recent research found that general practitioners (GP)s want practical guidance for using PDPT in appropriate situations. OBJECTIVE The aim of this article is to provide an overview of the process of offering PDPT and note the challenges GPs may face in its provision. DISCUSSION PDPT is one option for partner management when sexual partner(s) are unlikely or unable to seek timely care themselves. However, there are challenges to the use of PDPT in general practice. The provision of clear guidelines is an essential step to promote its appropriate use.
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Affiliation(s)
- Jacqueline Coombe
- BSocSc (Hons), PhD, Research Fellow, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Vic
| | - Jane Goller
- Jane Goller GradDip (Nursing), MPH, MHlthSc, PhD, Research Fellow, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Vic
| | - Helen Bittleston
- BA (Hons), MPH, Research Assistant, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Vic
| | - Deborah Bateson
- MA (Oxon), MSc (LSHTM), MBBS, Medical Director, Family Planning NSW, Sydney, NSW; Clinical Associate Professor, Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, NSW
| | - Christopher Bourne
- MM (Sexual Health), FAChSHM, Head, NSW STI Programs Unit, NSW Health, Sydney, NSW; Senior Staff Specialist, Sydney Sexual Health Centre, Sydney, NSW; Conjoint Associate Professor, Sexual Health Program, Kirby Institute, UNSW, Kensington, NSW
| | - Heather O'Donnell
- BAppSc, GradDipEd (Leadership, Policy and Change), Senior Policy Officer, Department of Health and Human Services, Melbourne, Vic
| | - Jane Tomnay
- RN, MHSc (Psychiatric Nursing), PhD, Director Centre for Excellence in Rural Sexual Health, Department of Rural Health, University of Melbourne, Shepparton, Vic
| | - Meredith Temple-Smith
- BSc, MPH, DHSc, Deputy Head, Director of Research Training, Department of General Practice, University of Melbourne, Parkville, Vic
| | - Jane S Hocking
- BAppSc, MPH, MHlthSc, PhD, Head, Sexual Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Vic
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15
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Vujovich-Dunn C, Wand H, Brotherton JML, Gidding H, Sisnowski J, Lorch R, Veitch M, Sheppeard V, Effler P, Skinner SR, Venn A, Davies C, Hocking J, Whop L, Leask J, Canfell K, Sanci L, Smith M, Kang M, Temple-Smith M, Kidd M, Burns S, Selvey L, Meijer D, Ennis S, Thomson C, Lane N, Kaldor J, Guy R. Measuring school level attributable risk to support school-based HPV vaccination programs. BMC Public Health 2022; 22:822. [PMID: 35468743 PMCID: PMC9036743 DOI: 10.1186/s12889-022-13088-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/24/2022] [Indexed: 12/27/2022] Open
Abstract
Background In Australia in 2017, 89% of 15-year-old females and 86% of 15-year-old males had received at least one dose of the HPV vaccine. However, considerable variation in HPV vaccination initiation (dose one) across schools remains. It is important to understand the school-level characteristics most strongly associated with low initiation and their contribution to the overall between-school variation. Methods A population-based ecological analysis was conducted using school-level data for 2016 on all adolescent students eligible for HPV vaccination in three Australian jurisdictions. We conducted logistic regression to determine school-level factors associated with lower HPV vaccination initiation (< 75% dose 1 uptake) and estimated the population attributable risk (PAR) and the proportion of schools with the factor (school-level prevalence). Results The factors most strongly associated with lower initiation, and their prevalence were; small schools (OR = 9.3, 95%CI = 6.1–14.1; 33% of schools), special education schools (OR = 5.6,95%CI = 3.7–8.5; 8% of schools), higher Indigenous enrolments (OR = 2.7,95% CI:1.9–3.7; 31% of schools), lower attendance rates (OR = 2.6,95%CI = 1.7–3.7; 35% of schools), remote location (OR = 2.6,95%CI = 1.6–4.3; 6% of schools,) and lower socioeconomic area (OR = 1.8,95% CI = 1.3–2.5; 33% of schools). The highest PARs were small schools (PAR = 79%, 95%CI:76–82), higher Indigenous enrolments (PAR = 38%, 95%CI: 31–44) and lower attendance rate (PAR = 37%, 95%CI: 29–46). Conclusion This analysis suggests that initiatives to support schools that are smaller, with a higher proportion of Indigenous adolescents and lower attendance rates may contribute most to reducing the variation of HPV vaccination uptake observed at a school-level in these jurisdictions. Estimating population-level coverage at the school-level is useful to guide policy and prioritise resourcing to support school-based vaccination programs. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13088-x.
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Affiliation(s)
- C Vujovich-Dunn
- University of New South Wales, Kirby Institute, Kensington, Australia.
| | - H Wand
- University of New South Wales, Kirby Institute, Kensington, Australia
| | - J M L Brotherton
- Australian Centre for the Prevention of Cervical Cancer, Population Health, East Melbourne, Victoria, Australia.,University of Melbourne, Melbourne School of Population and Global Health, Carlton, VIC, Australia
| | - H Gidding
- University of Sydney, Northern Clinical School, Sydney, Australia.,Women and Babies Research, Kolling Institute, Northern Sydney Local Health District, Sydney, Australia.,School of Population Health, University of New South Wales, Kensington, Australia.,National Centre for Immunisation Research and Surveillance, Sydney, Australia
| | - J Sisnowski
- University of New South Wales, Kirby Institute, Kensington, Australia.,Australian National University, National Centre for Epidemiology & Population Health, Canberra, Australia
| | - R Lorch
- University of New South Wales, Kirby Institute, Kensington, Australia
| | - M Veitch
- Department of Health and Human Services, Tasmanian Government, Hobart, Australia
| | - V Sheppeard
- Communicable Diseases Branch, NSW Health, St Leonards, New South Wales, Australia.,University of Sydney, Sydney School of Public Health, Camperdown, NSW, Australia
| | - P Effler
- Communicable Disease Control Directorate, Department of Health, Western Australia, East Perth, Australia
| | - S R Skinner
- University of Sydney, Specialty of Child and Adolescent Health, Faculty of Medicine and Health, Sydney, Australia.,Children's Hospital Westmead, Sydney Children's Hospitals Network, Westmead, Australia
| | - A Venn
- Menzies Institute for Medical Research, University of Tasmania, Tasmanian, Australia
| | - C Davies
- University of Sydney, Specialty of Child and Adolescent Health, Faculty of Medicine and Health, Sydney, Australia.,Children's Hospital Westmead, Sydney Children's Hospitals Network, Westmead, Australia
| | - J Hocking
- University of Melbourne, Melbourne School of Population and Global Health, Carlton, VIC, Australia
| | - L Whop
- Australian National University, National Centre for Epidemiology & Population Health, Canberra, Australia.,Menzies School of Health Research, Charles Darwin University, Cairns, QLD, Australia
| | - J Leask
- National Centre for Immunisation Research and Surveillance, Sydney, Australia.,University of Sydney, Sydney Nursing School, Faculty of Medicine and Health, Camperdown, NSW, Australia
| | - K Canfell
- The Daffodil Centre, University of Sydney, A Joint Venture With Cancer Council NSW, Sydney, Australia
| | - L Sanci
- University of Melbourne, Medicine, Dentistry and Health Sciences, Carlton, VIC, Australia
| | - M Smith
- The Daffodil Centre, University of Sydney, A Joint Venture With Cancer Council NSW, Sydney, Australia.,School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - M Kang
- University of Sydney, Westmead Clinical School, Sydney, New South Wales, Australia
| | - M Temple-Smith
- University of Melbourne, Medicine, Dentistry and Health Sciences, Carlton, VIC, Australia
| | - M Kidd
- Flinders University, Southgate Institute for Health, Society and Equity, Bedford Park, South Australia, Australia
| | - S Burns
- Curtin University, School of Population Health, Bentley, WA, Australia
| | - L Selvey
- University of Queensland, School of Public Health, St Lucia, QLD, Australia
| | - D Meijer
- Immunisation Unit, Health Protection NSW, St Leonard's, New South Wales, Australia
| | - S Ennis
- Immunisation Unit, Health Protection NSW, St Leonard's, New South Wales, Australia
| | - C Thomson
- Communicable Disease Control Directorate, Department of Health, Western Australia, East Perth, Australia
| | - N Lane
- Department of Health and Human Services, Tasmanian Government, Hobart, Australia
| | - J Kaldor
- University of New South Wales, Kirby Institute, Kensington, Australia
| | - R Guy
- University of New South Wales, Kirby Institute, Kensington, Australia
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16
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Lim MSY, Hocking JS, Sanci L, Temple-Smith M. A systematic review of international students' sexual health knowledge, behaviours, and attitudes. Sex Health 2022; 19:1-16. [PMID: 35177186 DOI: 10.1071/sh21073] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/01/2021] [Indexed: 11/23/2022]
Abstract
The demand for higher education has increased student mobility across the world. Studying abroad provides an opportunity for young adults to engage in sexual behaviours, some of which may be risky. Yet, little is known about international students' current sexual health knowledge or practices. The aim of this review was to identify their sexual health knowledge, behaviours, and attitudes. A search of five databases yielded 21 studies that met inclusion criteria. These studies used quantitative (n=13), qualitative (n=7) and mixed methods (n=1) and included a total of 4666 international and exchange students from diverse cultural backgrounds. Findings were grouped into three themes: sexual health knowledge, sexual behaviours, and sexual health attitudes. Asian international students had poorer levels of knowledge, suggesting a need for culturally appropriate sex education. They were less sexually experienced and were older than domestic students at first age of sex. Fewer engaged in risky sexual behaviours when compared to domestic students. They also reported fewer sexual partners and higher condom usage. However, culture influenced the sexual behaviours and attitudes of international students; in particular, Asian female international students, who tested risk-taking behaviours, such as casual sex, in more liberal Western countries. Appropriate intervention and further education are needed to decrease international students' sexual health risks.
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Affiliation(s)
- Madeleine S Y Lim
- Department of General Practice, The University of Melbourne, 780 Elizabeth Street, Melbourne, Vic. 3004, Australia
| | - Jane S Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3053, Australia
| | - Lena Sanci
- Department of General Practice, The University of Melbourne, 780 Elizabeth Street, Melbourne, Vic. 3004, Australia
| | - Meredith Temple-Smith
- Department of General Practice, The University of Melbourne, 780 Elizabeth Street, Melbourne, Vic. 3004, Australia
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17
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Bittleston H, Goller JL, Temple-Smith M, Hocking JS, Coombe J. 'I didn't want to visit a doctor unless it was extremely necessary': perspectives on delaying access to sexual and reproductive health care during the COVID-19 pandemic in Australia from an online survey. Aust J Prim Health 2022; 28:131-136. [PMID: 35109966 DOI: 10.1071/py21239] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/16/2021] [Indexed: 11/23/2022]
Abstract
Australians were subject to a series of COVID-19 lockdown restrictions throughout 2020. Although accessing medical care was allowable, concerns were raised that people were avoiding healthcare services. We explored young Australians' reasons for delaying seeking sexual and reproductive health (SRH) care during the pandemic, using data from two cross-sectional surveys. The surveys included a question asking whether respondents had delayed accessing care during the pandemic. Free-text responses from young Australians (aged 18-29 years) were analysed using conventional content analysis. In all, 1058 under-30s completed a survey, with 262 (24.8%) reporting they had delayed seeking SRH care. Of these, 228 (87.0%) respondents provided a free-text comment. Participants who commented were predominantly female (86.4%) and had a median age of 23 years (interquartile range 20-26 years). Most commonly, respondents delayed testing for sexually transmissible infections, cervical cancer screening, and contraceptive care. Some delayed accessing care despite experiencing symptoms. Participants avoided seeking care due to concerns about contracting COVID-19, uncertainty about accessing care during restrictions and anxiety relating to accessing SRH care. Although some reported a reduced need for SRH care, others required but did not access care. Young people should be reassured that SRH issues are a valid reason to access services, especially when experiencing symptoms.
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Affiliation(s)
- Helen Bittleston
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic. 3053, Australia; and Corresponding author
| | - Jane L Goller
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic. 3053, Australia
| | - Meredith Temple-Smith
- Department of General Practice, The University of Melbourne, Melbourne, Vic. 3010, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic. 3053, Australia
| | - Jacqueline Coombe
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic. 3053, Australia
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18
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Bellhouse C, Bilardi J, Temple-Smith M, Newman L. Subjective experiences of participating in the Supporting Transitions, Attachment and Relationships (STAR Mums) program, a psychological group intervention for high-risk pregnant women. SSM - Mental Health 2022. [DOI: 10.1016/j.ssmmh.2022.100065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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19
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Vujovich-Dunn C, Skinner SR, Brotherton J, Wand H, Sisnowski J, Lorch R, Veitch M, Sheppeard V, Effler P, Gidding H, Venn A, Davies C, Hocking J, Whop LJ, Leask J, Canfell K, Sanci L, Smith M, Kang M, Temple-Smith M, Kidd M, Burns S, Selvey L, Meijer D, Ennis S, Thomson CA, Lane N, Kaldor J, Guy R. School-Level Variation in Coverage of Co-Administered dTpa and HPV Dose 1 in Three Australian States. Vaccines (Basel) 2021; 9:vaccines9101202. [PMID: 34696310 PMCID: PMC8537995 DOI: 10.3390/vaccines9101202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/14/2021] [Accepted: 10/08/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Australian adolescents are routinely offered HPV and dTpa (diphtheria, tetanus, pertussis) vaccines simultaneously in the secondary school vaccination program. We identified schools where HPV initiation was lower than dTpa coverage and associated school-level factors across three states. METHODS HPV vaccination initiation rates and dTpa vaccination coverage in 2016 were calculated using vaccine databases and school enrolment data. A multivariate analysis assessed sociodemographic and school-level factors associated with HPV initiation being >5% absolute lower than dTpa coverage. RESULTS Of 1280 schools included, the median school-level HPV initiation rate was 85% (interquartile range (IQR):75-90%) and the median dTpa coverage was 86% (IQR:75-92%). Nearly a quarter (24%) of all schools had HPV vaccination initiation >5% lower than dTpa coverage and 11 % had >10% difference. School-level factors independently associated with >5% difference were remote schools (aOR:3.5, 95% CI = 1.7-7.2) and schools in major cities (aOR:1.8, 95% CI = 1.0-3.0), small schools (aOR:3.3, 95% CI = 2.3-5.7), higher socioeconomic advantage (aOR:1.7, 95% CI = 1.1-2.6), and lower proportions of Language-background-other-than-English (aOR:1.9, 95% CI = 1.2-3.0). CONCLUSION The results identified a quarter of schools had lower HPV than dTpa initiation coverage, which may indicate HPV vaccine hesitancy, and the difference was more likely in socioeconomically advantaged schools. As hesitancy is context specific, it is important to understand the potential drivers of hesitancy and future research needs to understand the reasons driving differential uptake.
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Affiliation(s)
- Cassandra Vujovich-Dunn
- The Kirby Institute, University of New South Wales, Kensington, Sydney 2052, Australia; (H.W.); (J.S.); (R.L.); (J.K.); (R.G.)
- Correspondence: ; Tel.: +61-2-9348-0033
| | - Susan Rachel Skinner
- Children’s Hospital Westmead, Sydney Children’s Hospitals Network, Sydney 2145, Australia; (S.R.S.); (C.D.)
- Faculty of Medicine and Health, University of Sydney, Specialty of Child and Adolescent Health, Sydney 2006, Australia
| | - Julia Brotherton
- Population Health, VCS Foundation Ltd., East Melbourne, Melbourne 3053, Australia;
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Melbourne 3010, Australia;
| | - Handan Wand
- The Kirby Institute, University of New South Wales, Kensington, Sydney 2052, Australia; (H.W.); (J.S.); (R.L.); (J.K.); (R.G.)
| | - Jana Sisnowski
- The Kirby Institute, University of New South Wales, Kensington, Sydney 2052, Australia; (H.W.); (J.S.); (R.L.); (J.K.); (R.G.)
- National Centre for Epidemiology & Population Health, Australian National University, Canberra 0200, Australia;
| | - Rebecca Lorch
- The Kirby Institute, University of New South Wales, Kensington, Sydney 2052, Australia; (H.W.); (J.S.); (R.L.); (J.K.); (R.G.)
| | - Mark Veitch
- Department of Health and Human Services, Tasmanian Government, Hobart 7001, Australia; (M.V.); (N.L.)
| | - Vicky Sheppeard
- Communicable Diseases Branch, Health Protection NSW, St Leonards, Sydney 2065, Australia;
- School of Public Health, University of Sydney, Camperdown, Sydney 2006, Australia;
| | - Paul Effler
- Department of Health, Communicable Disease Control Directorate, East Perth 6000, Australia; (P.E.); (C.A.T.)
| | - Heather Gidding
- School of Population Health, University of New Souh Wales, Sydney 2052, Australia;
- Norther Clinical School of Sydney, University of Sydney, Camperdown, Sydney 2006, Australia
- Women and Babies Research, Kollin Intstitye, Northern Sydney Local Health District, St Leaonards, Sydney 2064, Australia
- National Centre for Immunisation Research and Surveillance, Westmead, Sydney 2145, Australia
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Tasmanian 7000, Australia;
| | - Cristyn Davies
- Children’s Hospital Westmead, Sydney Children’s Hospitals Network, Sydney 2145, Australia; (S.R.S.); (C.D.)
- Faculty of Medicine and Health, University of Sydney, Specialty of Child and Adolescent Health, Sydney 2006, Australia
| | - Jane Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Melbourne 3010, Australia;
| | - Lisa J. Whop
- National Centre for Epidemiology & Population Health, Australian National University, Canberra 0200, Australia;
- Menzies School of Health Research, Charles Darwin University, Brisbane 4000, Australia
| | - Julie Leask
- Faculty of Medicine and Health, Sydney Nursing School, University of Sydney, Camperdown, Sydney 2006, Australia;
| | - Karen Canfell
- Cancer Research Division, Cancer Council, Brisbane 2011, Australia;
| | - Lena Sanci
- Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, Melbourne 3010, Australia; (L.S.); (M.T.-S.)
| | - Megan Smith
- School of Public Health, University of Sydney, Camperdown, Sydney 2006, Australia;
- Cancer Research Division, Cancer Council, Brisbane 2011, Australia;
| | - Melissa Kang
- Westmead Clinical School, University of Sydney, Sydney 2006, Australia;
| | - Meredith Temple-Smith
- Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, Melbourne 3010, Australia; (L.S.); (M.T.-S.)
| | - Michael Kidd
- Southgate Institute for Health, Flinders University, Adelaide 5042, Australia;
| | - Sharyn Burns
- School of Population Health, Curtin University, Perth 6102, Australia;
| | - Linda Selvey
- School of Public Health, University of Queensland, Brisbane 4072, Australia;
| | - Dennis Meijer
- Immunisation Unit, Health Protection NSW, St Leonards, Sydney 2065, Australia; (D.M.); (S.E.)
| | - Sonya Ennis
- Immunisation Unit, Health Protection NSW, St Leonards, Sydney 2065, Australia; (D.M.); (S.E.)
| | - Chloe A. Thomson
- Department of Health, Communicable Disease Control Directorate, East Perth 6000, Australia; (P.E.); (C.A.T.)
| | - Nikole Lane
- Department of Health and Human Services, Tasmanian Government, Hobart 7001, Australia; (M.V.); (N.L.)
| | - John Kaldor
- The Kirby Institute, University of New South Wales, Kensington, Sydney 2052, Australia; (H.W.); (J.S.); (R.L.); (J.K.); (R.G.)
| | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Kensington, Sydney 2052, Australia; (H.W.); (J.S.); (R.L.); (J.K.); (R.G.)
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20
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Sisnowski J, Vujovich-Dunn C, Gidding H, Brotherton J, Wand H, Lorch R, Veitch M, Sheppeard V, Effler P, Skinner SR, Venn A, Davies C, Hocking J, Whop L, Leask J, Canfell K, Sanci L, Smith M, Kang M, Temple-Smith M, Kidd M, Burns S, Selvey L, Meijer D, Ennis S, Thomson C, Lane N, Kaldor J, Guy R. Differences in school factors associated with adolescent HPV vaccination initiation and completion coverage in three Australian states. Vaccine 2021; 39:6117-6126. [PMID: 34493408 DOI: 10.1016/j.vaccine.2021.08.076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Schools are the primary setting for the delivery of adolescent HPV vaccination in Australia. Although this strategy has achieved generally high vaccination coverage, gaps persist for reasons that are mostly unknown. This study sought to identify school-level correlates of low vaccination course initiation and completion in New South Wales, Tasmania, and Western Australia to inform initiatives to increase uptake. METHODS Initiation was defined as the number of first doses given in a school in 2016 divided by vaccine-eligible student enrolments. Completion was the number of third doses given in a school in 2015-2016 divided by the number of first doses. Low initiation and completion were defined as coverage ≤ 25thpercentile of all reporting schools. We investigated correlations between covariates using Spearman's rank correlation coefficients. Due to multicollinearity, we used univariable logistic regression to investigate associations between school characteristics and low coverage. RESULTS Median initiation was 84.7% (IQR: 75.0%-90.4%) across 1,286 schools and median completion was 93.8% (IQR: 86.0%-97.3%) across 1,295 schools. There were strong correlations between a number of school characteristics, particularly higher Indigenous student enrolments and lower attendance, increasing remoteness, higher postcode socioeconomic disadvantage, and smaller school size. Characteristics most strongly associated with low initiation in univariate analyses were small school size, location in Tasmania, and schools catering for special educational needs. Low completion was most strongly associated with schools in Tasmania and Western Australia, remote location, small size, high proportion of Indigenous student enrolments, and low attendance rates. CONCLUSION This study provides indicative evidence that characteristics of schools and school populations are associated with the likelihood of low initiation and completion of the HPV vaccination course. The findings will guide further research and help target initiatives to improve vaccination uptake in schools with profiles associated with lower coverage.
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Affiliation(s)
- J Sisnowski
- The Kirby Institute, Faculty of Medicine, University of New South Wales, Wallace Wurth Building, High St., Kensington, New South Wales, Australia; Australian National University, National Centre for Epidemiology & Population Health, Canberra, Australia.
| | - C Vujovich-Dunn
- The Kirby Institute, Faculty of Medicine, University of New South Wales, Wallace Wurth Building, High St., Kensington, New South Wales, Australia.
| | - H Gidding
- University of New South Wales, School of Public Health and Community Medicine, Kensington, Australia; National Centre for Immunisation Research and Surveillance, Westmead, Australia; The University of Sydney Northern Clinical School, St Leonards, Australia.
| | - J Brotherton
- Population Health, VCS Foundation, East Melbourne, Victoria, Australia; University of Melbourne, Melbourne School of Population and Global Health, Carlton, Victoria, Australia.
| | - H Wand
- The Kirby Institute, Faculty of Medicine, University of New South Wales, Wallace Wurth Building, High St., Kensington, New South Wales, Australia.
| | - R Lorch
- The Kirby Institute, Faculty of Medicine, University of New South Wales, Wallace Wurth Building, High St., Kensington, New South Wales, Australia.
| | - M Veitch
- Tasmanian Government, Department of Health and Human Services, Hobart, Australia.
| | - V Sheppeard
- Communicable Diseases Branch, Health Protection NSW, St Leonards, New South Wales, Australia; University of Sydney, Sydney School of Public Health, Camperdown, New South Wales, Australia.
| | - P Effler
- Communicable Disease Control Directorate, Department of Health, Western Australia, East Perth, Australia.
| | - S R Skinner
- Children's Hospital Westmead, Sydney Children's Hospitals Network, Westmead, Australia; University of Sydney, Specialty of Child and Adolescent Health, Faculty of Medicine and Health, Camperdown, New South Wales, Australia.
| | - A Venn
- Menzies Institute for Medical Research, University of Tasmania, Tasmanian, Australia.
| | - C Davies
- Children's Hospital Westmead, Sydney Children's Hospitals Network, Westmead, Australia; University of Sydney, Specialty of Child and Adolescent Health, Faculty of Medicine and Health, Camperdown, New South Wales, Australia.
| | - J Hocking
- University of Melbourne, Melbourne School of Population and Global Health, Carlton, Victoria, Australia.
| | - L Whop
- Australian National University, National Centre for Epidemiology & Population Health, Canberra, Australia; Menzies School of Health Research, Charles Darwin University, Cairns, Queensland, Australia.
| | - J Leask
- National Centre for Immunisation Research and Surveillance, Westmead, Australia; University of Sydney, Sydney Nursing School, Faculty of Medicine and Health, Camperdown, New South Wales, Australia.
| | - K Canfell
- Cancer Research Division, Cancer Council, New South Wales, Australia.
| | - L Sanci
- University of Melbourne, Medicine, Dentistry and Health Sciences, Carlton, Victoria, Australia.
| | - M Smith
- Communicable Disease Control Directorate, Department of Health, Western Australia, East Perth, Australia; Cancer Research Division, Cancer Council, New South Wales, Australia.
| | - M Kang
- University of Sydney, Westmead Clinical School, New South Wales, Australia.
| | - M Temple-Smith
- University of Melbourne, Medicine, Dentistry and Health Sciences, Carlton, Victoria, Australia.
| | - M Kidd
- Flinders University, Southgate Institute for Health, Society and Equity, South Australia, Australia.
| | - S Burns
- Curtin University, School of Population Health, Western Australia, Australia.
| | - L Selvey
- University of Queensland, School of Public Health, Queensland, Australia.
| | - D Meijer
- Immunisation Unit, Health Protection NSW, St Leonards, New South Wales, Australia.
| | - S Ennis
- Immunisation Unit, Health Protection NSW, St Leonards, New South Wales, Australia.
| | - C Thomson
- Communicable Disease Control Directorate, Department of Health, Western Australia, East Perth, Australia.
| | - N Lane
- Tasmanian Government, Department of Health and Human Services, Hobart, Australia.
| | - J Kaldor
- The Kirby Institute, Faculty of Medicine, University of New South Wales, Wallace Wurth Building, High St., Kensington, New South Wales, Australia.
| | - R Guy
- The Kirby Institute, Faculty of Medicine, University of New South Wales, Wallace Wurth Building, High St., Kensington, New South Wales, Australia.
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21
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Coombe J, Kong FYS, Bittleston H, Williams H, Tomnay J, Vaisey A, Malta S, Goller JL, Temple-Smith M, Bourchier L, Lau A, Chow EPF, Hocking JS. Love during lockdown: findings from an online survey examining the impact of COVID-19 on the sexual health of people living in Australia. Sex Transm Infect 2021; 97:357-362. [PMID: 33203737 PMCID: PMC7670557 DOI: 10.1136/sextrans-2020-054688] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/22/2020] [Accepted: 10/03/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Australia recorded its first case of COVID-19 in late January 2020. On 22P March 2020, amid increasing daily case numbers, the Australian Government implemented lockdown restrictions to help 'flatten the curve'. Our study aimed to understand the impact of lockdown restrictions on sexual and reproductive health. Here we focus on sexual practices. METHODS An online survey was open from the 23PP April 2020 to 11P May 2020. Participants were recruited online via social media and other networks and were asked to report on their sexual practices in 2019 and during lockdown. Logistic regression was used to calculate the difference (diff) (including 95% CIs) in the proportion of sex practices between time periods. RESULTS Of the 1187 who commenced the survey, 965 (81.3%) completed it. Overall, 70% were female and 66.3% were aged 18-29 years. Most (53.5%) reported less sex during lockdown than in 2019. Compared with 2019, participants were more likely to report sex with a spouse (35.3% vs 41.7%; diff=6.4%; 95% CI 3.6 to 9.2) and less likely to report sex with a girl/boyfriend (45.1% vs 41.8%; diff=-3.3%; 95% CI -7.0 to -0.4) or with casual hook-up (31.4% vs 7.8%; 95% CI -26.9 to -19.8). Solo sex activities increased; 14.6% (123/840) reported using sex toys more often and 26.0% (218/838) reported masturbating more often. Dating app use decreased during lockdown compared with 2019 (42.1% vs 27.3%; diff= -14.8%; 95% CI -17.6 to -11.9). Using dating apps for chatting/texting (89.8% vs 94.5%; diff=4.7%; 95% CI 1.0 to 8.5) and for setting up virtual dates (2.6% vs 17.2%; diff=14.6%; 95% CI 10.1 to 19.2) increased during lockdown. CONCLUSION Although significant declines in sexual activity during lockdown were reported, people did not completely stop engaging in sexual activities, highlighting the importance of ensuring availability of normal sexual and reproductive health services during global emergencies.
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Affiliation(s)
- Jacqueline Coombe
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Fabian Yuh Shiong Kong
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Helen Bittleston
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Henrietta Williams
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Jane Tomnay
- Centre for Excellence in Rural Sexual Health, Department of Rural Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Alaina Vaisey
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sue Malta
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- National Ageing Research Institute Inc, Parkville, Victoria, Australia
| | - Jane L Goller
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Meredith Temple-Smith
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Louise Bourchier
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Lau
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Eric P F Chow
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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22
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Williames S, Temple-Smith M, Chondros P, Spike N, Salamone A, Magin P, Hiscock H, Sanci L. Are we preparing Victorian general practice registrars to be confident in all aspects of primary care paediatrics? Aust J Gen Pract 2021; 49:759-766. [PMID: 33123702 DOI: 10.31128/ajgp-08-19-5028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES General practitioners provide essential primary care to paediatric patients. The aim of this study was to explore associations between prevocational paediatric experiences of general practice registrars and their confidence in providing paediatric care in the general practice setting. METHOD This was a cross-sectional observational study. Paediatric experiences and level of confidence ratings were collected using an online survey emailed to 530 Victorian general practice registrars in 2017; the response rate was 41% (217/530). Analysis used descriptive statistics, cross tabulation and Fishers' exact test. RESULTS The most common paediatric training was undertaken in a general hospital emergency department (180/197, 91%). The majority of registrars reported that they felt confident or very confident in managing acute presentations (92% for upper respiratory tract infection, 80% for asthma, 81% for immunisation), but fewer were confident in managing mental health, behavioural or developmental presentations (all <36%). DISCUSSION Registrars felt more confident managing acute presentations. However, the predominantly hospital-based prevocational paediatric training offers limited exposure to - and, thus, confidence in - managing behavioural, mental health and developmental issues. Training opportunities to address this identified gap should be explored.
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Affiliation(s)
- Suzannah Williames
- BBiomed, MD, DRANZCOG, GP Registrar, Eastern Victoria General Practice Training (EVGPT), Vic
| | - Meredith Temple-Smith
- MPH, DHSc, Professor and Director of Research Training, Deputy Head, Department of General Practice, Melbourne Medical School, The University of Melbourne, Vic
| | - Patty Chondros
- PhD, MSc (Statistics), GDipEpid&Biost, BSc (Hons), Biostatistician, Department of General Practice, Melbourne Medical School, The University of Melbourne, Vic
| | - Neil Spike
- MBBS, FRACGP, AM, Director of Medical Education and Training, Eastern Victoria General Practice Training, Vic; Professorial Fellow, Department of General Practice, The University of Melbourne, Vic
| | - Angelina Salamone
- MBBS, FRACGP, Director of Medical Education and Training, Murray City Country Coast GP Training, Vic
| | - Parker Magin
- PhD, FRACGP, Conjoint Professor, Discipline of General Practice, School of Medicine and Public Health, The University of Newcastle, NSW; Director, Research and Evaluation Unit, GP Synergy, NSW
| | - Harriet Hiscock
- MBBS, FRACP, MD, Group Leader, Health Services, Centre for Community Child Health, Murdoch Children's Research Institute, Vic; Director, Health Services Research Unit, The Royal Children's Hospital, Vic; Principal Fellow, Department of Paediatrics, The University of Melbourne, Vic
| | - Lena Sanci
- MBBS, PhD, FRACGP, Head, Department of General Practice, Melbourne Medical School, The University of Melbourne, Vic
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23
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Goller JL, Coombe J, Bittleston H, Bourne C, Bateson D, Vaisey A, Tomnay J, O'Donnell H, Garret C, Estcourt CS, Temple-Smith M, Hocking JS. Patient delivered partner therapy for chlamydia infection is used by some general practitioners, but more support is needed to increase uptake: findings from a mixed-methods study. Sex Transm Infect 2021; 98:298-301. [PMID: 34193530 DOI: 10.1136/sextrans-2020-054933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 06/09/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Patient-delivered partner therapy (PDPT) describes the giving of a prescription or antibiotics by an index case with chlamydia to their sexual partners. PDPT has been associated with higher numbers of partners receiving treatment. In Australia, general practitioners (GPs) previously expressed negative views about PDPT. Health authority guidance for PDPT has since been provided in some areas. We investigated recent use and perceptions of PDPT for chlamydia among GPs in Australia. METHODS In 2019, we conducted an online survey comprising multiple-choice and open-ended questions to investigate GPs' chlamydia management practices, including PDPT. Logistic regression identified factors associated with ever offering PDPT. A directed content analysis of free-text data explored GPs' perceptions towards PDPT. RESULTS The survey received responses from 323 GPs; 85.8% (n=277) answered PDPT-focused questions, providing 628 free-text comments. Over half (53.4%) reported never offering PDPT, while 36.5% sometimes and 10.1% often offered PDPT. GPs more likely to offer PDPT were aged ≥55 years (adjusted OR (AOR) 2.9, 95% CI 1.4 to 5.8), worked in non-metropolitan areas (AOR 2.5, 95% CI 1.5 to 4.4) and jurisdictions with health authority PDPT guidance (AOR 2.3, 95% CI 1.4 to 3.9). Qualitative data demonstrated that many GPs recognised PDPT's potential to treat harder to engage partners but expressed hesitancy to offer PDPT because they considered partners attending for care as best practice. GPs emphasised a case-by-case approach that considered patient and partner circumstances to determine PDPT suitability. To alleviate medicolegal concerns, many GPs indicated a need for professional and health authority guidance that PDPT is permissible. They also desired practical resources to support its use. CONCLUSION GPs appear to accept the place of PDPT as targeted to those who may otherwise not access testing or treatment. Availability of health authority guidance appears to have supported some GPs to incorporate PDPT into their practice.
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Affiliation(s)
- Jane L Goller
- Centre for Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Jacqueline Coombe
- Centre for Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Helen Bittleston
- Centre for Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Christopher Bourne
- Sydney Sexual Health Centre, Sydney, New South Wales, Australia.,Kirby Institute, Kensington, New South Wales, Australia
| | - Deborah Bateson
- Family Planning New South Wales, Ashfield, New South Wales, Australia.,Discipline of Obstetrics, Gyanecology and Neonatology, Faculty of Medicine and Science, University of Sydney SDN, Sydney, New South Wales, Australia
| | - Alaina Vaisey
- Centre for Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Jane Tomnay
- Department of Rural Health, The University of Melbourne, Shepparton, Victoria, Australia
| | - Heather O'Donnell
- Centre for Excellence in Rural Sexual Health, Department of Rural Health, The University of Melbourne, Shepparton, Victoria, Australia
| | | | - Claudia S Estcourt
- Glasgow Caledonian University School of Health and Life Sciences, Glasgow, UK
| | | | - Jane S Hocking
- Centre for Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
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24
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Coombe J, Kong F, Bittleston H, Williams H, Tomnay J, Vaisey A, Malta S, Goller J, Temple-Smith M, Bourchier L, Lau A, Hocking JS. Contraceptive use and pregnancy plans among women of reproductive age during the first Australian COVID-19 lockdown: findings from an online survey. EUR J CONTRACEP REPR 2021; 26:265-271. [PMID: 33615946 DOI: 10.1080/13625187.2021.1884221] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Australia introduced 'lockdown' measures to control COVID-19 on 22 March 2020 which continued for a period of two months. We aimed to investigate the impact this had on sexual and reproductive health (SRH). MATERIALS AND METHODS Australians aged 18+ were eligible to participate in an online survey from 23 April to 11 May 2020. We report on the experiences of 518 female participants aged <50 years. Pregnancy intentions and contraceptive use were analysed using descriptive statistics. Odds ratios and 95% confidence intervals were calculated to investigate difficulty accessing SRH products and services. Qualitative data were analysed using conventional content analysis. RESULTS Most participants were aged 18-24 years, and indicated they were trying to avoid pregnancy. The oral contraceptive pill was the most common single method used however nearly 20% reported they were not using contraception. Women who were employed had less trouble accessing contraception during lockdown. Participants reported delaying childbearing or deciding to remain childfree due to COVID-19. CONCLUSION COVID-19 lockdown impacted the SRH of Australian women. Findings highlight the importance of continued access to SRH services and products during global emergencies.
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Affiliation(s)
- Jacqueline Coombe
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
| | - Fabian Kong
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
| | - Helen Bittleston
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
| | - Hennie Williams
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Australia
| | - Jane Tomnay
- Centre for Excellence in Rural Sexual Health, Department of Rural Health, University of Melbourne, Australia
| | - Alaina Vaisey
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
| | - Sue Malta
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia.,National Ageing Research Institute, Parkville, Australia
| | - Jane Goller
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
| | | | - Louise Bourchier
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
| | - Andrew Lau
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
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25
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Coombe J, Goller J, Vaisey A, Bourne C, Sanci L, Bateson D, Temple-Smith M, Hocking J. New best practice guidance for general practice to reduce chlamydia-associated reproductive complications in women. Aust J Gen Pract 2021; 50:50-54. [PMID: 33543164 DOI: 10.31128/ajgp-04-20-5330] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chlamydia is the most commonly diagnosed bacterial sexually transmissible infection (STI) in Australia, with most infections diagnosed and managed in general practice. Often asymptomatic, left untreated it can cause serious reproductive complications in women. There is now global recognition of the importance of enhanced chlamydia case management to reduce the risk of repeat infection and minimise harms of pelvic inflammatory disease (PID). OBJECTIVE The aim of this article is to provide evidence-based information and resources to help general practitioners engage in partner management and retesting as part of routine STI care, in accordance with Australia's Fourth National Sexually Transmissible Infections Strategy: 2018-2022, and to provide up-to-date evidence about anorectal chlamydia and other emerging concerns in women. DISCUSSION Evidence-based information and strategies for partner management and retesting the index case are provided in this article, in addition to information regarding the detection of PID, screening and treatment of anorectal chlamydia, antimicrobial resistance, and testing and treatment in pregnancy.
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Affiliation(s)
- Jacqueline Coombe
- BSocSc (Hons), PhD (Gender and Health), Research Officer, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Vic
| | - Jane Goller
- GradDip (Nursing), MPH, MHlthSc, PhD, Research Fellow, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Vic
| | - Alaina Vaisey
- BSPH, MPH, Research Officer, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Vic
| | - Christopher Bourne
- MM (Sexual Health), FAChSHM, Head, NSW STI Programs Unit, Centre for Population Health, UNSW Sydney, NSW; Senior Staff Specialist, Sydney Sexual Health Centre, NSW; Conjoint Associate Professor, Sexual Health Program, Kirby Institute, UNSW Sydney, NSW
| | - Lena Sanci
- MBBS, PhD, FRACGP, Head, Department of General Practice, Melbourne Medical School, The University of Melbourne, Vic
| | - Deborah Bateson
- MA (Oxon), MSc (LSHTM), MB BS, Medical Director, Family Planning, NSW; Clinical Associate Professor, Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and Health, University of Sydney, NSW
| | - Meredith Temple-Smith
- BSc, MPH, DHSc, Deputy Head, Director of Research Training, Department of General Practice, The University of Melbourne, Vic
| | - Jane Hocking
- BAppSc, MPH, MHlthSc, PhD, Head, Sexual Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Vic
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26
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Bellhouse C, Komiti A, Temple-Smith M, Bilardi J, Newman L. A psychological group intervention for high-risk pregnant women: a protocol of a feasibility and acceptability study of the STAR Mums program. J Reprod Infant Psychol 2021; 40:342-351. [PMID: 33522292 DOI: 10.1080/02646838.2021.1880001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND In pregnancy, the attachment relationship between a mother and her baby begins to develop and women are more motivated and willing to make changes to become more engaged and responsive mothers and have better relationships with their children. A transgenerational framework has proposed that dysfunctional relationship patterns are often repeated across generations and this has broadened the understanding of early difficulties in parenting. Despite this there has been little research specifically examining high-risk perinatal women and how their interactions with their infants are related to attachment or relational outcomes. METHODS This pilot study aims to evaluate, and to explore the acceptability and feasibility, of participating in the Supporting Transitions, Attachment and Relationships (STAR Mums) program, a psychodynamic attachment-based group intervention, for pregnant women with risk factors for attachment difficulties. The STAR Mums program aims to intervene during pregnancy to assist women with risk factors in the transition to parenthood with the desired outcome to improve the quality of mother-infant emotional interactions, regulation and the attachment relationship. This is a mixed-methods design study incorporating both qualitative and quantitative assessments of five groups of five first-time mothers over a 12-month period. CONCLUSIONS This paper outlines the STAR Mums intervention and protocol for assessing acceptability and feasibility. The STAR Mums program takes a preventative approach and supports early intervention for parents at risk of attachment difficulties with their infants. The results of this study will inform revisions to the current treatment manual and a larger-scale program evaluation to further examine the efficacy of this intervention.
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Affiliation(s)
- Clare Bellhouse
- Department of Psychiatry, University of Melbourne, Parkville, Australia
| | - Angela Komiti
- Department of Psychiatry, University of Melbourne, Parkville, Australia
| | | | - Jade Bilardi
- Department of General Practice, University of Melbourne, Parkville, Australia
| | - Louise Newman
- Department of Psychiatry, University of Melbourne, Parkville, Australia
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Layton E, Goller JL, Coombe J, Temple-Smith M, Tomnay J, Vaisey A, Hocking JS. 'It's literally giving them a solution in their hands': the views of young Australians towards patient-delivered partner therapy for treating chlamydia. Sex Transm Infect 2021; 97:256-260. [PMID: 33441448 DOI: 10.1136/sextrans-2020-054820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/12/2020] [Accepted: 12/22/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Patient-delivered partner therapy (PDPT) is a method for providing antibiotic treatment for the sexual partners of an index patient with an STI by means of a prescription or medication that the index patient gives to their sexual partner(s). Qualitative research regarding barriers and enablers to PDPT has largely focused on the views of healthcare providers. In this study, we sought to investigate the views of young people (as potential health consumers) regarding PDPT for chlamydia. METHODS Semi-structured telephone interviews were conducted with young Australian men and women. Participants were asked to provide their views regarding PDPT from the perspective of both an index patient and partner. Purposive and snowball sampling was used. Data were analysed thematically. RESULTS We interviewed 22 people (13 women, 9 men) aged 18-30 years, 15 of whom had previously been tested for chlamydia. Despite none having previous knowledge of or experience using PDPT, all viewed it positively and thought it should be widely available. Participants reported that they would be willing to give PDPT to their sexual partners in situations where trust and comfort had been established, regardless of the relationship type. Protecting their partners' privacy was essential, with participants expressing reluctance to provide their partners' contact details to a doctor without consent. Beyond logistical benefits, PDPT was viewed as a facilitator to partner notification conversations by offering partners a potential solution. However, most interviewees indicated a preference to consult with a healthcare provider (GP or pharmacist) before taking PDPT medication. Participants indicated that legitimacy of information when navigating a chlamydia diagnosis was crucial and was preferably offered by healthcare providers. CONCLUSIONS Though PDPT is unlikely to fully replace partners' interactions with healthcare providers, it may facilitate partner notification conversations and provide partners greater choice on how, when and where they are treated.
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Affiliation(s)
- Elly Layton
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Jane L Goller
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Jacqueline Coombe
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Meredith Temple-Smith
- Department of General Practice, University of Melbourne, Carlton, Victoria, Australia
| | - Jane Tomnay
- Centre for Excellence in Rural Sexual Health, University of Melbourne, Shepparton, Victoria, Australia
| | - Alaina Vaisey
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
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Bittleston H, Coombe J, Temple-Smith M, Bateson D, Hunady J, Sanci L, Hocking JS, Goller JL. Diagnosis of pelvic inflammatory disease and barriers to conducting pelvic examinations in Australian general practice: findings from an online survey. Sex Health 2021; 18:180-186. [PMID: 33832551 DOI: 10.1071/sh20176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 02/19/2021] [Indexed: 11/23/2022]
Abstract
Background Pelvic inflammatory disease (PID) is under-diagnosed globally, particularly in primary care, and if untreated may cause reproductive complications. This paper investigates PID diagnosis by Australian general practitioners (GPs) and barriers to their conducting a pelvic examination. METHODS An online survey investigating Australian GPs' chlamydia management, including PID diagnosis, was conducted in 2019. From 323 respondents, 85.8% (n = 277) answered multiple-choice questions about PID and 74.6% (n = 241) answered a free-text question about barriers to conducting pelvic examinations. Using multivariable logistic regression, we identified factors associated with conducting pelvic examinations. Barriers to performing pelvic examinations were explored using thematic analysis. RESULTS Most GPs indicated that they routinely ask female patients with a sexually transmissible infection about PID symptoms, including pelvic pain (86.2%), abnormal vaginal discharge (95.3%), abnormal vaginal bleeding (89.5%), and dyspareunia (79.6%). Over half reported routinely conducting speculum (69.0%) and bimanual pelvic (55.3%) examinations for women reporting pelvic pain. Female GPs were more likely to perform speculum [adjusted odds ratio (AOR) 4.6; 95%CI: 2.6-8.2] and bimanual pelvic examinations (AOR 3.7; 95%CI: 2.1-6.5). GPs with additional sexual health training were more likely to routinely perform speculum (AOR 2.2; 95%CI: 1.1-4.2) and bimanual pelvic examinations (AOR 2.1; 95%CI: 1.2-3.7). Barriers to pelvic examinations were patient unwillingness and/or refusal, GP gender, patient health-related factors, time pressures, and GP reluctance. CONCLUSION Although GPs typically ask about PID symptoms when managing patients with chlamydia, they are not consistently able or willing to perform pelvic examinations to support a diagnosis, potentially reducing capacity to diagnose PID.
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Affiliation(s)
- Helen Bittleston
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3053, Australia; and Corresponding author.
| | - Jacqueline Coombe
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3053, Australia
| | - Meredith Temple-Smith
- Department of General Practice, The University of Melbourne, 780 Elizabeth Street, Carlton, Vic. 3010, Australia
| | - Deborah Bateson
- Family Planning NSW, 328-336 Liverpool Road, Ashfield, NSW 2131, Australia
| | - Jill Hunady
- True Relationships and Reproductive Health, 230 Lutwyche Road, Windsor, Qld 4030, Australia
| | - Lena Sanci
- Department of General Practice, The University of Melbourne, 780 Elizabeth Street, Carlton, Vic. 3010, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3053, Australia
| | - Jane L Goller
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3053, Australia
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Wood A, Braat S, Temple-Smith M, Lorch R, Vaisey A, Guy R, Hocking J. A chlamydia education and training program for general practice nurses: reporting the effect on chlamydia testing uptake. Aust J Prim Health 2021; 27:36-42. [PMID: 33526167 DOI: 10.1071/py20056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 10/16/2020] [Indexed: 11/23/2022]
Abstract
The long-term health consequences of untreated chlamydia are an increased risk of pelvic inflammatory disease, ectopic pregnancies and infertility among women. To support increased chlamydia testing, and as part of a randomised controlled trial of a chlamydia intervention in general practice, a chlamydia education and training program for general practice nurses (GPN) was developed. The training aimed to increase GPNs' chlamydia knowledge and management skills. We compared the difference in chlamydia testing between general practices where GPNs received training to those who didn't and evaluated acceptability. Testing rates increased in all general practices over time. Where GPNs had training, chlamydia testing rates increased (from 8.3% to 19.9% (difference=11.6%; 95% CI 9.4-13.8)) and where GPNs did not have training (from 7.4% to 18.0% (difference=10.6%; 95% CI 7.6-13.6)). By year 2, significantly higher testing rates were seen in practices where GPNs had training (treatment effect=4.9% (1.1 - 8.7)), but this difference was not maintained in year 3 (treatment effect=1.2% (-2.5 - 4.9)). Results suggest a GPN chlamydia education and training program can increase chlamydia testing up to 2 years; however, further training is required to sustain the increase beyond that time.
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Affiliation(s)
- Anna Wood
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 780 Elizabeth Street, Carlton, Vic. 3053, Australia; and Corresponding author.
| | - Sabine Braat
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Vic. 3053, Australia
| | - Meredith Temple-Smith
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 780 Elizabeth Street, Carlton, Vic. 3053, Australia
| | - Rebecca Lorch
- South Eastern Sydney LHD HIV and Related Programs (HARP) Unit, Sydney, NSW 2010, Australia
| | - Alaina Vaisey
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Vic. 3053, Australia
| | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia
| | - Jane Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Vic. 3053, Australia
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Bourchier L, Malta S, Temple-Smith M, Hocking J. Do we need to worry about sexually transmissible infections (STIs) in older women in Australia? An investigation of STI trends between 2000 and 2018. Sex Health 2020; 17:517-524. [PMID: 33334416 DOI: 10.1071/sh20130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/05/2020] [Indexed: 11/23/2022]
Abstract
Background This study examined trends in chlamydia, gonorrhoea and syphilis diagnosis, and chlamydia testing and positivity, among older women in Australia between 2000 and 2018. METHODS Using national notifiable disease data and Medicare data, diagnosis rates were calculated for each sexually transmissible infection (STI), as well as testing and positivity rates for chlamydia. Data were compared between two older groups (55-64 and 65-74 years) and two younger groups (15-24 and 25-34 years). Poisson regression examined trends for 2000-18 and 2014-18 separately. RESULTS Rates for all STIs increased across all age groups and were highest in the two youngest age groups. From 2014 to 2018, chlamydia rates increased the most among those aged 55-64 years [incidence rate ratio (IRR) = 1.06; 95%CI: 1.02-1.10] and declined in those aged 15-24 years (IRR = 0.99; 95%CI: 0.99-0.99). Gonorrhoea rates increased the most among those aged 65-74 years (IRR = 1.47; 95%CI: 1.23-1.77) and least in those aged 15-24 years (IRR = 1.12; 95%CI: 1.10-1.13). Syphilis rates increased the most among those aged 55-64 years (IRR = 1.58; 95%CI: 1.25-1.99) and least in those aged 15-24 years (IRR = 1.29; 95%CI: 1.23-1.35). Chlamydia test positivity declined among younger women but remained stable in older women. CONCLUSIONS In general, STIs are increasing among older women in Australia at a faster rate than among younger women. Although the greatest burden is among younger women, STIs need to be considered and monitored among older women.
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Affiliation(s)
- Louise Bourchier
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3053, Australia; and Corresponding author.
| | - Sue Malta
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3053, Australia; and National Ageing Research Institute, Poplar Road, Parkville, Vic. 3052, Australia
| | - Meredith Temple-Smith
- Department of General Practice, The University of Melbourne, 780 Elizabeth Street, Melbourne, Vic. 3004, Australia
| | - Jane Hocking
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3053, Australia
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Claringbold L, Bilardi J, Temple-Smith M. Early Pregnancy Assessment Services in Australia: What psychosocial support is available? A qualitative study. Women Birth 2020; 34:e575-e583. [PMID: 33279445 DOI: 10.1016/j.wombi.2020.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 09/28/2020] [Accepted: 10/05/2020] [Indexed: 11/29/2022]
Abstract
PROBLEM Women commonly experience emotional distress following miscarriage but do not receive the support they need from healthcare providers. BACKGROUND Miscarriage can result in psychological morbidity; however, appropriate support at the time of a miscarriage can lead to better psychological outcomes. Early Pregnancy Assessment Services (EPASs) are dedicated outpatient services considered the "gold standard" for miscarriage care. Little is known about the psychosocial support EPASs provide in Australia. AIMS The aim of this study was to explore the provision of psychosocial support in Australian EPASs. METHODS Semi-structured interviews were conducted with 29 purposively sampled key-informants from 13 EPASs. Interviews were audio-recorded, transcribed, and thematically analysed. FINDINGS Considerable variation was found in how EPASs functioned and their provision of psychosocial support. Many services were co-located with antenatal services, run by doctors with limited experience and most did not offer any psychosocial training to staff specific to EPAS. Referrals for additional support were generally not offered for first trimester miscarriages, and follow-up typically focused on physical management rather than emotional wellbeing. All EPAS staff demonstrated a strong commitment to providing best possible care to women within their own clinical setting and acknowledged the need for improved psychosocial support. CONCLUSION This study provides the first exploration of Australian EPASs' provision of psychosocial support. It has shown that while health care professionals working in EPASs are dedicated to providing the best possible care to women within their clinical setting, psychosocial support is very limited and could be improved.
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Affiliation(s)
- Lily Claringbold
- Department of General Practice, University of Melbourne, Victoria, Australia
| | - Jade Bilardi
- Department of General Practice, University of Melbourne, Victoria, Australia; Central Clinical School, Monash University, Victoria, Australia; Melbourne Sexual Health Centre, Alfred Health, Victoria, Australia.
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Waterland JL, Edbrooke L, Appathurai A, Lawrance N, Temple-Smith M, Denehy L. 'Probably better than any medication we can give you': General practitioners' views on exercise and nutrition in cancer. Aust J Gen Pract 2020; 49:513-518. [PMID: 32738865 DOI: 10.31128/ajgp-12-19-5176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Exercise and healthy eating patterns are effective in improving health-related quality of life for patients with cancer. However, little is known about general practitioners' (GPs') views and experiences regarding providing exercise and nutrition recommendations to their patients with cancer. The aim of this study was to 1) report GPs' experiences of providing nutrition and exercise advice to their patients and 2) identify perceived barriers and enablers to implementation of exercise and nutrition advice throughout the cancer journey from the GP perspective. METHOD Twenty-three semi-structured interviews were conducted, and transcripts coded by two independent researchers. A thematic analysis was performed to derive main themes. RESULTS Four main themes were identified: the importance of exercise and nutrition recommendations for patients with cancer, the influence of the patient agenda, the influence of additional training or personal interest of the GP, and limitations of the primary care setting. DISCUSSION Increased communication between primary and tertiary care, availability of resources, professional development opportunities and access to allied health services is needed to further support GPs to deliver exercise and nutrition information to their patients with cancer. This study provides evidence of GPs' desire to be involved in supporting the healthy exercise and nutrition habits of their patients with cancer and presents avenues for future research and resource development.
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Affiliation(s)
- Jamie L Waterland
- BPTY (Hons), Physiotherapist, Allied Health Department, Peter MacCallum Cancer Centre, Vic
| | - Lara Edbrooke
- BAppSc (Physio), GDEB, PhD, Lecturer, Department of Physiotherapy, The University of Melbourne, Vic; Senior Researcher, Allied Health Research, Department of Allied Health, Peter MacCallum Cancer Centre, Vic
| | - Amanda Appathurai
- BHumNut (Hons), Research Assistant, Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Vic
| | - Naomi Lawrance
- BNutrSc, MDietPrac, Clinical Dietitian, Allied Health Department, Peter MacCallum Cancer Centre, Vic
| | - Meredith Temple-Smith
- BSc, MPH, DHSc, Deputy Head of Department and Director of Research Training, Department of General Practice, University of Melbourne, Parkville, Vic
| | - Linda Denehy
- PhD, Professor and Head, Melbourne School of Health Sciences, University of Melbourne, Vic; Allied Health Department, Peter MacCallum Cancer Centre, Vic
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Abstract
BACKGROUND AND OBJECTIVES Australia's high rate of unintended pregnancy could be lowered by increasing long-acting reversible contraception (LARC) use. Influences on Australian women's choice of less effective methods are not well understood. This qualitative study explored factors that influence young women's contraceptive choices. METHOD Semi-structured interviews were conducted with women aged 18-24 years until data saturation. Interviews were audio-recorded, transcribed and thematically analysed. RESULTS Contraceptive choice was influenced by factors including contraceptive knowledge, side effects, cultural norms, fear, control and social context. Women often initiated contraceptive use for non contraceptive purposes such as management of acne or period pain, and failed to reconsider new methods when needing contraception, revealing one possible explanation for low LARC use. DISCUSSION Findings indicate that women's contraceptive choices need regular review. Information about relative efficacy of contraceptive methods is necessary should women's reasons for using contraception include birth control in addition to non-contraceptive benefits.
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Affiliation(s)
- Lily Claringbold
- BSc (Hons), MPhil student, Department of General Practice, University of Melbourne, Parkville, Vic
| | - Lena Sanci
- MBBS, PhD, FRACGP, Head of Department, Department of General Practice, University of Melbourne, Parkville, Vic
| | - Meredith Temple-Smith
- BSc, MPH, DHSc, Deputy Head of Department and Director of Research Training, Department of General Practice, University of Melbourne, Parkville, Vic
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Coombe J, Goller J, Bittleston H, Vaisey A, Sanci L, Groos A, Tomnay J, Temple-Smith M, Hocking J. Sexually transmissible infections, partner notification and intimate relationships: a qualitative study exploring the perspectives of general practitioners and people with a recent chlamydia infection. Sex Health 2020; 17:503-509. [PMID: 33181063 DOI: 10.1071/sh20109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/17/2020] [Indexed: 11/23/2022]
Abstract
Background Individuals diagnosed with a chlamydia infection are advised to notify their sexual partners from the previous 6 months so that they too can get tested and treated as appropriate. Partner notification is an essential component of chlamydia management, helping to prevent ongoing transmission and repeat infection in the index case. However, partner notification can be challenging, particularly in circumstances where a relationship has ended or transmission has occurred beyond the primary relationship. METHODS In this study we use data from 43 semistructured interviews with general practitioners (GPs) and people with a recent diagnosis of chlamydia. The interviews examined experiences of chlamydia case management in the general practice context. Here, we focus specifically on the effect of a chlamydia infection on intimate relationships in the context of the consultation and beyond.? RESULTS A chlamydia infection can have significant consequences for intimate relationships. Although GPs reported speaking to their patients about the importance of partner notification and participants with a recent chlamydia infection reported notifying their sexual partners, both would appreciate further support to engage in these conversations. CONCLUSIONS Conversations with patients should go beyond simply informing them of the need to notify their sexual partners from the previous 6 months, and should provide information about why partner notification is important and discuss strategies for informing partners, particularly for those in ongoing relationships. Ensuring GPs have the training and support to engage in these conversations with confidence is vital.
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Affiliation(s)
- Jacqueline Coombe
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Parkville, Vic. 3053, Australia; and Corresponding author.
| | - Jane Goller
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Parkville, Vic. 3053, Australia
| | - Helen Bittleston
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Parkville, Vic. 3053, Australia
| | - Alaina Vaisey
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Parkville, Vic. 3053, Australia
| | - Lena Sanci
- Department of General Practice, The University of Melbourne, 3rd Floor, 780 Elizabeth Street, Carlton, Vic. 3053, Australia
| | - Anita Groos
- Communicable Diseases Branch, Queensland Department of Health, 15 Butterfield Street, Herston, Qld 4006, Australia
| | - Jane Tomnay
- Centre for Excellence in Rural Sexual Health, Department of Rural Health, The University of Melbourne, 49 Graham Street, Shepparton, Vic. 3630, Australia
| | - Meredith Temple-Smith
- Department of General Practice, The University of Melbourne, 3rd Floor, 780 Elizabeth Street, Carlton, Vic. 3053, Australia
| | - Jane Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Parkville, Vic. 3053, Australia
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Goller JL, Coombe J, Bourne C, Bateson D, Temple-Smith M, Tomnay J, Vaisey A, Chen MY, O Donnell H, Groos A, Sanci L, Hocking J. Patient-delivered partner therapy for chlamydia in Australia: can it become part of routine care? Sex Health 2020; 17:321-329. [PMID: 32741430 DOI: 10.1071/sh20024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/13/2020] [Indexed: 11/23/2022]
Abstract
Background Patient-delivered partner therapy (PDPT) is a method for an index patient to give treatment for genital chlamydia to their sexual partner(s) directly. In Australia, PDPT is considered suitable for heterosexual partners of men and women, but is not uniformly endorsed. We explored the policy environment for PDPT in Australia and considered how PDPT might become a routine option. METHODS Structured interviews were conducted with 10 key informants (KIs) representing six of eight Australian jurisdictions and documents relevant to PDPT were appraised. Interview transcripts and documents were analysed together, drawing on KIs' understanding of their jurisdiction to explore our research topics, namely the current context for PDPT, challenges, and actions needed for PDPT to become routine. RESULTS PDPT was allowable in three jurisdictions (Victoria, New South Wales, Northern Territory) where State governments have formally supported PDPT. In three jurisdictions (Western Australia, Australian Capital Territory, Tasmania), KIs viewed PDPT as potentially allowable under relevant prescribing regulations; however, no guidance was available. Concern about antimicrobial stewardship precluded PDPT inclusion in the South Australian strategy. For Queensland, KIs viewed PDPT as not allowable under current prescribing regulations and, although a Medicine and Poisons Act was passed in 2019, it is unclear if PDPT will be possible under new regulations. Clarifying the doctor-partner treating relationship and clinical guidance within a care standard were viewed as crucial for PDPT uptake, irrespective of regulatory contexts. CONCLUSION Endorsement and guidance are essential so doctors can confidently and routinely offer PDPT in respect to professional standards and regulatory requirements.
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Affiliation(s)
- Jane L Goller
- Melbourne School of Population & Global Health, University of Melbourne, 207 Bouverie Street, Parkville, Vic. 3010, Australia; and Corresponding author.
| | - Jacqueline Coombe
- Melbourne School of Population & Global Health, University of Melbourne, 207 Bouverie Street, Parkville, Vic. 3010, Australia
| | - Christopher Bourne
- NSW STI Programs Unit, NSW Ministry of Health, NSW 2010, Australia; and Sydney Sexual Health Centre, Sydney, NSW 2001, Australia
| | | | | | - Jane Tomnay
- Centre for Excellence in Rural Sexual Health, Department of Rural Health, The University of Melbourne, Vic. 3630, Australia
| | - Alaina Vaisey
- Melbourne School of Population & Global Health, University of Melbourne, 207 Bouverie Street, Parkville, Vic. 3010, Australia
| | - Marcus Y Chen
- Central Clinical School, Monash University, Melbourne, Vic. 3004, Australia; and Melbourne Sexual Health Centre, 580 Swanston Street, Carlton, Vic. 3053, Australia
| | - Heather O Donnell
- Victorian Government, Department of Health and Human Services, Vic. 3000, Australia
| | - Anita Groos
- Communicable Diseases Branch, Queensland Department of Health, Brisbane, Qld 4006, Australia
| | - Lena Sanci
- Department of General Practice, The University of Melbourne, Vic. 3010, Australia
| | - Jane Hocking
- Melbourne School of Population & Global Health, University of Melbourne, 207 Bouverie Street, Parkville, Vic. 3010, Australia
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Ash T, Mascarenhas L, Furler J, Temple-Smith M. Hepatitis B contact tracing: what works? Aust J Prim Health 2019; 24:470-479. [PMID: 30296395 DOI: 10.1071/py17087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 05/11/2018] [Indexed: 11/23/2022]
Abstract
In 2012, over 239000 people were living in Australia with chronic hepatitis B (CHB). Australia's Second National Hepatitis B Strategy (2014) recommends testing contacts to increase identification of people with CHB, but it is generally poorly performed. CHB prevalence in Australia is increasing and contact tracing (CT) remains an untapped strategy for identifying infected individuals. A systematic CT system has been established in a government-funded primary health centre in Melbourne, which services 2000 refugees. This mixed-methods study aimed to describe the structure of the CT system, determine its effectiveness and identify enablers of success. The CT system's structure was elicited from field notes. CT effectiveness (proportion of contacts traced and serologically confirmed as infected or immune to HBV) was determined by auditing clinical records. Semi-structured interviews with seven health professionals were thematically analysed to identify enablers of CT success. Overall, 122 CHB index cases had 420 contacts. And 90.0% (n=380) of 420 contacts were successfully traced, 68.0% (n=83) of index cases had 100% of their contacts successfully traced and 80.7% (n=339) of all contacts were immune; 28.8% (n=121) had evidence of previous exposure and 55.0% (n=231) had evidence of vaccination. Also, 8.1% (n=34) were chronically infected. Interviews elicited seven themes important to the success of the CT system: Teamwork; Organisation; Health professional expertise; Patient education; Centralisation of the system; Influence of patient culture; and Use of nurses in CT. Teamwork and Organisation were previously unidentified in the literature. This CT system is successful and could be implemented elsewhere, provided an organised, cohesive, nurse-led team is established.
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Affiliation(s)
- Thalia Ash
- The Northern Hospital, 180-185 Cooper Street, Epping, Vic. 3076, Australia
| | | | - John Furler
- Department of General Practice, Melbourne Medical School, Level 1, 200 Berkeley Street, Carlton, The University of Melbourne, Vic. 3010, Australia
| | - Meredith Temple-Smith
- Department of General Practice, Melbourne Medical School, Level 1, 200 Berkeley Street, Carlton, The University of Melbourne, Vic. 3010, Australia
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Abstract
BACKGROUND AND OBJECTIVES General practitioners (GPs) are well placed to promote sexual health to young men. Our previous research has suggested that this population expect GPs to initiate sexual health promotion. Little is known of GPs' perceptions of their role in sexual health promotion and perceived needs of young men. METHOD: Semi-structured interviews with GPs were recorded until data saturation. Data were managed with NVivo; consensus was reached on thematic analysis. RESULTS: In 17 semi-structured interviews, a young man symptomatic with a sexually transmissible infection (STI) was the most common sexual health presentation. GPs identified a range of barriers to, and facilitators, of initiating discussions about sexual health. Some GPs reported no young male sexual health presentations. GPs generally believed young men should be taking more responsibility for their sexual health. DISCUSSION Only some GPs endorsed young men's expectations that the GP would initiate a sexual health discussion. Increased awareness that young men are unlikely to seek sexual health advice would allow GPs to better tailor their approaches and increase opportunistic testing and sexual health promotion.
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Affiliation(s)
- Archibald Collyer
- MD, BSc (Hons), Resident, Northeast Health, Wangaratta, Vic; Department of General Practice, University of Melbourne, Vic.
| | - Siobhan Bourke
- MBBS, FAChSHM, MPH, GradCert PH (Sexual Health), Senior Lecturer, Centre for Excellence in Rural Sexual Health, University of Melbourne, Vic
| | - Meredith Temple-Smith
- DHSc, MPH, BSc, Professor and Director, Research Training, General Practice, University of Melbourne, Vic
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Nguyen V, Temple-Smith M, Bilardi J. Men's lived experiences of perinatal loss: A review of the literature. Aust N Z J Obstet Gynaecol 2019; 59:757-766. [PMID: 31414479 DOI: 10.1111/ajo.13041] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/24/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Perinatal loss is often considered an emotionally and physically traumatic event for expectant parents. While there is strong evidence of its impact on women, limited research has independently explored men's lived experiences. AIM This scoping review will examine current literature on the lived experiences of men whose partner has experienced a still-birth or miscarriage. MATERIAL AND METHODS The scoping review identified relevant articles by systematically searching through four electronic databases utilising a PRISMA search strategy. Strict inclusion and exclusion criteria were applied to articles. The articles' reference lists were further scrutinised until no further articles that met the criteria were located. Fifteen articles were located including 14 qualitative studies and one non-peer reviewed academic article. Articles were thematically analysed. RESULTS The review identified three major themes that are particularly pertinent to shaping the lived experiences of men whose partner has suffered a perinatal loss: (1) pregnancy attachment and the aftermath; (2) supporting their partner and being supported; and (3) impacts upon future pregnancies. CONCLUSION Perinatal loss can have negative implications for men's psychological and social well-being. Across the studies men had different levels of attachments to the pregnancy, influencing their emotional responses to the loss. Men perceived their primary role as being a supporter to their partners but received limited support themselves. Men often reported that their safe and trusting attitudes toward pregnancy had forever changed. Further areas of research are recommended in hopes of enhancing support for men, and consequently their partners and families, who experience perinatal loss.
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Affiliation(s)
- Van Nguyen
- Department of Social Work, The University of Melbourne, Melbourne, Victoria, Australia
| | - Meredith Temple-Smith
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jade Bilardi
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Monash University, Melbourne, Victoria, Australia
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Longman C, Temple-Smith M. Promoting professional behaviour in general practitioner training practices: The views of practice managers. Aust J Gen Pract 2019; 48:403-409. [PMID: 31220879 DOI: 10.31128/ajgp-11-18-4765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES General practitioners (GPs) are required by the Australian professional colleges of general practice - The Royal Australian College of General Practitioners and The Australian College of Rural and Remote Medicine - to practise a high standard of professional behaviour. General practice registrars (GPRs) learn this in their training practices not only from their general practice supervisors, but also the practice managers (PMs). Little is known of PMs' views of the meaning of the term 'professional behaviour' and how they view their role in GPR education. METHOD Nineteen semi-structured interviews with PMs were conducted. Saturation was reached and consensus achieved on the analysis. RESULTS PMs held nuanced views on the meaning of the term 'professional behaviour' and actively promoted and modelled this to their staff, including GPRs. PMs believed they had a role in GPR education. DISCUSSION Practice managers are well placed to model and teach professional behaviour, and their skills should be further used to educate GPRs.
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Affiliation(s)
- Christine Longman
- MBBS, MMed, FRACGP, General Practitioner and Medical Educator, Murray City Country Coast GP Training, Parkville, Vic
| | - Meredith Temple-Smith
- BSc, MPH, DHSc, Deputy Head of Department and Director of Research Training, Department of General Practice, University of Melbourne, Parkville, Vic
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Malta S, Temple-Smith M, Hunter J, McGavin D, Lyne J, Bickerstaffe A, Hocking J. Could an online or digital aid facilitate
discussions about sexual health with
older Australians in general practice? Aust J Gen Pract 2019; 47:870-875. [PMID: 31212407 DOI: 10.31128/ajgp-04-18-4557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background and objectives Older patients want to discuss sexual
health with general practitioners (GPs)
but feel uncomfortable doing so, as
do their GPs. Online and digital aids
(ODAs) are used in other clinical
contexts and could provide an effective
tool to overcome this discomfort. The
aim of this study was to explore health
practitioners’ views on the type of ODA
that could be used to facilitate sexual
health discussions between older
patients (aged ≥60 years) and health
practitioners. Methods Thirty-seven interviews were conducted
in Victoria, Australia, between March
and June 2017. Participants comprised
15 GPs, 12 practice nurses or practice
managers and 10 key informants (five
in sexual health, five in ODAs). Results Most ODAs currently available target
younger populations. Checklists or
self‑service kiosks may provide
effective means to facilitate sexual
health discussions with older patients
in primary care. Discussion ODAs are acceptable and feasible to
implement in younger populations but
need testing with older patients. Health
professionals need training to deal with
sexual health matters arising from using
such aids.
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Affiliation(s)
- Sue Malta
- PhD, Research Fellow, Melbourne School
of Population and Global Health, University of
Melbourne and Social Gerontology Division, National
Ageing Research Institute, Vic. susan.malta@
unimelb.edu.au
| | - Meredith Temple-Smith
- PhD, Director of Research
Training, Department of General Practice, University
of Melbourne, Vic
| | - Jesse Hunter
- MD, Melbourne Medical School, University of Melbourne, Vic
| | - Declan McGavin
- MD, Melbourne Medical School, University of Melbourne, Vic
| | - Jenni Lyne
- MD, Melbourne Medical School, University of Melbourne, Vic
| | - Adrian Bickerstaffe
- PhD, Melbourne School
of Population and Global Health, University of
Melbourne, Vic
| | - Jane Hocking
- PhD, Head, Sexual Health Unit,
Melbourne School of Population and Global Health,
University of Melbourne, Vic
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Malta S, Hocking J, Lyne J, McGavin D, Hunter J, Bickerstaffe A, Temple-Smith M. Do you talk to your older patients about sexual health? Health practitioners’ knowledge of, and attitudes towards, management of sexual health among older Australians. Aust J Gen Pract 2019; 47:807-811. [PMID: 31207681 DOI: 10.31128/ajgp-04-18-4556] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Research suggests that older patients want to talk about sexual health, but are reluctant to initiate these discussions with health practitioners. Little is known of the practitioners’ perspectives. The objective of this study was to explore health practitioners’ knowledge of and attitudes towards management of sexual health among older patients. METHOD Semi-structured interviews were conducted with 15 general practitioners (GPs) and six practice nurses in rural/metropolitan general practices in March to June 2017 in Victoria, Australia. RESULTS Most GPs believed it was appropriate to discuss sexual health with older patients but did not routinely do so. Common barriers included age and gender discordance between GP and patient, complexity of patient comorbidities and patient–doctor relationships. Practice nurses identified the limitations of their role as a barrier, although some nurses initiated discussions during health assessments. DISCUSSION Health practitioners generally believed the responsibility for initiation of sexual health discussions rested with patients, but understood patients’ reluctance. They saw the need for an intervention to assist in such discussions.
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Affiliation(s)
- Sue Malta
- PhD, Research Fellow, Melbourne School of Population and Global Health, University of Melbourne and Social Gerontology Division, National Ageing Research Institute, Vic.
| | - Jane Hocking
- PhD, Head, Sexual Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Vic
| | - Jenni Lyne
- MD, Melbourne Medical School, University of Melbourne, Vic
| | - Declan McGavin
- MD, Melbourne Medical School, University of Melbourne, Vic
| | - Jesse Hunter
- MD, Melbourne Medical School, University of Melbourne, Vic
| | - Adrian Bickerstaffe
- PhD, Melbourne School of Population and Global Health, University of Melbourne, Vic
| | - Meredith Temple-Smith
- PhD, Director of Research Training, Department of General Practice, University of Melbourne, Vic
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Thornton K, Webster S, Temple-Smith M. Is immunisation for children and young people in statutory care in Victoria 'all too hard'? A qualitative study with health professionals. Aust J Prim Health 2019; 25:131-136. [PMID: 30961786 DOI: 10.1071/py18096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 01/22/2019] [Indexed: 11/23/2022]
Abstract
This formative study aimed to identify health professionals' perspectives on vaccination issues among children in statutory out-of-home care in Victoria. Eight health professionals, drawn from a purposive Victorian sample known to be proactive in addressing the vaccination needs of children in out-of-home care, took part in semi-structured interviews. Questions addressed participants' views about roles and responsibilities, barriers and enabling factors affecting vaccination, and ideas about systems improvements. Interview transcripts were analysed thematically. The main themes that emerged were health professionals' observations about vaccine hesitancy among significant adults in the out-of-home care sector, the paucity of child medical history information available and diffuse responsibility for the provision of legal consent to vaccination. More accurate immunisation status monitoring appears warranted for children in out-of-home care. Unless the collection and maintenance of child medical records improves and vaccination consent processes are streamlined, health professionals will be limited in their capacity to provide efficient vaccination services to these children. Research on vaccine hesitancy among staff and carers in the statutory care sector may be of value. This study supports other Australian research that indicates these children may require more targeted, inter-sectoral immunisation approaches.
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Affiliation(s)
- Katherine Thornton
- Department of General Practice, The University of Melbourne, 200 Berkeley Street, Carlton, Vic. 3053, Australia; and Corresponding author.
| | - Susan Webster
- Department of General Practice, The University of Melbourne, 200 Berkeley Street, Carlton, Vic. 3053, Australia
| | - Meredith Temple-Smith
- Department of General Practice, The University of Melbourne, 200 Berkeley Street, Carlton, Vic. 3053, Australia
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Bellhouse C, Temple-Smith M, Watson S, Bilardi J. “The loss was traumatic… some healthcare providers added to that”: Women’s experiences of miscarriage. Women Birth 2019; 32:137-146. [DOI: 10.1016/j.wombi.2018.06.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 05/25/2018] [Accepted: 06/05/2018] [Indexed: 11/16/2022]
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Abstract
Hepatitis B is a complex disease requiring lifelong management. Infection is linked to birth in high prevalence regions including Africa and Asia. Best practice guidelines identify who to test for hepatitis B, however, a significant proportion of Australians with hepatitis B have not been diagnosed, and are subsequently at risk of serious morbidity and mortality. This study sought to address the gap between current and optimal hepatitis B testing in a primary care clinic with a likely high population of undiagnosed hepatitis B. Between September 2015 and December 2016, four interventions aimed at enhancing general practitioner testing practices were implemented: staff education, quality improvement and patient-triggered activities. Compared to the baseline (2014) the following parameters all increased in 2016: the number of patients tested (15 tests per month in 2014, 24 tests per months in 2016), the correct ordering of the recommended tests (17% in 2014, 61% in 2016) and hepatitis B vaccine dose ordering (n = 35 in 2014, n = 110 in 2016). However, the proportion of patients born in Africa or Asia tested for hepatitis B did not increase. Distribution of a patient held-reminder led to the greatest number of tests being ordered (n = 54 tests ordered in 1 month). Within a single primary care clinic situated in a high hepatitis B prevalence area, an intervention designed to improve adherence to hepatitis B testing guidelines, increased testing levels. A systematic approach can assist general practitioners to improve their understanding of hepatitis B testing and prioritise people most at risk.
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Affiliation(s)
- Jacqueline A Richmond
- The Royal Melbourne Hospital, Victorian Infectious Diseases Service, 300 Grattan Street, Parkville, Melbourne, 3000, Australia. .,Viral Hepatitis Research Program, Australian Research Centre in Sex, Health & Society, La Trobe University, 215 Franklin Street, Melbourne, 3000, Australia. .,Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, 300 Barry Street, Parkville, Melbourne, 3000, Australia.
| | - Joe Sasadeusz
- The Royal Melbourne Hospital, Victorian Infectious Diseases Service, 300 Grattan Street, Parkville, Melbourne, 3000, Australia
| | - Meredith Temple-Smith
- Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, 200 Berkely Street, Parkville, Melbourne, 3000, Australia
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Kaufman J, Temple-Smith M, Sanci L. Urinary tract infections in children: an overview of diagnosis and management. BMJ Paediatr Open 2019; 3:e000487. [PMID: 31646191 PMCID: PMC6782125 DOI: 10.1136/bmjpo-2019-000487] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/10/2019] [Accepted: 09/12/2019] [Indexed: 01/05/2023] Open
Abstract
Urinary tract infections (UTIs) are a common and potentially serious bacterial infection of childhood. History and examination findings can be non-specific, so a urine sample is required to diagnose UTI. Sample collection in young precontinent children can be challenging. Bedside dipstick tests are useful for screening, but urine culture is required for diagnostic confirmation. Antibiotic therapy must be guided by local guidelines due to increasing antibiotic resistance. Duration of therapy and indications for imaging remain controversial topics and guidelines lack consensus. This article presents an overview of paediatric UTI diagnosis and management, with highlights of recent advances and evidence updates.
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Affiliation(s)
- Jonathan Kaufman
- Department of Paediatrics, Western Health, Sunshine Hospital, St Albans, Victoria, Australia.,Health Services Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of General Practice, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Meredith Temple-Smith
- Department of General Practice, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lena Sanci
- Department of General Practice, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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46
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Hocking JS, Temple-Smith M, Guy R, Donovan B, Braat S, Law M, Gunn J, Regan D, Vaisey A, Bulfone L, Kaldor J, Fairley CK, Low N. Population effectiveness of opportunistic chlamydia testing in primary care in Australia: a cluster-randomised controlled trial. Lancet 2018; 392:1413-1422. [PMID: 30343857 DOI: 10.1016/s0140-6736(18)31816-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 07/20/2018] [Accepted: 07/30/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Screening young adults who are sexually active for genital Chlamydia trachomatis infection is promoted in several high-income countries, but its effectiveness at the population level is highly debated. We aimed to investigate the effects of opportunistic chlamydia testing in primary care on the estimated chlamydia prevalence in the population aged 16-29 years in Australia. METHODS We did a cluster-randomised controlled trial. Clusters were rural towns with a minimum of 500 women and men aged 16-29 years and no more than six primary care clinics. We randomly allocated each cluster using a computer-generated minimisation algorithm to receive a multifaceted, clinic-based chlamydia testing intervention or to continue usual care. The intervention included computerised reminders to test patients, an education package, payments for chlamydia testing, and feedback on testing rates. The primary outcome was chlamydia prevalence, estimated before randomisation (survey 1) and at the end of the trial (survey 2) in patients aged 16-29 years who attended the clinics. Analyses were done by intention to treat. General practitioners and clinic staff were aware of group allocation, whereas patients and laboratory staff who performed the chlamydia tests were not. This trial was completed on Dec 31, 2015, and is registered (ACTRN12610000297022). FINDINGS Between Dec 14, 2010, and Sept 14, 2015, 26 clusters (63 clinics) received the chlamydia testing intervention and 26 (67 clinics) continued usual care. Over a mean duration of 3·1 years (SD 0·3), 93 828 young adults attended intervention clinics and 86 527 attended control clinics. The estimated chlamydia prevalence decreased from 5·0% (95% CI 3·8 to 6·2) at survey 1 to 3·4% (2·7 to 4·1) at survey 2 in the intervention clusters (difference -1·6%, 95% CI -2·9 to -0·3) and from 4·6% (95% CI 3·5 to 5·7) at survey 1 to 3·4% (2·4 to 4·5) at survey 2 in the control clusters (difference -1·1%, -2·7 to 0·5). The unadjusted odds ratio for the difference between intervention and control clusters was 0·9 (95% CI 0·5 to 1·5). INTERPRETATION These findings, in conjunction with evidence about the feasibility of sustained uptake of opportunistic testing in primary care, indicate that sizeable reductions in chlamydia prevalence might not be achievable. FUNDING Australian Government Department of Health, National Health and Medical Research Council, Victorian Department of Health and Human Services, and New South Wales Ministry of Health.
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Affiliation(s)
- Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
| | | | - Rebecca Guy
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Basil Donovan
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Sydney Sexual Health Centre, Sydney, NSW, Australia
| | - Sabine Braat
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Matthew Law
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Jane Gunn
- Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
| | - David Regan
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Alaina Vaisey
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | | | - John Kaldor
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Yeung A, Hocking J, Guy R, Fairley CK, Smith K, Vaisey A, Donovan B, Imrie J, Gunn J, Temple-Smith M. 'It Opened My Eyes'-examining the impact of a multifaceted chlamydia testing intervention on general practitioners using Normalization Process Theory. Fam Pract 2018; 35:626-632. [PMID: 29608672 DOI: 10.1093/fampra/cmy011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Chlamydia is the most common notifiable sexually transmissible infection in Australia. Left untreated, it can develop into pelvic inflammatory disease and infertility. The majority of notifications come from general practice and it is ideally situated to test young Australians. OBJECTIVES The Australian Chlamydia Control Effectiveness Pilot (ACCEPt) was a multifaceted intervention that aimed to reduce chlamydia prevalence by increasing testing in 16- to 29-year-olds attending general practice. GPs were interviewed to describe the effectiveness of the ACCEPt intervention in integrating chlamydia testing into routine practice using Normalization Process Theory (NPT). METHODS GPs were purposively selected based on age, gender, geographic location and size of practice at baseline and midpoint. Interview data were analysed regarding the intervention components and results were interpreted using NPT. RESULTS A total of 44 GPs at baseline and 24 at midpoint were interviewed. Most GPs reported offering a test based on age at midpoint versus offering a test based on symptoms or patient request at baseline. Quarterly feedback was the most significant ACCEPt component for facilitating a chlamydia test. CONCLUSIONS The ACCEPt intervention has been able to moderately normalize chlamydia testing among GPs, although the components had varying levels of effectiveness. NPT can demonstrate the effective implementation of an intervention in general practice and has been valuable in understanding which components are essential and which components can be improved upon.
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Affiliation(s)
- Anna Yeung
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Jane Hocking
- Sexual Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Rebecca Guy
- Sexual Health Program, Kirby Institute, University of New South Wales, Sydney, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Kirsty Smith
- Sexual Health Program, Kirby Institute, University of New South Wales, Sydney, Australia
| | - Alaina Vaisey
- Sexual Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Basil Donovan
- Sexual Health Program, Kirby Institute, University of New South Wales, Sydney, Australia.,Sydney Sexual Health Centre, Sydney, Australia
| | - John Imrie
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Durban, South Africa
| | - Jane Gunn
- General Practice and Primary Health Care Academic Centre, University of Melbourne, Melbourne, Australia
| | - Meredith Temple-Smith
- General Practice and Primary Health Care Academic Centre, University of Melbourne, Melbourne, Australia
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48
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Ewert C, Collyer A, Temple-Smith M. 'Most young men think you have to be naked in front of the GP': a qualitative study of male university students' views on barriers to sexual health. Sex Health 2018; 13:124-30. [PMID: 26691872 DOI: 10.1071/sh15217] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 11/05/2015] [Indexed: 11/23/2022]
Abstract
UNLABELLED Background In Australia, 15- to 29-year-olds account for 75% of all sexually transmissible infection (STI) diagnoses. STI rates among young men are rising, with most diagnosed in general practice. Young men less frequently attend general practice than young women, and rarely present with sexual health issues, making it difficult for general practitioners (GPs) to offer opportunistic STI education and screening. Little is known of the barriers preventing male university students accessing general practice for sexual health care, or what would facilitate this. METHODS Semi-structured interviews were conducted with young men aged 18-24 years attending university between 2012 and 2014. Interviews were recorded, transcribed and analysed using content and thematic analysis. RESULTS Twenty-eight interviews of 26-50min duration found self-imposed views of masculinity, privacy and embarrassment as key barriers to accessing GPs for sexual health care. This was compounded by poor STI knowledge and not knowing when or where to go for care. Participants, except if they were international students, acknowledged school as an important source of sexual health education. The need for sexual health education at university was identified. While the Internet was a popular source, there were mixed views on the benefits of social media and text messaging for sexual health promotion. CONCLUSIONS Current expectations of young male university students to seek sexual health care or acquire sexual health information from medical care may be misplaced. Universities have an excellent opportunity to provide young men with appropriate sexual health information and could offer novel strategies to help young men look after their sexual health.
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Affiliation(s)
- Cameron Ewert
- Department of General Practice, The University of Melbourne, 200 Berkeley Street, Carlton, Vic. 3053, Australia
| | - Archibald Collyer
- Department of General Practice, The University of Melbourne, 200 Berkeley Street, Carlton, Vic. 3053, Australia
| | - Meredith Temple-Smith
- Department of General Practice, The University of Melbourne, 200 Berkeley Street, Carlton, Vic. 3053, Australia
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49
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Lorch R, Guy R, Temple-Smith M, Vaisey A, Wood A, Ford B, Murray C, Bourne C, Tomnay J, Hocking J, ACCEPt Consortium OBOT. The impact of a chlamydia education program on practice nurse's knowledge and attitudes in relation to chlamydia testing: a cross-sectional survey. Sex Health 2018; 13:73-80. [PMID: 26567608 DOI: 10.1071/sh15134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/28/2015] [Indexed: 11/23/2022]
Abstract
UNLABELLED Background We aimed to determine the impact of a chlamydia (Chlamydia trachomatis) education program on the knowledge of and attitudes towards chlamydia testing of practice nurses (PNs). METHODS A cross-sectional survey was conducted at baseline and 6-12 months following recruitment with PNs in the Australian Chlamydia Control Effectiveness Pilot. Likert scales were analysed as continuous variables (scores), and t-tests were used to assess changes in mean scores between survey rounds and groups. RESULTS Of the 72 PNs who completed both surveys, 42 received education. Epidemiology knowledge scores increased significantly between surveys in the education group (P<0.01), with change in knowledge being greater in the education group compared with the non-education group (P<0.01). Knowledge of recommended testing scenarios (P=0.01) and retesting following treatment (P<0.01) increased in the education group. Attitudes to testing scores improved over time in the education group (P=0.03), with PNs more likely to want increased involvement in chlamydia testing (P<0.01). Change in overall attitude scores towards testing between surveys was higher in the education group (P=0.05). Barriers to chlamydia testing scores also increased in the education group (P=0.03), with change in barriers greater in the education vs the non-education group (P=0.03). CONCLUSION The education program led to improved knowledge and attitudes to chlamydia, and could be made available to PNs working in general practice. Future analyses will determine if the education program plus other initiatives can increase testing rates.
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Affiliation(s)
- Rebecca Lorch
- The Kirby Institute, Wallace Wurth Building, UNSW Australia, Sydney, NSW 2052, Australia
| | - Rebecca Guy
- The Kirby Institute, Wallace Wurth Building, UNSW Australia, Sydney, NSW 2052, Australia
| | - Meredith Temple-Smith
- Department of General Practice, The University of Melbourne, 200 Berkeley Street, Parkville, Vic. 3010, Australia
| | - Alaina Vaisey
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3010, Australia
| | - Anna Wood
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3010, Australia
| | - Belinda Ford
- The Kirby Institute, Wallace Wurth Building, UNSW Australia, Sydney, NSW 2052, Australia
| | - Carolyn Murray
- NSW Sexually Transmissible Infection Programs Unit, PO Box 1614, Sydney, NSW 2001, Australia
| | - Chris Bourne
- NSW Sexually Transmissible Infection Programs Unit, PO Box 1614, Sydney, NSW 2001, Australia
| | - Jane Tomnay
- Centre for Excellence in Rural Sexual Health, The University of Melbourne, 49 Graham Street, Shepparton ,Vic. 3630, Australia
| | - Jane Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3010, Australia
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50
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Hulme-Chambers A, Temple-Smith M, Davidson A, Coelli L, Orr C, Tomnay JE. Australian women’s experiences of a rural medical termination of pregnancy service: A qualitative study. Sexual & Reproductive Healthcare 2018; 15:23-27. [DOI: 10.1016/j.srhc.2017.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 11/10/2017] [Accepted: 11/20/2017] [Indexed: 12/01/2022]
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