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

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.

Measuring school level attributable risk to support school-based HPV vaccination programs

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.

Differences in school factors associated with adolescent HPV vaccination initiation and completion coverage in three Australian states

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.

Dentists' Perspectives on Infection Control in Relation to Blood-borne Viruses

The prevalence of blood-borne viruses (BBV) continues to increase in Australia, as does the need for vigilant infection control. Despite this, some Australian health practitioners demonstrate poor compliance with recommended infection control practices. The aim of this study was to examine the experiences and attitudes of dentists regarding infection control, patients with BBV, occupational risk, and related matters, and identify reasons for non-compliance with infection control guidelines. A purposive sample of 25 Victorian dentists took part in semi-structured interviews between November 2003 and November 2004. Interviews were taped, transcribed and coded for thematic analysis. The majority of participants expressed compliance with standard precautions; however, many admitted to changing their routine infection control practices for patients known or assumed to have a BBV. Approximately half disclosed minor changes, such as double gloving; a small minority reported having treated people with a BBV at the end of a session. Most participants experienced apprehension about the risk of occupational exposure to BBV and admitted this as the reason for changing infection control practices. Reasons offered by participants for poor compliance included ignorance of either the effectiveness of standard precautions or BBV transmission, or confusion and frustration regarding inadequate or impractical infection control guidelines. It is suggested that infection control guidelines be specifically designed for dental practice, and that these be promoted in both undergraduate dental education and professional development.

Now, later or never? Challenges associated with hepatitis C treatment

BACKGROUND AND AIMS

Of the 259,000 Australians estimated to have a hepatitis C virus infection, very few have received antiviral therapy. This study identifies personal, psychological and structural barriers associated with decisions to begin treatment and the challenges associated with adhering to a demanding treatment regimen.

METHODS

Between August 2003 and May 2004, 224 people living in Victoria who were hepatitis C antibody positive completed a 78-item survey instrument. Participants were recruited from a variety of settings and included those who were on treatment for hepatitis C (n=45); previously on treatment (n=65); and people who had never experienced treatment (n=114).

RESULTS

The average age of the participants was 43 years. Men (n=29) were more likely than women (n=15) to be receiving treatment. Participants diagnosed in the past five years (31%) were more likely to be receiving treatment compared with those diagnosed more than five years ago (14%). Participants rated the effectiveness of treatment as the most important factor in influencing their decision to begin treatment. Side effects were rated the biggest challenge to adhering to treatment and were also rated as the most important consideration for those who decided against treatment.

CONCLUSIONS

This study has shown many decisions and challenges affect the uptake of, and adherence to, hepatitis C treatment. Dissemination and promotion of information about increased effectiveness of new treatments will greatly influence decisions to begin treatment. Careful management and minimisation of side effects are also essential to improve uptake and increase adherence to hepatitis C treatment.

Discrimination or discretion? Exploring dentists' views on treating patients with hepatitis C

BACKGROUND

People with hepatitis C (over 259 000 Australians) experience stigma and discrimination, whether perceived or actual, in health care settings. They are less likely to access health care, presenting a major barrier to preventive care and treatment. This study aims to identify factors contributing to such discrimination, barriers to optimal care and strategies to overcome these.

METHODS

A purposive sample of 25 Victorian dentists took part in semi-structured interviews to investigate their experiences and attitudes in providing care to people with hepatitis C. Interviews were taped, transcribed and coded for thematic analysis.

RESULTS

All dentists interviewed were aware of Standard Precautions. However, there were some who changed practices when seeing a client with hepatitis C, suggesting that they lack confidence in Standard Precautions. When prompted, these dentists were concerned that patients may perceive these actions as discriminatory. All participants, including a small minority who expressed negative views about injecting drug users, felt a professional obligation to treat all patients.

CONCLUSIONS

Most dentists have appropriate attitudes regarding patients with blood-borne viruses. However, it is important for dentists to understand how their actions may be interpreted by those who feel sensitive about their status. Dentists need to feel genuinely confident about Standard Precautions and have a realistic view of the infection risk posed by patients with blood-borne viruses.

Maximising response rates in a survey of general practitioners. Lessons from a Victorian survey on sexually transmissible diseases

OBJECTIVE

To describe factors that influence participation by general practitioners (GPs) in survey research, and in particular to examine the effectiveness of telephone prompts made by a GP researcher compared with non-medical researchers in a survey of GPs on sexually transmissible diseases (STDs).

DESIGN AND SETTING

A questionnaire survey of knowledge, attitudes, behaviour and practice (KABP) in relation to STDs was distributed to 520 Victorian GPs randomly selected from the Australian Medical Publishing Company's (AMPCo) database of Australian medical practitioners.

MAIN OUTCOME MEASURES

Number of GPs able to be contacted by telephone and cumulative and overall response rates to the questionnaire.

RESULTS

The overall response rate was 85%. Although the GP researcher was able to make contact by telephone in a higher proportion of cases (80%) than the non-GP researchers combined (69%, p < 0.01) response rates were not significantly different (83% versus 87%).

CONCLUSIONS

Telephone prompts to encourage GP response in survey research need not be made by a medical practitioner. Other important factors in relation to response rate that should be considered by researchers are GP involvement in the developing and piloting of the survey instrument, incentives and provision of detailed feedback of the results of the survey.

Managing people with HIV/AIDS--the involvement of Victorian general practitioners

OBJECTIVE

To examine aspects of knowledge, attitudes, behaviour and practice (KABP) of Victorian general practitioners (GPs) in relation to human immunodeficiency virus (HIV), as part of a larger KABP study relating to GPs and sexually transmissible diseases (STDs).

METHOD

Questionnaire survey of 520 randomly selected GPs.

RESULTS

A response rate of 85% was obtained. Most respondents were aware of the major risk factors for HIV infection and most GPs obtained consent before HIV testing. More than 22% of respondents had ordered an HIV test that was positive and 39% had been involved with the management of HIV positive patients (asymptomatic, symptomatic or both). The gender of the practitioner (male), greater frequency of STD diagnosis and greater level of ease in treating homosexual men were all significantly associated with having ordered an HIV test that was positive and with ongoing management of asymptomatic and symptomatic HIV positive patients, whereas practitioner age, frequency of advising on safe sex and providing contraceptive advice were not.

CONCLUSION

Thirty-nine per cent of Victorian GPs are now managing HIV positive patients, representing a 17% increase since 1989. We found that GP knowledge of HIV transmission and infection control was generally good although information on knowledge and practice beyond initial diagnosis was not sought. Given the evidence of a significant association between practitioner experience in HIV/AIDS management and survival of their patients, there is a need for further research into the educational and support needs of Australian GPs in relation to this increasingly complex area of clinical practice.

Barriers to sexual history taking in general practice

OBJECTIVE

The aim of this pilot study was to identify barriers to the taking of a sexual history in general practice.

METHOD

In order to canvass the widest range of opinion on this sensitive issue, focus groups of 4-8 general practitioners (GPs) were conducted using a GP facilitator. Groups shared one of the following common interests - considerable experience in sexual history taking, an interest in sexuality, large numbers of patients from a non-English speaking background, rural practice, Family Medicine Program trainee-ship or employment in a 24 hour clinic.

RESULTS

GPs identified a range of barriers including lack of time, fear of intrusion, age and sex of both GP and patient, fear of inadequacy, patient's offending behaviours, cultural differences (ethnic, gay and youth) and the presence of a third party.

CONCLUSION

To improve sexual history taking GPs may need assistance in the following areas: education about the range of sexual practices; initiation of a sexual history with both old and new patients; understanding how to deal with their own discomfort and in the use of appropriate and non-judgmental language. GPs need knowledge of resources for further information and referral. Recommendations regarding the minimum strategy for inclusion of a sexual history as part of a standard consultation are made.

A study of women who appear to default from management of an abnormal Pap smear

A study of nonattendance at a Dysplasia Clinic found that 20% of women who had an appointment in 1988 failed to attend the clinic during the next 18 months. Most of the nonattendance was among women who had previously been assessed at the Dysplasia Clinic. Only 6% of the nonattending women had cytological/histological evidence of CIN which remained untreated. If all women who did not default from attendance at the Dysplasia Clinic were correctly managed, then 1% of all women who have appointments made for the Dysplasia Clinic were potentially receiving inadequate management for lesions considered to have a precancerous potential. A questionnaire to the women who failed to attend these appointments identified pregnancy and seeking management elsewhere as the most commonly stated reasons for the nonattendance.