Melbourne School of Population and Global Health - Research Publications
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ItemIs there a role for practice nurses in increasing the uptake of the contraceptive implant in primary care?: survey of general practitioners and practice nurses(CSIRO PUBLISHING, 2016)BACKGROUND: Uptake of long-acting reversible contraception (LARC) in Australia is low. With appropriate training, practice nurses (PNs) in general practice clinics could help increase LARC uptake. METHODS: General practitioners (GPs) and PNs completed a postal survey to assess contraceptive implant knowledge and attitudes towards PNs providing contraception counselling and inserting the contraceptive implant. χ(2) tests were used to detect differences between GPs and PNs. Unadjusted odds ratios (OR) for the association between demographic characteristics and knowledge and attitudes towards the contraceptive implant were calculated for GPs and PNs separately. RESULTS: Four hundred and sixty-eight GPs and 1142 PNs participated. GPs had greater knowledge about LARC than PNs (59% vs 33%; P<0.01). A similar proportion of GPs and PNs (70%) agreed that PNs could become involved in contraceptive counselling. Among GPs, urban-based GPs were less likely to agree that their clinic would be supportive of the PN inserting the implant (OR=0.6; 95% CI: 0.4-0.9). Among PNs, older PNs (OR=0.5; 95% CI: 0.4-0.7) were less likely to agree that the clinic would support PNs inserting the contraceptive implant, but those with Pap test training were more likely to agree (OR=2.1; 95% CI: 1.5-3.0). CONCLUSIONS: This study found high levels of acceptability for PNs to provide contraceptive counselling and insertion of the contraceptive implant. Further research is needed to evaluate the impact of potential interventions that equip PNs with the skills to consult women about contraception and insert the contraceptive implant on LARC uptake.
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ItemA systematic examination of the use of Online social networking sites for sexual health promotion(BMC, 2011-07-21)BACKGROUND: In recent years social networking sites (SNSs) have grown rapidly in popularity. The popularity of these sites, along with their interactive functions, offer a novel environment in which to deliver health promotion messages. The aim of this paper is to examine the extent to which SNSs are currently being used for sexual health promotion and describe the breadth of these activities. METHODS: We conducted a systematic search of published scientific literature, electronic sources (general and scientific search engines, blogs) and SNSs (Facebook, MySpace) to identify existing sexual health promotion activities using SNSs. Health promotion activities were eligible for inclusion if they related to sexual health or behaviour, utilised one or more SNSs, and involved some element of health promotion. Information regarding the source and type of health promotion activity, target population and site activity were extracted. RESULTS: 178 sexual health promotion activities met the inclusion criteria and were included in the review; only one activity was identified through a traditional systematic search of the published scientific literature. Activities most commonly used one SNS, were conducted by not-for-profit organisations, targeted young people and involved information delivery. Facebook was the most commonly used SNS (used by 71% of all health promotion activities identified), followed by MySpace and Twitter. Seventy nine percent of activities on MySpace were considered inactive as there had been no online posts within the past month, compared to 22% of activities using Facebook and 14% of activities using Twitter. The number of end-users and posts in the last seven days varied greatly between health promotion activities. CONCLUSIONS: SNSs are being used for sexual health promotion, although the extent to which they are utilised varies greatly, and the vast majority of activities are unreported in the scientific literature. Future studies should examine the key factors for success among those activities attracting a large and active user base, and how success might be measured, in order to guide the development of future health promotion activities in this emerging setting.
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ItemWhat's in a message? Delivering sexual health promotion to young people in Australia via text messaging(BIOMED CENTRAL LTD, 2010-12-29)BACKGROUND: Advances in communication technologies have dramatically changed how individuals access information and communicate. Recent studies have found that mobile phone text messages (SMS) can be used successfully for short-term behaviour change. However there is no published information examining the acceptability, utility and efficacy of different characteristics of health promotion SMS. This paper presents the results of evaluation focus groups among participants who received twelve sexual health related SMS as part of a study examining the impact of text messaging for sexual health promotion to on young people in Victoria, Australia. METHODS: Eight gender-segregated focus groups were held with 21 males and 22 females in August 2008. Transcripts of audio recordings were analysed using thematic analysis. Data were coded under one or more themes. RESULTS: Text messages were viewed as an acceptable and 'personal' means of health promotion, with participants particularly valuing the informal language. There was a preference for messages that were positive, relevant and short and for messages to cover a variety of topics. Participants were more likely to remember and share messages that were funny, rhymed and/or tied into particular annual events. The message broadcasting, generally fortnightly on Friday afternoons, was viewed as appropriate. Participants said the messages provided new information, a reminder of existing information and reduced apprehension about testing for sexually transmitted infections. CONCLUSIONS: Mobile phones, in particular SMS, offer health promoters an exciting opportunity to engage personally with a huge number of individuals for low cost. The key elements emerging from this evaluation, such as message style, language and broadcast schedule are directly relevant to future studies using SMS for health promotion, as well as for future health promotion interventions in other mediums that require short formats, such as social networking sites.
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ItemThe levonorgestrel intrauterine device in Australia: analysis of prescribing data 2008-2012(BMC, 2018-11-27)BACKGROUND: Unplanned pregnancy is a significant problem in Australia. Local data pertaining to use of the levonorgestrel-releasing intra-uterine device (LNG-IUD), and associated factors are limited. The aim of this analysis was to calculate prescribing rates of the LNG-IUD in Australia, including trends in prescribing and associations with socio-demographic factors, in order to increase understanding regarding potential use. METHODS: We examined prescriptions for the LNG-IUD recorded in the national Pharmaceutical Benefits Scheme (PBS) from 2008 to 2012. Prescribing trends were examined according to patient age, remoteness of residential location, and proximity to relevant specialist health services. Associations between these factors and prescription rates were examined using poisson regression. Analyses were stratified by 5-year age-groups. RESULTS: Age-adjusted prescription rates rose from 11.50 per 1000 women aged 15-49 (95% CI: 11.41-11.59) in 2008 to 15.95 (95% CI:15.85-16.01) in 2012. Prescription rates increased most among 15-19-year-olds but remain very low at 2.76 per 1000 women (95% CI: 2.52-3.01). Absolute increases in prescriptions were greatest among 40-44-year-olds, rising from 16.73 per 1000 women in 2008 (95% CI: 16.12-17.34) to 23.77 in 2012 (95% CI: 22.58-24.29). Rates increased significantly within all geographical locations (p < 0.01). Non-metropolitan location was significantly associated with increased prescribing rates, the association diminishing with increasing age groups. CONCLUSIONS: Prescription of LNG-IUD in Australia is very low, especially among young women and those in major cities. Service providers and young women may benefit from targeted education outlining use of the LNG-IUD, strengthened training and referral pathways. Disparities in prescription according to location require further investigation.
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ItemCohort Profile: Ten to Men ( the Australian Longitudinal Study on Male Health)(OXFORD UNIV PRESS, 2017-06)
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ItemPrescription rates of the contraceptive implant in Australia 2008-2012: impact of patient age and area of residence(CSIRO PUBLISHING, 2016)UNLABELLED: Background Long-acting reversible contraceptives are an effective means of preventing unwanted pregnancies and associated negative consequences. The Sexual Health and Family Planning Association of Australia has called for efforts to address barriers to the uptake of long-acting reversible contraceptives (LARCs) in Australia, where LARC uptake is thought to be low, though comprehensive data describing use and associated factors is scarce. The aims of this study were to describe patterns of prescriptions for the etonogestrel-releasing subdermal implant (SDI) in Australia, 2008-2012, and associated factors. METHODS: Records of prescriptions written through Australia's Pharmaceutical Benefits Scheme from 2008 to 2012 were obtained, including patient age and geographic location. Direct, age-standardised rates (ASR) of prescriptions were calculated for each year and location, with multivariate analysis used to examine associations between prescription rates and patient age, location and proximity to family planning clinics (FPC) or Aboriginal Medical Services (AMS). RESULTS: ASR of prescriptions rose ~6% per year (OR 1.06, 95%CI: 1.05-1.06) from 13.05 per 1000 (2008) to 15.76 per 1000 (2012; P<0.01). Rates were highest among 15- to 19-year-olds, increasing from 20.81 (2008) to 29.09 per 1000 (2012: P<0.01) and lowest among 45- to 49-year-olds, increasing from 3.37 to 3.73 per 1000 (P<0.01). ASR by location were significantly higher in regional than metropolitan areas. CONCLUSIONS: This is the first analysis of SDI prescriptions across all ages and regions of Australia. Uptake of SDI in Australia is increasing but remains low. Significant associations were found between prescription rates and patient age and residence in regional/remote areas.
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ItemThe Australian longitudinal study on male health-methods(BMC, 2016-10-31)BACKGROUND: The Australian Longitudinal Study on Male Health (Ten to Men) was established in 2011 to build the evidence base on male health to inform policy and program development. METHODS: Ten to Men is a national longitudinal study with a stratified multi-stage cluster random sample design and oversampling in rural and regional areas. Household recruitment was conducted from October 2013 to July 2014. Males who were aged 10 to 55 years residing in private dwellings were eligible to participate. Data were collected via self-completion paper questionnaires (participants aged 15 to 55) and by computer-assisted personal interview (boys aged 10 to 14). Household and proxy health data for boys were collected from a parent via a self-completion paper-based questionnaire. Questions covered socio-demographics, health status, mental health and wellbeing, health behaviours, social determinants, and health knowledge and service use. RESULTS: A cohort of 15,988 males aged between 10 and 55 years was recruited representing a response fraction of 35 %. CONCLUSION: Ten to Men is a unique resource for investigating male health and wellbeing. Wave 1 data are available for approved research projects.
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ItemUnderstanding the low uptake of long-acting reversible contraception by young women in Australia: a qualitative study(BMC, 2015-09-10)BACKGROUND: Australia has high rates of teenage pregnancy compared with many Western countries. Long-acting reversible contraception (LARC) offers an effective method to help decrease unintended pregnancies; however, current uptake remains low. The aim of this study was to investigate barriers to LARC use by young women in Australia. METHODS: Healthcare professionals were recruited through publicly available sources and snowball sampling to complete an interview about young women's access to and use of LARC. The sample consisted of general practitioners, nurses, medical directors of reproductive and sexual health organisations, a sexual health educator, and health advocates. In addition, four focus groups about LARC were conducted with young women (aged 17-25 years) recruited via health organisations and a university. The data were analysed thematically. RESULTS: Fifteen healthcare professionals were interviewed and four focus groups were conducted with 27 young women. Shared barriers identified included norms, misconceptions, bodily consequences, and LARC access issues. An additional barrier identified by young women was a perceived lack of control over hormones entering the body from LARC devices. Healthcare professionals also raised as a barrier limited confidence and support in LARC insertions. Strategies identified to increase contraceptive knowledge and access included increasing nurses' role in contraceptive provision and education, improving sex education in schools, and educating parents. CONCLUSIONS: Challenges remain for young women to be able to make informed choices about contraception and easily access services. More research is needed around innovative approaches to increase LARC knowledge and access, including examining the role of nurses in enhancing young women's reproductive health.
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ItemThe maternal health outcomes of paid maternity leave: A systematic review(PERGAMON-ELSEVIER SCIENCE LTD, 2015-04)Paid maternity leave has become a standard benefit in many countries throughout the world. Although maternal health has been central to the rationale for paid maternity leave, no review has specifically examined the effect of paid maternity leave on maternal health. The aim of this paper is to provide a systematic review of studies that examine the association between paid maternity leave and maternal health. We conducted a comprehensive search of electronic databases (Medline, Embase, CINAHL, PsycINFO, Web of Science, Sociological Abstracts) and Google Scholar. We searched websites of relevant organisations, reference lists of key papers and journals, and citation indices for additional studies including those not in refereed journals. There were no language restrictions. Studies were included if they compared paid maternity leave versus no paid maternity leave, or different lengths of paid leave. Data were extracted and an assessment of bias was performed independently by authors. Seven studies were identified, with participants from Australia, Sweden, Norway, USA, Canada, and Lebanon. All studies used quantitative methodologies, including cohort, cross-sectional, and repeated cross-sectional designs. Outcomes included mental health and wellbeing, general health, physical wellbeing, and intimate partner violence. The four studies that examined leave at an individual level showed evidence of maternal health benefits, whereas the three studies conducting policy-level comparisons reported either no association or evidence of a negative association. The synthesis of the results suggested that paid maternity leave provided maternal health benefits, although this varied depending on the length of leave. This has important implications for public health and social policy. However, all studies were subject to confounding bias and many to reverse causation. Given the small number of studies and the methodological limitations of the evidence, longitudinal studies are needed to further clarify the effects of paid maternity leave on the health of mothers in paid employment.