Australian Population-based Survey Research Articles

Experiences of discrimination and positive treatment from health professionals: A national survey of adults with mental health problems.

To systematically investigate the scope and nature of discrimination and positive treatment experienced by adults with mental health problems when using health services in an Australian population-based survey. Australian adults (n = 1381) who reported a mental health problem or scored high on a screening questionnaire were interviewed about their experience of discrimination and positive treatment from healthcare professionals. Descriptions of experiences were content-analysed to identify key characteristics. In all, 11.8% of respondents reported discrimination from a health professional in the past 12 months. The most common types of discrimination included being treated dismissively, being judged and not being listened to, particularly regarding personal history and treatment needs. In contrast, 40.4% reported being treated more positively by their health professional because of their mental health problem. Key types of positive treatment by health professionals were being supportive and understanding and being a good listener. Good quality care approaches were also appreciated, including making a referral, being engaged in the treatment process, regularly checking the status of the person's mental health and providing information. A minority of respondents with mental health problems had experienced discrimination from their healthcare professional, potentially interfering with recovery. Anti-stigma education interventions for healthcare professionals should address how to increase knowledge and understanding of mental health problems, reduce negative attitudes and encourage supportive behaviours.

Personal Perspectives on Enablers and Barriers to Accessing Care for Hip and Knee Osteoarthritis.

Despite increasing demand for joint replacement surgery and other health services for hip and knee osteoarthritis (OA), barriers and enablers to individual access to care are not well understood. A comprehensive understanding of drivers at all levels is needed to inform efforts for improving access. The aim of this study was to explore perceived barriers and enablers to receiving conservative (nonsurgical) and surgical treatment for hip and knee OA. This was a qualitative study using directed content analysis. Semistructured telephone interviews were conducted, with 33 participants randomly sampled from an Australian population-based survey of hip and knee OA. Each interview covered factors contributing to receiving treatment for OA and perceived barriers to accessing care. Interview transcripts were coded and organized into themes. Key barriers to accessing care for OA included medical opinions about saving surgery for later and the appropriate age for joint replacement. Other common barriers included difficulty obtaining referrals or appointments, long waiting times, work-related issues, and limited availability of primary and specialist care in some areas. Several participants perceived a lack of effective treatment for OA. Private health insurance was the most frequently cited enabler and was perceived to support the costs of surgical and conservative treatments, including physical therapy, while facilitating faster access to surgery. Close proximity to services and assistance from medical professionals in arranging care also were considered enablers. People with hip or knee OA experience substantial challenges in accessing treatment, and these challenges relate predominantly to health professionals, health systems, and financial factors. Private health insurance was the strongest perceived enabler to accessing care for OA.

Who is holding the baby? Women's experiences of contact with their baby immediately after birth: An Australian population-based survey.

Seeing and holding their baby immediately after the birth is the pinnacle of the childbearing process for parents. Few studies have examined women's experiences of seeing and holding their baby immediately after birth. We investigated women's experiences of initial contact with their newborns using data from an Australian population-based survey. All women who gave birth in September/October in 2007 in two Australian states were mailed questionnaires six months following the birth. Women were asked three questions about early newborn contact including where their baby was held in the first hour after birth and whether they were able to hold their baby as soon and for as long as they liked. We examined the association between model of maternity care and early newborn contact stratified by admission to SCN/NICU. The majority (92%) of women whose babies remained with them reported holding their babies as soon and for as long as they liked in the first hour after birth. However, for women whose babies were admitted to SCN/NICU only a minority (47%) reported this. Women in public models of care (with the exception of primary midwifery care) whose babies remained with them were less likely to report holding their babies as soon and for as long as they liked compared to women in private care. Our findings suggest that there is potential to increase the proportion of mothers and fathers who get to hold their baby immediately after the birth by modifying birth suite and operating room practices.

Use of antiseptic hand rubs in the health and community services industry: an Australian population-based survey.

The use of antiseptic hand rubs (AHRs), rather than washing with soap and water, is considered to be the gold standard for reducing the frequency of nosocomial infections, as well as being less damaging to the hands than washing with soap and water, but little is known at a population level about usage patterns for AHRs. To describe AHR use patterns among workers in the health and community services industry in Australia. Using data from a population-based survey of Australian workers, we focused on health and community services workers' exposure to chemicals at work, including the use of AHRs. Data regarding the frequency of hand-washing were also collected. Nine hundred and fifty-six health and community service workers participated in the Australian National Hazard Exposure Worker Surveillance survey. Of these, 11% reported using AHRs, and 31% reported hand-washing >20 times per shift. According to an adjusted logistic regression model, professional workers [adjusted odds ratio (aOR) 2.29, 95% confidence interval (CI): 1.40-3.72] and frequent hand washers (aOR 3.08, 95%CI: 1.92-4.93) were more likely to use AHRs. AHR use by health and community service workers was generally lower than expected. AHR use was most likely to be reported by professionals and frequent hand washers, suggesting that AHRs are used as an adjunct to conventional hand-washing.

A longitudinal study of the health and wellbeing of culturally and linguistically diverse caregivers of people with psychosis in Australia.

Despite Australia being an ethnically diverse country, there are limited longitudinal studies of the health and wellbeing of culturally and linguistically diverse (CALD) carers of people with psychosis. An Australian population-based survey found that 22.7% of carers of people with mental disorders were born overseas. This study aimed to explore the demographic profile, social connectedness, psychological health, quality of life, grief and caregiving consequences of CALD carers of people with psychosis over 12 months. This longitudinal study utilised a prevalence survey design and recruited 52 CALD carers who were born in 24 countries outside Australia. A series of validated instruments were administered to assess carer health and wellbeing. Descriptive and inferential analysis of the results suggested that CALD carers experienced social isolation (34.7%), psychological distress (28.9%), moderate grief and caregiving consequences and poorer quality of life than the general population. Younger CALD carers and spouse carers experienced greater negative caregiving consequences than other kinship or friend carers. There were no significant changes in these outcomes over the 12-month period of the study. Ethnic-sensitive interventions are needed to better support CALD carers experiencing negative caregiving consequences, especially younger carers or spouses, within the current level of service provision.

Who is holding the baby? Women's experiences of contact with their baby immediately after birth: An Australian population-based survey

Abstract Background Seeing and holding their baby immediately after the birth is the pinnacle of the childbearing process for parents. Few studies have examined women's experiences of seeing and holding their baby immediately after birth. We investigated women's experiences of initial contact with their newborns using data from an Australian population-based survey. Methods All women who gave birth in September/October in 2007 in two Australian states were mailed questionnaires six months following the birth. Women were asked three questions about early newborn contact including where their baby was held in the first hour after birth and whether they were able to hold their baby as soon and for as long as they liked. We examined the association between model of maternity care and early newborn contact stratified by admission to SCN/NICU. Results The majority (92%) of women whose babies remained with them reported holding their babies as soon and for as long as they liked in the first hour after birth. However, for women whose babies were admitted to SCN/NICU only a minority (47%) reported this. Women in public models of care (with the exception of primary midwifery care) whose babies remained with them were less likely to report holding their babies as soon and for as long as they liked compared to women in private care. Conclusion Our findings suggest that there is potential to increase the proportion of mothers and fathers who get to hold their baby immediately after the birth by modifying birth suite and operating room practices.

Why are young women less likely to breastfeed? Evidence from an Australian population-based survey.

Younger mothers are less likely to continue breastfeeding compared with older mothers. However, few studies have explored this finding. The aim of this study was to investigate breastfeeding initiation and duration among women aged under 25 and 25years or older, and assess the extent to which any differences associated with maternal age were explained by other factors. All women who gave birth in September and October 2007 in two Australian states were mailed questionnaires 6months after the birth. Women were asked about infant feeding, maternity care experiences, sociodemographic characteristics, and exposure to stressful life events and social health issues. We examined the association between maternal age, breastfeeding initiation, and breastfeeding at 6months, while adjusting for a range of social and obstetric risk factors. While younger women were just as likely to initiate breastfeeding as older women (AdjOR 1.13; 95% CI 0.63-2.05), they had almost twice the odds of not breastfeeding at 6months (AdjOR 1.76; 95% CI 1.34-2.33). Several psychosocial factors may explain why young women are less likely to breastfeed for longer periods. Given the complexity of young childbearing women's lives, supporting them to breastfeed will require a multisectorial approach that addresses social disadvantage and resulting health inequalities.

Asking Women about Mental Health and Social Adversity in Pregnancy: Results of an Australian Population-Based Survey

Social adversity undermines health in pregnancy. The objective of this study was to examine the extent to which pregnant women were asked about their mental health and life circumstances in pregnancy checkups. Population-based postal survey of recent mothers in two Australian states. Around half of the 4,366 participants reported being asked about depression (45.9%) and whether they were anxious or worried about things happening in their life (49.6%); fewer reported being asked about relationship issues (29.6%), financial problems (16.6%), or family violence (14.1%). One in five women (18%) reported significant social adversity. These women were more likely to recall being asked about their mental health and broader social health issues. Far higher levels of inquiry were reported by women in the public maternity system with midwives more likely than doctors to ask about mental health, family violence, and other social hardships. Routine pregnancy visits afford a window of opportunity for identifying and supporting women experiencing mental health problems and social adversity. Changing practice to take advantage of this opportunity will require concerted and coordinated efforts by practitioners and policy makers to build systems to support public health approaches to antenatal care.

The Public’s views of mental health in pregnant and postpartum women: a population-based study

BackgroundWe used population-based data to determine the public’s views of prenatal and postnatal mental health and to identify predictors of those views.MethodsA computer-assisted telephone survey was conducted by the Population Health Laboratory (University of Alberta) with a random sample of participants from the province of Alberta, Canada. Respondents were eligible to participate if they were: 1) ≥18 years; and 2) contacted by direct dialing. Questions were drawn from the Perinatal Depression Monitor, an Australian population-based survey on perinatal mental health; additional questions were developed and tested to reflect the Canadian context. Descriptive and multivariable regression analyses were conducted.ResultsAmong the 1207 respondents, 74.7% had post-secondary education, 16.3% were in childbearing years, and over half (57.4%) reported knowing a woman who had experienced postpartum depression. Significantly more respondents had high levels of knowledge of postnatal (87.4%) than prenatal (70.5%) mental health (p < .01). Only 26.6% of respondents accurately identified that prenatal anxiety/depression could negatively impact child development. Personal knowledge of a woman with postpartum depression was a significant predictor of prenatal and postnatal mental health knowledge.ConclusionsWhile the public’s knowledge of postnatal mental health is high, knowledge regarding prenatal mental health and its influence on child development is limited. Strategies for improving perinatal mental health literacy should target these knowledge deficits.

Public views of acceptability of perinatal mental health screening and treatment preference: a population based survey.

BackgroundAt a prevalence rate of 13-25%, mental health problems are among the most common morbidities of the prenatal and postnatal periods. They have been associated with increased risk of preterm birth and low birthweight, child developmental delay, and poor child mental health. However, very few pregnant and postpartum women proactively seek help or engage in treatment and less than 15% receive needed mental healthcare. While system-related barriers limit accessibility and availability of mental health services, personal barriers, such as views of mental health and its treatment, are also cited as significant deterrents of obtaining mental healthcare. The purposes of this population-based study were to identify the public’s views regarding mental health screening and treatment in pregnant and postpartum women, and to determine factors associated with those views.MethodsA computer-assisted telephone survey was conducted by the Population Research Laboratory with a random sample of adults in Alberta, Canada. Questions were drawn from the Perinatal Depression Monitor, an Australian population-based survey on perinatal mental health; additional questions were developed and tested to reflect the Canadian context. Interviews were conducted in English and were less than 30 minutes in duration. Descriptive and multivariable regression analyses were conducted.ResultsAmong the 1207 respondents, 74.8% had post-secondary education, 16.3% were 18-34 years old, and two-thirds (66.1%) did not have children <18 years living at home. The majority of respondents strongly agreed/agreed that all women should be screened in the prenatal (63.0%) and postpartum periods (72.7%). Respondents reported that when seeking help and support their first choice would be a family doctor. Preferred treatments were talking to a doctor or midwife and counseling. Knowledge of perinatal mental health was the main factor associated with different treatment preferences.ConclusionsThe high acceptability of universal perinatal mental health screening among the public provides a strong message regarding the public value for routine screening during pregnancy and postpartum periods. Perinatal mental health literacy is the most prominent determinant of screening and treatment acceptability and preference. Efforts to enhance population literacy as part of a multifaceted perinatal mental health strategy may optimize pregnant and postpartum women’s mental health.

Women’s experience of domiciliary postnatal care in Victoria and South Australia: a population-based survey

Despite the expansion of postnatal domiciliary services, we know little about the women receiving visits and how they regard their care. The aim of this study is to examine the provision of postnatal domiciliary care from a consumer perspective. All women who gave birth in September-October 2007 in South Australia and Victoria were mailed questionnaires 6 months after the birth. Women were asked if they had received a midwifery home visit, and to rate the care they received. More women in South Australia reported receiving a domiciliary visit than in Victoria (88.0% v. 76.0%) and they were more likely to rate their care as 'very good' (69.1% v. 63.4%). Younger women, women on a lower income, who were holding a healthcare concession card or who had not completed secondary education were less likely to receive a visit. Although the majority of women in public maternity care in Victoria and South Australia receive domiciliary care and rate it positively, there are significant state-based differences. Those more likely to benefit from domiciliary care are less likely to receive a visit. There is a need to further explore the purpose, aims and content of domiciliary care at individual and state-wide levels.

In-Hospital Formula Supplementation of Breastfed Babies: A Population-Based Survey

In-hospital formula supplementation of breastfed newborns is commonplace despite its negative association with breastfeeding duration. Although several studies have described the use of formula supplementation, few have explored the factors that may be associated with its use. The aim of this study was to explore factors associated with in-hospital formula supplementation using data from a large Australian population-based survey. All women who gave birth in September and October 2007 in two Australian states were mailed questionnaires 6 months after the birth. Women were asked how they fed their baby while in hospital after the birth. Multivariable logistic regression was used to explore specified a priori factors associated with in-hospital formula supplementation. Of 4,085 women who initiated breastfeeding, 23 percent reported their babies receiving formula supplementation. Breastfed babies had greater odds of receiving formula supplementation if their mother was primiparous (adj. OR=2.16; 95% CI: 1.76-2.66); born overseas and of non-English-speaking background (adj. OR=2.03; 95% CI: 1.56-2.64); had a body mass index more than 30 (adj. OR=2.27; 95% CI: 1.76-2.95); had an emergency cesarean section (adj. OR=1.72; 95% CI: 1.3-2.28); or the baby was admitted to a special care nursery (adj. OR=2.72; 95% CI: 2.19-3.4); had a birthweight less than 2,500 g (adj. OR=2.02; 95% CI: 1.3-3.15) or was born in a hospital not accredited with Baby-Friendly Hospital Initiative (BFHI) (adj. OR=1.53; 95% CI: 1.2-1.94). The number of factors associated with in-hospital formula supplementation suggests that this practice is complex. Some results, however, point to an opportunity for intervention, with the BFHI appearing to be an effective strategy for supporting exclusive breastfeeding.

Prevalence and correlates of multiple cancer risk behaviors in an Australian population-based survey: results from the Queensland Cancer Risk Study

To report on the prevalence, clustering, and correlates of behavioral risk factors for cancer in the Queensland, Australia, population. The Queensland Cancer Risk Study was a population-based survey of 9419 Queensland residents aged 20-75 years. Information was collected through anonymous computer-assisted telephone interviews between February and November 2004. Prevalence of tobacco smoking, alcohol consumption, obesity, physical inactivity, sun exposure, and inadequate fruit and vegetable intake, weighted by age, gender, and geographic region. The majority of respondents reported between two and four cancer risk behaviors (79.4%). Men, those younger than 59 years and those with lower educational attainment had more than twofold increased odds of reporting multiple cancer risk factors. Marital status and geographic region were moderately associated with cancer risk. Smoking, high levels of alcohol consumption, and sun exposure were associated with up to twofold increased odds of engaging in multiple additional risk factors. This study identified key subgroups of the Queensland population with increased odds of engaging in multiple risk behaviors for cancer, particularly younger men and people with lower educational attainment. Individual behavioral risk factors can also exert a significant impact on the overall risk profile, and this may be a useful consideration for public health campaigns that target key health behaviors.

Health behaviors of cancer survivors: data from an Australian population-based survey

With increases in cancer survival, promotion of healthy lifestyle behaviors among survivors is receiving considerable attention. This study compared health behaviors among a large sample of Australian adult cancer survivors with an age- and sex-matched cohort of people with no cancer history. Using the Australian National Health Survey, 968 cancer survivors were identified, and randomly matched by age and sex to 5,808 respondents without a history of cancer. Six health behaviors were compared (smoking, physical activity, servings of vegetables, servings of fruit, alcohol use, skin checks), along with overweight and obesity, using polytomous logistic regression analyses controlling for selected chronic conditions. Models were applied across both groups and by tumor site. Compared to the non-cancer comparison group, cancer survivors were significantly more likely to be current (OR = 1.35) smokers, particularly those under 40 years (OR = 1.69), and more likely to have regular skin checks (OR = 1.76). Although not significant, there was consistent evidence that cancer survivors were slightly more likely to be overweight or obese (p = 0.065) and have higher levels of alcohol consumption (p = 0.088). There was no evidence of differences between survivors and controls for levels of physical inactivity, vegetable consumption or fruit consumption. Women with a history of gynecological cancers were much more likely to be current smokers (OR = 2.37), while other differences by sex and cancer site were consistent with overall patterns. Cancer survivors were also significantly more likely to report having a range of co-morbid chronic medical conditions. Given their increased risk of second cancers and co-morbid chronic conditions, the lack of difference in behavioral risk factors confirms the need for a focus on improving the health behaviors of cancer survivors. Collaborative chronic disease management models may be particularly appropriate in this regard.

Reasons to stay, reasons to go: results of an Australian population-based survey.

Debate about early obstetric discharge is occurring simultaneously in several different countries. An Australian population-based survey of recent mothers investigated women's views about shorter postnatal stays and assessed the impact of early discharge on important maternal health outcomes. Women's views and experiences of length of hospital stay were gathered by means of a statewide postal survey of all women who gave birth in Victoria, Australia, during two weeks in 1993. Questionnaires were mailed to women 6 to 7 months after the birth; 62.5 percent (n = 1336) responded. Most of the sample (64%) stayed in hospital for 5 or more days after the birth, 26.6 percent left on day 3 or 4, and 9.4 percent on day 1 or 2. Compared with women who stayed for 5 or more days, women who left in the first 48 hours were more likely to be multiparous; to have attended public models of care (public hospital clinic, shared care, public general practitioner, birth center); not to have private health insurance; to have experienced a lower level of obstetric intervention; and to have a very low income. Twenty-one percent of women who left within 48 hours, and 26 percent of those who left on day 3 or 4 described their stay as too short. Women who left on day 3 or 4, or within 48 hours, were not more likely to experience any of the adverse outcomes investigated in the study: breastfeeding problems, low confidence about caring for the baby, or depression 6 to 7 months after birth. Women who left on day 3 or 4 had slightly lower rates of breastfeeding at 3 and 6 months than women staying for longer or shorter periods. Concerns about possible adverse outcomes resulting from shorter postnatal stays were not borne out by the study findings. Large and carefully designed randomized trials are needed to resolve continuing uncertainties about the safety and possible benefits of shorter hospital stays.