Angela L. Todd

What works to increase the use of research in population health policy and programmes: a review

Policy agencies are implementing strategies to increase the use of research in policy decisions. This paper examines the evidence about the effectiveness of these strategies. We conducted an extensive search focused on population health policy and programmes. We classified 106 papers meeting study criteria into research type (conceptual, descriptive and intervention). We examined the descriptive studies to identify commonly nominated potential intervention strategies. We examined the intervention studies to evaluate the impact of the tested strategies in increasing the use of research in policy decisions. There is little evidence about which strategies increase the use of evidence in population health policy and programmes.

Pathways to a rising caesarean section rate: a population-based cohort study

Objectives To determine whether the obstetric pathways leading to caesarean section changed from one decade to another. We also aimed to explore how much of the increase in caesarean rate could be attributed to maternal and pregnancy factors including a shift towards delivery in private hospitals. Design Population-based record linkage cohort study. Setting New South Wales, Australia. Participants For annual rates, all women giving birth in NSW during 1994 to 2009 were included. To examine changes in obstetric pathways two cohorts were compared: all women with a first-birth during either 1994–1997 (82 988 women) or 2001–2004 (85 859 women) and who had a second (sequential) birth within 5 years of their first-birth. Primary outcome measures Caesarean section rates, by parity and onset of labour. Results For first-births, prelabour and intrapartum caesarean rates increased from 1994 to 2009, with intrapartum rates rising from 6.5% to 11.7%. This fed into repeat caesarean rates; from 2003, over 18% of all multiparous births were prelabour repeat caesareans. In the 1994–1997 cohort, 17.7% of women had a caesarean delivery for their first-birth. For their second birth, the vaginal birth after caesarean (VBAC) rate was 28%. In the 2001–2004 cohort, 26.1% of women had a caesarean delivery for their first-birth and the VBAC rate was 16%. Among women with a first-birth, maternal and pregnancy factors and increasing deliveries in private hospitals, only explained 24% of the rise in caesarean rates from 1994 to 2009. Conclusions Rising first-birth caesarean rates drove the overall increase. Maternal factors and changes in public/private care could explain only a quarter of the increase. Changes in the perceived risks of vaginal birth versus caesarean delivery may be influencing the pregnancy management decisions of clinicians and/or mothers.

Women׳s views about maternity care: How do women conceptualise the process of continuity?

OBJECTIVE to gain an understanding of how women conceptualise continuity of maternity care. DESIGN a qualitative study involving in-depth semi-structured interviews and thematic analysis. SETTING a range of urban and rural public hospitals in New South Wales, Australia. PARTICIPANTS 53 women aged 18-44 years (median age 27 years) receiving maternity care in 2011-2012. FINDINGS responses from women suggested five concepts of continuity: continuity of staff, continuity of relationship, continuity of information, continuity across pregnancies and continuity across locations. These concepts of continuity differed by parity and location. CONCLUSION AND IMPLICATIONS FOR PRACTICE continuity of maternity care has a variety of meanings to women. If health care providers are to commit to providing woman-centred maternity care it is important to recognise the diversity of womens experiences, and ensure that systems of care are flexible and appropriate to womens circumstances and needs.

Collecting and using aboriginal health information in New South Wales.

Objective: To describe the development of guidelines for the management of Aboriginal health information in NSW. The purpose of the guidelines is to promote the ethical management of Aboriginal health information, with appropriate consideration for cultural factors.

Women's beliefs about the duration of pregnancy and the earliest gestational age to safely give birth

American evidence suggests women are not well informed about the optimal duration of pregnancy or the earliest time for safe birth. Similar evidence does not exist in Australia.

Reducing caesarean section rates--no easy task.

To identify the greatest potential for reducing overall caesarean delivery rates, we used longitudinally linked data for women with consecutive births 2001–2009 to examine the likely impact of hypothetical risk‐based scenarios. Among women with a first birth, singleton, vertex‐presenting fetus at term, increasing the vaginal birth rate following induction of labour by 20% potentially has greatest impact, with a 12.1% relative decrease in the overall caesarean rate. The potential relative decrease in other scenarios ranged from 0.8 to 5.9%.

Ethnicity or cultural group identity of pregnant women in Sydney, Australia: Is country of birth a reliable proxy measure?

BACKGROUND Australia has one of the most ethnically and culturally diverse maternal populations in the world. Routinely few variables are recorded in clinical data or health research to capture this diversity. This paper explores how pregnant women, Australian-born and overseas-born, respond to survey questions on ethnicity or cultural group identity, and whether country of birth is a reliable proxy measure. METHODS As part of a larger study, pregnant women attending public antenatal clinics in Sydney, Australia, completed a survey about their knowledge and expectations of pregnancy duration. The survey included two questions on country of birth, and identification with an ethnicity or cultural group. Country of birth data were analysed using frequency tabulations. Responses to ethnicity or cultural group were analysed using inductive coding to identify thematic categories. RESULTS Among the 762 with 75 individual cultural groups or ethnicities and 68 countries of birth reported. For Australian-born women (n=293), 23% identified with a cultural group or ethnicity, and 77% did not. For overseas-born women (n=469), 44% identified with a cultural group or ethnicity and 56% did not. Responses were coded under five thematic categories. CONCLUSIONS Ethnicity and cultural group identity are complex concepts; women across and within countries of birth identified differently, indicating country of birth is not a reliable measure. To better understand the identities of the women receiving maternity care, midwives, clinicians and researchers have an ethical responsibility to challenge practices that quantify cultural group or ethnicity, or use country of birth as a convenient proxy measure.

Testing a health research instrument to develop a state-wide survey on maternity care.

Partnerships between researchers and end users are an important strategy for research uptake in policy and practice. This paper describes how collaboration between an academic research organisation (the Kolling Institute) and a government performance reporting agency (the New South Wales [NSW] Bureau of Health Information) contributed to the development of a new state-wide maternity care survey for NSW.

Women’s views about the timing of birth

BACKGROUND Estimated date of birth (EDB) is used to guide the care provided to women during pregnancy and birth, although its imprecision is recognised. Alternatives to the EDB have been suggested for use with women however their attitudes to timing of birth information have not been examined. AIMS To explore womens expectations of giving birth on or near their EDB, and their attitudes to alternative estimates for timing of birth. METHODS A survey of pregnant women attending four public hospitals in Sydney, Australia, between July and December 2012. RESULTS Among 769 surveyed women, 42% expected to birth before their due date, 16% after the due date, 15% within a day or so of the due date, and 27% had no expectations. Nulliparous women were more likely to expect to give birth before their due date. Women in the earlier stages of pregnancy were more likely to have no expectations or to expect to birth before the EDB while women in later pregnancy were more likely to expect birth after their due date. For timing of birth information, only 30% of women preferred an EDB; the remainder favoured other options. CONCLUSIONS Most women understood the EDB is imprecise. The majority of women expressed a preference for timing of birth information in a format other than an EDB. In support of woman-centred care, clinicians should consider discussing other options for estimated timing of birth information with the women in their care.

Are women birthing in New South Wales hospitals satisfied with their care

BackgroundSurveys of satisfaction with maternity care have been conducted using overnight inpatient surveys and dedicated maternity surveys in a number of Australian settings, however none have been used to report on satisfaction with maternity care among women in New South Wales. The aims of this study were to investigate the association between: 1) parity (first and subsequent births) and patient experience of hospital care at birth, and 2) other patient, birth and hospital characteristics and experience of hospital care at birth.MethodsData were from the New South Wales (NSW) Ministry of Health surveys of overnight hospital inpatients, including maternity patients, between 2007 and 2011. Questionnaires were mailed to a sample of patients three months after receiving inpatient services involving at least 1 night in a public hospital. Experience of care included 12 items grouped into: satisfaction with care, staff and information. Results were weighted to overall hospital facility populations and age-standardised. Frequencies and chi-square tests were used.ResultsAnalysis of responses from 5,367 obstetric patients revealed three quarters of women were satisfied with care provided in hospital. Compared with women who had previously given birth, first-time mothers were more likely to recommend their birth hospital to friends and family (60.5% versus 56.4%; P < 0.05), less likely to have experienced differing messages from staff (44.8% vs 59.4%; P < 0.001), and less likely to feel they had received sufficient information about feeding (58.8% vs 65.0%; P < 0.001) and caring for their babies (52.4% vs 65.2%; P < 0.001). While metropolitan women were more likely to rate their birth hospital positively (76.0% vs. 71.3%; P < 0.05) than their rural counterparts, rural women tended to rate the care they received (68.1% vs. 63.4%; P < 0.05), and doctors (70.7% vs 61.1%; P < 0.05) and nurses (73.5% vs. 66.9%; P < 0.001) more highly than metropolitan women.ConclusionsThe overall picture of maternity care satisfaction in New South Wales is a positive one, with three quarters of women satisfied with care. Further resources could be dedicated to ensuring consistency and amount of information provided, particularly to first-time mothers.