Frances Mary Doran

Factors that influence physical activity for pregnant and postpartum women and implications for primary care

Many pregnant women and women of child-bearing age do not engage in the recommended levels of physical activity despite the well known benefits. Pregnancy and the postpartum period can be a time when inactivity actually increases. Women who experience gestational diabetes mellitus (GDM) during their pregnancy are often advised to become more active in order to ameliorate their increased risk of developing type 2 diabetes. Health professionals have an influential role in promoting physical activity, which would be enhanced with an understanding of the factors that positively and negatively influence womens participation in physical activity during pregnancy and in the postpartum period. This research sought to explore these factors with pregnant and postpartum women including those who had experienced GDM and the attention given to physical activity during pregnancy. A survey was developed after a critical review of factors identified from previous studies. Women were recruited from the antenatal clinic, community health centres and the local media. Results from 72 women are reported from a predominately well educated, Caucasian population. Overall, the results were confirmatory of factors previously identified. Lack of child care, time constraints, no time and feeling unwell during pregnancy hindered activity and factors that facilitated activity included family support, enjoyment of activity and to prevent later health problems. It was also found that non-GDM women are given minimal advice about exercise during pregnancy. A checklist has been developed for health professionals, in partnership with women, to direct attention to the factors that enable and hinder participation in physical activity during and after pregnancy.

Women's health: consumer views for planning local health promotion and health care priorities

Abstract: A random door knock survey was conducted in five metropolitan postcode areas with a high proportion of low‐income households to establish: 1. the health problems experienced by women, 2. the problems with which women would have liked more help, and 3. womens perceptions of how their health care experiences might have been improved. In all, 214 women were interviewed. Across all age groups the most common problems were tiredness, premenstrual syndrome, stress, being overweight and disturbed sleep. Premenstrual syndrome, tiredness and arthritis were the most commonly experienced problems among younger, middle‐aged and older women respectively. In general, women were satisfied with the help available to them for their health problems, but one in five would have liked more help to cope with stress, and one in six said they would like help to address the issue of quality of medical care. In relation to health care services, suggestions for improvement included the provision of better health information from doctors and other health care professionals, and more opportunities for counselling and self‐help. The project findings will be used to influence the development of local policies and services, and will form the focus for local womens health promotion programs.

Barriers and facilitators of access to first-trimester abortion services for women in the developed world: a systematic review

Objectives To identify the barriers and facilitators to accessing first-trimester abortion services for women in the developed world. Methods Systematic review of published literature. CINAHL, PubMed, Proquest, MEDLINE, InformIT, Scopus, PsycINFO and Academic Search Premier were searched for papers written in the English language, from the developed world, including quantitative and qualitative articles published between 1993 and 2014. Results The search initially yielded 2511 articles. After screening of title, abstract and removing duplicates, 38 articles were reviewed. From the provider perspective, barriers included moral opposition to abortion, lack of training, too few physicians, staff harassment, and insufficient hospital resources, particularly in rural areas. From the womens perspective, barriers included lack of access to services (including distance and lack of service availability), negative attitudes of staff, and the associated costs of the abortion procedure. Service access could be enhanced by increasing training, particularly for mid-level practitioners; by increasing the range of service options, including the use of telehealth; and by creating clear guidelines and referral procedures to alternative providers when staff have a moral opposition to abortion. Conclusion Despite fewer legal barriers to accessing abortion services, the evidence from this review suggests that women in developed countries still face significant inequities in terms of the level of quality and access to services as recommended by the World Health Organization.

Prevalence, nature and determinants of postpartum mental health problems among women who have migrated from South Asian to high-income countries: a systematic review of the evidence.

BACKGROUND Women of reproductive age constitute a significant proportion of immigrants from South Asia to high-income countries. Pregnancy, childbirth and the postpartum period place increased demands on women׳s psychological resources and relationships. The aim of this review was to evaluate the available evidence about the prevalence, nature and determinants of postpartum mental health problems among South Asian women who have migrated to high-income countries. METHODS Using a systematic strategy, CINAHL, Medline, PsychInfo and Web of Science databases were searched. RESULTS Fifteen studies conducted in different high-income countries met inclusion criteria. Prevalence estimates of clinically significant symptoms of postpartum depression (CSS-PPD) varied widely (1.9-52%): the most common estimates ranged from 5 to 20%. Five studies found approximately a two-fold increase in risk of CSS-PPD (Odds Ratios 1.8-2.5) among overseas born women with a South Asian subgroup. The most common determinants appeared to be social factors, including social isolation and quality of relationship with the partner. Barriers to accessing health care included lack of English language proficiency, unfamiliarity with local services and lack of attention to mental health and cultural factors by health care providers. LIMITATIONS The settings, recruitment strategies, inclusion and exclusion criteria, representative adequacy of the samples and assessment measures used in these studies varied widely. Many of these studies did not use formally validated tools or undertake specific subgroup analyses. CONCLUSIONS Reductions in postpartum depression could be achieved by increasing awareness of available services and ensuring health care professionals support the mental health of women from diverse cultural and linguistic backgrounds.

Rural New South Wales women's access to abortion services: highlights from an exploratory qualitative study.

Objective The aim of the study was to identify factors that New South Wales (NSW) rural women experience in relation to their ability to access an abortion service and follow-up care. Design The qualitative responses from interviews are reported. Setting Rural and regional NSW. Participants Staff from community based non-government Womens Health Centres across regional/rural NSW and women in rural NSW who had accessed an abortion in the preceding fifteen years. Main outcomes A number of barriers that NSW rural women experience in relation to their ability to access an abortion and follow-up care were identified. Results The main barrier rural women experienced was travelling relatively long distances to access an abortion clinic because of lack of services in their local area. Women with limited financial resources needed to borrow money for the procedure and associated costs of travel and accommodation. Womens Health Centres provide a range of support and referral information. Lack of integrated care was reported. Conclusions Rural womens access to abortion services are impacted by the availability, accessibility and affordability of services and prevailing negative social attitudes. This exploratory study provides a snapshot of womens experiences of the process of seeking an abortion in rural NSW, where they are not available locally and women have to travel out of the area to access services. Findings indicate rural women experience multiple barriers in relation to their ability to access abortion services and follow-up care, which may impact on overall health outcomes.OBJECTIVE The aim of the study was to identify factors that New South Wales (NSW) rural women experience in relation to their ability to access an abortion service and follow-up care. DESIGN The qualitative responses from interviews are reported. SETTING Rural and regional NSW. PARTICIPANTS Staff from community based non-government Womens Health Centres across regional/rural NSW and women in rural NSW who had accessed an abortion in the preceding fifteen years. MAIN OUTCOMES A number of barriers that NSW rural women experience in relation to their ability to access an abortion and follow-up care were identified. RESULTS The main barrier rural women experienced was travelling relatively long distances to access an abortion clinic because of lack of services in their local area. Women with limited financial resources needed to borrow money for the procedure and associated costs of travel and accommodation. Womens Health Centres provide a range of support and referral information. Lack of integrated care was reported. CONCLUSIONS Rural womens access to abortion services are impacted by the availability, accessibility and affordability of services and prevailing negative social attitudes. This exploratory study provides a snapshot of womens experiences of the process of seeking an abortion in rural NSW, where they are not available locally and women have to travel out of the area to access services. Findings indicate rural women experience multiple barriers in relation to their ability to access abortion services and follow-up care, which may impact on overall health outcomes.

Action learning enhances professional development of research supervisors: an Australian health science exemplar

The worldwide academic workforce is ageing. At the same time, health and human services workforces are expanding. The preparation of educators to fill gaps in expertise and to position the health sciences for future growth is an urgent need. The findings from a recent action learning project that aimed to enhance the professional growth and development of higher degree researcher student supervisors in a School of Health and Human Sciences are presented. Seven early career researchers and the facilitator met for two hours every two to three weeks over 4 months between April and July 2010, in a rural and regional university in New South Wales, Australia. The processes initiated were a combination of experiential knowledge, referral to relevant published reports, use of an effective supervision checklist, and critical conversations. Learning outcomes centered on higher degree management and supervision pedagogy, communities of practice, knowledge translation, and the establishment of a research culture. The contextual barriers and implications of the methodology and learning outcomes for the professional development of health and human science practitioners, researchers and educators is also discussed.

Walking patterns in pregnancy

Women are encouraged to be active before, during and after pregnancy. However, most pregnant women do not engage in sufficient levels of physical activity. For women who experience gestational diabetes mellitus (GDM), physical activity recommendations are part of the standard management. Walking is the most common activity undertaken by women across the lifespan and often recommended by health professionals. Little research specifically exploring the patterns of walking before, during and after pregnancy has been undertaken. This study investigated patterns of walking undertaken by pregnant women, including those who experienced GDM. A sample of convenience was used to recruit pregnant or postpartum women in regional New South Wales, Australia. Women completed a self-report physical activity survey. The survey also included demographic questions, GDM diagnosis and physical activity advice received from health professionals. The respondents were divided into two groups; those with GDM (GDM) and those without GDM (NoGDM). In both groups, walking declined during pregnancy and returned to prepregnancy levels in the postpartum. This decline was similar to the decline observed in leisure-time physical activity. The GDM group walked more than the NoGDM group and a higher percentage of GDM reported being advised to engage in physical activity by health professionals. Even though walking is the most common activity undertaken for women across the lifespan, prepregnancy walking levels do not necessarily continue during pregnancy. Advice from health professionals may assist in maintaining walking levels during pregnancy. Encouraging pregnant women to continue their prepregnancy walking level may be a relatively simple strategy to increase participation in physical activity.