Janice Perkins

Adaptation and Validation of the SF-36 Health Survey for Use in Australia

This article reports on the process undertaken to adapt the U.S. version of the SF-36 to an Australian setting. In addition, the results of psychometric testing, using the International Quality of Life Assessment (IQOLA) Project process and standards, is also reported. The adaptation process involved a number of steps including: a series of forward and backward translations; ratings of the difficulty of translating the SF-36 and the quality of the resulting translation. To assess the psychometric properties of the Australian form, a random sample of people residing in the Hunter region of New South Wales, Australia, were invited to complete the SF-36 with 855 respondents consenting to complete the measure. Principal components analyses supported the assumption of two factors underlying the measure with the percentage of variance explained by these factors ranging from between 0.66 and 0.77. Demonstrable internal consistency (both item and scale) and test-retest reliability were also found.

An examination of self- and telephone-administered modes of administration for the Australian SF-36

The impact of administration mode on health-related quality of life measurement instruments has received little attention, especially for the SF-36. General community members were randomly selected to complete the Australian version of the SF-36 Health Survey using either telephone or mail modes. Modes were compared across a number of indices: data collection costs; consent rates and non-consent bias; data quality (completeness of data and internal consistency reliability); and response effects. Data collection costs were lower for the telephone mode. A significantly higher consent rate was achieved with the telephone mode. Those who were younger were more likely to refuse to participate when the mail mode was adopted, while older people were more likely not to consent to the telephone mode. The rate of missing responses was higher for the mail mode, while significant differences were found between modes in internal consistency reliability estimates. Health ratings were more favorable for the telephone administration. The results are discussed in light of the advantages and disadvantages of each administration mode.

The effectiveness of two smoking cessation programmes for use in general practice: a randomised clinical trial.

OBJECTIVE--To evaluate a structured, behavioural change, smoking cessation intervention designed for use within general practice. DESIGN--Randomised controlled clinical trial. SETTING--General practices in Newcastle, Australia. PATIENTS--311 Patients identified as smokers by a screening question were enrolled in the study. Of these, 101 were assigned to a structured behavioural change programme, 104 to a simple advice programme adapted from previous research, and 106 to a control group. No significant differences were found between groups for demographic and smoking related variables before the study. INTERVENTIONS--Patients in the simple advice group received a brief statement of advice from the general practitioner as well as three pamphlets; those in the structured intervention group were given strategies which included attitude and behavioural change programmes as well as techniques to aid compliance. The amount of smoking in all groups was assessed by self reports with validation by measurement of salivary cotinine concentrations. MAIN OUTCOME MEASURE--Significant increase in cessation rates. CONCLUSIONS--Significant differences between controls and the structured behavioural change group were found at the one month follow up, but only for self reported abstinence. The simple advice programme did not produce any significant differences over the control group. General practitioner evaluation of the structured programme highlighted difficulties in relation to the duration of the intervention. Overall the structured programme in its present form did not appear to be an effective programme for use within general practice.

Training medical practitioners in information transfer skills: the new challenge

Summary. Traditionally, undergraduate medical education has concentrated on teaching students how to gather information or take medical histories from their patients. However, research increasingly indicates that there is a need for medical practitioners to improve their skills in information transfer in a way which will increase the probability that patients are active collaborators in their treatment. Consequently, Newcastle Medical School has sought to develop training packages for medical students in information transfer skills. This paper describes the resulting training programme with particular emphasis on the areas selected for training, the methods by which students are taught, the necessary interactional skills and the assessment procedures which are applied.

Women's experiences of having a colposcopic examination: self-reported satisfaction with care, perceived needs and consequences

This study was conducted in seven gynaecological clinics in New South Wales (NSW), Australia. The study aimed to assess the level of satisfaction with care, unmet needs and consequences following the procedure reported by women having a colposcopic examination. Of the 161 eligible women attending colposcopy clinics who were approached to take part, 156 (97%) gave written consent to participate and 138 (86%) completed interviews. Consenting women were telephoned within 1 week of their clinic visit to complete a computer-assisted telephone interview (CATI). The survey addressed a number of issues relating to the care they received during their colposcopic examination: satisfaction with care, satisfaction with the waiting time to have a colposcopy, preferences for provider gender, information and health care needs while waiting for the colposcopy, information and health care needs during the colposcopy, short-term physical consequences and shortterm psychosocial consequences of the procedure. Results indicate that satisfaction with care among women ranged from 69% to 96%. The highest expressed needs while waiting for the colposcopy were for information about risks of cancer (91%), reasons for needing a colposcopy (86%), and the colposcopy procedure (86%). Women reported that outcomes such as anxiety and disinterest in sex had further worsened or not been improved following the colposcopy. The results indicate that interventions to address specific concerns would need to be designed, implemented and evaluated.

Increased focus on the teaching of interactional skills to medical practitioners

The interaction which occurs between the doctor and patient has been described as the cornerstone of medial care. Research has shown that interactional skills can have a substantial impact on patient outcomes in a number of areas. However, as practitioners do not necessarily acquire such skills through clinical practice, the introduction of formal training programmes for both under and postgraduate medical practitioners should be more closely examined. This paper outlines a number of issues which need to be considered in the formal instruction of medical practitioners in interactional skills. These issues include the teaching of skills within a clinical context that will reflect actual medical practice, the use of all medical disciplines to teach the skills and the inclusion of formal assessment strategies based on the same rigorous criteria as other components of the medical curriculum.

Self-reported cervical screening practices and beliefs of women from urban, rural and remote regions

This survey aimed to explore womens perceptions of a number of issues relating to the availability and utilisation of cervical cancer screening services in the rural, remote and urban regions of New South Wales (NSW) Australia. The survey involved urban, rural and remote regions of NSW determined by the definition of the Department of Community Services and Health. This was a cross-sectional telephone survey. Of the 339 eligible urban households, 265 (78%) completed interviews; of the 286 eligible rural households, 238 (83%) completed interviews; of the 285 eligible remote households, 230 (81%) completed interviews. Telephone contact was made with randomly selected households in each region. Women in the households were asked to complete a computer-assisted telephone interview. The survey addressed a number of issues relating to cervical screening: cervical cancer risk status; provider of Pap smear service; distance travelled to have a Pap smear; perceived barriers and facilitators to cervical screening. There was no statistically significant difference in the proportions of women from urban (74%), rural (76%), and remote (71%) regions who reported having a Pap smear in the 2 years preceding the survey. General practitioners provided the majority (more than 70%) of tests irrespective of region. Compared with women from urban areas, women from rural and remote areas were almost twice as likely to have had their last Pap smear from a male general practitioner. A greater proportion of women from remote regions had to travel for 60 minutes or more to access providers of Pap smear services. Few differences in the top three reported barriers to, and facilitators for screening were evident between regions and between those women who had and had not been adequately screened. Issues of distance, isolation and access to alternative service providers are a concern to women in rural and remote regions and should be considered by those involved in the implementation of cervical cancer screening services.

Factors relating to cervical screening in New South Wales, Australia.

The aims of this paper were to describe the geographical variation in Pap smear screening rates, standardised for age and adjusted for rates of hysterectomies and to assess the sociodemographic and health care factors associated with the variation. The data used in the study were the percentage of women who had had Pap smears between the years 1990 and 1992 based on the records of the Australian Health Insurance Commission (HIC). The best predictors of screening extracted from the model were the Index of Economic Resources and the proportion of women within each region who were born in non-English speaking countries.