ORCID Profile
0000-0003-1035-7110
Current Organisations
The University of Hong Kong
,
Family Planning NSW
,
University of Oxford Somerville College
,
The Daffodil Centre
,
London School of Hygiene and Tropical Medicine
,
Australian Medical Council
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Publications
Self‐collection for HPV screening: a game changer in the elimination of cervical cancer
Publisher: Wiley
Date: 09-09-2021
DOI: 10.5694/MJA2.51262
Age differences in attitudes toward safer sex practices in heterosexual men using an Australian Internet dating service
Publisher: CSIRO Publishing
Date: 2018
DOI: 10.1071/SH17074
Abstract: Background This cross-sectional study investigated sexually transmissible infection (STI) knowledge, safer sex attitudes and behaviours of sexually active, heterosexual men using an Internet dating service, and explored factors associated with protective attitudes. Methods: An anonymous online survey was sent to men who had logged onto an Internet dating service within the previous year. Factors associated with discussing STIs before sex and condom use intention with a new partner were analysed. Results: In total, 2339 responses were analysed. Men had lower STI knowledge scores, lower use of condoms and greater beliefs that condoms reduced interest in sex as age increased. Younger men (aged 18–29 years) were more likely to report intentions of only having sex with a new partner if a condom was used compared with older men aged over 60 years. Predictors of having a discussion about STIs with a new partner were older age, better knowledge of STIs, greater distress at a potential diagnosis of an STI and stronger future condom use intention. Intention to only have sex with a new female partner if a condom was used was associated with higher STI knowledge, discussing STIs with a new partner and distress at a diagnosis of an STI. Men with a higher number of sexual partners in the last year were less likely to have an STI discussion with new partners or intend to use a condom with a new partner. Conclusions: Older Internet-dating, heterosexual men are vulnerable to STIs. Health promotion interventions to increase STI awareness, condom use and STI testing in older men are warranted.
Young Women's Complex Patterns of Contraceptive Use: Findings from an Australian Cohort Study
Publisher: Guttmacher Institute
Date: 09-2020
DOI: 10.1363/PSRH.12158
‘Your hopes can run away with your realistic expectations’: a qualitative study of women and men’s decision-making when undergoing multiple cycles of IVF
Publisher: Oxford University Press (OUP)
Date: 2020
Abstract: What are the factors that contribute to the decision to continue or stop IVF treatment after multiple unsuccessful cycles? Factors contributing to the decision included external factors, such as their doctor’s guidance, success rates, the outcomes of previous cycles and anecdotal stories of success, as well as emotional and cognitive drivers, including perception of success, hope and fear of regret. Infertility affects about one in six Australian couples of reproductive age. Regarding IVF, some couples with a good prognosis drop out of treatment prematurely, whilst others continue for multiple cycles, despite limited chances of success. Little is known about what factors contribute to the decision to continue IVF after multiple failed cycles. Semi-structured face-to-face and telephone interviews were conducted with 22 participants. Interviews were audio-recorded, transcribed and analysed thematically using Framework analysis. Doctors and nurses at an Australian private fertility clinic recruited in iduals and/or couples who had undergone three or more complete unsuccessful cycles of IVF. The majority of participants had decided to or were leaning towards continuing treatment. Participants expressed a range of common factors important in their decision-making, which were evident both within and across couples. For most, their doctor’s advice and hope were key factors influencing their decision. Most participants expressed they would continue as long as there was a chance of success and until their doctor advised otherwise. Other factors included participants’ perception of their likelihood of success, hearing anecdotal stories of success after multiple cycles, positive outcomes of previous cycles and fear of regret. The s le was highly educated and recruited from one private Australian fertility clinic only. Many participants were also couples, which may have resulted in more homogenous data as they shared the same diagnosis for infertility and outcomes of previous cycles. Factors influencing the decision to continue or stop may differ in different sociodemographic populations and in other healthcare systems. Given the important role of the doctor’s guidance and patients’ own perceptions of their likelihood of success, which they tended to overestimate, it is vital that fertility specialists give accurate and transparent information regarding their likelihood of success and continue to regularly communicate this throughout the IVF journey. Anecdotal stories of success against the odds appeared to be influential in the decision to continue and underpinned unrealistic perceptions of possible success. More personalized, cumulative estimates of likelihood of success may help couples with their decision-making as well as with discussions about ending treatment or setting a limit before commencing IVF. The study was funded by the National Health and Medical Research Council (NHMRC) Program Grant (APP1113532). No further competing interests exist.
The impact of HPV vaccination beyond cancer prevention: effect on pregnancy outcomes
Publisher: Informa UK Limited
Date: 10-09-2021
New best practice guidance for general practice to reduce chlamydia-associated reproductive complications in women
Publisher: The Royal Australian College of General Practitioners
Date: 02-2021
Patient-centred discourse in sexual and reproductive health consultations
Publisher: SAGE Publications
Date: 09-03-2015
Abstract: There is an increasing recognition internationally of the critical impact of communication within healthcare. The link between ineffective communication, patient dissatisfaction and critical incidents is well established. Family Planning New South Wales (FPNSW) has sought to address patient-centred care and communication in its policy platform. This article reports on research conducted within FPNSW, which analysed the discourse features that constituted effective doctor–patient 1 communication in sexual and reproductive health consultations. The principal aim of the research was to understand how effectively messages were conveyed and received and to what degree patients were active participants in their own sexual healthcare. Analysed consultations were characterised by extremely high levels of communicative competence on the part of the doctors who integrated medical expertise with the development of interpersonal relationships with patients, thus positioning patients as active contributors to the consultations and to decisions about their ongoing treatment. The detailed linguistic analysis identified characteristic features of patient-centred communication that are essential to patient-centred care. These interactions demonstrate that communicating care is just as important as delivering care and involves a drawing together of the medical and the interpersonal in consultations. The article details strategies for interweaving medical knowledge and establishing rapport that can inform practitioner communication practices across different healthcare contexts.
How do Pacific Island countries add up on contraception, abortion and reproductive coercion? Guidance from the Guttmacher report on investing in sexual and reproductive health
Publisher: Springer Science and Business Media LLC
Date: 25-03-2021
DOI: 10.1186/S12978-021-01122-X
Abstract: The Guttmacher-Lancet Commission report on Sexual and Reproductive Health and Rights called for the acceleration of progress to achieve SRHR that is essential for sustainable development. To integrate the essential services defined in this report into universal health coverage in the 11 sovereign nations in the Pacific, quality data is required to ensure needs are met efficiently and equitably. However, there are no comprehensive reports for Pacific Island countries that provide insight into all areas of SRHR. We collated the latest literature to identify the most up-to-date relevant data from United Nations and Guttmacher Institute reports to discern gaps in SRHR information and services relating to contraception, abortion and reproductive coercion. Investment is urgently required to strengthen health information systems for SRHR in the Pacific.
Consideration sets and their role in modelling doctor recommendations about contraceptives
Publisher: Wiley
Date: 26-10-2016
DOI: 10.1002/HEC.3276
Abstract: Decisions about prescribed contraception are typically the result of a consultation between a woman and her doctor. In order to better understand contraceptive choice within this environment, stated preference methods are utilized to ask doctors about what contraceptive options they would discuss with different types of women. The role of doctors is to confine their discussion to a subset of products that best match their patient. This subset of options forms the consideration set from which the ultimate recommendation is made. Given the existence of consideration sets we address the issue of how to model appropriately the ultimate recommendations. The estimated models enable us to characterize doctor recommendations and how they vary with patient attributes and to highlight where recommendations are clear and when they are uncertain. The results also indicate systematic variation in recommendations across different types of doctors, and in particular we observe that some doctors are reluctant to embrace new products and instead recommend those that are more familiar. Such effects are one possible explanation for the relatively low uptake of more cost effective longer acting reversible contraceptives and indicate that further education and training of doctors may be warranted. Copyright © 2015 John Wiley & Sons, Ltd.
Cost-benefit analysis of enhancing the uptake of long-acting reversible contraception in Australia
Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/AH18190
Abstract: Objective Long-acting reversible contraception (LARC) is the most effective form of reversible contraception, but its use in Australia is low compared with other countries. The aim of this study was to evaluate the economic effect of an increase in LARC uptake to international rates. Methods An economic model was designed to assess two scenarios, namely increasing the current rate of LARC uptake of 12.5% to the international benchmark of 14.8% among: (1) women currently using the oral contraceptive pill (OCP) and (2) women at risk of pregnancy and not using contraception. Model inputs included cost of contraceptive methods, discontinuation rates and abortion and miscarriage costs associated with unintended pregnancies. Results Women who switch from an OCP to LARC would save A$114–157 per year. Those not currently using any contraception who adopt LARC would incur costs of A$36–194 per year, but would reap savings from the reduction in unintended pregnancies. Over 5 years there would be a net saving of A$74.4 million for Scenario 1 and A$2.4 million for Scenario 2. Conclusion Greater use of LARC would result in a net gain in economic benefits to Australia. These benefits are largely driven by women switching from an OCP to LARC who have reduced costs, as well as women wishing to avoid pregnancy who choose to use LARC rather than no method. This evidence will support women making an informed contraceptive choice and policy makers in increasing the accessibility of LARC. What is known about the topic? LARC is the most effective form of reversible contraception, but uptake in Australia is relatively low. What does this paper add? There are economic benefits to society for women who switch from an OCP to LARC, as well as for women who switch from no contraception to LARC. What are the implications for practitioners? The findings of this study will support women in making an informed contraceptive choice and policy makers in increasing the accessibility of LARC.
Ease of intrauterine contraceptive device insertion in family planning settings
Publisher: Wiley
Date: 29-10-2012
DOI: 10.1111/AJO.12007
Abstract: Intrauterine devices (IUDs) provide highly effective contraception for women worldwide. Reluctance to insert IUDs in the primary care setting may relate to concern about potential difficulty and complications, particularly in nulliparous women. To determine the practitioner, patient and procedural factors associated with abandoned IUD insertion, practitioner-reported difficulty of insertion and adverse events during IUD insertions in the family planning setting. This was a prospective study over a 12-month period of consecutive IUD insertions in four family planning clinics across New South Wales and Queensland. Patient, practitioner and device-related factors associated with abandoned IUD insertion, practitioner-reported ease of insertion and immediate insertion-related adverse events were analysed using logistic regression. Of 996 insertion procedures, successful insertion occurred in 95%, and 90% were reported as easy by the inserting doctor, including 80% of those in nulliparous women. Patient characteristics associated with an abandoned insertion were nulliparity (AOR 5.19 2.49-10.82) or caesarean section-only deliveries (AOR 5.38 2.58-11.22) and with practitioner-reported difficult insertion, nulliparity alone (AOR 1.98 1.11-3.54). Practitioners inserting fewer than 100 IUDs over the 12-month study period more frequently rated insertions as difficult (AOR 1.76 1.08-2.88). Complications occurred in 34 women and were more likely in nulliparous women (AOR 4.51 2.16-9.39). Most IUDs can be successfully inserted, even in nulliparous women, in a primary care setting. Referral to a specialist may be appropriate for some women who are nulliparous or had caesarean section-only deliveries, depending on the experience of the practitioner.
Increasing the availability of long-acting reversible contraception and medical abortion in primary care: the Australian Contraception and Abortion Primary Care Practitioner Support Network (AusCAPPS) cohort study protocol
Publisher: BMJ
Date: 12-2022
DOI: 10.1136/BMJOPEN-2022-065583
Abstract: Although primary care practitioners are the main providers of long-acting reversible contraception (LARC) and early medical abortion (EMA) in Australia, few provide these services. A professional community of practice (CoP) has the potential to improve LARC and EMA provision through evidence-based guidance, expert support and peer-to-peer engagement. The primary objective is to establish, implement and evaluate an innovative, multidisciplinary online CoP (AusCAPPS Network) to increase LARC and EMA services in Australian primary care. Secondary objectives are to (1) increase the number of general practitioners (GPs) and pharmacists certified to provide or dispense EMA, respectively, (2) increase LARC and EMA prescription rates and, (3) improve primary care practitioners’ knowledge, attitudes and provision of LARC and EMA. A stakeholder knowledge exchange workshop (KEW) will be conducted to inform the AusCAPPS Network design. Once live, we aim to reach 3000 GPs, practice nurses and community pharmacists members. Changes in the number of GPs and pharmacists certified to provide or dispense EMA, respectively, and changes in the number of LARCs and EMAs prescribed will be gleaned through health service data. Changes in the knowledge attitudes and practices will be gleaned through an online survey with 500 in iduals from each professional group at baseline and 12 months after members have joined AusCAPPs and experiences of the AusCAPPS Network will be evaluated using interviews with the project team plus a convenience s le of 20 intervention participants from each professional group. The project is underpinned by the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, and a realist framework will inform analysis. Ethical approval was received from the Monash University Human Research Ethics Committee (No. 28002). Dissemination will occur through KEWs, presentations, publications and domestic and international networks. ACTRN12622000655741.
The Guttmacher– Lancet Commission on sexual and reproductive health and rights: how does Australia measure up?
Publisher: AMPCo
Date: 12-03-2019
DOI: 10.5694/MJA2.50058
Lactic acid-containing products for bacterial vaginosis and their impact on the vaginal microbiota: A systematic review
Publisher: Public Library of Science (PLoS)
Date: 11-02-2021
DOI: 10.1371/JOURNAL.PONE.0246953
Abstract: The vaginal microbiota in bacterial vaginosis (BV) typically has low abundance of lactic acid producing lactobacilli. Lactic acid has properties that may make it effective for treating BV and/or restoring an optimal lactobacillus-dominated vaginal microbiota. We conducted a systematic review to describe the effect of intravaginal lactic acid-containing products on BV cure, and their impact on vaginal microbiota composition (PROSPERO registration: CRD42018115982). PubMed, Embase and OVID were searched from inception to November 2019 to identify eligible studies. Included studies evaluated an intravaginal lactic acid-containing product and reported BV cure using established diagnostic methods, and/or vaginal microbiota composition using molecular methods. Studies were independently screened and assessed, and the proportion of women cured post-treatment was calculated. Study results were described in a qualitative manner. We identified 1,883 articles and assessed 57 full-texts for eligibility. Seven different lactic acid-containing products were evaluated and differed with respect to excipients, lactic acid concentration and pH. Most studies had medium or high risk of bias. Three trials compared the efficacy of a lactic acid-containing product to metronidazole for BV cure. One study found lactic acid to be equivalent to metronidazole and two studies found lactic acid to be significantly inferior to metronidazole. Two studies included a control group receiving a placebo or no treatment. One reported lactic acid to be superior than no treatment and the other reported lactic acid to be equivalent to placebo. Lactic acid-containing products did not significantly impact the vaginal microbiota composition. There is a lack of high-quality evidence to support the use of lactic acid-containing products for BV cure or vaginal microbiota modulation. However, adequately powered and rigorous randomised trials with accompanying vaginal microbiota data are needed to evaluate the efficacy of lactic acid as a BV treatment strategy.
Prevalence and associated factors of urinary leakage among women participating in the 45 and Up Study
Publisher: Wiley
Date: 27-07-2018
DOI: 10.1002/NAU.23770
Abstract: The study was undertaken to investigate the prevalence of urinary leakage and its associated factors among a s le of females aged 45 years and over in New South Wales. Data were obtained from the 45 and Up Study wherein urinary leakage is identified as women who reported being troubled by leaking urine. At baseline, 143 096 females (2006-2009) and 59 060 females in the follow-up survey (2012-2015) were included in the analysis. We estimated the prevalence, and identified the factors associated with urinary leakage using logistic regression models. The prevalence of urinary leakage was 44.0% at baseline and 44.6% at the first follow-up survey. Among women who reported urinary leakage at baseline, 21.2% reported urine leakage once a week or less and 13.1% four or more times per week. Increasing age, abnormal BMI, back pain, anxiety, depression, and psychological distress were associated with greater odds of women reporting urinary leakage. Asian ancestry and being unemployed was associated with a lower risk for urinary incontinence. Findings from this analysis estimate that approximately one in two women aged 45 years and older will most likely experience urinary leakage. The associated factors could serve as screening indicators for urinary leakage.
How will transitioning from cytology to HPV testing change the balance between the benefits and harms of cervical cancer screening? Estimates of the impact on cervical cancer, treatment rates and adverse obstetric outcomes in Australia, a high vaccination coverage country.
Publisher: Wiley
Date: 05-10-2017
DOI: 10.1002/IJC.30926
Abstract: Primary HPV screening enables earlier diagnosis of cervical lesions compared to cytology, however, its effect on the risk of treatment and adverse obstetric outcomes has not been extensively investigated. We estimated the cumulative lifetime risk (CLR) of cervical cancer and excisional treatment, and change in adverse obstetric outcomes in HPV unvaccinated women and cohorts offered vaccination (>70% coverage in 12-13 years) for the Australian cervical screening program. Two-yearly cytology screening (ages 18-69 years) was compared to 5-yearly primary HPV screening with partial genotyping for HPV16/18 (ages 25-74 years). A dynamic model of HPV transmission, vaccination, cervical screening and treatment for precancerous lesions was coupled with an in idual-based simulation of obstetric complications. For cytology screening, the CLR of cervical cancer diagnosis, death and treatment was estimated to be 0.649%, 0.198% and 13.4% without vaccination and 0.182%, 0.056% and 6.8%, in vaccinated women, respectively. For HPV screening, relative reductions of 33% and 22% in cancer risk for unvaccinated and vaccinated women are predicted, respectively, compared to cytology. Without the implementation of vaccination, a 4% increase in treatment risk for HPV versus cytology screening would have been expected, implying a possible increase in pre-term delivery (PTD) and low birth weight (LBW) events of 19 to 35 and 14 to 37, respectively, per 100,000 unvaccinated women. However, in vaccinated women, treatment risk will decrease by 13%, potentially leading to 4 to 41 fewer PTD events and from 2 more to 52 fewer LBW events per 100,000 vaccinated women. In unvaccinated women in cohorts offered vaccination as 12-13 year olds, no change to lifetime treatment risk is expected with HPV screening. In unvaccinated women in cohorts offered vaccination as 12-13 year olds, no change to lifetime treatment risk is expected with HPV screening. HPV screening starting at age 25 in populations with high vaccination coverage, is therefore expected to both improve the benefits (further decrease risk of cervical cancer) and reduce the harms (reduce treatments and possible obstetric complications) associated with cervical cancer screening.
Treating male partners of women with bacterial vaginosis (StepUp): a protocol for a randomised controlled trial to assess the clinical effectiveness of male partner treatment for reducing the risk of BV recurrence.
Publisher: Springer Science and Business Media LLC
Date: 11-11-2020
DOI: 10.1186/S12879-020-05563-W
Abstract: Bacterial vaginosis (BV) is estimated to affect 1 in 3 women globally and is associated with obstetric and gynaecological sequelae. Current recommended therapies have good short-term efficacy but 1 in 2 women experience BV recurrence within 6 months of treatment. Evidence of male carriage of BV-organisms suggests that male partners may be reinfecting women with BV-associated bacteria (henceforth referred to as BV-organisms) and impacting on the efficacy of treatment approaches solely directed to women. This trial aims to determine the effect of concurrent male partner treatment for preventing BV recurrence compared to current standard of care. StepUp is an open-label, multicentre, parallel group randomised controlled trial for women diagnosed with BV and their male partner. Women with clinical-BV defined using current gold standard diagnosis methods (≥3 Amsel criteria and Nugent score (NS) = 4–10) and with a regular male partner will be assessed for eligibility, and couples will then be consented. All women will be prescribed oral metronidazole 400 mg twice daily (BID) for 7 days, or if contraindicated, a 7-day regimen of topical vaginal 2% clindamycin. Couples will be randomised 1:1 to either current standard of care (female treatment only), or female treatment and concurrent male partner treatment (7 days of combined antibiotics - oral metronidazole tablets 400 mg BID and 2% clindamycin cream applied topically to the glans penis and upper shaft [under the foreskin if uncircumcised] BID). Couples will be followed for up to 12 weeks to assess BV status in women, and assess the adherence, tolerability and acceptability of male partner treatment. The primary outcome is BV recurrence defined as ≥3 Amsel criteria and NS = 4–10 within 12 weeks of enrolment. The estimated s le size is 342 couples, to detect a 40% reduction in BV recurrence rates from 40% in the control group to 24% in the intervention group within 12 weeks. Current treatments directed solely to women result in unacceptably high rates of BV recurrence. If proven to be effective the findings from this trial will directly inform the development of new treatment strategies to impact on BV recurrence. The trial was prospectively registered on 12 February 2019 on the Australian and New Zealand Clinical Trial Registry (ACTRN12619000196145, Universal Trial Number: U1111–1228-0106, www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376883& isReview=true ).
What do young Australian women want (when talking to doctors about contraception)?
Publisher: Springer Science and Business Media LLC
Date: 15-03-2017
When online becomes offline: Attitudes to safer sex practices in older and younger women using an Australian internet dating service
Publisher: CSIRO Publishing
Date: 2012
DOI: 10.1071/SH10164
Abstract: Background The prevalence of sexually transmissible infections (STIs) is increasing among older Australian women, partly due to re-partnering after orce or death of a spouse. Older women may be less likely to use condoms with new sexual partners, exposing themselves to STIs. An online survey compared characteristics of internet dating women aged 40 and above with 18 to 39 year olds, and determined the factors associated with protective safer sex attitudes. Methods: An email directed women who had logged onto the internet dating service ‘RSVP’ in the previous 6 months to a survey hosted by Family Planning New South Wales. The survey explored demographic factors, STI-related knowledge and attitudes towards safer sex practices. Factors associated with discussing STIs before sex and refusing sex without a condom with a new partner were analysed using logistic regression. Results: The questionnaire was completed by 1788 women. Almost two-thirds (62.2%) were aged 40 or over. The majority (64.8%) were seeking a long-term partner. In the previous year, 41.5% of all women met a new sexual partner via the internet. Women aged years were significantly more likely to discuss STIs with a new partner but less likely to refuse sex without a condom compared with younger women. Conclusions: The internet is a useful venue for women of all ages to meet new sexual partners. Older women are vulnerable to STI acquisition through failure to use condoms with a new partner. Research is needed to determine effective interventions to increase condom use in this age group.
Inclusion of intrauterine device insertion to registered nurses’ scope of clinical practice
Publisher: Elsevier BV
Date: 02-2019
Doctors’ experience of the contraceptive consultation: a qualitative study in Australia
Publisher: BMJ
Date: 12-05-2016
DOI: 10.1136/JFPRHC-2015-101356
Abstract: Contraception is a field in which good doctor-patient communication is crucial and core to shared decision making. Despite the centrality of contraception to primary health care in Australia, little is known about how doctors manage the contraceptive consultation. In particular, little is known about how doctors discuss sexual issues related to contraception. Fifteen contraceptive providers participated in qualitative interviews averaging 45 min. Interviews were audio recorded, transcribed verbatim, and analysed using an inductive thematic approach. We found doctors were aware that they had to modify their illness-based 'scripts' in consultations about contraception, and said it was challenging always to adhere to a shared model of decision making. Prescribing behaviour reflected personal preferences in relation to some forms of contraception, and doctors were enthusiastic about the levonorgestrel-releasing intrauterine system. Doctors identified gaps in training in relation to sexuality and reported feeling tentative in raising sexual issues, even within contraceptive consultations. A range of factors-including tendencies to use illness scripts, personal preferences, and discomfort with communications about sexuality-appear to influence doctors' approaches to contraceptive management. Medical training that enables doctors to move out of an illness-treating framework and to improve their understanding of and comfort in discussing sexuality issues will improve their management of healthy women seeking contraception.
The COVID-19 Pandemic and Sexual and Reproductive Health and Rights in the Pacific.
Publisher: SAGE Publications
Date: 20-03-2021
Active surveillance as a management option for cervical intraepithelial neoplasia 2: An online experimental study
Publisher: Elsevier BV
Date: 04-2021
What's good and bad about contraceptive products?: A best-worst attribute experiment comparing the values of women consumers and GPs
Publisher: Springer Science and Business Media LLC
Date: 12-2012
DOI: 10.2165/11598040-000000000-00000
Abstract: In the past decade, the range of contraceptives available has increased dramatically. There are limited data on the factors that determine women's choices on contraceptive alternatives or what factors providers consider most important when recommending contraceptive products to women. Our objectives were to compare women's (consumers') preferences and GPs' (providers') views in relation to existing and new contraceptive methods, and particularly to examine what factors increase the acceptability of different contraceptive products. A best-worst attribute stated-choice experiment was completed online. Participants (Australian women of reproductive age and Australian GPs) completed questions on 16 contraceptive profiles. 200 women of reproductive age were recruited through a commercial panel. GPs from all states of Australia were randomly s led and approached by phone 162 GPs agreed to participate. Participants chose the best and worst attribute levels of hypothetical but realistic prescribed contraceptive products. Best and worst choices were modelled using multinomial logit and product features were ranked from best to worst according to the size of model coefficients. The most attractive feature of the contraceptive products for both GPs and women consumers were an administration frequency of longer than 1 year and light or no bleeding. Women indicated that the hormonal vaginal ring was the least attractive mode of administration. Women and GPs agree that longer-acting methods with less bleeding are important features in preferred methods of contraception however, women are also attracted to products involving less invasive modes of administration. While the vaginal ring may fill the niche in Australia for a relatively non-invasive, moderately long-acting and effective contraceptive, the results of this study indicate that GPs will need to promote the benefits of the vaginal ring to overcome negative perceptions about this method among women who may benefit from using it.
Can consumers learn to ask three questions to improve shared decision making? A feasibility study of the ASK (AskShareKnow) Patient–Clinician Communication Model® intervention in
Publisher: Wiley
Date: 14-09-2015
DOI: 10.1111/HEX.12409
‘Every medicine is part poison’: a qualitative inquiry into the perceptions and experiences of choosing contraceptive methods of migrant Chinese women living in Australia
Publisher: Springer Science and Business Media LLC
Date: 08-03-2021
DOI: 10.1186/S12905-021-01226-3
Abstract: In Australia, ethnic Chinese people are one of the largest, youngest and fastest growing overseas-born groups. Yet, little is known about their perceptions of contraceptive methods and their experiences with choosing one. Decisions about contraceptive methods are preference sensitive. Understanding the influencing factors of Chinese migrant women’s contraceptive method choice and practices will help cater to their decision-making needs in a culturally sensitive and responsive way. A qualitative study design underpinned by critical realism approach was used to explore Chinese migrant women’s perceptions and experiences of choosing contraceptive methods. Semi-structured interviews were conducted with 22 women who self-identified as being ethnically Chinese and had been living in Australia for no more than 10 years. The interview guide was adapted from the Ottawa Decision Support Framework. Majority of the interviews were conducted in Mandarin Chinese. Transcribed data was analysed using thematic analysis method. Four major themes were identified, including: ‘every medicine is part poison: hormonal contraceptives cause harm to the body’ ‘intrauterine device, a device used in the past for married women’ ‘it takes two (or one) to decide, depending on the relationship dynamics and contraception preferences’ and ‘it is not necessary to seek medical advice in choosing contraceptive methods’. Our findings suggest that Chinese migrant women’s perceptions and experiences of choosing contraceptive methods are influenced by complex personal, cultural, societal and inter-relational factors. Chinese migrant women were cautious of using hormonal methods due to fears of side-effects, including reduced or absent menstrual bleeding. Women were also reluctant to consider intrauterine devices as options due to associating them with past experiences of other women and themselves and also fears of potential complications. There was a reluctant attitude towards seeking medical advice regarding contraception due to beliefs that needing to use contraception is not an illness requiring treatment. Such findings are likely to be useful in increasing healthcare professionals’ and policy makers’ understanding of Chinese migrant women’s contraceptive method preferences, beliefs and behaviours. They also help to develop culturally and linguistically sensitive strategies, which goes beyond the provision of contraceptive counselling, in assisting Chinese migrant women’s decision-making needs.
Healthcare providers' perceptions of the challenges and opportunities to engage Chinese migrant women in contraceptive counselling: a qualitative interview study
Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/SH19215
Abstract: Background In Australia, there are many culturally and linguistically erse communities and Chinese migrants make up one of the largest. Yet, little is known about healthcare providers’ (HCPs) unique experiences in providing contraceptive care for Chinese migrant women. There is minimal research into the HCPs’ perceptions of challenges or opportunities in engaging Chinese migrant women in informed and shared decision-making processes during contraceptive counselling. The aim of this study is to explore HCPs’ experiences of providing contraceptive care for Chinese migrant women, their perceptions of women’s care needs when choosing contraceptive methods, as well as their own needs in supporting women’s decision-making. Methods: Semi-structured interviews were conducted with 20 HCPs in Sydney, Australia who had substantial experience in providing contraceptive services to Chinese women who were recent migrants. Transcribed audio-recorded data were analysed using thematic analysis. Results: Four main themes were identified, including: ‘Are you using contraception?’: the case for being proactive and opportunistic ‘Getting the message across’: barriers to communication ‘Hormones are unnatural?’: women favouring non-hormonal methods and ‘Word of mouth’: social influence on contraceptive method choice. Conclusions: In order to facilitate informed choice and shared decision-making with Chinese migrant women during contraceptive counselling, broader health system and community-level strategies are needed. Such strategies could include improving HCPs’ cultural competency in assessing and communicating women’s contraceptive needs providing professional interpreting services and translated materials and improving women’s health literacy, including their contraceptive knowledge and health system awareness.
The effect of adverse information and positive promotion on women's preferences for prescribed contraceptive products
Publisher: Elsevier BV
Date: 04-2013
DOI: 10.1016/J.SOCSCIMED.2012.12.025
Abstract: Recent rapid growth in the range of contraceptive products has given women more choice, but also adds complexity to the resultant decision of which product to choose. This paper uses a discrete choice experiment (DCE) to investigate the effect of adverse information and positive promotion on women's stated preferences for prescribed contraceptive products. In November 2007, 527 Australian women aged 18-49 years were recruited from an online panel. Each was randomly allocated to one of three information conditions. The control group only received basic information on contraceptive products. One treatment group also received adverse information on the risks of the combined oral pill. The other group received basic information and promotional material on the vaginal ring, newly introduced into Australia and on the transdermal patch, which is unavailable in Australia. Respondents completed 32 choice sets with 3 product options where each option was described by a product label: either combined pill, minipill, injection, implant, hormonal IUD, hormonal vaginal ring, hormonal transdermal patch or copper IUD and by the attributes: effect on acne, effect on weight, frequency of administration, contraceptive effectiveness, doctor's recommendation, effect on periods and cost. Women's choices were analysed using a generalized multinomial logit model (G-MNL) and model estimates were used to predict product shares for each information condition. The predictions indicated that adverse information did not affect women's preferences for products relative to only receiving basic information. The promotional material increased women's preferences for the transdermal patch. Women in all groups had a low preference for the vaginal ring which was not improved by promotion. The findings highlight the need for researchers to pay attention to setting the context when conducting DCEs as this can significantly affect results.
National Cervical Screening Program renewal in Australia: survey of clinician views and attitudes
Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/PY20032
Abstract: From 1 December 2017, the National Cervical Screening Program was renewed in Australia, with updated national cervical screening guidelines released. This study was performed to determine clinicians’ familiarity with the updated guidelines and explore their views and attitudes towards the renewed program. Clinicians providing cervical screening in New South Wales, Australia, were invited to complete an online survey in 2018. Of the 241 clinicians who responded, 91.5% supported the change to 5-yearly human papillomavirus screening from the age of 25 years. However, nearly 13% indicated they did not know where to access the renewed guidelines and 37% had never or rarely accessed them. Open-ended responses highlighted clinicians’ concerns about missed cancers and missed opportunities for health checks. Those raising these concerns accessed the guidelines less frequently. The findings highlight important areas for additional education and support for clinicians in translating guidelines into practice to ensure successful delivery of the renewed program.
Human papillomavirus prevalence and risk factors among Australian women 9–12 years after vaccine program introduction
Publisher: Elsevier BV
Date: 08-2021
Medical termination of pregnancy in general practice in Australia: A descriptive-interpretive qualitative study
Publisher: Springer Science and Business Media LLC
Date: 14-03-2017
An open-label randomized trial to determine the most effective regimen of vaginal estrogen to reduce the prevalence of atrophic changes reported in postmenopausal cervical smears
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2009
DOI: 10.1097/GME.0B013E318193E7CD
Abstract: Atrophic Papanicolaou (Pap) smears from postmenopausal women may be unsatisfactory for assessment or result in a false-positive diagnosis of a cytological abnormality. We investigated the effect of vaginal estrogen treatment before the Pap test on the odds of an atrophic smear. An open-label randomized controlled trial was conducted to compare the proportion of atrophic Pap smears from postmenopausal women assigned to either (1) a regimen of one 25-microg vaginal estradiol tablet inserted nightly for five nights before their Pap test, (2) a single 25-microg vaginal estradiol tablet before the test, or (3) a control group with no previous estrogen administration. All smears were reread and classified as atrophic or nonatrophic at the conclusion of the study by a single cytopathologist who was blinded to the study arms. One hundred fifty-four (94%) of the 164 postmenopausal women who consented to the study were included in the final analysis. Fifty-one women had received the five-night course of tablets, 50 had received one tablet, and 53 were assigned to the group with no previous estrogen use. The odds of an atrophic smear were significantly lower in women who used the five-night estrogen regimen than in women who did not use estrogen. The estimated odds ratio of an atrophic smear in the five-night regimen was 0.01 (95% CI, 0.03-0.26) compared with the no-estrogen control group. Moreover, using one tablet of estrogen had no significant effect on the likelihood of an atrophic smear compared with using none. The odds ratio of an atrophic smear in the single estrogen tablet group was 1.05 (95% CI, 0.48-2.29) compared with the no-estrogen group. The odds of an atrophic smear are significantly reduced for postmenopausal women who use a five-night regimen of vaginal estrogen before their Pap test.
What adolescents think of relationship portrayals on social media: a qualitative study
Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/SH20056
Abstract: Background Understanding the factors influencing adolescents’ relationship views is important because early romantic relationships often act as precursors for relationships in adulthood. This study sought to examine the types of relationship-focused content adolescents witness on social media and how they perceive its effect on their romantic relationship beliefs. Methods: Sixteen semistructured interviews were conducted with Australian adolescents aged 16–19 years who were purposively s led from a larger longitudinal study. Interview transcripts were analysed qualitatively using constructivist grounded theory. Results: Participants described the types of romantic relationship portrayals they saw on social media, including relationship-focused trends like ‘Relationship Goals’ and ‘Insta-Couples’. Participants explained their ability to identify incomplete and unrealistic relationship portrayals, as well as the pressure to share their relationships online in the same incomplete fashion. Views regarding the influence of social media were varied, but most believed social media relationship portrayals had some level of influence on young people’s relationship views some participants believed this occurred regardless of awareness of the incompleteness of the online portrayal. Conclusions: Although participant interview data revealed the pervasiveness of social media relationship portrayals, it also revealed the sophisticated capabilities of adolescents in critiquing online media portrayals.
Diagnosis of pelvic inflammatory disease and barriers to conducting pelvic examinations in Australian general practice: findings from an online survey
Publisher: CSIRO Publishing
Date: 09-04-2021
DOI: 10.1071/SH20176
Abstract: Background Pelvic inflammatory disease (PID) is under-diagnosed globally, particularly in primary care, and if untreated may cause reproductive complications. This paper investigates PID diagnosis by Australian general practitioners (GPs) and barriers to their conducting a pelvic examination. Methods: An online survey investigating Australian GPs’ chlamydia management, including PID diagnosis, was conducted in 2019. From 323 respondents, 85.8% (n = 277) answered multiple-choice questions about PID and 74.6% (n = 241) answered a free-text question about barriers to conducting pelvic examinations. Using multivariable logistic regression, we identified factors associated with conducting pelvic examinations. Barriers to performing pelvic examinations were explored using thematic analysis. Results: Most GPs indicated that they routinely ask female patients with a sexually transmissible infection about PID symptoms, including pelvic pain (86.2%), abnormal vaginal discharge (95.3%), abnormal vaginal bleeding (89.5%), and dyspareunia (79.6%). Over half reported routinely conducting speculum (69.0%) and bimanual pelvic (55.3%) examinations for women reporting pelvic pain. Female GPs were more likely to perform speculum [adjusted odds ratio (AOR) 4.6 95%CI: 2.6–8.2] and bimanual pelvic examinations (AOR 3.7 95%CI: 2.1–6.5). GPs with additional sexual health training were more likely to routinely perform speculum (AOR 2.2 95%CI: 1.1–4.2) and bimanual pelvic examinations (AOR 2.1 95%CI: 1.2–3.7). Barriers to pelvic examinations were patient unwillingness and/or refusal, GP gender, patient health-related factors, time pressures, and GP reluctance. Conclusion: Although GPs typically ask about PID symptoms when managing patients with chlamydia, they are not consistently able or willing to perform pelvic examinations to support a diagnosis, potentially reducing capacity to diagnose PID.
The preferences of women in Australia for the features of long-acting reversible contraception: results of a discrete choice experiment
Publisher: Informa UK Limited
Date: 28-07-2022
DOI: 10.1080/13625187.2022.2098947
Abstract: Long-acting reversible contraceptives (LARC), such as intrauterine devices (IUD) and implants, are highly effective. However, the uptake of LARC in Australia has been slow and the oral contraceptive pill (OC) remains the best known and most widely used contraceptive. Our aim was to investigate women's preferences for the features of LARC. We used a discrete choice experiment (DCE) in which each respondent completed 12 choice tasks. We recruited a general population s le of 621 women in Australia aged 18-49 using an online survey panel. A mixed logit model was used to analyse DCE responses a latent class model explored preference heterogeneity. Overall, 391 (63%) of women were currently using contraception 49.3% were using an OC. About 22% of women were using a LARC. Women prefer products that are more effective in preventing pregnancy, have low levels of adverse events (including negative effects on mood), and which their general practitioner (GP) recommends or says is suitable for them. Women have strong preferences for contraceptive products that are effective, safe, and recommended by their GP. The results indicate which characteristics of LARCs need to be front and centre in information material and in discussions between women and healthcare professionals.
Understanding women's choices for management of cervical intraepithelial neoplasia 2 (CIN2): Qualitative analysis of a randomised experimental study
Publisher: Wiley
Date: 08-10-2022
DOI: 10.1111/AJO.13440
Abstract: Active surveillance for cervical intraepithelial neoplasia 2 (CIN2) would allow time for most cases to regress naturally and in turn avoid potentially unnecessary and harmful treatment. To determine reasons for choosing active surveillance over surgery among women given a hypothetical diagnosis of CIN2. Women residing in Australia aged 25–40 years with no prior diagnosis of cervical cancer, cervical abnormality CIN2 or above, and/or previous hysterectomy, were randomised to one of four identical hypothetical scenarios of testing human papillomavirus (HPV)‐positive: high‐grade cytology and a diagnosis of CIN2 that used alternate terminology to describe resolution of abnormal cells and/or inclusion of an overtreatment statement. Participants selected active surveillance or surgery after viewing the scenario and free‐text reason/s for their choice were thematically analysed. Of the 1638 women randomised, 79% ( n = 1293) opted for active surveillance. The most common reasons for choosing active surveillance included concerns about surgery and associated risks, preferring to ‘wait and see’, trusting the doctor’s recommendations and having an emotional response toward surgery. For women who chose surgery, being risk‐averse, addressing the issue straight away and perceiving surgery to be the better option for them were the most common themes identified. When presented with balanced information on the benefits and harms of different management options for CIN2 and given a choice, most women in this hypothetical situation chose active surveillance over surgery. Addressing women’s concerns about active surveillance may open up the possibility that if deemed safe, it could be an acceptable alternative for women.
Fertility control? Middle-aged Australian women's retrospective reports of their pregnancies
Publisher: Elsevier BV
Date: 08-2008
DOI: 10.1111/J.1753-6405.2008.00261.X
Abstract: To assess middle-aged Australian women's retrospective reports of how intended and wanted were their pregnancies, and the degree of happiness associated with these pregnancies. A self-administered questionnaire was sent to 1000 participants in the Mid-Age cohort of the Australian Longitudinal Study on Women's Health. Responses from 811 women (81%) showed that, although 32% of first pregnancies were unplanned and 29% were unwanted, most women recall being happy with their pregnancies and termination rates were very low. The second pregnancy was the most planned and wanted and associated with the highest levels of happiness. While the majority of middle-aged women report having been happy to be pregnant, and the majority of pregnancies are described retrospectively as planned and wanted, a significant proportion of pregnancies are unwanted, unplanned or resulting from unintended contraceptive failure. The data support the continuing need for widely available, affordable and sensitive fertility control services.
Views and experiences of the female condom in Australia: An exploratory cross-sectional survey of cisgender women
Publisher: Public Library of Science (PLoS)
Date: 19-02-2021
DOI: 10.1371/JOURNAL.PONE.0246664
Abstract: The female condom is the only female-initiated form of protection against unintended pregnancy and sexually transmissible infections (STIs). However, use of this method in Australia is low. To better understand women’s views and experiences of the female condom, we conducted an interventional cross-sectional study. Cisgender women ≥16 years, heterosexually active and living in New South Wales were recruited through social media advertisements and email invitations to clients of a family planning service. Eligible participants were provided with three female condoms and invited to complete a follow-up survey. Survey responses for women who attempted to use at least one female condom were summarised using counts and proportions. We recruited 556 women few (30/556) had used the female condom before the study. There were 284 women who used, or attempted to use, a female condom during the study and completed the follow-up survey. Fifty-one percent (104/205) reported experiencing some difficulty in insertion, although only 46% (130/284) had seen an instructional demonstration. Approximately half (105/204) of women rated the sensation and comfort of the female condom as the same or better than the male condom, and 66% (137/204) reported that it provided the same or better lubrication. Approximately half of women said they would consider using the female condom again for STI prevention (51% (133/260)) or contraception (40% (103/260)), or would recommend to others (43% (112/260)). Findings highlight the need for increased health promotion and education regarding use of the female condom. To increase access it will be important to address method cost and availability in Australia. Future research should explore other perspectives of this method, including among the LGBTIQ+ community.
Patient delivered partner therapy for chlamydia infection is used by some general practitioners, but more support is needed to increase uptake: findings from a mixed-methods study.
Publisher: BMJ
Date: 30-06-2022
DOI: 10.1136/SEXTRANS-2020-054933
Abstract: Patient-delivered partner therapy (PDPT) describes the giving of a prescription or antibiotics by an index case with chlamydia to their sexual partners. PDPT has been associated with higher numbers of partners receiving treatment. In Australia, general practitioners (GPs) previously expressed negative views about PDPT. Health authority guidance for PDPT has since been provided in some areas. We investigated recent use and perceptions of PDPT for chlamydia among GPs in Australia. In 2019, we conducted an online survey comprising multiple-choice and open-ended questions to investigate GPs' chlamydia management practices, including PDPT. Logistic regression identified factors associated with ever offering PDPT. A directed content analysis of free-text data explored GPs' perceptions towards PDPT. The survey received responses from 323 GPs 85.8% (n=277) answered PDPT-focused questions, providing 628 free-text comments. Over half (53.4%) reported never offering PDPT, while 36.5% sometimes and 10.1% often offered PDPT. GPs more likely to offer PDPT were aged ≥55 years (adjusted OR (AOR) 2.9, 95% CI 1.4 to 5.8), worked in non-metropolitan areas (AOR 2.5, 95% CI 1.5 to 4.4) and jurisdictions with health authority PDPT guidance (AOR 2.3, 95% CI 1.4 to 3.9). Qualitative data demonstrated that many GPs recognised PDPT's potential to treat harder to engage partners but expressed hesitancy to offer PDPT because they considered partners attending for care as best practice. GPs emphasised a case-by-case approach that considered patient and partner circumstances to determine PDPT suitability. To alleviate medicolegal concerns, many GPs indicated a need for professional and health authority guidance that PDPT is permissible. They also desired practical resources to support its use. GPs appear to accept the place of PDPT as targeted to those who may otherwise not access testing or treatment. Availability of health authority guidance appears to have supported some GPs to incorporate PDPT into their practice.
The Sexual and Reproductive Health and Rights of Young People with Intellectual Disability: A Scoping Review
Publisher: Springer Science and Business Media LLC
Date: 07-03-2021
Men and masculinities in qualitative research on vasectomy: perpetuation or progress?
Publisher: Informa UK Limited
Date: 13-07-2020
DOI: 10.1080/14461242.2020.1789486
Abstract: Although vasectomy is a safe and highly effective method of contraception, uptake is variable globally, with scope for increased engagement in high income nations. Very little qualitative research has been published in recent years to explore men's perspectives on vasectomy, which represents a key opportunity to better understand and strengthen men's contribution to reproductive and contraception equality. This paper takes a scoping review approach to identify key findings from the small but important body of qualitative literature. Recent masculinities research argues that, despite some expansion in ways of being masculine, an underpinning ethos of
Contraception – what about the men? Experience, knowledge and attitudes: a survey of 2438 heterosexual men using an online dating service
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/SH16235
Abstract: Background There is little research on men’s contraceptive knowledge, attitudes and beliefs, yet the male partner is known to influence contraceptive choices. This study investigates contraceptive experiences, knowledge, attitudes and beliefs of a s le of sexually active, heterosexual men via an online dating site. Methods: An anonymous online survey was sent to men who had logged onto an online dating site within the previous year. Results: We analysed 2438 survey responses. A contraceptive method was used at last intercourse for 82% of men years old versus 69% of men ≥50 (P 0.0001). Condoms (35%), vasectomy (22%) and the contraceptive pill (21%) were the most commonly used methods. Older men were less likely to use condoms than younger men (P 0.0001). More than 80% of participants had heard of each method. The greatest perceived harm was with the emergency contraceptive pill, with 32% responding that it was ‘harmful to the health of the user’ and 37% not sure. Belief that contraception decision-making should be shared between partners increased from 57% in a ‘one-night stand’ to 75% in a casual relationship, to 92% in a long-term relationship. Conclusion: Among this s le there is high contraceptive use, especially vasectomy in older men and a desire to share contraceptive decision-making with their partners, especially in long-term relationships. However, low awareness of some methods and misperceptions about hormonal contraceptive method safety, especially the emergency contraceptive pill, highlight the need for education for men.
A three-year comparative study of continuation rates, bleeding patterns and satisfaction in Australian women using a subdermal contraceptive implant or progestogen releasing-intrauterine system
Publisher: Informa UK Limited
Date: 14-11-2013
DOI: 10.3109/13625187.2013.853034
Abstract: BACKGROUND Long-acting reversible contraceptive methods (LARCs) are safe, highly effective, readily reversible, and require no action on the part of the user following insertion. Early discontinuation may put women at increased risk of unintended pregnancy. METHODS Following insertion of a progestogen-only subdermal implant or intrauterine system (IUS) at Family Planning NSW, women 18 years and older completed a questionnaire about their choice. At 6 weeks, 6, 12, 24 and 36 months by telephone or online they completed a questionnaire about bleeding patterns, side effects, satisfaction, and reasons for discontinuation. RESULTS Two hundred IUS users and 149 implant users were enrolled. The former were generally older, married or in a de-facto relationship, and had children. Forty-seven percent of implant users discontinued within three years compared to 27% of IUS users (p = 0.002). In the first two years amenorrhoea was more frequent in implant users. Frequent bleeding/spotting was more prevalent in the first year of IUS use but over time was twice as prevalent in implant users. Infrequent bleeding/spotting was more common in IUS users. CONCLUSION Both devices are highly effective and acceptable cost-effective methods. While LARCs should be promoted to women of all ages seeking contraception, early discontinuation due to unacceptable bleeding highlights the need for pre-insertion counselling.
Safety of insertion of the copper IUD and LNG-IUS in nulliparous women: a systematic review
Publisher: Informa UK Limited
Date: 03-09-2018
DOI: 10.1080/13625187.2018.1526898
Abstract: Intrauterine contraception (IUC) is one of the more effective contraceptive methods for women at highest risk of unintended pregnancy. This includes younger, often nulliparous, women however, uptake has been relatively low in this group. In February 2017 we conducted a systematic review of randomised controlled trials, prospective and retrospective observational studies to identify barriers to IUC use in nulliparous women. Study quality was poor. No differences in rates of infection or expulsions between nulliparous and parous were seen. Fertility rates following removal appeared no different from the general population. Higher rates insertion difficulty, insertion failure and pain during insertion were observed in nulliparous women. A long-acting reversible contraceptive method such as IUC reduces the risk of unintended pregnancy since user failure is minimised. Evidence-based information about the advantages and disadvantages of IUC is required to inform decision-making and dispel any myths and misperceptions. Potential barriers to IUC use in nulliparous women, particularly concerns around infection, significantly higher rates of device expulsion and adverse effects on fertility, do not appear to be justified. IUC is appropriate for all medically-eligible women, including nulliparous women, and should be included in the range of contraceptive options discussed during counselling.
Expanding community pharmacists’ scope of practice in relation to contraceptive counselling and referral: a protocol for a pragmatic, stepped-wedge, cluster randomised trial (ALLIANCE)
Publisher: BMJ
Date: 08-2023
DOI: 10.1136/BMJOPEN-2023-073154
Abstract: Improving access to effective contraception has the potential to reduce unintended pregnancy and abortion rates. Community pharmacists could play an expanded role in contraceptive counselling and referral to contraceptive prescribers particularly when women are already attending community pharmacy to obtain emergency contraceptive pills (ECPs) or to have medical abortion (MA) medicines dispensed. The ALLIANCE trial aims to compare the subsequent uptake of effective contraception (hormonal or intrauterine) in women seeking ECP or MA medicines, who receive the ALLIANCE community pharmacy-based intervention with those who do not receive the intervention. ALLIANCE is a stepped-wedge pragmatic cluster randomised trial in Australian community pharmacies. The ALLIANCE intervention involves community pharmacists delivering structured, patient-centred, effectiveness-based contraceptive counselling (and a referral to a contraceptive prescriber where appropriate) to women seeking either ECPs or to have MA medicines dispensed. Women participants will be recruited by participating pharmacists. A total of 37 pharmacies and 1554 participants will be recruited. Pharmacies commence in the control phase and are randomised to transition to the intervention phase at different time points (steps). The primary outcome is the self-reported use of effective contraception at 4 months secondary outcomes include use of effective contraception and the rate of pregnancies or induced abortions at 12 months. A process and economic evaluation of the trial will also be undertaken. Ethical approval has been obtained from the Monash University Human Research Ethics Committee (#34563). An explanatory statement will be provided and written consent will be obtained from all participants (pharmacy owner, pharmacist and women) before their commencement in the trial. Dissemination will occur through a knowledge exchange workshop, peer-reviewed journal publications, presentations, social media and conferences. ACTRN12622001024730.
Parents’ Willingness to Allow Their Unaccompanied Children to Use Emerging and Future Travel Modes
Publisher: MDPI AG
Date: 29-01-2022
DOI: 10.3390/SU14031585
Abstract: This study investigated parents’ willingness to allow their unaccompanied child(ren) to use emerging and future travel modes (e.g., rideshare vehicles and automated vehicles). An online survey was completed by 631 Australian respondents (M = 39.2 years, SD = 10.5 years, Male: 36.6%) who reported that they currently lived with one or more children (17 or below). Approximately one-third (37.9%) of the respondents reported a willingness to allow their child to use a rideshare vehicle alone and more than half of the respondents (57.2%) reported a willingness to allow their child to use an automated vehicle alone. Respondents who expressed willingness to allow their child to use a rideshare vehicle alone were more likely to express a willingness to use an automated vehicle alone (79.1%) compared to respondents who were unwilling to use a rideshare vehicle (43.9%), χ2(1) = 75.158, p 0.001, Phi = 0.345. Two separate logistic regression models revealed key similarities and differences related to respondents’ willingness to allow their unaccompanied child to use both transport modes. Respondents’ willingness to allow their unaccompanied child to use a rideshare vehicle was significantly related to their previous use of a rideshare vehicle with their child, having an optimistic view of technology, annual mileage, their aberrant driving behaviours, and their desire for route-control and assurance features within the rideshare vehicle, χ2(7) = 159.594, p 0.001. Respondents’ willingness to allow their child to use an automated vehicle alone was significantly related to awareness of automated vehicles, education level, positive views towards technology, seeing technology to be innovative, and requirements for route control features within the automated vehicle, χ2(6) = 113.325, p 0.001. Despite the potential for emerging or future travel modes to provide additional personal transportation options, these results suggest that Australian parents are unwilling to allow their unaccompanied child to use these modes of transport. These findings will have significant implications for transport planning, particularly in growing communities where pressures on parents to transport their child(ren) to activities and events with minimal adult supervision is increasing.
Social media’s role in support networks among LGBTQ adolescents: a qualitative study
Publisher: CSIRO Publishing
Date: 28-10-2021
DOI: 10.1071/SH21110
Abstract: Background Adolescents use social media more frequently than other age groups. Social media has been described as a safe environment for lesbian, gay, bisexual, transgender and queer and/or questioning (LGBTQ) adolescents. As part of mixed-methods research investigating the association between social networks and sexual agency, we present qualitative findings on how LGBTQ adolescents connect online to form support networks. Methods We recruited 30 adolescents aged 14–17 years who identified as LGBTQ in terms of their gender or attraction in the longitudinal Social Networks and Agency Project. Semi-structured interviews were conducted online or face-to-face across Australia. Thematic analysis was used to explore perceptions and experiences of participants in relation to social media use and relationships. Results Two overarching themes were identified: LGBTQ adolescents use social media for identity, relationships and wellbeing support. Social media is not always free of discrimination for LGBTQ adolescents. Many LGBTQ participants joined Facebook groups to connect with LGBTQ peers. Facebook was considered a vital support for those with mental health concerns including suicidal ideation. Participants gave and received support from group members, which was considered useful for those feeling isolated or victimised. LGBTQ adolescents formed friendships, romantic relationships and gained information on sex, relationships, and sexual health from these groups. Participants described negative experiences including discrimination within Facebook groups, mismanaged groups and exposure to anti-LGBTQ sentiments. Conclusion Social media is an environment where LGBTQ adolescents can connect, educate and support each other, which may have beneficial effects for this marginalised group. There remain issues with social media including discrimination against and within LGBTQ communities.
Performing (heterosexual) femininity: female agency and role in sexual life and contraceptive use – a qualitative study in Australia
Publisher: Informa UK Limited
Date: 23-08-2016
DOI: 10.1080/13691058.2016.1214872
Abstract: Women's liberation and the sexual revolution have changed the social landscape for heterosexual women in the West over the past 50 years, but exploration of women's lived experiences of contraceptive use in the context of their sexual lives is comparatively recent. We conducted 94 in-depth open-ended interviews with women of reproductive age (16-49 years) living in New South Wales, Australia. Interviews were audio-recorded, transcribed verbatim and analysed using an inductive thematic approach. Four major themes are explored here: (1) what women do and do not do: unspoken gendered assumptions (2) focus on partner's pleasure (3) juggling responsibilities: sex as a chore and (4) women's sexual motivations. Findings suggest sexual double standards and gender expectations continue to pervade women's sexual and contraceptive practices. We found that women performed their femininity by focusing on enabling their male partner's pleasure, while simultaneously ignoring their own sexual desires, wishes or interests. Accompanying new-found freedoms are new-found responsibilities, as women now add managing modern contraceptives and a good sex life to their list of tasks alongside paid employment, domestic labour and childrearing. Our research findings suggest that women may derive different pleasures from sex, including what we term 'connection pleasure'.
Identifying gaps in dual protection from sexually transmissible infections and unintended pregnancies among Australian women: an observational study
Publisher: CSIRO Publishing
Date: 06-12-2021
DOI: 10.1071/SH21151
Abstract: Background Dual protection refers to the simultaneous prevention of sexually transmissible infection (STI) and unintended pregnancies. Optimal contraception and STI prevention strategies sometimes fail to align. Methods Using data from a large nationally representative population-based survey, we analysed the contraception and STI prevention behaviours at the last vaginal intercourse among 2420 heterosexually active women aged 16–34 years who had participated in the Second Australian Study of Health and Relationships, 2012–13. Results At their last vaginal intercourse, most women (95%) used contraception and half (49%) used condoms, either as a sole multipurpose method or in conjunction with another type of contraception. Condom use was highest (72%) among women whose most recent partner was a casual or occasional partner, followed by women with a regular partner (59%) and women with a cohabiting regular partner (40%). One-third of the women (34%) used condoms as a sole method, and 14% used oral contraceptives together with a condom. Few women used implants or intrauterine devices (8%) and, among them, very few women also used condoms ( %). Among the women who used a condom at their last vaginal intercourse, 49% reported both the correct use for STI prevention and consistent condom use during the previous 6 months. Among women using condoms, correct and consistent use was also highest among women whose most recent partner was a casual or occasional partner (76%). Conclusions Although almost all women used contraception and half used dual protection, few benefited from the protective effects of using condoms together with highly effective contraception.
The female condom: What do Australian women say?
Publisher: Wiley
Date: 21-02-2022
DOI: 10.1002/HPJA.459
Abstract: The female condom is a barrier method for the prevention of sexually transmissible infections and unintended pregnancy. Uptake of this method remains low in Australia, although little research has been undertaken to explore this. An interventional cross‐sectional study was undertaken in 2019 to explore the views and experiences of women in New South Wales. After trying the female condom, they were invited to complete an online survey and/or structured interview. Training in the use of the female condom was not provided. This paper reports on qualitative findings from open‐ended survey responses and interviews. In total, 284 participants completed the survey and 20 participated in an interview. Most were aware of the female condom prior to participating in the study, but few had used it previously. Four broad themes were identified from the data: (i) accessibility of the female condom, including cost and availability, (ii) supporting choice in different circumstances, (iii) aspects of empowerment and control and (iv) use of gendered language. The female condom may be an acceptable option for many women in Australia. To support the choice of method and promote uptake, it will be important to increase the accessibility of the female condom by raising awareness and addressing the issues of cost and availability. Further exploration of issues regarding inclusive language and messaging in health promotion c aigns and marketing is warranted to ensure that this product is accessible for all people who may wish to use it, regardless of gender or sexuality. Similar research could be undertaken with men artners and members of the LGBTQ+ community to explore their perspectives of the female condom. To support contraceptive choice and promote the uptake of the female condom for those who desire this method, it will be important to address the issues of cost and availability. Accessibility will also be enhanced through the consideration of inclusive language and messaging in health promotion c aigns and marketing of the female condom.
Pre-conception care: an important yet underutilised preventive care strategy
Publisher: AMPCo
Date: 29-04-2019
DOI: 10.5694/MJA2.50155
Current barriers and potential strategies to increase the use of long-acting reversible contraception (LARC) to reduce the rate of unintended pregnancies in Australia: An expert roundtable discussion
Publisher: Wiley
Date: 10-03-2017
DOI: 10.1111/AJO.12587
Abstract: Australia's abortion rates are among the highest in the developed world. Efficacy of the most commonly used form of contraception (oral contraceptives and condoms) relies on regular user compliance. Long-acting reversible contraception (LARC) virtually eradicates contraceptive failure as it is not user-dependent however, its uptake has been low. To provide an overview of barriers to LARC use in Australia and potential strategies to overcome these barriers. A roundtable of Australian experts was convened to share clinical perspectives and to explore the barriers and potential strategies to increase LARC use. Three broad barriers to LARC uptake were identified. (i) A paucity of Australian research exists that impedes closure of evidence gaps regarding contraceptive prescription and use. Systematic data collection is required. (ii) Within primary care, lack of familiarity with LARC and misperceptions about its use, lack of access to general practitioners (GPs) trained in LARC insertion/removal and affordability impede LARC uptake. Potential strategies to encourage LARC use include, GP education to promote informed choice by women, training in LARC insertions/removals, effective funding models for nurses to perform LARC insertions/removals, and rapid referral pathways. (iii) At the health system level, primary care incentives to provide LARC to women and health economic analyses to inform government policy changes are required. Although LARC decreases unintended pregnancies by eliminating user compliance issues, its uptake is low in Australia. Strategies that promote LARC uptake by targeting specific barriers may effectively reduce Australia's high unintended pregnancy rate.
Patient-delivered partner therapy for chlamydia in Australia: can it become part of routine care?
Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/SH20024
Abstract: Abstract Background Patient-delivered partner therapy (PDPT) is a method for an index patient to give treatment for genital chlamydia to their sexual partner(s) directly. In Australia, PDPT is considered suitable for heterosexual partners of men and women, but is not uniformly endorsed. We explored the policy environment for PDPT in Australia and considered how PDPT might become a routine option. Methods: Structured interviews were conducted with 10 key informants (KIs) representing six of eight Australian jurisdictions and documents relevant to PDPT were appraised. Interview transcripts and documents were analysed together, drawing on KIs’ understanding of their jurisdiction to explore our research topics, namely the current context for PDPT, challenges, and actions needed for PDPT to become routine. Results: PDPT was allowable in three jurisdictions (Victoria, New South Wales, Northern Territory) where State governments have formally supported PDPT. In three jurisdictions (Western Australia, Australian Capital Territory, Tasmania), KIs viewed PDPT as potentially allowable under relevant prescribing regulations however, no guidance was available. Concern about antimicrobial stewardship precluded PDPT inclusion in the South Australian strategy. For Queensland, KIs viewed PDPT as not allowable under current prescribing regulations and, although a Medicine and Poisons Act was passed in 2019, it is unclear if PDPT will be possible under new regulations. Clarifying the doctor–partner treating relationship and clinical guidance within a care standard were viewed as crucial for PDPT uptake, irrespective of regulatory contexts. Conclusion: Endorsement and guidance are essential so doctors can confidently and routinely offer PDPT in respect to professional standards and regulatory requirements.
Comparison of diaphragm and combined oral contraceptive pill users in the Australian family planning setting
Publisher: Informa UK Limited
Date: 2009
DOI: 10.1080/13625180601045337
Abstract: To determine the number of women fitted with a diaphragm or cervical cap at family planning clinics across the Australian State of New South Wales (NSW) from 2000 to 2005. To compare the demographic characteristics of women fitted with this form of contraceptive with women prescribed the combined oral contraceptive pill (COCP). An audit of women presenting for contraceptive services between 2000 and 2005 was undertaken. The demographic characteristics of women fitted with a barrier method or prescribed the COCP between 1st April, 2002, and 31st October, 2004, were obtained from the Family Planning NSW Activity Data Set (FADS). The proportion of women fitted with a diaphragm or cap remained constant between 2001 and 2005 at approximately 5%. During the 31 months that the study period lasted, 793 women were fitted with a diaphragm or cervical cap compared with 8047 women prescribed the COCP during the same time frame (including 76 women who received both a diaphragm and COCP prescription during this period). Women fitted with the barrier contraceptive were significantly more likely to be older, to have received a tertiary level education and to have private health insurance than their counterparts prescribed the COCP. They were less likely to come from a non-English speaking background. The diaphragm and cervical cap are viable contraceptive methods for a specific group of older, well-educated women. The possible benefits of female-controlled barrier devices in the prevention of sexually transmissible infections may result in a wider demographic use in the future.
Newer non-oral hormonal contraception
Publisher: BMJ
Date: 14-02-2013
DOI: 10.1136/BMJ.F341
Contraception and pregnancy then and now: Examining the experiences of a cohort of mid‐age Australian women
Publisher: Wiley
Date: 29-07-2009
Australian women's attitudes towards and understandings of the subdermal contraceptive implant: a qualitative study of never-users
Publisher: BMJ
Date: 03-03-2016
DOI: 10.1136/JFPRHC-2014-101132
Abstract: Few studies have explored Australian women's understandings of contraception. This study examined the attitudes towards, and understandings of, the subdermal contraceptive implant expressed by women living in New South Wales (NSW), Australia. As part of a larger qualitative study using in-depth, open-ended interviews in 2012-2013 with women aged 16-49 years who had ever used contraception ( The emergent themes were: satisfaction with current method weak personal opinions and ambivalence uncertainty due to specific concerns and strong negative reactions - fear and dislike. Although there were a few positive perceptions expressed by women who had never used the subdermal implant, for the majority of women the perception was predominantly negative. Women tended to form negative impressions from the stories of other women about the subdermal implant. Interventions to enhance evidence-informed awareness of the relative advantages and disadvantages of the implant - for ex le, improved access to supportive contraceptive counselling - need investigation in the Australian context. Avenues to improve women's perceived control over the device could also be usefully investigated.
Challenges for Researchers Investigating Contraceptive Use and Pregnancy Intentions of Young Women Living in Urban and Rural Areas of Australia: Face-to-Face Discussions to Increase Participation in a
Publisher: JMIR Publications Inc.
Date: 21-01-2013
DOI: 10.2196/JMIR.2266
Improving access to quality contraceptive counselling in community pharmacy: examining the knowledge, attitudes and practices of community pharmacists in Australia
Publisher: BMJ
Date: 21-11-2023
DOI: 10.1136/BMJSRH-2022-201623
Abstract: Across most of Australia, the role of community pharmacists in contraceptive care has been unchanged since 2004. To understand their current scope of practice and potential for practice advancements, we examined community pharmacists’ contraceptive knowledge and their attitudes, practices and perceived barriers to and benefits of contraceptive counselling provision. A nationwide postal survey was conducted between September and December 2020. We contacted a state/territory-stratified s le of 2149 community pharmacies and limited eligibility to one pharmacist per pharmacy. Summary statistics of respondent characteristics and parametric (χ 2 , linear regression) and non-parametric (Mann-Whitney, logistic regression) tests were computed for the outcomes: practices, knowledge (reported and tested), confidence, attitudes, barriers and benefits. Eligible responses were received from 366 pharmacies (19%). Pharmacists’ median age was 34. Most (85% of) pharmacists agreed that contraceptive counselling fits within their current professional activities and emphasised benefits to their patients, including improved access to contraceptive decision support (80%), as being key motivators of counselling. A lack of payment mechanisms (66%), training opportunities (55%) and technical assistance tools (54%) were the most important barriers. Self-rated knowledge and confidence were highest for combined oral contraceptive pills and lowest for the copper intrauterine device (IUD). When tested, pharmacists were very knowledgeable about method, dosage, frequencies and costs, and relatively less knowledgeable about side-effects and IUD suitability for adolescents. Community pharmacists provide contraceptive information and counselling but lack the necessary resources and support to be able to consistently provide quality, person-centred care. Remuneration mechanisms, training opportunities and pharmacy-specific professional resources need to be explored.
Enhancing use of emergency contraceptive pills: A systematic review of women’s attitudes, beliefs, knowledge, and experiences in Australia
Publisher: Informa UK Limited
Date: 26-11-2019
DOI: 10.1080/07399332.2018.1526286
Abstract: Over a decade after emergency contraceptive pills (ECPs) became available without a prescription, the rate of unintended pregnancies remains high in many settings. Understanding women's experiences and perceptions of ECPs may provide insights into this underutilization. We systematically searched databases to identify qualitative and quantitative primary studies about women's beliefs, knowledge, and experiences of ECPs in Australia. Findings demonstrate persistent misunderstandings around access, how ECPs work, and a moral discourse around acceptable versus unacceptable use. Addressing knowledge and the stigma around ECPs use is fundamental to increasing the use of this medically safe and effective strategy.
Contraception provision in the postpartum period: Knowledge, views and practices of midwives
Publisher: Elsevier BV
Date: 02-2021
How can we encourage the provision of early medical abortion in primary care? Results of a best–worst scaling survey
Publisher: CSIRO Publishing
Date: 07-12-2022
DOI: 10.1071/PY22130
Abstract: Background Almost one in four women in Australia experience an unintended pregnancy during their lifetime of these, approximately 30% currently end in abortion. Although early medical abortion (EMA) up to 9 weeks gestation is becoming more widely available in Australia, it is still not commonly offered in primary care. The aim of this study was to investigate the barriers and facilitators to the provision of EMA in primary care. Methods A s le of 150 general practitioners (GPs) and 150 registered nurses (RNs) working in Australia responded to a best–worst scaling survey designed to answer the following question: what are the most important facilitators and barriers to the provision of EMA in primary care? Results GPs believe that the lack of clinical guidelines, the amount of information provision and counselling required, and the fact that women who are not their patients may not return for follow-up are the most important barriers. For RNs, these three barriers, together with the stigma of being known as being involved in the provision of EMA, are the most important barriers. The formation of a community of practice to support the provision of EMA was identified by both professions as the most important facilitator. Conclusions Having access to a community of practice, enhanced training and reducing stigma will encourage the provision of EMA. Although clinical guidelines are available, they need to be effectively disseminated, implemented and endorsed by peak bodies. Primary care practices should consider using task sharing and developing patient resources to facilitate the provision of information and counselling.
Fall in Human Papillomavirus Prevalence Following a National Vaccination Program
Publisher: Oxford University Press (OUP)
Date: 19-10-2012
Abstract: In April 2007, Australia became the first country to introduce a national government-funded human papillomavirus (HPV) vaccination program. We evaluated the program's impact on genotype-specific HPV infection prevalence through a repeat survey of women attending clinical services. HPV genoprevalence in women aged 18-24 years attending family planning clinics in the prevaccine period (2005-2007) was compared with prevalence among women of the same age group in the postvaccine period (2010-2011). The same recruitment and testing strategies were utilized for both sets of s les, and comparisons were adjusted for potentially confounding variables. The prevalence of vaccine HPV genotypes (6, 11, 16, and 18) was significantly lower in the postvaccine s le than in the prevaccine s le (6.7% vs 28.7% P < .001), with lower prevalence observed in both vaccinated and unvaccinated women compared with the prevaccine population (5.0% [adjusted odds ratio, 0.11 95% confidence interval, 0.06-0.21] and 15.8% [adjusted odds ratio, 0.42 95% confidence interval, 0.19-0.93], respectively). A slightly lower prevalence of nonvaccine oncogenic HPV genotypes was also found in vaccinated women (30.8% vs 37.6% adjusted odds ratio, 0.68 95% confidence interval, 0.46-0.99). Four years after the commencement of the Australian HPV vaccination program, a substantial decrease in vaccine-targeted genotypes is evident and should, in time, translate into reductions in HPV-related lesions.
Renewal of the National Cervical Screening Program: health professionals’ knowledge about screening of specific populations in NSW, Australia
Publisher: The Sax Institute
Date: 2022
Abstract: The National Cervical Screening Program was renewed in Australia from 1 December 2017, with the introduction of 5-yearly human papilloma virus (HPV) screening from age 25, and the release of updated national screening guidelines. This study aimed to determine health professional knowledge of the renewed screening program following implementation. We invited health professionals providing cervical screening in New South Wales (NSW), Australia, to complete an online survey in late 2018, to better understand their knowledge of the renewed screening guidelines, in particular regarding screening of specific populations, and to ascertain whether they had undertaken any educational activities relevant to the renewal. A total of 241 responses were included in the data analysis. Health professionals demonstrated good knowledge of some aspects of the renewed program, including 64-85% correctly identifying limited indications for testing people younger than 25 years, 87% correctly identifying the need for completion of the Test of Cure protocol following treatment of high-grade lesions, and 71-80% correctly identifying management of symptomatic women. However several key knowledge gaps were identified including management of immune-deficient women (only 37% of respondents were aware of the need for 3-yearly screening), screening after total hysterectomy (56% were aware of guidance) and approximately 66% of health professionals correctly identifying indications for self-collected screening. One in ten health professionals had not undertaken any education specific to the renewal of the program. We found significant associations between knowledge levels and practitioner characteristics, including practitioners' frequency of access to the guidelines, specific educational activities undertaken and geographic location. Health professionals demonstrated strong knowledge of key aspects of the renewed National Cervical Screening program. However, our findings highlight some important gaps that may impact successful delivery of the program in Australia, and some significant associations between practitioner characteristics and knowledge levels, which will be important for education providers to note. Targeted educational interventions informed by these findings could support health professionals to better translate guidelines into practice and ensure successful delivery of this important public health program, particularly in regard to management of immune-deficient women, screening after hysterectomy and indications for self-collected screening.
A survey describing the use of complementary therapies and medicines by women attending a family planning clinic
Publisher: Springer Science and Business Media LLC
Date: 11-09-2013
Towards comprehensive early abortion service delivery in high income countries: insights for improving universal access to abortion in Australia
Publisher: Springer Science and Business Media LLC
Date: 22-10-2016
Clinical experience of trainees of The Royal Australian and New Zealand College of Obstetricians and Gynaecologists in insertion of long‐acting reversible contraceptives
Publisher: Wiley
Date: 30-03-2021
DOI: 10.1111/AJO.13344
Abstract: Long‐acting reversible contraceptives (LARCs) include both progestogen‐containing implants and intrauterine devices releasing either a progestogen or copper, providing highly effective contraception. Increasing uptake of LARCs is advocated by governments and professional organisations as an important strategy to reduce unintended pregnancy such uptake requires, among other measures, adequate training of doctors in the areas of obstetrics and gynaecology and women’s health. To assess The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) trainees’ (Fellowship, Diploma or Certificate of Women’s Health) experience and training in insertion and removal of LARCs. An invitation email to participate in an anonymous survey approved by the Continuing Professional Development Committee of RANZCOG was sent to all current RANZCOG trainees in the three categories. The responses were categorised and analysed. Of 1686 invited trainees, 294 (17.4%) responded: 250 in Australia and 44 in New Zealand 127 were undertaking Fellowship training (8.3% of those invited) and 166 (100% of those invited) were undertaking training for the Diploma (either DRANZCOG and DRANZCOG Advanced) or the Certificate of Women’s Health. Significant numbers of all categories of trainees had no or limited experience of insertion or removal of LARCs of all types and/or lacked self‐confidence in LARC provision. RANZCOG needs to address this training deficiency to continue as the leader in Australia in the provision of women’s reproductive healthcare.
User characteristics, experiences and continuation rates of copper intrauterine device use in a cohort of Australian women
Publisher: Wiley
Date: 05-10-2016
DOI: 10.1111/AJO.12534
Abstract: Copper intrauterine device (Cu-IUD) use in Australia is low despite being a highly effective, cost effective non-hormonal contraceptive with reported 12-month continuation rates of 85% compared to 59% for oral contraception. To describe the characteristics of Cu-IUD users in the Australian context, their experiences of side effects, continuation rates and reasons for discontinuation. Between August 2009 and January 2012 we undertook a prospective cohort study of consecutive women presenting for Cu-IUD insertion to three family planning clinics in Queensland and New South Wales. We used survival analysis for continuation rates and univariate and multivariable analyses to characterise users, their experiences up to three years and reasons for discontinuation. Of the 211 enrolled women, a third (36.0%) were aged under 30 and a third were nulliparous (36.5%). Efficacy and lack of hormones were the most frequently cited reasons to choose the method. Four women were lost to follow-up. Overall continuation rates were 79.1% at one year and 61.3% at three years. Early discontinuation was reduced in those with two or more children (adjusted hazards ratio 0.22, 95% CI 0.09-0.50). Heavy menstrual bleeding was the commonest reason for removal in 28 of 59 (47.5%) discontinuations due to complications or side effects. One uterine perforation and one method failure resulting in an ectopic pregnancy occurred. Cu-IUDs were chosen for their efficacy and lack of hormones by a range of Australian women, including young and nulliparous women. While bleeding-related side effects were relatively common, overall continuation rates were high. Serious complications and failures were rare.
The impact of cancer‐related fertility concerns on current and future couple relationships: People with cancer and partner perspectives
Publisher: Hindawi Limited
Date: 20-10-2021
DOI: 10.1111/ECC.13348
A review of intrauterine contraception in the Asia-Pacific region
Publisher: Elsevier BV
Date: 2017
DOI: 10.1016/J.CONTRACEPTION.2016.08.008
Abstract: Across the Asia-Pacific region, approximately 38% of pregnancies are unintended. Long-acting reversible contraception, such as intrauterine contraception (IUC), is effective in reducing unintended pregnancy. This study aims to review access to, uptake of and influencing factors on IUC use in the Asia-Pacific region. We searched PubMed and MEDLINE for articles published between 1990 and 2015. We identified and reviewed primary studies that examined the following points and were relevant to the Asia-Pacific region: available types and utilization rates of IUC and factors that influence these. We also obtained the opinions of local experts to gain a better understanding of the situation in specific countries. Types of IUC used and utilization rates vary widely across the region. Factors influencing rates of utilization relate to healthcare systems, such as government policy on and subsidization of IUC, types of healthcare providers authorized to place IUC and local guidelines on preinsertion screening. Healthcare provider factors include concerns around pelvic inflammatory disease and the suitability of IUC in certain groups of women, whereas end-user factors include lack of awareness of IUC, concerns about safety, cultural or religious attitudes, access to IUC and costs. Across the Asia-Pacific region, clear data gaps and unmet needs exist in terms of access to and uptake of IUC. We believe that several recommendations are necessary to update future practice and policy for enhanced IUC utilization so that women across this region have better access to IUC.
Abortion statistics and long-acting reversible contraception in Australia
Publisher: Wiley
Date: 06-2018
DOI: 10.1111/AJO.12810
The impact of COVID-19 on contraception and abortion care policy and practice: experiences from selected countries
Publisher: BMJ
Date: 11-08-2020
Is there a need for better sexual education of young men? Sexual behaviour and reproductive health in Swiss university students: a questionnaire-based pilot study
Publisher: Informa UK Limited
Date: 04-03-2018
DOI: 10.1080/13625187.2018.1458226
Abstract: There is evidence that men's perception of contraceptive methods and of their effectiveness and health risks have a major impact on couples contraceptive choices. Engaging men in decision making improves reproductive health outcomes. If they are better informed, men can potentially contribute to more effective use of contraception, thus reducing the rate of sexually transmitted infections and abortion. In Central European countries, few data are available on male contraceptive knowledge and behaviour. To collect more data we conducted an anonymous survey among young men studying at Zürich University in Switzerland. A questionnaire was distributed to 1500 male students which included a broad range of items addressing sexual behaviour, condom use and knowledge, and attitudes regarding contraceptive methods. Three hundred and sixty-one questionnaires were eligible for evaluation. Condoms and the combined oral contraceptive pill were the most frequently used methods. However, at last intercourse 15.6% of respondents had not used any method of contraception. Many respondents (37%) had had a one-night stand without protection. Contraceptive methods most regarded as unhealthy for women were the combined oral contraceptive pill, progestin-only methods, intrauterine devices (IUDs) and emergency contraception. Characteristics considered by young men to be important in determining contraceptive method choice were: efficacy, partner satisfaction and no impact on fertility and libido. Awareness among male Swiss students about contraceptive methods is high, but in-depth knowledge is limited. Myths were expressed about the combined oral contraceptive pill, progestin-only methods, IUDs and the emergency contraceptive pill. High-risk behaviour occurs frequently. The internet was reported to be the most important source of information about contraception.
Who is responsible for postpartum contraception advice and provision? The perspective of hospital‐based maternity clinicians in New South Wales, Australia
Publisher: Wiley
Date: 03-11-2023
DOI: 10.1111/AJO.13627
Abstract: Access to postpartum contraception is critical for the health of the mother and subsequent pregnancies. However, the differential roles and responsibilities of maternity care providers in contraception discussions and provision are often unclear. Our study, part of a larger study on midwifery provision of contraceptive implants, presents the perspectives of hospital‐based maternity clinicians. Participants suggested that contraception discussions and provision are a shared responsibility of maternity care providers but identified inconsistencies and issues with current approaches. Access to contraception could be improved through more routine discussions antenatally and postnatally and greater collaboration between maternity care providers in hospital, community and primary care settings.
Improving rural and regional access to long-acting reversible contraception and medical abortion through nurse-led models of care, task-sharing and telehealth (ORIENT): a protocol for a stepped-wedge pragmatic cluster-randomised controlled trial in Australian general practice
Publisher: BMJ
Date: 03-2023
DOI: 10.1136/BMJOPEN-2022-065137
Abstract: Women living in rural and regional Australia often experience difficulties in accessing long-acting reversible contraception (LARC) and medical abortion services. Nurse-led models of care can improve access to these services but have not been evaluated in Australian general practice. The primary aim of the ORIENT trial (ImprOving Rural and regIonal accEss to long acting reversible contraceptioN and medical abortion through nurse-led models of care, Tasksharing and telehealth) is to assess the effectiveness of a nurse-led model of care in general practice at increasing uptake of LARC and improving access to medical abortion in rural and regional areas. ORIENT is a stepped-wedge pragmatic cluster-randomised controlled trial. We will enrol 32 general practices (clusters) in rural or regional Australia, that have at least two general practitioners, one practice nurse and one practice manager. The nurse-led model of care (the intervention) will be codesigned with key women’s health stakeholders. Clusters will be randomised to implement the model sequentially, with the comparator being usual care. Clusters will receive implementation support through clinical upskilling, educational outreach and engagement in an online community of practice. The primary outcome is the change in the rate of LARC prescribing comparing control and intervention phases secondary outcomes include change in the rate of medical abortion prescribing and provision of related telehealth services. A within-trial economic analysis will determine the relative costs and benefits of the model on the prescribing rates of LARC and medical abortion compared with usual care. A realist evaluation will provide contextual information regarding model implementation informing considerations for scale-up. Supporting nurses to work to their full scope of practice has the potential to increase LARC and medical abortion access in rural and regional Australia. Ethics approval was obtained from the Monash University Human Research Ethics Committee (Project ID: 29476). Findings will be disseminated via multiple avenues including a knowledge exchange workshop, policy briefs, conference presentations and peer-reviewed publications. This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12622000086763).
Could HPV Testing on Self-collected Samples Be Routinely Used in an Organized Cervical Screening Program? A Modeled Analysis
Publisher: American Association for Cancer Research (AACR)
Date: 02-2021
DOI: 10.1158/1055-9965.EPI-20-0998
Abstract: Cervical screening on self-collected s les has mainly been considered for targeted use in underscreened women. Updated evidence supports equivalent sensitivity of PCR-based human papillomavirus (HPV) testing on self-collected and clinician-collected s les. Using a well-established model, we compared the lifetime impact on cancer diagnoses and deaths resulting from cervical screening using self-collected s les only, with and without the existing restriction in Australia to women aged 30+ years and ≥2 years overdue, compared with the mainstream program of 5-yearly HPV screening on clinician-collected s les starting at 25 years of age. We conservatively assumed sensitivity of HPV testing on self-collected relative to clinician-collected s les was 0.98. Outcomes were estimated either in the context of HPV vaccination (“routinely vaccinated cohorts ” uptake as in Australia) or in the absence of HPV vaccination (“unvaccinated cohorts”). In unvaccinated cohorts, the health benefits of increased participation from self-collection outweighed the worst case (2%) loss of relative test sensitivity even if only 15% of women, who would not otherwise attend, used it (“additional uptake”). In routinely vaccinated cohorts, population-wide self-collection could be marginally (0.2%–1.0%) less effective at 15% additional uptake but 6.2% to 12.4% more effective at 50% additional uptake. Most (56.6%–65.0%) of the loss in effectiveness in the restricted self-collection pathway in Australia results from the requirement to be 2 or more years overdue. Even under pessimistic assumptions, any potential loss in test sensitivity from self-collection is likely outweighed by improved program effectiveness resulting from feasible levels of increased uptake. Consideration could be given to offering self-collection more widely, potentially as an equal choice for women. See related commentary by Lim, p. 245
Evaluation of Chlamydia Partner Notification Practices and Use of the “Let Them Know” Website by Family Planning Clinicians in Australia: a Cross-Sectional Study
Publisher: JMIR Publications Inc.
Date: 24-06-2016
DOI: 10.2196/JMIR.5441
Young migrant and refugee people’s views on unintended pregnancy and abortion in Sydney
Publisher: Informa UK Limited
Date: 03-05-2020
Acceptability of the copper intrauterine device as a form of emergency contraception in New South Wales, Australia
Publisher: Informa UK Limited
Date: 19-02-2020
Assessment of herd immunity and cross-protection after a human papillomavirus vaccination programme in Australia: a repeat cross-sectional study
Publisher: Elsevier BV
Date: 10-2014
Pathways to a cancer-free future: A protocol for modelled evaluations to maximize the future impact of interventions on cervical cancer in Australia
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.YGYNO.2018.12.019
Abstract: Australia's HPV vaccination and HPV-based cervical screening programs are changing the landscape in cervical cancer prevention. We aim to identify areas which can make the biggest further impact on cervical cancer burden. This protocol describes the first stage of a program of work called Pathways-Cervix that aims to generate evidence from modelled evaluations of interventions across the cervical cancer spectrum. Based on evidence from literature reviews and guidance from a multi-disciplinary Scientific Advisory Committee (SAC), the most relevant evaluations for prevention, diagnosis and treatment were identified. Priority evaluations agreed by the SAC included: increasing/decreasing and retaining vaccination uptake at the current level vaccinating older women increasing screening participation methods for triaging HPV-positive women improving the diagnosis of cervical intraepithelial neoplasia (CIN) and cancer treating cervical abnormalities and cancer and vaccinating women treated for CIN2/3 to prevent recurrence. Evaluations will be performed using a simulation model, Policy1-Cervix previously used to perform policy evaluations in Australia. Exploratory modelling of interventions using idealised scenarios will initially be conducted in single birth cohorts. If these have a significant impact on findings then evaluations with more realistic assumptions will be conducted. Promising strategies will be investigated further by multi-cohort simulations predicting health outcomes, resource use and cost outcomes. Pathways-Cervix will assess the relative benefits of strategies and treatment options in a systematic and health economic framework, producing a list of 'best buys' for future decision-making in cervical cancer control.
Increasing the accessibility of long-acting reversible contraceptives through nurse-led insertions: A cost-benefit analysis
Publisher: Elsevier BV
Date: 02-2020
Unwanted Sex Due to Intoxication among Australians Aged 16–69 Years
Publisher: Informa UK Limited
Date: 14-10-2021
Community Treatment Order: Identifying the need for more evidence based justification of its use in first episode psychosis patients
Publisher: Elsevier BV
Date: 07-2017
DOI: 10.1016/J.SCHRES.2016.12.022
Abstract: Community Treatment Order (CTO) is a legal regime that obliges patients suffering mental disorder to adhere to treatment in the community and allows for a swift admission to hospital if necessary. Study aims were to: (i) determine CTO frequency in a large representative s le of first episode psychosis (FEP) patients (ii) compare the characteristics of patients with or without CTO before entry, during treatment and at discharge from an early psychosis program. Information on 660 patients treated at the Early Psychosis Prevention and Intervention Centre (EPPIC) between 1998 and 2000 was collected from medical files. 19.2% of patients were under CTO at least once during treatment and they differed on most pre-treatment, baseline, treatment and service discharge variables. They were less educated, more likely to have a history of offending behavior, had lower pre-morbid functioning, longer duration of untreated psychosis, increased prevalence and more persistent substance use disorders, greater severity of symptoms, lower functioning, poorer insight at any time during treatment and were more likely to be admitted to hospital. CTO frequency was high, likely related to the representativeness of the cohort. Characteristics of patients on CTO are comparable to those with serious and persistent mental illness. Considering the absence of solid evidence regarding the effectiveness of this form of compulsion, it is crucial to study the use of CTO in FEP patients in order to explore its impact and identify patients for whom it may be beneficial.
Management of heavy menstrual bleeding in Australian general practice: An analysis of BEACH data
Publisher: The Royal Australian College of General Practitioners
Date: 08-2021
Effectiveness of the progestin-only pill for migraine treatment in women: A systematic review and meta-analysis
Publisher: SAGE Publications
Date: 29-05-2017
Abstract: Migraine is highly prevalent in women (18%). Peak morbidity affects their most productive years, coinciding with peak fertility. Hormonal contraception is often tailored for migraine prevention. Estrogen-containing contraceptives may be contraindicated in women experiencing migraine with aura due to the risk of vascular events. While improvements in migraine with a progestin-only pill (POP), which inhibits ovulation are documented, the strength and quality of evidence has not been formally evaluated. To determine the effectiveness of progestin-only contraceptives for migraine treatment by systematic review and meta-analysis. MEDLINE, EMBASE and Cochrane Libraries were searched (1980 to September 2016) for studies on progestin-only treatments for migraine. Studies in English on non-menopausal women aged 18–50 with migraine diagnosed by formal criteria were included. Data were quality-assessed using the GRADE system. A random effects model was used for pooled analyses. Pooled analyses of four studies demonstrated that desogestrel 75 mcg/day, POP significantly but modestly reduced the number of migraine attacks and migraine days. Reduced intensity and duration, reduced analgesic and triptan use were observed, along with improved headache-related quality of life. GRADE analysis indicated evidence was low to very low for each outcome measure. Adverse effects resulted in treatment cessation for % of participants. Two studies compared desogestrel POP to a combined oral contraceptive, demonstrating similar migraine outcomes for both treatments. The desogestrel POP shows promise in improving migraine in women. Current evidence is observational and based on small s les of women using only one oral progestin-only formulation. Further randomized trials on additional progestin-only contraceptives are required to confirm their role in migraine management.
Related Organisations
Official Development Assistance
Location: United Kingdom of Great Britain and Northern Ireland
University Of Oxford Somerville College
Location: United Kingdom of Great Britain and Northern Ireland
Marie Stopes International
Location: United Kingdom of Great Britain and Northern Ireland
London School Of Hygiene And Tropical Medicine
Location: United Kingdom of Great Britain and Northern Ireland
Related Funding Activities
The Third Australian Study Of Health And Relationships (ASHR3): A Nationally Representative Health Survey
Start Date: 2019
End Date: 2023
Funder: National Health and Medical Research Council
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Funder: National Health and Medical Research Council
View Funded ActivityImplementation Of An Integrated Model Of Chlamydia Case Management In General Practice.
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End Date: 2023
Funder: National Health and Medical Research Council
View Funded ActivityCUE: Contraception Understandings And Experiences Of Australian Women
Start Date: 2012
End Date: 2017
Funder: Australian Research Council
View Funded ActivityCUPID: Contraceptive Use, Pregnancy Intention And Decisions Of Australian Women
Start Date: 2010
End Date: 2013
Funder: Australian Research Council
View Funded ActivityDevelopment And Feasibility Testing Of A ‘Consumer Questions’ Program To Increase Health Literacy And Empower Consumers To Participate In Decisions About Their Health
Start Date: 2010
End Date: 2013
Funder: Informed Medical Decisions Foundation
View Funded ActivityWHINURS (Women, Human Papilloma Virus Prevalence, Indigenous, Non-Indigenous, Urban, Rural): The Population Impact Of Human Papillomavirus Vaccination On Circulating Genotypes
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Funder: Cancer Council NSW
View Funded ActivityCentre For Research Excellence In Cervical Cancer Control
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View Funded ActivityOnline And Offline Social Networks And The Development Of Sexual Agency
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View Funded ActivityAntibiotic Treatment Of Male Partners To Reduce Recurrence Of Bacterial Vaginosis In Women: A Randomised Double-blind Controlled Trial
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End Date: 2020
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