Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 5 de 5
Filter
1.
Midwifery ; 111: 103369, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1851799

ABSTRACT

PROBLEM: In Australia, many women from refugee and migrant backgrounds experience significant health disparities and barriers to care and poor health literacy negatively influences their maternal and infant health outcomes. Improving health literacy improves these outcomes yet can be time consuming and difficult to provide within the confines of current models of maternity care. INTRODUCTION: Each year, more than 9000 women give birth across Monash Health's three maternity sites within one large public health service, located in Melbourne. Almost 60% of these women were born in non-English speaking countries and approximate 10% request the use of an interpreter at some point throughout their maternity experience. This project aimed to co-design animated videos focused on preconception, pregnancy, and postnatal care with women from refugee and migrant backgrounds. METHODS: The authors utilised previously prioritised maternity education needs as a starting point for design workshops undertaken with healthcare staff and women from the end-user communities. Over three workshops, sixteen healthcare staff volunteered to map or provide feedback on key touch points and barriers to quality, respectful care from the preconception period until six months postnatal. Arabic- and Dari-speaking women, led by bicultural educators, were all paid to user test these posters and the subsequently developed videos. RESULTS: The process utilised within this project yielded five posters, four videos and four important recommendations in maternity care to incorporate in the education posters and videos, which both healthcare workers and the Arabic- and Dari-speaking women referenced at each mapping and user testing session. These included (1) explaining maternity care (appointment, tests, diet, medications etc.); (2) culturally informed models of care; (3) recognising the role of the support person; and (4) the impact of COVID-19 on health provision and access. DISCUSSION: Maternal health literacy is a known predictor of perinatal outcomes. Globally, women report wanting more guidance and clearer understanding of what is taking place throughout their perinatal journey. This desire for knowledge is no different for women from non-English speaking backgrounds in Australia, though it may require more time and investment by health providers and educators. These posters and videos offer an attempt to support women, particularly women from refugee and migrant backgrounds, who require further healthcare explanations, to complement their current models of care, in a medium that is accessible and appropriate for them.


Subject(s)
COVID-19 , Health Literacy , Maternal Health Services , Refugees , Transients and Migrants , Female , Health Services Accessibility , Humans , Language , Pregnancy , Qualitative Research
2.
JAMA Intern Med ; 182(2): 106-114, 2022 Feb 01.
Article in English | MEDLINE | ID: covidwho-1838104

ABSTRACT

IMPORTANCE: Excessive gestational weight gain (GWG) is common and associated with adverse pregnancy outcomes. Antenatal lifestyle interventions limit GWG; yet benefits of different intervention types and specific maternal and neonatal outcomes are unclear. OBJECTIVE: To evaluate the association of different types of diet and physical activity-based antenatal lifestyle interventions with GWG and maternal and neonatal outcomes. DATA SOURCES: A 2-stage systematic literature search of MEDLINE, Embase, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, and Health Technology Assessment Database was conducted from February 1, 2017, to May 31, 2020. Search results from the present study were integrated with those from a previous systematic review from 1990 to February 2017. STUDY SELECTION: Randomized trials reporting GWG and maternal and neonatal outcomes. DATA EXTRACTION AND SYNTHESIS: Data were extracted for random-effects meta-analyses to calculate the summary effect estimates and 95% CIs. MAIN OUTCOMES AND MEASURES: Outcomes were clinically prioritized, with mean GWG as the primary outcome. Secondary outcomes included gestational diabetes, hypertensive disorders of pregnancy, cesarean section, preterm delivery, large or small for gestational age neonates, neonatal intensive care unit admission, or fetal death. RESULTS: A total of 117 randomized clinical trials of antenatal lifestyle interventions (involving 34 546 women) were included. Overall lifestyle intervention was associated with reduced GWG (-1.15 kg; 95% CI, -1.40 to -0.91), risk of gestational diabetes (odds ratio [OR], 0.79; 95% CI, 0.70-0.89), and total adverse maternal outcomes (OR, 0.89; 95% CI, 0.84-0.94) vs routine care. Compared with routine care, diet was associated with less GWG (-2.63 kg; 95% CI, -3.87 to -1.40) than physical activity (-1.04 kg; 95% CI, -1.33 to -0.74) or mixed interventions (eg, unstructured lifestyle support, written information with weight monitoring, or behavioral support alone) (-0.74 kg; 95% CI, -1.06 to -0.43). Diet was associated with reduced risk of gestational diabetes (OR, 0.61; 95% CI, 0.45-0.82), preterm delivery (OR, 0.43; 95% CI, 0.22-0.84), large for gestational age neonate (OR, 0.19; 95% CI, 0.08-0.47), neonatal intensive care admission (OR, 0.68; 95% CI, 0.48-0.95), and total adverse maternal (OR, 0.75; 95% CI, 0.61-0.92) and neonatal outcomes (OR, 0.44; 95% CI, 0.26-0.72). Physical activity was associated with reduced GWG and reduced risk of gestational diabetes (OR, 0.60; 95% CI, 0.47-0.75), hypertensive disorders (OR, 0.66; 95% CI, 0.48-0.90), cesarean section (OR, 0.85; 95% CI, 0.75-0.95), and total adverse maternal outcomes (OR, 0.78; 95% CI, 0.71-0.86). Diet with physical activity was associated with reduced GWG (-1.35 kg; 95% CI, -1.95 to -0.75) and reduced risk of gestational diabetes (OR, 0.72; 95% CI, 0.54-0.96) and total adverse maternal outcomes (OR, 0.81; 95% CI, 0.69-0.95). Mixed interventions were associated with reduced GWG only. CONCLUSIONS AND RELEVANCE: This systematic review and meta-analysis found level 1 evidence that antenatal structured diet and physical activity-based lifestyle interventions were associated with reduced GWG and lower risk of adverse maternal and neonatal outcomes. The findings support the implementation of such interventions in routine antenatal care and policy around the world.


Subject(s)
Diabetes, Gestational , Gestational Weight Gain , Hypertension , Premature Birth , Cesarean Section , Diabetes, Gestational/epidemiology , Diabetes, Gestational/prevention & control , Diet , Exercise , Female , Humans , Infant, Newborn , Male , Pregnancy , Pregnancy Outcome/epidemiology , Premature Birth/epidemiology , Premature Birth/prevention & control , Weight Gain
3.
Int J Environ Res Public Health ; 19(9)2022 04 21.
Article in English | MEDLINE | ID: covidwho-1818129

ABSTRACT

The COVID-19 pandemic has impacted perinatal mental health globally. We determined the maternal factors and pandemic-related experiences associated with clinically significant perinatal (pregnant and post-partum) depressive symptoms in Australian women. Participants (n = 2638; pregnant n = 1219, postnatal n = 1419) completed an online survey (August 2020 through February 2021) and self-reported on depression, social support, and COVID-19 related experiences. We found elevated depressive symptoms amongst 26.5% (pregnant) and 19% (postnatal) women. Multiple logistic regression analyses showed higher likelihood of elevated depression associated with residence in Victoria, lower education, past/current mental health problems, greater non-pandemic prenatal stress, age ≥ 35 years (pregnant women) and existing physical health issues or disability in self or others (postnatal women). Greater family stress/discord and lower social support (friends) was associated with higher odds of elevated perinatal depression, while lower social support (family) was significantly associated with elevated depressive symptoms in pregnant women. Greater depression was associated with social distancing, pandemic-related news exposure and changes to prenatal care (pregnant women). Single postnatal women showed lower odds of elevated depression than partnered women. Our findings underscore the importance of universal screening for depression and targeted support during a pandemic for perinatal women displaying vulnerability factors.


Subject(s)
COVID-19 , Depression , Pregnant Women/psychology , Social Support , Adult , Anxiety , Australia/epidemiology , COVID-19/complications , COVID-19/epidemiology , COVID-19/psychology , Depression/epidemiology , Depression/etiology , Depression/psychology , Depression, Postpartum/epidemiology , Depression, Postpartum/prevention & control , Depression, Postpartum/psychology , Female , Humans , Pandemics , Pregnancy , Stress, Psychological/epidemiology , Stress, Psychological/prevention & control
4.
Front Public Health ; 9: 630189, 2021.
Article in English | MEDLINE | ID: covidwho-1278465

ABSTRACT

Objective: To assess and share learnings on the motivators and behavioural adherence across sex and age to evolving strategies in public policy to prevent the spread of SARS-CoV-2 at the end of a first COVID-19 wave and the beginning of a second COVID-19 wave in Australia. Design and Setting: A national longitudinal survey using a framework based on evidence-based behaviour change models. The survey was administered to a national sample representative across sex, age and location was undertaken at two time points: May 1st to 5th, 2020, and July 1st to 7th, 2020. Results: Overall 2,056 surveys were completed across the first and second rounds, with 63% (1,296/2,056) completing both. Age range was 18-99 years (median 53, IQR: 34-64). Suboptimal physical distancing and self-quarantining if unwell/diagnosed was reported in one in four respondents and not getting a test at onset of symptoms reported in one in three. Those non-adherent to all three behaviours (19%, 60/323), were mainly male, younger, lived in major cities and reported fewer concerns or motivators to change behaviour. Overall, government lockdown measures were considered very important by 81% (835/1,032) and appropriate by 75% (772/1,029). Conclusions: Prior to the suppression of a second COVID-19 wave, a significant minority of Australians reported suboptimal behavioural adherence to vital policy strategies to limit SARS-CoV-2 spread, mostly young adults and men. Successful wave 2 suppression required consistent communication from political and health leaders and supportive public health and economic strategies. Additional lockdown and punitive strategies were needed in Victoria and were generally well-supported and adhered to. To limit subsequent lockdown, this work reinforces the need for a mix of communication around saving lives of the vulnerable, and other strategies targeting high risk groups, facilitation of easy testing and minimisation of financial impacts.


Subject(s)
COVID-19 , Adolescent , Adult , Aged , Aged, 80 and over , Communicable Disease Control , Health Knowledge, Attitudes, Practice , Humans , Longitudinal Studies , Male , Middle Aged , SARS-CoV-2 , Self Report , Victoria , Young Adult
5.
J Med Internet Res ; 22(9): e22002, 2020 09 07.
Article in English | MEDLINE | ID: covidwho-732939

ABSTRACT

BACKGROUND: The COVID-19 global pandemic has impacted the whole of society, requiring rapid implementation of individual-, population-, and system-level public health responses to contain and reduce the spread of infection. Women in the perinatal period (pregnant, birthing, and postpartum) have unique and timely needs for directives on health, safety, and risk aversion during periods of isolation and physical distancing for themselves, their child or children, and other family members. In addition, they are a vulnerable group at increased risk of psychological distress that may be exacerbated in the context of social support deprivation and a high-risk external environment. OBJECTIVE: The aim of this study is to examine the public discourse of a perinatal cohort to understand unmet health information and support needs, and the impacts on mothering identity and social dynamics in the context of COVID-19. METHODS: A leading Australian online support forum for women pre- through to postbirth was used to interrogate all posts related to COVID-19 from January 27 to May 12, 2020, inclusive. Key search terms included "COVID," "corona," and "pandemic." A three-phase analysis was conducted, including thematic analysis, sentiment analysis, and word frequency calculations. RESULTS: The search yielded 960 posts, of which 831 were included in our analysis. The qualitative thematic analysis demonstrated reasonable understanding, interpretation, and application of relevant restrictions in place, with five emerging themes identified. These were (1) heightened distress related to a high-risk external environment; (2) despair and anticipatory grief due to deprivation of social and family support, and bonding rituals; (3) altered family and support relationships; (4) guilt-tampered happiness; and (5) family future postponed. Sentiment analysis revealed that the content was predominantly negative (very negative: n=537 and moderately negative: n=443 compared to very positive: n=236 and moderately positive: n=340). Negative words were frequently used in the 831 posts with associated derivatives including "worried" (n=165, 19.9%), "risk" (n=143, 17.2%), "anxiety" (n=98, 11.8%), "concerns" (n=74, 8.8%), and "stress" (n=69, 8.3%). CONCLUSIONS: Women in the perinatal period are uniquely impacted by the current pandemic. General information on COVID-19 safe behaviors did not meet the particular needs of this cohort. The lack of nuanced and timely information may exacerbate the risk of psychological and psychosocial distress in this vulnerable, high-risk group. State and federal public health departments need to provide a central repository of information that is targeted, consistent, accessible, timely, and reassuring. Compensatory social and emotional support should be considered, using alternative measures to mitigate the risk of mental health disorders in this cohort.


Subject(s)
Coronavirus Infections/epidemiology , Internet , Mental Health/statistics & numerical data , Mothers/psychology , Parenting/psychology , Pneumonia, Viral/epidemiology , Postpartum Period/psychology , Pregnancy/psychology , Stress, Psychological/epidemiology , Adult , Anxiety/epidemiology , Australia/epidemiology , COVID-19 , Child , Coronavirus Infections/prevention & control , Female , Humans , Pandemics/prevention & control , Parturition/psychology , Pneumonia, Viral/prevention & control , Pregnancy Complications, Infectious/prevention & control , Pregnancy Complications, Infectious/psychology , Social Support
SELECTION OF CITATIONS
SEARCH DETAIL