Lesley Barclay

• The University of Sydney

Background With the impact of over two centuries of colonisation in Australia, First Nations families experience a disproportionate burden of adverse pregnancy and birthing outcomes. First Nations mothers are 3–5 times more likely than other mothers to experience maternal mortality; babies are 2–3 times more likely to be born preterm, low birth wei...

Background and purpose: Pregnant and breastfeeding women commonly use complementary medicine products (CMPs), including dietary supplements and herbal medicines. This study investigated women's reasons for use. Materials and methods A national, cross-sectional, online survey conducted between July–September 2019 investigated reasons for CMP use du...

Background Pregnant and breastfeeding women's use of complementary medicine products (CMPs) is common, and possibly associated with autonomous health care behaviours. However, the health literacy levels and health locus of control (HLOC) beliefs of women who use CMPs in pregnancy and lactation have not been previously assessed in a large Australian...

Background: Vaccine refusal is highly polarizing in Australia, producing a challenging social landscape for non-vaccinating parents. We sought to understand the lived experience of non-vaccinating parents in contemporary Australia. Methods: We recruited a national sample of non-vaccinating parents of children <18 yrs, advertising on national rad...

Problem Midwives may feel ill-equipped to manage clinical encounters with non-vaccinating parents. Background Pregnancy is a peak time in the formation of parents’ vaccination views and intention. Midwives are central to maternity care in Australia. While most midwives will have infrequent contact with families who intend not to vaccinate, when th...

Background Online recruitment can be targeted efficiently to recruit specific samples for survey research. It has been shown to be a cost-effective method of recruitment, and useful for geographically dispersed populations. Objectives To describe the use of Facebook to recruit a targeted sample of expectant and breastfeeding mothers to a national...

Introduction: Episiotomy is still performed routinely by clinicians in many countries. The aim of this study was to determine the knowledge of, attitudes towards and experience of episiotomy practice among clinicians working in public hospitals in Jordan. Methods: A cross-sectional study, using a self-administered survey questionnaire, was condu...

Issue addressed: This article reports the qualitative evaluation of 'Artspace', an innovative clinical program combining creative arts with physical and mental health care for young women. The program, provided since 2004, comprises weekly visual arts sessions alongside a youth health clinic offering drop-in appointments with a nurse, GP and couns...

Background: The prevalence of complementary medicine product (CMP) use by pregnant or breastfeeding Australian mothers is high, however, there is limited data on factors influencing women's decision-making to use CMPs. This study explored and described the factors influencing women's decisions take a CMP when pregnant or breastfeeding. Methods:...

This article reports on a study that explored what it means to be a mature-age Aboriginal and Torres Strait Islander university graduate in the context of age, life-stage, history, culture, socioeconomic status, race and place. Using narrative interview data and fieldwork observation, we focus on the graduates’ workplace experiences and take a case...

Background: Birthing on Country is an international movement to return maternity services to First Nations communities and community control for improved health and wellbeing. Question: How can we implement Birthing on Country services for Aboriginal and/or Torres Strait Islander families across Australia? Methods: We have developed a framewor...

Objective: Complementary medicine product use in pregnancy and lactation is common but little is known about women's health literacy and information-seeking regarding this. The objectives of this study were to identify and explore pregnant or breastfeeding women's sources of, and rationale for seeking complementary medicine products information, t...

Background Little is known about women's decision‐making processes regarding using complementary medicine products (CMPs) during pregnancy or lactation. Objectives To explore the decision‐making processes of women choosing to use CMPs in pregnancy and lactation; and to investigate how women's health literacy influences their decisions. Design, se...

Objectives To explain vaccination refusal in a sample of Australian parents. Design Qualitative design, purposive sampling in a defined population. Setting A geographically bounded community of approximately 30 000 people in regional Australia with high prevalence of vaccination refusal. Participants Semi structured interviews with 32 non-vaccin...

Background: Maternal health literacy plays an important role in women's decisions regarding health care during pregnancy and lactation. This systematic review aimed to investigate the use of complementary medicine products by pregnant and breastfeeding women; information sources accessed, and the role health literacy plays in women's use of comple...

This article describes two strategies that have strengthened the capacity and effectiveness of rural health advocacy in Australia over the past nearly three decades. The first is the development of the National Rural Health Alliance, an organisation that grew from strategic efforts to develop relationships between rural and remote health practition...

Background: The prevalence of complementary medicine use in pregnancy and lactation has been increasingly noted internationally. This systematic review aimed to determine the complementary medicine products (CMPs) used in pregnancy and/or lactation for the benefit of the mother, the pregnancy, child and/or the breastfeeding process. Additionally,...

Background and objectives: Trauma and adversity have serious health consequences, particularly when experienced in early life. These health consequences can be significantly lessened if young people access appropriate care when needed. In 2004, the Blue Mountains Women's Health and Resource Centre created a Young Women's Clinic (YWC) that began pr...

Despite strong evidence confirming vaccination is safe and effective, some parents choose not to vaccinate their children. In 2016, the Australian Government introduced legislation strengthening links between vaccination compliance and some government payments. We interviewed thirty-one non-vaccinating parents about the impacts of this policy. Data...

Objective To investigate the feasibility and outcomes of introducing childbirth preparation programs in a sample of Maternal and Child Health centres in Jordan. Design An exploratory, descriptive design, and practice- research engagement was used to implement and evaluate the proposed childbirth preparation program. Face to face interviews and fie...

Objective To determine the percentage of research projects funded by the National Health and Medical Research Council in the period 2000–2014 that aimed specifically to deliver health benefits to Australians living in rural and remote areas and to estimate the proportion of total funding this represented in 2005–2014. Design This is a retrospectiv...

Introduction: In Australia, many small birthing units have closed in recent years, correlating with adverse outcomes including a rise in the number of babies born before arrival to hospital. Concurrently, a raft of national policy and planning documents promote continued provision of rural and remote maternity services, articulating a strategic in...

Objective: To identify the risk factors for preterm birth, low birthweight and small for gestational age babies among remote-dwelling Aboriginal women. Methods: The study included 713 singleton births from two large remote Aboriginal communities in Northern Territory, Australia in 2004-2006 (retrospective cohort) and 2009-2011 (prospective cohor...

Background In Australia the health outcomes of remote dwelling Aboriginal infants are comparable to infants in developing countries. This research investigates service quality, from the clinicians? perspective and as observed and recorded by the researcher, in two large Aboriginal communities in the Top End of northern Australia following health sy...

Background Australia has a universal health care system and a comprehensive safety net. Despite this, outcomes for Australians living in rural and remote areas are worse than those living in cities. This study will examine the current state of equity of access to birthing services for women living in small communities in rural and remote Australia...

Problem: The past two decades have seen progressive decline in the number of rural birthing services across Australia. Background: Despite health system pressures on small birthing units to close there have been examples of resistance and survival. Aim: This descriptive study explored the evolution of a rural birthing service in a small town t...

The well established disparities in health outcomes between Indigenous and non-Indigenous Australians include a significant and concerning higher incidence of preterm birth, low birth weight and newborn mortality. Chronic diseases (eg, diabetes, hypertension, cardiovascular and renal disease) that are prevalent in Indigenous Australian adults have...

The precipitous closure of rural maternity services in industrialized countries over the past two decades is underscored in part by assumptions of efficiencies of scale leading to cost-effectiveness. However, there is scant evidence to support this and the costing evidence that exists lacks comprehensiveness. To clearly understand the cost-effectiv...

This paper describes an eight-month community-based participatory research project to introduce and evaluate the implementation of an asset-based approach to Tuberculosis (TB) leadership groups in three villages in Flores Island, Indonesia. An asset-based intervention that emphasized discovering, mobilizing, and strengthening the capacities of loca...

Background The community’s awareness of Tuberculosis (TB) and delays in health care seeking remain important issues in Indonesia despite the extensive efforts of community-based TB programs delivered by a non-government organisation (NGO). This study explored the knowledge and behaviours in relation to TB and early diagnosis before and after an ass...

Objective: To describe the outcomes of a public hospital maternity unit in rural New South Wales (NSW) following the adaptation of the service from an obstetrician and general practitioner-obstetrician (GPO)-led birthing service to a low-risk midwifery group practice (MGP) model of care with a planned caesarean section service (PCS). Design: A r...

Background: Primary Maternity Units (PMUs) offer less expensive and potentially more sustainable maternity care, with comparable or better perinatal outcomes for normal pregnancy and birth than higherlevel units. However, little is known about how these maternity services operate in rural and remote Australia, in regards to location, models of car...

Objective: to explore perceptions and examples of risk related to pregnancy and childbirth in rural and remote Australia and how these influence the planning of maternity services. Design: data collection in this qualitative component of a mixed methods study included 88 semi-structured individual and group interviews (n=102), three focus groups...

Decisions to close small maternity units in rural and remote communities have often precipitated a community response as women and families rally to save local services. But where are the midwives? We argue here that professional bodies such as colleges of midwives have a responsibility to advocate more strongly at a political level for evidence-ba...

Background: Australian breastfeeding rates fall significantly in the months following birth, often as a result of breastfeeding complications. Aim: To explore the potential risk factors for nipple trauma and breast engorgement in a group of women who were referred to the in home breastfeeding service in Melbourne, Australia. Method: A retrospe...

Decisions to close small maternity units in rural and remote communities have often precipitated a community response as women and families rally to save local services. But where are the midwives? We argue here that professional bodies such as colleges of midwives have a responsibility to advocate more strongly at a political level for evidence-ba...

Objective: to compare the quality of care before and after the introduction of the new Midwifery Group Practice. Design: a cohort study. Setting: the health centers (HCs) in two of the largest remote Aboriginal communities (population 2200-2600) in the Top End of the Northern Territory (NT), each located approximately 500km from Darwin. The th...

Background: The Australian Home Medicines Review (HMR) program consists of a pharmacist reviewing a patient's medicines at his or her home and reporting findings to the patient's general practitioner (GP) to assist optimisation of medicine management. Previous research has shown that the complex HMR program rules impede access to the HMR program b...

The evidence-based policy (EBP) movement has received significant attention in the scientific literature; however, there is still very little empirical research to provide insight into how policy decisions are made and how evidence is used. The lack of research on this topic in low- and middle-income countries is of particular note. We examine the...

Integration of mental health services is a prominent Australian mental health policy goal; however, there is little detail in the literature of how integrated mental health services are established or function. This study aimed to describe a nurse practitioner-led primary healthcare rural mental health service and evidence of how the service was in...

Objective There is a need to adapt pathways to care to promote access to mental health services for Indigenous people in Australia. This study explored Indigenous community and service provider perspectives of well-being and ways to promote access to care for Indigenous people at risk of depressive illness. Design A participatory action research fr...

Across Australia there are substantial disparities in uptake of antenatal testing for fetal anomalies, with very low uptake observed among Aboriginal women. The reasons behind these disparities are unclear, although poorer access to testing has been reported in some communities. We interviewed health care practitioners to explore the perceived barr...

In Australia, Home Medicines Review (HMR) has been found to be an important tool to raise awareness of medication safety, reduce adverse events and improve medication adherence. Aboriginal and Torres Strait Islander people are 'underserviced' by the HMR program and are the most likely of all Australians to miss out on HMRs despite their high burden...

Background: Aboriginal women in rural areas have lower rates of breastfeeding than Australian averages. The reasons for this are poorly understood. Aboriginal people experience higher morbidity and increased rates of chronic disease throughout the life cycle. The protective effects of sustained breastfeeding could benefit rural Aboriginal communit...

Background Policy informs the planning and delivery of rural and remote maternity services and influences the perinatal outcomes of the 30 per cent of Australian women and their babies who live outside the major cities. Currently however, there are no planning tools that identify the optimal level of birthing services for rural and remote communiti...

Australia has a well-accepted system of universal child and family health (CFH) services. However, government reports and research indicate that these services vary across states and territories, and many children and families do not receive these services. The aim of this paper was to explore professionals' perceptions of the challenges and opport...

Background: Home Medicines Reviews could improve the quality use of medicines and medicines adherence among Aboriginal people. Despite high level of chronic disease very few Home Medicines Review are currently being conducted for Aboriginal and Torres Strait Islander people. Objective: The aim of this research was to explore the barriers and fac...

Objectives Australian Aboriginal people have at least eight times the incidence of end-stage kidney disease, requiring dialysis, as the non-Aboriginal population. Provision of health services to rural Aboriginal people with renal disease is challenging due to barriers to access and cultural differences. We aimed to describe the experiences of Abori...

‘They put funerals and family in front of their dialysis’: A qualitative study of service provider’s perspectives on service delivery for Aboriginal people receiving haemodialysis in rural New South Wales Background Providing renal services to rural dwelling Aboriginal people is challenging due to access and cultural issues. This study describes s...

Chronic kidney disease has a higher prevalence in Indigenous populations globally. The incidence of end-stage kidney disease in Australian Aboriginal people is eight times higher than non-Aboriginal Australians. Providing services to rural and remote Aboriginal people with chronic disease is challenging because of access and cultural differences. T...

Case studies and semi-structured interview prompts used to guide health care provider interviews.

Context: Reflexivity is crucial for non-Aboriginal researchers working with Aboriginal people. This article describes a process of ’reflexive practice’ undertaken by a white clinician/researcher while working with Aboriginal people. The clinician/researcher elicited Aboriginal people’s experience of being haemodialysis recipients in rural Australia...

Objective: This paper articulates the importance of accurately identifying maternity services. It describes the process and challenges of identifying the number, level and networks of rural and remote maternity services in public hospitals serving communities of between 1000 and 25000 people across Australia, and presents the findings of this proc...

Background Health services research is a well-articulated research methodology and can be a powerful vehicle to implement sustainable health service reform. This paper presents a summary of a five-year collaborative program between stakeholders and researchers that led to sustainable improvements in the maternity services for remote-dwelling Aborig...

Context: Reflexivity is crucial for non-Aboriginal researchers working with Aboriginal people. This article describes a process of 'reflexive practice' undertaken by a white clinician/researcher while working with Aboriginal people. The clinician/researcher elicited Aboriginal people's experience of being haemodialysis recipients in rural Australi...

Background: Policy informs the planning and delivery of rural and remote maternity services and influences the perinatal outcomes of the 30 per cent of Australian women and their babies who live outside the major cities. Currently however, there are no planning tools that identify the optimal level of birthing services for rural and remote communit...

We investigated the impact of pre-existing mental ill health on postpartum maternal outcomes. Women reporting childbirth trauma received counselling (Promoting Resilience in Mothers' Emotions; n = 137) or parenting support (n = 125) at birth and 6 weeks. The EuroQol Five dimensional (EQ-5D)-measured health-related quality of life at 6 weeks, 6 and...

Providing services to rural dwelling minority cultural groups with serious chronic disease is challenging due to access to care and cultural differences. This study aimed to describe service providers' perspectives on health services delivery for Aboriginal people receiving haemodialysis for end-stage kidney disease in rural Australia. Semistructur...

Disparities exist in pregnancy and birth outcomes between Australian Aboriginal women and their non-Aboriginal counterparts. Understanding patterns of health service use by Aboriginal women is critical. This study describes the use of maternal health services by remote dwelling Aboriginal women in northern Australia during pregnancy, birth and the...

To explore Aboriginal and Torres Strait Islander patients' experiences with medicines and the barriers and facilitators to their effective use of medicines. A descriptive, qualitative study, using 18 semi-structured focus groups with 101 Aboriginal and Torres Strait participants. Groups were conducted at 11 Aboriginal health services. These were re...

Remote dwelling Aboriginal infants from northern Australia have a high burden of disease and frequently use health services. Little is known about the quality of infant care provided by remote health services. This study describes the adherence to infant guidelines for anaemia and growth faltering by remote health staff and barriers to effective se...

Primary maternity units are commonly those run by midwives who provide care to women with low-risk pregnancies with no obstetric, anaesthetic, laboratory or paediatric support available on-site. In some other countries, primary level maternity units play an important role in offering equitable and accessible maternity care to women with low-risk pr...

Research indicates that multiple factors are associated with decisions women make about infant feeding, yet few studies have explored the decision-making process. In this article, we present the analysis that produced the core category “deconstructing best,” previously reported as part of a grounded theory exploring 37 Australian women’s infant fee...

Objective: there is a significant gap in pregnancy and birth outcomes for Australian Aboriginal and Torres Strait Islander women compared with other Australian women. The provision of appropriate and high quality antenatal care is one way of reducing these disparities. The aim of this study was to assess adherence to antenatal guidelines by clinic...

;Rural Australia is facing a potential crisis in the supply and retention of GPs, that is compounded by an aging and earlier-retiring workforce compared with metropolitan areas. The objective of this study was to explore the most important retention factors in a sample of older rural GPs. Semi-structured interviews were conducted with 16 rural GPs...

to compare the cost-effectiveness of two models of service delivery: Midwifery Group Practice (MGP) and baseline cohort. a retrospective and prospective cohort study. a regional hospital in Northern Territory (NT), Australia. baseline cohort included all Aboriginal mothers (n=412), and their infants (n=416), from two remote communities who gave bir...

Objective: to describe the experiences of women, midwives and others during the establishment of a new model of maternity care for remote dwelling Aboriginal women transferred to a regional centre in northern Australia for maternity care and birth. Design: a mixed method design within a Participatory Action Research approach was used. Qualitativ...

The closure of rural maternity units in Australia means an increasing number of women are transferred into major centres to await birth. Accurately excluding the onset of labour could delay relocation. The fetal fibronectin (fFN) test is used to predict preterm birth; however, the accuracy of this test for determining impending term birth is unclea...

This cross-cultural qualitative study examined the ethical, language and cultural complexities around offering fetal anomaly screening in Australian Aboriginal communities. There were five study sites across the Northern Territory (NT), including urban and remote Aboriginal communities. In-depth interviews were conducted between October 2009 and Au...

This article describes and analyses the participatory action research (PAR) process used by researchers working with policy leaders and clinicians to facilitate health service improvement around postnatal discharge planning processes for remote-dwelling Aboriginal women and their newborn infants. The research presented here was a sub-study of a lar...

Objective: to describe perceptions of participating in a study testing the effectiveness of a perinatal emotional support intervention (Promoting Resilience in Mothers Emotions; PRIME) by women identified as experiencing emotional distress after birth. Design: qualitative descriptive approach. Semi-structured telephone interviews with 33 women r...

Background The continued increase in hospital admissions is a significant and complex issue facing health services. There is little research exploring patient perspectives or examining individual admissions among patients with frequent admissions for chronic ambulatory care sensitive (ACS) conditions. This paper aims to describe characteristics of...

Appendix 1. Additional material on survey questionnaire measures.

OBJECTIVES: To describe the role of midwives and maternity care in three low resource settings and to challenge some policy options introduced to reduce maternal mortality for women residing in rural and remote areas. APPROACH: A series of retrospective analyses were undertaken drawing on work the authors have conducted in rural and remote China, T...

In the Northern Territory, 64% of Indigenous births are to remote-dwelling mothers. Delivering high-quality health care in remote areas is challenging, but service improvements, informed by participative action research, are under way. Evaluation of these initiatives requires appropriate indicators. Few of the many existing maternal and infant heal...

Comparisons of birth outcomes between Australian Indigenous and non-Indigenous populations show marked inequalities. These comparisons obscure Indigenous disparities. There is much variation in terms of culture, language, residence, and access to services amongst Australian Indigenous peoples. We examined outcomes by region and remoteness for Indig...

This paper is an empirically informed opinion piece revisiting an argument published in Midwifery 10 years ago, that the increasing professionalisation of breast feeding was not supporting women in Australia in sustaining breast feeding. We present the last 10 years of primary research on the topic, explore major policy initiatives and the establis...

A traditional birth attendant (TBA) is a person who assists the mother during childbirth and who initially acquired her skills by delivering babies herself or through apprenticeship to other TBAs. In many parts of the world, TBAs continue to provide a significant proportion of maternity care during pregnancy, birth, and the postpartum period. In Sa...

Australia is a wealthy developed country. However, there are significant disparities in health outcomes for Aboriginal infants compared with other Australian infants. Health outcomes tend to be worse for those living in remote areas. Little is known about the health service utilisation patterns of remote dwelling Aboriginal infants. This study desc...

To examine the impact of maternity waiting homes on the use of facility-based birthing services for women in two remote districts of Timor-Leste. A before-and-after study design was used to compare the number of facility-based births in women who lived at different distances (0-5, 6-25, 26-50 and > 50 km) from the health centre before and after imp...

OBJECTIVE: To examine the impact of maternity waiting homes on the use of facility-based birthing services for women in two remote districts of Timor-Leste. METHODS: A before-and-after study design was used to compare the number of facility-based births in women who lived at different distances (0-5, 6-25, 26-50 and > 50 km) from the health centre...