%0 Journal Article
%~ PubMed
%A Fenwick, Jennifer
%A Gamble, Jenny
%A Creedy, Debra
%A Barclay, Lesley
%A Buist, Anne
%A Ryding, Elsa Lena
%T Women's perceptions of emotional support following childbirth: A qualitative investigation.
%B Midwifery
%D 2013
%C United Kingdom
%I Churchill Livingstone
%V 29
%N 3
%P 217-224
%@ 1532-3099
%X 
%Z FOR Codes: 111499 111006


%0 Journal Article
%~ PubMed
%A Steenkamp, Malinda
%A Rumbold, Alice
%A Barclay, Lesley
%A Kildea, Sue
%T A population-based investigation into inequalities amongst Indigenous mothers and newborns by place of residence in the Northern territory, Australia.
%B BMC Pregnancy and Childbirth
%D 2012
%C United Kingdom
%I BioMed Central Ltd.
%V 12
%N 1
%P 44
%@ 1471-2393
%X ABSTRACT: BACKGROUND: 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 Indigenous subgroups and explored data for communities to inform health service delivery and interventions. METHODS: Our population-based study examined maternal and neonatal outcomes for 7,560 mothers with singleton pregnancies from Australia''s Northern Territory Midwives'' Data Collection (2003-2005) using uni- and multivariate analyses. Groupings were by Indigenous status; region (Top End (TE)/Central Australia (CA)); Remote/Urban residence; and across two large TE communities. RESULTS: Of the sample, 34.1% were Indigenous women, of whom 65.6% were remote-dwelling versus 6.7% of non-Indigenous women. In comparison to CA Urban mothers: TE Remote (adjusted odds ratio [aOR] 1.47, 95%CI: 1.13, 1.90) and TE Urban mothers (aOR 1.36 (95% CI: 1.02, 1.80) were more likely, but CA Remote mothers (aOR 0.43; 95% CI: 0.31, 0.58) less likely to smoke during pregnancy; CA Remote mothers giving birth at >32 weeks gestation were less likely to have attended [greater than or equal to]five antenatal visits (aOR 0.55; 95%CI: 0.36, 0.86); TE Remote (aOR 0.71; 95%CI: 0.53, 0.95) and CA Remote women (aOR 0.68; 95%CI: 0.49, 0.95) who experienced labour had lower odds of epidural/spinal/narcotic pain relief; and TE Remote (aOR 0.47; 95%CI: 0.34, 0.66), TE Urban (aOR 0.67; 95%CI: 0.46, 0.96) and CA Remote mothers (aOR 0.52; 95%CI: 0.35, 0.76) all had lower odds of having a ''normal'' birth. The aOR for preterm birth for TE Remote newborns was 2.09 (95%CI: 1.20, 3.64) and they weighed 137g (95%CI: -216g, -59g) less than CA Urban babies. There were few significant differences for communities, except for smoking prevalence. CONCLUSIONS: This paper is one of few quantifying inequalities between groups of Australian Indigenous women and newborns at a regional level. Indigenous mothers and newborns do worse on some outcomes if they live remotely, especially if they live in the TE. Smoking prevention and high-quality antenatal care is fundamental to addressing many of the adverse outcomes identified in this paper.
%Z FOR Codes: 111717 111499 111701


%0 Journal Article
%~ PubMed
%A Shaban, Insaf
%A Barclay, Lesley
%A Lock, Linette
%A Homer, Caroline
%T Barriers to developing midwifery as a primary health-care strategy: A Jordanian study.
%B Midwifery
%D 2012
%C United Kingdom
%I Churchill Livingstone
%V 28
%N 1
%P 106-11
%@ 1532-3099
%X To identify the current barriers to developing midwifery as a primary health-care strategy in Jordan and to explore the strategies to overcome these barriers.
%Z FOR Codes: 111006 111717 1110


%0 Journal Article
%~ PubMed
%A Barclay, Lesley
%T Evidence: making an impact.
%B International Journal of Evidence-Based Healthcare
%D 2012
%C Australia
%I Wiley-Blackwell Publishing Asia
%V 10
%N 1
%P 1-2
%@ 1744-1609
%X 
%Z FOR Codes: 1117


%0 Journal Article
%~ PubMed
%A Longman, Jo M
%A I Rolfe, Margaret
%A Passey, Megan D
%A Heathcote, Kathy E
%A Ewald, Dan P
%A Dunn, Therese
%A Barclay, Lesley M
%A Morgan, Geoffrey G
%T Frequent hospital admission of older people with chronic disease: a cross-sectional survey with telephone follow-up and data linkage.
%B BMC Health Services Research
%D 2012
%C United Kingdom
%I BioMed Central Ltd.
%V 12
%N 1
%P 373
%@ 1472-6963
%X 
%Z FOR Codes: 1103


%0 Journal Article
%~ PubMed
%A Bar-Zeev, Sarah J
%A Barclay, Lesley
%A Farrington, Cath
%A Kildea, Sue
%T From hospital to home: The quality and safety of a postnatal discharge system used for remote dwelling Aboriginal mothers and infants in the top end of Australia.
%B Midwifery
%D 2012
%C United Kingdom
%I Churchill Livingstone
%V 28
%N 3
%P 366-373
%@ 1532-3099
%X OBJECTIVE: to examine the transition of care in the postnatal period from a regional hospital to a remote health service and describe the quality and safety implications for remote dwelling Aboriginal mothers and infants. DESIGN: a retrospective cohort study of maternal health service utilisation and birth outcomes, key informant interviews with health service providers and participant observation in a hospital and two remote health centres. Data were analysed using descriptive statistics and content analysis. SETTING: a maternity unit in a regional public hospital and two remote health centres within large Aboriginal communities in the Top End of the Northern Territory, Australia. FINDINGS: poor discharge documentation, communication and co-ordination between hospital and remote health centre staff occurred. In addition, the lack of clinical governance and a specific position holding responsibility for the postnatal discharge planning process in the hospital system were identified as serious risks to the safety of the mother and infant. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: the quality and safety of discharge practices for remote dwelling mothers and their infants in the transition from hospital to their remote health service following birth need to be improved. The discharge process and service delivery model must be restructured to reduce the adverse effects of poor standards of care on mothers and infants.
%Z FOR Codes: 110399 111799 111006


%0 Journal Article
%A Josif, Cath
%A Barclay, Lesley
%A Bar-Zeev, Sarah
%A Kildea, Sue
%A Brittin, Maureen
%T How participatory action research supported improvements to the postnatal discharge summary system used for remote dwelling Aboriginal mothers and infants in the Top End of Australia
%B Action Research
%D 2012
%C United Kingdom
%I Sage Publications Ltd.
%V 10
%N 4
%P 387-405
%@ 1476-7503
%X 
%Z FOR Codes: 111701 111402


%0 Journal Article
%~ PubMed
%A Steenkamp, Malinda
%A Rumbold, Alice R
%A Kildea, Sue
%A Bar-Zeev, Sarah J
%A Kruske, Sue
%A Dunbar, Terry
%A Barclay, Lesley
%T Measuring what matters in delivering services to remote-dwelling Indigenous mothers and infants in the Northern Territory, Australia.
%B The Australian Journal of Rural Health
%D 2012
%C Australia
%I Wiley-Blackwell Publishing Asia
%V 20
%N 4
%P 228-237
%@ 1440-1584
%X Problem:??? 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 health indicators are specifically framed for the remote context or exemplify an Indigenous consumer perspective. We aimed to identify an indicator framework with appropriate indicators to demonstrate improvements in health outcomes, determinants of health and health system performance for remote-dwelling mothers and infants from pregnancy to first birthday. Design:??? We reviewed existing indicators; invited input from experts; investigated existing administrative data collections and examined findings from a record audit, ethnographic work and the evaluation of the Darwin Midwifery Group Practice. Setting:??? Northern Territory. Process:??? About 660 potentially relevant indicators were identified. We adapted the Aboriginal and Torres Strait Islander Health Performance Framework and populated the resulting framework with chosen indicators. We chose the indicators best able to monitor the impact of changes to remote service delivery by eliminating duplicated or irrelevant indicators using expert opinion, triangulating data and identifying key issues for remote maternal and infant health service improvements. Lessons learnt:??? We propose 31 indicators to monitor service delivery to remote-dwelling Indigenous mothers and infants. Our inclusive indicator framework covers the period from pregnancy to the first year of life and includes existing indicators, but also introduces novel ones. We also attempt to highlight an Indigenous consumer.
%Z FOR Codes: 111701 111706


%0 Journal Article
%~ PubMed
%A Barclay, Lesley
%A Longman, Jo
%A Schmied, Virginia
%A Sheehan, Athena
%A Rolfe, Margaret
%A Burns, Elaine
%A Fenwick, Jennifer
%T The professionalising of breast feeding-Where are we a decade on?
%B Midwifery
%D 2012
%C United Kingdom
%I Churchill Livingstone
%V 28
%N 3
%P 281-290
%@ 1532-3099
%X 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 establishment and growth of lactation consultants in Australia to see if this has made a difference to sustained rates of breast feeding. We present an analysis of the only consistently collected national statistics on breast feeding and compare this with national and state level government data collections from the last decade. We have found that the considerable effort invested in trying to improve duration of breast feeding amongst women in Australia appears to have failed to improve sustained breast-feeding rates. We argue that this situation might be related to losing sight of the embodied nature of breast feeding and the relationships that must exist between the mother and baby, the knowledge and skills women quickly develop, and a loss of woman to woman support. We conclude that midwives have a major role in avoiding us reproducing similar, unintended, negative consequences to those resulting from increasing obstetrician managed normal birth. These include midwifery scrutiny and involvement in policy development and institutional practices and the design of services.
%Z FOR Codes: 1110 111402 111704


%0 Journal Article
%~ PubMed
%A Wild, Kayli
%A Barclay, Lesley
%A Kelly, Paul
%A Martins, Nelson
%T The tyranny of distance: maternity waiting homes and access to birthing facilities in rural Timor-Leste.
%B Bulletin of the World Health Organization
%D 2012
%C Switzerland
%I World Health Organization
%V 90
%N 2
%P 97-103
%@ 1564-0604
%X 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.
%Z FOR Codes: 111708 111717 111499


%0 Journal Article
%~ PubMed
%A Bar-Zeev, Sarah J
%A Kruske, Sue G
%A Barclay, Lesley M
%A Bar-Zeev, Naor H
%A Carapetis, Jonathan R
%A Kildea, Sue V
%T Use of health services by remote dwelling Aboriginal infants in tropical northern Australia: a retrospective cohort study.
%B BMC Pediatrics
%D 2012
%C United Kingdom
%I BioMed Central Ltd.
%V 12
%N 1
%P 19
%@ 1471-2431
%X ABSTRACT: BACKGROUND: 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 describes health service utilisation patterns at the primary and referral level by remote dwelling Aboriginal infants from northern Australia. RESULTS: Data on 413 infants were analysed. Following birth, one third of infants were admitted to the regional hospital neonatal nursery, primarily for preterm birth. Once home, most (98%) health service utilisation occurred at the remote primary health centre, infants presented to the centre about once a fortnight (mean 28 presentations per year, 95%CI 26.4-30.0). Half of the presentations were for new problems, most commonly for respiratory, skin and gastrointestinal symptoms. Remaining presentations were for reviews or routine health service provision. By one year of age 59% of infants were admitted to hospital at least once, the rate of hospitalisation per infant year was 1.1 (95%CI 0.9-1.2). CONCLUSIONS: The hospitalisation rate is high and admissions commence early in life, visits to the remote primary health centre are frequent. Half of all presentations are for new problems. These findings have important implications for health service planning and delivery to remote dwelling Aboriginal families.
%Z FOR Codes: 111701 111403


%0 Journal Article
%~ PubMed
%A Thompson, Robyn E
%A Kildea, Sue V
%A Barclay, Lesley M
%A Kruske, Sue
%T An account of significant events influencing Australian breastfeeding practice over the last 40 years.
%B Women and birth : journal of the Australian College of Midwives
%D 2011
%C Netherlands, Austral
%I Elsevier BV
%V 24
%N 3
%P 97-104
%@ 1878-1799
%X Low breastfeeding duration rates reflect the pain and distress experienced by many women who discontinue breastfeeding in the early weeks and months of life. This paper explores modern key historical events that have significantly influenced Australian breastfeeding education and practice.
%Z FOR Codes: 111006 111704


%0 Journal Article
%~ PubMed
%A Longman, Jo M
%A Singer, Judy B
%A Gao, Yu
%A Barclay, Lesley M
%A Passey, Megan E
%A Pirotta, Julie P
%A Heathcote, Kathy E
%A Ewald, Dan P
%A Saberi, Vahid
%A Corben, Paul
%A Morgan, Geoffrey G
%T Community based service providers' perspectives on frequent and/or avoidable admission of older people with chronic disease in rural NSW: a qualitative study.
%B BMC Health Services Research
%D 2011
%C United Kingdom
%I BioMed Central Ltd.
%V 11
%N 
%P 265
%@ 1472-6963
%X ABSTRACT:
%Z FOR Codes: 110307 111717 111702


%0 Journal Article
%~ PubMed
%A Nagel, Tricia
%A Kavanagh, David
%A Barclay, Lesley
%A Trauer, Thomas
%A Chenhall, Richard
%A Frendin, Jennifer
%A Griffin, Carolyn
%T Integrating treatment for mental and physical disorders and substance misuse in Indigenous primary care settings.
%B Australasian Psychiatry
%D 2011
%C United States
%I Sage Publications Ltd.
%V 19
%N Suppl 1
%P S17-S19
%@ 1440-1665
%X OBJECTIVE: Australian Indigenous peoples in remote and rural settings continue to have limited access to treatment for mental illness. Comorbid disorders complicate presentations in primary care where Indigenous youths and perinatal women are at particular risk. Despite this high comorbidity there are few examples of successful models of integrated treatment. This paper outlines these challenges and provides recommendations for practice that derive from recent developments in the Northern Territory. CONCLUSIONS: There is a strong need to develop evidence for the effectiveness of integrated and culturally informed individual and service level interventions. We describe the Best practice in Early intervention Assessment and Treatment of depression and substance misuse study which seeks to address this need.
%Z FOR Codes: 111714 111701 111717


%0 Journal Article
%~ PubMed
%A Perkins, David A
%A Barclay, Lesley
%A Browne, Kim M
%A Blunden, Lou-Anne
%A Fragar, Lyn J
%A Kelly, Brian J
%A Lower, Tony
%A Lyle, David M
%A Saberi, Vahid
%A Stain, Helen J
%A Sidford, Jan R
%T The Australian Rural Health Research Collaboration: building collaborative population health research in rural and remote NSW.
%B New South Wales public health bulletin
%D 2011
%C Australia
%I CSIRO Publishing
%V 22
%N 1-2
%P 23-6
%@ 1034-7674
%X The health problems faced by rural and remote communities are complex and not amenable to simple or short-term solutions. The Australian Rural Health Research Collaboration, which comprises rural research centres, area health services and policy makers in NSW, investigates these problems. Founded in 2002, it has grown to become the leading rural research collaboration in Australia. It aims to: conduct high quality research; build the capacity of researchers and clinicians; and encourage the translation of research evidence into practice for the benefit of rural and remote communities. The success of the Collaboration is illustrated by the increase in research outputs, funds generated, the strength of the relationships between partners and the ability to address complex research problems such as the mental health of rural and remote communities often deemed too difficult or expensive to include in metropolitan-based research. Keys to success have been the inclusive public health ethos, the participation of senior researchers and service managers, the critical mass of researchers achieved through collaboration and effective leadership and governance. This demonstrates the value of supporting cooperative research and capacity building in rural and remote areas where the size of research groups is small and where effective multi-disciplinary and co-operative research can pay dividends.
%Z FOR Codes: 111799


%0 Journal Article
%~ PubMed
%A Khresheh, Reham
%A Suhaimat, Aida
%A Jalamdeh, Fawzia
%A Barclay, Lesley
%T The effect of a postnatal education and support program on breastfeeding among primiparous women: a randomized controlled trial.
%B International Journal of Nursing Studies
%D 2011
%C United Kingdom
%I Elsevier Ltd
%V 48
%N 9
%P 1058-1065
%@ 1873-491X
%X Women''s traditional way of breastfeeding has altered in Jordan with rates declining in recent years.
%Z FOR Codes: 111717


%0 Journal Article
%~ PubMed
%A Kildea, S
%A Kruske, S
%A Barclay, L
%A Tracy, S
%T 'Closing the Gap': how maternity services can contribute to reducing poor maternal infant health outcomes for Aboriginal and Torres Strait Islander women.
%B Rural and Remote Health
%D 2010
%C Australia
%I Australian Rural Health Education Network
%V 10
%N 3
%P 1383
%@ 1445-6354
%X CONTEXT: The reproductive health outcomes for Aboriginal and Torres Strait Islander mothers and infants are significantly poorer than they are for other Australians; they worsen with increasing remoteness where the provision of services becomes more challenging. Australia has committed to ''Overcoming Indigenous Disadvantage'' and ''Closing the Gap'' in health outcomes. ISSUES: Fifty-five per cent of Aboriginal and Torres Strait Islander birthing women live in outer regional and remote areas and suffer some of the worst health outcomes in the country. Not all of these women are receiving care from a skilled provider, antenatally, in birth or postnatally while the role of midwives in reducing maternal and newborn mortality and morbidity is under-utilised. The practice of relocating women for birth does not address their cultural needs or self-identified risks and is contributing to these outcomes. An evidence based approach for the provision of maternity services in these areas is required. Australian maternal mortality data collection, analysis and reporting is currently insufficient to measure progress yet it should be used as an indicator for ''Closing the Gap'' in Australia. LESSONS LEARNED: A more intensive, coordinated strategy to improve maternal infant health in rural and remote Australia must be adopted. Care needs to address social, emotional and cultural health needs, and be as close to home as possible. The role of midwives can be enabled to provide comprehensive, quality care within a collaborative team that includes women, community and medical colleagues. Service provision should be reorganised to match activity to need through the provision of caseload midwives and midwifery group practices across the country. Funding to embed student midwives and support Aboriginal and Torres Strait Islander women in this role must be realised. An evidence base must be developed to inform the provision of services in these areas; this could be through the testing of the Rural Birth Index in Australia. The provision of primary birthing services in remote areas, as has occurred in some Inuit and New Zealand settings, should be established. ''Birthing on Country'' that incorporates local knowledge, on-site midwifery training and a research and evaluation framework, must be supported.
%Z FOR Codes: 111701 111499


%0 Journal Article
%~ PubMed
%A Dahlen, Hannah G
%A Barclay, Lesley
%A Homer, Caroline S E
%T 'Reacting to the unknown': experiencing the first birth at home or in hospital in Australia.
%B Midwifery
%D 2010
%C United Kingdom
%I Churchill Livingstone
%V 26
%N 4
%P 415-23
%@ 0266-6138
%X to explore the experiences of a small group of first-time mothers giving birth at home or in hospital.
%Z FOR Codes: 111006


%0 Journal Article
%~ PubMed
%A Gao, Yu
%A Barclay, Lesley
%T Availability and quality of emergency obstetric care in Shanxi Province, China.
%B International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics
%D 2010
%C Ireland, United King
%I Elsevier Ireland Ltd
%V 110
%N 2
%P 181-5
%@ 1879-3479
%X To investigate the availability and quality of emergency obstetric care (EmOC) received by women in a rural Chinese province.
%Z FOR Codes: 111799 1117


%0 Journal Article
%~ PubMed
%A Gao, Yu
%A Barclay, Lesley
%A Kildea, Sue
%A Hao, Min
%A Belton, Suzanne
%T Barriers to increasing hospital birth rates in rural Shanxi Province, China.
%B Reproductive Health Matters
%D 2010
%C Netherlands, United
%I Elsevier BV
%V 18
%N 36
%P 35-45
%@ 1460-9576
%X This study investigated the reasons for continued high rates of home births in rural Shanxi Province, northern China, despite a national programme designed to encourage hospital deliveries. We conducted semi-structured interviews with 30 home-birthing women in five rural counties and drew on hospital audit data, observations and interviews with local health workers from a larger study. Multiple barriers were identified, including economic and geographic factors and poor quality of maternity care. Women''s main reasons for not having institutional births were financial difficulties (n=26); poor quality of antenatal care (n=13); transport problems (n=11); dissatisfaction with hospital care expressed as fear of being in hospital (n=10); convenience of being at home and continuity of care provided by traditional birth attendants (TBAs) (n=10); and belief that the birth would be normal (n=6). These barriers must all be overcome to improve access to and acceptability of hospital birth. To ensure that the national policy of improving the hospital birth rate is implemented effectively, the government needs to improve the quality of antenatal and delivery care, increase financial subsidies to reduce out-of-pocket payments, remove transport barriers, and where hospital birth is not available in remote areas, consider allowing skilled attendance at home on an outreach basis and integrate TBAs into the health system.
%Z FOR Codes: 111404


%0 Journal Article
%~ PubMed
%A Wild, Kayli
%A Barclay, Lesley
%A Kelly, Paul
%A Martins, Nelson
%T Birth choices in Timor-Leste: A framework for understanding the use of maternal health services in low resource settings.
%B Social science & medicine (1982)
%D 2010
%C United Kingdom
%I Pergamon
%V 71
%N 11
%P 2038-45
%@ 1873-5347
%X The high rate of maternal mortality in Timor-Leste is a persistent problem which has been exacerbated by the long history of military occupation and ongoing political crises since independence in 1999. It is similar to other developing countries where there have been slow declines in maternal mortality despite 20 years of Safe Motherhood interventions. The national Ministry of Health, United Nations (UN) agencies and non-government organisations (NGOs) have attempted to reduce maternal mortality by enacting policies and interventions to increase the number of births in health centres and hospitals. Despite considerable effort in promoting facility-based delivery, most Timorese women birth at home and the lack of midwives means few women have access to a skilled birth attendant. This paper investigates factors influencing access to and use of maternal health services in rural areas of Timor-Leste. It draws on 21 interviews and 11 group discussions with Timorese women and their families collected over two periods of fieldwork, one month in September 2006 and five months from July to December 2007. Theoretical concepts from anthropology and health social science are used to explore individual, social, political and health system issues which affect the way in which maternal health services are utilised. In drawing together a range of theories this paper aims to extend explanations around access to maternal health services in developing countries. An empirically informed framework is proposed which illustrates the complex factors that influence women''s birth choices. This framework can be used by policy-makers, practitioners, donors and researchers to think critically about policy decisions and where investments can have the most impact for improving maternal health in Timor-Leste and elsewhere.
%Z FOR Codes: 111708


%0 Journal Article
%~ PubMed
%A Ashwell, Helen
%A Barclay, Lesley
%T Challenges to achieving sustainable community health development within a donor aid business model.
%B Australian and New Zealand journal of public health
%D 2010
%C Australia
%I Wiley-Blackwell Publishing Asia
%V 34
%N 3
%P 320-325
%@ 1326-0200
%X Objective: This paper explores the paradox of donor aid being delivered through a business model through a case study in Papua New Guinea. Methods: A retrospective review of project implementation and an outcome evaluation provided an opportunity to examine the long-term results and sustainability of a large project. Analysis was informed by data collected from 175 interviews (national, provincial, district and village), 93 community discussions and observations across 10 provinces. Results: Problems with the business model of delivering aid were evident from implementation data and in an evaluation conducted two years after project completion (2006). Compounding the business model effect were challenges of over-ambitious project goals with limited flexibility to adapt to changing circumstances, a donor payment system requiring short-term productivity and excessive reporting requirements. Conclusion: An overly ambitious project design, donor dominance within the business model and limited local counterpart capacity created problems in the community initiatives component of the project. Contractual pressures can negatively influence long-term outcomes that require development of local leadership and capacity. Future planning for donor project designs needs to be flexible, smaller in scope and have a longer timeframe of seven to 10 years. Implications: Donor-funded projects need to be sufficiently flexible to apply proven principles of community development, build local ownership and allow adequate time to build counterpart knowledge and skills.
%Z FOR Codes: 111708


%0 Journal Article
%~ PubMed
%A Harris, Amanda
%A Zhou, Yun
%A Liao, Hua
%A Barclay, Lesley
%A Zeng, Weiyue
%A Gao, Yu
%T Challenges to maternal health care utilization among ethnic minority women in a resource-poor region of Sichuan Province, China.
%B Health policy and planning
%D 2010
%C United Kingdom
%I Oxford University Press
%V 25
%N 4
%P 311-8
%@ 1460-2237
%X We present a simple descriptive study of maternal health care utilization among ethnic minority women in a remote region of China. Factors that affect women obtaining care and their decision-making are explored. Results show that utilization of maternal health care services is associated with a range of social, economic, cultural and geographic factors as well as the policies of the state and the delivery of services. Utilization is not necessarily increased through easy access to a health facility. We identify potential for improving utilization through developing the role of village-based health care workers, expanding mobile antenatal care clinics and changing the way township hospital services are provided and funded. This would include modifications to rural health insurance schemes. Several of these changes are achievable at the township or county level. The findings of this study provide insights that can be used by local health providers, planners and decision-makers to improve the provision of maternal health care services to ethnic minority women.
%Z FOR Codes: 111704


%0 Journal Article
%~ PubMed
%A Sheehan, Athena
%A Schmied, Virginia
%A Barclay, Lesley
%T Complex decisions: theorizing women's infant feeding decisions in the first 6 weeks after birth.
%B Journal of Advanced Nursing
%D 2010
%C United Kingdom
%I Wiley-Blackwell Publishing Ltd.
%V 66
%N 2
%P 371-380
%@ 1365-2648
%X AIM: This paper is a report of a grounded theory study of woman''s infant feeding experiences and decisions in the first 6 weeks after birth. BACKGROUND: Breastfeeding is considered the optimum method of infant feeding. Studies have identified numerous factors associated with infant feeding decisions. What remains unexplored are the mechanisms by which socio-demographic, biomedical and psychosocial factors influence infant feeding decisions. Research highlights the need for further investigation of the experiences and decision-making processes of both breastfeeding and formula-feeding women. METHOD: A constructionist grounded theory approach to data collection and analysis was used. Data for this study were collected and analysed between 2003 and 2004. Further data, collected in a previous study in 2000, were theoretically sampled and analysed in 2005. In-depth interviews with 37 women from various socio-demographic areas in New South Wales, Australia provided data. FINDINGS: The core category was ''deconstructing best''. ''Deconstructing best'' was the infant feeding decision-making process in the first 6 weeks after birth. The process of ''deconstructing best'' involved seven phases: planning, expecting, realizing, questioning, getting on with it, defending and qualifying. Four main categories -''it''s really best to breastfeed'', ''it''s the unknown'', ''it''s not the only thing going on'', and ''everybody''s best is different''- comprised the context within which deconstructing best occurred. CONCLUSION: Woman''s infant feeding decisions cannot be viewed in isolation from other post-natal experiences and needs. Infant feeding decisions will only be understood and appropriately supported when they are seen in relation to the circumstances of a woman''s life, her immediate sociocultural context and individual experience.
%Z FOR Codes: 1110


%0 Journal Article
%~ PubMed
%A Barclay, Lesley
%A Tracy, Sally K
%T Legally binding midwives to doctors is not collaboration.
%B Women and Birth
%D 2010
%C Netherlands, Austral
%I Elsevier BV
%V 23
%N 1
%P 1-2
%@ 1878-1799
%X 
%Z FOR Codes: 111799


%0 Journal Article
%~ PubMed
%A Steenkamp, Malinda
%A Bar-Zeev, Sarah
%A Rumbold, Alice
%A Barclay, Lesley
%A Kildea, Sue
%T Pragmatic indicators for remote Aboriginal maternal and infant health care: why it matters and where to start.
%B Australian and New Zealand Journal of Public Health
%D 2010
%C Australia
%I Wiley-Blackwell Publishing Asia
%V 34
%N Suppl 1
%P S5-S8
%@ 1326-0200
%X OBJECTIVE: There are challenges in delivering maternal and infant health (MIH) care to remote Northern Territory (NT) communities. These include fragmented care with birthing in regional hospitals resulting in cultural and geographical dislocation for Aboriginal women. Many NT initiatives are aimed at improving care. Indicators for evaluating these for remote Aboriginal mothers and infants need to be clearer. We reviewed existing indicators to inform a set of pragmatic indicators for reporting improvement in remote MIH care. METHODS: Scientific databases and grey literature (organisational websites and Google Scholar) were searched using the terms ''Aboriginal/maternal/infant/remote health/monitoring performance''. Key stakeholders identified omitted indicators sets. Relevant sets were reviewed and organised by indicator type, stage of patient journey, topic and theme. RESULTS: Forty-two indicators sets were found. Seven focused on Aboriginal health, 23 on reproductive/maternal health, eight on child/infant health and four on other aspects, e.g. remote health. We identified more than 1,000 individual indicators. Of these, 656 were relevant for our purpose and were subsequently organised into 300 topics and 16 themes for antenatal, birth and postpartum, and infant care by indicator type. CONCLUSION: There are many measures for monitoring health care delivery to mothers and infants. Few are framed around remote MIH services, despite poorer health outcomes of remote mothers and infants and the specific challenges with providing care in this setting. Establishing relevant indicators is vital to support relevant data collection and the development of appropriate policy for remote Aboriginal maternal and infant care.
%Z FOR Codes: 111799


%0 Journal Article
%~ PubMed
%A Ashwell, Helen Es
%A Barclay, Lesley
%T Problems measuring community health status at a local level: Papua New Guinea's health information system.
%B Rural and Remote Health
%D 2010
%C Australia
%I Australian Rural Health Education Network
%V 10
%N 4
%P 1539
%@ 1445-6354
%X The Papua New Guinea Department of Health monitors the performance of the health system using a computerised national health information system. This article draws on the recent evaluation of a national-wide donor-project community development initiative to highlight the problems of the lack of and disaggregated village health data. This data could be used to monitor health status, health worker performance and intervention impact.
%Z FOR Codes: 1117


%0 Journal Article
%A Dahlen, Hannah G
%A Barclay, Lesley
%A Homer, Caroline SE
%T Processing the first birth: journeying into ‘motherland’
%B Journal of Clinical Nursing
%D 2010
%C United Kingdom
%I Blackwell Publishers
%V 19
%N 13-14
%P 1977–1985
%@ 0962-1067
%X 
%Z FOR Codes: 111402


%0 Journal Article
%~ PubMed
%A Khresheh, Reham
%A Barclay, Lesley
%T The lived experience of Jordanian women who received family support during labor.
%B MCN. The American Journal of Maternal Child Nursing
%D 2010
%C United States
%I Lippincott Williams & Wilkins
%V 35
%N 1
%P 47-51
%@ 1539-0683
%X PURPOSE: Policies regarding childbirth in Jordan currently exclude attendance by a female relative to provide support. This study was done in order to describe the experience of a group of Jordanian women who had been afforded support from a female relative during a nursing research project. DESIGN AND METHODS: Semistructured interviews were conducted with 25 women at 6 weeks postpartum. All of the women had given birth at the main hospital in the southern region of Jordan. FINDINGS: Women had positive experiences with their female relative support. Four themes were identified as common to the women involved: (1) increased sense of security, (2) provision of physical help, (3) communicating the woman''s needs/wishes to her professional caregivers, and (4) emotional support and encouragement. CLINICAL IMPLICATIONS: The results show that the support of a female relative was helpful for this small group of Jordanian women experiencing their first labor and birth. Since the literature clearly shows that support in labor is appropriate and produces improved outcomes, public health practitioners in maternal and child health, along with hospitals, should emphasize this as a valuable resource for pregnant women. Non-Western or developing countries could benefit from more fully using evidence currently in the literature on a range of practices, including that of emotional and social support in labor.
%Z FOR Codes: 111708 111402


%0 Journal Article
%~ PubMed
%A Dahlen, Hannah G
%A Barclay, Lesley M
%A Homer, Caroline S E
%T The novice birthing: theorising first-time mothers' experiences of birth at home and in hospital in Australia.
%B Midwifery
%D 2010
%C United Kingdom
%I Churchill Livingstone
%V 26
%N 1
%P 53-63
%@ 0266-6138
%X to explore first-time mothers'' experiences of birth at home and in hospital in Australia.
%Z FOR Codes: 111006


%0 Journal Article
%~ PubMed
%A Ashwell, Helen Elizabeth Scott
%A Barclay, Lesley
%T A retrospective analysis of a community-based health program in Papua New Guinea.
%B Health promotion international
%D 2009
%C United Kingdom
%I Oxford University Press
%V 24
%N 2
%P 140-8
%@ 0957-4824
%X The Women and Children''s Health Project was a large Australian funded aid Project that sought to improve the health of women and children in Papua New Guinea between 1998 and 2004. Community development and health promotion interventions aimed to increase community support for attended birth and children''s health. Green and Kreuter''s [Green, L. W. and Kreuter, M. W. (2005) Health Program Planning: An Educational and Ecological Approach, 4th edition. McGraw-Hill, New York] precede-proceed model of health program planning was applied retrospectively to critique the design, implementation and evaluation of the Project. An outcome evaluation (2006) provided data for this analysis and investigated long-term impact using a multi-methods approach. Application of the precede-proceed model was useful, but the model fails to sufficiently well identify ''inhibiting factors'' as part of the educational and ecological assessment during the planning phase. Pre-defined objectives and contractually obligated outputs in a donor funded business model negatively influenced Project activity and outcomes. Despite this and the challenging context for implementation, Project interventions improved interaction between the community and health systems, and improved use of maternal child health services.
%Z FOR Codes: 111708


%0 Journal Article
%~ PubMed
%A Ashwell, Helen E
%A Barclay, Lesley
%T Outcome evaluation of community health promotion intervention within a donor funded project climate in Papua New Guinea.
%B Rural and Remote Health
%D 2009
%C Australia
%I Australian Rural Health Education Network
%V 9
%N 4
%P 1219
%@ 1445-6354
%X INTRODUCTION: The Australian Agency for International Development (AusAID) funded Women and Children''s Health Project sought to improve the health of women and children throughout Papua New Guinea between 1998 and 2004. The project utilised education, community development and health promotion interventions aimed to increase community support for the health of women and children. METHODS: An outcome evaluation in 2006 investigated the long-term impact of the project using a multi-methods approach and covering 10 selectively sampled provinces, 19 districts and 93 communities. Qualitative data were collected from 175 interviews (national to village level) and 77 community discussions. Quantitative data from national, provincial and district levels were examined to attempt to validate findings. RESULTS: The evaluation found new-health-knowledge initiated changes to lifestyle practices and improved physical health and social and economic well-being in villages where volunteers and staff had been trained. Factors influencing success were a health-motivated person acting as a catalyst for change, empowered leadership through new community governance structures, effective visual tools and village health volunteers linking community and rural health workers. Failure was attributed to poor understanding of community development, limited information sharing, a ''top down'' approach to community development and weak community leadership. CONCLUSION: The project''s community health interventions improved the interaction between the community and health system, and influenced improved use of maternal and child health services. Evaluation suggests sustainable improvements in health can be achieved through community led and maintained activity.
%Z FOR Codes: 111799


%0 Book Section
%A Barclay, Lesley
%T Samoan Midwives' Stories: Joining Social and Professional Midwives in New Models of Birth
%B Birth Models That Work
%D 2009
%C United States
%I University of California Press
%V 
%N 
%P 119-140
%@ 9780520248632
%E Davis-Floyd, Robbie E.
%E Daviss, Betty-Anne
%E Tritten, Jan
%E Barclay, Lesley
%X 
%Z FOR Codes: 111715 111006


%0 Journal Article
%~ PubMed
%A Sheehan, Athena
%A Schmied, Virginia
%A Barclay, Lesley
%T Women's experiences of infant feeding support in the first 6 weeks post-birth.
%B Maternal & child nutrition
%D 2009
%C United Kingdom
%I Wiley-Blackwell Publishing Ltd.
%V 5
%N 2
%P 138-150
%@ 1740-8709
%X Research suggests women find the first 2 to 6 weeks to be the most difficult time for breastfeeding. It has been identified that women need and seek support with breastfeeding during this time. Support is a difficult concept to define. When discussed by professionals, support for breastfeeding is generally viewed in terms of providing information and educational interventions. There is little understanding of the different elements of breastfeeding support strategies and the mechanisms by which support operates. Further, there is a paucity of qualitative research specifically reporting women''s experiences and expectations of professional support. This paper describes women''s expectations and experiences of ''infant feeding support'' provided by health professionals in the first 6 weeks post-birth. The findings are drawn from a grounded theory study exploring women''s infant feeding decisions in the first 6 weeks post-birth. Participants were recruited from a variety of socio-demographic areas of Sydney and the NSW Central Coast, Australia in 2003-2004. The women in this study discussed aspects of what they considered helpful and/or unhelpful in terms of professional support. In addition, they also provided insight into aspects of interactions that were deemed important to them as new mothers learning to feed their babies. The results are presented in three sections: expecting support, experiencing support and evaluating support. The findings help to better understand components of professional practices and behaviours that can be considered supportive. The support behaviours are far more complex than simply increasing education and knowledge of infant feeding. They demonstrate the need for sensitive individualized care and show that this type of support can increase women''s confidence to breastfeed.
%Z FOR Codes: 111401 111403 111704 111403


%0 Journal Article
%~ PubMed
%A Barclay, Lesley
%T A feminist history of Australian midwifery from colonisation until the 1980s.
%B Women and Birth
%D 2008
%C Netherlands
%I Elsevier BV
%V 21
%N 1
%P 3-8
%@ 1871-5192
%X This paper uses a feminist interpretation and secondary sources to describe the history of Australian midwifery from colonisation until the 1980s. There have been too few midwife scholars who have had access to or used primary data collections to describe the role and place of midwives in the colonising community. I draw on a range of biography, medical literature and work by sociologists and economic historians to produce a limited picture of the history of professional midwifery. This helps to explain the position of midwives today and the problematic relationship we often have with medicine.
%Z FOR Codes: 111006


%0 Journal Article
%~ PubMed
%A Fenwick, Jennifer
%A Barclay, Lesley
%A Schmied, Virginia
%T Craving closeness: a grounded theory analysis of women's experiences of mothering in the Special Care Nursery.
%B Women and birth : journal of the Australian College of Midwives
%D 2008
%C Netherlands
%I Elsevier BV
%V 21
%N 2
%P 71-85
%@ 1871-5192
%X AIM: The aim of the study was to increase knowledge and understanding of how women begin their roles as mothers when their infant is in the neonatal nursery. BACKGROUND: Research is limited into how women experience mothering in contexts such as the neonatal nursery. Consequently many nurses and midwives remain inadequately informed of parents'' experiences which we know may have long-term family outcomes. METHOD: This paper presents the overarching synthesis of a grounded theory analysis of data collected from 28 Australian women whose infants were in Special Care Nurseries. It draws together a number of previous publications that have described in detail the categories derived from the analysis that explain the actions, interactions and reactions women engage in as they seek to ''connect'' with their infant. Data collection consisted of two in-depth interviews conducted with women, 333h of taped cot side recordings, field notes and interview data collected from 20 nursery staff, 19 of whom were midwives. FINDINGS: Six major categories were identified that, when combined, explained the intense emotional, cognitive and worry ''work'' women undertook with both their infants and the nursery staff in an effort to learn how to mother in the nursery. Four explained how women worked to get to know and connect with their infants. The first three were labelled ''just existing'', ''striving to be the baby''s mother'' and ''trying to establish competence''. The fourth, ''learning and playing the game'', overlays the first three and represents the reality of having to undertake these already difficult and unexpected activities of mothering in the nursery. Two categories ''becoming connected'' and ''struggling to mother'' were identified as the consequences of women''s actions and interactions. A significant finding of the study was the impact of the interactions between nurses and mothers'' mothering. The nurse-mother relationship had the potential to significantly affect how women perceived their connection to the infant and their confidence in caring for their infant which occurred through a three way interaction. CONCLUSIONS: It becomes clear that the intense work women undertake as mothers in the nursery is focused on not only the infant, which might have been expected, but also the nursery staff. It is driven by their desire to develop or re-establish some sense of competence in the eyes of the nurse and to achieve control over the situation. Achieving physical closeness with the baby was a major strategy through which women not only learned about and gained intimate knowledge of their infant, but also demonstrated authority and ownership. It appears that reorientating the delivery of services from the infant to the mother-infant dyad would improve the care women and families receive during their nursery experience.
%Z FOR Codes: 111402


%0 Journal Article
%A Svensson, Jane
%A Barclay, Lesley
%A Cooke, Margaret
%T Effective Antenatal Education: Strategies Recommended by Expectant and New Parents
%B Journal of Perinatal Education
%D 2008
%C United States
%I Lamaze International
%V 17
%N 4
%P 33-42
%@ 1058-1243
%X 
%Z FOR Codes: 111707


%0 Journal Article
%~ PubMed
%A Khresheh, Reham
%A Barclay, Lesley
%T Implementation of a new birth record in three hospitals in Jordan: a study of health system improvement.
%B Health policy and planning
%D 2008
%C United Kingdom
%I Oxford University Press
%V 23
%N 1
%P 76-82
%@ 0268-1080
%X This study tested the introduction of a new integrated clinical record in Jordan where currently no clinical report links antenatal, birth and postnatal care for women. As a result, no continuity of information is provided to clinicians nor are there national statistics on trends, or performance of hospitals around birth. Our study was conducted in the Jordanian Ministry of Health, the maternity wards and registration departments of three hospitals in Jordan and in the Maternal and Child Health Centres located near these hospitals. We used an exploratory, descriptive design and practice-research engagement to investigate and report on the process of change to improve and implement the new birth record. Through engaging practitioners in research, care improved, the quality of reporting changed, managers developed more effective measures of hospital performance and policy makers were provided with information that could form the basis of a national maternity data monitoring system. Quantitative and qualitative audit data demonstrated improved clinical reporting, organizational development and sustained commitment to the new record from clinicians, managers and policy leaders.
%Z FOR Codes: 111402 111707


%0 Journal Article
%~ PubMed
%A Kildea, Sue
%A Pollock, Wendy Elizabeth
%A Barclay, Lesley
%T Making pregnancy safer in Australia: the importance of maternal death review.
%B Australian & New Zealand Journal of Obstetrics & Gynaecology
%D 2008
%C Australia
%I Blackwell Publishing Asia
%V 48
%N 2
%P 130-136
%@ 1479-828X
%X Australia is one of the safest countries in the world to birth. Because maternal deaths are rare, often the focus during pregnancy is on the well-being of the fetus. The relative safety of birth has fostered a shift in the focus of maternal health, from survival, to the model of care or the birth experience. Yet women still die in Australia as a result of child bearing and many of these deaths are associated with avoidable factors. The purpose of this paper is to outline the maternal death monitoring and review process in Australia and to present to clinicians the salient features of the most recently published Australian maternal death report. The notion of preventability and the potential for practice to have an effect on reducing maternal mortality are also discussed.
%Z FOR Codes: 111402


%0 Journal Article
%A Land, Marie
%A Barclay, Lesley
%T Nurses' contribution to child protection
%B Journal of Neonatal, Paediatric and Child Health Nursing
%D 2008
%C Australia
%I Cambridge Publishing
%V 11
%N 1
%P 18-24
%@ 1441-6638
%X 
%Z FOR Codes: 111006


%0 Journal Article
%A Dahlen, Hannah G
%A Barclay, Lesley
%A Homer, Caroline
%T Preparing for the First Birth: Mothers' Experiences at Home and in Hospital in Australia
%B Journal of Perinatal Education
%D 2008
%C United States
%I Lamaze International
%V 17
%N 4
%P 21-32
%@ 1058-1243
%X 
%Z FOR Codes: 111402


%0 Journal Article
%~ PubMed
%A Barclay, Lesley
%T Woman and midwives: position, problems and potential.
%B Midwifery
%D 2008
%C United Kingdom
%I Churchill Livingstone
%V 24
%N 1
%P 13-21
%@ 0266-6138
%X OBJECTIVE: to describe and analyse birthing models in a number of countries, particularly Samoa and China, that have been the focus of my recent research; to discuss how cultural frameworks, colonisation and ideas of what is ''modern'' influence the nature, place of birth and its attendant. IMPLICATIONS FOR PRACTICE: midwives need to reflect on their practice and consider broader health policy and how it affects health systems. They also need to understand the social, economic, historical and cultural context of practice, including the influence of gender inequality and attitudes to women and themselves as midwives.
%Z FOR Codes: 111006


%0 Journal Article
%~ PubMed
%A Khresheh, Reham
%A Homer, Caroline
%A Barclay, Lesley
%T A comparison of labour and birth outcomes in Jordan with WHO guidelines: a descriptive study using a new birth record.
%B Midwifery
%D 2007
%C United Kingdom
%I Churchill Livingstone
%V 25
%N 0
%P e11-8
%@ 0266-6138
%X to examine data collected during the testing of a new birth record in Jordan from 1 July to 31 August 2004, and to compare these practices with guidelines from the World Health Organization (WHO) and evidence-based recommendations. This was part of a larger study that used an action research approach to engage practitioners in implementation of the new record.
%Z FOR Codes: 111006


%0 Journal Article
%~ PubMed
%A Svensson, Jane
%A Barclay, Lesley
%A Cooke, Margaret
%T Antenatal Education as Perceived by Health Professionals.
%B The Journal of Perinatal Education
%D 2007
%C United States
%I Lamaze International
%V 16
%N 1
%P 9-15
%@ 1058-1243
%X This article aims to identify the learning needs of expectant and new parents for antenatal education as perceived by health professionals. In Australia, antenatal education programs are predominantly designed by health professionals, and recent research has challenged the efficacy of this approach. The data collected from 73 health professionals, reported here, demonstrates that their perceptions of the concerns and interests of expectant and new parents were divided into three interrelated categories: "need to know...what''s happening," "they won''t listen," and "balanced information." The health professional ideas for improving antenatal education were limited and identified a reluctance to change practice.
%Z FOR Codes: 111707 111402


%0 Journal Article
%~ PubMed
%A Harris, Amanda
%A Gao, Yu
%A Barclay, Lesley
%A Belton, Suzanne
%A Yue, Zweng Wei
%A Min, Hao
%A Auqun, Xu
%A Hua, Liao
%A Yun, Zhou
%T Consequences of birth policies and practices in post-reform China.
%B Reproductive health matters
%D 2007
%C Netherlands
%I Elsevier BV
%V 15
%N 30
%P 114-124
%@ 0968-8080
%X This paper comments on the provision of birthing services in Sichuan and Shanxi Provinces in China within a policy context. The goal was to understand possible unintended and harmful health outcomes for women in the light of international evidence, to better inform practice and policy development. Data were collected from October 2005 to April 2007 in 25 hospitals across 13 counties and one city. Normal and caesarean birth records were audited, observations made of facilities and interviews conducted with officials, administrators, health workers, women who delivered in hospital facilities and women who delivered at home. We argue that in the context of a neo-liberal health economy with poorly developed government regulatory policies, those with the power to pay for maternity care may be vulnerable to a new range of risks to their health from those positioned to make a profit. While poor communities may lack access to basic services, wealthier socio-economic groups may risk an increase in maternal morbidity and mortality through the overuse of avoidable intervention. We recommend a stronger evidence base for hospital maternity services and changes to the role of the State in countering systemic problems.
%Z FOR Codes: 111402


%0 Journal Article
%A Khresheh, Reham
%A Barclay, Lesley
%T Practice—research engagement(PRE): Jordanian experience in three Ministry of Health hospitals
%B Action Research
%D 2007
%C United Kingdom
%I Sage Publications Ltd.
%V 5
%N 2
%P 123–138
%@ 1476-7503
%X 
%Z FOR Codes: 111717


%0 Journal Article
%~ PubMed
%A Weymouth, S
%A Davey, C
%A Wright, J I
%A Nieuwoudt, L-A
%A Barclay, L
%A Belton, S
%A Svenson, S
%A Bowell, L
%T What are the effects of distance management on the retention of remote area nurses in Australia?
%B Rural and remote health
%D 2007
%C Australia
%I Australian Rural Health Education Network
%V 7
%N 3
%P 652
%@ 1445-6354
%X INTRODUCTION: Australian remote area nurses (RANs) are specialist advanced practice nurses. They work in unique, challenging and sometimes dangerous environments to provide a diverse range of healthcare services to remote and predominantly Aboriginal communities. There is an emerging skills gap in the remote nursing workforce as experienced and qualified RANs leave this demanding practice. There is a shortage of new nurses interested in working in these areas, and many of those who enter remote practice leave after a short time. Distance management was examined in order to gain a better understanding of its effects on the retention of RANs in the Australian states of Northern Territory (NT), Western Australia (WA) and South Australia (SA). Distance management in this context occurs when the health service''s line management team is located geographically distant from the workplace they are managing. METHODS: The study used a mixed method design, with a combination of anonymous surveys and interviews conducted by telephone and face to face. Qualitative and quantitative data were collected. The data were thematically analysed and basic descriptive statistics were also used. All RANs who worked in government and other non-Aboriginal controlled remote health services in NT, SA and WA were included in the sample. Sixty-one RANs (anonymous survey, 55% response rate) and 26 ex-RANs (telephone interview) participated in the research. The ex-RANs were sampled using a snowball technique where interviewees recommended former colleagues for interview. Nine nursing executives with expertise in distance management of remote health services also contributed (face-to-face interview), and they are referred to as ''the experts''. RESULTS: Respondents expressed a dichotomy in their reactions to remote area nursing. On one hand, they expressed a strong sense of pleasure and satisfaction in the nature of their work; while, on the other, they expressed dissatisfaction with aspects of infrastructure, support and management practices. Positive aspects included autonomy of practice, working in a small team, cross-cultural practice, and the beauty and isolation of the setting. Negative aspects included poor orientation, high stress, inadequate resources, poor systems, unrealistic expectations from communities and managers leading to excessive workload, and perceived lack of support from management. The greatest negative issue raised was poor handling of leave replacement, where RANs on leave were not replaced with appropriately qualified and skilled nurses. Respondents noted a frequent change in managers, and reported that the lack of stability in management contributed to lack of support for both RANs and their managers. Lack of support from managers was frequently cited as a main cause for ex-RANs leaving their employment. Despite this, almost all respondents indicated a willingness to remain in the remote workforce if possible. Experts noted that where management was dysfunctional, RAN retention rates fell. They also acknowledged the need for good communication, interpersonal skills, availability of staff development, leave, relief staff, feedback, debriefing, professional support and working conditions. Experts believed managers should make use of available and emerging technology to communicate with RANs, and work to improve RANs'' understanding of the role of the management team. CONCLUSIONS: Remote Australian Aboriginal communities are mainly served by RANs in a health system that is sometimes ill-equipped and at times poorly managed. The theme of a second-class health system being serviced by RANs who felt they were treated as second-class health practitioners appeared throughout the data. Poor distance management practices may contribute to the high turnover of staff in remote Australia. Retention of RANs may increase with better managerial practices, such as effective communication and leadership, staffing replacement and leave, prompt attention to infrastructure issues, and staff development and appraisal. These are the keys to ensuring that RANs feel supported and valued. Remote area nursing is a rewarding career and, with systemic support, RANs may stay longer in remote practice.
%Z FOR Codes: 1110 1117 111099 111717


%0 Book Section
%A Kildea, Sue
%A Ellwood, David
%A Barclay, Lesley
%A Sullivan, Elizabeth
%T Caesarean section
%B Maternal deaths in Australia 2000–2002
%D 2006
%C Australia
%I Australian Institute of Health and Welfare
%V 
%N 
%P 82-84
%@ 1-74024-550-4
%E Sullivan, Elizabeth
%E King, James F
%X 
%Z FOR Codes: 111402


%0 Journal Article
%~ PubMed
%A Kruske, Sue
%A Kildea, Sue
%A Barclay, Lesley
%T Cultural safety and maternity care for Aboriginal and Torres Strait Islander Australians.
%B Women and birth
%D 2006
%C Netherlands
%I Elsevier BV
%V 19
%N 3
%P 73-77
%@ 1871-5192
%X PURPOSE: To discuss cultural safety and critique the provision of culturally appropriate maternity services to remote Aboriginal and Torres Strait Islander women in Australia. PROCEDURE: The literature and policies around ''culture'' and ''cultural safety'' are discussed and applied to the provision of maternity services to Aboriginal and Torres Strait Islander women in remote areas of Australia. FINDINGS: The current provision of maternity services to Aboriginal and Torres Strait Islander women, particularly those living in remote Australia, appears largely inadequate. The provision of culturally safe maternity care requires health system reform at all levels including: the individual practitioner response; the educational preparation of practitioners; the delivery of maternity services and the development of policy at local, state and national level. This paper considers the changes that can be made from the individual practitioner through to the design and implementation of maternity services. PRINCIPAL CONCLUSIONS: Cultural safety provides a useful framework to improve the delivery of maternity services to remote Aboriginal and Torres Strait Islander women and their families.
%Z FOR Codes: 111006 111701


%0 Journal Article
%~ PubMed
%A Kildea, Sue
%A Barclay, Lesley
%A Brodie, Pat
%T Maternity care in the bush: using the Internet to provide educational resources to isolated practitioners.
%B Rural and remote health
%D 2006
%C Australia
%I Australian Rural Health Education Network
%V 6
%N 3
%P 559
%@ 1445-6354
%X INTRODUCTION: Telecommunication infrastructure is being rolled out across Australia with little knowledge about the uptake by health professionals in remote areas. Computer mediated communication has the potential to offer educational support to remote practitioners; however, the viability of this is uncertain. The aim of this research was to establish and evaluate an internet-based resource library targeting the needs of remote area maternity service providers. METHODS: A participatory action research (PAR) approach was used to involve remote area maternity service providers in the Northern Territory of Australia. The evaluation of the resource library included its performance on reach, agency affiliation and richness, factors identified to affect the sustainability and utility of such a resource. An additional component of the evaluation framework documented the facilitators of and barriers to using an information technology strategy to reduce the isolation of remote area maternity service providers. RESULTS: Overall, the evaluation of the resource library was very positive. Feedback from the PAR team described the resource as contemporary, useful and relevant. Practitioners in leadership and education positions identified the resource library as a valuable tool that enabled them to access professional knowledge, which could then be distributed to any remote-based practitioners, who experienced difficulties with access themselves. The evaluation found that logistical issues were a major problem for potential users. Hardware inadequacies, access difficulties, unfamiliarity with computers, and a lack of management support for nursing and midwifery staff to utilise the resource, were all identified barriers. Remote-area practitioners highlighted education, training and 24 hour support as key priorities. CONCLUSIONS: Results from this research clearly showed the potential of web-based resources to offer educational support through access to clinical guidelines, reports and research, thus reducing the isolation of the remote practitioner. However, it highlighted the need for clear strategic direction at policy level, whereby all stakeholders unite to synchronise the rollout of information technology infrastructure with the necessary education, training and support as an integral component.
%Z FOR Codes: 111402 1117


%0 Journal Article
%~ PubMed
%A Mills, Annie
%A Barclay, Lesley
%T None of them were satisfactory: women's experiences with contraception.
%B Health care for women international
%D 2006
%C United States
%I Taylor & Francis Inc.
%V 27
%N 5
%P 379-398
%@ 0739-9332
%X Seventy-two women, aged between 18 and 50 years, participated in focus groups to talk about their experiences with using contraception. There were both continuities and differences between women in each of the age groups. Younger women appeared to be more accepting of medical opinion, while many older women rejected medical interference in contraceptive decisions. Patterns of use were similar with the pill having been the contraceptive of first choice for the majority of women. The most persistent feature through the groups was a strong sense of dissatisfaction with contraception, in terms of both side effects and range of available methods.
%Z FOR Codes: 111716 111401


%0 Journal Article
%A Kruske, Sue
%A Barclay, Lesley
%A Schmied, Virginia
%T Primary Health Care, Partnership and Polemic: Child and Family Health Nursing Support in Early Parenting
%B Australian Journal of Primary Health
%D 2006
%C Australia
%I CSIRO Publishing
%V 12
%N 2
%P 57-65
%@ 1324-2296
%X 
%Z FOR Codes: 111717 111002


%0 Journal Article
%~ PubMed
%A Svensson, Jane
%A Barclay, Lesley
%A Cooke, Margaret
%T The Concerns and Interests of Expectant and New Parents: Assessing Learning Needs.
%B The Journal of perinatal education
%D 2006
%C United States
%I Lamaze International
%V 15
%N 4
%P 18-27
%@ 1058-1243
%X Antenatal education is an important component of antenatal care in the developed world, but research indicates that it may not be meeting consumer needs. This article provides an overview of a needs assessment that aimed to determine the concerns and interests of expectant and new parents and how they prefer to learn during the periods of pregnancy and the early weeks of parenthood. The findings could be used to develop an innovative approach to antenatal education in order to prepare expectant and new parents for the birth experience and the early weeks of parenthood. The current study''s results identified that expectant and new parents'' concerns and interests during pregnancy, childbirth, and new parenting fall within five interrelated conceptual areas: 1) perceiving achievement or failure; 2) taking on "risk"; 3) riding an emotional "roller coaster" of joy, anxiety, and uncertainty; 4) needing to "know...what is normal"; and 5) needing help to "perform well."
%Z FOR Codes: 111499