Decolonisation for health: A lifelong process of unlearning for Australian white nurse educators.

Indigenous nurse scholars across nations colonised by Europeans articulate the need for accomplices (as opposed to mere performative allies) to work alongside them and support their ongoing struggle for health equity and respect and to prioritise and promote culturally safe healthcare. Although cultural safety is now being mandated in nursing codes of practice as a strategy to address racism in healthcare, it is important that white nurse educators have a comprehensive understanding about cultural safety and the pedagogical skills needed to teach it to undergraduate nurses. We open this article with stories of our journeys as two white nurses in becoming accomplices and working alongside Indigenous Peoples, as patients and colleagues. Our lived experience of the inertia of healthcare and education organisations to address systemic and institutional resistance to the practice of cultural safety underpins the intention of this article. We understand that delivering this challenging and complex topic effectively and respectfully is best achieved when Indigenous and white educators work together at the cultural interface. Doing so requires commitment from white nurses and power holders within universities and healthcare institutions. A decolonising approach to nurse education at individual and institutional levels is fundamental to support and grow the work that needs to be done to reduce health inequity and increase cultural safety. White nurse accomplices can play an important role in teaching future nurses the importance of critical reflection and aiming to reduce power imbalances and racism within healthcare environments. Reducing power imbalances in healthcare environments and decolonising nursing practice is the strength of a cultural safety framework.

The influence of an educational intervention on nursing students' domestic violence knowledge and attitudes: a pre and post intervention study.

BACKGROUND: Nurses, as the largest group of health professionals, have a key role in recognising, mitigating and preventing domestic violence. However, studies demonstrating effective undergraduate educational interventions are lacking. The research aim was to compare undergraduate nursing students' knowledge and attitudes about domestic violence before and after an educational intervention on domestic violence and explore their views on the most useful teaching strategies. METHODS: A quasi-experimental pre and post design was used to determine the impact of an educational intervention. Australian nursing students enrolled in a first-year undergraduate subject were invited to participate. The educational intervention included a 40-min pre-recorded lecture on domestic violence, and a two-hour face-to-face workshop facilitated by an expert, supported by readings. Students completed a pre- and post-intervention online anonymous survey using a validated instrument, the Inventory on Beliefs and Attitudes towards Domestic Violence. Wilcoxon signed rank tests were used to compare pre and post intervention results. RESULTS: Approximately 400 students completed the voluntary workshop; 198 students completed the pre survey, 176 completed the post survey and 59 (13.1%) completed both. Post intervention, participants indicated stronger agreement on 15 of 22 items. The inventory score became significantly more positive (Z = -3.196, p = .001, CI -.206--0.067) post intervention. Of the 173 students who indicated post intervention which forms of education they found useful, 38.2% considered face-to-face tutorials to be the most useful education modality. CONCLUSIONS: This study demonstrates the effectiveness of even a small educational intervention in changing attitudes, and creating awareness and knowledge of the context, prevalence, perpetrators, and significant associated burden of illness related to domestic violence, and nurses' responsibility to support victims.

Nurses and midwives reporting of workplace violence and aggression: an integrative review.

Background: The experience of workplace violence and aggression is a common occurrence among the nursing and midwifery workforce, however, it is largely under-reported. Reasons for underreporting are not well understood.Aim: To review factors that influence nurses' and midwives' reporting of workplace violence and aggression from patients and visitors in hospital inpatient settings.Method: In this integrative review papers were identified through a search of electronic databases Embase, Emcare, PsychInfo, Medline, and CINAHL for literature between 2009 and 2020.Findings: Five papers met the inclusion criteria. Three themes were identified which influence reporting: organisational culture; accepting violence as part of the job; and type of violence.Discussion: Workplace policies supported by management and education programmes are required to improve the reporting of workplace violence and aggression by nurses and midwives.Conclusion: Workplace violence and aggression is under-reported by nurses and midwives in hospital inpatient settings. Reporting systems are not valued and nurses have come to accept workplace violence and aggression. Further research is required to explore strategies to improve workplace violence and aggression reporting culture and assess current education programmes using validated tools.

"Teaching in Circle" with student nurses contributes to experiential understanding of Cultural Safety.

Background: Cultural safety is mandated for Australian nursing practice and education. Cultural safety privileges the knowledge of the client, who determines whether healthcare is culturally safe. Understanding and learning cultural safety requires critical self-reflection to expose clinicians' assumptions, unconscious biases, beliefs and actions, and their impact on clients. More research is required on best-practice strategies on how students learn about cultural safety in nursing education. Experiential pedagogical methods may be one such strategy to promote understanding of principles that underpin safe environments.Objectives: To explore the influence of "Teaching in Circle" to enhance students' understanding of cultural safety within the classroom environment.Methods: Students in first-year undergraduate Bachelor of nursing units participated. Teachers facilitated tutorials using a respectful adaptation of "Teaching in Circle" methodology; it was underpinned by the principles of Yarning, an Aboriginal and Torres Strait Islander Peoples way of learning and communicating in groups. Students developed principles to guide the facilitation of a more culturally safe classroom, providing written feedback on the environment and their participation in the circle.Results: Student feedback was reflected in three themes: "Journey through unfamiliar territory"; "More personable way of learning and sharing" and "Relational engagement creates safety". Student perspectives resonated strongly with the principles of cultural safety or lack of within healthcare settings. The method disrupted normative classroom/learning environments and supported experiential learning about the principles of cultural safety.Conclusions: "Teaching in circle" provided an experiential means of enhancing first-year nursing students' understanding of the principles of cultural safety. This learning should be embedded in the nursing curriculum and on-going education to prepare nurses to provide culturally safer care to Aboriginal and Torres Strait Islander Peoples. The study supports similar research calling for innovative learner-focused, experiential methods for the development of the practice of cultural safety in Australian nursing education.Impact statement: Exploratory research project, "Teaching in Circle" with student nurses contributes to experiential understanding of cultural safety principles.

Cultural Safety: teachers' engagement with an Indigenous pedagogical method in undergraduate nursing education.

Background: Given the continued disparity between the health of Indigenous Australian people's health and that of the broader Australian population, cultural safety is mandated as a component of undergraduate education as a strategy to improve health care. Evidence suggests that academics are not confident to teach cultural safety to undergraduate nursing students.Objectives: To explore the efficacy of an Indigenous teaching method (Teaching in Circle) to create culturally safe classrooms and to build the capacity and confidence of teachers to teach about cultural safety.Design: An Indigenous pedagogy was adapted for use in tutorials by teachers, with mentorship provided by an Indigenous knowledge expert. Teaching in Circle (TiC) methodology was implemented by teachers in tutorials.Methods: All nurse academics teaching in the Bachelor of Nursing program at a small regional Australian university were eligible to participate. Information about the project was provided in team meetings, with invitations to participate. Teachers provided a written reflection on the method and participated in regular on-line mentored support meetings throughout the teaching session. Data were analysed, using a reflective, inductive systematic process.Results: Final themes were "Sticking with initial disconcertment and discomfort"; "A renewed enjoyment of teaching"; "Learning and adapting", "The influence of the method on safety" and "Shifts in classroom dynamics".Impact Statement: 'Teaching in Circle', underpinned by respectful practice, positively influences culturally safe teaching and learning environments. The method enhances academics' confidence to teach cultural safety to undergraduate nursing students and supports an understanding of the essential components of culturally safe health care.Conclusions: Evidence suggests the method built capacity to teach and foster experiential learning of safety, and thus what is required to create a culturally safe teaching and learning space.

Evaluation of a digital application to support internationally qualified nurses' communication and leadership skills.

BACKGROUND: Internationally qualified nurses enrolled in Australian bridging programs to support professional registration lack confidence, and require support and time to develop communication and leadership skills in the clinical setting. Strategies that strengthen professional self-concept have been demonstrated to improve the nursing performance of internationally qualified nurses. OBJECTIVE: To evaluate an interactive mobile application called mPreceptor, specifically designed to support internationally qualified nurses' communication and leadership skills during a 6 week clinical placement. The application facilitated weekly learning content and activities in the areas of clinical communication and leadership, including self-assessment, goal-setting, case studies, and weekly detailed reflections while on placement. DESIGN: A quasi-experimental pre and post-test design with a non-equivalent comparison group was used to explore the effectiveness of mPreceptor on internationally qualified nurses' self-appraisal of professional self-concept, including leadership and communication skills, compared with standard clinical placement. The psychometrically tested Nurse Self-Concept Questionnaire, measured changes to perceived professional self-concept. RESULTS: Overall, there was a significant increase in Nurse Self-Concept following the clinical placement, confirming that the bridging program for internationally qualified nurses in Australia improves leadership and communication skills. Leadership skills were significantly greater for those internationally qualified nurses who engaged with mPreceptor. CONCLUSION: Further research is required to investigate the application of interactive mobile applications, as effective education resources to facilitate internationally qualified nurses' transition of skills and knowledge to the Australian healthcare context.

Patient decision aids in clinical practice for people with diabetes: a scoping review.

BACKGROUND: People with diabetes need to make regular choices that influence their long-term morbidity and mortality. Patient decision aids are validated tools and when used collaboratively between healthcare professionals, patients and carers, can help guide value-based discussions which encourage choices that are well informed and personally relevant. OBJECTIVE: To explore the use and effect of patient decision aids in the management of diabetes. METHOD: A scoping review design was used. Medline, ProQuest, PsycINFO, Scopus, and Cumulative Index to Nursing and Allied Health Literature databases were searched for peer-reviewed articles published between January 1998 and December 2018. RESULTS: Patient decision aids are not commonly or widely used in diabetes management. They offer a suitable adjunct to practice within the domains of healthcare knowledge, active participation, and communication, and shared decision-making between patients and healthcare professionals. CONCLUSION: Patient decision aids can offer a simple and easy-to-use method to potentially improve diabetes health literacy, through the process of shared decision-making and two-way conversations. However, there are current limitations on using them to positively influence clinical outcomes or long-term changes in self-care behaviors within the management of diabetes. Further research to explore the validity of using patient decision aids long term in these areas is required.

'I didn't feel judged': exploring women's access to telemedicine abortion in rural Australia.

INTRODUCTION Regardless of geographical location, safe and legal abortion is an essential reproductive health service. Accessing an abortion is problematic for women in rural areas. Although telemedicine is globally established as safe and effective for medical abortion in urban settings, there is a paucity of research exploring access to telemedicine abortion for women in rural locations. AIM The aim of this qualitative research is to explore and better understand women's access to telemedicine abortion in Australian rural areas. METHODS Structured interviews were conducted with women (n=11) living in rural areas who had experienced a telemedicine abortion within the last 6 months. Phone interviews were recorded and transcribed verbatim. Data underwent a Patient-Centred Access framework analysis and were coded according to the domain categories of approachability/ability to perceive, acceptability/ability to seek, availability/ability to reach, affordability/ability to pay, and appropriateness/ability to engage. RESULTS Rural women had severely limited access to abortion care. The five domains of the Patient-Centred Access model demonstrated that when women with the prerequisite personal skills and circumstances are offered a low-cost service with compassionate staff and technical competence, telemedicine can innovate to ensure rural communities have access to essential reproductive health services. DISCUSSION Telemedicine offers an innovative model for ensuring women's access to medical abortion services in rural areas of Australia and likely has similar applicability to international non-urban contexts. Strategies are needed to ensure women with lower literacy and less favourable situational contexts, can equitably access abortion services through telemedicine.

A cross-sectional study of domestic violence instruction in nursing and midwifery programs: Out of step with community and student expectations.

BACKGROUND: Domestic violence is a global health concern. Nurses and midwives must respond to those who experience domestic violence, although many are not prepared to do this. The World Health Organization recommend that domestic violence content be included in all pre-registration training as a matter of urgency. OBJECTIVES: To examine self-reported undergraduate student perceptions of domestic violence content in their programs of study and student attitudes and beliefs about domestic violence. DESIGN: A cross-sectional research design with online survey was employed from June to October 2017. METHODS: Using convenience sampling, 1076 students were recruited to the study from a total population sample of just over 6000 undergraduate nursing and midwifery students; a response rate of 17.9%. Survey data reported the nature and frequency of teaching and learning along with student attitudes and beliefs about domestic violence. Open ended responses were examined via thematic analysis. SETTINGS: Nine Australian universities offering undergraduate nursing and midwifery degrees. PARTICIPANTS: Undergraduate university nursing and midwifery students. RESULTS: Over half of students surveyed (53.7%, n = 578) reported that domestic violence was not addressed in their program of study. A direct correlation was found between students' perceived preparedness to assess and respond to domestic violence, and the amount of taught content in their program of study. CONCLUSION: This major gap in curricula has significant implications for professional practice preparedness. Further research should focus on examining the reasons why quality domestic violence content is lacking in undergraduate nursing and midwifery programs and how prioritisation of domestic violence content can be improved.

Australian nursing and midwifery student beliefs and attitudes about domestic violence: A multi-site, cross-sectional study.

Nurses and midwives have a professional responsibility to identify and provide effective care to those experiencing domestic violence. Pre-registration preparation may develop this capability. In order to inform curriculum development, this study explored Australian nursing and midwifery students' attitudes and beliefs about domestic violence. Data were collected between June and October 2017. Descriptive statistics were calculated and comparative analysis performed on independent variables. Thematic analysis was performed on open-ended qualitative responses. Participants included 1076 students from nine Australian universities. The majority were enrolled in nursing programs (88.4%), followed by midwifery (8.6%), and combined nursing/midwifery (2.4%) programs. There was no statistically significant difference in scores by year level across all subscales, suggesting there was no developmental change in beliefs and attitudes toward domestic violence over the course of study. Nursing students held views that were more violence-tolerant than midwifery students. Australian and Chinese-born males were more likely to refute that domestic violence is more common against women. Students had a limited understanding of domestic violence suggesting a critical need to address undergraduate nursing and midwifery curricula.

Exploring cultural safety with Nurse Academics. Research findings suggest time to "step up".

Background: As the largest professional group employed within the health care system, the capacity for nurses to contribute to improving the health of Australian Indigenous people is substantial. Cultural safety has recently been incorporated into the national codes of conduct for nurses. Nurse academics have a key role in ensuring graduates are culturally safe practitioners. Staff capacity is a crucial consideration if cultural safety is to be embedded effectively within nursing curriculum. Aims: The aim of this study was to explore capability in relation to cultural safety with Nurse Academics at a regional university in New South Wales, Australia. Design: Mixed methods approach incorporating a survey and individual interviews. Methods: Casual and permanent nurse academics involved in teaching the undergraduate nursing program were eligible to participate. Results: Fifteen staff completed the survey and eight participated in an interview. Although the importance of cultural safety was recognised, there was a lack of comprehensive understanding and lack of confidence to teach the philosophy and practices of cultural safety. There was strong support cultural safety and anti-racism professional development. Impact statement: Building staff capacity is a crucial consideration if cultural safety is to be embedded within nursing curriculum. Conclusions: Cultural safety professional development is a starting point for nurses to develop their skills in providing culturally safe care and an essential step towards shifting the institutional and professional culture of the nursing profession. Research findings are clear it is time for Nurse Academics to "Step up" to effectively embed cultural safety in undergraduate nursing curriculum.

Psychometric testing of inventory of beliefs and attitudes on domestic violence.

Background Domestic violence (DV) is an international public health issue associated with adverse health outcomes for adults and children. There have been widespread calls to increase nurses' capacity to respond to DV and improve undergraduate nursing education in this area. However, there are few valid, reliable and contemporary measures of nursing attitudes towards and beliefs concerning DV that are suited for use in evaluating education programmes. Aim To establish the psychometric properties of a newly developed inventory designed to measure nursing students' beliefs about and attitudes towards DV. Discussion Exploratory factor analysis identified five factors, with a Cronbach's alpha of 0.646. The few factors loading>.80 suggest that the instrument has good discriminate validity. The absence of cross-loadings indicate good convergent validity. Conclusion The inventory provides one of the first validated and reliable measures for examining undergraduate nursing students' attitudes towards and beliefs about DV. Implications for practice The instrument is suited for use by nurse educators in assessing the influence of curriculum design and teaching strategies on student beliefs and attitudes. It would also be useful in studies investigating nurses' clinical practice on domestic violence.

Actual availability of appointments at general practices in regional New South Wales, Australia.

BACKGROUND: There is limited data to inform policy about the availability and costs of primary healthcare at the local level. The objective of this article was to determine the appointment availability and out-of-pocket costs for patients presenting with non urgent conditions to general practices in a regional setting. METHODS: A cross-sectional, census study included all 184 general practices across 12 local government areas in northern New South Wales. Practices were telephoned in a randomised sequence on weekday mornings by a researcher. RESULTS: Twenty-two practices were excluded from the study as these were specialised only services; therefore, the sample size was n = 162. The rate of same-day appointment availability was 47.5% (n = 77/162; range: 11-63%), and bulk-billing availability was 21% (range: 0-50%). The mean out-of-pocket cost was $29.98 (range: $12.95-60.30). DISCUSSION: Availability of primary healthcare and bulk billing across northern New South Wales is highly variable. Areas with low service availability should be targeted by policy.

Ready, willing and able? A survey of clinicians' perceptions about domestic violence screening in a regional hospital emergency department.

BACKGROUND: Domestic violence (DV) has significant health impacts for victims and their families. Despite evidence that routine screening increases the identification of DV and opportunities for support; routine screening is uncommon in Australian emergency departments (EDs). This study explored ED clinicians' level of support for DV screening; current screening practices; and perceived barriers and readiness to screen prior to a pilot intervention. METHODS: Census survey of 76 ED clinicians. A number of questionnaire items were generated through a review of the literature, with readiness to screen for DV assessed through the short version of the Domestic Violence Healthcare Provider Scale [1]. The confidential and anonymous online survey was hosted on the Qualtrics platform. Descriptive and comparative statistical analysis was performed using IBM SPSS version 22. RESULTS: Most clinicians supported screening for DV in the ED. In the absence of protocols, 72.3% (n=55) of clinicians reported currently engaging in case-based screening, which preferenced women with physical injury. The majority did not always feel comfortable screening for DV (79.7% n=59) and reported they had received insufficient training for this role (88.7% n=55). Lower perceived self-efficacy and fear of offending were statistically associated with discomfort or negative beliefs about DV enquiry (p=<0.05). CONCLUSION: Emergency department clinicians reported feeling ill-equipped and under-prepared to inquire about and respond to DV. These findings provide valuable insight about the training and support needs of ED clinicians prior to the commencement of routine screening in EDs.

Student nurses' knowledge and attitudes towards domestic violence: results of survey highlight need for continued attention to undergraduate curriculum.

AIMS AND OBJECTIVES: To gain a comprehensive understanding of undergraduate nursing student attitudes and views towards domestic violence, and employ the findings to inform undergraduate curriculum development. BACKGROUND: Nurses have an important role in identifying people who are victims of domestic violence through screening and facilitating their access to assistance and support. Undergraduate nursing education is key to shaping attitudes and facilitating the development of a comprehensive understanding of domestic violence. Little research has been undertaken exploring nursing students' attitudes towards domestic violence. METHODS: A cross-sectional survey of undergraduate nursing students enrolled in a three-year Bachelor of Nursing programme across three campuses of a regional university in NSW, Australia. Students completed a pen and paper survey during class time and descriptive and comparative analysis was undertaken. RESULTS: The majority of respondents were female, first year students females aged 17-26 years. Many students understood the nature and consequences of domestic violence, yet others across the course of the programme demonstrate attitudes that reflect a lack of understanding and misconceptions of domestic violence. Stereotypical and gendered attitudes that normalise violence within intimate partner relationships and sustain victim-blaming attitudes were evident across the cohort. CONCLUSIONS: It is important for nurses to understand the relationship between exposure to violence and women's ill health, and be able to respond appropriately. Undergraduate programmes need to highlight the important role of nurses around domestic violence and address stereotypical conceptions about domestic violence. RELEVANCE TO CLINICAL PRACTICE: Continued effort is required to address domestic violence in undergraduate nursing education so that nursing graduates understand the association between violence exposure and poor health and are able to assess exposure and respond appropriately in the clinical environment.

Barriers around access to abortion experienced by rural women in New South Wales, Australia.

INTRODUCTION: Little is known about Australian rural women's overall experiences of accessing an abortion service and the barriers they encounter. Approximately one in three Australian women access an abortion at some time in their lives. Most abortions are undertaken during the first trimester of pregnancy in private clinics. Although both medical and surgical abortions are uncomplicated medical procedures, abortion remains a contentious area of women's health. Whilst it is clear that rural women experience disparities in relation to access to health care, there is a gap in the evidence on rural women's experiences of accessing an abortion. The aim of the present study was to identify factors that women in rural New South Wales (NSW) experience in accessing abortion services and suggestions about how rural women could be better supported when seeking access to an abortion service. METHODS: In-depth qualitative interviews were undertaken with rural women living in NSW who had had an abortion in the previous 15 years. Participants self-selected for a phone or face-to-face interview, in response to promotion of the study through women's services, community flyers and press releases. RESULTS: Rural women in this study experienced many barriers to accessing an abortion. Women travelled 1-9 hours one way to access an abortion in clinics. Several women borrowed money for the abortion fee. Five themes were identified: finding information about the provider; stigma, shame and secrecy; logistics involved in accessing the clinic related to travel, money and support; medical and surgical abortion; and ways rural women could be better supported in this process. Suggestions to improve rural women's access to abortion services included more affordable services that were 'closer to home' as a way to reduce travel and cost, and to normalise abortion as a women's health rights issue. CONCLUSIONS: Despite welcome legal and pharmaceutical reform in Australia, results from this small study indicate that there is a long way to go remove barriers on issues rural women experience in their process of accessing reproductive care, including the pervasiveness of abortion stigma. Services closer to home may help reduce inequities in access to health care experienced by rural women. Strategies such as broader use of tele-health and willingness of general practitioners to become authorised prescribers for medical abortions could help to reduce long distances to travel to services and the financial burden experienced by rural women.

Sri Lankan-born women who have given birth in Victoria: a survey of their primary postpartum health-care needs.

Women who migrate are vulnerable after giving birth. Normal postpartum adaptive challenges are heightened by separation from family and lack of familiarity with local services. The aim was to investigate primary care needs among Sri Lankan-born women with at least one Victorian-born child aged under 2 years. Health care, information and support needs and unmet needs were assessed in a structured Sinhala or English survey offered in print, online or by telephone. Fifty women provided data. Most (80%) had at least one relative from Sri Lanka to stay for postpartum support. Despite this, many had difficulties settling (62%), feeding (58%) and soothing (42%) their babies. They used significantly fewer health services on average (2.3) than mothers in the general community (2.8) (P<0.004). Only 32% of primiparous women attended at least one First-Time Parents' group session. Of women experiencing infant care difficulties, only two-thirds accessed care from a Maternal and Child Health Nurse and only one-third from a General Practitioner. Sri Lankan-born mothers have significant unmet needs for primary care, which are not reduced by informal support. A two-pronged approach is indicated in which women are informed about primary care availability, and the cultural competence and client friendliness of services is strengthened.

Barriers and facilitators of access to first-trimester abortion services for women in the developed world: a systematic review.

OBJECTIVES: To identify the barriers and facilitators to accessing first-trimester abortion services for women in the developed world. METHODS: Systematic review of published literature. CINAHL, PubMed, Proquest, MEDLINE, InformIT, Scopus, PsycINFO and Academic Search Premier were searched for papers written in the English language, from the developed world, including quantitative and qualitative articles published between 1993 and 2014. RESULTS: The search initially yielded 2511 articles. After screening of title, abstract and removing duplicates, 38 articles were reviewed. From the provider perspective, barriers included moral opposition to abortion, lack of training, too few physicians, staff harassment, and insufficient hospital resources, particularly in rural areas. From the women's perspective, barriers included lack of access to services (including distance and lack of service availability), negative attitudes of staff, and the associated costs of the abortion procedure. Service access could be enhanced by increasing training, particularly for mid-level practitioners; by increasing the range of service options, including the use of telehealth; and by creating clear guidelines and referral procedures to alternative providers when staff have a moral opposition to abortion. CONCLUSION: Despite fewer legal barriers to accessing abortion services, the evidence from this review suggests that women in developed countries still face significant inequities in terms of the level of quality and access to services as recommended by the World Health Organization.

Rural New South Wales women's access to abortion services: highlights from an exploratory qualitative study.

OBJECTIVE: The aim of the study was to identify factors that New South Wales (NSW) rural women experience in relation to their ability to access an abortion service and follow-up care. DESIGN: The qualitative responses from interviews are reported. SETTING: Rural and regional NSW. PARTICIPANTS: Staff from community based non-government Women's Health Centres across regional/rural NSW and women in rural NSW who had accessed an abortion in the preceding fifteen years. MAIN OUTCOMES: A number of barriers that NSW rural women experience in relation to their ability to access an abortion and follow-up care were identified. RESULTS: The main barrier rural women experienced was travelling relatively long distances to access an abortion clinic because of lack of services in their local area. Women with limited financial resources needed to borrow money for the procedure and associated costs of travel and accommodation. Women's Health Centres provide a range of support and referral information. Lack of integrated care was reported. CONCLUSIONS: Rural women's access to abortion services are impacted by the availability, accessibility and affordability of services and prevailing negative social attitudes. This exploratory study provides a snapshot of women's experiences of the process of seeking an abortion in rural NSW, where they are not available locally and women have to travel out of the area to access services. Findings indicate rural women experience multiple barriers in relation to their ability to access abortion services and follow-up care, which may impact on overall health outcomes.

Prevalence, nature and determinants of postpartum mental health problems among women who have migrated from South Asian to high-income countries: a systematic review of the evidence.

BACKGROUND: Women of reproductive age constitute a significant proportion of immigrants from South Asia to high-income countries. Pregnancy, childbirth and the postpartum period place increased demands on women׳s psychological resources and relationships. The aim of this review was to evaluate the available evidence about the prevalence, nature and determinants of postpartum mental health problems among South Asian women who have migrated to high-income countries. METHODS: Using a systematic strategy, CINAHL, Medline, PsychInfo and Web of Science databases were searched. RESULTS: Fifteen studies conducted in different high-income countries met inclusion criteria. Prevalence estimates of clinically significant symptoms of postpartum depression (CSS-PPD) varied widely (1.9-52%): the most common estimates ranged from 5 to 20%. Five studies found approximately a two-fold increase in risk of CSS-PPD (Odds Ratios 1.8-2.5) among overseas born women with a South Asian subgroup. The most common determinants appeared to be social factors, including social isolation and quality of relationship with the partner. Barriers to accessing health care included lack of English language proficiency, unfamiliarity with local services and lack of attention to mental health and cultural factors by health care providers. LIMITATIONS: The settings, recruitment strategies, inclusion and exclusion criteria, representative adequacy of the samples and assessment measures used in these studies varied widely. Many of these studies did not use formally validated tools or undertake specific subgroup analyses. CONCLUSIONS: Reductions in postpartum depression could be achieved by increasing awareness of available services and ensuring health care professionals support the mental health of women from diverse cultural and linguistic backgrounds.