A randomised controlled trial of consumption of dark chocolate in pregnancy to reduce pre-eclampsia: Difficulties in recruitment, allocation and adherence.

In 2013-2014 we undertook a randomised controlled trial (RCT) to determine whether the daily ingestion of dark chocolate during pregnancy could reduce the incidence of pre-eclampsia in primigravidae. However, after two years we had not succeeded in recruiting more than 3.5% of the number of participants required to answer the research question, and the trial was halted. We also reviewed the literature on this topic and found it to be limited. We report here our findings and discuss the difficulties facing researchers in this area.

Increasing access to sexual health care for rural and regional young people: Similarities and differences in the views of young people and service providers.

OBJECTIVE: This study aims to describe the views of sexual health service providers on access issues for young people and consider them together with the views of young people themselves. DESIGN: A cross-sectional mixed-methods study design involving semi-structured interviews with health service providers and an electronic survey with young people. SETTING: Four towns in rural and regional Queensland, Australia. PARTICIPANTS: A total of 32 service providers: 9 sexual health nurses, 8 general practitioners, 6 school-based youth health nurses, 5 sexual health educators, 2 Australian Aboriginal health workers and 2 youth workers. There were 391 young people who participated in the Young People's Survey. MAIN OUTCOME MEASURES: Themes generated from interviews with service providers and quantitative data from young people addressing access to sexual and reproductive health (SRH) services for rural and regional young people. RESULTS: Service providers frequently identified structural barriers, confidentiality and lack of awareness of SRH services as barriers for young people seeking SRH care. Young people also reported that structural factors such as transport, cost and service operating hours were important; however, they placed greater value on personal attributes of service providers, particularly welcoming and non-judgemental attitudes. CONCLUSION: Health service policy and training focused on attitudinal qualities of individual service providers may improve access to SRH services for young people. Selective staff recruitment and professional development are important to increase sensitivity to youth issues. Promotion of non-judgemental and confidential care may also improve access for youth.

Supporting GP advanced rural skills training.

OBJECTIVE: The aim of this study was to: investigate doctors' experiences of support during GP advanced rural skills training, and identify strategies to improve support. DESIGN: The qualitative responses from a cross-sectional, postal survey are reported. SETTING: Rural vocational training sector. PARTICIPANTS: Sixty-one doctors who had completed GP advanced rural skills training (procedural or non-procedural) in Queensland between 1995 and June 2009 participated in the study. MAIN OUTCOME MEASURE: Advanced trained doctors' experiences of support and their strategy recommendations to improve support. RESULTS: Experiences and strategies to improve support were developed into a framework of support, consisting of three theme areas. Strategies included: provision of training and career advice to allow immediate use of advanced skills; introduction of rural attachments and rural case studies during training to ensure rural orientation; development of GP mentor and peer networks for clinical and non-clinical support; advocacy to improve understanding and recognition of advanced rural skills training. CONCLUSIONS: Expanded support is required across the pre-enrolment, training, early practice continuum. A holistic approach to support is required. Training providers, professional bodies, health departments, universities and workforce agencies need to work together to address and resource the support needs of advanced, rural GP trainees before, during and after training.

Development of a questionnaire measuring student attitudes to working and living in rural areas.

INTRODUCTION: Student attachments in rural locations have been instigated, in part to foster positive attitudes to rural practice and encourage rural recruitment. Based on medical and allied health literature, it was hypothesised that students' attitudes to rural practice and rural life encompasses the following three dimensions: (1) community and social issues; (2) family and personal issues; and (3) professional issues. However, there are limited studies assessing attitudinal change before and after rural placement and no valid and reliable tools which examine change across all three dimensions. This article reports on the development, reliability and validity of such a tool to fill this gap in the rural health research literature. METHODS: Students who undertook a rural placement in South Australia or a rural placement organised by the Mt Isa Centre for Rural and Remote Health in Queensland, Australia, during 2001 were invited to complete a pre- and post-placement questionnaire (n = 243). The response rate for the pre-placement questionnaire was 74.9% (n = 182) and 50.2% (n = 122) for the post-placement questionnaire. A literature review informed the content of the initial questionnaire, which consisted of a series of statements to which respondents were instructed to indicate how strongly they agreed or disagreed on a Likert scale of one to six. The assessment of validity and reliability of the questionnaire involved three main processes. Content validity was assessed by discussion and rating by academics and students, resulting in 18 questionnaire items. Exploratory factor analysis was used to provide evidence of construct validity. The internal consistency reliability of the questionnaire was assessed using Cronbach's alpha. RESULTS: The Cronbach's alpha coefficient for the post-questionnaire was 0.68, acceptable for newly developed scales. Exploratory factor analysis and varimax rotation was conducted for pre- and post-placement (n = 110) questionnaires. The pre-placement questionnaire did not lend itself to logical interpretation, probably due to the diverse attitudes students may have pre-rural placement. However the factors on the post-placement questionnaire were interpretable. The Scree Plot indicated four factors, explaining 60.82% of the total variance. The factors were rotated using the normalised varimax rotation method. The factors extracted were: (1) friendliness and support in rural areas; (2) isolation and socialisation problems associated with living and working in rural areas; (3) enjoyable aspects of living in a rural area; and (4) opportunities that working in a rural area provides. CONCLUSIONS: Analysis of the Student Attitudes to Rural Practice and Life Questionnaire provides evidence of validity. The study identified four factors associated with student attitudes to living and working in rural areas, which differ from those hypothesised. The main deviation was Factor 2, grouping all the negative aspects of isolation and socialisation in a rural area. The resulting factors provide a more integrated reflection of the rural experience, rather than the rigid categorisation of professional, social and personal issues. Reliability was found to be adequate. The questionnaire is able to measure student attitudes to rural practice and rural life, and may be used to evaluate the impact of rural placement on student attitudes.

Young people's perceptions of sexual and reproductive health in regional and rural Queensland: capturing the views of adolescents through reference groups and a user-friendly electronic survey.

UNLABELLED: Background Young people in regional and rural Queensland have difficulty accessing sexual and reproductive health (SRH) services. Young people's views regarding barriers and enablers for accessing SRH services and markers of quality are largely unknown. METHODS: Young people's perceptions regarding SRH services are explored through a cross-sectional study via eight reference group meetings and an electronic survey in four sites: Atherton Tablelands, Rockhampton, Toowoomba and Townsville. The survey, developed in consultation with young people, was administered online and face to face using tablet computers. Data from 391 rural and regional participants was precoded for bivariate comparisons involving χ(2) and confidence interval (CI) tests. RESULTS: The most valued markers of quality in SRH services defined by young people all related to staff characteristics. Young people preferred services where staff were friendly (87.3%; 95% CI: 83.8-90.8%), easy to talk to (91.4%; 95% CI: 88.5-94.3%), good listeners (95.4%; 95% CI: 93.2-97.6%) and did not judge them (90.5%; 95% CI: 87.4-93.6%). A model of SRH service delivery encompassed within general health services was highly valued by 58.9% (95% CI 53.7-64.1%). However, 36.2% (95% CI: 31.4-41.0%) preferred to seek care from SRH specialist services. CONCLUSIONS: Service provision can be improved by training, and retaining friendly, attentive and non-judgemental staff. A model of service provision that includes general health care and provides sexual health services may increase the acceptability and accessibility of SRH services among youth. Additionally, our study highlights the need for choice between general and specialist SRH services.

A performance assessment module for experienced general practitioners.

OBJECTIVE: To trial in Australian general practice a performance assessment module based on review of a sample of videotaped consultations. DESIGN: As part of a broader project 33 doctors provided 20 videotaped consultations collected according patient age, gender and problems encountered. The consultations were rated by a single trained rater. RESULTS: The consultations covered sufficient variety of patient ages, gender balance and problems encountered to achieve validity and the single rater design achieved defensible reliability (generalisability coefficient 0.86). CONCLUSION: The module is suitable for further exploration as an optional method for certification or re-certification assessment.