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Beilby K, Hammarberg K. ChatGPT: a reliable fertility decision-making tool? Hum Reprod 2024; 39:443-447. [PMID: 38199794 PMCID: PMC10905498 DOI: 10.1093/humrep/dead272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/11/2023] [Indexed: 01/12/2024] Open
Abstract
The internet is the primary source of infertility-related information for most people who are experiencing fertility issues. Although no longer shrouded in stigma, the privacy of interacting only with a computer provides a sense of safety when engaging with sensitive content and allows for diverse and geographically dispersed communities to connect and share their experiences. It also provides businesses with a virtual marketplace for their products. The introduction of ChatGPT, a conversational language model developed by OpenAI to understand and generate human-like text in response to user input, in November 2022, and other emerging generative artificial intelligence (AI) language models, has changed and will continue to change the way we interact with large volumes of digital information. When it comes to its application in health information seeking, specifically in relation to fertility in this case, is ChatGPT a friend or foe in helping people make well-informed decisions? Furthermore, if deemed useful, how can we ensure this technology supports fertility-related decision-making? After conducting a study into the quality of the information provided by ChatGPT to people seeking information on fertility, we explore the potential benefits and pitfalls of using generative AI as a tool to support decision-making.
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Affiliation(s)
- Kiri Beilby
- Education Program in Reproduction and Development, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Karin Hammarberg
- Global and Women’s Health, School of Public and Health and Preventative Medicine, Monash University, Melbourne, Australia
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Davidson N, Hammarberg K, Fisher J. 'If I'm not sick, I'm not going to see the doctor': Access to preventive sexual and reproductive health care for Karen women from refugee backgrounds living in Melbourne, Australia-A qualitative study. Health Promot J Austr 2024. [PMID: 38325438 DOI: 10.1002/hpja.844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 10/30/2023] [Accepted: 01/22/2024] [Indexed: 02/09/2024] Open
Abstract
ISSUE ADDRESSED Women from refugee backgrounds have poorer health outcomes than host country populations. People from Myanmar, most of whom are from the Karen ethnic minority constitute one of the largest groups of humanitarian visa entrants to Australia since 2015. Barriers to and enablers of preventive sexual and reproductive health (SRH) for this group of women are poorly understood. The objective is to establish the preventive SRH care needs and experiences of Karen women from refugee backgrounds living in Australia. METHODS A qualitative study using semi-structured interviews was conducted with a purposive sample of Karen women. A bi-cultural worker assisted in recruitment and interpreting during data collection. All interviews were conducted in Karen language with a bi-cultural worker interpreting into English during the interview. Audio recordings of English dialogue were transcribed verbatim. Thematic analysis was used to analyse and report data. RESULTS Thirteen women were interviewed. Five major themes were identified: (1) prevention awareness including lack of access to education and knowledge of services pre-arrival; appreciation of the new health system; limited vaccination knowledge, (2) perceived need for prevention including consequences of not screening; health care provider (HCP) attendance, (3) health information seeking including providing a comprehensive approach to information delivery; trusted sources of information, (4) barriers including missed opportunities; communication, language, illiteracy; lack of continuity of care and, (5) enablers including HCP' characteristics; peer support and individual responsibility. CONCLUSION Findings from this study indicate that to improve access to preventive SRH services a multi-component strategy is needed. Provision of preventive SRH information using a multi-pronged approach; peer and community support interventions; and HCPs offering services and information opportunistically would benefit Karen women unfamiliar with preventive SRH care. SO WHAT?: Primary prevention services and education codesigned with community members may be effective in improving Karen women's access to SRH care.
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Affiliation(s)
- Natasha Davidson
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Karin Hammarberg
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Jane Fisher
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia
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Dwyer R, Jachno K, Tran T, Owen A, Layton N, Collyer T, Kirkman M, Lowthian J, Hammarberg K, McNeil JJ, Woods RL, Berk M, Fisher J. Symptoms of depression and risk of emergency department visits among people aged 70 years and over. BMC Public Health 2024; 24:385. [PMID: 38317172 PMCID: PMC10845391 DOI: 10.1186/s12889-024-17794-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 01/17/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Older people experiencing depression and anxiety have higher rates of health service utilisation than others, but little is known about whether these influence their seeking of emergency care. The aim was to examine the associations between symptoms of depression and the use of emergency health care, in an Australian context, among a population of people aged 70 years and over initially free of cardiovascular disease, dementia or major physical disability. METHODS We undertook secondary analyses of data from a large cohort of community-dwelling Australians aged [Formula: see text]70 years. Multivariable logistic regression was used to compare the association of symptoms of depression (measured using the Center for Epidemiological Studies Depression Scale 10 question version, CESD at baseline) with subsequent episodes of emergency care, adjusting for physical and social factors of clinical interest. Marginal adjusted odds ratios were calculated from the logistic regression. RESULTS Data were available for 10,837 Australian participants aged at least 70 years. In a follow-up assessment three years after the baseline assessment, 17.6% of people self-reported an episode of emergency care (attended an ED of called an emergency ambulance) in the last 12 months. Use of emergency healthcare was similar for men and women (17.8% vs. 17.4% p = 0.61). A score above the cut-off on the CESD at baseline was associated with greater use of emergency health care (OR = 1.35, 95% CI 1.11,1.64). When modelled separately, there was a greater association between a score above the cut-off on the CESD and emergency healthcare for women compared with men. CONCLUSIONS This study is unique in demonstrating how depressive symptoms among healthy older persons are associated with subsequent increased use of emergency healthcare. Improved understanding and monitoring of mental health in primary care is essential to undertake effective healthcare planning including prevention of needing emergency care.
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Affiliation(s)
- Rosamond Dwyer
- School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
- Emergency Department, Peninsula Health, Frankston, VIC, Australia.
- National Centre for Healthy Ageing, Melbourne, Australia.
| | - Kim Jachno
- School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Thach Tran
- School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Global and Women's Health Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Natasha Layton
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Taya Collyer
- Academic Unit, Peninsula Clinical School, Central Clinical School, Peninsula Health, Monash University, Melbourne, VIC, Australia
| | - Maggie Kirkman
- School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Global and Women's Health Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Judy Lowthian
- School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Bolton Clarke Research Institute, Forrest Hill, VIC, Australia
| | - Karin Hammarberg
- School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Global and Women's Health Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Michael Berk
- The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, IMPACT, Deakin University, Geelong, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
- Orygen The National Centre of Excellence in Youth Mental Health, Parkville, Australia
| | - Jane Fisher
- School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Global and Women's Health Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Martins MV, Koert E, Sylvest R, Maeda E, Moura-Ramos M, Hammarberg K, Harper J. Fertility education: recommendations for developing and implementing tools to improve fertility literacy†. Hum Reprod 2024; 39:293-302. [PMID: 38088127 PMCID: PMC10833069 DOI: 10.1093/humrep/dead253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 10/05/2023] [Indexed: 02/02/2024] Open
Abstract
Many recent societal trends have led to the need for fertility education, including the age at which individuals become parents, the development of new reproductive technologies, and family diversity. Fertility awareness has emerged as a concept very recently and is increasingly gaining recognition. However, fertility education is often neglected as there is no consensus on the appropriate content, target populations, or on who should provide it. This article attempts to provide an overview of the use of interventions to improve fertility education. We emphasize the importance of delivering evidence-based information on fertility and reproductive health through various methods while providing guidelines for their standardization and systematization. Recommendations are provided to aid the development and implementation of fertility education tools, including: the establishment of a comprehensive understanding of the target populations; the incorporation of theories of behavioural change; the inclusion of the users' perspectives and the use of participatory research; and the use of specific guidelines for increasing engagement. By following these recommendations, it is expected that fertility education resources can contribute to improving fertility literacy, empowering individuals and couples to make informed reproductive decisions, and ultimately reducing the incidence of infertility and need for fertility treatment.
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Affiliation(s)
- Mariana V Martins
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- Centre for Psychology at University of Porto, Porto, Portugal
| | - Emily Koert
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Randi Sylvest
- The Fertility Department, University hospital Rigshospitalet, Copenhagen, Denmark
| | - Eri Maeda
- Department of Public Health, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Mariana Moura-Ramos
- Clinical Psychology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Center for Research in Neuropsychology and Cognitive and Behavioural Intervention, University of Coimbra, Coimbra, Portugal
| | - Karin Hammarberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Victorian Assisted Reproductive Treatment Authority, Melbourne, Australia
| | - Joyce Harper
- EGA Institute for Women’s Health, University College London, London, UK
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Gallagher S, Attinger S, Sassano A, Sutton E, Kerridge I, Newson A, Farsides B, Hammarberg K, Hart R, Jackson E, Ledger W, Mayes C, Mills C, Norcross S, Norman RJ, Rombauts L, Waldby C, Yazdani A, Lipworth W. Medicine in the marketplace: clinician and patient views on commercial influences on assisted reproductive technology. Reprod Biomed Online 2024; 48:103850. [PMID: 38582042 DOI: 10.1016/j.rbmo.2024.103850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 01/15/2024] [Accepted: 01/20/2024] [Indexed: 04/08/2024]
Abstract
RESEARCH QUESTION What are the views and experiences of patient and expert stakeholders on the positive and negative impacts of commercial influences on the provision of assisted reproductive technology (ART) services, and what are their suggestions for governance reforms? DESIGN Semi-structured interviews were conducted with 31 ART industry experts from across Australia and New Zealand and 25 patients undergoing ART from metropolitan and regional Australia, between September 2020 and September 2021. Data were analysed using thematic analysis. RESULTS Expert and patient participants considered that commercial forces influence the provision of ART in a number of positive ways - increasing sustainability, ensuring consistency in standards and providing patients with greater choice. Participants also considered commercial forces to have a number of negative impacts, including increased costs to government and patients; the excessive use of interventions that lack sufficient evidence to be considered part of standard care; inadequately informed consent (particularly with regard to financial information); and threats to patient-provider relationships and patient-centred care. Participants varied in whether they believed that professional self-regulation is sufficient. While recognizing the benefits of commercial investment in healthcare, many considered that regulatory reforms, as well as organizational cultural initiatives, are needed as means to ensure the primacy of patient well-being. CONCLUSIONS The views expressed in this study should be systematically and critically examined to derive insights into how best to govern ART. These insights may also inform the design and delivery of other types of healthcare that are provided in the private sector.
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Affiliation(s)
- Siun Gallagher
- Sydney Health Ethics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Sara Attinger
- Sydney Health Ethics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Elizabeth Sutton
- Monash Bioethics Centre, School of Philosophical, Historical and International Studies, Monash University, Clayton, Victoria, Australia
| | - Ian Kerridge
- Sydney Health Ethics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Haematology Department, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Ainsley Newson
- Sydney Health Ethics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Bobbie Farsides
- Brighton and Sussex Medical School, University of Sussex, Brighton, East Sussex, UK
| | - Karin Hammarberg
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Roger Hart
- Obstetrics and Gynaecology, UWA Medical School, University of Western Australia, Perth, Western Australia, Australia
| | | | - William Ledger
- School of Women's and Children's Health, University of New South Wales, Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Christopher Mayes
- Alfred Deakin Institute of Citizenship and Globalisation, Deakin University, Waurn Ponds, Victoria, Australia
| | - Catherine Mills
- Monash Bioethics Centre, School of Philosophical, Historical and International Studies, Monash University, Clayton, Victoria, Australia
| | | | - Robert J Norman
- The Robinson Research Institute, School of Biomedicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Luk Rombauts
- Department of Obstetrics and Gynaecology, Monash University Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Catherine Waldby
- Research School of Social Sciences, ANU College of Arts and Social Sciences, Canberra, Australian Capital Territory, Australia
| | - Anusch Yazdani
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Wendy Lipworth
- Department of Philosophy, Macquarie University, Sydney, New South Wales, Australia
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Davison N, Stanzel K, Hammarberg K. The Impact of Social Determinants of Health on Australian Women's Capacity to Access and Understand Health Information: A Secondary Analysis of the 2022 National Women's Health Survey. Healthcare (Basel) 2024; 12:207. [PMID: 38255095 PMCID: PMC10815356 DOI: 10.3390/healthcare12020207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
The ability to access, understand, judge, and use health information is crucial for making informed decisions about health and optimal health outcomes. This secondary data analysis investigated associations between social determinants of health and Australian women's ability to access and understand health information using data from 10,652 women who responded to the 2022 National Women's Health Survey. A score (0-5) was created based on five questions assessing the participants' ability to access and understand health information, which was dichotomised into low (≤3) and high (≥4) scores. The data were analyzed using descriptive statistics, univariate comparisons, and multivariable binary logistic regression. Almost a quarter of the women had a low score. Non-native English speakers were approximately four times more likely to have low health literacy than native English speakers. Additionally, women without tertiary education, financially disadvantaged women, and First Nations women were almost twice as likely to have lower health literacy than other women. These findings suggest that social determinants of health decrease the capacity to access and understand health information. To reduce health inequalities, healthcare systems and health professionals must consider the factors that reduce women's capacity to access and understand health information and address the health information needs of socioeconomically disadvantaged women.
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Affiliation(s)
| | - Karin Stanzel
- Global and Women’s Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (N.D.); (K.H.)
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Copp T, Thompson R, Hammarberg K, Lensen S, Augustine L, Doust J, Peate M, Cvejic E, Mol BW, Lieberman D, McCaffery KJ. Attitudes, knowledge and practice regarding the anti-müllerian hormone test among general practitioners and reproductive specialists: A cross-sectional study. BJOG 2024. [PMID: 38196321 DOI: 10.1111/1471-0528.17741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/14/2023] [Accepted: 12/10/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE To describe clinicians' attitudes, knowledge and practice relating to the anti-müllerian hormone (AMH) test. DESIGN Cross-sectional nationwide survey. SETTING Australia. POPULATION OR SAMPLE A total of 362 general practitioners (GPs), gynaecologists and reproductive specialists. METHODS Clinicians were recruited through relevant professional organisations, with data collected from May 2021 to April 2022. MAIN OUTCOME MEASURES Clinicians' attitudes, knowledge and practice relating to the AMH test, measured using multiple choice, Likert scales and open-ended items. RESULTS Fifteen percent of GPs (n = 27) and 40% of gynaecologists and other specialists (n = 73) order at least one AMH test per month. Specialists reported raising the idea of testing most of the time, whereas GPs reported that patient request was more common. Half of clinicians lacked confidence interpreting (n = 182, 51%) and explaining (n = 173, 48%) an AMH result to their patients. Five percent (n = 19) believed the test was moderately/very useful in predicting natural conception/birth and 22% (n = 82) believed the same for predicting premature menopause, despite evidence that the test cannot reliably predict either. Forty percent (n = 144) had previously ordered the test to help with reproductive planning and 21% (n = 75) to provide reassurance about fertility. CONCLUSIONS Clinicians reported use of AMH testing in clinical circumstances not supported by the evidence. With the proliferation of direct-to-consumer testing, efforts to support clinicians in the judicious use of testing and effectively navigating patient requests are needed.
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Affiliation(s)
- Tessa Copp
- Sydney Health Literacy Lab, Faculty of Medicine and Health, School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Rachel Thompson
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Camperdown, New South Wales, Australia
| | - Karin Hammarberg
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Sarah Lensen
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Lidiya Augustine
- Sydney Health Literacy Lab, Faculty of Medicine and Health, School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Jenny Doust
- Australian Women and Girls' Health Research Centre, School of Public Health, The University of Queensland, St Lucia, Queensland, Australia
| | - Michelle Peate
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Erin Cvejic
- Sydney Health Literacy Lab, Faculty of Medicine and Health, School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Aberdeen Centre for Women's Health Research, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Devora Lieberman
- City Fertility Centre Pty Ltd, Sydney, New South Wales, Australia
| | - Kirsten J McCaffery
- Sydney Health Literacy Lab, Faculty of Medicine and Health, School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
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McMahon C, Hammarberg K, Lensen S, Wang R, Mol BW, Vollenhoven BJN. What do women undergoing in vitro fertilization (IVF) understand about their chance of IVF success? Hum Reprod 2024; 39:130-138. [PMID: 37976406 PMCID: PMC10767958 DOI: 10.1093/humrep/dead239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 09/19/2023] [Indexed: 11/19/2023] Open
Abstract
STUDY QUESTION How well informed are Australian women who undergo IVF about their chances of having a baby? SUMMARY ANSWER Only one in four women estimated their individual chance of success with IVF accurately, with most women overestimating their chance. WHAT IS KNOWN ALREADY Limited knowledge about infertility and infertility treatment in the general population is well-documented. The few studies that have investigated patients' knowledge about the chance of IVF success suggest that while IVF patients are aware of average success rates, they tend to be unrealistic about their own chance of success. STUDY DESIGN, SIZE, DURATION We conducted an anonymous online survey of 217 women who had started IVF since 2018 in Australia. The survey was advertised on social media, enabling women from across Australia to participate. Responses were collected in June 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS The survey included questions on demographic characteristics and IVF history. It asked what participants thought their chance of having a baby from one IVF treatment cycle was, how they rated their knowledge about chance of success, and about their experience of receiving IVF-related information. Participants' estimations of their chance of success were compared with their chance as calculated by the Society for Assisted Reproductive Technology's (SART) online calculator. Responses to a free-text question about what information women wished they had been given when they started treatment were analysed thematically. MAIN RESULTS AND THE ROLE OF CHANCE Only about a quarter (58/217, 27%) of participants accurately estimated their chance of having a baby within 20% relative to their SART calculated chance, with more than half (118/217, 54%) overestimating their chance. Ninety percent of women indicated that their preferred source of treatment information was a consultation with their doctor, despite less than half (44%) reporting that doctors explained the probability of having a baby with IVF well (mean 5.9/10). In free-text responses, many women also reported that they wished they had been given more realistic information about IVF and their chance of success. LIMITATIONS, REASONS FOR CAUTION The dissemination method precludes calculation of response rate, and it is not possible to know if participants are representative of all women undergoing IVF. Additionally, we only surveyed women undergoing IVF, while those who decided not to have IVF were not included. Therefore, women who overestimated their chance may have been overrepresented. There is also inherent imprecision in the way understanding of chance of success was estimated. The potential impact of recall bias could neither be quantified nor excluded. It is difficult to determine to what extent women's lack of understanding of what is possible with IVF is due to poor information-provision by clinicians and the clinic, and how much can be explained by optimism bias. WIDER IMPLICATIONS OF THE FINDINGS The finding of poor understanding of personal chance of success amongst women undergoing IVF in Australia requires further investigation to determine potential reasons for this. The findings can be used by clinics to develop strategies for improvement in the information-provision process to ensure that women can make informed decisions about their fertility treatment. STUDY FUNDING/COMPETING INTEREST(S) This study received no external funding. S.L. is supported by a NHMRC Investigator Grant (APP1195189). R.W. is supported by a NHMRC Investigator Grant (APP2009767). B.W.M. is supported by a NHMRC Investigator Grant (GNT1176437). B.W.M. reports consultancy for Merck and ObsEva and has received research funding and travel funding from Merck. The other authors have no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- C McMahon
- Department of Obstetrics & Gynaecology, Monash University, Melbourne, VIC, Australia
| | - K Hammarberg
- School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
- Victorian Assisted Reproductive Treatment Authority (VARTA), Melbourne, VIC, Australia
| | - S Lensen
- Department of Obstetrics and Gynaecology, Royal Women’s Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - R Wang
- Department of Obstetrics & Gynaecology, Monash University, Melbourne, VIC, Australia
| | - B W Mol
- Department of Obstetrics & Gynaecology, Monash University, Melbourne, VIC, Australia
- Aberdeen Centre for Women’s Health Research, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
- Women’s and Newborn Program, Monash Health, Melbourne, VIC, Australia
| | - B J N Vollenhoven
- Department of Obstetrics & Gynaecology, Monash University, Melbourne, VIC, Australia
- Women’s and Newborn Program, Monash Health, Melbourne, VIC, Australia
- Monash IVF, Melbourne, VIC, Australia
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9
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Hammarberg K, Halliday J, Kennedy J, Burgner DP, Amor DJ, Doyle LW, Juonala M, Ranganathan S, Welsh L, Cheung M, McLachlan R, McBain J, Lewis S. Does being conceived by assisted reproductive technology influence adult quality of life? HUM FERTIL 2023; 26:1008-1014. [PMID: 35317704 DOI: 10.1080/14647273.2022.2042860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/08/2021] [Indexed: 11/04/2022]
Abstract
Numerous studies have investigated the physical health and development of children and adolescents conceived with assisted reproductive technology (ART). Less is known about the quality of life of ART-conceived adults. This study explores the contributions of being conceived with ART and psychosocial cofactors present in young adulthood to the quality of life of adults aged 22-35 years. Young adults conceived through ART or natural conception (NC) completed questionnaires which included a standardized measure of quality of life (World Health Organization Quality of Life - Brief assessment (WHOQoL-BREF)) when aged 18-28 years (T1) and again when aged 22-35 years (T2). The WHOQoL-BREF has four domains: (i) Physical, (ii) Psychological, (iii) Social relationships and (iv) Environment. A total of 193 ART-conceived and 86 NC individuals completed both questionnaires. When accounting for other cofactors in multivariable analyses, being ART-conceived was strongly associated with higher scores (better quality of life) on the Social relationships, and Environment WHOQoL-BREF domains at T2. In addition, less psychological distress, a better relationship with parents, a better financial situation, and perceptions of being about the right weight at T1 were associated with higher scores on one or more of the WHOQoL-BREF domains at T2. In conclusion, being ART-conceived can confer advantages in quality of life in adulthood, independent of psychosocial cofactors.
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Affiliation(s)
- Karin Hammarberg
- Global and Women's Health, Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Victorian Assisted Reproductive Treatment Authority, Melbourne, Australia
| | - Jane Halliday
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Joanne Kennedy
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - David P Burgner
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - David J Amor
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Lex W Doyle
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, University of Melbourne, Parkville, Australia
| | - Markus Juonala
- Department of Internal Medicine, University of Turku, Turku, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
| | - Sarath Ranganathan
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Liam Welsh
- Murdoch Children's Research Institute, Parkville, Australia
| | - Michael Cheung
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Robert McLachlan
- Monash IVF Group Pty Ltd, Richmond, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | | | - Sharon Lewis
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
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10
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Kneebone E, Hammarberg K, Everingham S, Beilby K. Australian intended parents' decision-making and characteristics and outcomes of surrogacy arrangements completed in Australia and overseas. HUM FERTIL 2023; 26:1448-1458. [PMID: 37937822 DOI: 10.1080/14647273.2023.2270157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 09/10/2023] [Indexed: 11/09/2023]
Abstract
Markets for international surrogacy often arise in jurisdictions with limited regulations regarding assisted reproductive technologies. In some countries, like Australia, regulated domestic surrogacy services are often sidestepped for international providers. This study describes how Australian intended parents decide where to pursue surrogacy and compares the characteristics and outcomes of arrangements completed within and outside of Australia. The findings show that, although intended parents preferred undergoing surrogacy in Australia, perceiving the process as too long and complicated was a common reason to pursue an international arrangement. Multiple embryo transfer, anonymous gamete donation, and a lack of counselling were common in international surrogacy arrangements. When compared to surrogacy arrangements completed in Australia, where single embryo transfer is mandatory for surrogacy cycles, the rates of multiple birth, preterm birth and neonatal intensive care in international surrogacy were higher. These findings raise concerns about the health and welfare of international surrogacy participants, particularly the surrogates and children. In lieu of any international instrument regulating surrogacy, improving access to surrogacy at a domestic level would reduce the number of people engaging with international arrangements and in turn, reduce the potential for harm.
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Affiliation(s)
- Ezra Kneebone
- Education Program in Reproduction and Development, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Karin Hammarberg
- Global and Women's Health, School of Public and Health and Preventative Medicine, Monash University, Melbourne, Australia
| | | | - Kiri Beilby
- Education Program in Reproduction and Development, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Melbourne, Australia
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11
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Davidson N, Hammarberg K, Fisher J. Ethical Considerations in Research With People From Refugee and Asylum Seeker Backgrounds: A Systematic Review of National and International Ethics Guidelines. J Bioeth Inq 2023:10.1007/s11673-023-10297-w. [PMID: 37889418 DOI: 10.1007/s11673-023-10297-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 08/03/2023] [Indexed: 10/28/2023]
Abstract
Refugees and asylum seekers may experience challenges related to pre-arrival experiences, structural disadvantage after migration and during resettlement requiring the need for special protection when participating in research. The aim was to review if and how people with refugee and asylum seeker backgrounds have had their need for special protection addressed in national and international research ethics guidelines. A systematic search of grey literature was undertaken. The search yielded 2187 documents of which fourteen met the inclusion criteria. Few guidelines addressed specific ethical considerations for vulnerable groups much less people with refugee and asylum seeker backgrounds. One guideline explicitly addressed vulnerability for refugees and asylums seekers. To ensure members of ethics committees and researchers consider the potential challenges of conducting research with these groups, guidelines may need to be supplemented with a refugee and asylum seeker specific research ethics framework. Such a framework may be necessary to optimally protect people with refugee and asylum seeker backgrounds in research.
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Affiliation(s)
- Natasha Davidson
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia.
| | - Karin Hammarberg
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - Jane Fisher
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia
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12
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Biggs SN, Halliday J, Hammarberg K. Psychological consequences of a diagnosis of infertility in men: a systematic analysis. Asian J Androl 2023; 26:00129336-990000000-00121. [PMID: 37695221 PMCID: PMC10846829 DOI: 10.4103/aja202334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/28/2023] [Indexed: 09/12/2023] Open
Abstract
Almost half of infertility cases involve male infertility. Understanding the consequence of a diagnosis of male infertility, as a sole or partial contributor to the couples' infertility, to the mental health of men is required to ensure clinical care meets their psychological needs. The aim of this systematic analysis was to synthesize the evidence regarding whether men diagnosed with male factor infertility experience greater psychological distress than (1) men described as fertile and (2) men in couples with other infertility diagnoses. Online databases were searched using a combination of Medical Subject Headings (MeSH) headings and keywords relating to male infertility and psychological distress. The search yielded 1016 unique publications, of which 23 were included: 8 case-control, 14 prospective cohort, and 1 data linkage studies. Seven aspects of psychological distress were identified depression, anxiety, self-esteem, quality of life, fertility-related stress, general psychological stress or well-being, and psychiatric conditions. Case-control studies reported that men with male factor infertility have more symptoms of depression, anxiety and general psychological distress, worse quality of some aspects of life, and lower self-esteem than controls. When men with male factor infertility were compared to men in couples with other causes of infertility, there were few differences in the assessed aspects of psychological distress. Despite methodological limitations within the studies, this systematic analysis suggests that the experience of infertility, irrespective of its cause, negatively affects men's mental health and demonstrates the need for assisted reproduction technology (ART) providers to consider men undergoing assisted reproduction as individuals with their own unique support needs.
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Affiliation(s)
- Sarah N Biggs
- Reproductive Epidemiology, Murdoch Children’s Research Institute, Melbourne 3052, Australia
| | - Jane Halliday
- Reproductive Epidemiology, Murdoch Children’s Research Institute, Melbourne 3052, Australia
- Department of Paediatrics, University of Melbourne, Melbourne 3052, Australia
| | - Karin Hammarberg
- Public Health and Preventative Medicine, Monash University, Melbourne 3004, Australia
- Victorian Assisted Reproductive Treatment Authority, Melbourne 3000, Australia
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13
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Johnson A, Thompson R, Nickel B, Shih P, Hammarberg K, Copp T. Websites Selling Direct-to-Consumer Anti-Mullerian Hormone Tests. JAMA Netw Open 2023; 6:e2330192. [PMID: 37603332 PMCID: PMC10442712 DOI: 10.1001/jamanetworkopen.2023.30192] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/14/2023] [Indexed: 08/22/2023] Open
Abstract
Importance The recent provision of direct-to-consumer (DTC) Anti-Mullerian Hormone (AMH) testing in several countries has been contentious, particularly due to concerns about judicious testing and informed consent. Objective To describe and analyze information on websites that sell DTC AMH tests. Design, Setting, and Participants Qualitative study including content analysis of text information from websites in multiple countries that sell AMH tests DTC. The top 50 search results from 4 different internet search strings were captured and reviewed for eligibility. Data were extracted in March 2022 and analyzed from April 2022 to July 2023. Main outcomes and measures Themes and categories were derived from the website content using a conventional inductive approach, with a particular focus on information content, quality and accuracy, as well as the tone and language used. Results Twenty-seven websites across 7 different countries formed the sample for analysis. Information varied considerably across websites and was organized into 6 overarching categories: (1) whether a test description was included (25 websites [93%]); (2) statements about what the test can do, which included indicating ovarian reserve (26 websites [96%]) and indicating likelihood of conceiving (20 websites [74%]); (3) statements about the usefulness of the test result, which included enabling women to adjust their reproductive timeline (11 websites [41%]) and determining whether egg freezing was a viable option (8 websites [30%]); (4) blood collection method (ie, through a laboratory or an at-home sample); (5) promotion tactics, such as stating the convenience of testing (24 websites [89%]) and using language promoting empowerment and control (7 websites [26%]); and (6) statements about limitations of the test, which included polycystic ovary syndrome falsely inflating AMH levels (13 websites [48%]) and that it cannot accurately predict chances of conceiving (9 websites [33%]). Conclusion and relevance In this qualitative study including content analysis, most websites selling DTC AMH tests included false and misleading claims which might lead consumers to purchase an AMH test in the belief that it can reliably predict fertility potential and age of menopause. Depending on the test result, this may in turn lead to misplaced anxiety or reassurance about one's fertility and modifications to subsequent conception or contraceptive plans and behavior.
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Affiliation(s)
- Alexis Johnson
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachel Thompson
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Brooke Nickel
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Patti Shih
- Faculty of Arts, Social Sciences and Humanities, School of Health and Society, Australian Centre for Health Engagement, Evidence and Values, University of Wollongong, Wollongong, New South Wales, Australia
| | - Karin Hammarberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tessa Copp
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Sarwari M, Beilby K, Hammarberg K, Hickey M, Lensen S. Endometrial scratching in Australia, New Zealand and the United Kingdom (UK): a follow-up survey. HUM FERTIL 2023; 26:599-604. [PMID: 34905720 DOI: 10.1080/14647273.2021.1995902] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 08/30/2021] [Indexed: 10/19/2022]
Abstract
Endometrial scratching is a common IVF add-on. In 2015, a survey in Australia, New Zealand and the United Kingdom (UK) reported that 83% of fertility specialists recommended endometrial scratching for IVF. Several large trials have since been published reporting no clear evidence for improved live birth rates following endometrial scratching before IVF. An online survey was undertaken to ascertain the current practices and views across Australia, New Zealand, and the UK. A total of 121 eligible responses were received between October and December 2020 (fertility specialists (n = 61), embryologists (n = 26) and fertility nurses (n = 24)). Among fertility specialists, 34% currently offer endometrial scratching, mostly in the case of recurrent implantation failure. Most respondents were neutral or did not believe endometrial scratching improved pregnancy and live birth rates (>90%), except for in women with recurrent implantation failure (29% believed it can increase pregnancy and live birth rates in this group). More than half of respondents viewed reducing psychological distress as a benefit of endometrial scratching (55%). Among fertility specialists not offering endometrial scratching, 51% previously offered it but no longer do. The decline in use over the last five years likely reflects a response to recent evidence reporting no benefit from the procedure.
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Affiliation(s)
- Madina Sarwari
- Department of Obstetrics & Gynaecology, Monash University, Melbourne, Australia
| | - Kiri Beilby
- Department of Obstetrics & Gynaecology, Monash University, Melbourne, Australia
| | - Karin Hammarberg
- Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Sarah Lensen
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
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15
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Copp T, Thompson R, Doust J, Hammarberg K, Peate M, Lensen S, Cvejic E, Lieberman D, Mol BW, McCaffery KJ. Community awareness and use of anti-Müllerian hormone testing in Australia: a population survey of women. Hum Reprod 2023:7193900. [PMID: 37309652 PMCID: PMC10391311 DOI: 10.1093/humrep/dead111] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/04/2023] [Indexed: 06/14/2023] Open
Abstract
STUDY QUESTION What is the anti-Mullerian hormone (AMH) test usage, awareness, and perceived reasons for testing in a representative community sample of women in Australia? SUMMARY ANSWER : Among women aged 18-55 years, 13% had heard about AMH testing and 7% had had an AMH test, with the top three reasons for testing including due to infertility investigations (51%), considering pregnancy and wanting to understand their chances (19%) or to find out if a medical condition had affected fertility (11%). WHAT IS KNOWN ALREADY The growing availability of direct-to-consumer AMH testing has raised concerns about overuse, however as most AMH tests are paid for privately by consumers, data on test usage is not publicly available. STUDY DESIGN, SIZE, DURATION National cross-sectional survey of 1773 women, conducted in January 2022. PARTICIPANTS/MATERIALS, SETTING, METHODS Females aged 18-55 years were recruited from the representative 'Life in Australia' probability-based population panel and completed the survey online or by telephone. Main outcome measures included if and how participants had heard about AMH testing, whether they had ever had an AMH test, main reason for testing and test access. MAIN RESULTS AND THE ROLE OF CHANCE Of the 2423 women who were invited 1773 responded (73% response rate). Of these, 229 (13%) had heard about AMH testing and 124 (7%) had had an AMH test. Testing rates were highest among those currently aged 35-39 years (14%) and associated with educational attainment. Almost all accessed the test through their general practitioner or fertility specialist. Reasons for testing were: part of an infertility investigation (51%), considering pregnancy and wanting to understand chances of conceiving (19%), finding out if a medical condition had affected fertility (11%), curiosity (9%), considering egg freezing (5%), and considering delaying pregnancy (2%). LIMITATIONS, REASONS FOR CAUTION Although the sample was large and mostly representative, it was over-represented by people holding a university degree and under-represented by people aged 18-24, however, we used weighted data where possible to account for this. All data were self-reported so there is a risk of recall bias. The number of survey items was also restricted, so the type of counselling women received prior to testing, reasons for declining an AMH test or test timing were not measured. WIDER IMPLICATIONS OF THE FINDINGS Whilst most women reported having an AMH test for appropriate reasons, about one third had it for reasons not supported by evidence. Public and clinician education about the lack of utility of AMH testing for women not undergoing infertility treatment is needed. STUDY FUNDING/COMPETING INTEREST(S) This project was supported by a National Health and Medical Research Council (NHMRC) Centre for Research Excellence grant (1104136) and Program grant (1113532). T.C. is supported by an NHMRC Emerging Leader Research Fellowship (2009419). B.W.M. reports research funding, consultancy and travel support from Merck. D.L. is the Medical Director of City Fertility NSW and reports consultancy for Organon, Ferring, Besins and Merck. The authors have no other competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Tessa Copp
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Rachel Thompson
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Jenny Doust
- Centre of Longitudinal and Life Course Research, School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Karin Hammarberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Michelle Peate
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Sarah Lensen
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Erin Cvejic
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | | | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
- Aberdeen Centre for Women's Health Research, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Kirsten J McCaffery
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, NSW, Australia
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Sandhu S, Hickey M, Braat S, Hammarberg K, Lew R, Fisher J, Ledger W, Peate M. Information and decision support needs: A survey of women interested in receiving planned oocyte cryopreservation information. J Assist Reprod Genet 2023; 40:1265-1280. [PMID: 37058261 PMCID: PMC10101825 DOI: 10.1007/s10815-023-02796-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/03/2023] [Indexed: 04/15/2023] Open
Abstract
PURPOSE Identifying the information and decision support needs of women interested in receiving planned oocyte cryopreservation (POC) information. METHODS An online survey of Australian women, aged 18-45, interested in receiving POC information, proficient in English, with internet access. The survey covered POC information sources, information delivery preferences, POC and age-related infertility knowledge (study-specific scale), Decisional Conflict Scale (DCS), and time spent considering POC. Target sample size (n=120) was determined using a precision-based method. RESULTS Of 332 participants, 249 (75%) had considered POC, whilst 83 (25%) had not. Over half (54%) had searched for POC information. Fertility clinic websites were predominately used (70%). Most (73%) believed women should receive POC information between ages 19-30 years. Preferred information providers were fertility specialists (85%) and primary care physicians (81%). Other methods rated most useful to deliver POC information were online. Mean knowledge score was 8.9/14 (SD:2.3). For participants who had considered POC, mean DCS score was 57.1/100 (SD:27.2) and 78% had high decisional conflict (score >37.5). In regression, lower DCS scores were associated with every 1-point increase in knowledge score (-2.4; 95% CI [-3.9, -0.8]), consulting an IVF specialist (-17.5; [-28.0, -7.1]), and making a POC decision (-18.4; [-27.5, -9.3]). Median time to decision was 24-months (IQR: 12.0-36.0) (n=53). CONCLUSION Women interested in receiving POC information had knowledge gaps, and wanted to be informed about the option by age 30 years from healthcare professionals and online resources. Most women who considered using POC had high decisional conflict indicating a need for decision support.
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Affiliation(s)
- Sherine Sandhu
- Department of Obstetrics & Gynaecology, University of Melbourne, Royal Women's Hospital, Melbourne, Australia.
| | - Martha Hickey
- Department of Obstetrics & Gynaecology, University of Melbourne, Royal Women's Hospital, Melbourne, Australia
| | - Sabine Braat
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- MISCH (Methods and Implementation Support for Clinical and Health) Research Hub, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Karin Hammarberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Victorian Assisted Reproductive Treatment Authority, Melbourne, Australia
| | - Raelia Lew
- Department of Obstetrics & Gynaecology, University of Melbourne, Royal Women's Hospital, Melbourne, Australia
- Reproductive Services Unit, Royal Women's Hospital, Melbourne, Australia
| | - Jane Fisher
- Global and Women's Health Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - William Ledger
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
- Department of Reproductive Medicine, Royal Hospital for Women, Sydney, Australia
| | - Michelle Peate
- Department of Obstetrics & Gynaecology, University of Melbourne, Royal Women's Hospital, Melbourne, Australia
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Sandhu S, Hickey M, Lew R, Hammarberg K, Braat S, Agresta F, Parle A, Allingham C, Peate M. The development and phase 1 evaluation of a Decision Aid for elective egg freezing. BMC Med Inform Decis Mak 2023; 23:83. [PMID: 37147687 PMCID: PMC10161420 DOI: 10.1186/s12911-023-02178-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 04/21/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Elective egg freezing decisions are complex. We developed a Decision Aid for elective egg freezing and conducted a phase 1 study to evaluate its acceptability and utility for decision-making. METHODS The online Decision Aid was developed according to International Patient Decision Aid Standards and evaluated using a pre/post survey design. Twenty-six Australian women aged 18-45 years, interested in receiving elective egg freezing information, proficient in English, and with access to the internet were recruited using social media and university newsletters. Main outcomes were: acceptability of the Decision Aid; feedback on the Decision Aid design and content; concern raised by the Decision Aid, and; utility of the Decision Aid as measured by scores on the Decisional Conflict Scale and on a study-specific scale assessing knowledge about egg freezing and age-related infertility. RESULTS Most participants found the Decision Aid acceptable (23/25), balanced (21/26), useful for explaining their options (23/26), and for reaching a decision (18/26). Almost all reported satisfaction with the Decision Aid (25/26) and the level of guidance it provided (25/26). No participant reported serious concerns about the Decision Aid, and most would recommend it to other women considering elective egg freezing (22/26). Median Decisional Conflict Scale score decreased from 65/100 (Interquartile range: 45-80) pre-Decision Aid to 7.5/100 (Interquartile range: 0-37.5) post-Decision Aid review (p < 0.001). Median knowledge score increased from 8.5/14 (Interquartile range: 7-11) pre-Decision Aid to 11/14 (Interquartile range: 10-12) post-Decision Aid review (p = 0.01). CONCLUSION This elective egg freezing Decision Aid appears acceptable and useful for decision-making. It improved knowledge, reduced decisional conflict and did not raise serious concerns. The Decision Aid will be further evaluated using a prospective randomised control trial. STUDY REGISTRATION ACTRN12618001685202 (retrospectively registered: 12 October 2018).
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Affiliation(s)
- Sherine Sandhu
- Department of Obstetrics & Gynaecology, The University of Melbourne, Royal Women's Hospital, Level 7, Cnr Grattan Street & Flemington Road, Parkville, Melbourne, Australia.
| | - Martha Hickey
- Department of Obstetrics & Gynaecology, The University of Melbourne, Royal Women's Hospital, Level 7, Cnr Grattan Street & Flemington Road, Parkville, Melbourne, Australia
| | - Raelia Lew
- Department of Obstetrics & Gynaecology, The University of Melbourne, Royal Women's Hospital, Level 7, Cnr Grattan Street & Flemington Road, Parkville, Melbourne, Australia
- Reproductive Services Unit, Royal Women's Hospital, Melbourne, Australia
| | - Karin Hammarberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Victorian Assisted Reproductive Treatment Authority, Melbourne, Australia
| | - Sabine Braat
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- MISCH (Methods and Implementation Support for Clinical and Health) Research Hub, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | | | - Anna Parle
- Department of Obstetrics & Gynaecology, The University of Melbourne, Royal Women's Hospital, Level 7, Cnr Grattan Street & Flemington Road, Parkville, Melbourne, Australia
| | - Catherine Allingham
- Department of Obstetrics & Gynaecology, The University of Melbourne, Royal Women's Hospital, Level 7, Cnr Grattan Street & Flemington Road, Parkville, Melbourne, Australia
| | - Michelle Peate
- Department of Obstetrics & Gynaecology, The University of Melbourne, Royal Women's Hospital, Level 7, Cnr Grattan Street & Flemington Road, Parkville, Melbourne, Australia
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18
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Brear MR, Shabangu PN, Hammarberg K, Fisher J. Structural Influences on Consent Decisions in Participatory Health Research in Eswatini. J Empir Res Hum Res Ethics 2023; 18:24-36. [PMID: 36591920 DOI: 10.1177/15562646221147811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Recognition that structural factors influence participation decisions and have potential to coerce participation, emerged relatively recently in research ethics literature. Empirical evidence to elucidate the nature of "structural" coercion and influence is needed to optimise respect for autonomy through voluntary informed consent. We present findings from ethnographic data about community co-researchers' experiences designing and implementing demographic and health survey consent procedures in participatory health research in Eswatini. Informed by Bourdieu's sociological theory of multiple types of capital/power, our findings detail structural influences on research participation decisions, highlight the inherently power-laden dynamics of consent interactions, and suggest that to be optimally ethical, research ethics principles and practices should consider and account for structural power dynamics.
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Affiliation(s)
- Michelle R Brear
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | | | - Karin Hammarberg
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jane Fisher
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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19
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Mertes H, Harper J, Boivin J, Ekstrand Ragnar M, Grace B, Moura-Ramos M, Rautakallio-Hokkanen S, Simopoulou M, Hammarberg K, International Reproductive Health Education Collaboration (IRHEC) OBOT. Stimulating fertility awareness: the importance of getting the language right. Hum Reprod Open 2023; 2023:hoad009. [PMID: 37082102 PMCID: PMC10112336 DOI: 10.1093/hropen/hoad009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 03/08/2023] [Indexed: 04/22/2023] Open
Abstract
While education about fertility is not intrinsically controversial, finding the right language to communicate the topic can be challenging, as there are several risks of unintended negative effects such as dissonance, anxiety, culpability, and stigma due to social norming. In this article, we share some of our learnings from promoting fertility awareness in the hope that they will inspire further debate and research on this topic. Starting from the ethical principles of respect for reproductive autonomy, avoiding harm (in terms of stigma or anxiety) and inclusivity, we have formulated five recommendations: (i) frame fertility awareness messages with (reproductive) autonomy in mind and aim to be inclusive of those who do not represent the traditional nuclear family; (ii) be empathetic and steer clear of blame; (iii) avoid scaremongering and offer a positive angle; (iv) give due consideration to both women and men in fertility health messaging; and (v) tailor the messages to particular contexts and audiences and develop resources in close collaboration with the target groups.
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Affiliation(s)
- H Mertes
- Correspondence address. Department of Philosophy and Moral Sciences, Ghent University, Blandijnberg 2, 9000 Gent, Belgium. E-mail:
| | - J Harper
- EGA Institute for Women’s Health, University College London, London, UK
| | - J Boivin
- Cardiff Fertility Studies Group, School of Psychology, Cardiff University, Cardiff, UK
| | | | - B Grace
- Department of Sexual and Reproductive Health, Faculty of Population Health Sciences, UCL Institute for Women’s Health, University College London, London, UK
| | - M Moura-Ramos
- Centro Hospitalar e Universitário de Coimbra, University of Coimbra, Coimbra, Portugal
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, University of Coimbra, Coimbra, Portugal
| | | | - M Simopoulou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - K Hammarberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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20
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Sullivan E, Safi N, Li Z, Remond M, Chen TYT, Javid N, Dickinson JE, Ives A, Hammarberg K, Anazodo A, Boyle F, Fisher J, Halliday L, Duncombe G, McLintock C, Wang AY, Saunders C. Perinatal outcomes of women with gestational breast cancer in Australia and New Zealand: A prospective population-based study. Birth 2022; 49:763-773. [PMID: 35470904 PMCID: PMC9790712 DOI: 10.1111/birt.12642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 02/22/2022] [Accepted: 04/07/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To determine the epidemiology, clinical management, and outcomes of women with gestational breast cancer (GBC). METHODS A population-based prospective cohort study was conducted in Australia and New Zealand between 2013 and 2014 using the Australasian Maternity Outcomes Surveillance System (AMOSS). Women who gave birth with a primary diagnosis of breast cancer during pregnancy were included. Data were collected on demographic and pregnancy factors, GBC diagnosis, obstetric and cancer management, and perinatal outcomes. The main outcome measures were preterm birth, maternal complications, breastfeeding, and death. RESULTS Forty women with GBC (incidence 7.5/100 000 women giving birth) gave birth to 40 live-born babies. Thirty-three (82.5%) women had breast symptoms at diagnosis. Of 27 women diagnosed before 30 weeks' gestation, 85% had breast surgery and 67% had systemic therapy during pregnancy. In contrast, all 13 women diagnosed from 30 weeks had their cancer management delayed until postdelivery. There were 17 preterm deliveries; 15 were planned. Postpartum complications included the following: hemorrhage (n = 4), laparotomy (n = 1), and thrombocytopenia (n = 1). There was one late maternal death. Eighteen (45.0%) women initiated breastfeeding, including 12 of 23 women who had antenatal breast surgery. There were no perinatal deaths or congenital malformations, but 42.5% of babies were preterm, and 32.5% were admitted for higher-level neonatal care. CONCLUSIONS Gestational breast cancer diagnosed before 30 weeks' gestation was associated with surgical and systemic cancer care during pregnancy and planned preterm birth. In contrast, cancer treatment was deferred to postdelivery for women diagnosed from 30 weeks, reflecting the complexity of managing expectant mothers with GBC in multidisciplinary care settings.
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Affiliation(s)
- Elizabeth Sullivan
- College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Nadom Safi
- College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Zhuoyang Li
- College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Marc Remond
- College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Tina Y. T. Chen
- Faculty of HealthUniversity of Technology SydneySydneyNew South WalesAustralia
| | - Nasrin Javid
- Faculty of HealthUniversity of Technology SydneySydneyNew South WalesAustralia
| | - Jan E. Dickinson
- Faculty of Health and Medical SciencesThe University of Western AustraliaPerthWestern AustraliaAustralia
| | - Angela Ives
- Faculty of Health and Medical Sciences, Medical SchoolThe University of Western AustraliaPerthWestern AustraliaAustralia
| | - Karin Hammarberg
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Antoinette Anazodo
- School of Women and ChildrenUniversity of New South WalesSydneyNew South WalesAustralia
| | - Frances Boyle
- Patricia Ritchie Centre for Cancer Care and ResearchMater Hospital Sydney, and University of SydneySydneyNew South WalesAustralia
| | - Jane Fisher
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Lesley Halliday
- School of Public Health and Community MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Greg Duncombe
- Faculty of Medicine, Centre for Clinical ResearchUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Claire McLintock
- National Women's HealthAuckland City HospitalAucklandNew Zealand
| | - Alex Y. Wang
- Faculty of HealthUniversity of Technology SydneySydneyNew South WalesAustralia
| | - Christobel Saunders
- Faculty of Health and Medical SciencesThe University of Western AustraliaPerthWestern AustraliaAustralia
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21
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Whyte S, Chan HF, Ferguson N, Godwin M, Hammarberg K, Torgler B. Understanding the Reasons Why Men and Women Do Not Donate Gametes. Reprod Sci 2022; 30:1651-1659. [PMID: 36401071 PMCID: PMC10160187 DOI: 10.1007/s43032-022-01112-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/12/2022] [Indexed: 11/19/2022]
Abstract
AbstractThe global under-supply of sperm and oocyte donors is a serious concern for assisted reproductive medicine. Research has explored self-selected populations of gamete donors and their ex-post rationalisations of why they chose to donate. However, such studies may not provide the necessary insight into why the majority of people do not donate. Utilising the unique open form responses of a large sample (n = 1035) of online survey respondents, we examine the reasons participants cite when asked: “Why haven’t you donated your sperm/eggs?.” We categorise these responses into four core themes (conditional willingness, barriers, unconsidered, and conscientious objector) and eleven lower-order themes. We find that, on average, women are more conditionally willing (8.2% difference; p = 0.008) to participate in gamete donation than men. We also find that women are more likely than men to justify their non-donation based on their reproductive history (21.3% difference; p = 0.000) or kin selection and inclusive fitness (5.7% difference; p = 0.008). However, compared to women, men are more likely to validate their non-donation based on sociocultural or social norms (6% difference; p = 0.000) or religion (1.7% difference; p = 0.030). That so many of our study participants report in-principal willingness for future participation in gamete donation speaks to the need for increased research on understanding non-donor population preferences, motivations, and behaviours.
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22
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Brear MR, Shabangu PN, Hammarberg K, Fisher J. Ethical tensions surrounding 'third-party disclosure' by participants: Lessons from participatory health research in Eswatini. Glob Public Health 2022; 17:2617-2629. [PMID: 34569431 DOI: 10.1080/17441692.2021.1983000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Third-party disclosure by participants is inherent to much global health research. It presents ethical tensions with respecting the autonomy and privacy of non-consenting individuals whose data are disclosed but is neglected in ethics guidelines. Our aim was to describe and ethically reflect on, third party disclosure in a community-participatory demographic and health survey (DHS) implemented within participatory health research (PHR) about community-based care of children affected by AIDS in Eswatini. We collected DHS data and analysed it statistically. We studied the PHR process and outcomes ethnographically and analysed the data interpretively, using theories that conceptualise secrecy as relational and power-laden. We found that third parties' data were disclosed by DHS respondents (typically women), including data about health conditions, abuse perpetration and being a caregiving burden. Ethnographic findings suggested that some third parties may not have consented to us collecting their data. However, respecting third parties' autonomy and privacy presents ethical tensions related to silencing survey respondents and impairing knowledge creation. To minimise the ethical tensions surrounding third-party disclosure researchers can analyse risks, benefits and power dynamics and extend their ethical responsibilities to protect participants to also protect non-participants, and from data collection to also include reporting.
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Affiliation(s)
- Michelle R Brear
- Faculty of Medicine, Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Faculty of Humanities, Anthropology and Development Studies, University of Johannesburg, Johannesburg, South Africa
| | | | - Karin Hammarberg
- Faculty of Medicine, Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jane Fisher
- Faculty of Medicine, Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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23
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Boyle JA, Black K, Dorney E, Amor DJ, Brown L, Callander E, Camilleri R, Cheney K, Gordon A, Hammarberg K, Jeyapalan D, Leahy D, Millard J, Mills C, Musgrave L, Norman RJ, O'Brien C, Roach V, Skouteris H, Steel A, Walker S, Walker R. Setting Preconception Care Priorities in Australia Using a Delphi Technique. Semin Reprod Med 2022; 40:214-226. [PMID: 35760312 DOI: 10.1055/s-0042-1749683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Preconception health affects fertility, pregnancy, and future health outcomes but public awareness of this is low. Our aims were to rank priorities for preconception care (PCC), develop strategies to address these priorities, and establish values to guide future work in preconception healthcare in Australia. A Delphi technique involved two rounds of online voting and mid-round workshops. Inputs were a scoping review of PCC guidelines, a priority setting framework and existing networks that focus on health. During July and August, 2021, 23 multidisciplinary experts in PCC or social care, including a consumer advocate, completed the Delphi technique. Ten priority areas were identified, with health behaviors, medical history, weight, and reproductive health ranked most highly. Six strategies were identified. Underpinning values encompassed engagement with stakeholders, a life course view of preconception health, an integrated multi-sectorial approach and a need for large scale collaboration to implement interventions that deliver impact across health care, social care, policy and population health. Priority populations were considered within the social determinants of health. Health behaviors, medical history, weight, and reproductive health were ranked highly as PCC priorities. Key strategies to address priorities should be implemented with consideration of values that improve the preconception health of all Australians.
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Affiliation(s)
- Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University. Clayton, VIC, Australia
| | - Kirsten Black
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Edwina Dorney
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - David J Amor
- Murdoch Children's Research Institute and University of Melbourne Department of Paediatrics, Royal Children's Hospital, Parkville, VIC, Australia
| | - Louise Brown
- Jean Hailes for Women's Health, East Melbourne, VIC, Australia
| | - Emily Callander
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University. Clayton, VIC, Australia
| | - Renea Camilleri
- Jean Hailes for Women's Health, East Melbourne, VIC, Australia
| | - Kate Cheney
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Adrienne Gordon
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Karin Hammarberg
- Global and Women's Health, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Dheepa Jeyapalan
- Victorian Health Promotion Foundation (VicHealth), Melbourne, VIC, Australia
| | - Deana Leahy
- Faculty of Education, Monash University, Clayton, VIC, Australia
| | - Jo Millard
- Australian Primary Health Care Nurses Association (APNA), Melbourne, VIC, Australia
| | - Catherine Mills
- Monash Bioethics Centre, Faculty of Arts, School of Philosophical, Historical and International Studies, Monash University, Clayton, VIC, Australia
| | - Loretta Musgrave
- Centre for Midwifery, Child and Family Health, School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Robert J Norman
- Robinson Research Institute, University of Adelaide, SA, Australia
| | | | - Vijay Roach
- Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Melbourne, VIC, Australia
| | - Helen Skouteris
- Monash Warwick Professor in Health and Social Care Improvement and Implementation Science, Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Amie Steel
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Sue Walker
- Maternal Fetal Medicine, Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Ruth Walker
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University. Clayton, VIC, Australia
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24
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Wessels C, Vollenhoven B, Hammarberg K, Lensen S, Mol B. O-200 Women’s understanding of their personal chance of success with IVF. Hum Reprod 2022. [DOI: 10.1093/humrep/deac105.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
How well informed are Australian women who undergo In Vitro Fertilisation (IVF) about their treatment and their chances of having a baby?
Summary answer
Only one in four women accurately estimated their individual chance of success with IVF and most women overestimated their chance.
What is known already
IVF is the cornerstone of infertility treatment, and high quality, transparent and reliable treatment information is essential for patient-centred care. A recent review into IVF practice in Victoria, Australia has highlighted deficiencies in information-provision. Similar findings have also been reported internationally. An assessment of women’s understanding of various aspects of the treatment is needed to identify information gaps that should be addressed by clinicians. While limited knowledge about infertility and infertility treatment in the general population is well-documented, little is known about the level of knowledge about infertility treatment among women undergoing IVF treatment.
Study design, size, duration
We conducted an anonymous online survey of women who had started IVF since 2018 in Australia. The survey aimed to assess how well-informed women feel about their treatment, and was advertised on social media, enabling women from across Australia to participate. Responses were collected from 3 to 21 June 2021.
Participants/materials, setting, methods
The survey included questions on demographic characteristics and IVF history. It also asked how well-informed participants felt about their treatment, what they thought their chance of having a baby from one IVF treatment cycle was, how they rated their knowledge about chance of success, and about their experience of receiving IVF-related information. Participants’ beliefs about chance of success were compared with their chance as calculated by the Society for Assisted Reproductive Technology’s (SART) online calculator.
Main results and the role of chance
The survey was completed by 225 women. Only about a quarter (25.8%) of participants accurately estimated their chance of success within 20% relative to their SART calculated chance, and more than half (52.4%) overestimated their chance. Among women who rated their understanding of their chance of success as ‘high’ (7-10/10), less than one third (31.6%) accurately estimated their chance of success. Older age and having undergone several cycles were associated with women being more likely to overestimate their chance of success (odds ratios of 3.2 and 2.5, respectively). Ninety percent of women indicated that their preferred source of treatment information was a consultation with their doctor, despite many women reporting that doctors only explained the probability of having a baby with IVF moderately well (mean 5.9/10). Women also reported that they wished they had been given more realistic information about IVF and their chance of success. It is difficult to determine to what extent women’s lack of understanding of what is possible with IVF is due to poor information-provision by clinicians and the clinic, and how much can be explained by optimism bias.
Limitations, reasons for caution
The dissemination method precludes calculation of response rate, and it is not possible to know if participants are representative of all women undergoing IVF. There is inherent imprecision in the way understanding of chance of success was estimated. The potential impact of recall bias could neither be quantified nor excluded.
Wider implications of the findings
The poor understanding of personal chance of success amongst women undergoing IVF in Australia, highlights the need for systematic and evidence-based improvement in the way clinics inform patients about the probability of having a baby with IVF. Further research into how information-provision in IVF can be improved is needed.
Trial registration number
Not applicable
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Affiliation(s)
- C Wessels
- Monash University, Department of Obstetrics and Gynaecology , Melbourne, Australia
| | - B Vollenhoven
- Monash University, Department of Obstetrics and Gynaecology , Melbourne, Australia
| | - K Hammarberg
- Monash University, School of Public Health and Preventive Medicine - Global and Women's Health , Melbourne, Australia
| | - S Lensen
- University of Melbourne, Department of Obstetrics and Gynaecology , Parkville, Australia
| | - B Mol
- Monash University, Department of Obstetrics and Gynaecology , Melbourne, Australia
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25
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De Mouzon J, Harper J, Hammarberg K. O-111 The International Fertility Education Initiative. Hum Reprod 2022. [DOI: 10.1093/humrep/deac105.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Awareness Raising. The International Fertility Education Initiative
Jacques de Mouzon, Joyce Harper, Karin Hammarberg, and the IFEI group
Clearly, from the international reports on Assisted reproductive technology, more and more patients go to be treated by ART everywhere in the World, even in the richest countries where access is not limited by economic constraints. At the same time, there is a large tendency of maternal age increase at conception and birth, whereas it is well known that there is a fertility decline both with women’s and men’s age. It clearly appears that one driver concerns the lack of awareness of people of reproductive age on the factors affecting the chance of conceiving and of getting a healthy baby.
Thus, to improve fertility awareness in the public, a group of 45 specialists in infertility from about twenty countries met in 2020 and decided to launch an initiative, together with patients’ associations, the International Fertility Education initiative (IFEI). The group includes experts of various scientific fields: clinicians, nurses / midwifes, scientists, psychologists, ethicists, public health, patients. The chair is Pr. Joyce Harper, who was at the initiative of this initiative
The IFEI objectives and creation were published in Human Reproduction open in 2021. Objectives include research and actions to improve fertility awareness. The mission can be summarized as follows: To increase fertility awareness using the life course approach, in order to improve reproductive health and facilitate decision-making in family planning among adolescents, people of reproductive age, primary healthcare, education professionals, and policymakers through development, evaluation and dissemination of inclusive educational resources. Four strategic goals have been identified
5 working groups have been designed to cover the mission and strategic goals:
IFEI has regular meetings where each group progresses are discussed. The groups advancements will be presented at the ESHRE annual meeting in Milano, during the special session entitled “Awareness Raising”. In 2021, IFEI has established links with ESHRE, under the umbrella of the special interest group Global and Socio-cultural Aspects of Infertility. In 2022, links are being established also with IFFS and FIGO, to develop a consistent action.
In conclusion, IFEI is rapidly progressing towards its objectives and several countries has already developed specific national action plans that are consistent with the general aim on fertility awareness
Trial registration number
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Affiliation(s)
| | - J Harper
- UCL Institute for Women’s Health, Reproductive Science and Society Group , London, United Kingdom
| | - K Hammarberg
- Monash University, Global and Women's Health Public Health and Preventive Medicine , Melbourne, Australia
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26
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Dorney E, Boyle JA, Walker R, Hammarberg K, Musgrave L, Schoenaker D, Jack B, Black KI. A Systematic Review of Clinical Guidelines for Preconception Care. Semin Reprod Med 2022; 40:157-169. [PMID: 35576970 DOI: 10.1055/s-0042-1748190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Preconception care (PCC) involves a wide-ranging set of interventions to optimize health prior to pregnancy. These interventions seek to enhance conception rates, pregnancy outcomes, childhood health, and the health of future generations. To assist health care providers to exercise high-quality clinical care in this domain, clinical practice guidelines from a range of settings have been published. This systematic review sought to identify existing freely accessible international guidelines, assess these in terms of their quality using the AGREE II tool, and assess the summary recommendations and the evidence level on which they are based. We identified 11 guidelines that focused on PCC. Ten of these were classified as moderate quality (scores ranging from 3.5 to 4.5 out of 7) and only one was classified as very high quality, scoring 6.5. The levels of evidence for recommendations ranged from the lowest possible level of evidence (III) to the highest (I-a): the highest quality evidence available is for folic acid supplementation to reduce risk of neural tube defects and the role of antiviral medication to prevent HIV transmission. This systematic review identified that high-quality guidelines on PCC are lacking and that few domains of PCC recommendations are supported by high-quality evidence.
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Affiliation(s)
- Edwina Dorney
- Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ruth Walker
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Karin Hammarberg
- Global and Women's Health, School of Public Health and Preventative Medicine, Monash University, Victoria, Australia
| | - Loretta Musgrave
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Danielle Schoenaker
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Brian Jack
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Kirsten I Black
- Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
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27
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Stanzel KA, Hammarberg K, Nguyen T, Fisher J. 'They should come forward with the information': menopause-related health literacy and health care experiences among Vietnamese-born women in Melbourne, Australia. Ethn Health 2022; 27:601-616. [PMID: 32228051 DOI: 10.1080/13557858.2020.1740176] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Objectives: Health literacy refers to an individual's capacity to access, understand, evaluate and use health information to make well informed health-related decision to maintain and promote optimal health. Low health literacy is linked with worse health outcomes and is more common in people from socio-economically disadvantaged backgrounds and from culturally and linguistically diverse backgrounds and among people with limited education. Peri-menopausal and postmenopausal health behaviour predicts health in later life. This qualitative study was conducted in Melbourne, Australia. The aim of this study was to explore menopause-related health literacy and experiences with menopause-related health care among Vietnamese-born women who had immigrated to Australia as adults.Design: A qualitative study using semi-structured interviews was conducted with women aged between 45 and 60 years and who were either in the peri or postmenopausal phase. Transcripts were analysed thematically.Results: A total of 12 women were interviewed. Participants viewed menopause as a natural event and obtained most of their menopause-related information from family and friends. Limited English language proficiency affected their capacity to access, understand, evaluate and use menopause-related health information. They identified their Vietnamese speaking General Practitioners (GPs) as a reliable source of health information, but 'shyness' prevented them from asking questions about menopause and they suggested that GPs need to initiate menopause-related health conversations.Conclusion: Low menopause-related health literacy among Vietnamese-born immigrant women may limit their opportunities to access information about and benefit from menopause-related health-promoting behaviours. Access to menopause-related health information in relevant community languages is essential to support immigrant women to make well informed menopause-related health decisions.
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Affiliation(s)
- Karin A Stanzel
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Karin Hammarberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Trang Nguyen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jane Fisher
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Hammarberg K, Stocker R, Romero L, Fisher J. Pregnancy planning health information and service needs of women with chronic non-communicable conditions: a systematic review and narrative synthesis. BMC Pregnancy Childbirth 2022; 22:236. [PMID: 35317730 PMCID: PMC8941766 DOI: 10.1186/s12884-022-04498-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 02/11/2022] [Indexed: 12/18/2022] Open
Abstract
Background Preparing for pregnancy and being in the best possible health before conception improves reproductive outcomes. For women living with a chronic non-communicable disease (NCD), pregnancy planning is essential to allow optimal disease control in preparation for pregnancy. Aim The aim was to review the literature relating to the pregnancy planning health information and service needs of women with NCDs. Method The MEDLINE (Ovid), Embase (Ovid), Emcare (Ovid), PsycINFO (Ovid), CINAHL and Scopus databases were searched. Studies were included if they were published in peer-reviewed English language journals between January 2010 and June 2020 and reported on the pregnancy planning health information and service needs of women with rheumatic diseases, asthma, cystic fibrosis, depression and/or anxiety, type 1 diabetes mellitus, epilepsy, or multiple sclerosis. Risk of bias was assessed using QualSyst. The characteristics of the studies were tabulated and summarised. Key findings of the included studies were analysed thematically using an inductive approach, where the study findings determined the themes. Findings are reported in a narrative synthesis. Results The database searches yielded 8291 results, of which 4304 remained after duplicates were removed. After abstract screening 104 full-text papers were reviewed. Of these 15 met inclusion criteria and were included in analysis. The narrative synthesis of the included studies revealed six themes: ‘Women with chronic conditions have unmet preconception health information needs’, ‘Women with chronic conditions want personalised preconception health information’, ‘Preferred sources of preconception health information’, ‘Learning from the experiences of other women’, ‘Improving preconception health discussions with health care professionals’, and ‘Women want holistic care’. These themes were consistent across all studies, highlighting the similarity of experiences and needs of women with different chronic conditions. Conclusion To improve pregnancy outcomes for women living with NCDs, health care providers need to ask women of reproductive age proactively and routinely about their pregnancy intentions and provide them with personalised advice on how to avoid unplanned pregnancy and be in optimal health when they wish to conceive. PROSPERO registration number CRD42020176308. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04498-1.
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Affiliation(s)
- Karin Hammarberg
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Ruby Stocker
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Lorena Romero
- The Ian Potter Library, The Alfred, Melbourne, Australia
| | - Jane Fisher
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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29
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Hammarberg K, de Silva R. Parenthood aspirations and understanding of factors that affect the chance of achieving them: A population survey. Reprod Biomed Soc Online 2022; 14:265-270. [PMID: 35419498 PMCID: PMC8904178 DOI: 10.1016/j.rbms.2021.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/13/2021] [Accepted: 11/29/2021] [Indexed: 06/14/2023]
Abstract
Most women and men want and expect to have children. Parental age and some health behaviours affect fertility and the chance of conception. The aim of this study was to gauge people's parenthood aspirations and knowledge about the factors that affect their chance of achieving them. Members of an Australian probability-based online panel aged 18-45 years were invited to complete a survey with questions about parenthood goals and knowledge about factors known to affect fertility. Of the 965 eligible people, 716 (74.2%) completed the survey. Only 6% stated that they did not want biological children. Around one in 10 respondents had experienced infertility. Amongst respondents aged 35-45 years, almost one in five (18%) had experienced infertility. Overall, respondents reported high levels of confidence about their understanding of preventative measures associated with safe sex and avoiding unwanted pregnancies. However, confidence in understanding of factors affecting ability to conceive was lower. Almost one-third of respondents believed that female fertility starts to decline between the ages of 35 and 39 years, and another one-third of respondents believed that the decline starts at 40 years of age or later. One in four respondents believed that male fertility starts to decline at 50 years of age or later. Findings suggest that people of reproductive age in Australia have inadequate knowledge about the factors that affect the chance of achieving their parenthood goals. Fertility health education initiatives are needed to allow people to make informed decisions about childbearing, and reduce the risk of unfulfilled parenthood aspirations.
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Affiliation(s)
- Karin Hammarberg
- Victorian Assisted Reproductive Treatment Authority, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Renee de Silva
- Victorian Assisted Reproductive Treatment Authority, Melbourne, Australia
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Moll T, Gerrits T, Hammarberg K, Manderson L, Whittaker A. Reproductive travel to, from and within sub-Saharan Africa: A scoping review. Reprod Biomed Soc Online 2022; 14:271-288. [PMID: 35419496 PMCID: PMC8907603 DOI: 10.1016/j.rbms.2021.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/26/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
Scholarly interest in reproductive travel has increased in recent years, but travel within, to and from the African continent has received much less attention. We reviewed the literature on cross-border reproductive travel to and from countries of sub-Saharan Africa in order to understand the local forms of this trade. Access to fertility care remains deeply stratified, which is an ongoing concern in a region with some of the highest rates of infertility. We found a wide variety of reasons for reproductive travel, including a lack of trusted local clinics. Destinations were chosen for reasons including historical movements for medical treatment broadly, diasporic circulations, pragmatic language reasons, and ties of former colonial relations. We describe the unique tempos of treatment in the region, ranging from some intended parents staying in receiving countries for some years to the short-term contingent support networks that reprotravellers develop during their treatment and travel. Unique to the region is the movement of medical professionals, such as the 'fly-in, fly-out' clinic staff to deliver fertility care. Future research should include practices and movements to presently neglected 'reprohubs', particularly Kenya and Nigeria; the impact of pandemic-related lockdowns and border closures on the movements of intended parents, reproductive assistors and reproductive material; and the impact of low-cost protocols on treatment access within the region. This scoping review provides insight into the relevant work on cross-border reproductive care in sub-Saharan Africa, where a unique combination of access factors, affordability, and sociocultural and geopolitical issues fashion individuals' and couples' cross-border reproductive travel within, to and from Africa.
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Affiliation(s)
- Tessa Moll
- School of Public Health, University of the Witwatersrand, Parktown, South Africa
| | - Trudie Gerrits
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, the Netherlands
| | - Karin Hammarberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Victorian Assisted Reproductive Treatment Authority, Melbourne, VIC, Australia
| | - Lenore Manderson
- School of Public Health, University of the Witwatersrand, Parktown, South Africa
- School of Social Sciences, Faculty of Arts, Monash University, Clayton, Melbourne, VIC, Australia
| | - Andrea Whittaker
- School of Social Sciences, Faculty of Arts, Monash University, Clayton, Melbourne, VIC, Australia
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Davidson N, Hammarberg K, Romero L, Fisher J. Access to preventive sexual and reproductive health care for women from refugee-like backgrounds: a systematic review. BMC Public Health 2022; 22:403. [PMID: 35220955 PMCID: PMC8882295 DOI: 10.1186/s12889-022-12576-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 01/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Globally, the number of forcibly displaced women is growing. Refugee and displaced women have poorer health outcomes compared to migrant and host country populations. Conflict, persecution, violence or natural disasters and under-resourced health systems in their country of origin contribute to displacement experiences of refugee and displaced women. Poor health outcomes are further exacerbated by the migration journey and challenging resettlement in host countries. Preventive sexual and reproductive health (SRH) needs of refugee and displaced women are poorly understood. The aim was to synthesise the evidence about access to preventive SRH care of refugee and displaced women. Methods A systematic review of qualitative, quantitative and mixed methods studies of women aged 18 to 64 years and health care providers' (HCPs’) perspectives on barriers to and enablers of SRH care was undertaken. The search strategy was registered with PROSPERO in advance of the search (ID CRD42020173039). The MEDLINE, PsycINFO, Embase, CINAHL, and Global health databases were searched for peer-reviewed publications published any date up to 30th April 2020. Three authors performed full text screening independently. Publications were reviewed and assessed for quality. Study findings were thematically extracted and reported in a narrative synthesis. Reporting of the review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Results The search yielded 4083 results, of which 28 papers reporting 28 studies met inclusion criteria. Most related to contraception and cervical or breast cancer screening. Three main themes and ten subthemes relating to SRH care access were identified: interpersonal and patient encounter factors (including knowledge, awareness, perceived need for and use of preventive SRH care; language and communication barriers), health system factors (including HCPs discrimination and lack of quality health resources; financial barriers and unmet need; HCP characteristics; health system navigation) and sociocultural factors and the refugee experience (including family influence; religious and cultural factors). Conclusions Implications for clinical practice and policy include giving women the option of seeing women HCPs, increasing the scope of practice for HCPs, ensuring adequate time is available during consultations to listen and develop refugee and displaced women’s trust and confidence, strengthening education for refugee and displaced women unfamiliar with preventive care and refining HCPs’ and interpreters’ cultural competency. More research is needed on HCPs’ views regarding care for refugee and displaced women. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12576-4.
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Bandyopadhyay M, Stanzel K, Hammarberg K, Hickey M, Fisher J. Accessibility of web-based health information for women in midlife from culturally and linguistically diverse backgrounds or with low health literacy. Aust N Z J Public Health 2021; 46:269-274. [PMID: 34939717 DOI: 10.1111/1753-6405.13192] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/01/2021] [Accepted: 11/01/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To measure the accessibility of Australian web-based health information for midlife women including those from culturally and linguistically diverse (CALD) backgrounds or with low health literacy. METHODS Search terms relating to midlife health were entered into Google Australia to identify health information websites. The content of the first two results pages was assessed using the European Commission's quality criteria for health websites. Readability was assessed using the Flesch Readability Ease Score with Grade 8 accepted as the average Australian reading level. RESULTS Sixteen websites were evaluated. Accessibility scores ranged between 0 and 8. The Victorian Government's health website Better Health Channel and the Jean Hailes for Women's Health website contained the most accessible information, each scoring 8, but were both 'difficult to read' on the readability test. Four websites included written resources in languages other than English and two had information in audio-visual format in languages other than English. CONCLUSIONS There is a gap in accessible online health information for Australian women from CALD backgrounds or those with low health literacy. Implications for public health: Healthy behaviour changes in midlife may lead to better health in older age. More accessible health information resources are needed for women in midlife from CALD backgrounds and those with low health literacy.
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Affiliation(s)
- Mridula Bandyopadhyay
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria
| | - Karin Stanzel
- Public Health and Preventive Medicine, Monash University, Victoria
| | - Karin Hammarberg
- Public Health and Preventive Medicine, Monash University, Victoria
| | - Martha Hickey
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria
| | - Jane Fisher
- Public Health and Preventive Medicine, Monash University, Victoria
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Dorney E, Millard J, Hammarberg K, Griffin K, Gordon A, McGeechan K, Black KI. Australian primary health care nurses. Aust J Prim Health 2021; 28:63-68. [PMID: 34847988 DOI: 10.1071/py21104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/12/2021] [Indexed: 11/23/2022]
Abstract
Preconception care (PCC) entails counselling and interventions to optimise health before pregnancy. Barriers to this service delivery include access and time. Primary healthcare nurses (PHCNs) are uniquely placed to deliver PCC. The aim of this study was to understand PHCNs' knowledge, practice and attitudes to PCC. A cross-sectional study was performed of a convenience sample of PHCNs in Australia who were seeing people of reproductive age. Recruitment was via the Australian Primary Health Care Nurses Association (APNA) electronic communication platforms. The 18-item, online, anonymous survey captured demographics, as well as PCC knowledge, practices and attitudes. Descriptive statistics were used to describe our findings. In all, 152 completed surveys were received. Of all respondents, 74% stated they discuss PCC in their practice, although only 13% do so routinely. Of these, more preconception discussions are held with women than with men. In total, 95% of respondents identified at least one barrier to delivery of PCC, with lack of time and knowledge being the most common. The findings of this study can inform targeted strategies, including education programs and resources, and consideration of incentives to support PHCNs deliver PCC. This study identifies areas for improvement at the individual, organisational and health system levels to enhance the role of PHCNs in PCC.
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Affiliation(s)
- E Dorney
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; and Corresponding author
| | - J Millard
- Australian Primary Care Nurses Association, Melbourne, Vic. 3000, Australia
| | - K Hammarberg
- Global and Women's Health and Preventative Medicine, Monash University, Melbourne, Vic. 3004, Australia
| | - K Griffin
- Australian Primary Care Nurses Association, Melbourne, Vic. 3000, Australia
| | - A Gordon
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - K McGeechan
- Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - K I Black
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
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Hammarberg K, Stocker R. Evaluation of an online learning module to improve nurses' and midwives' capacity to promote preconception health in primary healthcare settings. Aust J Prim Health 2021; 27:462-466. [PMID: 34645562 DOI: 10.1071/py21026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/03/2021] [Indexed: 12/19/2022]
Abstract
Optimal parental preconception health improves the likelihood of a successful pregnancy and a healthy child. Although primary healthcare professionals believe that it is within their role to promote preconception health to people of reproductive age, few do this routinely, in part because they lack knowledge on the topic and confidence to discuss it with their patients. The aim of this study was to evaluate the efficacy and acceptability of a free online learning module to assist nurses and midwives in primary health care to promote preconception health in their practice. A repeat online survey was administered before and after completion of the online learning module. The survey included questions gauging knowledge about and attitudes towards promoting preconception health. In all, 121 nurses/midwives completed the two surveys and the learning module. There were statistically significant improvements in the knowledge scores (from 6.42 to 8.31; P < 0.001) and in the proportion of participants who reported feeling confident in their knowledge about preconception health (from 15% to 53%). Almost all (95%) were satisfied with the duration and content of the learning module. The findings of this study suggest that the learning module is acceptable and improves nurses' and midwives' capacity to promote preconception health in their practice.
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Affiliation(s)
- Karin Hammarberg
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, Vic. 3004, Australia; and Victorian Assisted Reproductive Treatment Authority, Level 30, 570 Bourke Street, Melbourne, Vic. 3000, Australia; and Corresponding author.
| | - Ruby Stocker
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, Vic. 3004, Australia
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Harper JC, Hammarberg K, Simopoulou M, Koert E, Pedro J, Massin N, Fincham A, Balen A. The International Fertility Education Initiative: research and action to improve fertility awareness. Hum Reprod Open 2021; 2021:hoab031. [PMID: 34532596 PMCID: PMC8441587 DOI: 10.1093/hropen/hoab031] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/21/2021] [Indexed: 12/16/2022] Open
Affiliation(s)
- Joyce C Harper
- EGA Institute for Women's Health, Reproductive Science and Society Group, University College London, London, UK
| | - Karin Hammarberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Victorian Assisted Reproductive Treatment Authority, Melbourne, VIC, Australia
| | - Mara Simopoulou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Emily Koert
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Juliana Pedro
- Centre for Reproductive Genetics A. Barros, Porto, Portugal.,Centre for Psychology at University of Porto, Porto, Portugal
| | - Nathalie Massin
- Department of Gynecology, Obstetrics and Reproductive Medicine, Intercommunal Hospital, Creteil Cedex, France
| | | | - Adam Balen
- Reproductive Medicine, Leeds Teaching Hospitals, Leeds, UK
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Hammarberg K, Tran T, Kirkman M, Rowe H, Fisher J. Preferred policy options to assist post‐COVID‐19 mental health recovery: A population study. Australian Journal of Public Administration 2021; 80. [PMCID: PMC8652460 DOI: 10.1111/1467-8500.12507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The aim of this study was to gauge the opinions of people in Australia about policies to help them recover from the consequences of COVID‐19 pandemic and its associated restrictions. An anonymous online survey of people aged 18 years and older in Australia was available from 1 July to 31 August 2020. It included 16 proposed policies which respondents rated as ‘Not at all helpful’, ‘Somewhat helpful’, or ‘Very helpful’ in assisting them recover from the COVID‐19 restrictions. In all, 9220 people completed the survey. The most endorsed policy was ‘To have a publicly available plan about management of future pandemics’ which was rated as ‘very helpful’ by 46.1% of respondents. Four other policies were rated as ‘very helpful’ by more than 30% of respondents: two related to mental health support, one to individual financial support for living expenses, and one to support for community organisations. Government preparedness for future pandemics and support for mental health, individual finance, and community organisations should be policy priorities in the post‐COVID‐19 recovery phase. The findings can guide policy development to support people in Australia as they recover from COVID‐19 and the restrictions that have been imposed to control its spread. An anonymous online survey of almost 10,000 people in Australia gauged their preferred policy options to assist post‐COVID‐19 mental health recovery. Government preparedness for future pandemics and support for mental health, individual finance, and community organisations were the most endorsed policy priorities in the post‐COVID‐19 recovery phase.
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Affiliation(s)
- Karin Hammarberg
- Global and Women's Health, School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Thach Tran
- Global and Women's Health, School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Maggie Kirkman
- Global and Women's Health, School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Heather Rowe
- Global and Women's Health, School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Jane Fisher
- Global and Women's Health, School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
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Rowe HJ, Hammarberg K, Dwyer S, Camilleri R, Fisher JR. Improving clinical care for women with endometriosis: qualitative analysis of women's and health professionals' views. J Psychosom Obstet Gynaecol 2021; 42:174-180. [PMID: 31691598 DOI: 10.1080/0167482x.2019.1678022] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Endometriosis is a chronic condition where endometrial-like cells proliferate outside the uterus causing pain and disability. Limited treatments are available but symptom management is essential for social and economic participation. The aim was to compare women's and health professionals' perceptions of quality of endometriosis health care and opportunities for improvements. METHODS Women participated in closed moderated online discussion groups and health professionals in semi-structured telephone interviews. Discussion group text and interview transcripts were thematically analyzed using the Framework Analysis approach. RESULTS Forty-six women, 12 general practitioners (GPs), and 1 gynecologist participated. Endometriosis can have debilitating consequences. However, women reported that healthcare providers may dismiss symptoms, lack essential knowledge and provide inconsistent advice; treatments are seldom successful or without adverse side-effects. Health professionals acknowledged limitations in expertise, persistent myths, and challenges in achieving best practice. Enhancing collaborative care skills, individualized treatment plans, and local referral pathways to multi-disciplinary care may improve satisfaction with endometriosis care-giving and receiving. CONCLUSIONS This is the first comparison of patient and practitioner perceptions of endometriosis in primary healthcare. Models of multi-disciplinary, collaborative care need to be developed and evaluated against consumer-informed measures of women's wellbeing, quality of life and satisfaction with symptom management and health care.
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Affiliation(s)
- Heather J Rowe
- Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Karin Hammarberg
- Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sarah Dwyer
- Jean Hailes Foundation, Melbourne, Australia
| | | | - Jane Rw Fisher
- Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Harper JC, Hammarberg K, Simopoulou M, Koert E, Pedro J, Massin N, Fincham A, Balen A. The International Fertility Education Initiative: research and action to improve fertility awareness. Hum Reprod Open 2021. [PMID: 34532596 DOI: 10.1093/hropen/hoab031/6357711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Joyce C Harper
- EGA Institute for Women's Health, Reproductive Science and Society Group, University College London, London, UK
| | - Karin Hammarberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Victorian Assisted Reproductive Treatment Authority, Melbourne, VIC, Australia
| | - Mara Simopoulou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Emily Koert
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Juliana Pedro
- Centre for Reproductive Genetics A. Barros, Porto, Portugal.,Centre for Psychology at University of Porto, Porto, Portugal
| | - Nathalie Massin
- Department of Gynecology, Obstetrics and Reproductive Medicine, Intercommunal Hospital, Creteil Cedex, France
| | | | - Adam Balen
- Reproductive Medicine, Leeds Teaching Hospitals, Leeds, UK
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Lensen S, Hammarberg K, Polyakov A, Wilkinson J, Whyte S, Peate M, Hickey M. O-215 How common is add-on use and how do patients decide whether to use them? A national survey of IVF patients. Hum Reprod 2021. [DOI: 10.1093/humrep/deab128.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
How common is IVF add-on use in Australia, and what drives the use?
Summary answer
Most women (82%) had used one or more IVF add-ons and more than half (54%) first learned about the add-ons from their fertility specialist.
What is known already
IVF add-ons are procedures, techniques or medicines which may be considered nonessential to IVF, usually used in attempts to improve the probability of conception and live birth. Despite widespread concern about unproven IVF add-ons, information about the prevalence of their use is limited because these data are not available in national registries or datasets.
Study design, size, duration
Women who had undergone IVF in Australia since 2017 were recruited via social media. Women were excluded if they were gestational surrogates, had used a surrogate, or underwent IVF for oocyte donation or elective oocyte cryopreservation only. Eligible women completed an online survey which was open from 21st June to 14th July 2020.
Participants/materials, setting, methods
Survey questions included demographics, IVF and medical history, and questions specifically about IVF add-ons such as: the type of add-ons used, information sources consulted, and where participants first heard about add-ons. Women also responded to questions about the importance of scientific evidence regarding safety and effectiveness, factors considered in decision-making around add-on use and the presence of any decision regret.
Main results and the role of chance
A total of 1,590 responses were analyzed after excluding 287 ineligible responses. Participants were generally representative of women who undergo IVF in Australia in terms of age, indication for IVF, and use of ICSI for fertilisation. Most women had used at least one add-on (82%), and these were usually associated with an additional fee (72%). It was most common to first learn about IVF add-ons from the fertility specialist (54%), and most women reported that they and their specialist contributed equally to the decision to use add-ons.
Women viewed scientific evidence for safety and effectiveness as very important
on a scale from 0-100, an importance score over 90 was selected by more than half of the participants. Additionally, many (49%) assumed that add-ons were risk-free. Most women experienced regret at the decision to use IVF add-ons (66%), and this regret was greatest among women who experienced IVF failure when using add-ons (83%) and those who believed that the specialist drove the decision to use the add-ons (75%).
Limitations, reasons for caution
This was a retrospective survey of IVF patients, therefore it may suffer from bias due to patient recall. It does not consider the perspective of the IVF clinic or fertility specialist. Certain questions may be more prone to biased responses, such as those regarding who contributed to decision making.
Wider implications of the findings
The high prevalence of add-on use is likely generalizable to other settings where IVF treatment is largely private. Although women viewed scientific evidence as very important, most had used unproven IVF add-ons. This might suggest that women were not aware of the lack of robust evidence to support their use.
Trial registration number
Not applicable
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Affiliation(s)
- S Lensen
- University of Melbourne, Obstetrics and Gynaecology, Parkville, Australia
| | - K Hammarberg
- Victorian Assisted Reproductive Treatment Authority, Research, Melbourne, Australia
| | - A Polyakov
- Melbourne IVF, Melbourne IVF, Melbourne, Australia
| | - J Wilkinson
- University of Manchester, Centre for Biostatistics- Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - S Whyte
- Queensland University of Technology, School of Economics and Finance, Brisbane, Australia
| | - M Peate
- University of Melbourne, Obstetrics and Gynaecology, Parkville, Australia
| | - M Hickey
- University of Melbourne, Obstetrics and Gynaecology, Parkville, Australia
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Lensen S, Hammarberg K, Polyakov A, Wilkinson J, Whyte S, Peate M, Hickey M. How common is add-on use and how do patients decide whether to use them? A national survey of IVF patients. Hum Reprod 2021; 36:1854-1861. [PMID: 33942073 DOI: 10.1093/humrep/deab098] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/23/2021] [Indexed: 12/17/2022] Open
Abstract
STUDY QUESTION What is the prevalence and pattern of IVF add-on use in Australia? SUMMARY ANSWER Among women having IVF in the last 3 years, 82% had used one or more IVF add-on, most commonly acupuncture, preimplantation genetic testing for aneuploidy and Chinese herbal medicine. WHAT IS KNOWN ALREADY IVF add-ons are procedures, techniques or medicines which may be considered nonessential to IVF, but usually used in attempts to improve the probability of conception and live birth. The use of IVF add-ons is believed to be widespread; however, there is little information about the prevalence and patterns of use in different settings. STUDY DESIGN, SIZE, DURATION An online survey was distributed via social media to women in Australia who had undergone IVF since 2017. Women were excluded if they were gestational surrogates, used a surrogate, or underwent ovarian stimulation for oocyte donation or elective oocyte cryopreservation only. The survey was open from 21 June to 14 July 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS Survey questions included demographics, IVF and medical history, and use of IVF add-ons including details of the type of add-on, costs and information sources used. Participants were also asked about the relative importance of evidence regarding safety and effectiveness, factors considered in decision-making and decision regret. MAIN RESULTS AND THE ROLE OF CHANCE A total of 1590 eligible responses were analysed. Overall, 82% of women had used one or more add-ons and these usually incurred an additional cost (72%). Around half (54%) had learned about add-ons from their fertility specialist, and most reported that the decision to use add-ons was equally shared with the specialist. Women placed a high level of importance on scientific evidence for safety and efficacy, and half (49%) assumed that add-ons were known to be safe. Most women experienced some regret at the decision to use IVF add-ons (66%), and this was more severe among women whose IVF was unsuccessful (83%) and who believed that the specialist had a larger contribution to the decision to use add-ons (75%). LIMITATIONS, REASONS FOR CAUTION This retrospective survey relied on patient recall. Some aspects were particularly prone to bias such as contributions to decision-making. This approach to capturing IVF add-on use may yield different results to data collected directly from IVF clinics or from fertility specialists. WIDER IMPLICATIONS OF THE FINDINGS There is a very high prevalence of IVF add-on use in Australia which may be generalisable to other settings with similar models of IVF provision. Although women placed high importance on scientific evidence to support add-ons, most add-ons do not have robust evidence of safety and effectiveness. This suggests that IVF patients are not adequately informed about the risks and benefits of IVF add-ons, or are not aware of the paucity of evidence to support their use. STUDY FUNDING/COMPETING INTEREST(S) This research was supported by a McKenzie Postdoctoral Fellowship Grant (University of Melbourne), a Department of Obstetrics and Gynaecology Innovation Grant (University of Melbourne) and an NHMRC Investigator Grant (APP1195189). A.P. declares that he provides fertility services at Melbourne IVF (part of Virtus Health). J.W. reports grants from Wellcome Trust, during the conduct of the study, and that publishing benefits his career. The remaining authors report no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- S Lensen
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - K Hammarberg
- Victorian Assisted Reproductive Treatment Authority, Melbourne, VIC, Australia.,Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - A Polyakov
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, VIC, Australia.,Melbourne IVF, Melbourne, VIC, Australia.,Reproductive Biology Unit, Royal Women's Hospital, Flemington, VIC, Australia
| | - J Wilkinson
- Centre for Biostatistics, Manchester Academic Health Science Centre, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, UK
| | - S Whyte
- School of Economics and Finance, Queensland University of Technology (QUT), Brisbane, QLD, Australia.,Centre for Behavioural Economics, Society & Technology (BEST), Queensland University of Technology (QUT), Brisbane, QLD, Australia.,Centre in Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Kelvin Grove, QLD, Australia.,ARC Training Centre for Cell and Tissue Engineering Technologies, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - M Peate
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - M Hickey
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, VIC, Australia
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Copp T, Nickel B, Lensen S, Hammarberg K, Lieberman D, Doust J, Mol BW, McCaffery K. Anti-Mullerian hormone (AMH) test information on Australian and New Zealand fertility clinic websites: a content analysis. BMJ Open 2021; 11:e046927. [PMID: 34233986 PMCID: PMC8264877 DOI: 10.1136/bmjopen-2020-046927] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES The anti-Mullerian hormone (AMH) test has been promoted as a way to inform women about their future fertility. However, data consistently show the test is a poor predictor of natural fertility potential for an individual woman. As fertility centre websites are often a primary source of information for reproductive information, it is essential the information provided is accurate and reflects the available evidence. We aimed to systematically record and categorise information about the AMH test found on Australian and New Zealand fertility clinic websites. DESIGN Content analysis of online written information about the AMH test on fertility clinic websites. SETTING Accredited Australian and New Zealand fertility clinic websites. METHODS Data were extracted between April and June 2020. Any webpage that mentioned the AMH test, including blogs specifically about the AMH test posted since 2015, was analysed and the content categorised. RESULTS Of the 39 active accredited fertility clinics' websites, 25 included information about the AMH test. The amount of information varied widely, and embodied four overarching categories; (1) the utility of the AMH test, (2) who the test is suitable for, (3) possible actions in response to the test and (4) caveats and limitations of the test. Eight specific statements about the utility of the test were identified, many of which are not evidence-based. While some websites were transparent regarding the test's limitations, others mentioned no caveats or included persuasive statements actively promoting the test as empowering for a range of women in different circumstances. CONCLUSIONS Several websites had statements about the utility of the AMH test that are not supported by the evidence. This highlights the need for higher standards for information provided on fertility clinic websites to prevent women being misled to believe the test can reliably predict their fertility.
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Affiliation(s)
- Tessa Copp
- Faculty of Medicine and Health, Wiser Healthcare, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Brooke Nickel
- Faculty of Medicine and Health, Wiser Healthcare, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Lensen
- Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
| | - Karin Hammarberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Victorian Assisted Reproductive Treatment Authority, Melbourne, Victoria, Australia
| | - Devora Lieberman
- City Fertility Centre Pty Ltd, Sydney, New South Wales, Australia
| | - Jenny Doust
- Centre of Longitudinal and Life Course Research, School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Kirsten McCaffery
- Faculty of Medicine and Health, Wiser Healthcare, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Brear MR, Shabangu PN, Hammarberg K, Fisher J. Enhancing demographic survey protocols to characterise household dynamics that influence health - a participatory approach from rural Eswatini. Glob Public Health 2021; 17:1699-1712. [PMID: 34061711 DOI: 10.1080/17441692.2021.1936118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Standard Western demographic survey protocols fail to capture dynamics, such as circular migration and support networks, that profoundly influence the health of non-Western domestic social groups, typically called households. Enhanced protocols are needed because survey data provide the primary evidence base for health policy and planning globally. We present the participatory development, implementation and analysis of a novel demographic survey protocol, that aimed to better capture domestic social dynamics in rural Eswatini, southern Africa. The multiple-method study incorporated participatory health research about a community affected by HIV/AIDS, of which the survey formed part, and an ethnography of the participatory survey development process. Analysis of the data revealed limitations in the reliability and validity of standardised survey questions for measuring household membership, in contexts where circular migration and polygamy are common. Standard survey protocols potentiate double-counting members and misclassifying 'child-headed' and 'female-headed' households. They neglect social and economic dynamics that are known to influence health. Our novel demographic survey protocol provides a simple alternative method for capturing core data about circular migration and its impact on health. The study illustrates the contributions participatory and ethnographic research can make to enhancing demographic surveys.
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Affiliation(s)
- Michelle R Brear
- School of Public Health and Preventive Medicine, Global and Women's Health, Monash University, Melbourne, Australia.,Department of Anthropology and Development Studies, University of Johannesburg, Johannesburg, South Africa.,Afromontane Research Unit, University of the Free State-Qwaqwa, Phuthaditjaba, South Africa
| | | | - Karin Hammarberg
- School of Public Health and Preventive Medicine, Global and Women's Health, Monash University, Melbourne, Australia
| | - Jane Fisher
- School of Public Health and Preventive Medicine, Global and Women's Health, Monash University, Melbourne, Australia
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Juonala M, Lewis S, McLachlan R, Hammarberg K, Kennedy J, Saffery R, McBain J, Welsh L, Cheung M, Doyle LW, Amor DJ, Burgner DP, Halliday J. American Heart Association ideal cardiovascular health score and subclinical atherosclerosis in 22-35-year-old adults conceived with and without assisted reproductive technologies. Hum Reprod 2021; 35:232-239. [PMID: 31834929 DOI: 10.1093/humrep/dez240] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/13/2019] [Accepted: 10/07/2019] [Indexed: 01/21/2023] Open
Abstract
STUDY QUESTION Is ART related with the association of American Heart Association (AHA) ideal cardiovascular health score and markers of subclinical atherosclerosis? SUMMARY ANSWER The associations between AHA score and markers of subclinical atherosclerosis in ART and non-ART groups were similar in magnitude. WHAT IS KNOWN ALREADY Long-term consequences of ART on cardiovascular health are unknown. STUDY DESIGN, SIZE, DURATION The study cohort for the cross-sectional analyses consisted of 172 ART-conceived and 78 non-ART conceived individuals of same age (range 22-35 years). PARTICIPANTS/MATERIALS, SETTING, METHODS Cardiovascular risk factor status was evaluated with American Heart Association (AHA) ideal cardiovascular health score consisting of seven factors (body mass index, blood pressure, total cholesterol, glucose, diet and physical activity, non-smoking). Carotid artery intima-media thickness (cIMT), arterial pulse-wave velocity (PWV) and retinal microvascular parameters were evaluated as markers of early atherosclerosis. Group comparisons in continuous variables were performed with t-tests. For categorical variables, comparisons were performed with chi-square tests. The relationships between AHA score and the markers of atherosclerosis were examined with linear regression analyses adjusted for age and sex. MAIN RESULTS AND THE ROLE OF CHANCE There was no difference in AHA ideal health score between the ART and non-ART groups; mean (SD) scores were 4.1(1.4) versus 4.0(1.5), respectively, P = 0.65. No differences were observed between groups for any individual ideal health metric (P always >0.2). AHA score was not associated with cIMT or retinal measures in either group (P always >0.05). An inverse association was observed between AHA score and PWV in the ART group (beta (95% CI) -0.18(-0.26 to -0.10)). A numerically similar relationship was observed in the smaller non-ART group (-0.19(-0.39 to 0.01)). LIMITATIONS, REASONS FOR CAUTION Even though this cohort is among the largest ART studies with extensive cardiovascular data, the sample is still relatively small and the statistical power is limited. As the study population was still in early adulthood, we were not able to evaluate the associations with clinical cardiovascular events, but utilized non-invasive methods to assess early markers of subclinical atherosclerosis. WIDER IMPLICATIONS OF THE FINDINGS These findings suggest that ART-conceived individuals do not have increased vulnerability for cardiovascular risk factors. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by a National Health & Medical Research Council Project Grant (APP1099641), The Royal Children's Hospital Research Foundation, Monash IVF Research and Education Foundation, and Reproductive Biology Unit Sperm Fund, Melbourne IVF. The authors have no conflicts of interest relevant to this article to disclose.
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Affiliation(s)
- Markus Juonala
- Department of Internal Medicine, University of Turku, Turku, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
- Murdoch Children's Research Institute, Parkville, Australia
| | - Sharon Lewis
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Robert McLachlan
- Hudson Institute of Medical Research, Clayton, Australia
- Monash IVF Group Pty Ltd, Richmond, Australia
- Dept of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Karin Hammarberg
- Global Public Health, Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Victorian Assisted Reproductive Treatment Authority, Melbourne, Australia
| | - Joanne Kennedy
- Murdoch Children's Research Institute, Parkville, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - John McBain
- Reproductive Services, Royal Women's Hospital, Parkville, Australia
| | - Liam Welsh
- Murdoch Children's Research Institute, Parkville, Australia
- Departments of Respiratory Medicine, Cardiology and Infectious Diseases, The Royal Children's Hospital, Parkville, Australia
| | - Michael Cheung
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Departments of Respiratory Medicine, Cardiology and Infectious Diseases, The Royal Children's Hospital, Parkville, Australia
| | - Lex W Doyle
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
- Research Office, The Royal Women's Hospital, Parkville, Australia
| | - David J Amor
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - David P Burgner
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Departments of Respiratory Medicine, Cardiology and Infectious Diseases, The Royal Children's Hospital, Parkville, Australia
| | - Jane Halliday
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
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Pearson L, Holton S, McLachlan R, Hammarberg K. Australian men's fertility information seeking attitudes and behaviour: A qualitative investigation. Sex Reprod Healthc 2021; 29:100621. [PMID: 33894435 DOI: 10.1016/j.srhc.2021.100621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/21/2021] [Accepted: 04/07/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Most women and men want and expect to have children but increasing maternal and paternal ages reduce their ability to achieve this. Most research relating to childbearing has focused on women. The aim of this study was to explore reproductive-aged men's fertility information-seeking attitudes and behaviours. METHODS Focus group discussions were conducted with younger (18-30 years, 3 groups) and older (31-45 years, 3 groups) men, residing in urban, peri-urban or rural settings in Victoria, Australia. The topics covered included men's fatherhood aspirations and intentions, and their attitudes and behaviours relating to seeking information about fertility. Focus group discussions were audio-recorded and transcribed, and transcripts analyzed thematically. RESULTS Six focus group discussions were conducted with a total of 39 participants. Four key themes were identified: 1. 'No need for fertility-related information'; 2. 'Knowledge and awareness of fertility'; 3. 'Fertility is women's business'; and 4. 'Fertility and manhood'. Fertility and fertility information seeking was perceived by many participants as women's domain. While men did not seek information about fertility unless they experienced fertility difficulties, they reported learning about fertility through the lived experiences of others, predominantly family and friends who experienced infertility. CONCLUSION Fertility-related health promotion initiatives and reproductive health information targeting men are needed to encourage men to be active participants in reproductive decision making to optimize the chance of both women and men achieving their parenthood goals. Narrative health messages may be a successful way to convey fertility information to men.
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Affiliation(s)
- Lauren Pearson
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, 4/553 St Kilda Road, Melbourne 3004, Victoria, Australia
| | - Sara Holton
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, 4/553 St Kilda Road, Melbourne 3004, Victoria, Australia; School of Nursing and Midwifery, Deakin University, Geelong Waterfront Campus, 1 Geringhap Street, Geelong 3220, Victoria, Australia.
| | - Robert McLachlan
- Healthy Male, Melbourne, Vic 3004, Australia; Monash IVF Group Pty Ltd, Richmond 3121, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton 3168, Australia
| | - Karin Hammarberg
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, 4/553 St Kilda Road, Melbourne 3004, Victoria, Australia; Victorian Assisted Reproductive Treatment Authority, Level 30/570 Bourke Street Melbourne, Victoria 3000, Australia
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45
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Lensen S, Chen S, Goodman L, Rombauts L, Farquhar C, Hammarberg K. IVF add-ons in Australia and New Zealand: A systematic assessment of IVF clinic websites. Aust N Z J Obstet Gynaecol 2021; 61:430-438. [PMID: 33594674 DOI: 10.1111/ajo.13321] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/17/2020] [Accepted: 01/15/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND In vitro fertilisation (IVF) 'add-ons' are extra (non-essential) procedures, techniques or medicines, which usually claim to increase the chance of a successful IVF outcome. Use of IVF add-ons is believed to be widespread in many settings; however, information about add-on availability in Australasia is lacking. AIMS To understand which add-ons are advertised on Australasian IVF clinic websites, and what is the evidence for their benefit. MATERIALS AND METHODS A systematic assessment of website content was undertaken between December 2019-April 2020, capturing IVF add-ons advertised, including costs, claims of benefit, statements of risk or limitations, and evidence of effectiveness for improving live birth and pregnancy. A literature review assessed the strength and quality of evidence for each add-on. RESULTS Of the 40 included IVF clinics websites, 31 (78%) listed one or more IVF add-ons. A total of 21 different add-ons or add-on groups were identified, the most common being preimplantation genetic testing for aneuploidies (offered by 63% of clinics), time-lapse systems (33%) and assisted hatching (28%). In most cases (77%), descriptions of the IVF add-ons were accompanied by claims of benefit. Most claims (90%) were not quantified and very few referenced scientific publications to support the claims (9.8%). None of the add-ons were supported by high-quality evidence of benefit for pregnancy or live birth rates. The cost of IVF add-ons varied from $0 to $3700 (AUD/NZD). CONCLUSIONS There is widespread advertising of add-ons on IVF clinic websites, which report benefits for add-ons that are not supported by high-quality evidence.
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Affiliation(s)
- Sarah Lensen
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Sheng Chen
- Victorian Assisted Reproductive Treatment Authority, Melbourne, Victoria, Australia
| | - Lucy Goodman
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Luk Rombauts
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Cindy Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Karin Hammarberg
- Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Owen AJ, Tran T, Hammarberg K, Kirkman M, Fisher JRW. Poor appetite and overeating reported by adults in Australia during the coronavirus-19 disease pandemic: a population-based study. Public Health Nutr 2021; 24:275-281. [PMID: 32972479 PMCID: PMC7556905 DOI: 10.1017/s1368980020003833] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/02/2020] [Accepted: 09/21/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE As a result of the coronavirus-19 disease (COVID-19) pandemic, Australia adopted emergency measures on 22 March 2020. This study reports the effect of the COVID-19 lockdown on appetite and overeating in Australian adults during the first month of emergency measures. DESIGN This study reports analysis of data from the population-based, self-completed survey. The main outcome measure was an item from the Patient Health Questionnaire 9 asking: 'Over the past 2 weeks, how often have you been bothered by poor appetite or overeating?'. Data on sociodemographic factors, symptoms of anxiety and depression, and the impact of COVID-19 and lockdown were also collected. Multivariable logistic regression was used to examine associations with poor appetite or overeating. SETTING An anonymous online survey available from 3 April to 2 May 2020. PARTICIPANTS A total of 13 829 Australian residents aged 18 years or over. RESULTS The weighted prevalence of being bothered by poor appetite or overeating in the past 2 weeks was 53·6 %, with 11·6 % (95 % CI 10·6, 12·6) of the cohort reporting poor appetite or overeating nearly every day. High levels of anxiety, concern about contracting COVID-19, being in lockdown with children and reporting a severe impact of the lockdown were associated with increased odds of poor appetite or overeating. CONCLUSIONS Given the widespread prevalence of being bothered by poor appetite or overeating, universal public health interventions to address emotion-focused or situational eating during periods of lockdown may be appropriate.
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Affiliation(s)
- AJ Owen
- Centre of Cardiovascular Research and Education in Therapeutics, School of Public Health & Preventive Medicine, 553 St Kilda Rd, Melbourne, Victoria3004, Australia
| | - T Tran
- Global and Women’s Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - K Hammarberg
- Global and Women’s Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - M Kirkman
- Global and Women’s Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - JRW Fisher
- Global and Women’s Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Hogan RG, Hammarberg K, Wang AY, Sullivan EA. ‘Battery hens’ or ‘nuggets of gold’: a qualitative study on the barriers and enablers for altruistic egg donation. HUM FERTIL 2021; 25:688-696. [DOI: 10.1080/14647273.2021.1873430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Rosemarie G. Hogan
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, Australia
- School of Nursing, The University of Notre Dame Australia, Sydney, Australia
| | - Karin Hammarberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Victorian Assisted Reproductive Treatment Authority, Melbourne, Australia
| | - Alex Y. Wang
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Elizabeth A. Sullivan
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, Australia
- Faculty of Health and Medicine, The University of Newcastle, Newcastle, Australia
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Tran TD, Hammarberg K, Kirkman M, Nguyen HTM, Fisher J. Alcohol use and mental health status during the first months of COVID-19 pandemic in Australia. J Affect Disord 2020; 277:810-813. [PMID: 33065821 PMCID: PMC7476559 DOI: 10.1016/j.jad.2020.09.012] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/21/2020] [Accepted: 09/02/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND We aimed to estimate the population prevalence of people with changes in their usual patterns of alcohol use during the early stages of the novel coronavirus pandemic of 2020 (COVID-19) pandemic in Australia; assess the association between mental health status and changes in alcohol use during the pandemic; and examine if the associations were modified by gender and age. METHODS This study was an anonymously-completed online self-report survey. Changes in alcohol use were assessed using a single fixed-choice study-specific question. Mental health was assessed using the Patient Health Questionnaire 9 and the Generalized Anxiety Disorder Scale. RESULTS A total of 13,829 people contributed complete data and were included in the analysis. Overall, about one in five adults reported that they had been drinking more alcohol since the COVID-19 pandemic began than they used to. People were more likely to be drinking alcohol more than they used to if they had more severe symptoms of depression or anxiety. The associations between depressive and anxiety symptoms and increased alcohol use since the COVID-19 pandemic began were consistent between females and males. LIMITATIONS Online surveys are less accessible to some groups of people. The data are self-report and not diagnostic. Cross-sectional data can identify associations, not causal relationships. The study was limited to participants from Australia. CONCLUSIONS These data indicate that there is a need for public policies focused on alcohol use during the COVID-19 pandemic and the strategies should include specific consideration of the needs of people with mental health problems.
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Affiliation(s)
- Thach Duc Tran
- School of Public Health and Preventive Medicine, Monash University, Australia.
| | - Karin Hammarberg
- School of Public Health and Preventive Medicine, Monash University, Australia
| | - Maggie Kirkman
- School of Public Health and Preventive Medicine, Monash University, Australia
| | - Hau Thi Minh Nguyen
- School of Public Health and Preventive Medicine, Monash University, Australia
| | - Jane Fisher
- School of Public Health and Preventive Medicine, Monash University, Australia
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Hammarberg K, Tran T, Kirkman M, Fisher J. Sex and age differences in clinically significant symptoms of depression and anxiety among people in Australia in the first month of COVID-19 restrictions: a national survey. BMJ Open 2020; 10:e042696. [PMID: 33234659 PMCID: PMC7688441 DOI: 10.1136/bmjopen-2020-042696] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To identify sex and age differences in clinically significant symptoms of depression and anxiety and the factors associated with these differences among adults in Australia during COVID-19-related restrictions. DESIGN Anonymous online survey. SETTING Australia. PARTICIPANTS Adults aged over 18 years living in Australia were eligible and 13 829 contributed complete data. Of these, 13 762 identified as female (10 434) or male (3328) and were included in analyses. INTERVENTIONS None. OUTCOME MEASURES Clinically significant symptoms of depression (≥10 on Patient Health Questionnaire 9) or anxiety (≥10 on Generalized Anxiety Disorder Scale 7 (GAD-7)), and experiences of irritability (GAD-7 item 6). RESULTS Women were more likely than men to have clinically significant symptoms of depression (26.3% (95% CI 25.4 to 27.1) vs 20.1% (95% CI 18.7 to 21.5), p<0.001) and anxiety (21.8% (95% CI 21.0 to 22.6) vs 14.2% (95% CI 13.0 to 15.4), p<0.001) and to have experienced irritability in the previous fortnight (63.1% (95% CI 62.1 to 64.0) vs 51.4% (95% CI 49.7 to 53.2), p<0.001). They were also more likely than men to be doing unpaid work caring for children (22.8% (95% CI 22.0 to 23.6) vs 8.6% (95% CI 7.7 to 9.6), p<0.001) and dependent relatives (9.8% (95% CI 9.2 to 10.3) vs 5.7% (95% CI 4.9 to 6.5), p<0.001) which made significant contributions to the mental health outcomes of interest. Loss of employment, fear of contracting COVID-19 and feeling a severe impact of the restrictions were associated with poorer mental health in women and men of all ages. CONCLUSIONS Rates of clinically significant symptoms of depression and anxiety were higher among women than men. Rather than being intrinsically more vulnerable to mental health problems during the COVID-19 pandemic, the higher risk of symptoms of anxiety and depression among women may in part be explained by their disproportionate burden of unpaid caregiving.
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Affiliation(s)
- Karin Hammarberg
- Global and Women's Helath, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Thach Tran
- Global and Women's Helath, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Maggie Kirkman
- Global and Women's Helath, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jane Fisher
- Global and Women's Helath, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Fisher JR, Tran TD, Hammarberg K, Sastry J, Nguyen H, Rowe H, Popplestone S, Stocker R, Stubber C, Kirkman M. Mental health of people in Australia in the first month of COVID-19 restrictions: a national survey. Med J Aust 2020; 213:458-464. [PMID: 33107063 PMCID: PMC7756394 DOI: 10.5694/mja2.50831] [Citation(s) in RCA: 175] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/20/2020] [Indexed: 11/17/2022]
Abstract
Objectives To estimate the population prevalence of clinically significant symptoms of depression, generalised anxiety, thoughts of being better off dead, irritability, and high optimism about the future, and of direct experience of COVID‐19, loss of employment caused by COVID‐19 restrictions, worry about contracting COVID‐19, or major disadvantage because of the restrictions; to examine the relationship between these experiences and reporting mental symptoms. Design, setting, participants Anonymous online survey of adult Australian residents, 3 April – 2 May 2020. Main outcome measures Self‐reported psychological status during the preceding fortnight assessed with the Patient Health Questionnaire 9 (PHQ‐9; symptoms of depression) and the Generalised Anxiety Disorder Scale (GAD‐7). Optimism about the future was assessed with a 10‐point study‐specific visual analogue scale. Results 13 829 respondents contributed complete response data. The estimated prevalence of clinically significant symptoms of depression (PHQ‐9 ≥ 10) was 27.6% (95% CI, 26.1–29.1%) and of clinically significant symptoms of anxiety (GAD‐7 ≥ 10) 21.0% (95% CI, 19.6–22.4%); 14.6% of respondents (95% CI, 13.5–16.0%) reported thoughts of being better off dead or self‐harm (PHQ‐9, item 9) on at least some days and 59.2% (95% CI, 57.6–60.7%) that they were more irritable (GAD‐7, item 6). An estimated 28.3% of respondents (95% CI, 27.1–29.6%) reported great optimism about the future (score ≥ 8). People who had lost jobs, were worried about contracting COVID‐19, or for whom the restrictions had a highly adverse impact on daily life were more likely to report symptoms of depression or anxiety, and less likely to report high optimism than people without these experiences. Conclusions Mental health problems were widespread among Australians during the first month of the stage two COVID‐19 restrictions; in addition, about one‐quarter of respondents reported mild to moderate symptoms of depression or anxiety. A public mental health response that includes universal, selective and indicated clinical interventions is needed.
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Affiliation(s)
| | | | - Karin Hammarberg
- Monash University, Melbourne, VIC.,Victorian Assisted Reproductive Treatment Authority, Melbourne, VIC
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