Universal for whom? Evaluating an urban Aboriginal population's access to a mainstream universal health home visiting program

Abstract

Objective. To investigate access to a Universal Health Home Visit program for families of Aboriginal and nonAboriginal infants and the effect of a one-off home visit on subsequent health service utilisation.Methods. A case-control study was undertaken drawing 175 Aboriginal infants from an Aboriginal birth cohort study and 352 matched non-Aboriginal infants. A structured file audit extracted data from child and family health nurse records. Receipt of home visit and effect on ongoing use of child and family nurses services was compared for Aboriginal and nonAboriginal infants.Results. Of the 527 infants, 279 (53.0%) were visited at home within 2 weeks. This is below NSW Health benchmarks. Significantly fewer Aboriginal infants (42.9%) compared to non-Aboriginal infants (58.0%) received a home visit within 2 weeks (P < 0.01). Receipt of a single home visit did not affect future service use or the number of child health checks infants received.Conclusion. This study highlights the challenges of ensuring equitable access to a universal post-natal home visiting program. Assessing ways in which universal services are delivered to ensure equity of access may help to re-evaluate target expectations, reduce demand on nursing staff, improve targeting of vulnerable infants and help in further developing and implementing effective health policy.What is known about the topic? The rate of home visits within NSW is 45%, which is well below the recommended target rate of 65%. Aboriginal families utilise health services differently than non-Aboriginal families. What does this paper add? Inequalities in accessing a home visit within 2 weeks were found, with families of Aboriginal infants being less likely than families of non-Aboriginal infants to receive a home visit within 2 weeks. Factors such as being a young mother, an unpartnered mother, a mother with psychosocial risks identified antenatally, or residing in a disadvantaged suburb were associated with not receiving a visit within 2 weeks. Receipt of a home visit did not, despite the program's aim, affect further health service use. What are the implications for practitioners? Practitioners and managers need to be aware of the challenges in providing equitable access within a universal post-natal home visiting program.

Immunisation coverage among a birth cohort of Aboriginal infants in an urban community

“…A greater proportion of infants of mothers who were under 20 years of age, delivering their first child, had not completed year 10 or resided in a disadvantaged suburb were not found in the ACIR when compared with infants who did not have these factors present. Within this population, we have previously found similar factors to be associated with not having a post‐natal home visit by a child and family nurse recorded in community health records . Together, these results suggest that there are families with particular socio‐economic profiles who are at greater risk of having universal services not recorded in mainstream health record systems.…”

“…First, the data extractor searched the database by infant's name and date of birth; those that could not be found were then searched for by Medicare number. Data on immunisations received by the age of 2.5 years (900 days) were extracted …”

Computerised Aboriginal and Torres Strait Islander health assessments in primary health care research

“…Biddle recommends taking the most efficient approach possible to data collection and analysis in order to minimise participant burden. 180 In summary, research data published in the last five years and indexed on PubMed, 107 Aboriginal health liaison 8,041 b No O'Connor et al 115 Chlamydia 7,103 b Yes Dutton et al 170 Health 128 Albuminuria 860 No Lopez et al 114 Ischaemic heart disease 833 b Yes Hopkins et al 105 Psychological resilience 677 No Arjunan et al 106 Tobacco use 663 No Jamieson et al 164 Oral 113 Stressful events in children 344 b No Lalla et al 103 Oral mucosal disease 342 No Radford et al 104 Dementia 336 No Whish-Wilson et al 99 Birth outcomes 301 Yes Roberts-Thomson et al 117 Oral health 251 No Dorrington et al 174 Pap smears 213 No Gardener et al 102 Children 205 No Wong et al 126 Midwifery 177 Infant health 175 Yes Luke et al 181 Suicidal 169 Breast feeding 159 Yes Webster et al (Gudaga study) 166 Child growth 157 No Scott et al 110 Sexual health 155 No Miller et al (Gudaga study) 118 Child language assessment 150 No Arrow 100 Oral …”