Sharon James

Background: Interventions and policies to optimise preconception health are increasing internationally. This stems from growing recognition that improving preconception health can improve maternal and child health outcomes and advance equity by reducing inequalities and address inequities for people of reproductive age and any children they may have. Interventions and policies should be evaluated through population-level surveillance of preconception health to inform the development of new initiatives, monitor effectiveness, and support advocacy for international adoption of successful strategies. However, there is currently no internationally agreed set of preconception health indicators available and suitable for international surveillance. The International Core Indicators for Preconception Health and Equity (iCIPHE) Alliance was established to address this gap. Aim: To prioritise core indicators that can be used in low-, middle- and high-income countries for surveillance of preconception health and equity. Methods: We held two workshops with the iCIPHE Alliance (multi-sectoral stakeholders from low-, middle- and high-income countries) to inform the design of this international consensus study. The development of core indicators will consist of three steps: (1) identifying an initial long-list of candidate surveillance indicators, and defining principles for scoring the importance of each indicator, through a literature review, public involvement, and workshops with iCIPHE Alliance members; (2) scoring each candidate indicator in terms of its importance for surveillance through a two-round Delphi survey among study participants; and (3) agreeing on the final core indicators through a series of consensus meetings with a selected group of study participants. We will recruit study participants from all World Health Organization (WHO) regions across four stakeholder groups: people of reproductive age (who do not belong to any of the other stakeholder groups); health and social care professionals; policy and programme professionals; and researchers. Dissemination: We will disseminate the priority core indicators through peer-reviewed publication, lay summaries, policy briefs and presentations. An implementation strategy, to enable monitoring of inequalities, inequities, and changes in preconception health over time within and between countries, will be developed with relevant national and international organisations to inform next steps.

Introduction: Community pharmacists can play a key role in the prevention and management of unintended pregnancy, including in the provision of counselling and by dispensing contraception, and for medication abortion (MA). However, Australian pharmacists’ practice and knowledge of effective contraceptive methods, including long-acting reversible contraception (LARC), is unknown, and few were registered to dispense MA at the time of the study. Aim: Our aim was to understand the knowledge, attitudes and practices of Australian community pharmacists in LARC and MA care. Method: We conducted a cross-sectional national online survey of community pharmacists from July until October 2021. Participants were recruited through convenience sampling via mail and partner organisations’ emails, newsletters, and mailing lists. We used descriptive statistical analysis, including counts, proportions, Pearson’s chi-squared tests and Poisson regression for data analysis. Our descriptive survey forms part of the Australian Contraception and Abortion Primary Care Practitioner Support Network (AusCAPPS) mixed-methods project (ACTRN12622000655741). Results: There were 533 eligible responses; 72% (n = 385) self-identified as women, and 71% (n = 378) were from metropolitan areas. Respondents' correct LARC knowledge varied, with 88% understanding LARC effectiveness, 67.7% understanding return to fertility, and 65.9% understanding LARC suitability for nulliparous women. Most pharmacists were registered to dispense MA (70%; n = 373), although fewer than half discussed LARC at the time of dispensing MA. Those working outside metropolitan areas were more likely to be registered to dispense MA and feel that they had the knowledge and confidence to dispense MA. Conclusion: With community pharmacists increasing scope of service in relation to contraception and MA, ongoing education and support will ensure they have accurate information for the provision of LARC and MA.

Background: Interventions and policies to optimise preconception health are increasing internationally. This stems from growing recognition that improving preconception health can improve maternal and child health outcomes and advance equity by reducing inequalities and address inequities for people of reproductive age and any children they may have. Interventions and policies should be evaluated through population-level surveillance of preconception health to inform the development of new initiatives, monitor effectiveness, and support advocacy for international adoption of successful strategies. However, there is currently no internationally agreed set of preconception health indicators available and suitable for international surveillance. The International Core Indicators for Preconception Health and Equity (iCIPHE) Alliance was established to address this gap. Aim: To prioritise core indicators that can be used in low-, middle- and high-income countries for surveillance of preconception health and equity. Methods: We held two workshops with the iCIPHE Alliance (multi-sectoral stakeholders from low-, middle- and high-income countries) to inform the design of this international consensus study. The development of core indicators will consist of three steps: (1) identifying an initial long-list of candidate surveillance indicators, and defining principles for scoring the importance of each indicator, through a literature review, public involvement, and workshops with iCIPHE Alliance members; (2) scoring each candidate indicator in terms of its importance for surveillance through a two-round Delphi survey among study participants; and (3) agreeing on the final core indicators through a series of consensus meetings with a selected group of study participants. We will recruit study participants from all World Health Organization (WHO) regions across four stakeholder groups: people of reproductive age (who do not belong to any of the other stakeholder groups); health and social care professionals; policy and programme professionals; and researchers. Ethical approval: This study has been approved by the University of Southampton Faculty of Medicine Ethics Committee (ERGO 104447). Dissemination: We will disseminate the priority core indicators through peer-reviewed publication, lay summaries, policy briefs and presentations. An implementation strategy, to enable monitoring of inequalities, inequities, and changes in preconception health over time within and between countries, will be developed with relevant national and international organisations to inform next steps.

Objective: To examine geographical variation in utilisation of hormonal long-acting reversible contraceptives (LARCs), namely the hormonal intrauterine device (IUD) and implant. Study design: Cross-sectional study of Australian women aged 15–54 years using Pharmaceutical Benefits Scheme (PBS) dispensing data from 2018 to 2021. We calculated age‐standardised rates of LARC dispensing per 1000 women across each Statistical Area Level 3 (SA3) according to remoteness and socioeconomic status (SES) indices. Differences between minimum and maximum rates of LARC utilisation in SA3s were used to determine magnitude of variation. Results: Between 2018 and 2021, hormonal IUD dispensing rates increased from 18.4 to 21.6 per 1000 women in major cities, 25.2 to 30.6 per 1000 in inner regional, 25.4 to 28.7 per 1000 in outer regional, and 17.7 to 20.0 per 1000 in remote areas. This corresponded to decreases in implant dispensing rates from 14.6 to 12.6 per 1000 women in major cities, 25.3 to 23.1 per 1000 in inner regional, 28.0 to 25.3 per 1000 in outer regional, and 20.7 to 19.6 per 1000 in remote areas. Rates of LARC utilisation varied considerably across SA3s, ranging from 10.9 to 37.8 per 1000 women. Increasing SES was associated with increasing hormonal IUD rates in major cities (incidence rate ratio (IRR) 1.06, 95% CI 1.04 to 1.08), inner regional (IRR 1.06, 95% CI 1.03 to 1.09) and remote (IRR 1.44, 95% CI 1.12 to 1.85) areas, but decreasing implant rates in major cities (IRR 0.89, 95% CI 0.86 to 0.91) and inner regional areas (IRR 0.91, 95% CI 0.88 to 0.94). Conclusion: Given observed variation in LARC utilisation, efforts to identify and address barriers towards more equitable access to LARC methods appear warranted.

Background: Web-based surveys are a cost-effective technique to engage a large population of participants in research projects, including those who were previously difficult to reach due to geographic location, safety, and vulnerability. While web-based surveys have many advantages, they can be more susceptible to fraud, especially when a generic invitation link or a financial incentive is offered. There is a paucity of literature presenting experiences for mitigating this type of fraudulent study response, yet this important foundation is needed to inform the work of researchers and institutional review boards (IRBs) to support the collection of high-quality, appropriate data. Objective: This study aims to analyze, compare, and contrast the range of strategies used to prevent, detect, and remove fraudulent responses by investigating 4 web-based surveys in Australia and Canada, each of which experienced fraudulent responses. Methods: Our descriptive multiple case study presents 4 research projects from Australia and Canada that experienced survey fraud. These web-based surveys recruited patients of, or clinicians providing, family planning services. We describe each study’s approach to preventing fraud (primary prevention; eg, CAPTCHA) and a screening protocol to detect fraudulent responses during data collection (secondary prevention). Once fraud was detected, each study team developed strategies to protect data integrity, in consultation with coinvestigators, ethics committees/ IRBs, and biostatisticians, to remove fraudulent respondents from the dataset (tertiary prevention). Results: All studies recruited via a generic survey link and provided remuneration, which are common risk factors for fraud. Several studies also relied on social media for recruitment. All 4 studies implemented tertiary fraud detection strategies to identify and remove fraudulent responses and maintain data integrity (removing between 16% and 45% of respondents). Including personal identifiers during data collection provided 3 of the studies with a more robust option to identify and remove fraudulent respondents. Where personal identifiers could not be used (eg, to protect the identity of a vulnerable study population), investigators relied on a complex fraud detection algorithm verified by manual team review. Conclusions: Commonly used web-based anonymized survey methods, particularly those offering incentives for participation, are at substantial risk for fraud. Across these 4 studies, robust fraud detection methods were essential to ensure data reliability, with varying strategies, such as using personal identifiers, applied based on specific survey contexts. Fraud mitigation criteria explored in this multicase analysis can be adapted to other web-based surveys, survey topics, and populations. Implementing the fraud prevention and detection methods within survey design will assist researchers and IRBs in protecting data integrity. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12622000655741; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=383919 and ClinicalTrials.gov NCT05793944; https://clinicaltrials.gov/study/NCT05793944

Background: Interconception care (ICC), provided between pregnancies, can improve women’s health, pregnancy outcomes and infant health. Women face challenges in accessing and prioritising ICC due to issues including caring roles, transport and clinician availability. We aimed to elicit women’s preferences for ICC engagement. Methods: A discrete choice experiment (DCE) was conducted to assess women’s preferences about ICC. Australian women who had experienced pregnancy completed an online survey in March 2024 comprised of questions about sociodemographic characteristics, ICC attitudes regarding informational needs, healthcare professional involvement and service location. We used a mixed logit model to analyse DCE responses, willingness to pay estimates for different attribute levels and applied latent class modelling to explore preference heterogeneity. Free text responses were grouped by key ideas. Results: From 191 responses, numbers were similar across age categories, 46% had experienced pregnancy loss, and 87% had a child/children. Respondents preferred ICC provided by a nurse/midwife, offered during home visits or in-person consultations with a child-friendly waiting area, with appointments lasting 30 or 60 min, and at lower costs. There were no strong preferences regarding appointment wait times. Respondents favoured consultations scheduled up to 1 year after delivery. Follow-up questions indicated that most identified informational needs about emotional and mental health support (74.3%) as important, midwives were a preferred healthcare professional (71.7%) and general practice was the most favoured ICC location (64.9%). Conclusions: Ensuring clinician and setting familiarity, longer appointment times and lower appointment costs will support women’s access to ICC. Policy and funding support are needed for ICC provision.

BACKGROUND Web-based surveys are a cost-effective technique to engage a large population of participants in research projects, including those who were previously difficult to reach due to geographic location, safety, and vulnerability. While web-based surveys have many advantages, they can be more susceptible to fraud, especially when a generic invitation link or a financial incentive is offered. There is a paucity of literature presenting experiences for mitigating this type of fraudulent study response, yet this important foundation is needed to inform the work of researchers and institutional review boards (IRBs) to support the collection of high-quality, appropriate data. OBJECTIVE This study aims to analyze, compare, and contrast the range of strategies used to prevent, detect, and remove fraudulent responses by investigating 4 web-based surveys in Australia and Canada, each of which experienced fraudulent responses. METHODS Our descriptive multiple case study presents 4 research projects from Australia and Canada that experienced survey fraud. These web-based surveys recruited patients of, or clinicians providing, family planning services. We describe each study’s approach to preventing fraud (primary prevention; eg, CAPTCHA) and a screening protocol to detect fraudulent responses during data collection (secondary prevention). Once fraud was detected, each study team developed strategies to protect data integrity, in consultation with coinvestigators, ethics committees/ IRBs, and biostatisticians, to remove fraudulent respondents from the dataset (tertiary prevention). RESULTS All studies recruited via a generic survey link and provided remuneration, which are common risk factors for fraud. Several studies also relied on social media for recruitment. All 4 studies implemented tertiary fraud detection strategies to identify and remove fraudulent responses and maintain data integrity (removing between 16% and 45% of respondents). Including personal identifiers during data collection provided 3 of the studies with a more robust option to identify and remove fraudulent respondents. Where personal identifiers could not be used (eg, to protect the identity of a vulnerable study population), investigators relied on a complex fraud detection algorithm verified by manual team review. CONCLUSIONS Commonly used web-based anonymized survey methods, particularly those offering incentives for participation, are at substantial risk for fraud. Across these 4 studies, robust fraud detection methods were essential to ensure data reliability, with varying strategies, such as using personal identifiers, applied based on specific survey contexts. Fraud mitigation criteria explored in this multicase analysis can be adapted to other web-based surveys, survey topics, and populations. Implementing the fraud prevention and detection methods within survey design will assist researchers and IRBs in protecting data integrity. CLINICALTRIAL Australian New Zealand Clinical Trials Registry ACTRN12622000655741; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=383919 and ClinicalTrials.gov NCT05793944; https://clinicaltrials.gov/study/NCT05793944

Aim: To examine practice nurse knowledge, attitudes, and practices about medication abortion in Australia. Design: Cross‐sectional survey. Methods: A national online survey was conducted from July to December 2021. Nurses working in general practice were recruited using convenience sampling. Data collected included demographics, knowledge, attitudes, and practices in abortion care. Analyses used included descriptive statistics and Poisson regression. Results: From 489 responses, knowledge about medication abortion, its provision, and efficacy was low. Although many respondents felt it was acceptable to assist in medication abortion, few indicated involvement. Those with advanced qualifications had greater perceived knowledge of abortion counselling. Respondent involvement in medication abortion was more likely if they had worked in general practice for a long time, their primary place of work was outside of general practice, or had advanced nursing qualifications. Conclusions: Given their role in the community, there is an opportunity to better utilise practice nurses for abortion care. Incorporation of abortion into the nursing curriculum and routine practice, including supportive funding mechanisms for care, is needed. Implications: Low knowledge and a lack of practice nurses providing abortion services adversely impact patient access. Impact: Practice nurse provision of medication abortion has not yet been optimised. While practice nurses reported acceptability to provide abortion care, this could be enhanced with funding, education, and service normalisation. These results will inform policy makers, educators, patients, general practices, and nurses to support patient access to abortion care. Incorporating abortion care into nursing curriculum and practice will support women's access to these services. Reporting Method: CHERRIES guideline. Patient or Public Contribution: Professional groups, family planning organisations, industry, and government grant partners supported the study's recruitment. Trial Registration: ACTRN12622000655741

Aim: To describe practice nurse long‐acting reversible contraception (LARC) knowledge and practices. Design: Cross‐sectional survey. Methods: Between July and December 2021, we conducted an online survey using convenience sampling to recruit Australian nurses who work in primary care, known as practice nurses. We collected data about demographics and knowledge and practices relating to LARC. Analysis used descriptive statistics and Poisson regression. Results: From 489 eligible responses, most respondents were women and the majority worked in metropolitan practices. Most (90.4%) believed that their advice could influence women's contraceptive choices. Few inserted/removed intrauterine devices (IUDs) (11.2%) or implants (15.9%). Of those that did insert LARC, most did so one to five times in the last month (IUDs 72.2%; implants 73.6%). General practice as a primary place of work was negatively associated with implant provision. Respondents with more general practice experience (≥ 15 years) and/or higher qualifications were more likely to respond correctly to knowledge questions and provide IUDs or implants. Most (62.8%) correctly identified IUD suitability for nulliparous women. Conclusions: Practice nurses have knowledge gaps and limited practice opportunities for LARC provision. Implications: Practice nurses need supportive funding policies and ongoing education and skills development to enhance patient access to LARC and their choice of provider. Reporting Method: CHERRIES guideline. Patient or Public Contribution: Partner organisations assisted with the study's recruitment. Trial Registration: ACTRN12622000655741

Background: Prevention and self-management of lifestyle risks can reduce non-communicable disease risks and improve the health of mothers and their children. We explored Australian women’s preferences for lifestyle risk reduction engagement during the interconception period. Methods: We conducted a qualitative descriptive interview study between February and May 2022. Women and people who have been pregnant and intended to have more children were recruited. We asked participants about their preferences for lifestyle risk reduction between pregnancies. Following reflexive thematic analysis, we conceptualised findings using the COM-B system. Results: Among 17 participants, most had given birth to one child and intended to have another child in 1 to 2 years. Our analysis found that most described lifestyle risk reduction engagement through nutrition and exercise, informed by personal experiences and their health goals for a future pregnancy/child. Key attributes affecting engagement in lifestyle risk reduction activities included their feasibility and practicality, habits and routines, motivation, pregnancy planning, and the source and quality of information. Participants’ capacity and capability to engage in lifestyles supportive of interconception health were varied and influenced by juggling the routines of work, finances, health and evolving caring responsibilities. Community-based influences, including the availability of recreational infrastructure, the level of support provided by partners/family/peers and culture, also influenced participants’ engagement in lifestyle risk reduction activities. Conclusions: For lifestyles that encourage interconception health, maximising participants’ capability and opportunities required motivation and access to infrastructure supportive of healthy meal options and exercise, health services and community networks.