Alcohol, Abstinence, Efficacy, and Social Normative Expectancies: The Relationship to Alcoholics\u27 Level of Drinking Following Inpatient Treatment

It has been argued that individuals receiving traditional alcohol treatment do not necessarily perceive life-long abstinence from alcohol as a favorable treatment outcome, and that negative expectations associated with this abstinence goal may have an adverse effect on treatment outcome. However, abstinence expectancies have never been systematically explored. This study used the Theory of Planned Behavior to investigate the relationship between the abstinence outcome expectancies of alcoholics beginning treatment and subsequent alcohol consumption. The independent and combined effects of abstinence outcome expectancies, alcohol outcome expectancies, self-efficacy expectancies (to abstain from alcohol use), and the normative beliefs of individuals beginning inpatient abstinence-oriented alcohol treatment were related to level of drinking during the 90 days following treatment. One hundred ten individuals receiving inpatient alcohol treatment were recruited for the main portion of this study. A questionnaire that included belief-based measures of attitude toward alcohol and abstinence, a belief-based measure of social normative pressure to either use or abstain from alcohol, a belief-based measure of one\u27s perceived behavioral control to abstain from alcohol, and a measure of behavioral intention to use alcohol during the 3 months following treatment was developed for use in this study. The questionnaire was administered to all subjects. During the 90-day Follow-Up period, subjects were sent brief questionnaires and asked to report any alcohol or drug use. Eighty-nine percent of the subjects provided follow-up information for the first 30 days, while 76% provided information for the entire 90 days. An analysis of the data indicated that scores obtained from the belief-based measure of perceived behavioral control and scores from the belief-based measure of attitude toward abstinence were moderately correlated with intention to abstain from alcohol, while alcohol attitude scores and subjective norm scores were uncorrelated. Contrary to expectations, scores obtained from a measure of intention to use alcohol and the measure of perceived behavioral control were minimally predictive of scores from follow-up measures of drinking. However, intention and perceived behavioral control were minimally predictive of scores from follow-up measures of drinking. However, intention and perceived behavioral control scores were somewhat more predictive of drug use for the 90-day Follow-Up period. These results were discussed in light of the Theory of Planned Behavior and the similarities between alcohol expectancies and drug expectancies

Assessment of the dimensionality of the Wijma delivery expectancy/experience questionnaire using factor analysis and Rasch analysis

Background: Fear of childbirth has negative consequences for a woman's physical and emotional wellbeing. The most commonly used measurement tool for childbirth fear is the Wijma Delivery Expectancy Questionnaire (WDEQ-A). Although originally conceptualized as unidimensional, subsequent investigations have suggested it is multidimensional. This study aimed to undertake a detailed psychometric assessment of the WDEQ-A; exploring the dimensionality and identifying possible subscales that may have clinical and research utility. Methods: WDEQ-A was administered to a sample of 1410 Australian women in mid-pregnancy. The dimensionality of WDEQ-A was explored using exploratory (EFA) and confirmatory factor analysis (CFA), and Rasch analysis. Results: EFA identified a four factor solution. CFA failed to support the unidimensional structure of the original WDEQ-A, but confirmed the four factor solution identified by EFA. Rasch analysis was used to refine the four subscales (Negative emotions: five items; Lack of positive emotions: five items; Social isolation: four items; Moment of birth: three items). Each WDEQ-A Revised subscale showed good fit to the Rasch model and adequate internal consistency reliability. The correlation between Negative emotions and Lack of positive emotions was strong, however Moment of birth and Social isolation showed much lower intercorrelations, suggesting they should not be added to create a total score. Conclusion: This study supports the findings of other investigations that suggest the WDEQ-A is multidimensional and should not be used in its original form. The WDEQ-A Revised may provide researchers with a more refined, psychometrically sound tool to explore the differential impact of aspects of childbirth fear.Full Tex

Effect of dialect on identification and severity of speech impairment in Indigenous Australian children

This study investigated the effect of dialectal difference on identification and rating of severity of speech impairment in children from Indigenous Australian backgrounds. The speech of 15 Indigenous Australian children identified by their parents/caregivers and teachers as having ‘difficulty talking and making speech sounds’ was assessed using the Diagnostic Evaluation of Articulation and Phonology. Fourteen children were identified with speech impairment on the Diagnostic Evaluation of Articulation and Phonology using Standard Australian English (AusE) as the target pronunciation; whereas 13 were identified using Australian Aboriginal English (AAE) as the target. There was a statistically significant decrease in seven children’s severity classification and a statistically significant increase in all children’s percentage of consonants, vowels and phonemes correct when comparing AAE with AusE. Features of AAE used by the children included /h/ insertion and deletion, primary stress on the first syllable and diphthongs alternating with short clear vowels. It is important that speech-language pathologists consider children’s dialect as one component of culturally and linguistically appropriate services

Development of a co‐designed, evidence‐based, multi‐pronged strategy to support normal birth

Australia's caesarean section (CS) rate has been steadily increasing for decades. In response to this, we co‐designed an evidence‐based, multi‐pronged strategy to increase the normal birth rate in Queensland and reduce the need for CS. We conducted three workshops with a multi‐stakeholder group to identify a broad range of options to reduce CS, prioritise these options, and achieve consensus on a final strategy. The strategy comprised of: universal access to midwifery continuity‐of‐care and choice of place of birth; multi‐disciplinary normal birth education; resources to facilitate informed decision‐making; respectful maternity care and positive workplace culture; and establishment of a Normal Birth Collaborative

A cost analysis of upscaling access to continuity of midwifery carer: Population-based microsimulation in Queensland, Australia

Objective To quantify the economic impact of upscaling access to continuity of midwifery carer, compared with current standard maternity care, from the perspective of the public health care system. Methods We created a static microsimulation model based on a whole-of-population linked administrative data set containing all public hospital births in one Australian state (Queensland) between July 2017 to June 2018 (n = 37,701). This model was weighted to represent projected State-level births between July 2023 and June 2031. Woman and infant health service costs (inpatient, outpatient and emergency department) during pregnancy and birth were summed. The base model represented current standard maternity care and a counterfactual model represented two hypothetical scenarios where 50 % or 65 % of women giving birth would access continuity of midwifery carer. Costs were reported in 2021/22 AUD. Results The estimated cost savings to Queensland public hospital funders per pregnancy were $336 in 2023/24 and$546 with 50 % access. With 65 % access, the cost savings were estimated to be $534 per pregnancy in 2023/24 and$839 in 2030/31. A total State-level annual cost saving of $12 million in 2023/24 and$19 million in 2030/31 was estimated with 50 % access. With 65 % access, total State-level annual cost savings were estimated to be $19 million in 2023/24 and$30 million in 2030/31. Conclusion Enabling most childbearing women in Australia to access continuity of midwifery carer would realise significant cost savings for the public health care system by reducing the rate of operative birth

Worldwide prevalence of tocophobia in pregnant women: systematic review and meta-analysis

Introduction: Tocophobia is defined as a severe fear of pregnancy and childbirth. There is increasing evidence that tocophobia may have short-term and long-term adverse effects on mother and baby. We performed a systematic review and meta-analysis to determine the global prevalence of tocophobia in pregnancy. Material and methods: Relevant articles were identified through searching six relevant databases: MEDLINE, CINAHL, Pubmed, PsycINFO, Maternity & Infant Care and Scopus between 1946 and April 2016. We used search terms for tocophobia prevalence in pregnant women that we agreed with a medical librarian. There were no language restrictions. Two review authors independently assessed data for inclusion, extracted data and assessed quality using a standardized appraisal tool. Meta-analysis was performed to determine the overall pooled-prevalence of tocophobia. Several subgroup and sensitivity analyses were conducted. Results: Thirty-three studies were included in the systematic review from 18 countries of which data from 29 studies were used in the meta-analysis of 853 988 pregnant women. Definition of tocophobia varied, whereas prevalence rates ranged between 3.7 and 43%. The overall pooled prevalence of tocophobia, using a random-effects model, was 14% (95% CI 0.12â 0.16). Significant heterogeneity was observed (I2 = 99.25%, p = 0.00), which was not explained in subgroup analyses including tocophobia definition used, screening trimester and parity. Conclusion: The prevalence of tocophobia is estimated at 14% and appears to have increased in recent years (2000 onwards). Considerable heterogeneity (99.25%) was noted that may be attributed to lack of consensus on the definition of tocophobia, so our results should be interpreted with caution