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AIM: To synthesise the evidence about preventive strategies using BA with pregnant women at risk of perinatal subthreshold depression.

IntroductionInfluenza immunisation is a highly cost-effective public health intervention. Despite a comprehensive National Immunisation Program, influenza vaccination in children and adolescents with special risk medical conditions (SRMCs) is suboptimal. Flutext-4U is an innovative, multi-component strategy targeting paediatric hospitals, general practice and parents of children and adolescents with SRMC. The Flutext-4U study aims to assess the impact of Flutext-4U to increase influenza immunisation in children and adolescents with SRMC.Methods and analysisThis is a randomised controlled trial involving parents of children and adolescents (aged >6 months to Parents (of children/adolescents with SRMC) are randomised (1:1 ratio) to standard care plus intervention (SMS reminder messages to parents; reminders (written correspondence) for their child’s GP from the hospital’s Paediatric Outpatients Department) or standard care (hospital vaccine availability, ease of access and reminders for WCH subspecialists) with randomisation stratified by age-group (14 to The primary outcome is influenza vaccination, as confirmed by the Australian Immunisation Register.The proportion vaccinated (primary outcome) will be compared between randomised groups using logistic regression, with adjustment made for age group at randomisation. The effect of treatment will be described using an OR with a 95% CI.Ethics and disseminationThe protocol and all study materials have been reviewed and approved by the Women’s and Children’s Health Network Human Research Ethics Committee (HREC/20/WCHN/5). Results will be disseminated via peer-reviewed publication and at scientific meetings, professional and public forums.Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12621000463875).

Background: Aboriginal and Torres Strait Islander women, hereafter called Indigenous women, can experience a lack of understanding of their cultural needs when accessing maternity care in the standard hospital care system. Aim: To explore the lived experiences described by Indigenous women accessing labour and birth care in the standard hospital care system at a tertiary public hospital in South Australia. Methods: An interpretive Heideggerian phenomenological approach was used. Indigenous women who accessed standard care voluntarily agreed to participate in semi-structured interviews with Indigenous interviewers. The interviews were transcribed and analysed informed by van Manen's approach. Findings: Thematic analysis revealed six main themes: "knowing what is best and wanting the best for my baby", "communicating my way", "how they made me feel", "all of my physical needs were met", "we have resilience and strength despite our hardships" and "recognising my culture". Conclusion: Indigenous women in this study expressed and shared some of their cultural needs, identifying culturally unsafe practices. Recommendations to address these include the extension of current care planners to include cultural needs; Aboriginal Maternal Infant Care (AMIC) workers for women from rural and remote areas; AMIC workers on call to assist the women and midwives; increased education, employment and retention of Indigenous midwives; increased review into the women's experiences; removal of signs on the door restricting visitors in the birth suite; flexibility in the application of hospital rules and regulations; and changes to birthing services in rural and remote areas so women may not have to relocate for birth. Refereed/Peer-reviewed

Background Aboriginal and Torres Strait islander 1 1The term Aboriginal is inclusive of both Aboriginal and Torres Strait Islander peoples in this study. women face considerable health disparity in relation to their maternity health outcomes when compared to non-Aboriginal women. Culture and culturally appropriate care can contribute to positive health outcomes for Aboriginal women. How midwives provide culturally appropriate care and how the care is experienced by the women is central to this study. Aim To explore the lived experiences of midwives providing care in the standard hospital care system to Aboriginal women at a large tertiary teaching hospital. Methods An interpretive Heideggerian phenomenological approach was used. Semi-structured interviews were conducted with thirteen volunteer midwives which were transcribed, analysed and presented informed by van Manen's approach. Findings Thematic analysis revealed six main themes: "Finding ways to connect with the women", "building support networks – supporting with and through Aboriginal cultural knowledge", "managing the perceived barriers to effective care", "perceived equity is treating women the same", "understanding culture" and "assessing cultural needs – urban versus rural/remote Aboriginal cultural needs". Conclusion The midwives in this study have shared their stories of caring for Aboriginal women. They have identified communication and building support with Aboriginal health workers and families as important. They have identified perceived barriers to the provision of care, and misunderstanding around the interpretation of cultural safety in practice was found. Suggestions are made to support midwives in their practice and improve the experiences for Aboriginal women.

Background: Increasing numbers of children with complex health needs are being cared for in their own homes. Caring for a child with complex health needs is an enormous task for a family and so access to suitable respite is critical for the wellbeing of all members of the family. Aim: The aim of this study was to explore the concept of 'suitable' respite from the perspective of the carer and whether suitable respite is currently available. Method: A qualitative descriptive approach was used. Five people who acted as a carer for a child with complex health agreeing to participate in the study. Semi-structured interviews were conducted in the home of the carers and interview data analyses with a thematic analysis. Results: This study identified some of the barriers and enablers for families when accessing respite services for children with complex health needs. Carers describe optimal respite for these children to be similar to a family home with suitable facilities, equipment and activities for children. Flexible respite services and enthusiastic competent staff were considered very important by the family carers. Conclusion: Further research is needed to better understand the complexities of care for CWCHN and to identify effective strategies to support family carers.

Background: Induction of labor, an increasingly common intervention, is often preceded by the application of an agent to prime or ripen the cervix. We conducted a randomized controlled trial to compare clinical, economic, and psychosocial outcomes of inpatient and outpatient cervical priming before induction of labor. In this paper we present the psychosocial outcomes. Methods: Women participating in a randomized controlled trial in two Australian metropolitan teaching hospitals completed questionnaires to measure anxiety and depression at enrollment, and to examine satisfaction, experiences, depression, and infant feeding 7weeks after giving birth. Data analysis was by intention to treat and by having received the intervention as intended (approximately 50% in each group). Results: Of 1,004 eligible women, 85 percent consented (n=407, outpatient; n=414 inpatient). No statistically significant or clinically relevant differences were found in immediate anxiety, depression, or infant feeding. Small, statistically significant differences favoring outpatient priming were found in seven of the nine subscales in the 7-week postpartum questionnaire. The direction of the effect was maintained, mostly with a larger effect size in women who received the intervention. Conclusion: Women allocated to outpatient priming were more satisfied with their priming experience than women allocated to inpatient priming. Being informed that they could go home after cervical priming did not increase women's anxiety. Refereed/Peer-reviewed