Universal for whom? Evaluating an urban Aboriginal population’s access to a mainstream universal health home visiting program
John Widdup A , Elizabeth J. Comino A B , Vana Webster A and Jennifer Knight AA Centre for Primary Health Care and Equity, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia. Email: z3298958@unsw.edu.au; v.webster@unsw.edu.au; knightj@unsw.edu.au
B Corresponding author. Email: e.comino@unsw.edu.au
Australian Health Review 36(1) 27-33 https://doi.org/10.1071/AH10961
Submitted: 30 August 2010 Accepted: 29 April 2011 Published: 9 February 2012
Journal Compilation © CSIRO Publishing 2012 Open Access CC BY-NC-ND
Abstract
Objective. To investigate access to a Universal Health Home Visit program for families of Aboriginal and non-Aboriginal 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 non-Aboriginal 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.
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