title: Health behaviour modelling for prenatal diagnosis in Australia: a geodemographic framework for health service utilisation and policy development.
abstract: BACKGROUND
  Despite the wide availability of prenatal screening and diagnosis, a number of studies have reported no decrease in the rate of babies born with Down syndrome. The objective of this study was to investigate the geodemographic characteristics of women who have prenatal diagnosis in Victoria, Australia, by applying a novel consumer behaviour modelling technique in the analysis of health data.
  
  
  METHODS
  A descriptive analysis of data on all prenatal diagnostic tests, births (1998 and 2002) and births of babies with Down syndrome (1998 to 2002) was undertaken using a Geographic Information System and socioeconomic lifestyle segmentation classifications.
  
  
  RESULTS
  Most metropolitan women in Victoria have average or above State average levels of uptake of prenatal diagnosis. Inner city women residing in high socioeconomic lifestyle segments who have high rates of prenatal diagnosis spend 20% more on specialist physician's fees when compared to those whose rates are average. Rates of prenatal diagnosis are generally low amongst women in rural Victoria, with the lowest rates observed in farming districts. Reasons for this are likely to be a combination of lack of access to services (remoteness) and individual opportunity (lack of transportation, low levels of support and income). However, there are additional reasons for low uptake rates in farming areas that could not be explained by the behaviour modelling. These may relate to women's attitudes and choices.
  
  
  CONCLUSIONS
  A lack of statewide geodemographic consistency in uptake of prenatal diagnosis implies that there is a need to target health professionals and pregnant women in specific areas to ensure there is increased equity of access to services and that all pregnant women can make informed choices that are best for them. Equally as important is appropriate health service provision for families of children with Down syndrome. Our findings show that these potential interventions are particularly relevant in rural areas. Classifying data to lifestyle segments allowed for practical comparisons of the geodemographic characteristics of women having prenatal diagnosis in Australia at a population level. This methodology may in future be a feasible and cost-effective tool for service planners and policy developers.
authors.affiliation: Public Health Genetics, Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Victoria, 3052, Australia. evi.muggli@mcri.edu.au
authors.forename: Evelyne E
authors.initials: EE
authors.lastname: Muggli
authors.forename: David
authors.initials: D
authors.lastname: McCloskey
authors.forename: Jane L
authors.initials: JL
authors.lastname: Halliday
mesh_terms: D000328:Adult; D017677:Age Distribution; D000649:Amniocentesis / Q000706:statistics & numerical data*; D015193:Chorionic Villi Sampling / Q000706:statistics & numerical data*; D003710:Demography; D004314:Down Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics; D005260:Female; D005843:Geography; D006801:Humans; D008423:Maternal Age; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D011247:Pregnancy; D012111:Residence Characteristics; D012424:Rural Population; D014505:Urban Population; D014739:Victoria / Q000453:epidemiology