title: Challenges to Providing Fetal Anomaly Testing in a Cross-Cultural Environment: Experiences of Practitioners Caring for Aboriginal Women.
abstract: BACKGROUND
  Across Australia there are substantial disparities in uptake of antenatal testing for fetal anomalies, with very low uptake observed among Aboriginal women. The reasons behind these disparities are unclear, although poorer access to testing has been reported in some communities. We interviewed health care practitioners to explore the perceived barriers to providing fetal anomaly screening to Aboriginal women.
  
  
  METHODS
  In 2009 and 2010, in-depth interviews were undertaken with 59 practitioners in five urban and remote sites across the Northern Territory (NT) of Australia. Data were analyzed thematically. Maximum variation sampling, independent review of findings by multiple analysts, and participant feedback were undertaken to strengthen the validity of findings.
  
  
  RESULTS
  Participants included midwives (47%), Aboriginal health practitioners (AHP) (32%), general practitioners (12%), and obstetricians (9%); almost all (95%) were female. Participants consistently reported difficulties counseling women. Explaining the concept of "risk" (of abnormalities and the screening test result) was identified as particularly challenging, because of a perceived lack of an equivalent concept in Aboriginal languages. While AHPs could assist with overcoming language barriers, they are underutilized. Participants also identified impediments to organizing testing including difficulties establishing gestational age, late presentation for care, and a lack of standardized information and training.
  
  
  CONCLUSIONS
  The availability of fetal anomaly testing is challenged by communication difficulties, including a focus on culturally specific biomedical concepts, and organizational barriers to arranging testing. Developing educational activities that address the technical aspects of screening and communication skills will assist in improving access. These activities must include AHPs.
authors.affiliation: The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia.
authors.forename: Alice R
authors.initials: AR
authors.lastname: Rumbold
authors.affiliation: Institute of Human Security and Social Change, La Trobe University, Melbourne, Vic., Australia.
authors.forename: Kayli J
authors.initials: KJ
authors.lastname: Wild
authors.affiliation: Yalu Marnggithinyaraw Research Centre, Galiwinku, NT, Australia.
authors.forename: Elaine Lawurrpa
authors.initials: EL
authors.lastname: Maypilama
authors.affiliation: Mater Health Service, Mater Research Institute & School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, QLD, Australia.
authors.forename: Sue V
authors.initials: SV
authors.lastname: Kildea
authors.affiliation: University Centre for Rural Health, a collaboration between The University of Sydney, University of Western Sydney, University of Wollongong, Southern Cross University with NNSW Local Health District, Sydney, NSW, Australia.
authors.forename: Lesley
authors.initials: L
authors.lastname: Barclay
authors.affiliation: The Ritchie Centre and the Carl Wood Chair of Obstetrics and Gynaecology at Monash University, Melbourne, Vic., Australia.
authors.forename: Euan M
authors.initials: EM
authors.lastname: Wallace
authors.affiliation: Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia.
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: Boyle
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001315:Australia / Q000453:epidemiology; D003144:Communication Barriers; D000013:Congenital Abnormalities / Q000175:diagnosis / Q000208:ethnology; D054521:Cultural Competency / Q000458:organization & administration; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D020380:Needs Assessment; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data
keywords: Aboriginal; fetal anomaly screening; health practitioners; qualitative