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Dr Amie Steel

Postdoctoral Research Fellow, Faculty of Health
Health Services Research
 
Can supervise: Yes

Chapters

Prior, J., Dunston, R., Kroll, T., Adams, J. & Steel, A. 2017, 'Traditional, complementary and integrative medicine and global health challenges' in Adams, J. & et al (eds), Public Health and Health Services Research in Traditional, Complementary and Integrative Medicine: International Perspectives, Imperial College Press, London.
Peng, W., Sibbritt, D., Steel, A. & Adams, J. 2017, 'Women's Health and Complementary and Integrative Medicine' in Women's Health and Complementary and Integrative Medicine, Routledge.
Steel, A., Hall, H., Frawley, J.E., Aiyepola & Adams, J. 2017, 'Pregnancy and CIM' in Adams, J., Steel, A. & Broom, A. (eds), Women's Health and Complementary and Integrative Medicine, Routledge, London, UK.
Adams, J., Hollenberg, D., Broom, A., Steel, A.E., Sibbritt, D. & Lui, C. 2013, 'Integration in Primary Health Care: A focus upon practice and education and the importance of a critical social science perspective' in Adams, J., Magin, P. & Broom, A. (eds), Primary Health Care and Complementary and Integrative Medicine, Imperial College Press, London, pp. 203-227.
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In this chapter we argue that the mainstream work and commentary around integrative health care and education has often lacked a critical social science perspective
Steel, A.E., Frawley, J.E., Adams, J., Sibbritt, D. & Broom, A. 2013, 'Primary Health Care, Complementary and Alternative Medicine and Women's Health: A Focus Upon Menopause' in Adams, J., Magin, P. & Broom, A. (eds), Primary Health Care and Complementary and Integrative Medicine, Imperial College Press, London, pp. 11-33.
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Australian Women are integrating primary health care and complementary and alternative medicine to alleviate a range of symptoms and conditions. This chapter introduces the use of CAM for women's health in general and more particularly, explores the integration of CAM alongside mainstream primary health care
Adams, J., Lui, C., Sibbritt, D., Broom, A., Wardle, J., Homer, C.S., Steel, A.E. & Beck, S. 2012, 'Women's use of complementary and alternative medicine during pregnancy: A critical review of the literature' in Adams, J., Andrews, G., Barnes, J., Broom, A. & Magin, P. (eds), Traditional, Complementary and Integrative Medicine, Palgrave Macmillan, Basingstoke, pp. 35-43.
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The use of complementary and alternative medicine has attracted much attention and debate in recent years. The objective of this critical review is to examine the evidence base on use of complementary products and therapies during pregnancy. It examines an important but neglected issue in maternity care. Methods: A database search was conducted in MEDLINE, CINAHL, AMED, and Maternity and Infant Care. A total of 24 papers published between 1999 and 2008 met the selection criteria and were included in the review. Results: Findings of these 24 papers were extracted and reported under four themes: "user prevalence and profile," "motivation and condition of use," "perception and self-reported evaluation," and "referral and information sources." Conclusions: This review highlights four research gaps in the literature, a lack of: large representative samples; in-depth understanding of user experiences and risk perceptions; research comparing consumption patterns across cultures and over time; and work exploring the nature of the therapeutic encounter with complementary practitioners in this area of women's health care.
Adams, J., Sibbritt, D., Broom, A., Wardle, J., Steel, A.E., Murthy, V. & Daley, J. 2012, 'Research capacity building in traditional, complementary and integrative medicine: Grass-roots action towards a broader vision' in Adams, J., Andrews, G., Barnes, J., Broom, A. & Magin, P. (eds), Traditional, Complementary and Integrative Medicine, Palgrave Macmillan, London, pp. 275-281.
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Developing capacity to undertake health research effectively is an integral component of national and global health research systems (Lansang and Dennis, 2004) and is essential to producing a sound evidence base for decision making in policy and practice (Cooke, 2005). Moreover, research capacity building (RCB) - nurturing and producing sustainable increased capacity for future research endeavours - is important fOr all health research fields and TCIM is no exception (Andrews, 2006; Adams, 2007). There is currently a great opportunity to embrace RCB in relation to TCIM in order to help develop an evidence base and a stronger and more robust research culture among scholars and practitioners alike.
Wardle, J. & Steel, A.E. 2010, 'Fertility, preconception care and pregnancy' in Sarris, J. & Wardle, J. (eds), Clinical Naturopathy: An evidence-based guide to practice, Churchill Livingstone, Sydney, pp. 622-652.

Conferences

Steel, A. & Frawley, J. 2015, 'Steel A, Frawley J, Adams J, Sibbritt D, Broom A. (2015). 'The labour and birth outcomes associated with the use of herbal medicine in pregnancy.' NHAA International Conference on Herbal Medicine. Sydney, 20-22 March 2015.'.
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Frawley, J. & Steel, A. 2014, 'Frawley J, Steel A. (2014). 'Complementary and alternative medicine (CAM) use during pregnancy: Navigating safe maternity care.' PHAA 43rd Annual Conference, The future of public health: big challenges, big opportunities, Perth, Australia.'.
Steel, A., Sibbritt, D., Adams, J. & Frawley, J. 2014, 'Steel A, Sibbritt D, Adams J, Frawley J, Broom A, Gallois C. (2014). 'The Association Between Women's Choice of Birth Setting and Their Use of CAM During Labor and Birth.' 2014 International Research Congress on Integrative Medicine and Health, Miami, US.'.
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Steel, A., Adams, J., Broom, A., Sibbritt, D. & Frawley, J. 2014, 'Steel A, Adams J, Broom A, Sibbritt D, Frawley J. (2014). 'Marginalization and Companionable Silence: CAM Practitioners' Perspectives of Their Interprofessional Relationships with Maternity Care Providers.' 2014 International Research Congress on Integrative Medicine and Health, Miami, US.'.
Steel, A., Adams, J., Sibbritt, D., Broom, A. & Frawley, J.E. 2013, 'Steel A, Adams J, Sibbritt D, Broom A, Frawley J. (2013). 'The influence of complementary and alternative medicine use in pregnancy on pain management in labour and birth outcomes' presented at the 2013 International Research Congress on Integrative Medicine and Health, London, UK.'.
Steel, A. & Frawley, J. 2013, 'Steel A, Frawley J. (2013). 'Managing chronic degenerative joint conditions in naturopathic practice' presented at presented at the 2013 International Research Congress on Integrative Medicine and Health, London, UK.'.

Journal articles

Frawley, J., Sibbritt, D., Steel, A., Chang, S. & Adams, J. 2017, 'Complementary and Conventional Health-care Utilization Among Young Australian Women With Urinary Incontinence.', Urology, vol. 99, pp. 92-99.
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OBJECTIVE: To examine the relationship between health status and health service utilization (including conventional and complementary and alternative medicine [CAM]) accessed by women experiencing urinary incontinence (UI). Although a high number of younger women report symptoms of UI, such as leaking urine, only a small proportion seek help for these symptoms. MATERIALS AND METHODS: The Australian Longitudinal Study on Women's Health is a large nationally representative study that investigates the health and well-being of women. The 2 most recent surveys (2006 and 2009) of the young cohort (women aged 28-33 and 31-36 respectively) were analyzed. RESULTS: The presence of UI was 8.5% in 2006 (n=859) and 23.3% in 2009 (n=1878), whereas the percentage of women who sought help for their UI was 18.6% (n=160) and 2.2% (n=182) respectively. Women with UI had poorer health compared with women without UI (P<.005), and women who sought help for their symptoms had poorer physical functioning than women who did not (P<.005). Women who sought help were greater users of conventional and CAM health services (P<.005), including a general practitioner, specialist, hospital doctor, physiotherapist, and naturopath. CONCLUSION: UI is relatively common in younger women. However, many do not seek help. Of the women who do seek care, a large number visit CAM professionals as well as conventional medical professionals, despite a lack of research evaluating the efficacy of CAM treatment. Research is needed to explore CAM practitioner approaches to the treatment of UI and to evaluate the efficacy of these treatments.
Steel, A., Adams, J. & Sibbritt, D. 2017, 'The Characteristics of Women Who Use Complementary Medicine While Attempting to Conceive: Results from a Nationally Representative Sample of 13,224 Australian Women.', Womens Health Issues, vol. 27, no. 1, pp. 67-74.
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BACKGROUND: Preconception is acknowledged globally as an important part of ensuring health for the next generation and is underpinned by principles of health promotion and preventive medicine. There is a demand for more holistic, preventive health care within preconception health services. Many women are also using complementary medicine during their reproductive years. MATERIALS AND METHODS: This paper presents a longitudinal analysis of women's consultations with a complementary medicine practitioner while attempting to become pregnant, and the characteristics of women who choose to consult a complementary medicine practitioner during the preconception period. The cross-sectional and longitudinal analyses conducted in this study utilise data from the 1973 through 1978 cohort of the Australian Longitudinal Study on Women's Health (n&nbsp;=&nbsp;13,224). Multivariate logistic regression models and generalized estimating equation models, with and without time lag, were used. RESULTS: Women who identified as attempting to conceive were more likely to consult with an acupuncturist (adjusted odds ratio, 1.46) or a naturopath/herbalist (adjusted odds ratio, 1.30). Women who consulted with an acupuncturist were likely to be consulting with a specialist doctor (odds ratio, 3.73) and/or have previous fertility issues (odds ratio, 2.30). Women who consulted with a naturopath were more likely to report experiencing premenstrual tension (odds ratio, 2.30) but less likely to have had a previous miscarriage (odds ratio, 0.18). CONCLUSIONS: Policymakers and other health professionals need to be aware that health professionals who are largely unregulated and structurally isolated from conventional health care may be actively contributing to women's reproductive and physical health during the preconception period.
Steel, A., Sundberg, T., Reid, R., Ward, L., Bishop, F.L., Leach, M., Cramer, H., Wardle, J. & Adams, J. 2017, 'Osteopathic manipulative treatment: A systematic review and critical appraisal of comparative effectiveness and health economics research.', Musculoskeletal Science and Practice, vol. 27, pp. 165-175.
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In recent years, evidence has emerged regarding the effectiveness of osteopathic manipulative treatments (OMT). Despite growing evidence in this field, there is need for appropriate research designs that effectively reflect the person-centred system of care promoted in osteopathy and provide data which can inform policy decisions within the healthcare system. The purpose of this systematic review is to identify, appraise and synthesise the evidence from comparative effectiveness and economic evaluation research involving OMT. A database search was conducted using CINAHL, PubMed, PEDro, AMED, SCOPUS and OSTMED.DR, from their inception to May 2015. Two separate searches were undertaken to identify original research articles encompassing the economic evaluation and comparative effectiveness of OMT. Identified comparative effectives studies were evaluated using the Cochrane risk of bias tool and appraised using the Good Reporting of Comparative Effectiveness (GRACE) principles. Identified economic studies were assessed with the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines. Sixteen studies reporting the findings of comparative effectiveness (n&nbsp;=&nbsp;9) and economic evaluation (n&nbsp;=&nbsp;7) research were included. The comparative effectiveness studies reported outcomes for varied health conditions and the majority (n&nbsp;=&nbsp;6) demonstrated a high risk of bias. The economic evaluations included a range of analyses and considerable differences in the quality of reporting were evident. Despite some positive findings, published comparative effectiveness and health economic studies in OMT are of insufficient quality and quantity to inform policy and practice. High quality, well-designed, research that aligns with international best practice is greatly needed to build a pragmatic evidence base for OMT.
Adams, J., Lauche, R., Peng, W., Steel, A., Moore, C., Amorin-Woods, L.G. & Sibbritt, D. 2017, 'A workforce survey of Australian chiropractic: the profile and practice features of a nationally representative sample of 2,005 chiropractors.', BMC Complementary and Alternative Medicine, vol. 17, no. 1, pp. 1-8.
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BACKGROUND: This paper reports the profile of the Australian chiropractic workforce and characteristics of chiropractic care from a large nationally-representative sample of practitioners. METHODS: A 21-item questionnaire examining practitioner, practice and clinical management characteristics was distributed to all registered chiropractors (n=4,684) in Australia in 2015 via both online and hard copy mail out. RESULTS: The survey attracted a response rate of 43% (n=2,005), and the sample is largely representative of the national chiropractic workforce on a number of key indicators. The average age of the chiropractors was 42.1&nbsp;years, nearly two-thirds are male, and the vast majority hold a bachelor degree or higher qualification. Australian chiropractors are focused upon treating people across a wide age range who mainly present with musculoskeletal conditions. Australian chiropractors have referral relationships with a range of conventional, allied health and complementary medicine (CAM) providers. CONCLUSION: The chiropractic profession represents a substantial component of the contemporary Australian health care system with chiropractors managing an estimated 21.3 million patient visits per year. While the Australian chiropractic workforce is well educated, research engagement and research capacity remains sub-optimal and there is much room for further capacity building to help chiropractic reach full potential as a key integrated profession within an evidence-based health care system. Further rich, in-depth research is warranted to improve our understanding of the role of chiropractic within the Australian health care system.
Steel, A., Sibbritt, D., Schloss, J., Wardle, J., Leach, M., Diezel, H. & Adams, J. 2017, 'An Overview of the Practitioner Research and Collaboration Initiative (PRACI): a practice-based research network for complementary medicine.', BMC Complement Altern Med, vol. 17, no. 1, p. 87.
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BACKGROUND: The Practitioner Research and Collaboration Initiative (PRACI) is an innovative, multi-modality practice-based research network (PBRN) that represents fourteen complementary medicine (CM) professions across Australia. It is the largest known PBRN for complementary healthcare in the world and was launched in 2015. The purpose of this paper is to provide an update on the progress of the PRACI project, including a description of the characteristics of PRACI members in order to facilitate further sub-studies through the PRACI PBRN. METHODS: A CM workforce survey was distributed electronically to CM practitioners across fourteen disciplines, throughout Australia. Practitioners electing to become a member of PRACI were registered on the PBRN database. The database was interrogated and the data analysed to described sociodemographic characteristics, practice characteristics, professional qualification and practice interest of PRACI members. RESULTS: Foundational members of PRACI were found to be predominately female (76.2%) and middle-aged (82.5%). Members were primarily located in urban settings (82.5%) across the Eastern seaboard of Australia (82.5%), with few working remotely. The main modalities represented include massage therapists (58.5%), naturopaths (26.4%) and nutritionists (14.4%). The primary area of clinical interest for PRACI members were general health and well-being (75.4%), musculoskeletal complaints (72%) and pain management (62.6%). CONCLUSIONS: PRACI provides an important infrastructure for complementary healthcare research in Australia and its success relies on CM practitioners being involved in the research being conducted through the PBRN. The aim of this database is to ensure that the research conducted through PRACI is rigorous, robust, clinically relevant and reflects the diversity of clinical practice amongst CM practitioners in Australia.
Steel, A., Sundberg, T., Reid, R., Ward, L., Bishop, F., Leach, M., Cramer, H., Wardle, J. & Adams, J. 2017, 'Corrigendum to "Osteopathic manipulative treatment: A systematic review and critical appraisal of comparative effectiveness and health economics research" [Musculoskelet. Sci. Pract. 27 165-175].', Musculoskelet Sci Pract, vol. 30, p. 86.
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Steel, A., Blaich, R., Sundberg, T. & Adams, J. 2017, 'The role of osteopathy in clinical care: Broadening the evidence-base', International Journal of Osteopathic Medicine.
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&copy; 2017 Elsevier Ltd.Osteopathy is a system of health care practiced in various countries throughout the world that focuses on osteopathic manual techniques as a cornerstone of patient care. However, we still know little about the practice, role and use of osteopathy within the broader health system in most countries. With this in mind, this paper proposes a possible framework for advancing further research on this topic. The framework is divided into issues associated with core stakeholders including health consumers, osteopaths, other health professionals, and policymakers and funding bodies. The development of a rigorous health services research agenda around this topic has much to offer and the framework outlined here is offered with the hope of inspiring a broader field of inquiry into osteopathy in the clinical care setting.
Adams, J., Steel, A., Frawley, J., Broom, A. & Sibbritt, D. 2017, 'Substantial out-of-pocket expenditure on maternity care practitioner consultations and treatments during pregnancy: estimates from a nationally-representative sample of pregnant women in Australia.', BMC Pregnancy Childbirth, vol. 17, no. 1, p. 114.
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BACKGROUND: A wide range of health care options are utilised by pregnant women in Australia. The out-of-pocket costs of maternity care in Australia vary depending on many factors including model of care utilised, health insurance coverage, and women's decision to access health services outside of conventional maternity care provision. METHODS: Women from the 1973-78 cohort of the Australian Longitudinal Study on Women's Health (ALSWH) who identified as pregnant or as recently having given birth in 2009 were invited to complete a sub-study questionnaire investigating health service utilisation during their most recent pregnancy. RESULTS: A total of 1,835 women agreed to participate in the sub-study. The majority of women (99.8%) consulted with a conventional health care practitioner during pregnancy, 49.4% consulted with a complementary and alternative medicine practitioner at least once during pregnancy and 89.6% of the women used a complementary and alternative medicine product. Women reported an average of AUD$781.10 in out-of-pocket expenses for consultations with conventional health care practitioners, AUD$185.40 in out-of-pocket expenses for consultations with complementary and alternative medicine practitioners and AUD$179.60 in out-of-pocket expenses for complementary and alternative medicine products. From the study data we estimate Australian pregnant women spend over AUD$337&nbsp;M on out-of-pocket health services. CONCLUSION: While the majority of pregnant women in Australia may obtain health services via the publically-funded health care system and/or private health insurance coverage, our analysis identifies substantial out-of-pocket expenditure for health care by pregnant women - a trend in public spending for maternity care of importance to policy makers, health administrators, and health professionals.
Foley, H. & Steel, A. 2017, 'Patient perceptions of clinical care in complementary medicine: A systematic review of the consultation experience', Patient Education and Counseling, vol. 100, no. 2, pp. 212-223.
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Foley, H. & Steel, A. 2017, 'Patient perceptions of patient-centred care, empathy and empowerment in complementary medicine clinical practice: A cross-sectional study', Advances in Integrative Medicine.
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Foley, H. & Steel, A. 2017, 'The Nexus Between Patient-Centered Care and Complementary Medicine: Allies in the Era of Chronic Disease?', The Journal of Alternative and Complementary Medicine, vol. 23, no. 3, pp. 158-163.
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Steel, A. & Reid, R. 2017, 'A need for a better understanding of the role, value and effectiveness of complementary and integrative medicine for women with endometriosis', Advances in Integrative Medicine.
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Frawley, J., Sundberg, T., Steel, A., Sibbritt, D., Broom, A. & Adams, J. 2016, 'Prevalence and characteristics of women who consult with osteopathic practitioners during pregnancy; a report from the Australian Longitudinal Study on Women's Health (ALSWH).', Journal of Bodywork and Movement Therapies, vol. 20, no. 1, pp. 168-172.
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The use of complementary medicine (CM) is common during pregnancy with visits to osteopathic practitioners growing in recent years. This study was conducted to investigate the prevalence and characteristics of women who consult osteopathic practitioners during pregnancy.The study sample was obtained via the Australian Longitudinal Study on Women's Health (ALSWH). The women answered questions about consultations with osteopathic practitioners, pregnancy-related health concerns and attitudes to CM use.A total response rate of 79.2% (1835) was obtained. Of these, 104 women (6.1%) consulted with an osteopath during pregnancy for a pregnancy-related health condition. Women were more likely to consult an osteopath if they suffered from back pain, sadness, weight management issues, or had a history of retained placenta.Women are visiting osteopaths for help with common pregnancy health complaints, highlighting the need for research to evaluate the safety, clinical and cost effectiveness of osteopathy in pregnancy.
Hall, H., Lauche, R., Adams, J., Steel, A., Broom, A. & Sibbritt, D. 2016, 'Healthcare utilisation of pregnant women who experience sciatica, leg cramps and/or varicose veins: A cross-sectional survey of 1835 pregnant women', Women and Birth, vol. 29, no. 1, pp. 35-40.
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Lauche, R., Hall, H., Adams, J., Steel, A., Broom, A. & Sibbritt, D. 2016, 'Health-care utilisation amongst pregnant women who experience sleeping problems and/or tiredness or fatigue: secondary analysis of a cross-sectional survey of 1835 pregnant women.', Sleep & breathing = Schlaf & Atmung, vol. 20, no. 1, pp. 355-362.
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Sleeping problems and fatigue in pregnancy are often accepted as a normal part of pregnancy; however, these conditions can be linked to serious consequences for both the mother and child. Despite established links between sleeping disturbance and a wide range of pregnancy complications, little is known about the health-care utilisation of women experiencing sleeping problems and fatigue. This study addresses the existing gap in the literature by examining cross-sectional data to identify health service utilisation patterns of pregnant women experiencing sleeping problems and/or tiredness or fatigue.In 2010, a sub-study of the Australian Longitudinal Study on Women's Health was conducted as a cross-sectional survey of 2445 women who had recently given birth. Associations between reported symptoms of sleeplessness and/or tiredness or fatigue and health service utilisation were determined using logistic regression analysis.During their pregnancy, 15.2&nbsp;% of women experienced sleeping problems while 35.4&nbsp;% experienced tiredness or fatigue. Women most commonly consulted with an obstetrician (n=96) or a general practitioner (GP) (n=74) for their tiredness or fatigue rather than a midwife (n=56). A substantial number of women sought help from a complementary and alternative medicine (CAM) practitioner for sleeping problems (33&nbsp;%) or tiredness/fatigue (28&nbsp;%).Sleeping problems and/or tiredness or fatigue is reported by a reasonable percentage of pregnant women, and women obtain assistance from conventional and CAM practitioners for their symptoms, but not all seek help. Given the serious implications of untreated sleep- and fatigue-related symptoms for mother and baby, this area of research deserves and requires more attention.
Frawley, J., Sibbritt, D., Broom, A., Gallois, C., Steel, A. & Adams, J. 2016, 'Women's attitudes towards the use of complementary and alternative medicine products during pregnancy.', Journal of Obstetrics and Gynaecology, vol. 36, no. 4, pp. 462-467.
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The aim of this study was to analyse women's attitudes towards the use of complementary and alternative medicine (CAM) products during pregnancy. The study sample was obtained via the Australian Longitudinal Study on Women's Health or ALSWH. A response rate of 79.2% (n = 1,835) was attained. Women who use herbal medicines (34.5%, n = 588) view CAM as a preventative measure, are looking for something holistic and are concerned about evidence of clinical efficacy when considering the use of these products during pregnancy. Women who use aromatherapy (17.4%, n = 319) and homoeopathy (13.3%, n = 244) want more personal control over their body and are concerned more about their own personal experience of the efficacy of CAM than clinical evidence of efficacy. As CAM use in pregnancy appears to be increasingly commonplace, insights into women's attitudes towards CAM are valuable for maternity healthcare providers.
Cramer, H., Ward, L., Steel, A., Lauche, R., Dobos, G. & Zhang, Y. 2016, 'Prevalence, Patterns, and Predictors of Yoga Use Results of a US Nationally Representative Survey', AMERICAN JOURNAL OF PREVENTIVE MEDICINE, vol. 50, no. 2, pp. 230-235.
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Frawley, J., Sibbritt, D., Broom, A., Gallois, C., Steel, A. & Adams, J. 2016, 'Complementary and alternative medicine practitioner use prior to pregnancy predicts use during pregnancy.', Women and Health, vol. 56, no. 8, pp. 926-939.
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The objective of this study was to determine if prior visits to a complementary and alternative medicine (CAM) practitioner were associated with CAM use during pregnancy. The study sample comprised the Australian Longitudinal Study on Women's Health. Women were surveyed prior to pregnancy in 2006, and then again in 2010 if they were pregnant or had recently given birth, and asked a range of questions relating to demographic variables, health status and use of CAM. A multivariable analysis identified significant covariates associated with visits to specific CAM practitioner modalities during pregnancy. Of the 447 women who consulted a CAM practitioner prior to pregnancy, 62.4% (n&nbsp;=&nbsp;279) continued this use during pregnancy. Prior use of massage therapy, acupuncture, herbalist/naturopath or chiropractor was related to use of the same service during pregnancy. Higher income and working full-time were associated with the continued use of massage, while continued visits to a chiropractor were associated with having depressive symptoms, a urinary tract infection and living in a rural community. Prior use of CAM was highly related to continuing use during pregnancy. Further research is required to elucidate the benefits women attain from a CAM-model of care that they do not get from their conventional maternity care providers alone.
Steel, A., Frawley, J., Sibbritt, D., Broom, A. & Adams, J. 2016, 'The characteristics of women who use hypnotherapy for intrapartum pain management: Preliminary insights from a nationally-representative sample of Australian women', Complementary Therapies in Medicine, vol. 25, pp. 67-70.
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Wardle, J.L., Sibbritt, D., Broom, A., Steel, A. & Adams, J. 2016, 'Is Health Practitioner Regulation Keeping Pace with the Changing Practitioner and Health-Care Landscape? An Australian Perspective.', Frontiers in public health, vol. 4, p. 91.
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Health-care delivery is undergoing significant evolution and change. Task substitution has resulted in some practitioner groups expanding their scope of practice by assuming more complex clinical roles, new practitioner groups have emerged, and consumer-driven demand has changed the way the public engage with health practitioners and the way many health-care services are delivered. Using Australia as a case study, this paper explores the issue of the hesitancy to include new professions in health professions regulation schemes. Despite the significant changes in the health-care delivery landscape, policy development in this area has remained relatively static, with active resistance to extending formal registration to new practitioner groups. Ignoring the issue of new practitioner groups in regulatory schemes is unacceptable from a public health perspective and runs against the key public protection objectives of health practitioner regulation. Development of pathways for the entry of new health practitioner groups into regulatory schemes must be developed as a matter of priority.
Reid, R., Steel, A., Wardle, J., Trubody, A. & Adams, J. 2016, 'Complementary medicine use by the Australian population: A critical mixed studies systematic review of utilisation, perceptions and factors associated with use', BMC Complementary and Alternative Medicine, vol. 16, no. 1.
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Wardle, J., Frawley, J., Steel, A. & Sullivan, E. 2016, 'Complementary medicine and childhood immunisation: A critical review.', Vaccine, vol. 34, no. 38, pp. 4484-4500.
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Vaccination is one of the most significant and successful public health measures of recent times. Whilst the use of complementary medicine (CM) continues to grow, it has been suggested that CM practitioners hold anti-vaccination views. The objective of this critical review is to examine the evidence base in relation to CM practitioner attitudes to childhood vaccination alongside attitudes to vaccination among parents who visit CM practitioners and/or use CM products.A database search was conducted in MEDLINE, PubMed, CINAHL, EMBASE and AMED for research articles published between January 2000 and September 2015 that evaluated either CM practitioner or CM user attitudes and intention towards childhood vaccination.A total of 23 articles were found that detailed the attitudes of CM practitioners to vaccination. A further 16 papers examined the association between the use of CM products and visits to CM practitioners, and immunisation. The interface between CM and vaccination is complex, multi-factorial and often highly individualised. The articles suggest that there is no default position on immunisation by CM practitioners or parents who use CM themselves, or for their children. Although CM use does seem positively associated with lower vaccination uptake, this may be confounded by other factors associated with CM use (such as higher income, higher education or distrust of the medical system), and may not necessarily indicate independent or predictive relationships.Although anti-vaccination sentiment is significant amongst some CM practitioners, this review uncovers a more nuanced picture, and one that may be more agreeable to public health values than formerly assumed.
Steel, A., Cramer, H., Leung, B., Lauche, R., Adams, J., Langhorst, J. & Dobos, G. 2016, 'Characteristics of Homeopathy Users among Internal Medicine Patients in Germany', Forschende Komplementaermedizin: Wissenschaft Praxis Perspektiven, vol. 23, no. 5, pp. 284-289.
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Background Homeopathy use continues to grow in many European countries, and some studies have examined the characteristics of patients using homeopathy within the general population. The aim of this study was to identify predictors for homeopathy use among internal medicine patients. Patients and Methods A cross-sectional analysis was conducted among all patients being referred to the Department of Internal and Integrative Medicine at Essen, Germany, over a 3-year period. The analysis examined whether patients had used homeopathy for their primary medical complaint before, the perceived benefit, and the perceived harm of homeopathy use. Odds ratios with 95% confidence intervals were calculated using multiple logistic regression analysis. Results Of 2,045 respondents, 715 (35.0%) reported having used homeopathy for their primary medical complaint (diagnosis according to the International Statistical Classification of Diseases and Related Health Problems), with 359 (50.2%) reporting perceived benefits and 15 (2.1%) reporting harm. Homeopathy use was positively associated with female gender, high school level education, suffering from fibromyalgia or subthreshold depression, and being fast food abstinent, while patients with osteoarthritis, spinal or other pain, smokers, and patients with a high externalsocial health locus of control were less likely to use homeopathy. Conclusion Personal characteristics and health status may impact on the use and the perceived helpfulness of homeopathy.
Steel, A., Lucke, J., Reid, R. & Adams, J. 2016, 'A systematic review of women's and health professional's attitudes and experience of preconception care service delivery.', Family practice, vol. 33, no. 6, pp. 588-595.
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The value and importance of preconception care (PCC) have been acknowledged by leading health organizations as a vital element within preventive medicine and health promotion for the wider population. The translation of PCC from position statement to relevant service and programme delivery is essential for the benefits of PCC to be realized and relies on insights from health services research. This article aims to review contemporary health services research literature examining women's and health professionals' perceptions and experiences of PCC services.A systematic review of original research published between 2003 and 2015 was conducted in November 2015. Multiple databases (PubMed, CINAHL, AMED and Maternity and Infant Care) were searched through two distinct searches to capture research literature reporting the perspective of health professionals and women towards PCC service delivery.The search identified 13 papers (4 reported the perceptions of women, 11 described the views of health professionals [2 papers reported findings from both groups]). The analyses of the contemporary literature revealed five broad areas of focus: women's service needs regarding PCC, PCC training and education requirements, role delineation around PCC, priority and value of PCC and barriers and obstacles to PCC.Despite the mounting evidence supporting the value and importance of PCC, there is insufficient research attention given to the clinical reality of PCC service and programme delivery. The transfer of PCC guidelines from broad policy to grass roots practice requires a more detailed consideration of the practicalities of implementing PCC within contemporary women's health care.
Steel, A., Adams, J., Frawley, J., Wardle, J., Broom, A., Sidebotham, M. & Sibbritt, D. 2016, 'Does Australia's Health Policy Environment Create Unintended Outcomes for Birthing Women?', BIRTH-ISSUES IN PERINATAL CARE, vol. 43, no. 4, pp. 273-276.
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Steel, A.E. 2016, 'Important considerations of the use of complementary and alternative medicine through pregnancy, labour and birth: an update based on recent Australian research', Australian Journal of Herbal Medicine, vol. 28, no. 2, pp. 36-40.
Wardle, J., Cook, N., Steel, A.E. & Barker, C. 2016, 'The World Naturopathic Federation: global opportunities for the Australian profession', Australian Journal of Herbal Medicine, vol. 28, no. 1, pp. 3-3.
Schloss, J. & Steel, A. 2016, 'Medical synopsis: Yoga may assist females with multiple sclerosis by influencing cortisol and adrenocorticotropic hormone (ACTH) levels', Advances in Integrative Medicine, vol. 3, no. 3, pp. 112-113.
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Schloss, J. & Steel, A. 2016, 'Medical synopsis: Nightly fasting may assist breast cancer patients and other people with cancer', Advances in Integrative Medicine, vol. 3, no. 2, pp. 66-67.
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Steel, A.E., Adams, J., Sibbritt, D., Broom, A., Gallois, C. & Frawley, J.E. 2015, 'Managing the pain of labour: factors associated with the use of labour pain management for pregnant Australian women.', Health Expectations, vol. 18, no. 5, pp. 1633-1644.
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Despite high rates of women's use of intrapartum pain management techniques, little is known about the factors that influence such use. ... Examine the determinants associated with women's use of labour pain management. ... Cross-sectional survey of a substudy of women from the 'young' cohort of the Australian Longitudinal Study of Women's Health (ALSWH). ... Women aged 3135 years who identified as being pregnant or recently given birth in the 2009 ALSWH survey (n = 2445) were recruited for the substudy. The substudy survey was completed by 1835 women (RR = 79.2%).
Steel, A., Frawley, J., Adams, J. & Diezel, H. 2015, 'Trained or professional doulas in the support and care of pregnant and birthing women: A critical integrative review', Health and Social Care in the Community, vol. 23, no. 3, pp. 225-241.
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&copy; 2014 John Wiley & Sons Ltd. The professionalisation of doula care and research interest in this area of maternity care/support have both grown internationally in recent years highlighting important broader issues around the access, continuity and delivery of maternity care services. However, no work to date has provided a critical appraisal of the international literature on this topic. In response, this paper presents the first critical review of international empirical literature examining professional doula care for pregnant and birthing women. A database search of AMED, CINAHL, Maternity and Infant Care, and MEDLINE using the search term, "doula" was undertaken. A total of 48 papers published between 1980 and March 2013 involving trained or professional doulas were extracted. Four descriptive categories were identified from the review: 'workforce and professional issues in doula care'; 'trained or professional doula's role and skill'; 'physical outcomes of trained or professional doula care'; and 'social outcomes of trained or professional doula care'. Of the studies evaluating outcomes of doula care, there were a number with design and methodology weaknesses. The review highlights a number of gaps in the research literature including a lack of research examining doula workforce issues; focus upon the experience and perspective of significant stakeholders such as expectant fathers with regard to trained or professional doula care; clinical trials measuring both subjective experiences and physical outcomes of trained or professional doula support; synergy between the design of clinical trials research examining trained or professional doula care and the clinical reality of professional doula practice. It is imperative that key aspects of trained doula care be subject to further rigorous, empirical investigation to help establish an evidence base to guide policy and practice relating to this area of support and care for pregnant and birthing women.
Adams, J., Frawley, J., Steel, A., Broom, A. & Sibbritt, D. 2015, 'Use of pharmacological and non-pharmacological labour pain management techniques and their relationship to maternal and infant birth outcomes: Examination of a nationally representative sample of 1835 pregnant women', MIDWIFERY, vol. 31, no. 4, pp. 458-463.
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Adams, J., Steel, A., Chang, S. & Sibbritt, D. 2015, 'Helping address the national research and research capacity needs of Australian chiropractic: introducing the Australian Chiropractic Research Network (ACORN) project.', Chiropractic and Manual Therapies, vol. 23, no. 12.
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Chiropractic is a popular health care choice in Australia and yet major gaps in our empirical understanding of this area of practice remain. Furthermore, while some research excellence exists, a largely uncoordinated approach to research activity and development has in effect led to silos of interest and a lack of strategic 'big-picture' planning essential to producing a sustainable research culture and capacity for the profession. This commentary identifies the significance of a number of key features - including a national, coordinated focus, and a rich engagement with the practitioner and patient base amongst others - arguably important to the future development of research and research capacity within Australian chiropractic. The design features and phases of the Australian Chiropractic Research Network (ACORN) project are also outlined. ACORN is one contemporary initiative specifically developed to address chiropractic's research and research capacity building needs and help grow a broad evidence-base to inform safe, effective patient care.
Adams, J., Frawley, J., Steel, A., Broom, A. & Sibbritt, D. 2015, 'Use of pharmacological and non-pharmacological labour pain management techniques and their relationship to maternal and infant birth outcomes: Examination of a nationally representative sample of 1835 pregnant women', Midwifery, vol. 31, no. 4, pp. 458-463.
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&copy; 2015 Elsevier Ltd. Women use various labour pain management techniques during birth. The objective of this study is to investigate women's use of pharmacological and non-pharmacological labour pain management techniques in relation to birth outcomes. Methods: a sub-survey of a nationally representative sample of pregnant women (. n=1835) from the Australian Longitudinal Study on Women's Health. Results: our analysis identified women's use of water for labour pain management as decreasing the likelihood of their baby being admitted to special care nursery (OR=0.42, p<0.004) whereas the use of epidural increased this likelihood (OR=3.38, p<0.001) as well as for instrumental childbirth (OR=7.27, p<0.001). Epidural and pethidine use decreased women's likelihood of continuing breast-feeding (ORs=0.68 and 0.59, respectively, both p<0.01) whereas the use of breathing techniques and massage for pain control increased the likelihood of women continuing breast-feeding (ORs=1.72 and 1.62, respectively, both p<0.01). Conclusions: our study illustrates associations between the use of both pharmacological and non-pharmacological labour pain management techniques and selected birth outcomes while controlling for confounding variables. There remain significant gaps in the evidence base for the use of non-pharmacological labour pain control methods and our findings provide a platform with which to develop a broad clinical research programme around this topic.
Steel, A., Lucke, J. & Adams, J. 2015, 'The prevalence and nature of the use of preconception services by women with chronic health conditions: an integrative review.', BMC Womens Health, vol. 15, p. 14.
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BACKGROUND: There is growing evidence that preconception care may have an important role in preventing short and long term adverse health consequences for women and their offspring. This is particularly the case for women with chronic health conditions due to the rising prevalence of chronic disease in global populations. With this in mind, this paper presents an integrative systematic review of contemporary research outlining the use of preconception services and practices by women with chronic health conditions. METHODS: A search was conducted through PubMed, CINAHL, AMED, and Maternity and Infant Care databases which identified 672 papers examining preconception care and preconception services for women with chronic health conditions. Fourteen papers which were written in English, presented original research, and reported on the prevalence or nature of use of preconception care by women with chronic health conditions were included in the review. Critical appraisal of study quality and thematic categorical grouping of identified papers was undertaken. RESULTS: Current research evidence, as identified through this review, examines three major topic areas: the prevalence of preconception care practices, use of services and characteristics of users; knowledge of the value and impact of preconception care and availability of preconception services for women with chronic health conditions; and women's attitudes, approaches and experiences of preconception care and preconception services. Prevalence estimates of engagement with preconception care range between 18.1% and 45%, with most studies focusing on women with type 1 or 2 diabetes. Significant gaps in women's knowledge of preconception care for women with chronic health conditions were also identified. Women with chronic health conditions reported experiencing emotional distress as a result of their engagement with preconception care services. They also commonly described feeling a need to employ discipline to c...
Steel, A., Frawley, J., Adams, J. & Diezel, H. 2015, 'Trained or professional doulas in the support and care of pregnant and birthing women: A critical integrative review', Health and Social Care in the Community, vol. 23, no. 3, pp. 225-241.
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&copy; 2014 John Wiley & Sons Ltd. The professionalisation of doula care and research interest in this area of maternity care/support have both grown internationally in recent years highlighting important broader issues around the access, continuity and delivery of maternity care services. However, no work to date has provided a critical appraisal of the international literature on this topic. In response, this paper presents the first critical review of international empirical literature examining professional doula care for pregnant and birthing women. A database search of AMED, CINAHL, Maternity and Infant Care, and MEDLINE using the search term, "doula" was undertaken. A total of 48 papers published between 1980 and March 2013 involving trained or professional doulas were extracted. Four descriptive categories were identified from the review: 'workforce and professional issues in doula care'; 'trained or professional doula's role and skill'; 'physical outcomes of trained or professional doula care'; and 'social outcomes of trained or professional doula care'. Of the studies evaluating outcomes of doula care, there were a number with design and methodology weaknesses. The review highlights a number of gaps in the research literature including a lack of research examining doula workforce issues; focus upon the experience and perspective of significant stakeholders such as expectant fathers with regard to trained or professional doula care; clinical trials measuring both subjective experiences and physical outcomes of trained or professional doula support; synergy between the design of clinical trials research examining trained or professional doula care and the clinical reality of professional doula practice. It is imperative that key aspects of trained doula care be subject to further rigorous, empirical investigation to help establish an evidence base to guide policy and practice relating to this area of support and care for pregnant and birthing women.
Frawley, J., Adams, J., Steel, A., Broom, A., Gallois, C. & Sibbritt, D. 2015, 'Women's Use and Self-Prescription of Herbal Medicine during Pregnancy: An Examination of 1,835 Pregnant Women', Women's Health Issues, vol. 25, no. 4, pp. 396-402.
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Steel, A., Hemmings, B., Sibbritt, D. & Adams, J. 2015, 'Research challenges for a complementary medicine higher education institution: Results from an organisational climate survey', EUROPEAN JOURNAL OF INTEGRATIVE MEDICINE, vol. 7, no. 5, pp. 442-449.
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Steel, A., Adams, J., Sibbritt, D. & Broom, A. 2015, 'The outcomes of complementary and alternative medicine use among pregnant and birthing women: current trends and future directions.', Women's Health, vol. 11, no. 3, pp. 309-323.
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Complementary and alternative medicine is used by a substantial number of pregnant women and maternity care providers are often faced with the task of ensuring women are using safe and effective treatments while respecting a woman's right to autonomous decision-making. In the era of evidence-based medicine maternity health professionals are expected to draw upon the best available evidence when making clinical decisions and providing health advice. This review will outline the current trends in research evidence associated with the outcomes of complementary and alternative medicine use amongst pregnant and birthing women as well as highlight some potential directions for future development in this important yet largely unknown topic in contemporary maternity care.
Cramer, H., Frawley, J., Steel, A., Hall, H., Adams, J., Broom, A. & Sibbritt, D. 2015, 'Characteristics of women who practice yoga in different locations during pregnancy', BMJ Open, vol. 5, no. 8, pp. e008641-e008641.
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Steel, A., Adams, J., Frawley, J., Broom, A. & Sibbritt, D. 2015, 'The characteristics of women who birth at home, in a birth centre or in a hospital labour ward: A study of a nationally-representative sample of 1835 pregnant women', Sexual & Reproductive Healthcare, vol. 6, no. 3, pp. 132-137.
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Reid, R.J. & Steel, A.E. 2015, 'The importance of the PRACI project for grass roots complementary medicine practice: A call for practitioner involvement', Australian Journal of Herbal Medicine, vol. 27, no. 3.
Wardle, J. & Steel, A. 2015, 'Systematic reviews in integrative medicine: A clinician's guide to publication', Advances in Integrative Medicine, vol. 2, no. 2, pp. 103-109.
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&copy; 2015. The role of evidence-based medicine in integrative medicine is becoming increasingly important, and with this increasing comes a need for succinct summaries of research evidence. Systematic reviews are essential to summarise evidence relating to efficacy and safety of healthcare and to summarise health care trends and phenomena accurately and reliably. However, reviews can bring with them numerous biases and methodological issues, particularly related to the sourcing of information used, and therefore need to be conducted in a systematic and methodical process. Specialised fields such as integrative medicine bring with them their own unique challenges in conducting an accurate and reliable review. This article describes practical and academic insights into writing a systematic review for publication.
Schloss, J. & Steel, A. 2015, 'Thriving after cancer: The role of integrative medicine (IM) in cancer survivorship and wellbeing programs', Advances in Integrative Medicine, vol. 2, no. 3, pp. 123-124.
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Steel, A.E., Adams, J., Sibbritt, D., Broom, A., Frawley, J.E. & Gallois, C. 2014, 'The Infuence of Complementary and Alternative Medicine Use in Pregnancy on Labor Pain Management Choices: Results from a Nationally Representative Sample of 1,835 Women', Journal of Alternative and Complementary Medicine, vol. 20, no. 2, pp. 87-97.
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Objectives: This study examines involvement with a range of complementary and alternative medicine (CAM) during pregnancy on the use of pharmacologic (PPMT) and nonpharmacologic (NPMT) pain management techniques for labor and birth. Design: Longitudinal analysis of survey data. Participants: A substudy (n=2445) of the ``young cohort of the nationally representative Australian Longitudinal Study on Womens Health was conducted. Outcome measures: Use of PPMT and NPMT during labor and birth. Results: The survey was completed by 1835 women (response rate, 79.2%). Most respondents used either intrapartum PPMT (81.9%) or NPMT (74.4%). Many (60.7%) used some form of CAM during pregnancy and also used PPMT during birth. More than two thirds of women (66.7%) who used NPMT used CAM during pregnancy. There was a general trend of increased likelihood of NPMT use by women who applied CAM during pregnancy. There was an inverse effect on use of epidural analgesia for women who consumed herbal teas during pregnancy (odds ratio, 0.60).
Steel, A.E., Wardle, J., Diezel, H.M., Johnstone, K. & Adams, J. 2014, 'Educating for collaboration: The outcomes of an interprofessional education workshop for complementary and alternative maternity care providers', Advances in Integrative Medicine, vol. 1, no. 1, pp. 17-24.
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Objectives: Despite high community use of complementary and alternative medicine (CAM) poor collaboration between conventional and CAM practitioners have been identified in many health sectors including maternity care. This is in part associated with a deficit in the formal training of CAM practitioners which overlooks collaborative practice skills and guidelines. This study evaluates the outcomes of an interprofessional education workshop which endeavours to improve the collaborative practice of CAM practitioners providing care to pregnant women. Methods: A pre-workshop and post-workshop questionnaire which evaluated the participants' perception of self-proficiency and their interprofessional practice behaviours when providing maternity care. Descriptive and inferential statistical analysis of the data was undertaken. Results: CAM practitioners (n = 30) providing care to pregnant women participated in the project. Prior to taking part in the workshop a low level of confidence in pregnancy-specific physiology and psychology knowledge more broadly but also poor confidence in engaging with conventional maternity care providers and understanding conventional models of maternity care was identified amongst participants. Participants who felt more positive about their knowledge of pregnancy and birth physiology were more likely to enquire about women's conventional care and discuss safety issues with women in their care. Following workshop involvement the participant's awareness of the models of maternity care available to Australian women improved alongside participants' knowledge of the scope and role of obstetricians and midwives. There was a reduced need by participants to have their role acknowledged by conventional care providers as important to enable effective collaboration after workshop completion. Conclusions: Interprofessional education is argued to be a valuable tool to promote interprofessional collaboration and communication. It may be employed as a use...
Frawley, J., Adams, J., Broom, A., Steel, A., Gallois, C. & Sibbritt, D. 2014, 'Majority of Women Are Influenced by Nonprofessional Information Sources When Deciding to Consult a Complementary and Alternative Medicine Practitioner During Pregnancy', Journal of Alternative and Complementary Medicine, vol. 20, no. 7, pp. 571-577.
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Steel, A., Adams, J., Sibbritt, D., Broom, A., Gallois, C. & Frawley, J. 2014, 'Determinants of Women Consulting with a Complementary and Alternative Medicine Practitioner for Pregnancy-Related Health Conditions', Women and Health, vol. 54, no. 2, pp. 127-144.
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Steel, A., Adams, J., Sibbritt, D., Broom, A., Frawley, J. & Gallois, C. 2014, 'The Influence of Complementary and Alternative Medicine Use in Pregnancy on Labor Pain Management Choices: Results from a Nationally Representative Sample of 1,835 Women', JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE, vol. 20, no. 2, pp. 87-97.
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Steel, A., Adams, J., Sibbritt, D., Broom, A., Frawley, J. & Gallois, C. 2014, 'Relationship between complementary and alternative medicine use and incidence of adverse birth outcomes: An examination of a nationally representative sample of 1835 Australian women', Midwifery, vol. 30, no. 12, pp. 1157-1165.
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Objective: there is evidence of high use of complementary and alternative medicine (CAM) by pregnant women. Despite debate and controversy regarding CAM use in pregnancy there has been little research focus upon the impacts of CAM use on birth outcomes. This paper reports findings outlining the incidence of adverse birth outcomes among women accessing CAM during pregnancy. Design: a survey based cohort sub study from the nationally representative Australian Longitudinal Study on Women's Health (ALSWH) was undertaken in 2010. Participants.: women (aged 31-36 years) who identified in 2009 as pregnant or recently given birth (n=2445) from the younger cohort (n=8012) of ALSWH were recruited for the study. Measurements and findings: participants' responses were analysed to examine the relationship between use of CAM and adverse birth outcomes from their most recent pregnancy. Of the respondents (n=1835; 79.2%), there were variations in birth outcomes for the women who used different CAM. Notably, the outcome which was most commonly associated with CAM use was emotional distress. This was found to occur more commonly in women who practised meditation/yoga at home, used flower essences, or consulted with a chiropractor. In contrast, women who consulted with a chiropractor or consumed herbal teas were less likely to report a premature birth, whilst participation in yoga classes was associated with an increased incidence of post parturn/intrapartum haemorrhage. Key conclusions: the results emphasise the necessity for further research evaluating the safety and effectiveness of CAM for pregnant women, with a particular focus on birth outcomes. Implications for practice: health professionals providing care need to be aware of the potential birth outcomes associated with CAM use during pregnancy to enable the provision of accurate information to women in their care, and to assist in safely supporting women accessing CAM to assist with pregnancy, labour and birth.
Bowman, D., Steel, A., Adams, J., Sibbritt, D. & Broom, A. 2014, 'The characteristics of women using different forms of botanical medicines to manage pregnancy-related health conditions: A preliminary cross-sectional analysis', Advances in Integrative Medicine, vol. 1, no. 3, pp. 138-143.
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Objective: To ascertain the attitudes, perceptions and characteristics of women who used varying forms of botanical medicine (herbal extracts and tinctures, herbal teas, aromatherapy oils) during pregnancy, birth and lactation. Methods: Longitudinal data from a sub-study of women (n = 2445) from the Australian Longitudinal Study of Women's Health (ALSWH) was analysed for the characteristics of women who used only one form of botanical medicine (herbal extracts and tinctures, herbal teas or aromatherapy oils), Fisher's exact tests were used to compare categorical variables due to the small cell numbers of the individual categories. A modified Bonferroni correction was used to compensate for multiple testing. All analyses were performed using Stata 11.1 and statistical significance was set at p = 0.05. Results: Women who held private health insurance were more likely to consult with an acupuncturist or naturopath for pregnancy-related health conditions and use herbal extracts and tinctures rather than herbal teas or aromatherapy oils. Women who used herbal extracts and tinctures also reported higher rates of epidural use and were more likely to initiate breastfeeding than those using aromatherapy oils. Women who used herbal teas were more likely to discuss their expectations of their birth with a general practitioner than a midwife and use birthing pools, baths or showers as intrapartum pain management. Women who used herbal teas were also more likely to initiate breastfeeding than those choosing aromatherapy, and moreover, continue breastfeeding for more than 6 months. Women who showed a preference for breathing techniques as intrapartum pain management were more likely to use aromatherapy rather than herbal extracts, tinctures or teas during pregnancy. Conclusions: Our analysis is a preliminary insight into an as yet unassessed aspect of maternity care. More in-depth investigation of the characteristics of women who choose to use herbal medicines, teas and aromat...
Steel, A., Adams, J. & Sibbritt, D. 2014, 'Developing a multi-modality complementary medicine practice-based research network: The PRACI project', Advances in Integrative Medicine, vol. 1, no. 3, pp. 113-118.
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Steel, A., Adams, J., Broom, A., Sibbritt, D., Frawley, J. & Gallois, C. 2014, 'Marginalization and Companionable Silence: CAM Practitioners' Perspectives of Their Interprofessional Relationships with Maternity Care Providers', The Journal of Alternative and Complementary Medicine, vol. 20, no. 5, pp. A111-A111.
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Frawley, J.E., Steel, A., Adams, J., sibbritt, D., Broom, A. & Gallois, C. 2014, 'The Association between women's choice of birth setting and their use of CAM during labor and birth.', Journal of Alternative and Complementary Medicine, vol. 20, no. 5.
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Steel, A.E. & McEwen, B. 2014, 'The need for higher degrees by research for complementary medicine practitioners', Australian Journal of Herbal Medicine, vol. 26, no. 4.
Diezel, H., Adams, J., Wardle, J. & Steel, A. 2014, 'Does Complementary and Alternative Medicine Exist in Australian Nursing and Midwifery Courses?', The Journal of Alternative and Complementary Medicine, vol. 20, no. 5, pp. A100-A100.
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Wardle, J., Adams, J., Lui, C. & Steel, A.E. 2013, 'Current challenges and future directions for naturopathic medicine in Australia: a qualitative examination of perceptions and experiences from grassroots practice', BMC Pregnancy Childbirth, vol. 13, no. 15, pp. 1-10.
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Naturopaths are an increasingly significant part of the healthcare sector in Australia, yet despite their significant role there has been little research on this practitioner group. Currently the naturopathic profession in Australia is undergoing a period of rapid professional growth and change. However, to date most research exploring the perceptions of naturopaths has been descriptive in nature and has focused on those in leadership positions rather than grassroots practitioners. This article explores the perceptions and experiences of practising naturopaths on the challenges and future directions of their profession.
Diezel, H.M., Steel, A.E., Wardle, J. & Johnstone, K. 2013, 'Patterns and influences of interprofessional communication between midwives and CAM practitioners: A preliminary examination of the perceptions of midwives', Australian Journal of Medical Herbalism, vol. 25, no. 1, pp. 4-10.
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Women are increasingly using complementary and alternative medicine (CAM) such as naturopathy and Western herbal medicine during their pregnancy and midwives have described an affinity for CAM. However, the reality of the midwife-CAM practitioner interfa
Frawley, J.E., Adams, J., Sibbritt, D., Steel, A.E., Broom, A. & Gallois, C. 2013, 'Prevalence and determinants of complementary and alternative medicine use during pregnancy: Results from a nationally representative sample of Australian pregnant women', Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 53, no. 4, pp. 347-352.
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Background: Pregnant women have been identi?ed as high users of complementary and alternative medicine (CAM). However, no research to date has provided a detailed analysis of the prevalence and determinants of CAM consumption amongst pregnant women. Aim: To examine the prevalence and determinants of CAM use by pregnant women, utilising a national representative sample. Methods: The study sample was obtained via the Australian Longitudinal Study on Womens Health. This paper is based on a sub-study of 1,835 pregnant women, administered in 2010. The women answered questions about CAM use, demographics, pregnancy-related health concerns and health service utilisation. Results: Complementary and alternative medicine use was found to be high with 48.1% (n = 623) of pregnant women consulting a CAM practitioner and 52.0% (n = 842) of women using CAM products (excluding vitamins and minerals) during pregnancy. CAM practitioner visits were more likely for selected pregnancy-related health concerns, namely back pain or back ache, neck pain and labour preparation. Women were less likely to consult a CAM practitioner if they suffered with headaches/migraines. Employment was also found to be predictive of pregnant womens visits to a CAM practitioner. Signi?cant health history and demographic predictors of CAM product use were tiredness and fatigue, embarking on preparation for labour and having a university education. Conclusion: Most pregnant women are utilising CAM products and/or services as part of their maternity care and obstetricians, general practitioners and midwives need to enquire with women in their care about possible CAM use to help promote safe, effective coordinated maternity care.
Steel, A.E., Diezel, H.M., Johnstone, K., Sibbritt, D., Adams, J. & Adair, R. 2013, 'The Value of Care Provided by Student Doulas: An Examination of the Perceptions of Women in Their Care', Journal of Perinatal Education, vol. 22, no. 1, pp. 39-48.
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This study provides an examination of women's perceptions of care provided by student doulas undertaking a formal qualification in doula support services. Feedback forms completed by women attended by student doulas undertaking a formal qualification in doula support services were analyzed. The women (N = 160) consistently rated the student doulas' contribution to their experience of birth favorably. Qualitative analysis revealed that women value the presence of their student doulas highly with reference to the student doulas' demeanor, support provided to family, interface with other health professionals, and learned skills. Within the Australian context, this study suggests that the support provided by student doulas that have completed a formal training course is held in positive regard by the women receiving their care.
Steel, A.E., Frawley, J.E., Sibbritt, D. & Adams, J. 2013, 'A preliminary profile of Australian women accessing doula care: Findings from the Australian Longitudinal Study on Women's Health', Australian and New Zealand Journal of Obstetrics & Gynaecology, vol. 53, no. 6, pp. 589-592.
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Despite growing interest and controversy regarding the value of doulas in contemporary maternity care, little is known about the profile of women who choose to involve a doula in their care team. This preliminary analysis indicates that women's attitudes towards maternity care may influence their use of a doula more so than demographic factors. Further research examining these
Wardle, J.L., Steel, A.E. & Adams, J. 2013, 'Tensions in Naturopathic Education Response', JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE, vol. 19, no. 12, pp. 979-980.
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Wardle, J., Steel, A. & McIntyre, E. 2013, 'Independent registration for naturopaths and herbalists in Australia: The coming of age of an ancient profession in contemporary healthcare', Australian Journal of Herbal Medicine, vol. 25, no. 3.
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Steel, A., Diezel, H., Wardle, J. & Johnstone, K. 2013, 'Patterns of inter-professional communication between complementary and conventional practitioners providing maternity care services: A preliminary examination of the perceptions of CAM practitioner', Australian Journal of Herbal Medicine, vol. 25, no. 2, pp. 57-61.
Pierantozzi, A.M., Steel, A. & Seleem, M. 2013, 'Integrating complementary and alternative medicine into medical intern teaching: preliminary findings from an Australian Hospital.', Complement Ther Clin Pract, vol. 19, no. 4, pp. 237-242.
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Globally, the use of complementary and alternative medicine (CAM) as a component of healthcare is well documented [1]. In Australia, despite escalating use of CAM [2], inclusion within medical curriculum is poorly developed. This study reports findings from a pilot-study of medical interns which examined whether the delivery of a CAM education session had impacted on their attitude, perceived knowledge and subsequent clinical practice. The results indicate that the participants' attitudes towards CAM education were positive, with 92% of participants considering it important for inclusion in junior doctor education. Post-session, participants also reported an acquisition of knowledge in relation to common interactions between CAM and conventional medical treatments and indicated a positive impact on subsequent clinical practice, specifically noting increased awareness of CAM enquiry in clinical practice. Results of this pilot study indicate that CAM and junior doctor education may have a positive impact on improving patient safety and management.
Adams, J. & Steel, A.E. 2012, 'Editorial: Investigating complementary and alternative medicine in maternity care: The need for further public health/health services research', Complementary Therapies in Clinical Practice, vol. 18, pp. 73-74.
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The relationship between complementary and alternative medicine (CAM) and maternity care has attracted much attention over recent years and there has been a movement towards developing and promoting an evidence-base to help understand the interface between CAM, midwifery and wider mainstream maternity care.
Wardle, J., Steel, A. & Adams, J. 2012, 'A Review Of Tensions And Risks In Naturopathic Education And Training In Australia: A Need For Regulation', Journal Of Alternative And Complementary Medicine, vol. 18, no. 4, pp. 363-370.
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In line with increasing complementary medicine (CAM) use, the Australian government has committed considerable resources to the training of CAM practitioners.
Steel, A.E., Adams, J., Sibbritt, D., Broom, A., Gallois, C. & Frawley, J.E. 2012, 'Utilisation of complementary and alternative medicine (CAM) practitioners within maternitycare provision: results from a nationally representative cohort study of 1,835 pregnant women', BMC Pregnancy and Childbirth, vol. 12, pp. 146-146.
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Background: There is little known about women's concurrent use of conventional and complementary health care during pregnancy, particularly consultation patterns with complementary and alternative medicine (CAM). This study examines health service utilisation among pregnant women including consultations with obstetricians, midwives, general practitioners (GPs) and CAM practitioners.
Steel, A.E. & Adams, J. 2012, 'Developing midwifery and complementary medicine collaboration: The potential of interprofessional education?', Complementary Therapies in Clinical Practice, vol. 18, no. 4, pp. 261-264.
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A higher percentage of referrals to complementary and alternative medicine (CAM) by midwives can be linked to their af?nity with CAM. However, midwifery education does not commonly include CAM as part of the curriculum leaving potential for misinformation and unsafe practice. An approach to CAM education which encourages collaboration between all care providers is needed to ensure safe, womancentred maternity care. Whilst a number of models have been considered in health education they are not without their limitations when aiming to promote interprofessional collaboration.
Adams, J. & Steel, A. 2012, 'Investigating complementary and alternative medicine in maternity care: the need for further public health/health services research.', Complementary therapies in clinical practice, vol. 18, no. 2, pp. 73-74.
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Steel, A.E. & Adams, J. 2011, 'The Interface Between Tradition and Science:Naturopaths' Perspectives of Modern Practice', Journal of Alternative and Complementary Medicine, vol. 17, no. 10, pp. 967-972.
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Objectives: Although there has been much international commentary, little is known about the interface between traditional knowledge and scientific research in modern naturopathic practice. This study aimed to explore this interface from the perspective of naturopaths. Design: Semistructured interviews were conducted with naturopaths in current practice. The participants were selected using purposive sampling, and the data from the interviews were interpreted using thematic analysis. Settings/location: Interviews were conducted in a place suitable to each participant. Subjects: Twelve (12) naturopaths in current clinical practice were interviewed. The participants represented a diversity of characteristics including gender, time in practice, level of qualification, and clinical contact hours per week.
Steel, A.E. & Adams, J. 2011, 'The role of naturopathy in pregnancy, labour and post-natal care: Broadening the evidence-base', Complementary Therapies in Clinical Practice, vol. 17, no. 4, pp. 189-192.
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It is known that women are high users of complementary and alternative medicine (CAM) including naturopathy and that CAM is frequently used by pregnant women. However, we still know little about the consumption, practice and role of naturopathy in pregnancy, labour and post-natal care. With this in mind, this paper proposes a possible framework for advancing further research on this topic. The framework is divided into issues associated with three core stakeholder groups-pregnant women, naturopaths/herbalists and other maternity health professionals including obstetricians, midwives and general practitioners. The development of a rigorous health services research agenda around this topic has much to offer maternity-care users, practitioners and policy makers and the framework outlined here is offered with the hope of inspiring further inquiry into this significant issue in women's health.
Steel, A.E., Adams, J. & Sibbritt, D. 2011, 'Complementary and Alternative Medicine in Pregnancy: a Systematic Review', Journal of the Australian Traditional-Medicine Society, vol. 17, no. 4, pp. 205-209.
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A systematic review of recent peer-reviewed literature exploring women&acirc;s use of complementary and alternative medicine (CAM) in pregnancy, birth and postnatal care.
Steel, A. & Adams, J. 2011, 'The Application And Value Of Information Sources In Clinical Practice: An Examination Of The Perspective Of Naturopaths', Health Information And Libraries Journal, vol. 28, no. 2, pp. 110-118.
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Background: The approach of evidence-based medicine (EBM), providing a paradigm to validate information sources and a process for critiquing their value, is an important platform for guiding practice. Researchers have explored the application and value o
Steel, A.E. & Adams, J. 2011, 'Approaches to clinical decision-making: A qualitative study of naturopaths', Complementary Therapies in Clinical Practice, vol. 17, pp. 81-84.
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The type of information used and its application in clinical practice has generated interest due to its relationship to evidence-based medicine (EBM). However, it is also acknowledged that the principles of EBM place less value on practitioners' experience and intuitive insights when making clinical decisions.
Steel, A. & Johnstone, K. 2011, 'The impact of an inter-professional education workshop on the perceptions of practice behaviours of midwives in relation to complementary and alternative medicine', Women and Birth, vol. 24, pp. S44-S45.
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Steel, A. & Adair, R. 2011, 'The ghost in the room: the role of doulas in maternity care in Australia', Women and Birth, vol. 24, pp. S44-S44.
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Reports

Steel, A., Frawley, J. & Frawley, J.E. 2013, Steel A, Frawley J, Dobson A, Jackson C, Lucke J, Tooth L, Brown W, Byles J, Mishra G. (2013). Women's health in NSW – a life course approach: an Evidence Check rapid review brokered by the Sax Institute. NSW Ministry of Health. https://www.saxinstitute.org.au/wp-content/uploads/Womens-health-in-NSW2....