Early dynamic ultrasound in the assessment and management of neonatal instability of the hip: An intervention through health literacies to transform rural and regional health

Author: Susan Charlton

Charlton, Susan, 2019 Early dynamic ultrasound in the assessment and management of neonatal instability of the hip: An intervention through health literacies to transform rural and regional health, Flinders University, College of Nursing and Health Sciences

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Late diagnosis of developmental dysplasia of the hip in infants is reported to be an increasing problem in Australia, particularly in rural and remote areas (Azzopardi, Van Essen, Cundy, Tucker, & Chan, 2011; Studer K, 2016). Debate exists worldwide as to the value of selective or universal ultrasound screening as a diagnostic measure. Australian clinical guidelines advocate clinical assessment for all, with selective ultrasound screening for those at risk of the problem. Impacts for rural families with delayed diagnosis, access to treatment, and lifetime hip problems led to doctoral research into the use of universal screening in a regional centre in Australia. ‘At risk’ is a blunt policy implement. How it operates to understand and log regional injustice remains a key variable in this research.

Difficulties in conducting a controlled research experiment in two regional centres in South Australia were encountered, highlighting differences in health service between the two regions. These difficulties revealed much wider discrepancies in regional health service provision, which included recruitment and retention of allied health and medical practitioners, resistance to change, funding issues, consistency of service, and acceptance of innovation. Variations in health literacy, particularly in relation to infant hip problems, were a major factor. Geographic location may have had some influence on the outcome.

What commenced as a qualitative and empirical study developed into an interdisciplinary exploration, probing relationships between theories of health literacy and regional inequalities. Through this theoretical intervention, I demonstrated that the health service benefits from better collaboration and sharing of knowledge, scaffolded onto programmes of health literacy, included a more effective use of available expertise and a more open approach to the universal screening for neonatal instability of the hip. Developments in technology, particularly mobile screening devices, can now make a difference in overcoming some of the geographic difficulties of regional and rural access to services.

Universal early dynamic scanning of infant hips in one regional centre has demonstrated that early knowledge of hip status affects parental knowledge and may lead to improved management in the crucial period of early hip development. Regular assessment of infant hips must be part of child health visits at least until the development of normal walking and these examinations should be documented in the child’s personal health record.

My original contribution to knowledge resulted from a challenging research project, and the challenges that jutted from it. When ascertaining the reasons for those challenges, the focus, priorities and research questions changed. The resultant doctorate demonstrates the value of theoretical interventions in empirical research. The theoretical explanation became more resonant and important in understanding the value of health literacy and why regional health is complex to study. Unexpected differences were found between two regional centres in South Australia and these contributed to the research difficulties, crystallising the need to advance hip development knowledge in parents. A consistent approach to knowledge about optimal hip development and neonatal care, combined with accessibility to accurate assessment of hip status, should be available to all and may go some way to improving the outcome and lifetime hip statistics for regional infants.

Keywords: neonatal instability of the hip, anterior dynamic ultrasound, rural and regional health, health literacy

Subject: Public Health thesis

Thesis type: Doctor of Philosophy
Completed: 2019
School: College of Nursing and Health Sciences
Supervisor: Professor Tara Brabazon