Reconceptualising specialisation: integrating refugee health in primary care

Health literacy and cultural responsiveness of primary health care systems and services in Australia: reflections from service providers, stakeholders, and people from refugee backgrounds

BACKGROUND

Primary health care [PHC] services with general practitioners (GPs) as the first point of access to health care services for people from refugee backgrounds in Australia can play a crucial role in building health literacy and promoting access to culturally appropriate services. To achieve equitable access and engagement, services and systems must be responsive to diverse health literacy and cultural needs. This study aims to explore how primary health services respond as a system and organisation to the health literacy and cultural needs of people from refugee backgrounds in Australia.

METHODS

This exploratory qualitative study involved 52 semi-structured interviews among 19 Africans from refugee backgrounds, 14 service providers, including GPs and nurses, and 19 other stakeholders, such as service managers/directors. Participants resided in New South Wales, Victoria, and Queensland. Interviews were audio-recorded, transcribed, and coded into QSR NVivo 12. Data analysis was guided by reflexive thematic analysis.

FINDINGS

Three interrelated themes were identified from the data relating to the health literacy and cultural responsiveness of PHC systems and services. The first theme, 'variable and ad hoc organisational response to health literacy and culturally responsive care,' demonstrated that some organisations did not systematically address the inherent complexity of navigating the health system nor the capacity of services and providers to respond to the cultural needs of people from refugee backgrounds. The second theme, 'individual provider responsibility,' captured the individual providers' interpersonal and relational efforts in supporting the health literacy and cultural needs of people from refugee backgrounds based on their motivation and adaptation. The third theme, 'refugee patient responsibility,' encapsulated people from refugee backgrounds' adaptations to and learning of the health system to navigate and access services.

CONCLUSION

Health literacy and culturally responsive practices need to be systematised by PHC organisations to be implemented and sustained over time. There is a need for diversity in the organisational leadership and health care workforce, organisational commitment, health literacy and culturally responsive care policies, provider training, and auditing practice as essential components of the change process. Engaging with refugee communities would allow services to focus on people from refugee backgrounds' needs by design.

"To Be Treated as a Person and Not as a Disease Entity"-Expectations of People with Visual Impairments towards Primary Healthcare: Results of the Mixed-Method Survey in Poland

Primary care is the core part of the Polish healthcare system. Improving its quality for vulnerable populations is among the principal goals of global and national health policies. Identifying patients' needs is critical in this process. People who are blind or have low vision often demonstrate comorbidities and require more specific healthcare. The aim of this study was to explore the needs of Polish persons with visual impairments when they use primary care services. 219 respondents answered the "Patient value" questionnaire from the project Quality and Costs of Primary Care in Europe (QUALICOPC) and an open question regarding additional patients' needs. Statistical and content analyses were used. The expectations of the study group regarding primary care appeared to be higher than those described in studies among other populations. Equity and accessibility were the most valued dimensions of care. Among particular aspects of care, those connected with psychosocial competencies and awareness of disability among medical staff appeared most frequently. Some personal characteristics were associated with preferences, including age, gender, longstanding conditions, quality of life, and disability-related variables. Our study indicates a need for multilevel interventions in legislation, economics, and medical staff training, with the people-centered approach as the option maximizing chances to meet diverse healthcare needs arising from particular disabilities.

The Refugee Co-Location Model may be useful in addressing refugee barriers to care. What do refugees think?

Co-location of services for refugees may be beneficial in addressing barriers to care. This model of care involves support for a specialist refugee nurse service with general practice, as well as developing partnerships with settlement support agencies and Primary Health Networks. We consider published literature on refugee perceptions of co-location, different models of care, upcoming research and priorities in the area.

Fitting Health Care to People: Understanding and Adapting to the Epidemiology and Health Literacy of People Affected by Viral Hepatitis from Culturally and Linguistically Diverse Migrant Backgrounds

This study explored the epidemiology and health literacy of people affected by viral hepatitis (VH) from migrant culturally and linguistically diverse (CALD) backgrounds attending a community-based general practitioner and specialty hepatology shared-care (HEPREACH) clinic in Brisbane, Australia. Patient-reported data on health literacy and clinical information from adult patients (n = 66) of CALD background recruited from the liver clinic were analyzed. Health literacy was assessed using a 5-question, 12-point scale. Variance weighted multiple linear regression was used to identify factors associated with knowledge about VH. About three-quarters of patients (74.2%) were diagnosed with hepatitis B. The median knowledge score was 7.8 (interquartile range [IQR] 6‒9). One in five patients did not understand the infective nature of VH, 30.3% did not understand mother-to-child transmission risk, and 30-40% of patients thought activities such as kissing, sharing food or mosquito bites could spread VH. Only 6% of patients understood the risk of liver cancer and the need for regular screening. Higher educational level (secondary, β = 4.8, p < 0.0001 or tertiary, β = 8.1, p < 0.0001 vs. primary) was associated with better knowledge, and transition through a refugee camp (vs. not, β = - 1.2, p = 0.028) and country of diagnosis (overseas vs. Australia, β = - 1.9, p = 0.016) were associated with poorer knowledge. Country of origin, refugee status and opportunities for tertiary education impact patients' understanding of VH. Ensuring delivery of culturally appropriate care and education is critical to improve knowledge, reduce misconceptions to improve care and outcomes for VH in CALD migrant communities.

Empowering refugee families in transit: the development of a culturally competent and compassionate training and support package

Background

Refugee parents who fled conflicts suffered violence and traumas and face huge challenges in supporting the health and welfare of their children while in transit.

Aims

To describe the development of a culturally competent and compassionate training and support package (TSP) for nurses, social and health care workers and volunteers, with a focus on parenting needs among unsettled refugees fleeing conflict.

Methods

The multi-method approach included: a scoping review covering parenting needs of refugees fleeing conflict zones; collection of stories from refugee parents, healthcare workers and volunteers via a mobile application; discussions between team members; a piloted and evaluated curriculum.

Results

High levels of family distress and deterioration of parental identity were identified. Informed by these results, the curriculum is articulated along 20 bite-sized learning units, covering four age stages of childhood as well as targeting adults’ well-being. Pilot training was evaluated positively, confirming feasibility and usefulness of the TSP.

Conclusions

Unsettled refugee parents fleeing conflicts face psycho-social and practical difficulties negatively affecting their parenting skills. The care workforce should be trained in order to provide culturally competent and compassionate support to help these families. Open access digital platforms are promising as autodidactic and self-help tools among hard-to-reach populations.

Exploring electronic health records to estimate the extent of catch-up immunisation and factors associated with under-immunisation among refugees and asylum seekers in south east Queensland

BACKGROUND

Australia is one of the leading countries resettling people from refugee-like backgrounds. Catch-up immunisation is a key priority in this cohort. However, few studies have included asylum seekers and the adult age group in their study sample. In addition, Electronic Health Records (EHR) has recently been recognised as a vital tool in big data analysis with the capacity to contribute to informed strategic decision making. As such, the main aim of this study is to explore EHR routinely used in a specialised refugee clinic in South East Queensland to estimate the extent of catch-up immunisation and assess the factors associated with under-immunisation among refugees and asylum seekers.

METHODS

A quantitative study involving a secondary data analysis on a pre-existing dataset was undertaken. Relevant data was extracted from the EHR in the clinic. SPSS was used to perform Statistical data analysis.

RESULTS

The majority of clients originated from Papua New Guinea, followed by Iran and Afghanistan. When assessing the uptake of catch-up immunisations among refugees and asylum seekers, MMR (Measles-Mumps-Rubella), Polio and DTP (Diphtheria-Tetanus-Pertussis) had the highest uptake, while HPV (Human Papilloma Virus), Pneumococcal and Hib (Haemophilus influenza type b) immunisations had the lowest uptake. Binary logistic regression revealed that the younger patients, the refugees (compared to asylum seekers) and those with a longer residential duration in Australia are at a higher risk of being under-immunised.

CONCLUSION

This study indicates that the broader group of immigrants, and in particular refugees and asylum seekers, do not represent a homogenous group in terms of immunisation coverage, and that each cohort should be carefully considered during immunisation interventions and strategies. This will be particularly important during targeted health promotions and future immunisation programs in this cohort.