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Peprah P, Lloyd J, Harris M. Health literacy and cultural responsiveness of primary health care systems and services in Australia: reflections from service providers, stakeholders, and people from refugee backgrounds. BMC Public Health 2023; 23:2557. [PMID: 38129802 PMCID: PMC10734201 DOI: 10.1186/s12889-023-17448-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023] Open
Abstract
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.
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Affiliation(s)
- Prince Peprah
- Social Policy Research Centre, University of New South Wales, Sydney, NSW, 2052, Australia.
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Jane Lloyd
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, 2052, Australia
- Australia's National Research Organisation for Women's Safety, Sydney, NSW, 2000, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, 2052, Australia
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Binder-Olibrowska KW, Godycki-Ćwirko M, Wrzesińska MA. "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. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13519. [PMID: 36294098 PMCID: PMC9602634 DOI: 10.3390/ijerph192013519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/22/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
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.
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Affiliation(s)
| | - Maciek Godycki-Ćwirko
- Centre for Family and Community Medicine, Faculty of Medical Sciences, Medical University of Lodz, Kopcinskiego 20, 90-153 Lodz, Poland
| | - Magdalena Agnieszka Wrzesińska
- Department of Psychosocial Rehabilitation, Faculty of Health Sciences, Medical University of Lodz, Lindleya 6, 90-131 Lodz, Poland
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Taye B, Valery P, Liddle B, Woodward A, Shahid S, Farley R, Sackey D, Clark P. Australian general practitioners’ perceptions of the barriers and opportunities for community-based care of patients with viral hepatitis: a mixed methods study. J Prim Health Care 2022; 14:229-236. [DOI: 10.1071/hc22005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/21/2022] [Indexed: 11/23/2022] Open
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Au M, Preston R, Ray RA, Davis M. The Refugee Co-Location Model may be useful in addressing refugee barriers to care. What do refugees think? Aust J Prim Health 2021; 27:425-426. [PMID: 34809746 DOI: 10.1071/py21178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/04/2021] [Indexed: 11/23/2022]
Abstract
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.
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Affiliation(s)
- Michael Au
- Western Sydney Local Health District, NSW, Australia; and College of Medicine and Dentistry, James Cook University, Qld, Australia; and Corresponding author.
| | - Robyn Preston
- College of Medicine and Dentistry, James Cook University, Qld, Australia; and School of Health, Medical and Applied Sciences, Central Queensland University, Qld, Australia
| | - Robin A Ray
- College of Medicine and Dentistry, James Cook University, Qld, Australia
| | - Meg Davis
- Townsville Multicultural Support Group, Townsville, Qld, Australia
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Taye BW, Valery PC, Liddle B, Woodward AJ, Sackey D, Williams S, Chang GKF, Clark PJ. 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. J Immigr Minor Health 2021; 24:1196-1205. [PMID: 34787805 DOI: 10.1007/s10903-021-01305-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
Abstract
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.
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Affiliation(s)
- Belaynew W Taye
- Faculty of Medicine, The University of Queensland, Brisbane, Australia. .,Mater Research Institute, Brisbane, Australia. .,QIMR Berghofer Medical Research Institute, Brisbane, Australia.
| | | | - Burglind Liddle
- Department of Gastroenterology and Hepatology, Mater Hospitals, Brisbane, Australia
| | - Aidan J Woodward
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia
| | - Donata Sackey
- Mater Refugee Health and Mater-University of Queensland, Brisbane, Australia
| | | | | | - Paul J Clark
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Mater Research Institute, Brisbane, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Department of Gastroenterology and Hepatology, Mater Hospitals, Brisbane, Australia
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Papadopoulos I, Lazzarino R, Sakellaraki O, Dadãu V, Apostolara P, Kuckert-Wöstheinrich A, Mauceri M, Kouta C. Empowering refugee families in transit: the development of a culturally competent and compassionate training and support package. J Res Nurs 2021; 27:200-214. [PMID: 35813174 PMCID: PMC9264421 DOI: 10.1177/17449871211018736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Irena Papadopoulos
- Head of the Research Centre, Department of Mental Health and Social Work, Middlesex University, UK
- Associate Professor, Department of Nursing, Cyprus University of Technology, Cyprus
| | - Runa Lazzarino
- Anthropologist, Department of Mental Health and Social Work, Middlesex University, UK
- Associate Professor, Department of Nursing, Cyprus University of Technology, Cyprus
| | - Ourania Sakellaraki
- Independent Consultant, Greece
- Associate Professor, Department of Nursing, Cyprus University of Technology, Cyprus
| | - Victor Dadãu
- President, EDUNET Association, Romania
- Associate Professor, Department of Nursing, Cyprus University of Technology, Cyprus
| | - Paraskevi Apostolara
- Lecturer, Nursing Department, National and Kapodistrian University of Athens, Greece
- Associate Professor, Department of Nursing, Cyprus University of Technology, Cyprus
| | - Andrea Kuckert-Wöstheinrich
- Lecturer, Nursing Department, Vorarlberg University of Applied Sciences, Austria; Senior Project Manager, St. Augustinus Gruppe, Germany
- Associate Professor, Department of Nursing, Cyprus University of Technology, Cyprus
| | - Manuela Mauceri
- Neuroscientist and Social Psychologist, Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Italy
- Associate Professor, Department of Nursing, Cyprus University of Technology, Cyprus
| | - Christiana Kouta
- Associate Professor, Department of Nursing, Cyprus University of Technology, Cyprus
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Nyanchoga MM, Lee P, Barbery G. 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. Vaccine 2021; 39:6238-6244. [PMID: 34556368 DOI: 10.1016/j.vaccine.2021.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 07/21/2021] [Accepted: 09/08/2021] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
| | - Patricia Lee
- Senior Lecturer, School of Medicine, Gold Coast Campus, Griffith University, Southport, QLD 4222, Australia.
| | - Gaery Barbery
- Lecturer, Health Services Management, School of Medicine, Griffith University, South Bank, QLD 4101, Australia.
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Preston R. An extraordinary year. Aust J Prim Health 2020. [DOI: 10.1071/pyv26n6_ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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