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Mellahn K, Kilkenny M, Siyambalapitiya S, Lakhani A, Purvis T, Reyneke M, Cadilhac DA, Rose ML. Comparing acute hospital outcomes for people with post-stroke aphasia who do and do not require an interpreter. Top Stroke Rehabil 2024; 31:527-536. [PMID: 38116813 DOI: 10.1080/10749357.2023.2295128] [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: 08/21/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND People with communication differences are known to have poorer hospital outcomes than their peers. However, the combined impact of aphasia and cultural/linguistic differences on care and outcomes after stroke remains unknown. OBJECTIVES To investigate the association between cultural/linguistic differences, defined as those requiring an interpreter, and the provision of acute evidence-based stroke care and in-hospital outcomes for people with aphasia. METHODS Cross-sectional, observational data collected in the Stroke Foundation National Audit of Acute Services (2017, 2019, 2021) were used. Multivariable regression models compared evidence-based care and in-hospital outcomes (e.g., length of stay) by interpreter status. Models were adjusted for sex, hospital location, stroke type and severity, with clustering by hospital. RESULTS Among 3122 people with aphasia (median age 78, 49% female) from 126 hospitals, 193 (6%) required an interpreter (median age 78, 55% female). Compared to people with aphasia not requiring an interpreter, those requiring an interpreter had similar care access but less often had their mood assessed (OR 0.50, 95% CI 0.32, 0.76), were more likely to have physiotherapy assessments (96% vs 90% p = 0.011) and carer training (OR 4.83, 95% CI 1.70, 13.70), had a 2 day longer median length of stay (8 days vs 6 days, p = 0.003), and were less likely to be independent on discharge (OR 0.54, 95% CI 0.33, 0.89). CONCLUSIONS Some differences exist in the management and outcomes for people with post-stroke aphasia who require an interpreter. Further research to explore their needs and the practical issues underpinning their clinical care pathways is required.
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Affiliation(s)
- Kathleen Mellahn
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
- School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia
| | - Monique Kilkenny
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Australia
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | | | - Ali Lakhani
- School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia
| | - Tara Purvis
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Australia
| | - Megan Reyneke
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Australia
| | - Dominique A Cadilhac
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Australia
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Miranda L Rose
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
- School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia
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Gray C, Porter G, Lobo R, Crawford G. Development and evaluation of health education resources for culturally and linguistically diverse populations: a systematic review. HEALTH EDUCATION RESEARCH 2024; 39:102-118. [PMID: 36994771 DOI: 10.1093/her/cyad015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/13/2023] [Accepted: 03/14/2023] [Indexed: 06/19/2023]
Abstract
People from culturally and linguistically diverse (CaLD) backgrounds in Australia generally experience poorer health outcomes, explained in part by low levels of health literacy. We conducted a systematic review to examine the development and evaluation of health education resources designed for CaLD populations. Five electronic databases were searched for English language, peer-reviewed studies published between 1980 and 2020. Thirty-four studies met the inclusion criteria. Twenty-four different health education resources were described and broadly categorized into four types: media campaigns (n = 10), text-based materials (n = 5), films (n = 8) and radio (n = 1). Studies were assessed against domains adapted from a health literacy guideline incorporating: need, collaboration, audience, health literacy, theory, test and process and impact evaluation. All but one study met the majority of the domains. All studies reported positive evaluation outcomes; this may be due to studies involving community early in resource design and including health literacy considerations in their design. Reporting resource design and evaluation against standard practice controls is recommended to build a more robust evidence base for developing effective health education resources for use by audiences from CaLD backgrounds.
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Affiliation(s)
- Corie Gray
- Curtin School of Population Health, Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia
| | - Georgia Porter
- Curtin School of Population Health, Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia
| | - Roanna Lobo
- Curtin School of Population Health, Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia
| | - Gemma Crawford
- Curtin School of Population Health, Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia
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Marcus K, Balasubramanian M, Short SD, Sohn W. Quantitative analysis on dental utilisation in culturally and linguistically diverse mothers. Aust J Prim Health 2024; 30:NULL. [PMID: 38056884 DOI: 10.1071/py23136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/27/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Culturally and linguistically diverse (CALD) mothers are influential in children's behaviours, yet little is known about this population. Furthermore, insufficient quantitative and context-based studies are available with CALD mothers and their access to oral health care. To address this gap, the study investigates oral health behaviours, psychological factors and remoteness area with dental utilisation in CALD mothers, within the NSW context. METHODS Informed by middle-range theory and a CALD-specific rainbow model, the 2013 and 2015 NSW Adult Population Health Survey was analysed. Variables for CALD mothers included household structure, age and language spoken. Multivariable analysis was conducted with oral health behaviours, psychological and remoteness variables, with dental utilisation as the outcome. RESULTS The sample was weighted (n =190,283). In total, 39.8% did not have a dental visit, and older mothers (aged 36-55 years) sought more dental services than younger mothers (aged 18-35 years). Higher odds for treatment dental care (aOR 2.21, 95% CI 1.12-4.37) than prevention-oriented care were found. Mothers experiencing moderate levels of psychological distress (aOR 0.49, 95% CI 0.31-0.77), or residing in outer regional and remote regions (aOR 0.19, 95% CI 0.04-0.85) were less likely to utilise dental care. CONCLUSION Findings underline geographical issues in dental care utilisationand the need for integrated care for CALD mothers experiencing psychological distress, and to encourage uptake of preventive oral health care. Addressing cost barriers necessitates for universal health coverage. Multidisciplinary integration of healthcare services with improved primary sector collaboration between governments and healthcare providers, and the expansion to regional services are required for equity in CALD communities.
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Affiliation(s)
- Kanchan Marcus
- The University of Sydney, Faculty of Medicine and Health, Menzies Centre for Health Policy and Economics, Charles Perkins Centre, Sydney, NSW 2006, Australia
| | - Madhan Balasubramanian
- Flinders University, Health Care Management, College of Business, Government and Law, Adelaide, SA, Australia; and The University of Sydney, School of Dentistry, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Stephanie D Short
- The University of Sydney, School of Health Sciences, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Woosung Sohn
- The University of Sydney, Faculty of Medicine and Health, Menzies Centre for Health Policy and Economics, Charles Perkins Centre, Sydney, NSW 2006, Australia; and The University of Sydney, School of Dentistry, Faculty of Medicine and Health, Sydney, NSW, Australia
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Leung B, Pilleron S, Bastiaannet E, Coombs LA, Jin R, Kantilal K, Kantilal K, Kenis C, Kobekyaa F, Kosmari L, Krok-Schoen JL, Li J, Mac Eochagain C, Newton L, Ruegg T, Stolz-Baskett P, Zhao Y, Bradley C, Puts M, Haase KR. Cancer treatment-related decision-making among culturally and linguistically diverse older adults with cancer: A scoping review by the International Society of Geriatric Oncology Nursing and Allied Health Interest Group. J Geriatr Oncol 2023; 14:101607. [PMID: 37633779 DOI: 10.1016/j.jgo.2023.101607] [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: 03/27/2023] [Revised: 07/06/2023] [Accepted: 08/15/2023] [Indexed: 08/28/2023]
Abstract
INTRODUCTION Countries with large economies are observing a growing number of culturally and linguistically diverse (CALD) older adults, many of whom will be affected by cancer. Little is known about the experiences and factors that influence cancer treatment decision-making in this population. The purposes of this scoping review are: (1) to summarize the published literature on cancer treatment-related decision-making with this population; and (2) to identify potential differences in how cancer treatment decisions are made compared to non-CALD older adults with cancer. MATERIALS AND METHODS We conducted a scoping review following Arksey and O'Malley and Levac methods, Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review Guidelines. We conducted a comprehensive multidatabase search, screening 1,139 titles/abstracts. Following data abstraction, we analyzed the data using tabular and narrative summary. RESULTS We extracted data from six studies that met the inclusion criteria: four quantitative and two qualitative; five from the United States and one from Canada. Three themes were identified: (1) barriers to decision-making, (2) the influence of family and friends on decisionmaking, and (3) differences in uptake and types of treatment received between CALD and non-CALD older adults. DISCUSSION This comprehensive review of treatment decision-making among CALD older adults with cancer highlights the paucity of research in this area. The findings are limited to North American populations and may not represent experiences in other regions of the world. Future research should focus on studying their treatment-related decision-making experiences to improve the quality of care for this vulnerable population.
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Affiliation(s)
- Bonnie Leung
- Department of Medical Oncology, BC Cancer, Vancouver, Canada; Faculty of Applied Science, School of Nursing, University of British Columbia, Vancouver, Canada.
| | - Sophie Pilleron
- Ageing, Cancer, and Disparities Research Unit, Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Esther Bastiaannet
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Lorinda A Coombs
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, USA
| | - Rana Jin
- Princess Margaret Cancer Centre, Toronto, Canada
| | - Kavita Kantilal
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Kumud Kantilal
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Cindy Kenis
- Department of General Medical Oncology and Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Leuven, Belgium
| | - Francis Kobekyaa
- Faculty of Applied Science, School of Nursing, University of British Columbia, Vancouver, Canada
| | | | - Jessica L Krok-Schoen
- Division of Health Sciences, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, USA
| | - Juan Li
- Xiangya School of Nursing, Central South University, Changsha, China
| | | | - Lorelei Newton
- School of Nursing, University of Victoria, Victoria, Canada
| | | | - Petra Stolz-Baskett
- Institute of Nursing, Zurich University of Applied Sciences SHAW, Winterthur, Switzerland; School of Nursing, Midwifery & Health Practice, Te Herenga Waka/Victoria University of Wellington, Wellington, New Zealand
| | - Yue Zhao
- Department of General, Visceral, Tumor and Transplantation Surgery, University Hospital of Cologne, Cologne, Germany
| | - Cara Bradley
- Dr. John Archer Library, University of Regina, Regina, Canada
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Kristen R Haase
- Faculty of Applied Science, School of Nursing, University of British Columbia, Vancouver, Canada
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Truong M, Dwyer J, Chan J, Bugeja L. Availability and quality of data related to cultural and linguistic diversity in the Victorian Suicide Register: A pilot study. Aust N Z J Public Health 2023; 47:100078. [PMID: 37586128 DOI: 10.1016/j.anzjph.2023.100078] [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: 07/29/2022] [Revised: 03/29/2023] [Accepted: 07/16/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVE While people from culturally and linguistically diverse (CALD) backgrounds have been identified as a priority for suicide prevention in Australia, little is known about suicide in CALD communities. We aim to describe the availability and quality of CALD data in the Victorian Suicide Register (VSR). METHODS A retrospective consecutive case series review of suicides reported to the Coroners Court of Victoria during 2016 was conducted. Using the VSR, we identify suicides showing evidence of CALD identity and relevant variables were extracted and coded according to an adapted Australian Institute of Health and Welfare framework. RESULTS During 2016, 126 of 652 suicides (19.3%, 95% confidence intervals 16.4-22.6) were flagged as showing evidence of CALD. The two most frequent CALD indicators for which information was recorded were country of birth and year of arrival. There was less information pertaining to citizenship, residency/visa status, preferred language, English language proficiency and religious affiliation. CONCLUSIONS This study demonstrates that the VSR, like other databases, has substantial gaps in availability and quality of CALD data. IMPLICATIONS A framework to capture richer data on cultural, religious and linguistic diversity when coding suicides is needed to inform policy on suicide prevention initiatives designed for CALD communities.
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Affiliation(s)
- Mandy Truong
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia; Menzies School of Health Research, Darwin, Northern Territory, Australia.
| | - Jeremy Dwyer
- Coroners Prevention Unit, Coroners Court of Victoria, Southbank, Victoria, Australia
| | - Jocelyn Chan
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Lyndal Bugeja
- Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
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Marcus K, Balasubramanian M, Short S, Sohn W. Barriers and facilitators to dental care among culturally and linguistically diverse carers: A mixed-methods systematic review. Community Dent Oral Epidemiol 2023; 51:327-344. [PMID: 35342972 DOI: 10.1111/cdoe.12745] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 03/02/2022] [Accepted: 03/09/2022] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Culturally and linguistically diverse (CALD) communities experience widespread inequalities in dental care utilization. While, several studies have reported factors contributing to such inequalities, a synthesis of evidence is lacking for CALD carers. This review examined the barriers and facilitators to dental care utilization among CALD carers. METHODS Medline, CINAHL, ProQuest, Scopus and Web of Science were searched for dental utilization and related factors, without geographic limitations. An integrated mixed-method design was adopted, where both qualitative and quantitative findings were combined into a single synthesis. Critical appraisal was conducted using JBI tools, and a Universal Health Coverage (UHC) framework guided the synthesis approach. Reliability and researcher triangulation occurred throughout the conduct of this review. RESULTS A total of 20 papers were included: qualitative (n = 8), quantitative (n = 8) and mixed method (n = 4). Studies were from Australia, Canada, South Korea, Trinidad and Tobago, United Kingdom and the United States. Three studies insufficiently reported confounding variables and nine qualitative papers lacked philosophical perspectives. Affordability was the foremost barrier at the system level, followed by psychosocial negative provider experiences and language/communication issues at the provider level. Cultural, knowledge, attitudes and beliefs were individual-family level factors. Utilizing a UHC framework, the barriers and facilitators were aggregated at three levels; financial-system, provider and individual-family levels and illustrated in the rainbow model of CALD oral health. CONCLUSION The review strengthens evidence for multilayered, system-related policies and culturally sensitive provision of services for reducing oral healthcare inequalities in CALD carers.
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Affiliation(s)
- Kanchan Marcus
- Faculty of Medicine and Health, School of Dentistry, The University of Sydney, Surry Hills, New South Wales, Australia
| | - Madhan Balasubramanian
- Health Care Management, College of Business, Government and Law, Flinders University, Adelaide, South Australia, Australia
- Faculty of Medicine and Health, Menzies Centre for Health Policy and Economics, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Stephanie Short
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Woosung Sohn
- Faculty of Medicine and Health, School of Dentistry, The University of Sydney, Surry Hills, New South Wales, Australia
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Knipping D, Garnett A, Jiang BB. Access and Use of Services by Caregivers of Older Adults: A Scoping Review of Cultural and Linguistic Diversity. J Appl Gerontol 2023. [PMID: 36866817 DOI: 10.1177/07334648231158490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Westernized countries are home to an increasingly culturally and linguistically diverse (CLD) older adult population. Informal caregivers of CLD older adults face unique challenges accessing and using home- and community-based services (HCBS). This scoping review sought to identify facilitators and barriers to access and use of HCBS for informal caregivers of CLD older adults. Arksey and O'Malley's framework guided a systematic search of five electronic databases. The search strategy retrieved 5979 unique articles. Forty-two studies met the inclusion criteria and informed this review. Facilitators and barriers were identified at three stages of using services: knowledge, access, and use of services. Findings concerning access to HCBS were subdivided into willingness and ability to access HCBS. Results emphasize the need for changes in healthcare systems, organizations, and providers to provide culturally appropriate care and improve the accessibility and acceptability of HCBS for informal caregivers of CLD older adults.
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Affiliation(s)
| | - Anna Garnett
- Nursing, 6221University of Western Ontario, London, ON, Canada
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8
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Mejia GC, Ju X, Kumar S, Soares GH, Balasubramanian M, Sohn W, Jamieson L. Immigrants experience oral health care inequity: findings from Australia's National Study of Adult Oral Health. Aust Dent J 2023; 68:7-18. [PMID: 36229042 PMCID: PMC10952364 DOI: 10.1111/adj.12942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Oral health service utilization contributes to positive oral health and indicates realised access to services. The study aimed to describe patterns of oral health service use among overseas-born and Australian-born populations and assess equity in access to services. METHODS The study used data from Australia's National Study of Adult Oral Health 2017-2018 and was guided by the Aday and Andersen framework of access to health and Australia's National Oral Health Plan. Descriptive analyses of service use by perceived need, enabling and predisposing factors were compared between four groups: Australian-born and overseas-born who mainly speak English and Australian-born and overseas-born who mainly speak a language other than English. RESULTS Overseas-born who mainly speak a language other than English experienced greater oral health care inequity, largely driven by financial difficulty (avoided care due to cost: 42% vs 27%-28%; avoided/delayed visiting due to cost: 48% vs. 37%-38%; cost prevented treatment: 32% vs. 18%-24%). The most favourable visiting patterns were among the Australian-born population who speak a language other than English. CONCLUSIONS The study shows clear inequity experienced among immigrants in accessibility as measured through indicators of oral health care utilization and factors related to inequity, such as the ability to pay for services.
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Affiliation(s)
- GC Mejia
- Australian Research Centre for Population Oral HealthAdelaide Dental School, University of AdelaideAdelaideSouth AustraliaAustralia
| | - X Ju
- Australian Research Centre for Population Oral HealthAdelaide Dental School, University of AdelaideAdelaideSouth AustraliaAustralia
| | - S Kumar
- Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - GH Soares
- Australian Research Centre for Population Oral HealthAdelaide Dental School, University of AdelaideAdelaideSouth AustraliaAustralia
| | - M Balasubramanian
- Health Care ManagementCollege of Business, Government and Law, Flinders UniversityAdelaideSouth AustraliaAustralia
- Menzies Centre for Health Policy and EconomicsSchool of Public Health, The University of SydneySydneyNew South WalesAustralia
| | - W Sohn
- Population Oral Health, Sydney Dental School, Faculty of Medicine and HealthThe University of SydneyAdelaideSouth AustraliaAustralia
| | - L Jamieson
- Australian Research Centre for Population Oral HealthAdelaide Dental School, University of AdelaideAdelaideSouth AustraliaAustralia
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Smith J, Rabba AS, Ali A, Datta P, Dresens E, Faragaab N, Hall G, Heyworth M, Ige K, Lawson W, Lilley R, Syeda N, Pellicano E. 'Somali parents feel like they're on the outer': Somali mothers' experiences of parent-teacher relationships for their autistic children. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023:13623613221146077. [PMID: 36680459 DOI: 10.1177/13623613221146077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
LAY ABSTRACT Good relationships between parents and schools can improve autistic children's school success. There are many reasons why families from different cultural backgrounds find it harder to develop good relationships with schools, such as language barriers, discrimination and unfamiliarity with education systems. We know little about what 'good relationships' look like for these families. Here, we worked with a team of autistic and non-autistic researchers as well as an Advisory Group of Somali parents to conduct interviews with 15 Somali mothers of kindergarten and school-age autistic children. We asked mothers about their experiences of their child's education, communication with teachers and what a good relationship with schools would look like. We also asked how they felt the Somali community understood autism. We looked for common things that mothers said. We found that mothers were very proud of their children. They had high expectations, particularly about what children could do by themselves. Mothers found it frustrating that teachers had low expectations, that schools were not good at communicating with them and that autism-specific skills and experience were uncommon in schools. They also reported racist attitudes towards their children. Mothers experienced stigma and lacked resources, but support was gained from their daughters and their religion. Mothers themselves were proactively increasing community awareness and knowledge about autism in the hope that they and their autistic children would be valued and better supported. Our work has implications for how teachers and schools can work together with Somali parents to forge better futures for autistic children.
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Affiliation(s)
- Jodie Smith
- Macquarie University, Australia.,La Trobe University, Australia
| | | | | | | | | | - Nadia Faragaab
- Macquarie University, Australia.,Positive Partnerships, Australia
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Marcus K, Balasubramanian M, Short SD, Sohn W. Dental hesitancy: a qualitative study of culturally and linguistically diverse mothers. BMC Public Health 2022; 22:2199. [PMID: 36443774 PMCID: PMC9703727 DOI: 10.1186/s12889-022-14513-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/01/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Oral healthcare is paramount and inextricably linked to well-being. Yet, the evidence indicates that culturally and linguistically diverse (CALD) migrant communities have unequal access to mainstream dental services due to several barriers. The purpose of this study was to investigate the oral healthcare experiences, attitudes and barriers to oral healthcare utilisation in CALD mothers. METHODS A qualitative study with semi-structured interviews was conducted within a social constructivism epistemology. CALD mothers who identified as non-English speaking, foreign country born, with a child under 12, were recruited though purposive snowball sampling. Questions probed oral healthcare experiences, barriers, enablers, and attitudes. Verbatim typed transcripts were thematically analysed using grounded methodology. RESULTS Thirty-three CALD mothers participated; twenty from India, five from Fiji, four from China, two from Nepal and one each from Israel and Macedonia. Languages included Cantonese, Fiji-Hindi, Gujrati, Hebrew, Hindi, Kannada, Mandarin, Maharashtrian, Macedonian, Nepalese, Punjabi, Sanskrit, Telegu and Urdu. Cost was the foremost barrier to oral healthcare services, followed by Confidence in quality care for the provision of services and treatment. Confusion in navigating a public and private healthcare system was highlighted and Competing priorities took precedence. Complacency referred to 'no need' or lack of urgency in dental care. Subsequently, dental hesitancy (superordinate theme) described the patterning of data as comprising the five 'C' factors and was theorised as the dental hesitancy phenomenon to explain the occurrence of delay or avoidance in utilising dental care. CONCLUSION Findings highlight the utility of the dental hesitancy phenomenon unearthed within this study. CALD mothers explained five 'C' dimensions: cost, confidence, confusion, competing priorities and complacency as barriers to accessing timely dental care. Multisectoral collaboration between healthcare systems, universal health coverage and primary sector support is required to address dental hesitancy in CALD mothers. Further, this study contributes to the field of behavioural and social sciences in oral health and augments the literature on dental avoidance.
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Affiliation(s)
- Kanchan Marcus
- grid.1013.30000 0004 1936 834XPopulation Oral Health, Faculty of Medicine and Health, The University of Sydney School of Dentistry, Surry Hills, NSW Australia ,grid.1013.30000 0004 1936 834XMenzies Centre for Health Policy and Economics, School of Public Health, The University of Sydney, Camperdown, NSW Australia
| | - Madhan Balasubramanian
- grid.1014.40000 0004 0367 2697Health Care Management, College of Business, Government and Law, Flinders University, Adelaide, Australia ,grid.1013.30000 0004 1936 834XMenzies Centre for Health Policy and Economics, School of Public Health, The University of Sydney, Camperdown, NSW Australia
| | - Stephanie D. Short
- grid.1013.30000 0004 1936 834XMenzies Centre for Health Policy and Economics, School of Public Health, The University of Sydney, Camperdown, NSW Australia
| | - Woosung Sohn
- grid.1013.30000 0004 1936 834XPopulation Oral Health, Faculty of Medicine and Health, The University of Sydney School of Dentistry, Surry Hills, NSW Australia ,grid.1013.30000 0004 1936 834XMenzies Centre for Health Policy and Economics, School of Public Health, The University of Sydney, Camperdown, NSW Australia
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Marcus K, Balasubramanian M, Short SD, Sohn W. Dental diaspora: oral health care attitudes and experiences in culturally and linguistically diverse mothers in Australia. BMC Health Serv Res 2022; 22:1314. [PMID: 36329526 PMCID: PMC9632598 DOI: 10.1186/s12913-022-08708-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/19/2022] [Indexed: 11/06/2022] Open
Abstract
Background Globally oral health care is unequally accessible or utilised within culturally and linguistically diverse (CALD) migrant communities. Yet much remains unknown about CALD mothers and their oral healthcare experiences in Australia. Hence, this paper explores the oral health care attitudes and experiences of CALD mothers within the Australian context with the broader objective to reduce oral health inequalities. Methods Qualitative semi-structured interviews were conducted from a social constructivism paradigm. Participants were foreign country born, spoke language/s other than English and have a child. Purposive snowball sampling and recruitment was conducted through CALD organisations and social media. Participants were interviewed for their attitudes and experiences to dental care and frequency of utilisation in Australia and the home country. Interviews were transcribed verbatim and grounded analysis (Strauss and Corbin) performed. Researcher bias was reduced through reflexivity and triangulation. Results The participants (n = 33) included 20 CALD mothers born in India and 13 from either China, Fiji, Nepal, Macedonia and Israel. The theme, experiences with health workforce personnel revealed positive attitudes toward CALD providers from similar cultural and/or linguistic backgrounds. We coin these CALD providers as the ‘dental diaspora’. The dental diaspora facilitated CALD mothers through culture and/or language factors, alleviating cost barriers and flexibility in appointments. Dental travel to the home country was affirmed, however family visitation was the foremost reason for travel. Conclusion The findings suggest that the dental diaspora plays a significant role in promoting oral health care utilisation for first generation CALD mothers in Australia. This paper brings to light the phenomenon of the ‘dental diaspora’ as an essential health workforce that contributes to addressing inequities in oral healthcare utilisation within CALD migrant communities. Universal health coverage in oral health is further affirmed, as aligned to the WHO policy context.
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Affiliation(s)
- Kanchan Marcus
- grid.1013.30000 0004 1936 834XPopulation Oral Health, Faculty of Medicine and Health, The University of Sydney Dental School, Surry Hills, NSW Australia ,grid.1013.30000 0004 1936 834XMenzies Centre for Health Policy and Economics, School of Public Health, The University of Sydney, Camperdown, NSW Australia
| | - Madhan Balasubramanian
- grid.1013.30000 0004 1936 834XMenzies Centre for Health Policy and Economics, School of Public Health, The University of Sydney, Camperdown, NSW Australia ,grid.1014.40000 0004 0367 2697Health Care Management, College of Business, Government and Law, Flinders University, Bedford Park, SA Australia
| | - Stephanie D Short
- grid.1013.30000 0004 1936 834XMenzies Centre for Health Policy and Economics, School of Public Health, The University of Sydney, Camperdown, NSW Australia
| | - Woosung Sohn
- grid.1013.30000 0004 1936 834XPopulation Oral Health, Faculty of Medicine and Health, The University of Sydney Dental School, Surry Hills, NSW Australia ,grid.1013.30000 0004 1936 834XMenzies Centre for Health Policy and Economics, School of Public Health, The University of Sydney, Camperdown, NSW Australia
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