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Dowding C, Mikocka-Walus A, Skvarc D, O'Shea M, Olive L, Evans S. Learning to cope with the reality of endometriosis: A mixed-methods analysis of psychological therapy in women with endometriosis. Br J Health Psychol 2024; 29:644-661. [PMID: 38467518 DOI: 10.1111/bjhp.12718] [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: 03/05/2023] [Accepted: 02/22/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVES Despite the need and uptake of mental health support by women with endometriosis, no research to date has explored their experience of psychological therapy. We aimed to understand the factors that predict engagement in psychological therapy by Australian women with endometriosis and to qualitative explore their experience of psychological support. DESIGN Mixed-methods design. METHODS A total of 200 women with self-reported endometriosis were recruited from the community. We explored; (1) the demographic and clinical predictors of engagement in psychological therapy, (2) the psychological approaches that seem most valuable to women in the management of endometriosis and (3) their experience engaging in psychological therapy for endometriosis. RESULTS Nearly half of women reported to have seen a psychologist within the past year, particularly for pain. Younger age (OR, .94; 95% CI, .886-.993), depressive symptoms (OR, 1.05; 95% CI, 1.002-1.099), and working part time compared to full time (OR, 2.17, 95% CI, 1.012-4.668), increased the likelihood of engaging in psychological therapy. Template thematic analysis identified three themes; (1) endometriosis and pain have multi-faceted psychological effects, (2) psychological support is sought to adjust and live with endometriosis and (3) there are helpful and unhelpful psychological tools for women with endometriosis. CONCLUSIONS Our findings support the use of psychological therapy in the management of endometriosis, and the need for psychological therapy to acknowledge the chronicity and impact of symptoms, to enlist multidisciplinary support and to consider alternative options. Further advocacy is required to educate women on the benefits of psychological therapy for endometriosis.
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Affiliation(s)
- Charlotte Dowding
- Faculty of Health, School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Antonina Mikocka-Walus
- Faculty of Health, School of Psychology, Deakin University, Geelong, Victoria, Australia
- Centre for Social and Early Emotional Development, Faculty of Health, School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - David Skvarc
- Faculty of Health, School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Melissa O'Shea
- Faculty of Health, School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Lisa Olive
- Faculty of Health, School of Psychology, Deakin University, Geelong, Victoria, Australia
- Centre for Social and Early Emotional Development, Faculty of Health, School of Psychology, Deakin University, Geelong, Victoria, Australia
- IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Subhadra Evans
- Faculty of Health, School of Psychology, Deakin University, Geelong, Victoria, Australia
- Centre for Social and Early Emotional Development, Faculty of Health, School of Psychology, Deakin University, Geelong, Victoria, Australia
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Prokopovich K, Braunack-Mayer A, Street J, Stanoevska B, Pitts L, Phillipson L. Applying a Participatory Action Research Approach to Engage an Australian Culturally and Linguistically Diverse Community around Human Papillomavirus Vaccination: Lessons Learned. Vaccines (Basel) 2024; 12:978. [PMID: 39340010 PMCID: PMC11436009 DOI: 10.3390/vaccines12090978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/20/2024] [Accepted: 08/23/2024] [Indexed: 09/30/2024] Open
Abstract
Globally, migrant and culturally and linguistically diverse (CALD) communities are known to have inequitable access to HPV vaccination. One participatory research approach used to engage CALD communities around vaccination is participatory action research (PAR), but we know little about the use of PAR to engage priority migrant and CALD communities around school and HPV vaccination. To address this gap, we partnered with our local Multicultural Health Service to understand how the largest CALD group in our region of New South Wales, Australia, engages with their local school and HPV vaccination program. Through a long-standing PAR relationship, we used a participatory research method (World Café) approach to explore the level of awareness and engagement a multi-generational community member had concerning HPV vaccination. We acted by sharing a co-designed information website to answer the community's questions about HPV vaccination. We then evaluated these engagements with surveys, focus groups and online analytic platforms. Last, we reflected with project partners and health service stakeholders on the overall project outcomes and shared our learnings. In our discussion, we shared our lessons learned and contributed to a wider conversation about the benefits, challenges, and practicalities of using PAR to engage a priority CALD community around HPV vaccination.
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Affiliation(s)
- Kathleen Prokopovich
- Australian Centre for Health Engagement, Evidence and Values, Faculty of the Arts, Social Science and Humanities, University of Wollongong, Northfields Ave., Wollongong, NSW 2522, Australia
| | - Annette Braunack-Mayer
- Australian Centre for Health Engagement, Evidence and Values, Faculty of the Arts, Social Science and Humanities, University of Wollongong, Northfields Ave., Wollongong, NSW 2522, Australia
| | - Jackie Street
- Australian Centre for Health Engagement, Evidence and Values, Faculty of the Arts, Social Science and Humanities, University of Wollongong, Northfields Ave., Wollongong, NSW 2522, Australia
- School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Level 4, Rundle Mall Plaza, 50 Rundle Mall, Adelaide, SA 5000, Australia
| | - Biljana Stanoevska
- Multicultural and Refugee Health Service-Illawarra Shoalhaven Local Health District, 67 King St., Warrawong, NSW 2502, Australia
| | - Leissa Pitts
- Multicultural and Refugee Health Service-Illawarra Shoalhaven Local Health District, 67 King St., Warrawong, NSW 2502, Australia
| | - Lyn Phillipson
- Australian Centre for Health Engagement, Evidence and Values, Faculty of the Arts, Social Science and Humanities, University of Wollongong, Northfields Ave., Wollongong, NSW 2522, Australia
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Barr KR, Hawker P, Winata T, Wang S, Smead M, Ignatius H, Kohlhoff J, Schmied V, Jalaludin B, Lawson K, Liaw ST, Lingam R, Page A, Lam-Cassettari C, Boydell K, Lin PI, Katz I, Dadich A, Raman S, Grace R, Doyle AK, McClean T, Di Mento B, Preddy J, Woolfenden S, Eapen V. Family member and service provider experiences and perspectives of a digital surveillance and service navigation approach in multicultural context: a qualitative study in identifying the barriers and enablers to Watch Me Grow-Electronic (WMG-E) program with a culturally diverse community. BMC Health Serv Res 2024; 24:978. [PMID: 39180037 PMCID: PMC11344394 DOI: 10.1186/s12913-024-11397-y] [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: 03/29/2024] [Accepted: 08/02/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Children and families from priority populations experienced significant psychosocial and mental health issues to the COVID-19 pandemic. Yet they also faced significant barriers to service access, particularly families from culturally and linguistically diverse (CALD) backgrounds. With most child and family health nurse clinics ceasing in-person consultations due to the pandemic, many children missed out on health and developmental checks. The aim of this study was to investigate the perspectives and experiences of family members and service providers from an urban, CALD community regarding the implementation of a digital, developmental surveillance, Watch Me Grow-Electronic (WMG-E) program. METHODS Semi-structured interviews were conducted with 17 family members, service navigators, and service providers in a multicultural community in South Western Sydney, Australia. This qualitative study is an implementation evaluation which formed as part of a larger, two-site, randomised controlled trial of the WMG-E program. A reflexive thematic analysis approach, using inductive coding, was adopted to analyse the data. RESULTS Participants highlighted the comprehensive and personalised support offered by existing child and family health services. The WMG-E was deemed beneficial because the weblink was easy and quick to use and it enabled access to a service navigator who support family access to relevant services. However, the WMG-E was problematic because of technology or language barriers, and it did not facilitate immediate clinician involvement when families completed the weblink. CONCLUSIONS Families and service providers in this qualitative study found that using WMG-E empowered parents and caregivers to access developmental screening and learn more about their child's development and engage with relevant services. This beds down a new and innovative solution to the current service delivery gap and create mechanisms that can engage families currently not accessing services, and increases knowledge around navigating the health and social care services. Notwithstanding the issues that were raised by families and service providers, which include accessibility challenges for CALD communities, absence of clinical oversight during screening, and narrow scope of engagement with available services being offered, it is worth noting that improvements regarding these implementation factors must be considered and addressed in order to have longevity and sustainability of the program. TRIAL REGISTRATION The study is part of a large randomised controlled trial (Protocol No. 1.0, Version 3.1) was registered with ANZCTR (registration number: ACTRN12621000766819) on July 21st, 2021 and reporting of the trial results will be according to recommendations in the CONSORT Statement.
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Affiliation(s)
- Karlen R Barr
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Liverpool, NSW, Australia
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Patrick Hawker
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Teresa Winata
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
- National Disability Insurance Scheme Quality and Safeguards Commission, Parramatta, NSW, Australia
| | - Si Wang
- Research and Evaluation Group, The Salvation Army, Sydney, NSW, Australia
| | - Melissa Smead
- Murrumbidgee Local Health District, Wagga Wagga, NSW, Australia
| | - Hilda Ignatius
- South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Jane Kohlhoff
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Karitane, Carramar, NSW, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Parramatta, NSW, Australia
| | - Bin Jalaludin
- South Western Sydney Local Health District, Liverpool, NSW, Australia
- School of Public Health and Community Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Kenny Lawson
- School of Business, Western Sydney University, Campbelltown, NSW, Australia
| | - Siaw-Teng Liaw
- WHO Collaborating Centre for eHealth, University of New South Wales, Sydney, NSW, Australia
- Population Child Health Research Group, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Raghu Lingam
- Population Child Health Research Group, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Andrew Page
- School of Medicine, Western Sydney University, Parramatta, NSW, Australia
| | - Christa Lam-Cassettari
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Liverpool, NSW, Australia
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Katherine Boydell
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Black Dog Institute, Sydney, NSW, Australia
| | - Ping-I Lin
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Liverpool, NSW, Australia
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Ilan Katz
- Social Policy Research Centre, Faculty of Arts, Design, and Architecture, University of New South Wales, Sydney, NSW, Australia
| | - Ann Dadich
- School of Business, Western Sydney University, Campbelltown, NSW, Australia
| | - Shanti Raman
- South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Rebekah Grace
- Transforming Early Education and Child Health Research Centre, Western Sydney University, Campbelltown, NSW, Australia
| | - Aunty Kerrie Doyle
- School of Medicine, Western Sydney University, Parramatta, NSW, Australia
| | | | - Blaise Di Mento
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - John Preddy
- Murrumbidgee Local Health District, Wagga Wagga, NSW, Australia
- Rural Clinical School, School of Clinical Medicine, University of New South Wales, Wagga Wagga, NSW, Australia
| | - Susan Woolfenden
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Sydney Local Health District, Sydney, NSW, Australia
| | - Valsamma Eapen
- Academic Unit of Infant, Child and Adolescent Psychiatry, South Western Sydney Local Health District, Liverpool, NSW, Australia.
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.
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Hassan A, Kerr DA, Begley A. 'It's Just Not Working', a Qualitative Exploration of the Weight-Related Healthcare Experiences of Individuals of Arab Heritage With Higher Weight in Australia. Health Expect 2024; 27:e14134. [PMID: 38967878 PMCID: PMC11225603 DOI: 10.1111/hex.14134] [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] [Received: 02/29/2024] [Revised: 06/06/2024] [Accepted: 06/19/2024] [Indexed: 07/06/2024] Open
Abstract
INTRODUCTION Culturally and linguistically diverse population groups disproportionately experience higher weight and other non-weight-related discrimination in healthcare settings outside of their ancestral country. Little is known about the experiences of individuals with Arab heritage. This study aimed to qualitatively explore the intersectional weight-related healthcare experiences of individuals of Arab heritage with higher weight in Australia. METHODS A general inductive enquiry approach was used. Purposive, convenience and snowball sampling was used to recruit individuals of Arab heritage residing in Australia. Individuals were invited to participate in an online semistructured interview. Interviews were recorded, transcribed and thematically analysed. RESULTS Fifteen participants took part in the study. Of these participants, 93% were female (n = 14), 80% were aged between 18 and 44 years (n = 12), 73% were university educated (n = 11), 53% were born outside of Australia (n = 8) and all were Muslim (n = 15). Four main themes were identified: (1) appearance-based judgement, (2) generalised advice and assumptions, (3) cultural responsiveness and (4) healthcare system constraints. CONCLUSION Individuals of Arab heritage with higher weight in Australia, namely, females, often perceive their healthcare experiences as dismissive of their cultural and religious needs and driven by causality assumptions around weight. It is crucial that care delivered encompasses cultural humility, is weight-inclusive and acknowledges systemic constraints. Cultural safety training benchmarks, healthcare management reform and weight-inclusive healthcare approaches are recommended to assist healthcare providers in delivering effective, holistic and culturally safe care. PATIENT OR PUBLIC CONTRIBUTION Insights gained from conversations with Arab heritage community members with lived experiences regarding weight-related healthcare encounters informed the study design and approach.
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Affiliation(s)
- Amira Hassan
- School of Population HealthCurtin UniversityPerthWestern AustraliaAustralia
- Curtin Health Innovation Research InstituteCurtin UniversityPerthWestern AustraliaAustralia
| | - Deborah A. Kerr
- School of Population HealthCurtin UniversityPerthWestern AustraliaAustralia
- Curtin Health Innovation Research InstituteCurtin UniversityPerthWestern AustraliaAustralia
| | - Andrea Begley
- School of Population HealthCurtin UniversityPerthWestern AustraliaAustralia
- Curtin Health Innovation Research InstituteCurtin UniversityPerthWestern AustraliaAustralia
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Tannerah A, Hazel O, Desson S, Farah R, Kamil‐Thomas Z, Iqbal H, Eames C, Saini P, Bifarin O. Consultations With Muslims From Minoritised Ethnic Communities Living in Deprived Areas: Identifying Inequities in Mental Health Care and Support. Health Expect 2024; 27:e14132. [PMID: 38956944 PMCID: PMC11220172 DOI: 10.1111/hex.14132] [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] [Received: 12/03/2023] [Revised: 04/27/2024] [Accepted: 06/19/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Limited research concerning existing inequities in mental health care and support services in the United Kingdom captures perceptions and lived experiences of the significantly underrepresented Muslim population. METHODS Underpinned by social constructivist theory, we used consultation to facilitate public and patient involvement and engagement (PPIE) to identify inequities in mental health care and support experienced by Muslims from minoritised ethnic communities living in deprived areas in Liverpool, UK. The rationale was to (a) better inform standards and policies in healthcare and (b) provide a psychologically safe space to members of the Muslim community to share perceptions and experiences of mental health care and support services. To ensure trustworthiness of the data, member checking was adopted. This paper describes the procedure to achieving this consultation, including our recruitment strategy, data collection and analysis as well as key findings. FINDINGS Twenty-seven consultees attended the women's consultation and eight consultees attended the men's consultation. Consultees were from Yemeni, Somali, Sudanese, Egyptian, Algerian, Pakistani and Moroccan communities and share the Islamic faith. Four key interlinked themes were identified from consultees' narratives: (1) broken cycle of trust; (2) an overmedicalised model of care; (3) community mental health prevention initiatives; and (4) culturally conscious training and education. CONCLUSIONS The Muslim population has identified numerous barriers to accessing mental health support and there is a need to resource activities that would aid deeper understanding of mental health support needs through continuous and meaningful community initiatives. This would afford mental health practitioners and organisations opportunities for developing realistic anti-racism strategies, effectively adopting social prescription, strengthening partnerships and collaborations aimed at supporting delivery of evidence-based mental health care provisions to tackle mental health inequities. PATIENT AND PUBLIC INVOLVEMENT This paper reports on the involvement and engagement of Muslims from minoritised ethnic communities living in the Liverpool city region.
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Affiliation(s)
- Ashraf Tannerah
- School of Nursing and Advanced Practice, School of PsychologyLiverpool John Moores UniversityLiverpoolUK
- Alder Hey Children's NHS Foundation TrustLiverpoolUK
| | | | - Sheree Desson
- School of Nursing and Advanced Practice, School of PsychologyLiverpool John Moores UniversityLiverpoolUK
- Mersey Care NHS Foundation TrustLiverpoolUK
| | - Rahima Farah
- Central Liverpool Primary Care NetworkLiverpoolUK
- Liverpool City CouncilLiverpoolUK
| | - Zalihe Kamil‐Thomas
- School of Nursing and Advanced Practice, School of PsychologyLiverpool John Moores UniversityLiverpoolUK
| | - Halima Iqbal
- School of Nursing and Healthcare LeadershipUniversity of BradfordBradfordUK
| | - Catrin Eames
- School of Nursing and Advanced Practice, School of PsychologyLiverpool John Moores UniversityLiverpoolUK
| | - Pooja Saini
- School of Nursing and Advanced Practice, School of PsychologyLiverpool John Moores UniversityLiverpoolUK
| | - Oladayo Bifarin
- School of Nursing and Advanced Practice, School of PsychologyLiverpool John Moores UniversityLiverpoolUK
- Mersey Care NHS Foundation TrustLiverpoolUK
- Senior Research Leader ProgrammeNational Institute for Health and Care Research (NIHR)LondonUK
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Crawford K, Wilson C, Mulley WR, Toussaint ND, Kennedy E, Andrew N, Ward A, Truong M. Factors Influencing Kidney Transplantation Experiences for Patients From Culturally and Linguistically Diverse Backgrounds: A Qualitative Study. Health Expect 2024; 27:e14166. [PMID: 39097762 PMCID: PMC11297906 DOI: 10.1111/hex.14166] [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] [Received: 01/18/2024] [Revised: 07/18/2024] [Accepted: 07/22/2024] [Indexed: 08/05/2024] Open
Abstract
BACKGROUND Disparities in aspects of chronic kidney disease progression and management exist for patients from culturally and linguistically diverse (CALD) backgrounds, including with treatment and outcomes for kidney transplantation. OBJECTIVE This study aimed to explore factors that impact kidney transplant outcomes from the perspective of kidney transplant recipients (KTRs) from CALD backgrounds and their family caregivers. METHODS A descriptive qualitative design was utilised. Participants were recruited from two tertiary hospitals in Victoria, Australia. Semi-structured interviews were conducted with KTRs who were born overseas in countries where English is not the primary language. Interviews were also conducted with family caregivers. Analysis was guided by the Framework Method, and emergent subcategories were mapped into the categories identified in Andersen's Health Service Utilisation Model. RESULTS Data from 21 KTRs and five caregivers were grouped under the categories of Population Characteristics, Environment, Health Behaviour and Outcomes. KTRs believed that neither culture nor religious beliefs impacted how they managed their transplant or healthcare utilisation. KTRs expressed satisfaction with their care, felt no inequity with how they were treated by health professionals and expressed gratitude for the Australian healthcare system. Language did not necessarily impact transplant outcomes, but there was a reliance on interpreters for non-English-speaking patients as most written information was in English. Caregivers were instrumental in providing support but discussed the challenges involved. CONCLUSION This study explored factors influencing kidney transplantation for KTRs from a CALD background. The study provided insight into how to deliver quality healthcare to these patients, highlighting the importance of health services providing information that is written in the patient's own language and respectively asking KTRs about their health beliefs or customs. Caregivers were instrumental in supporting KTRs, but there is a need to better prepare them for this role. PATIENT OR PUBLIC CONTRIBUTION Patient and public involvement was integrated into the design and delivery of the study. KTRs from CALD backgrounds assisted with framing the research questions and offering advice on the recruitment and data collection process.
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Affiliation(s)
| | - Catherine Wilson
- Nursing Institute of Health and WellbeingFederation UniversityMount HelenVictoriaAustralia
| | - William R. Mulley
- Department of NephrologyMonash Medical CentreClaytonVictoriaAustralia
- Centre for Inflammatory Diseases, Department of MedicineMonash UniversityClaytonVictoriaAustralia
| | - Nigel D. Toussaint
- Department of NephrologyThe Royal Melbourne HospitalParkvilleVictoriaAustralia
- Department of Medicine (RMH)University of MelbourneParkvilleVictoriaAustralia
| | - Elaine Kennedy
- Department of NephrologyMonash Medical CentreClaytonVictoriaAustralia
| | - Narissa Andrew
- Department of NephrologyThe Royal Melbourne HospitalParkvilleVictoriaAustralia
| | - Andrea Ward
- Department of NephrologyThe Royal Melbourne HospitalParkvilleVictoriaAustralia
| | - Mandy Truong
- Monash Nursing and MidwiferyMonash UniversityClaytonVictoriaAustralia
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Elliott SA, Bialy L, Scott SD, Hartling L. Exploring methods for creating or adapting knowledge mobilization products for culturally and linguistically diverse audiences: a scoping review. Arch Public Health 2024; 82:111. [PMID: 39034399 PMCID: PMC11265177 DOI: 10.1186/s13690-024-01334-0] [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: 02/12/2024] [Accepted: 06/29/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Connecting end-users to research evidence has the power to improve patient knowledge and inform health decision-making. Differences in the culture and language of the end users may shape the effectiveness of knowledge mobilization (KMb). This scoping review set out to understand current approaches and methods when creating or adapting KMb products for culturally and linguistically diverse (CALD) audiences. METHODS We searched 3 databases (Ovid Medline, CINAHL via EBSCOhost, PsychINFO) from 2011 until August 2023. We included any literature about KMb product creation or adaptation processes serving CALD communities. A primary reviewer screened all identified publications and a second reviewer screened publications excluded by the primary. Data were extracted using a standardized form by one reviewer and verified by a second reviewer. Studies were categorized by type of adaptations ('surface' and/or 'deep' structure) and mapped based on type of stakeholder engagement used in the research approach (i2S model), and end-user involvement (content, design, evaluation and dissemination) in KMb product creation or adaptation. RESULTS Ten thousand two hundred ninety-nine unique titles and abstracts were reviewed, 670 full-text studies were retrieved and reviewed, and 78 studies were included in final data extraction and mapping. Twenty-four studies (31%) created or adapted exclusively text-based KMb products such as leaflets and pamphlets and 49 (63%) produced digital products such as videos (n = 16, 33%), mobile applications (n = 14, 29%), and eHealth websites (n = 7, 14%). Twenty-five studies (32%) reported following a framework or theory for their creation or adaptation efforts. Twenty-eight studies (36%) engaged stakeholders in the research approach. Nearly all (96%) involved end-users in creating or adapting the KMb products through involvement in content development (n = 64), design features (n = 52), evaluation (n = 44) and dissemination (n = 20). Thirty-two (41%) studies included reflections from the research teams on the processes for creating or adapting KMb products for CALD communities. CONCLUSION Included studies cited a variety of methods to create or adapt KMb products for CALD communities. Successful uptake of created or adapted KMb products was often the result of collaboration and involvement with end-users for more applicable, accessible and meaningful products. Further research developing guidance and best practices is needed to support the creation or adaptation of KMb products with CALD communities. REGISTRATION Protocol submitted to Open Science Framework on August 16, 2022 ( https://osf.io/9jcw4/ ).
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Affiliation(s)
- Sarah A Elliott
- Alberta Research Centre for Health Evidence (ARCHE), Faculty of Medicine and Dentistry, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada.
| | - Liza Bialy
- Alberta Research Centre for Health Evidence (ARCHE), Faculty of Medicine and Dentistry, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Shannon D Scott
- Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence (ARCHE), Faculty of Medicine and Dentistry, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
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Peters S, Peebles E, Carwana M. Lost in translation: a national cross-sectional study on medical interpreter use by pediatric residents. Postgrad Med J 2024; 100:504-511. [PMID: 38453142 DOI: 10.1093/postmj/qgae026] [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: 10/10/2023] [Revised: 01/25/2024] [Accepted: 01/27/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Lack of communication in a family's preferred language is inequitable and results in inferior care. Pediatric residents provide care to many families with non-English or French language preferences (NEFLP). There is no data available about how Canadian pediatric residents use interpreters, making it difficult to develop targeted interventions to improve patient experience. OBJECTIVES Our purpose was to assess translation services in pediatric training centers and evaluate resident perception of their clinical skills when working with NEFLP patients and families. This survey represents the first collection of data from Canadian pediatric residents about interpreter services. METHODS Eligible participants included all pediatric residents enrolled in an accredited Canadian pediatric training program. An anonymous survey was developed in REDCap© and distributed via email to all pediatric residents across Canada. Descriptive statistics were performed in STATA v15.1. RESULTS 122 residents responded. Interpreter services were widely available but underused in a variety of clinical situations. Most (85%) residents felt they provided better care to patients who shared their primary language (English or French), compared with families who preferred other languages-even when an interpreter was present. This finding was consistent across four self-assessed clinical skills. CONCLUSIONS Residents are more confident in their clinical and communication skills when working with families who share their primary language. Our findings suggest that residents lack the training and confidence to provide equal care to families with varying language preferences. Pediatric training programs should develop curriculum content that targets safe and effective interpreter use while reviewing non-spoken aspects of cultural awareness and safety.
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Affiliation(s)
- Sarah Peters
- Department of Pediatrics, University of British Columbia, UBC Faculty of Medicine Rm 2D19, 4480 Oak Street, BC Children's Hospital, Vancouver, BC V6H 3V4, Canada
- BC Children's Hospital Research Institute, 938 W 28th Ave, Vancouver, BC V5Z 4H4, Canada
| | - Erin Peebles
- Department of Pediatrics, University of British Columbia, UBC Faculty of Medicine Rm 2D19, 4480 Oak Street, BC Children's Hospital, Vancouver, BC V6H 3V4, Canada
- BC Children's Hospital Research Institute, 938 W 28th Ave, Vancouver, BC V5Z 4H4, Canada
| | - Matthew Carwana
- Department of Pediatrics, University of British Columbia, UBC Faculty of Medicine Rm 2D19, 4480 Oak Street, BC Children's Hospital, Vancouver, BC V6H 3V4, Canada
- BC Children's Hospital Research Institute, 938 W 28th Ave, Vancouver, BC V5Z 4H4, Canada
- University of British Columbia, Human Early Learning Partnership, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada
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Nashwan AJ, Kunjavara J. Enhancing cancer care safety for ethnic minority patients: insights from healthcare professionals. Evid Based Nurs 2024:ebnurs-2024-104005. [PMID: 38914449 DOI: 10.1136/ebnurs-2024-104005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2024] [Indexed: 06/26/2024]
Affiliation(s)
- Abdulqadir J Nashwan
- Nursing & Midwifery Research Department, Hamad Medical Corporation, Doha, Doha, Qatar
| | - Jibin Kunjavara
- Nursing & Midwifery Research Department, Hamad Medical Corporation, Doha, Doha, Qatar
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Dennaoui N, Guagliano JM, Kolt GS, Jammal M, George ES. A systematic review of culturally adapted physical activity interventions for culturally and linguistically diverse children and adolescents. Prev Med 2024; 183:107979. [PMID: 38697226 DOI: 10.1016/j.ypmed.2024.107979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/01/2024] [Accepted: 04/29/2024] [Indexed: 05/04/2024]
Abstract
OBJECTIVE Limited evidence shows culturally and linguistically diverse (CALD) children and adolescents are less active, compared to the general population. It is unclear, how physical activity interventions have been adapted for CALD children and adolescents to enhance engagement. This study aimed to review culturally adapted physical activity interventions targeting CALD children and adolescents. METHODS All studies recruited children and adolescents (i.e., aged ≥5 to <18 years old) from CALD backgrounds, targeted physical activity, and included cultural adaptations. Cultural adaptations were defined as surface structures (i.e., observable characteristics of a targeted population) or deep structures (i.e., rooted in core ethnic values derived from individual cultures. RESULTS Twenty studies were included. Ten studies used a combination of surface and deep structure adaptations. Of these 10 studies, 3 found a significant between-group difference in physical activity favouring the intervention group. Among studies (n = 6) that used surface structure adaptations (e.g., language adjustments to information sheets, consent forms, and resources), 1 found a significant intervention effect on physical activity. With studies (n = 4) that used deep structure adaptations (e.g., incorporating traditional songs and dances relevant to cultural groups), 1 study found a significant intervention effect on physical activity. CONCLUSION A small number of studies found significant changes to increase physical activity levels. We found there is a lack of consistent evidence indicating that incorporating surface and/or deep structure adaptations result in significant changes in physical activity. Future research should focus on establishing higher quality methodology when developing culturally adapted interventions for CALD populations.
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Affiliation(s)
- Nariman Dennaoui
- School of Health Sciences, Western Sydney University, Sydney, Australia.
| | - Justin M Guagliano
- School of Health Sciences, Western Sydney University, Sydney, Australia; Translational Health Research Institute (THRI), Western Sydney University, Sydney, Australia
| | - Gregory S Kolt
- School of Health Sciences, Western Sydney University, Sydney, Australia
| | - Melissa Jammal
- School of Health Sciences, Western Sydney University, Sydney, Australia
| | - Emma S George
- School of Health Sciences, Western Sydney University, Sydney, Australia; Translational Health Research Institute (THRI), Western Sydney University, Sydney, Australia
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Brijnath B, Muoio R, Feldman P, Ghersi D, Chan AW, Welch V, Treweek S, Green H, Orkin AM, Owusu-Addo E. "We are not invited": Australian focus group results on how to improve ethnic diversity in trials. J Clin Epidemiol 2024; 170:111366. [PMID: 38631530 DOI: 10.1016/j.jclinepi.2024.111366] [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: 10/24/2023] [Revised: 03/26/2024] [Accepted: 04/09/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES Lack of ethnic diversity in trials may contribute to health disparities and to inequity in health outcomes. The primary objective was to investigate the experiences and perspectives of ethnically diverse populations about how to improve ethnic diversity in trials. STUDY DESIGN AND SETTING Qualitative data were collected via 16 focus groups with participants from 21 ethnically diverse communities in Australia. Data collection took place between August and September 2022 in community-based settings in six capital cities: Sydney, Melbourne, Perth, Adelaide, Brisbane, and Darwin, and one rural town: Bordertown (South Australia). RESULTS One hundred and fifty-eight purposively sampled adults (aged 18-85, 49% women) participated in groups speaking Tamil, Greek, Punjabi, Italian, Mandarin, Cantonese, Karin, Vietnamese, Nepalese, and Arabic; or English-language groups (comprising Fijian, Filipino, African, and two multicultural groups). Only 10 participants had previously taken part in medical research including three in trials. There was support for medical research, including trials; however, most participants had never been invited to participate. To increase ethnic diversity in trial populations, participants recommended recruitment via partnering with communities, translating trial materials and making them culturally accessible using audiovisual ways, promoting retention by minimizing participant burden, establishing trust and rapport between participants and researchers, and sharing individual results. Participants were reluctant to join studies on taboo topics in their communities (eg, sexual health) or in which physical specimens (eg, blood) were needed. Participants said these barriers could be mitigated by communicating about the topic in more culturally cognizant and safe ways, explaining how data would be securely stored, and reinforcing the benefit of medical research to humanity. CONCLUSION Participants recognized the principal benefits of trials and other medical research, were prepared to take part, and offered suggestions on recruitment, consent, data collection mechanisms, and retention to enable this to occur. Researchers should consider these community insights when designing and conducting trials; and government, regulators, funders, and publishers should allow for greater innovation and flexibility in their processes to enable ethnic diversity in trials to improve.
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Affiliation(s)
- Bianca Brijnath
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia; Social Gerontology, National Ageing Research Institute, Melbourne, Australia; School of Social Sciences, University of Western Australia, Perth, Australia.
| | - Rachel Muoio
- Social Gerontology, National Ageing Research Institute, Melbourne, Australia
| | - Peter Feldman
- Social Gerontology, National Ageing Research Institute, Melbourne, Australia
| | - Davina Ghersi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - An-Wen Chan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Vivian Welch
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Shaun Treweek
- Health Services Research Unit, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland
| | - Heidi Green
- Health Services Research Unit, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland; Research and Insights Team, COUCH Health, Manchester, UK
| | - Aaron M Orkin
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Li Ka Shing Knowledge Institute of Unity Health, Toronto, Canada
| | - Ebenezer Owusu-Addo
- Social Gerontology, National Ageing Research Institute, Melbourne, Australia; Bureau of Integrated Rural Development, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
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McDonald CE, Granger CL, Louie J, Tran T, Remedios LJ. Health information and resources in hospital outpatient waiting areas may not meet the needs of older adults from culturally and linguistically diverse backgrounds: A cross-cultural qualitative study. Health Info Libr J 2024. [PMID: 38797964 DOI: 10.1111/hir.12534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/23/2024] [Accepted: 04/17/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Health information and resources are often provided in hospital outpatient waiting areas but may not meet the cultural and health literacy needs of older adults from culturally and linguistically diverse (CALD) backgrounds. OBJECTIVES To explore the perspectives and experiences of Cantonese- and Vietnamese-speaking patients and carers in this setting. METHODS This qualitative interview-based study was conducted from December 2019 to March 2020 at a single outpatient rehabilitation service located at a tertiary public hospital. Four adult consumers (two older adult patients, two caregivers) from CALD backgrounds participated in semi-structured interviews with bilingual researchers. Data were transcribed, translated and analysed using reflexive thematic analysis. RESULTS Five themes were developed which highlighted that older adults' language profiles shaped their health information needs and ability to access resources in waiting areas. Cultural factors such as filial responsibility may also influence health information preferences. DISCUSSION Older consumers from CALD backgrounds did not have equitable access to health information and resources in the waiting area compared with English-literate older adults. CONCLUSION Health information and resources in waiting areas warrant improving to better meet the needs of older patients from CALD backgrounds and their caregivers.
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Affiliation(s)
- Cassie E McDonald
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Allied Health-Physiotherapy, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Allied Health, Alfred Health, Melbourne, Victoria, Australia
| | - Catherine L Granger
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Allied Health-Physiotherapy, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Julie Louie
- Department of Allied Health-Physiotherapy, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Thy Tran
- Sub-Acute Community Services, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Louisa J Remedios
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Physiotherapy, Federation University, Melbourne, Victoria, Australia
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Chauhan A, Chitkara U, Walsan R, Sansom-Daly UM, Manias E, Seah D, Dalli A, El-Kabbout N, Tieu T, Sarwar M, Faiz M, Huang N, Rocha VM, Pal A, Harrison R. Co-designing strategies to improve advance care planning among people from culturally and linguistically diverse backgrounds with cancer: iCanCarePlan study protocol. BMC Palliat Care 2024; 23:123. [PMID: 38760714 PMCID: PMC11102140 DOI: 10.1186/s12904-024-01453-z] [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] [Received: 01/11/2024] [Accepted: 05/08/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Advance care planning (ACP) describes the process of supporting individuals at any age or stage of health to consider and share their personal values, life goals, and preferences regarding future health care. Engaging in ACP is associated with better-quality of care in which people receive care in lines with their wishes, values and preferences. Direct translations of ACP guides and resources do not attend to the considerable inter- and intra-ethnic variations in cultural and religious or spiritual beliefs that shape preferences among people from culturally and linguistically diverse (CALD) backgrounds. ICanCarePlan is a three-year project that aims to determine the prevalence of ACP documentation among people from CALD backgrounds with cancer, identify resources available and their use to support ACP among CALD communities, identify barriers and facilitators of person-centred ACP, and to develop, through co-design with consumers and clinicians, approaches that enhance the process ACP for people from CALD backgrounds. METHOD A mixed-method sequential approach will be used comprising of four studies. Study one is retrospective medical record review of approximately 1500 medical records to establish the prevalence of ACP documentation among CALD patient records in cancer services. Study two is a document analysis synthesising the resources available in the Australian health system to support ACP. Study three is a qualitative study with healthcare staff and consumers to explore barriers and enablers of person-centred ACP. Evidence generated from studies one to three will inform the conduct of co-design with stakeholders to develop approaches to improve ACP processes among CALD communities. Language, technical and financial support for meaningful involvement with consumers from CALD backgrounds throughout this project is outlined. A plan for distress management is also made due to sensitive nature of the topic. The research project has also established a project steering group consisting of three consumer members who are from CALD backgrounds. DISCUSSION The project will address a national priority issue for a growing population of CALD communities in Australia. The project will provide novel evidence of ACP among CALD communities and novel strategies developed with stakeholders to enhance uptake and experiences of ACP.
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Affiliation(s)
- Ashfaq Chauhan
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW, Australia.
| | - Upma Chitkara
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW, Australia
| | - Ramya Walsan
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW, Australia
| | - Ursula M Sansom-Daly
- Behavioural Sciences Unit, School of Clinical Medicine, Discipline of Paediatrics & Child Health, UNSW Medicine and Health, Randwick Clinical Campus, UNSW Sydney, Sydney, NSW, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia
- Sydney Youth Cancer Service, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Davinia Seah
- Sacred Heart Supportive and Palliative Care, St Vincent's Hospital Sydney, Sydney, NSW, Australia
| | - Angie Dalli
- Australian Commission on Safety and Quality in Health Care, Sydney, NSW, Australia
| | | | - Thit Tieu
- Sisters' Cancer Support Group Inc., Sydney, NSW, Australia
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, Australia
| | - Mashreka Sarwar
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, Australia
| | - Misbah Faiz
- District Clinical Governance, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Nancy Huang
- Macarthur Cancer Therapy Centre, South Western Sydney Local Health District, Sydney, NSW, Australia
| | | | - Abhijit Pal
- Liverpool Hospital, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Reema Harrison
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW, Australia
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14
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King L, Minyaev S, Grantham H, Clark RA. Opinions of Nurses and Physicians on a Patient, Family, and Visitor Activated Rapid Response System in Use Across Two Hospital Settings. Jt Comm J Qual Patient Saf 2024; 50:269-278. [PMID: 38296749 DOI: 10.1016/j.jcjq.2024.01.002] [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: 03/25/2023] [Revised: 12/30/2023] [Accepted: 01/03/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Early detection of deterioration of hospitalized patients with timely intervention improves outcomes in the hospital. Patients, family members, and visitors (consumers) at the patient's bedside who are familiar with the patient's condition may play a critical role in detecting early patient deterioration. The authors sought to understand clinicians' views on consumer reporting of patient deterioration through an established hospital consumer-initiated escalation-of-care system. METHODS A convenience sample of new graduate-level to senior-level nurses and physicians from two hospitals in South Australia was administered a paper survey containing six open-ended questions. Data were analyzed with a matrix-style framework and six steps of thematic analysis. RESULTS A total of 244 clinicians-198 nurses and 46 physicians-provided their views on the consumer-initiated escalation-of-care system. Six major themes and subthemes emerged from the responses indicating that (1) clinicians were supportive of consumer reporting and felt that consumers were ideally positioned to recognize deterioration early and raise concerns about it; (2) management support was required for consumer escalation processes to be effective; (3) clinicians' workload could possibly increase or decrease from consumer escalation; (4) education of consumers and staff on escalation protocol is a requirement for success; (5) there is need to build consumer confidence to speak up; and (6) there is a need to address barriers to consumer escalation. CONCLUSION Clinicians were supportive of consumers acting as first reporters of patient deterioration. Use of interactive, encouraging communication skills with consumers was recognized as critical. Annual updating of clinicians on consumer reporting of deterioration was also recommended.
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Tang D, Jawad D, Dragoje V, Wen LM, Taki S. The use of interpreter services and its barriers faced by hospital staff when accessing interpreters for patients with low English proficiency during the COVID-19 pandemic. Health Promot J Austr 2024. [PMID: 38402882 DOI: 10.1002/hpja.850] [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: 09/25/2023] [Revised: 01/17/2024] [Accepted: 02/08/2024] [Indexed: 02/27/2024] Open
Abstract
ISSUE ADDRESSED Patients with low English proficiency (LEP) often require interpreter services in health care, however, their usage remains low. This study aimed to explore the barriers to accessing interpreter services and suggests ways services can be improved in hospitals. METHODS We conducted focus groups with clinicians and a retrospective audit of patient records. The clinicians were recruited from the inpatient wards and Emergency Department in a Sydney hospital, August 2022. The focus group discussion explored clinicians' experiences using an interpreter, and ways to improve access to the service. It was recorded, transcribed and coded thematically using Braun and Clarke's (2006) 6-step framework. The patient record data were linked with the interpreter service booking data to determine whether patients flagged as requiring an interpreter on admission were provided with the service. RESULTS Two focus groups were conducted with clinicians (N = 9 in total). Long wait times for telephone interpreters, an inflexible booking system, and low availability of in-person interpreters were identified as the barriers. The COVID-19 pandemic also impacted in-person service provision. CONCLUSION Some systemic barriers including an inflexible booking process and long wait times for immediate interpreter services were identified. The low use of interpreter services is attributed to the difficulties accessing the service and poor documentation in patient records. SO WHAT?: Greater availability of in-person interpreter services, an upgraded booking system, and effective implementation the NSW Health Standard Procedures for Working with Health Care Interpreters will address some of these barriers.
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Affiliation(s)
- Davina Tang
- Diversity Programs and Strategy Hub, Population Health, Sydney Local Health District, Sydney, New South Wales, Australia
- Australian Institute of Health Service Management, School of Business and Economics, University of Tasmania, Sydney, New South Wales, Australia
| | - Danielle Jawad
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Health Promotion Unit, Population Health Research & Evaluation Hub, Sydney Local Health District, Sydney, New South Wales, Australia
- National Health and Medical Research Council Centre of Research Excellence in the Early Prevention of Obesity in Childhood - Translate, The University of Sydney, Sydney, New South Wales, Australia
| | - Vesna Dragoje
- Sydney Health Care Interpreter Service, Population Health, Sydney Local Health District, Sydney, New South Wales, Australia
- Australian Institute of Translators and Interpreters (AUSIT), Sydney, New South Wales, Australia
- National Accreditation Authority for Translators and Interpreters (NAATI), Sydney, New South Wales, Australia
| | - Li Ming Wen
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Health Promotion Unit, Population Health Research & Evaluation Hub, Sydney Local Health District, Sydney, New South Wales, Australia
- National Health and Medical Research Council Centre of Research Excellence in the Early Prevention of Obesity in Childhood - Translate, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and Their Families, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Sarah Taki
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Health Promotion Unit, Population Health Research & Evaluation Hub, Sydney Local Health District, Sydney, New South Wales, Australia
- National Health and Medical Research Council Centre of Research Excellence in the Early Prevention of Obesity in Childhood - Translate, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and Their Families, Sydney Local Health District, Sydney, New South Wales, Australia
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16
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Chauhan A, Newman B, Manias E, Joseph K, Leone D, Walpola RL, Seale H, Smith AB, Harrison R. Creating safer cancer care with ethnic minority patients: A qualitative analysis of the experiences of cancer service staff. Health Expect 2024; 27:e13979. [PMID: 39102700 PMCID: PMC10825879 DOI: 10.1111/hex.13979] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/12/2023] [Accepted: 01/12/2024] [Indexed: 08/07/2024] Open
Abstract
INTRODUCTION Effective consumer engagement practices can enhance patient safety. This is important for consumers from ethnic minority backgrounds who are exposed to increased risk of patient safety events. Using the Systems Engineering Initiative for Patient Safety model, this study explored staff experiences of creating opportunities for engagement with consumers from ethnic minority backgrounds to contribute to their cancer care safety. METHOD A qualitative study was conducted using semistructured interviews with cancer service staff from four cancer services across two states in Australia. Purposive sampling was used to recruit healthcare staff from a diverse range of professions. Data were analysed using the Framework Analysis method. RESULTS Fifty-four interviews were conducted with healthcare staff. Analysis of the qualitative interview data identified enablers and associated challenges that contributed to creating a shared understanding between consumers and staff of the information, processes, expectations and problems arising in care. Enablers and challenges are reported in relation to four themes: (1) co-creating safety through shared understanding of care processes; (2) tools and technologies support planned communication; (3) organisational policy levers exist but lack implementation in direct care and (4) formal tasks incorporate consumer engagement more readily than informal interactions. CONCLUSION The availability of infrastructure and resources to support communication with consumers from ethnic minority backgrounds was limited to specific tasks across the cancer care continuum. Strategies implemented by health services to foster effective communication during formal interactions now require expansion to support and create conditions for effective consumer engagement during informal and everyday care tasks. The use of innovative language support tools and cultural considerations are required at the service and system level to support consumer engagement in all types of care interactions. PUBLIC AND PATIENT INVOLVEMENT The study was embedded within a larger project that included a consumer investigator and was guided by a consumer advisory group (CAG). These consumer team members have lived experience of cancer and are from diverse ethnic backgrounds. CAG members provided feedback on the draft interview guide and participant information for this study.
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Affiliation(s)
- Ashfaq Chauhan
- Centre for Health Systems and Safety Research, Australian Institute of Health InnovationMacquarie UniversityMacquarie ParkNew South WalesAustralia
| | - Bronwyn Newman
- Centre for Health Systems and Safety Research, Australian Institute of Health InnovationMacquarie UniversityMacquarie ParkNew South WalesAustralia
| | - Elizabeth Manias
- School of Nursing and MidwiferyMonash UniversityClaytonVictoriaAustralia
| | - Kathryn Joseph
- Centre for Health Systems and Safety Research, Australian Institute of Health InnovationMacquarie UniversityMacquarie ParkNew South WalesAustralia
| | - Desiree Leone
- Multicultural Health ServicesWestern Sydney Local Health DistrictNorth ParramattaNew South WalesAustralia
| | - Ramesh L. Walpola
- School of Health SciencesUNSW SydneyKensingtonNew South WalesAustralia
| | - Holly Seale
- School of Population HealthUNSW SydneyKensingtonNew South WalesAustralia
| | - Allen Ben Smith
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSWCamperdownNew South WalesAustralia
- Ingham Institute for Applied Medical ResearchLiverpoolUK
| | - Reema Harrison
- Centre for Health Systems and Safety Research, Australian Institute of Health InnovationMacquarie UniversityMacquarie ParkNew South WalesAustralia
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Davison N, Stanzel K, Hammarberg K. The Impact of Social Determinants of Health on Australian Women's Capacity to Access and Understand Health Information: A Secondary Analysis of the 2022 National Women's Health Survey. Healthcare (Basel) 2024; 12:207. [PMID: 38255095 PMCID: PMC10815356 DOI: 10.3390/healthcare12020207] [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: 11/28/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
The ability to access, understand, judge, and use health information is crucial for making informed decisions about health and optimal health outcomes. This secondary data analysis investigated associations between social determinants of health and Australian women's ability to access and understand health information using data from 10,652 women who responded to the 2022 National Women's Health Survey. A score (0-5) was created based on five questions assessing the participants' ability to access and understand health information, which was dichotomised into low (≤3) and high (≥4) scores. The data were analyzed using descriptive statistics, univariate comparisons, and multivariable binary logistic regression. Almost a quarter of the women had a low score. Non-native English speakers were approximately four times more likely to have low health literacy than native English speakers. Additionally, women without tertiary education, financially disadvantaged women, and First Nations women were almost twice as likely to have lower health literacy than other women. These findings suggest that social determinants of health decrease the capacity to access and understand health information. To reduce health inequalities, healthcare systems and health professionals must consider the factors that reduce women's capacity to access and understand health information and address the health information needs of socioeconomically disadvantaged women.
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Affiliation(s)
| | - Karin Stanzel
- Global and Women’s Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (N.D.); (K.H.)
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Peter M, Maddocks S, Tang C, Camp PG. Simplicity: Using the Power of Plain Language to Encourage Patient-Centered Communication. Phys Ther 2024; 104:pzad103. [PMID: 37823776 DOI: 10.1093/ptj/pzad103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/16/2023] [Accepted: 07/24/2023] [Indexed: 10/13/2023]
Affiliation(s)
- Maryke Peter
- Centre for Heart Lung Innovation, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Experimental Medicine Graduate Program, Faculty of Graduate and Postdoctoral Studies, University of British Columbia, Vancouver, Canada
| | - Stacy Maddocks
- Centre for Heart Lung Innovation, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Clarice Tang
- Department of Physical Therapy, Victoria University, Melbourne, Australia
| | - Pat G Camp
- Centre for Heart Lung Innovation, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
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Hayba N, Cheek C, Austin E, Testa L, Richardson L, Safi M, Ransolin N, Carrigan A, Harrison R, Francis-Auton E, Clay-Williams R. Strategies to Improve Care in the Emergency Department for Culturally and Linguistically Diverse Adults: a Systematic Review. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01876-z. [PMID: 38117444 DOI: 10.1007/s40615-023-01876-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/01/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND The emergency department (ED) is an important gateway into the health system for people from culturally and linguistically diverse (CALD) backgrounds; their experience in the ED is likely to impact the way they access care in the future. Our review aimed to describe interventions used to improve ED health care delivery for adults from a CALD background. METHODS An electronic search of four databases was conducted to identify empirical studies that reported interventions with a primary focus of improving ED care for CALD adults (aged ≥ 18 years), with measures relating to ED system performance, patient outcomes, patient experience, or staff experience. Studies published from inception to November 2022 were included. We excluded non-empirical studies, studies where an intervention was not provided in ED, papers where the full text was unavailable, or papers published in a language other than English. The intervention strategies were categorised thematically, and measures were tabulated. RESULTS Following the screening of 3654 abstracts, 89 articles underwent full text review; 16 articles met the inclusion criteria. Four clear strategies for targeting action tailored to the CALD population of interest were identified: improving self-management of health issues, improving communication between patients and providers, adhering to good clinical practice, and building health workforce capacity. CONCLUSIONS The four strategies identified provide a useful framework for targeted action tailored to the population and outcome of interest. These detailed examples show how intervention design must consider intersecting socio-economic barriers, so as not to perpetuate existing disparity. REGISTRATION PROSPERO registration number: CRD42022379584.
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Affiliation(s)
- Nematullah Hayba
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Colleen Cheek
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia.
| | - Elizabeth Austin
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Luke Testa
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Lieke Richardson
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Mariam Safi
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
- Internal Medicine Research Unit, Department of Regional Health Research, University Hospital of Southern Denmark, Aabenraa, University of Southern Denmark, Odense, Denmark
| | - Natália Ransolin
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
- Construction Management and Infrastructure Post-Graduation Program (PPGCI), Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
| | - Ann Carrigan
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Reema Harrison
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Emilie Francis-Auton
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Robyn Clay-Williams
- Construction Management and Infrastructure Post-Graduation Program (PPGCI), Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
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Iqbal MP, Newman B, Ellis LA, Mears S, Harrison R. Characterising consumer engagement in virtual models of care: A systematic review and narrative synthesis. PATIENT EDUCATION AND COUNSELING 2023; 115:107922. [PMID: 37542823 DOI: 10.1016/j.pec.2023.107922] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Widespread adoption of digital tools and technologies now support the delivery of virtual healthcare. Although, consumer engagement is central to care processes in virtual care models, there is paucity of evidence regarding the nature and outcomes of consumer engagement. This study aimed to determine the nature of consumer engagement used in virtual models of care, and its impact on quality and safety of care. METHODS A systematic review was undertaken with a narrative synthesis, with a search strategy applied to five electronic databases (CINAHL, EMBASE, MEDLINE, PsycINFO and Web of Science) RESULTS: Fifty-eight studies were included in the review that utilised a variety of virtual models of care across care services. Consumer engagement, such as patients' active involvement in monitoring, capturing and reporting their health data, was a common feature of the identified virtual models. CONCLUSION Increasing use of virtual models of care requires consideration of the role of patients and their support persons in the use of technology and in wider care processes that occur at a distance from health professionals. Ensuring consumers are equipped with necessary support to effectively engage in virtual care is important to ensure equity in access to, and outcomes of, virtual care models.
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Affiliation(s)
- Maha Pervaz Iqbal
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
| | - Bronwyn Newman
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Stephen Mears
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Reema Harrison
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Fehlberg Z, Best S, Long JC, Theodorou T, Pope C, Hibbert P, Williams S, Freeman L, Righetti S, Archibald AD, Braithwaite J. Scaling-up and future sustainability of a national reproductive genetic carrier screening program. NPJ Genom Med 2023; 8:18. [PMID: 37524740 PMCID: PMC10390466 DOI: 10.1038/s41525-023-00357-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 06/01/2023] [Indexed: 08/02/2023] Open
Abstract
An understanding of factors influencing implementation is essential to realise the benefits of population-based reproductive genetic carrier screening programs. The aim of this study was to synthesise data collected during the Australian Reproductive Genetic Carrier Screening Project (Mackenzie's Mission) to track how priorities shifted over time and identify important factors during scaling-up and for sustainment. We used a multi-method qualitative approach to integrate longitudinal project data collected from 10 project committees with 16 semi-structured interviews conducted with study team members. Both datasets were analysed using the Consolidated Framework for Implementation Research (CFIR) to identify constructs of interest within early, mid-point, and future implementation phases. Several CFIR constructs were present across implementation. The complexity of implementation presented challenges that were overcome through a quality-designed and packaged product, formal and informal networks and communication, and access to knowledge and information. Addressing the diverse consumer needs through resources and increasing community and non-genetic speciality engagement remained a priority throughout and for future sustainment. Going forward, further addressing program complexities and securing funding were emphasised. By applying an implementation framework, findings from this study may be useful for future effort towards building and/or sustaining reproductive genetic carrier screening programs.
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Affiliation(s)
- Zoe Fehlberg
- Australian Institute of Heath Innovation, Macquarie University, Sydney, Australia
- Australian Genomics Health Alliance, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Stephanie Best
- Australian Institute of Heath Innovation, Macquarie University, Sydney, Australia.
- Australian Genomics Health Alliance, Melbourne, Australia.
- Murdoch Children's Research Institute, Melbourne, Australia.
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia.
- Victorian Comprehensive Cancer Centre, Melbourne, Australia.
- Sir Peter MacCallum Cancer Centre Dept of Oncology, University of Melbourne, Melbourne, Australia.
| | - Janet C Long
- Australian Institute of Heath Innovation, Macquarie University, Sydney, Australia
| | - Tahlia Theodorou
- Australian Institute of Heath Innovation, Macquarie University, Sydney, Australia
| | - Catherine Pope
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Peter Hibbert
- Australian Institute of Heath Innovation, Macquarie University, Sydney, Australia
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Sharon Williams
- School of Health & Social Care, Swansea University, Swansea, Wales, UK
| | - Lucinda Freeman
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Sarah Righetti
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
- Centre for Clinical Genetics, Sydney Children's Hospital Network, Sydney, Australia
| | - Alison D Archibald
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Heath Innovation, Macquarie University, Sydney, Australia
- Australian Genomics Health Alliance, Melbourne, Australia
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Cheek C, Hayba N, Richardson L, Austin EE, Francis Auton E, Safi M, Ransolin N, Vukasovic M, De Los Santos A, Murphy M, Harrison R, Churruca K, Long JC, Hibbert PD, Carrigan A, Newman B, Hutchinson K, Mitchell R, Cutler H, Holt L, Braithwaite J, Gillies D, Salmon PM, Walpola RL, Zurynski Y, Ellis LA, Smith K, Brown A, Ali R, Gwynne K, Clay-Williams R. Experience-based codesign approach to improve care in Australian emergency departments for complex consumer cohorts: the MyED project protocol, Stages 1.1-1.3. BMJ Open 2023; 13:e072908. [PMID: 37407042 DOI: 10.1136/bmjopen-2023-072908] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
INTRODUCTION Emergency department (ED) care must adapt to meet current and future demands. In Australia, ED quality measures (eg, prolonged length of stay, re-presentations or patient experience) are worse for older adults with multiple comorbidities, people who have a disability, those who present with a mental health condition, Indigenous Australians, and those with a culturally and linguistically diverse (CALD) background. Strengthened ED performance relies on understanding the social and systemic barriers and preferences for care of these different cohorts, and identifying viable solutions that may result in sustained improvement by service providers. A collaborative 5-year project (MyED) aims to codesign, with ED users and providers, new or adapted models of care that improve ED performance, improve patient outcomes and improve patient experience for these five cohorts. METHODS AND ANALYSIS Experience-based codesign using mixed methods, set in three hospitals in one health district in Australia. This protocol introduces the staged and incremental approach to the whole project, and details the first research elements: ethnographic observations at the ED care interface, interviews with providers and interviews with two patient cohorts-older adults and adults with a CALD background. We aim to sample a diverse range of participants, carefully tailoring recruitment and support. ETHICS AND DISSEMINATION Ethics approval has been obtained from the Western Sydney Local Health District Human Research Ethics Committee (2022/PID02749-2022/ETH02447). Prior informed written consent will be obtained from all research participants. Findings from each stage of the project will be submitted for peer-reviewed publication. Project outputs will be disseminated for implementation more widely across New South Wales, Australia.
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Affiliation(s)
- Colleen Cheek
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Nema Hayba
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Lieke Richardson
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Elizabeth E Austin
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Emilie Francis Auton
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Mariam Safi
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Natália Ransolin
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Matthew Vukasovic
- Department of Emergency Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Aaron De Los Santos
- Department of Emergency Medicine, Blacktown and Mount Druitt Hospital, Blacktown, New South Wales, Australia
| | - Margaret Murphy
- Department of Emergency Medicine, Westmead Hospital, Westmead, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - Reema Harrison
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Peter D Hibbert
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- University of South Australia Division of Health Sciences, Adelaide, South Australia, Australia
| | - Ann Carrigan
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Bronwyn Newman
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Karen Hutchinson
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Henry Cutler
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Macquarie University Centre for the Health Economy, Macquarie University, Sydney, New South Wales, Australia
| | - Leanne Holt
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Donna Gillies
- NDIS Quality and Safeguards Commission, Penrith, New South Wales, Australia
| | - Paul M Salmon
- Centre for Human Factors and Sociotechnical Systems, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Ramesh Lahiru Walpola
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Yvonne Zurynski
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kylie Smith
- Emergency Care Institute, NSW Agency for Clinical Innovation, St Leonards, New South Wales, Australia
| | - Anthony Brown
- Western Sydney University, Penrith, New South Wales, Australia
| | - Reza Ali
- Department of Emergency Medicine, Blacktown and Mount Druitt Hospital, Blacktown, New South Wales, Australia
| | - Kylie Gwynne
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Dammery G, Vitangcol K, Ansell J, Ellis LA, Smith CL, Carrigan A, Braithwaite J, Zurynski Y. The Patient Activation Measure (PAM) and the pandemic: Predictors of patient activation among Australian health consumers during the COVID-19 pandemic. Health Expect 2023; 26:1107-1117. [PMID: 36810854 PMCID: PMC10154866 DOI: 10.1111/hex.13725] [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: 10/16/2022] [Revised: 01/29/2023] [Accepted: 02/01/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Preventative healthcare is crucial for improving individual patient outcomes and is integral to sustainable health systems. The effectiveness of prevention programs is enhanced by activated populations who are capable of managing their own health and are proactive to keep themselves well. However, little is known about the level of activation among people drawn from general populations. We used the Patient Activation Measure (PAM) to address this knowledge gap. METHODS A representative, population-based survey of Australian adults was conducted in October 2021 during the Delta strain outbreak of the COVID-19 pandemic. Comprehensive demographic information was collected, and the participants completed the Kessler-6 psychological distress scale (K6) and PAM. Multinomial and binomial logistic regression analyses were performed to determine the effect of demographic factors on PAM scores, which are categorised into four levels: 1-participants disengaged with their health; 2-becoming aware of how to manage their health; 3-acting on their health; and 4-engaging with preventative healthcare and advocating for themselves. RESULTS Of 5100 participants, 7.8% scored at PAM level 1; 13.7% level 2, 45.3% level 3, and 33.2% level 4. The mean score was 66.1, corresponding to PAM level 3. More than half of the participants (59.2%) reported having one or more chronic conditions. Respondents aged 18 to 24 years old were twice as likely to score PAM level 1 compared with people aged 25-44 (p < .001) or people aged over 65 years (p < .05). Speaking a language other than English at home was significantly associated with having low PAM (p < .05). Greater psychological distress scores (K6) were significantly predictive of low PAM scores (p < .001). CONCLUSION Overall, Australian adults showed high levels of patient activation in 2021. People with lower incomes, of younger age, and those experiencing psychological distress were more likely to have low activation. Understanding the level of activation enables targeting sociodemographic groups for extra support to increase the capacity to engage in prevention activities. Conducted during the COVID-19 pandemic, our study provides a baseline for comparison as we move out of the pandemic and associated restrictions and lockdowns. PATIENT OR PUBLIC CONTRIBUTION The study and survey questions were co-designed with consumer researchers from the Consumers Health Forum of Australia (CHF) as equal partners. Researchers from CHF were involved in the analysis of data and production of all publications using data from the consumer sentiment survey.
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Affiliation(s)
- Genevieve Dammery
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health InnovationMacquarie UniversitySydneyAustralia
- NHMRC Partnership Centre for Health System SustainabilityMacquarie UniversitySydneyAustralia
| | - Kathryn Vitangcol
- NHMRC Partnership Centre for Health System SustainabilityMacquarie UniversitySydneyAustralia
- Centre for Health Services ResearchThe University of QueenslandWoolloongabbaQueenslandAustralia
| | - James Ansell
- Consumers Health Forum of AustraliaDeakin WestAustralian Capital TerritoryAustralia
| | - Louise A. Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health InnovationMacquarie UniversitySydneyAustralia
- NHMRC Partnership Centre for Health System SustainabilityMacquarie UniversitySydneyAustralia
| | - Carolynn L. Smith
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health InnovationMacquarie UniversitySydneyAustralia
- NHMRC Partnership Centre for Health System SustainabilityMacquarie UniversitySydneyAustralia
| | - Ann Carrigan
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health InnovationMacquarie UniversitySydneyAustralia
- NHMRC Partnership Centre for Health System SustainabilityMacquarie UniversitySydneyAustralia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health InnovationMacquarie UniversitySydneyAustralia
- NHMRC Partnership Centre for Health System SustainabilityMacquarie UniversitySydneyAustralia
| | - Yvonne Zurynski
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health InnovationMacquarie UniversitySydneyAustralia
- NHMRC Partnership Centre for Health System SustainabilityMacquarie UniversitySydneyAustralia
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Radhamony R, Cross WM, Townsin L, Banik B. Perspectives of culturally and linguistically diverse (CALD) community members regarding mental health services: A qualitative analysis. J Psychiatr Ment Health Nurs 2023. [PMID: 36947100 DOI: 10.1111/jpm.12919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/14/2023] [Accepted: 02/28/2023] [Indexed: 03/23/2023]
Abstract
WHAT IS KNOWN ABOUT THE SUBJECT?: Immigrant, refugee and asylum seeker populations worldwide are at high risk of mental health issues National mental health policies call for recognising Australian society's multicultural characteristics to ensure adequate mental health services to CALD communities Several barriers exist for people from CALD communities in Victoria to access and utilise mental health services Improving mental health professionals' knowledge of mental health service provision and cultural responsiveness can enhance CALD community access to services. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: We analysed the perspectives of people from CALD communities in Victoria regarding their needs and experiences with mental health services. Participants reported diverse perceptions and understanding of mental health issues and services Various challenges were identified regarding health service utilisation for the CALD community in Victoria, including language barriers, stigma towards mental health issues, mental health illiteracy, distrust and lack of familiarity with mainstream mental health services. These challenges were acknowledged by community members even after a long residence in Australia The data generated on the beliefs about mental health issues and consequent help-seeking behaviours highlight the importance of culturally sensitive targeted prevention and early intervention strategies and ongoing commitment to building mental health literacy in the wider community WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The information from the study can be adapted for quality improvement and culturally responsive practices The strategies for effective service delivery drawn by this paper can be a comprehensive resource tool for mental health professionals, organisations and policymakers The findings imply that CALD mental health service users and their families will likely benefit from improved service assessment and quality of mental health care and equity when MHNs undertake cultural competence training and bring that into their practice. ABSTRACT INTRODUCTION: Victoria is one of the most multicultural states in Australia. Many CALD communities in Victoria may have encountered complicated migration journeys and complex life stressors during their initial settlement, leading to adverse mental health concerns. This diversity necessitates public policy settings to ensure equity and access in health services planning and delivery. While the MH policies and services take cultural diversity into account, there needs to be more implementation of those components of MH policies that relate to the particular needs of various CALD communities in Victoria. Even though mental health services prevent and address mental health issues, many barriers can impair CALD community access and utilisation of mental health services. Furthermore, the recent Royal Commission inquiry into the Victorian Mental Health system drives a renewed policy imperative to ensure meaningful engagement and cultural safety of all people accessing and utilising mental health services (Department of Health, 2023). AIM This study focused on the perspectives of people from CALD communities in Victoria regarding their mental health service needs, understandings of and experiences with mental health services to prepare an education package for mental health nurses as part of a larger multi-method research project. METHOD A qualitative descriptive design was used to collect and analyse the perspectives of 21 participants in Victoria, using telephone interviews, followed by thematic analysis. RESULTS The themes and sub-themes identified were: Settling issues; Perceptions of understanding of mental health issues (help-seeking attitudes toward mental health issues; the need for CALD community education); perceived barriers to accessing and utilising mental health services in Victoria (socio-cultural and language barriers; stigma, labelling and discrimination; knowledge and experience of accessing health facilities); experience with mental health services and professionals. DISCUSSION Community participation, mental health professional education and robust research regarding the mental health needs of CALD people are some of the recommended strategies to improve access and utilisation of mental health services in Victoria. IMPLICATIONS FOR PRACTICE The current study can contribute to the existing knowledge, understanding, practice and quality improvement as it vividly portrays the issues of various CALD communities in Victoria. The findings of this study imply that CALD MH service users and their families are likely to benefit in terms of improved service assessment and quality of MH care and equity when MHNs undertake CC training and bring that into their practice.
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Affiliation(s)
- Reshmy Radhamony
- Institute of Health and Wellbeing, Federation University, Berwick, Australia
| | | | - Louise Townsin
- Federation University, Berwick, Australia
- Torrens University, Adelaide, South Australia
| | - Biswajit Banik
- Institute of Health and Wellbeing, Federation University, Berwick, Australia
- Manna Institute, Regional Australia Mental Health Research and Training Institute, A project of Regional University Network (RUN), led by the University of New England, Armidale, NSW, Australia
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Claeys A, Berdai-Chaouni S, Tricas-Sauras S, De Donder L. Barriers and facilitators in providing care for patients with a migration background. J Clin Nurs 2023; 32:912-925. [PMID: 35968776 DOI: 10.1111/jocn.16491] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/23/2022] [Accepted: 07/28/2022] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to identify the barriers and facilitators experienced by healthcare professionals while caring for patients with a migration background. BACKGROUND People with a migration background often face several structural inequalities and barriers in terms of accessibility to, and affordability of, healthcare. In order to provide quality care for patients with a migration background, it is important to understand which barriers healthcare professionals experience that prevent them from providing care and which factors can facilitate this. DESIGN AND METHODS Qualitative research following the COREQ criteria. A total of six focus groups (n = 37) and 12 individual interviews were conducted with a multidisciplinary sample: doctors, nurses, social workers, and occupational therapists. Nursing and medical students were also included. Thematic content analysis was used. RESULTS Key findings suggest that the main barrier is that healthcare professionals regard people with a migration background as "the other". Healthcare professionals do not feel secure or competent to provide care for these "others." According to the healthcare professionals, the hospital structures-and, particularly, the managerial instances-appear to be only slightly supportive. Structural barriers at the level of the healthcare system, such as limited implementation of care coordination and austerity measures (time pressure or economic restrictions), were also perceived as barriers. Facilitators can be the healthcare professionals' attitude or the flexibility of the management. CONCLUSIONS Healthcare professionals experience barriers in caring for people with a migration background. Othering plays a key role in building or maintaining several barriers. A multilevel approach is necessary to tackle these barriers and enable facilitators. RELEVANCE TO CLINICAL PRACTICE Raising awareness about "othering" in the educational programs of students and healthcare professionals is essential. Also, deploying support mechanisms and valuing the competences of multicultural and multi-lingual healthcare professionals can help facilitate quality care for patients with a migrant background. PATIENT OR PUBLIC CONTRIBUTION Patients, informal and formal caregivers participated in the study at several stages (e.g.: by involving them during the research design phase or providing feedback and input at specific moments across the study). In addition, community participants played a key role also during the research design and data analysis phases as well as by facilitating patients' recruitment.
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Affiliation(s)
- Ann Claeys
- Department of Healthcare, Design and Technology, Erasmushogeschool Brussel, Brussels, Belgium.,Department of Educational Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Saloua Berdai-Chaouni
- Department of Healthcare, Design and Technology, Erasmushogeschool Brussel, Brussels, Belgium.,Department of Educational Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Sandra Tricas-Sauras
- Department of Healthcare, Design and Technology, Erasmushogeschool Brussel, Brussels, Belgium.,Social Approaches to Health Research Centre, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Liesbeth De Donder
- Department of Educational Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Prokopovich K, Phillipson L, West Pitts L, Stanoevska B, Street J, Braunack-Mayer A. Using World Cafés to engage an Australian culturally and linguistically diverse community around human papillomavirus vaccination. Health Expect 2023; 26:1039-1051. [PMID: 36798035 PMCID: PMC10154861 DOI: 10.1111/hex.13703] [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: 10/14/2022] [Revised: 12/12/2022] [Accepted: 12/27/2022] [Indexed: 02/18/2023] Open
Abstract
INTRODUCTION Internationally, cultural factors are associated with vaccine uptake and completion in ethnic minority communities. Whilst Australia has achieved high human papillomavirus (HPV) vaccination, little is known about how culture or ethnicity influences HPV vaccination engagement. To address these gaps, we partnered with our Local Health District to explore how one culturally and linguistically diverse (CALD) community engages with school and HPV vaccination. METHODS We adapted a participatory research method (the World Café) to engage one local CALD community-the Macedonian community (Our bi-cultural researcher and participants preferred the term 'Macedonia' rather than The Republic of North Macedonia as outlined in the 2018 Prespa agreement) in New South Wales (Australia)-to discuss HPV and school vaccination. Our qualitative analysis combined deductive codes taken from the Tailoring Immunization Programme framework, inductive codes guided by narrative inquiry (temporality, sociality and place) and previously known vaccination 'trust' frameworks. RESULTS In late 2019, 31 local Macedonian community members were purposely recruited for two World Cafés (n = 15 mothers/grandmothers and n = 16 young adults). Our themes reveal a community narrative grounded in historical vaccine experiences, family views on vaccination and a general trust in schools. Participants collectively discussed how 'increasing knowledge' and 'tailoring health communications' could strengthen community vaccine decision-making. CONCLUSION This study demonstrates how research partnerships and participatory methods can be applied in CALD community settings to research engagement with school and HPV vaccination. Our World Café dialogues highlight a positive narrative about vaccines, where community vaccination behaviours were built on multilayer trust relationships despite low vaccine knowledge. Our findings further knowledge around 'public trust' in school vaccination, highlighting the importance of existing (or missing) trust relationships when tailoring vaccine communication to local CALD communities. PATIENT OR PUBLIC CONTRIBUTION Participants who took part in the World Cafes were all local Macedonian community parents or young adults who have been or will be exposed to the health services offered by school-based HPV vaccination. Thus, all the data collected came from their personal experiences with the school vaccination programme, or how they expect to participate in the programme. To ensure our study design was culturally appropriate and tailored to the Macedonian community, we engaged with the relevant local health stakeholders (the bi-cultural Multicultural Health Officer and Multicultural Health Service Manager Programme Director) to adapt and refine the World Café method for this context and setting. Our local health stakeholders also reviewed our preliminary findings, assisted with data interpretation and participated in manuscript editing.
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Affiliation(s)
- Kathleen Prokopovich
- Australian Centre for Health Engagement, Evidence and Values, School of Health and Society, Faculty of the Arts, Social Science and Humanities, University of Wollongong, Wollongong, New South Wales, Australia
| | - Lyn Phillipson
- School of Health and Society, Faculty of the Arts, Social Science and Humanities, University of Wollongong, Wollongong, New South Wales, Australia
| | - Leissa West Pitts
- Multicultural and Refugee Health Service, Illawarra Shoalhaven Local Health District, Warrawong, New South Wales, Australia
| | - Biljana Stanoevska
- Multicultural and Refugee Health Service, Illawarra Shoalhaven Local Health District, Warrawong, New South Wales, Australia
| | - Jackie Street
- Australian Centre for Health Engagement, Evidence and Values, School of Health and Society, Faculty of the Arts, Social Science and Humanities, University of Wollongong, Wollongong, New South Wales, Australia.,School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Annette Braunack-Mayer
- Australian Centre for Health Engagement, Evidence and Values, School of Health and Society, Faculty of the Arts, Social Science and Humanities, University of Wollongong, Wollongong, New South Wales, Australia
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Lakin K, Kane S. A critical interpretive synthesis of migrants' experiences of the Australian health system. Int J Equity Health 2023; 22:7. [PMID: 36624465 PMCID: PMC9827657 DOI: 10.1186/s12939-022-01821-2] [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: 08/30/2022] [Accepted: 12/25/2022] [Indexed: 01/10/2023] Open
Abstract
While the health of and healthcare use by migrants has received significant scholarly and policy attention in Australia, current debates highlight that a critical examination of the theoretical underpinnings of these inquiries and responses is needed. We conducted a systematic review and critical interpretive synthesis (CIS) to critically examine how the policy and scholarly literature conceptualises migrants' interactions with and experiences of the Australian health system. Guided by PRISMA, we searched for literature without imposing any limits. We also searched key State and Federal Government websites for relevant policy documents. Our initially broad inclusion criteria became refined as the CIS progressed. We prioritised the likely relevance and theoretical contribution of the papers to our inquiry over methodological quality. The CIS of 104 papers revealed that the Australian scholarly literature and policy documents consistently homogenise and reduce migrants according to an assumed, (1) cultural identity, (2) linguistic affiliation, and/or (3) broad geographic origin. Based on these three critiques and drawing on the theoretical literature, we propose a synthesising argument on how the Australian literature could better conceptualise migrants' experiences of the Australian health system. We contend that both research and policy should explicitly recognise and engage with the multifaceted and shifting ways that migrants define themselves, generally, and during their encounters with destination country health systems. Engagement with this notion is necessary for also understanding how aspects of migrants' identities are dynamically co-constructed during their interactions with the health system. These understandings have implications for improving the design and implementation of policies and programs directed at improving the responsiveness of Australia's health system to the needs and expectations of migrant communities specifically, and destination countries broadly.
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Affiliation(s)
- Kimberly Lakin
- Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Level 2, 32 Lincoln Square, Melbourne, 3010, Australia
| | - Sumit Kane
- Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Level 2, 32 Lincoln Square, Melbourne, 3010, Australia.
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Jacob R, Prince DS, Pipicella JL, Nguyen A, Bagatella M, Alvaro F, Maley M, Foo H, Middleton P, Kayes T, DiGirolamo J, Davison SA, Levy MT. Routine screening of emergency admissions at risk of chronic hepatitis (SEARCH) identifies and links hepatitis B cases to care. Liver Int 2023; 43:60-68. [PMID: 36050826 PMCID: PMC10087472 DOI: 10.1111/liv.15414] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 08/13/2022] [Accepted: 08/29/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS Significant barriers exist with hepatitis B (HBV) case detection and effective linkage to care (LTC). The emergency department (ED) is a unique healthcare interaction where hepatitis screening and LTC could be achieved. We examined the efficacy and utility of automated ED HBV screening for Overseas Born (OB) patients. METHODS A novel-automated hepatitis screening service "SEARCH" (Screening Emergency Admissions at Risk of Chronic Hepatitis) was piloted at a metropolitan hospital. A retrospective and comparative analysis of hepatitis testing during the SEARCH pilot compared to a period of routine testing was conducted. RESULTS During the SEARCH pilot, 4778 OB patients were tested for HBV (86% of eligible patient presentations), compared with 1.9% of eligible patients during a control period of clinician-initiated testing. SEARCH detected 108 (2.3%) hepatitis B surface antigen positive patients including 20 (19%) in whom the diagnosis was new. Among 88 patients with known HBV, 57% were receiving medical care, 33% had become lost to follow-up and 10% had never received HBV care. Overall, 30/88 (34%) patients with known HBV were receiving complete guideline-based care prior to re-engagement via SEARCH. Following SEARCH, LTC was successful achieved in 48/58 (83%) unlinked patients and 19 patients were commenced on anti-viral therapy. New diagnoses of cirrhosis and hepatocellular carcinoma were made in five and one patient(s) respectively. CONCLUSIONS Automated ED screening of OB patients is effective in HBV diagnosis, re-diagnosis and LTC. Prior to SEARCH, the majority of patients were not receiving guideline-based care.
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Affiliation(s)
- Rachael Jacob
- Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, New South Wales, Australia.,The University of New South Wales, Sydney, New South Wales, Australia
| | - David S Prince
- Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, New South Wales, Australia.,The University of New South Wales, Sydney, New South Wales, Australia
| | - Joseph L Pipicella
- Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, New South Wales, Australia.,The Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Angela Nguyen
- Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, New South Wales, Australia.,School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Melissa Bagatella
- Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Frank Alvaro
- Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, New South Wales, Australia.,New South Wales Health Pathology, Sydney, New South Wales, Australia
| | - Michael Maley
- Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, New South Wales, Australia.,The Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,New South Wales Health Pathology, Sydney, New South Wales, Australia
| | - Hong Foo
- Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, New South Wales, Australia.,New South Wales Health Pathology, Sydney, New South Wales, Australia
| | - Paul Middleton
- Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, New South Wales, Australia.,The University of New South Wales, Sydney, New South Wales, Australia.,South Western Emergency Research Institute, UNSW, Sydney, New South Wales, Australia
| | - Tahrima Kayes
- Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Julia DiGirolamo
- Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Scott A Davison
- Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, New South Wales, Australia.,The University of New South Wales, Sydney, New South Wales, Australia
| | - Miriam T Levy
- Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, New South Wales, Australia.,The University of New South Wales, Sydney, New South Wales, Australia.,The Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
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Crawford G, Connor E, McCausland K, Reeves K, Blackford K. Public Health Interventions to Address Housing and Mental Health amongst Migrants from Culturally and Linguistically Diverse Backgrounds Living in High-Income Countries: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16946. [PMID: 36554827 PMCID: PMC9778908 DOI: 10.3390/ijerph192416946] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
Migrants from culturally and linguistically diverse (CaLD) backgrounds experience factors that may increase health inequities related to a range of determinants of health including housing and mental health. However, the intersection between mental health and housing for migrants is poorly understood. A scoping review searched four academic databases for concepts related to cultural and linguistic diversity, housing conditions, and public health interventions to address homelessness. A total of 49 articles were included and seven key themes identified: housing provision; mental health intersections and interventions; complexity and needs beyond housing; substance use; service provider and policy issues; the role of cultural and linguistic diversity; and consumer experience. The intersection of ethnicity with other social determinants of health and housing was highlighted though there were limited interventions tailored for migrants. Studies generally pointed to the positive impacts of Housing First. Other sub-themes emerged: social connection and community; shame, stigma, and discrimination; health and support requirements; and employment, financial assistance, and income. Consumer choice was identified as vital, along with the need for systemic anti-racism work and interventions. To support secure housing for migrants and mitigate mental health impacts, closer attention is required towards migration factors along with broader, tailored services complementing housing provision.
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Affiliation(s)
- Gemma Crawford
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Perth, WA 6845, Australia
- School of Population Health, Curtin University, Perth, WA 6845, Australia
| | - Elizabeth Connor
- School of Population Health, Curtin University, Perth, WA 6845, Australia
| | - Kahlia McCausland
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Perth, WA 6845, Australia
- School of Population Health, Curtin University, Perth, WA 6845, Australia
| | - Karina Reeves
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Perth, WA 6845, Australia
- School of Population Health, Curtin University, Perth, WA 6845, Australia
| | - Krysten Blackford
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Perth, WA 6845, Australia
- School of Population Health, Curtin University, Perth, WA 6845, Australia
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Chandrakumar A, Hoon E, Benson J, Stocks N. Barriers and facilitators to cervical cancer screening for women from culturally and linguistically diverse backgrounds; a qualitative study of GPs. BMJ Open 2022; 12:e062823. [PMID: 36375978 PMCID: PMC9664274 DOI: 10.1136/bmjopen-2022-062823] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To explore general practitioners' (GPs) perspectives on the barriers and facilitators to cervical cancer screening (CCS) for women from culturally and linguistically diverse (CALD) backgrounds. DESIGN Qualitative descriptive study involving semi-structured interviews, with interview guide informed by the Theoretical Domains Framework. SETTING Adelaide, South Australia. PARTICIPANTS Twelve GPs with experience in providing CCS to women from CALD backgrounds participated. RESULTS Four main themes emerged: 'importance of clinician-patient relationship', 'patients' cultural understanding regarding health care and CCS', 'communication and language' and 'health system related'. Each theme had several subthemes. GPs' professional relationship with their patients and repeated advice from other clinicians, together with the provision of opportunistic CCS, were described as facilitators, and encompassed the theme of 'importance of clinician-patient relationship'. This theme also raised the possibility of self-collection human papilloma virus tests. Lack of awareness and knowledge, lower priority for cancer screening and patients' individual circumstances contributed to the theme of 'patients' cultural understanding regarding health care and CCS', and often acted as barriers to CCS. 'Communication and language' consisted of language difficulties, interpreter use and use of appropriate resources. Language difficulties were a barrier to the provision of CCS, and GPs used interpreters and written handouts to help overcome this. The theme of 'health system related' involved the increased time needed for CCS consults for CALD women, access to appointments, funding, health promotion and effective use of practice management software. CONCLUSIONS This study highlights that multiple, inter-related barriers and facilitators influence CALD women's engagement with CCS, and that GPs needed to manage all of these factors in order to encourage CCS participation. More efforts are needed to address the barriers to ensure that GPs have access to appropriate resources, and CALD patients have access to GPs they trust.
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Affiliation(s)
- Abira Chandrakumar
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- GPEx Ltd, Unley, South Australia, Australia
| | - Elizabeth Hoon
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | | | - Nigel Stocks
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
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Mistry SK, Harris E, Harris MF. Scoping the needs, roles and implementation of bilingual community navigators in general practice settings. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5495-e5505. [PMID: 36004646 DOI: 10.1111/hsc.13973] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 07/10/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
This research aimed to explore the needs, potential roles and implementation of Bilingual Community Navigators (BCNs) in providing navigation support for patients in general practice settings in Australia. A total of 19 participants (general practitioners, practice managers, practice nurses and receptionists) from five general practices in Sydney where most of the patients spoke a language other than English were interviewed about their views on needs, potential roles and implementation of BCNs in general practice settings. Data were collected between August 2019 and July 2020. The interview transcripts were inductively analysed for themes. Themes emerged across four broad categories: patients' barriers to access health and social care services; potential roles of BCNs; recruitment, training, and employment of BCNs and considerations and anticipated barriers to BCNs' role. Many barriers both at the patient and at the service provider levels in accessing healthcare and social care services were consistent with the Levesque et al. access framework including lack of understanding of the health system, language and cultural barriers, hesitancy to approach general practice and problems navigating services. Participants believed that BCNs would be able to help overcome these barriers through health education, support in booking appointments, arranging transport, providing language and cultural support and improving communication with the health services. Conditions for effective implementation of BCNs in practice included proper training of the navigators to ensure patient confidentiality and addressing organisational/system barriers such as lack of a funding mechanism, a clear role definition of BCNs and acceptance of BCNs by patients. BCNs potential role in facilitating access to appropriate care by culturally and linguistically diverse (CALD) patients in general practice warrants further evaluation in the context of the Australian healthcare system.
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Affiliation(s)
- Sabuj Kanti Mistry
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Elizabeth Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
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Chauhan A, Newman B, Walpola RL, Seale H, Manias E, Wilson C, Harrison R. Assessing the environment for engagement in health services: The Audit for Consumer Engagement (ACE) tool. Health Expect 2022; 25:3027-3039. [DOI: 10.1111/hex.13610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/07/2022] [Accepted: 09/10/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ashfaq Chauhan
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences Macquarie University North Ryde New South Wales Australia
| | - Bronwyn Newman
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences Macquarie University North Ryde New South Wales Australia
| | - Ramesh Lahiru Walpola
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney Kensington New South Wales Australia
| | - Holly Seale
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney Kensington New South Wales Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation Deakin University Melbourne Victoria Australia
| | - Carlene Wilson
- Olivia Newton‐John Cancer Wellness and Research Centre Austin Health Heidelberg Victoria Australia
- School of Psychology and Public Health La Trobe University Bundoora Victoria Australia
| | - Reema Harrison
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences Macquarie University North Ryde New South Wales Australia
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Morris L, Dumville J, Treweek S, Miah N, Curtis F, Bower P. Evaluating a tool to improve engagement and recruitment of under-served groups in trials. Trials 2022; 23:867. [PMID: 36210444 PMCID: PMC9549666 DOI: 10.1186/s13063-022-06747-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 09/13/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Despite substantial awareness that certain groups (e.g. ethnic minorities) are under-represented and under-served in trials, limited progress has been made in addressing this. As well as a public service and ethical duty to recruit and engage under-served groups in relevant research, importantly, there are clear scientific benefits, for example, increased generalisability. The key aims of the current study were to explore the following: general barriers and facilitators to enhancing the recruitment of under-served groups into trials, the usability and value of a specific tool (INCLUDE Ethnicity Framework) to support engagement and recruitment of under-served groups, and ways of engaging diverse patient, public and community involvement and engagement (PCIE) groups. METHODS Firstly, researchers completed a brief survey in relation to a specific trial in which they were involved (N = 182, 38% response rate). A second stage involved sampling survey respondents and asking them to complete the INCLUDE Ethnicity Framework and then a remote semi-structured interview (N = 15). Qualitative data were analysed using thematic analysis. Finally, we conducted a consultation process with PCIE contributors primarily to develop guidelines for discussing the INCLUDE Ethnicity Framework with PCIE representatives. RESULTS Researchers recognised the importance of increasing engagement and recruitment of under-served groups within trials, but varied in their knowledge, ability and commitment to implementation in practice. The INCLUDE Ethnicity Framework was described by some as raising their awareness of how inclusion could be improved. Respondents highlighted a need for shared resources and wider structural change to facilitate such engagement. PCIE was identified, in the survey and interviews, as the most common method of trying to improve recruitment of under-served groups. However, researchers also commonly highlighted that PCIE groups were sometimes not very diverse. CONCLUSIONS There is a need for researchers to consider the funding and time resources required for diverse and inclusive recruitment to trials and for funders to enable this. The INCLUDE Ethnicity Framework can help to raise awareness of inclusion challenges. This study indicates that it is important to take proactive steps to involve relevant under-served groups in PCIE and practical suggestions are made to facilitate this.
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Affiliation(s)
- Lydia Morris
- grid.5379.80000000121662407NIHR Applied Research Collaboration Greater Manchester, Manchester Academic Health Science Centre, Research and Innovation Division, Manchester University Foundation NHS Trust, Manchester, UK ,grid.5379.80000000121662407Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Jo Dumville
- grid.5379.80000000121662407NIHR Applied Research Collaboration Greater Manchester, Manchester Academic Health Science Centre, Research and Innovation Division, Manchester University Foundation NHS Trust, Manchester, UK ,grid.5379.80000000121662407Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Shaun Treweek
- grid.7107.10000 0004 1936 7291Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Nasima Miah
- The Centre for Ethnic Health Research, NIHR ARC East Midlands, Nottingham, UK
| | - Ffion Curtis
- The Centre for Ethnic Health Research, NIHR ARC East Midlands, Nottingham, UK
| | - Peter Bower
- grid.5379.80000000121662407NIHR Applied Research Collaboration Greater Manchester, Manchester Academic Health Science Centre, Research and Innovation Division, Manchester University Foundation NHS Trust, Manchester, UK ,grid.5379.80000000121662407Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
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What are the predictors of TOMM failure in clinical TBI populations? A retrospective analysis. J Int Neuropsychol Soc 2022; 29:336-345. [PMID: 35811454 DOI: 10.1017/s1355617722000339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To determine base rates of invalid performance on the Test of Memory Malingering (TOMM) in patients with traumatic brain injury (TBI) undertaking rehabilitation who were referred for clinical assessment, and the factors contributing to TOMM failure. METHODS Retrospective file review of consecutive TBI referrals for neuropsychological assessment over seven years. TOMM failure was conventionally defined as performance <45/50 on Trial 2 or Retention Trial. Demographic, injury, financial compensation, occupational, and medical variables were collected. RESULTS Four hundred and ninety one TBI cases (Median age = 40 years [IQR = 26-52], 79% male, 82% severe TBI) were identified. Overall, 48 cases (9.78%) failed the TOMM. Logistic regression analyses revealed that use of an interpreter during the assessment (adjusted odds ratio [aOR] = 8.25, 95%CI = 3.96-17.18), outpatient setting (aOR = 4.80, 95%CI = 1.87-12.31) and post-injury psychological distress (aOR = 2.77, 95%CI = 1.35-5.70) were significant multivariate predictors of TOMM failure. The TOMM failure rate for interpreter cases was 49% (21/43) in the outpatient setting vs. 7% (2/30) in the inpatient setting. By comparison, 9% (21/230) of non-interpreter outpatient cases failed the TOMM vs. 2% (4/188) of inpatient cases. CONCLUSIONS TOMM failure very rarely occurs in clinical assessment of TBI patients in the inpatient rehabilitation setting. It is more common in the outpatient setting, particularly in non-English-speaking people requiring an interpreter. The findings reinforce the importance of routinely administering stand-alone performance validity tests in assessments of clinical TBI populations, particularly in outpatient settings, to ensure that neuropsychological test results can be interpreted with a high degree of confidence.
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Stavert BM, Monaro S, Tienstra L, Naganathan V, Aitken SJ. Protocol for a qualitative study exploring haemodialysis dependent patients' arteriovenous fistula experience, values and concerns in Sydney, Australia. BMJ Open 2022; 12:e058152. [PMID: 36691241 PMCID: PMC9171227 DOI: 10.1136/bmjopen-2021-058152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 05/11/2022] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION The experiences of patients from culturally and linguistically diverse backgrounds, with chronic mental illness, disabilities or who identify as sexual or religious minorities are under-represented in clinical research on arteriovenous fistula (AVF) for haemodialysis access. A greater understanding of the experiences, values and concerns of these diverse patient groups are needed to provide haemodialysis access care that addresses the needs of all haemodialysis-dependent patients. This study seeks to describe a broad range of patient experiences related to the creation, care and surveillance of AVFs, including interactions with healthcare teams. METHODS AND ANALYSIS This qualitative study will use semistructured interviews with individual patients purposefully selected to provide a diverse patient population. A deliberate strategy will be used to recruit a demographically broad range of participants. Thematic analysis of interview transcripts, using a constant comparative methodology, will generate themes that describe patient experiences, values and concerns. Findings from this study will give a nuanced insight into the experiences of patients on haemodialysis with respect to their AVF. ETHICS AND DISSEMINATION Ethical approval for this study was provided by the Sydney Local Health District Human Research Ethics Committee (REGIS identifier: 2021/ETH00362, CH reference number: CH62/6/2021-033). Results will be made available to the participants, local health district, funders and other researchers through various hospital and academic forums. Data will also be published in peer-reviewed journals and be part of a larger body of work looking into patient-reported outcome measures for patients with AVF.
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Affiliation(s)
- Bethany Miriam Stavert
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Vascular Surgery Department, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Susan Monaro
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Vascular Surgery Department, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Lisa Tienstra
- Renal Medicine Department, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Vasi Naganathan
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Education and Research on Ageing, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Sarah Joy Aitken
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Vascular Surgery Department, Concord Repatriation General Hospital, Concord, New South Wales, Australia
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Souza ADZD, Hoffmeister LV, Moura GMSSD. FACILITATORS AND BARRIERS OF PATIENT INVOLVEMENT IN HOSPITAL SERVICES: INTEGRATIVE REVIEW. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2020-0395en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective to identify the facilitating factors and barriers that influence patient involvement in hospital services. Method integrative review; search of articles published between January 2011 and December 2020, in the electronic databases PubMed, Web of Science, Cinahl, Lilacs and Scopus, using descriptors related to "patient involvement", Barriers, Facilitators, in English, Spanish and Portuguese. Data collection was performed from May to June 2021, identifying 32 publications that met the inclusion criteria. Results the analysis resulted in three categories of facilitating factors and barriers: communication, actors of involvement and organizational culture, allowing the elaboration of a theoretical model of patient involvement. This model shows that in the centrality of the process are the actors involved, that is, patients and professionals, inserted in an organizational context, being influenced by leadership, culture, environment, available resources and processes, where communication permeates as a basis for involvement. Conclusion the facilitating factors and barriers identified in this review, synthesized in a theoretical model, allow transcending theoretical knowledge for practice. The complexity to operationalize this model requires patients, professionals, health services and society join forces to make this theoretical proposition a practice incorporated by the services.
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Affiliation(s)
| | - Louíse Viecili Hoffmeister
- Universidade NOVA de Lisboa, Portugal; Comprehensive Health Research Center, Portugal; Escola Superior de Enfermagem de Lisboa, Portugal
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Souza ADZD, Hoffmeister LV, Moura GMSSD. FACILITADORES E BARREIRAS DO ENVOLVIMENTO DO PACIENTE NOS SERVIÇOS HOSPITALARES: REVISÃO INTEGRATIVA. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2020-0395pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo identificar os fatores facilitadores e as barreiras que influenciam no envolvimento do paciente nos serviços hospitalares. Método revisão integrativa; realizada busca de artigos publicados entre janeiro de 2011 e dezembro de 2020, nas bases eletrônicas PubMed, Web of Science, Cinahl, Lilacs e Scopus, utilizando descritores relacionados a “patient involvement”, Barriers, Facilitators, nos idiomas inglês, espanhol e português. Coleta de dados realizada de maio a junho de 2021, identificando-se 32 publicações que atenderam aos critérios de inclusão. Resultados a análise resultou em três categorias de fatores facilitadores e barreiras: comunicação, atores do envolvimento e cultura organizacional, permitindo a elaboração de um modelo teórico de envolvimento do paciente. Esse modelo mostra que na centralidade do processo estão os atores envolvidos, ou seja, pacientes e profissionais, inseridos em um contexto organizacional, sendo influenciados pela liderança, cultura, ambiente, recursos disponíveis e processos, onde a comunicação perpassa como base para o envolvimento. Conclusão os fatores facilitadores e as barreiras identificadas nesta revisão, sintetizados num modelo teórico, permitem transcender o conhecimento teórico para a prática. A complexidade para operacionalizar esse modelo requer que pacientes, profissionais, serviços de saúde e sociedade unam os esforços para tornar esta proposição teórica em uma prática incorporada pelos serviços.
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Affiliation(s)
| | - Louíse Viecili Hoffmeister
- Universidade NOVA de Lisboa, Portugal; Comprehensive Health Research Center, Portugal; Escola Superior de Enfermagem de Lisboa, Portugal
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Bodicoat DH, Routen AC, Willis A, Ekezie W, Gillies C, Lawson C, Yates T, Zaccardi F, Davies MJ, Khunti K. Promoting inclusion in clinical trials-a rapid review of the literature and recommendations for action. Trials 2021; 22:880. [PMID: 34863265 PMCID: PMC8643184 DOI: 10.1186/s13063-021-05849-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/20/2021] [Indexed: 11/18/2022] Open
Abstract
Background Without inclusion of diverse research participants, it is challenging to understand how study findings will translate into the real world. Despite this, a lack of inclusion of those from under-served groups in research is a prevailing problem due to multi-faceted barriers acting at multiple levels. Therefore, we rapidly reviewed international published literature, in relation to clinical trials, on barriers relating to inclusion, and evidence of approaches that are effective in overcoming these. Methods A rapid literature review was conducted searching PubMed for peer-reviewed articles that discussed barriers to inclusion or strategies to improve inclusion in clinical trial research published between 2010 and 2021. Grey literature articles were excluded. Results Seventy-two eligible articles were included. The main barriers identified were language and communication, lack of trust, access to trials, eligibility criteria, attitudes and beliefs, lack of knowledge around clinical trials, and logistical and practical issues. In relation to evidence-based strategies and enablers, two key themes arose: [1] a multi-faceted approach is essential [2]; no single strategy was universally effective either within or between trials. The key evidence-based strategies identified were cultural competency training, community partnerships, personalised approach, multilingual materials and staff, communication-specific strategies, increasing understanding and trust, and tackling logistical barriers. Conclusions Many of the barriers relating to inclusion are the same as those that impact trial design and healthcare delivery generally. However, the presentation of these barriers among different under-served groups may be unique to each population’s particular circumstances, background, and needs. Based on the literature, we make 15 recommendations that, if implemented, may help improve inclusion within clinical trials and clinical research more generally. The three main recommendations include improving cultural competency and sensitivity of all clinical trial staff through training and ongoing personal development, the need to establish a diverse community advisory panel for ongoing input into the research process, and increasing recruitment of staff from under-served groups. Implementation of these recommendations may help improve representation of under-served groups in clinical trials which would improve the external validity of associated findings. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05849-7.
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Affiliation(s)
| | - Ash C Routen
- Centre for Ethnic Health Research, University of Leicester, Leicester General Hospital, Leicester, UK.,Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Andrew Willis
- Centre for Ethnic Health Research, University of Leicester, Leicester General Hospital, Leicester, UK.,Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Winifred Ekezie
- Centre for Ethnic Health Research, University of Leicester, Leicester General Hospital, Leicester, UK.,Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Clare Gillies
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Claire Lawson
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Francesco Zaccardi
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK.,Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Kamlesh Khunti
- Centre for Ethnic Health Research, University of Leicester, Leicester General Hospital, Leicester, UK. .,Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK. .,NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK. .,Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK.
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King L, Ullah S, Belan I, Clark RA, Young T, Grantham H, Peacock G, Kidd MR. You're Worried, We're Listening: Online Testing of the Effectiveness of Education Materials to Improve Consumer Knowledge and Confidence in Reporting Patient Deterioration. J Patient Saf 2021; 17:e1413-e1419. [PMID: 34570001 DOI: 10.1097/pts.0000000000000906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Early identification of patient deterioration in hospital is important to reduce mortality, avoidable morbidity, length of stay, and associated healthcare costs. By closely observing physical and behavioral changes, deteriorating patients are more likely to be identified. Patients and family at the bedside can play an important role in reporting deterioration if made aware of how to do so. Therefore, the objective of this study was to undertake an online evaluation of educational materials designed to improve consumers' knowledge and confidence to report patient deterioration. METHODS A convenience sample was used to recruit community-based participants for an online survey. A self-designed validated instrument was used to undertake a preintervention and postintervention test involving 3 types of educational materials. Quantitative data were analyzed with Wilcoxon signed rank test to compare participants' knowledge and confidence before and after exposure to the intervention. Conventional content analyses examined responses on key messages and recommendations to improve the educational materials. RESULTS A total of 84 respondents completed both prequestionnaires and postquestionnaires. After exposure to the education materials, analyses confirmed that knowledge and confidence scores were significantly higher than baseline measures. Content analyses indicated a clear understanding of the key messages presented in the materials. Four main recommendations were made regarding the education materials. CONCLUSIONS Participants readily identified the key messages in the educational materials and demonstrated increased knowledge and confidence to report concerns about deterioration. Further research is required to determine the efficacy of the educational materials in relation to consumer behavior.
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Affiliation(s)
- Lindy King
- From the College of Nursing and Health Sciences
| | | | | | - Robyn A Clark
- College of Nursing and Health Sciences, Caring Futures Institute
| | - Tom Young
- College of Humanities, Arts and Social Sciences, Flinders University, Adelaide, South Australia
| | - Hugh Grantham
- Flinders Medical Centre/School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia
| | - Guy Peacock
- Division of Mental Health Services, Southern Adelaide Local Health Network (SALHN) Adelaide, South Australia
| | - Michael R Kidd
- Professor of Primary Care Reform, The Australian National University, Canberra, Australian Capital Territory, Australia
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Adhikari M, Kaphle S, Dhakal Y, Duwadi S, Subedi R, Shakya S, Tamang S, Khadka M. Too long to wait: South Asian migrants' experiences of accessing health care in Australia. BMC Public Health 2021; 21:2107. [PMID: 34789215 PMCID: PMC8596381 DOI: 10.1186/s12889-021-12132-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 10/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Migrants settling in a new country experience multiple complexities in navigating health care systems and adapting to a new way of life in the host country. In South Asia, migrating to another country for better life opportunities has been an ongoing trend and migration to Australia has significantly increased in recent years. Lower utilisation of health services and higher risks of chronic diseases among South Asian migrants poses a continuing challenge for the Australian health care system and little is known about why this demographic group does not access health services at the same rate. This study aimed to explore factors influencing access to health care by South Asian migrants in Australia. METHODS Using a mixed-method design, we conducted 62 online survey and 14 in-depth interviews with participants from four South Asian countries: Nepal, India, Bhutan, and Sri Lanka. Participants were recruited using a purposive snowball sampling approach following a standard ethical approval process. Survey data were analysed descriptively in SPSS and interview data were recorded, transcribed, and analysed thematically. RESULTS South Asian migrants experienced various complexities while accessing health services in Australia. The findings of this study highlighted a number of negative factors influencing their experiences of accessing health care: long waiting times for public health care, the expense of private health care, and communication problems due to socio-cultural differences. South Asian migrants also expressed their concern for a greater investment of resources into public health care to enable them to access quality and affordable care in these settings. CONCLUSIONS Given limited evidence available to help understand factors leading to the lower utilisation of health care and higher risks of chronic diseases among South Asian migrants, this study plays an important role in highlighting social, cultural, financial, and institutional factors that are critical to designing appropriate health-care strategies. This study recommends incorporating a collaborative and culturally competent model of care to increase access to health care and thereby help reduce existing disparities in health outcomes among South Asian migrant populations.
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Affiliation(s)
- Manju Adhikari
- LA GRANDEE International College, Pokhara Metropolitan City, Province 4 Nepal
| | | | - Yamuna Dhakal
- Central Queensland University, Melbourne, VIC Australia
| | - Sabina Duwadi
- Central Queensland University, Melbourne, VIC Australia
| | - Rajan Subedi
- Central Queensland University, Melbourne, VIC Australia
| | - Sonu Shakya
- Central Queensland University, Melbourne, VIC Australia
| | - Sunil Tamang
- Central Queensland University, Melbourne, VIC Australia
| | - Mukesh Khadka
- Central Queensland University, Melbourne, VIC Australia
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41
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Chauhan A, Leefe J, Shé ÉN, Harrison R. Optimising co-design with ethnic minority consumers. Int J Equity Health 2021; 20:240. [PMID: 34736455 PMCID: PMC8567634 DOI: 10.1186/s12939-021-01579-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/25/2021] [Indexed: 12/19/2022] Open
Abstract
Co-design as a participatory method aims to improve health service design and implementation. It is being used more frequently by researchers and practitioners in various health and social care settings. Co-design has the potential for achieving positive outcomes for the end users involved in the process; however, involvement of diverse ethnic minority population in the process remains limited. While the need to engage with diverse voices is identified, there is less information available on how to achieve meaningful engagement with these groups. Ethnic minorities are super-diverse population and the diversity between and within these groups need consideration for optimising their participation in co-design. Based on our experience of working with diverse ethnic minority groups towards the co-design of consumer engagement strategies to improve patient safety in cancer services as part of the two nationally-funded research projects in Australia, we outline reflections and practical techniques to optimise co-design with people from diverse ethnic backgrounds. We identify three key aspects of the co-design process pertinent to the involvement of this population; 1) starting at the pre-commencement stage to ensure diverse, seldom heard consumers are invited to and included in co-design work, 2) considering logistics and adequate resources to provide appropriate support to address needs before, during and beyond the co-design process, and 3) supporting and enabling a diversity of contributions via the co-design process.
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Affiliation(s)
- Ashfaq Chauhan
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation (AIHI), Macquarie University, North Ryde, NSW, 2109, Australia.
| | - Jessica Leefe
- System Transformation Evaluation and Patient Experience, Agency for Clinical Innovation (ACI), NSW Health, St Leonards, NSW, 2065, Australia
| | - Éidín Ní Shé
- School of Population Health, University of New South Wales (UNSW), Sydney, NSW, 2052, Australia
| | - Reema Harrison
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation (AIHI), Macquarie University, North Ryde, NSW, 2109, Australia
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Chauhan A, Walpola RL. Ensuring medication safety for consumers from ethnic minority backgrounds: The need to address unconscious bias within health systems. Int J Qual Health Care 2021; 33:6401650. [PMID: 34664657 DOI: 10.1093/intqhc/mzab145] [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: 07/20/2021] [Revised: 09/16/2021] [Accepted: 10/18/2021] [Indexed: 11/14/2022] Open
Abstract
Medication safety remains a pertinent issue for health systems internationally, with patients from ethnic minority backgrounds recognized at increased risk of exposure to harm resulting from unsafe medication practices. While language and communication barriers remain a central issue for medication safety for patients from ethnic minority backgrounds, increasing evidence suggests that unconscious bias can alter practitioner behaviours, attitudes and decision-making leading to unsafe medication practices for this population. Systemwide, service and individual level approaches such as cultural competency training and self-reflections are used to address this issue, however, the effectiveness of these strategies is not known. While engagement is proposed to improve patient safety, the strategies currently used to address unconscious bias seem tokenistic. We propose that including consumers from ethnic minority backgrounds in design and delivery of the education programs for health professionals, allocating extra time to understand their needs and preferences in care, and co-designing engagement strategies to improve medication related harm with diverse ethnic minority groups are key to mitigating medication related harm arising as a result of unconscious bias.
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Affiliation(s)
- Ashfaq Chauhan
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation (AIHI), Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW 2109, Australia
| | - Ramesh Lahiru Walpola
- School of Population Health, University of New South Wales (UNSW) Sydney, Level 2, Samuels Building, Kensington, NSW 2052, Australia
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Strategies of communicating health-related risks to vulnerable groups of immigrants during a pandemic: a scoping review of qualitative and quantitative evidence. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2021. [DOI: 10.1108/ijhg-06-2021-0070] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this rapid scoping review was to map existing literature on risk communication strategies implemented by authorities and aimed at vulnerable immigrants in the context of pandemics.
Design/methodology/approach
Existing literature on the topic was charted in terms of its nature and volume by summarizing evidence regarding the communication strategies. Literature searches were conducted in Academic Search Premier and CINAHL, databases were searched from 2011 to present on March 31, 2021.
Findings
Five articles met the criteria and were included in this review, pointing at limited research in this area. The findings indicated that a close interaction between communication authorities and immigrants is important. Community education, building trust in communication sources, clear risk communication and inclusive decision-making among all were found to be important when communicating health risks to immigrants.
Research limitations/implications
The primary limitation of this rapid scoping review is that the literature searches were conducted in only two databases, namely, Academic Search Premier and CINAHL. A wider search across several other databases could have given more profound results. Furthermore, some studies where immigrants were conceptualized as, for instance, “disadvantaged groups” might be overseen due to a choice of the search strategy used in this study. There are also certain limitations related to the studies included in this review.
Practical implications
Identifying efficient ways of conveying recommendations may further assist authorities and scientists in developing more effective health-related risk communication.
Originality/value
This study covered health-related risk communication in the context of pandemics, addressing the need to investigate different groups of immigrants and the challenges related to communicating risks to these groups.
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Shé ÉN, Gordan A, Hughes B, Hope T, McNally T, Whelan R, Staunton M, Grayson M, Hazell L, Wilson I, Stephens R, Quinn E, McCann A. "Could you give us an idea on what we are all doing here?" the Patient Voice in Cancer Research (PVCR) starting the journey of involvement in Ireland. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:63. [PMID: 34517919 PMCID: PMC8436020 DOI: 10.1186/s40900-021-00301-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/20/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Involving patients and their carers in research has become more common, as funders demand evidence of involvement. The 'Patient Voice in Cancer Research' (PVCR) is an initiative led by University College Dublin (UCD) in Ireland. It encourages and enables people affected by cancer, and their families to become involved in shaping and informing the future of cancer research across the island of Ireland. Its aim is to identify the questions and needs that matter most to (i) people living with a cancer diagnosis, and (ii) those most likely to improve the relevance of cancer research. The initiative commenced in April 2016. METHODS This paper presents a reflective case study of our journey thus far. We outline three key stages of the initiative and share what we have learnt. At the core of PVCR, is a focus on building long-term relationships. RESULTS We have developed over time an inclusive initiative that is built on trust and respect for everyone's contributions. This work is grounded on collegiality, mixed with a good sense of humour and friendship. CONCLUSION The development of PVCR has taken time and investment. The benefits and impact of undertaking this work have been immensely rewarding and now require significant focus as we enhance cancer research across the island of Ireland.
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Affiliation(s)
- Éidín Ní Shé
- School of Population Health, University of New South Wales, Kensington, Australia
| | - Aoife Gordan
- UCD School of Medicine, University College Dublin, UCD, Belfield, Dublin 4, Ireland
| | - Barbara Hughes
- UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, UCD Belfield, Dublin 4, Ireland
| | - Tom Hope
- Expert by Experience, Prostate Cancer Patient, Dunboyne, Ireland
| | - Teresa McNally
- Expert by Experience, Representing Family Carers, Dublin, Ireland
| | - Ramon Whelan
- Expert by Experience Testicular Cancer Patient, Dublin, Ireland
| | - Mary Staunton
- Expert by Experience, University College Dublin (UCD), Dublin, Ireland
| | | | - Liane Hazell
- National Cancer Research Institute (NCRI), UK Forum Programme Manager, London, UK
| | - Iseult Wilson
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | | | - Elaine Quinn
- UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, UCD Belfield, Dublin 4, Ireland
| | - Amanda McCann
- UCD School of Medicine, University College Dublin, UCD, Belfield, Dublin 4, Ireland
- UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, UCD Belfield, Dublin 4, Ireland
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McGuire T, Yozwiak D, Aultman JM. The Mental Health of Refugees during a Pandemic: The Impact of COVID-19 on Resettled Bhutanese Refugees. Asian Bioeth Rev 2021; 13:375-399. [PMID: 34539868 PMCID: PMC8436029 DOI: 10.1007/s41649-021-00183-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 07/22/2021] [Accepted: 07/27/2021] [Indexed: 11/26/2022] Open
Abstract
This paper is the first of two in a series. In this paper, we identify mental health needs and challenges in the age of COVID-19 among Nepali-speaking, Bhutanese resettled refugees in the USA. We argue for a public health justice framework that looks critically at social determinants impacting mental health (SDIMH) barriers, which negatively impact our Bhutanese population, and serves as a theoretical foundation toward public policy and law that will inform healthcare decisions and fair treatment of resettled refugees at the clinical bedside and in the community. We first describe our Bhutanese refugee population and the critical mental health issues that, for many, originated during political persecution and violent ethnic cleansing initiatives, or while living in refugee camps prior to resettlement to the USA. We present a social justice framework emerging from an extensive literature review and incorporating core social determinants specific to mental health in the age of COVID-19, which are guided by the social determinants of economic stability; neighborhoods and physical environment; education; nutrition and exercise; community and social context; healthcare system; and legal system. We illustrate specific SDIMH of our resettled Bhutanese refugees during the pandemic, followed by a second paper that details recommendations for applying the SDIMH in a collective effort to address specific barriers to mental healthcare and support.
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Kyoon Achan G, Eni R, Kinew KA, Phillips-Beck W, Lavoie JG, Katz A. The Two Great Healing Traditions: Issues, Opportunities, and Recommendations for an Integrated First Nations Healthcare System in Canada. Health Syst Reform 2021; 7:e1943814. [PMID: 34375567 DOI: 10.1080/23288604.2021.1943814] [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: 10/20/2022] Open
Abstract
The First Nations in Manitoba, Canada, are calling for active recognition and incorporation of holistic traditional healing and medicine ways and approaches by the mainstream healthcare system that has hitherto tended to ignore all but biomedical approaches. This request for recognition requires elaboration on areas of opportunity for collaboration that could positively influence both Indigenous and allopathic medicine. We discuss pathways to an integrated healthcare system as community-based primary healthcare transformation. A community-based participatory research approach was used to engage eight Manitoba First Nations communities. One hundred and eighty-three (183) in-depth, semi-structured key informant interviews were completed in all communities. Grounded theory guided data analysis using NVivo 10 software. We learned that increased recognition and incorporation of traditional healing and medical methods would enhance a newly envisioned funded health system. Elders and healers will be meaningfully involved in the delivery of community-based primary health care. Funding for traditional healing and medicines are necessary components of primary health care. An overall respect for Indigenous health knowledge would aid transformation in community-based primary health care. Recognition of and respect for traditional healing, healers, medicines, therapies, and approaches is also recommended as part of addressing the legacy and intergenerational impact of assimilative policies including Indian residential schools as the Truth and Reconciliation Commission of Canada has stated in its Calls to Action.
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Affiliation(s)
- Grace Kyoon Achan
- Children's Hospital Research Institute of Manitoba & Department of Community Health Sciences, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rachel Eni
- Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Snuneymuxw First Nation, Nanaimo, British Columbia, Canada
| | - Kathi Avery Kinew
- First Nation Health and Social Secretariat Manitoba, Winnipeg, Manitoba, Canada
| | - Wanda Phillips-Beck
- First Nation Health and Social Secretariat Manitoba, Winnipeg, Manitoba, Canada
| | - Josée G Lavoie
- Ongomiizwin- Indigenous Institute of Health and Healing, Department of Community Health Sciences, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alan Katz
- Manitoba Centre for Health Policy/Max Rady Faculty of Health Sciences, Winnipeg, Manitoba, Canada
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Baumeister A, Chakraverty D, Aldin A, Seven ÜS, Skoetz N, Kalbe E, Woopen C. "The system has to be health literate, too" - perspectives among healthcare professionals on health literacy in transcultural treatment settings. BMC Health Serv Res 2021; 21:716. [PMID: 34289853 PMCID: PMC8293586 DOI: 10.1186/s12913-021-06614-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 06/08/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Effective communication is a central aspect of organizational health literacy. Healthcare professionals are expected to ensure an effective and satisfactory flow of information and to support their patients in accessing, understanding, appraising, and applying health information. This qualitative study aimed to examine the health literacy-related challenges, needs, and applied solutions of healthcare professionals when engaging with persons with a migrant background. Based on the integrated model of health literacy (Sørensen et al., BMC Public Health 12:80, 2012), we focused on environmental, personal, and situational factors that shape health literacy in transcultural treatment settings. METHODS We conducted five focus group discussions with healthcare professionals (N = 31) who are in regular contact with persons with a migrant background. Discussions were transcribed verbatim and analyzed using qualitative content analysis by applying a deductive-inductive categorization procedure. Deductive categories were derived from the integrated model of health literacy. RESULTS Challenges included a mismatch in the provision and use of health services. Participants regarded easily accessible services and outreach counselling as helpful solutions. Further challenges were the migrant patients' distrust in healthcare professionals and the German healthcare system, the participants' uncertainty in dealing with patients' expectations and needs, and the patients' non-compliance with appointments. Environmental factors included systemic lack of time and economic pressure. Both were reported as impeding the flow of information in all treatment settings. Participants with a migrant background themselves (n = 16) regarded this personal factor as an opportunity that increased patients' trust in them. They also reported challenges such as high levels of responsibility felt when ad hoc interpreting for colleagues. CONCLUSIONS Known issues observed in the delivery of healthcare for the majority population (i.e., systemic lack of time, economic pressure) appear to be intensified in the context of migration. An increasingly diverse patient clientele indicates a growing need for culture-sensitive, health-literate healthcare organizations. A corresponding diversity of the health workforce is desirable and should be strengthened by national finance and educational programs. Healthcare professionals who interpret for colleagues should be given the necessary time. Further studies are needed to develop appropriate interventions for improving health literacy at individual and organizational levels. Funding for interpreting services should be expanded.
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Affiliation(s)
- Annika Baumeister
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (CERES), University of Cologne and Research Unit Ethics, Faculty of Medicine and University Hospital Cologne, 50931, Cologne, Germany.
| | - Digo Chakraverty
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937, Cologne, Germany
| | - Angela Aldin
- Evidence-Based Internal Medicine, Department I of Internal Medicine and Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935, Cologne, Germany
| | - Ümran Sema Seven
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937, Cologne, Germany
| | - Nicole Skoetz
- Evidence-Based Internal Medicine, Department I of Internal Medicine and Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935, Cologne, Germany
| | - Elke Kalbe
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937, Cologne, Germany
| | - Christiane Woopen
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (CERES), University of Cologne and Research Unit Ethics, Faculty of Medicine and University Hospital Cologne, 50931, Cologne, Germany
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Chauhan A, Walpola RL, Manias E, Seale H, Walton M, Wilson C, Smith AB, Li J, Harrison R. How do health services engage culturally and linguistically diverse consumers? An analysis of consumer engagement frameworks in Australia. Health Expect 2021; 24:1747-1762. [PMID: 34264537 PMCID: PMC8483202 DOI: 10.1111/hex.13315] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 06/19/2021] [Accepted: 06/25/2021] [Indexed: 11/30/2022] Open
Abstract
Background Engagement frameworks provide the conceptual structure for consumer engagement in healthcare decision making, but the level to which these frameworks support culturally and linguistically diverse (CALD) consumer engagement is not known. Objective This study aimed to investigate how consumer engagement is conceptualised and operationalized and to determine the implications of current consumer engagement frameworks for engagement with CALD consumers. Method Altheide's document analysis approach was used to guide a systematic search, selection and analytic process. Australian Government health department websites were searched for eligible publicly available engagement frameworks. A narrative synthesis was conducted. Results Eleven engagement frameworks published between 2007 and 2019 were identified and analysed. Only four frameworks discussed engagement with CALD consumers distinctly. Organisational prerequisites to enhance engagement opportunities and approaches to enable activities of engagement were highlighted to improve CALD consumers' active participation in decision making; however, these largely focused on language, with limited exploration of culturally sensitive services. Conclusion There is limited discussion of what culturally sensitive services look like and what resources are needed to enhance CALD consumer engagement in high‐level decision making. Health services and policy makers can enhance opportunities for engagement with CALD consumers by being flexible in their approach, implementing policies for reimbursement for participation and evaluating and adapting the activities of engagement in collaboration with CALD consumers. Patient/Public Contribution This study is part of a wider ‘CanEngage’ project, which includes a consumer investigator, and is supported by a consumer advisory group. The study was conceived with inputs from the consumer advisory group, which continued to meet regularly with the project team to discuss the methodology and emerging findings.
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Affiliation(s)
- Ashfaq Chauhan
- School of Population Health, UNSW Sydney, Kensington, New South Wales, Australia
| | - Ramesh L Walpola
- School of Population Health, UNSW Sydney, Kensington, New South Wales, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Melbourne, Victoria, Australia
| | - Holly Seale
- School of Population Health, UNSW Sydney, Kensington, New South Wales, Australia
| | - Merrilyn Walton
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Carlene Wilson
- Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia.,School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Allan B Smith
- Centre for Oncology Education and Research Translation (CONSORT), Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, New South Wales, Australia
| | - Jiadai Li
- School of Population Health, UNSW Sydney, Kensington, New South Wales, Australia
| | - Reema Harrison
- School of Population Health, UNSW Sydney, Kensington, New South Wales, Australia
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Marshall S, Xu H, Taki S, Laird Y, Love P, Wen LM, Rissel C. Engagement, satisfaction, retention and behavioural outcomes of linguistically diverse mothers and infants participating in an Australian early obesity prevention trial. Health Promot J Austr 2021; 33:350-360. [PMID: 34245623 DOI: 10.1002/hpja.521] [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: 10/21/2020] [Accepted: 07/06/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Early obesity prevention research interventions in Australia generally expect participants to be able to communicate in English, but do not account for other languages. This study aimed to investigate engagement, satisfaction, retention and behavioural outcomes of linguistically diverse participants from a mainstream early childhood obesity prevention trial. METHODS Healthy Beginnings is a nurse-led intervention based in Sydney, supporting families with optimal infant feeding and active play via telephone. This secondary analysis assessed participant engagement in the nurse telephone calls (call completions), satisfaction and behavioural outcomes (6- and 12-month survey data) and retention (survey completions), in the first year of life according to participants' language spoken at home (English or other language). RESULTS Of 1155 mothers, 533 (46%) spoke a language other than English at home. Significantly fewer mothers speaking a language other than English completed the 6-month survey (79%) compared to those speaking English (84%), yet mothers speaking a language other than English who completed the program were more satisfied with the program overall. Significantly fewer mothers speaking a language other than English completed the final four nurse calls (of six) (56%-65%) compared to those speaking English (70%-80%). Adjusted odds ratios showed selected behavioural outcomes were significantly more positive for participants speaking English at home. CONCLUSIONS Healthy Beginnings trial participants who spoke a language other than English at home had less favourable engagement, retention and behavioural outcomes compared to those who spoke English. So what? Early obesity prevention interventions should consider cultural adaptations to improve engagement and effectiveness among culturally and linguistically diverse families.
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Affiliation(s)
- Sarah Marshall
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,The National Health and Medical Research Council Centre for Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia
| | - Huilan Xu
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia
| | - Sarah Taki
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,The National Health and Medical Research Council Centre for Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia.,Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia
| | - Yvonne Laird
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Penelope Love
- The National Health and Medical Research Council Centre for Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia.,Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Li Ming Wen
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,The National Health and Medical Research Council Centre for Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia.,Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia
| | - Chris Rissel
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,The National Health and Medical Research Council Centre for Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH CRE), Sydney, Australia
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Ekezie W, Routen A, Denegri S, Khunti K. Patient and public involvement for ethnic minority research: an urgent need for improvement. J R Soc Med 2021; 114:347-350. [PMID: 33625873 PMCID: PMC8415812 DOI: 10.1177/0141076821994274] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- W Ekezie
- Diabetes Research Centre, University of Leicester, UK
| | - A Routen
- Diabetes Research Centre, University of Leicester, UK
| | - S Denegri
- Academy of Medical Sciences, London, UK
| | - K Khunti
- Diabetes Research Centre and The Centre for Black Minority Health, University of Leicester, UK
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