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Dardess P, Dokken DL, Unaka NI, Casillas CA, Rouse L, Patel U, Rodriguez LR, Beck AF. Diversity, Equity, and Inclusion in Patient and Family Advisory Councils: Advancing Best Practice in Children's Hospitals. J Pediatr Health Care 2024; 38:184-193. [PMID: 38429030 DOI: 10.1016/j.pedhc.2023.11.006] [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: 09/01/2023] [Revised: 09/29/2023] [Accepted: 11/18/2023] [Indexed: 03/03/2024]
Abstract
INTRODUCTION This qualitative research study explored practices that support and advance diverse membership in Patient and Family Advisory Councils (PFACs) in children's hospitals and the involvement of PFACs in organization-level diversity, equity, and inclusion work. METHOD This study consisted of a focused literature review and 17 key informant interviews. The study sought to identify important learnings about (1) recruiting and supporting patient and family advisors (PFAs) from historically marginalized populations and (2) ways to develop and sustain meaningful partnerships with PFAs and PFACs in diversity, equity, and inclusion work. RESULTS The study findings highlighted a number of best practices for hospitals to adopt, including more actively reaching out to communities served, addressing barriers to participation through approaches and structures such as specialty PFACs and "tiered" options for participation by PFAs, and co-creation of inclusive environments. DISCUSSION To move forward with this work, additional research, true commitment from health care organizations, and shared guidance and tools for the field are needed.
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Risk and Protective Factors Experienced by Fathers of Refugee Background during the Early Years of Parenting: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116940. [PMID: 35682523 PMCID: PMC9180233 DOI: 10.3390/ijerph19116940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 11/17/2022]
Abstract
Fathers of refugee background with young children can experience significant mental health difficulties, with the potential for intergenerational impacts. This study aimed to explore how fathers of refugee background experience risk and protective factors for their own health and wellbeing during the early years of parenting. Semi-structured interviews and one semi-structured focus group were conducted with fathers of refugee background, with young children (0–5 years), who had settled in Australia. Transcribed interviews were analysed using thematic analysis, informed by the socioecological model of health. A total of 21 fathers participated in the study. Risk factors experienced included: prior experiences of trauma, reduced access to family support in Australia, adjustments in parenting roles, and the challenges of learning a new language and securing employment. Fathers drew on a number of sources of strength, including a sense of joy from fatherhood and support from partners, families, and communities. While most fathers regularly accompanied their partners and children to healthcare appointments, they were rarely asked by healthcare professionals about their own needs. Our findings support the idea that there is a need for greater assistance for fathers, particularly for navigating issues arising from the settlement process. Healthcare services working with families of refugee background must adopt a father-inclusive, trauma-informed approach that is responsive to fathers’ needs.
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Having a Say in Research Directions: The Role of Community Researchers in Participatory Research with Communities of Refugee and Migrant Background. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084844. [PMID: 35457711 PMCID: PMC9024418 DOI: 10.3390/ijerph19084844] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 12/10/2022]
Abstract
Research teams in high-income countries often fail to acknowledge the capacity and contributions of Community Researchers. This qualitative exploratory study used decolonising methodology and the Foundation House ‘Refugee Recovery Framework’ to understand Community Researchers’ perceptions and experiences of their role, and how research teams can integrate the knowledge they bring into research. Purposive sampling was used to facilitate the recruitment of eight Community Researchers from five different community groups working in Melbourne, Victoria. Semi-structured interviews lasting forty to sixty minutes occurred between December 2020 and January 2021. Data were analysed using reflexive thematic analysis. Findings reported in this paper include eight themes: ‘nothing about us without us’; ‘open the door’; a safe space to share; every step of the way; this does not translate; finding the right way to ask; a trauma-informed approach; and support within the workplace. The knowledge obtained demonstrates that Community Researchers facilitate meaningful participation in research for women, families, and communities of refugee or migrant background. Community Researchers’ presence, knowledge, and skills are vital in establishing culturally safe research practices and developing accessible language to facilitate conversations about sensitive research topics across multiple languages. Community Researchers can make important contributions at all stages of research, including data collection and interpretation.
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Goedhart NS, Pittens CACM, Tončinić S, Zuiderent-Jerak T, Dedding C, Broerse JEW. Engaging citizens living in vulnerable circumstances in research: a narrative review using a systematic search. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:59. [PMID: 34479622 PMCID: PMC8414765 DOI: 10.1186/s40900-021-00306-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/23/2021] [Indexed: 06/13/2023]
Abstract
Although public engagement in research is increasingly popular, the involvement of citizens living in vulnerable circumstances is rarely realized. This narrative review aims to describe and critically analyse concerns and corresponding strategies, tools, and methods that could support the inclusion of these citizens in health research. The 40 studies that are included were thematically analysed using the socioecological model. Concerns originate most often on the intrapersonal level of the socioecological model, but concerns were also identified at institutional, community, and policy levels. It is thought-provoking that there is a lack of attention for the research and policy structure in which engagement practices are designed, implemented and evaluated. More research is needed to explore how these cultures could be changed in a way that promotes rather than restrains the engagement of citizens living in vulnerable circumstances in research and policymaking.
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Affiliation(s)
- N S Goedhart
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- Department of Ethics, Law and Humanities, Amsterdam UMC, Amsterdam, The Netherlands.
| | - C A C M Pittens
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - S Tončinić
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - T Zuiderent-Jerak
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - C Dedding
- Department of Ethics, Law and Humanities, Amsterdam UMC, Amsterdam, The Netherlands
| | - J E W Broerse
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Riggs E, Yelland J, Mensah FK, Gold L, Szwarc J, Kaplan I, Small R, Middleton P, Krastev A, McDonald E, East C, Homer C, Nesvadba N, Biggs L, Braithwaite J, Brown SJ. Group Pregnancy Care for refugee background women: a codesigned, multimethod evaluation protocol applying a community engagement framework and an interrupted time series design. BMJ Open 2021; 11:e048271. [PMID: 34281928 PMCID: PMC8291298 DOI: 10.1136/bmjopen-2020-048271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Pregnancy and early parenthood are key opportunities for interaction with health services and connecting to other families at the same life stage. Public antenatal care should be accessible to all, however barriers persist for families from refugee communities to access, navigate and optimise healthcare during pregnancy. Group Pregnancy Care is an innovative model of care codesigned with a community from a refugee background and other key stakeholders in Melbourne, Australia. Group Pregnancy Care aims to provide a culturally safe and supportive environment for women to participate in antenatal care in a language they understand, to improve health literacy and promote social connections and inclusion. This paper outlines Froup Pregnancy Care and provides details of the evaluation framework. METHODS AND ANALYSIS The evaluation uses community-based participatory research methods to engage stakeholders in codesign of evaluation methods. The study is being conducted across multiple sites and involves multiple phases, use of quantitative and qualitative methods, and an interrupted time series design. Process and cost-effectiveness measures will be incorporated into quality improvement cycles. Evaluation measures will be developed using codesign and participatory principles informed by community and stakeholder engagement and will be piloted prior to implementation. ETHICS AND DISSEMINATION Ethics approvals have been provided by all six relevant authorities. Study findings will be shared with communities and stakeholders via agreed pathways including community forums, partnership meetings, conferences, policy and practice briefs and journal articles. Dissemination activities will be developed using codesign and participatory principles.
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Affiliation(s)
- Elisha Riggs
- Intergenerational Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Yelland
- Intergenerational Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Fiona K Mensah
- Intergenerational Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lisa Gold
- Deakin Health Economics, Deakin University, Burwood, Victoria, Australia
- Population Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Josef Szwarc
- Victorian Foundation for Survivors of Torture, Melbourne, Victoria, Australia
| | - Ida Kaplan
- Victorian Foundation for Survivors of Torture, Melbourne, Victoria, Australia
| | - Rhonda Small
- Judith Lumely Centre, La Trobe University, Melbourne, Victoria, Australia
- Department of Women's and Children's Health, Division of Reproductive Health, Karolinska Institute, Stockholm, Sweden
| | - Philippa Middleton
- Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Faculty of Medical and Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Ann Krastev
- Intergenerational Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Ellie McDonald
- Intergenerational Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Christine East
- School of Nursing and Midwifery/Mercy Hospital for Women, La Trobe University, Melbourne, Victoria, Australia
| | - Caroline Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Natalija Nesvadba
- Multicultural Services, Mercy Hospitals Victoria Ltd, Melbourne, Victoria, Australia
| | - Laura Biggs
- Intergenerational Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Stephanie J Brown
- Intergenerational Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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Rumbold AR, Yelland J, Stuart-Butler D, Forbes M, Due C, Boyle FM, Middleton P. Addressing stillbirth inequities in Australia: Steps towards a better future. Women Birth 2020; 33:520-525. [PMID: 33092701 DOI: 10.1016/j.wombi.2020.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/04/2020] [Accepted: 08/31/2020] [Indexed: 12/14/2022]
Abstract
Persistent disparities in stillbirth risk and care are present in Australia. Eliminating these disparities is possible with a commitment to enhancing and scaling up models of culturally safe maternity care shown to be effective for Aboriginal and Torres Strait Islander women and those of migrant and refugee backgrounds. Campaigns to improve public awareness of stillbirth also play an important role in reducing stillbirth risk and consequences. To achieve reach and impact in communities at risk, messaging needs to be framed around the social and cultural context of women's lives. Here we describe important initiatives underway within the Stillbirth Centre of Research Excellence to develop a coordinated national approach to stillbirth prevention and care in communities that bear a disproportionate burden of stillbirth.
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Affiliation(s)
- Alice R Rumbold
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, Australia.
| | - Jane Yelland
- Intergenerational Health, Murdoch Children's Research Institute, Parkville, Australia; Department of General Practice, University of Melbourne, Australia
| | - Deanna Stuart-Butler
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - The University of Queensland (MRI-UQ), Australia
| | - Madeline Forbes
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - The University of Queensland (MRI-UQ), Australia
| | - Clemence Due
- School of Psychology, The University of Adelaide, Australia
| | - Frances M Boyle
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - The University of Queensland (MRI-UQ), Australia; Institute for Social Science Research, The University of Queensland, Australia
| | - Philippa Middleton
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, Australia
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Niemi M, Manhica H, Gunnarsson D, Ståhle G, Larsson S, Saboonchi F. A Scoping Review and Conceptual Model of Social Participation and Mental Health among Refugees and Asylum Seekers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4027. [PMID: 31640210 PMCID: PMC6843961 DOI: 10.3390/ijerph16204027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 11/17/2022]
Abstract
Social participation plays a key role in the integration of refugees and asylum seekers into their host societies, and is also closely tied to the mental health of those populations. The aim of this scoping review was to study how the concept of social participation is described in empirical research, and how it is associated with mental health outcomes. METHODS In total, 64 studies were identified through searches in PubMed, PsycInfo, and Sociological Abstracts. These studies describe various forms of social participation among refugees and asylum seekers, and 33 of them also addressed various forms of mental health outcomes. RESULTS The identified studies described forms and conditions of social participation-both in the host country and transnationally-that could be synthesized into three broad dimensions: (1) Regulatory frameworks, conditions and initiatives; (2) Established societal organizations and social structures; and (3) Community organized groups. Each of these consisted of several sub-domains. The identified dimensions of social participation were also associated with psychosocial well-being and decreased psychological distress. CONCLUSIONS There is a need for policies to enable and support the participation of refugees and asylum seekers in various dimensions of social structures in host societies. Social participation enhances resilience, re-establishes social lives, and acts as a protective factor against poor mental health outcomes.
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Affiliation(s)
- Maria Niemi
- Department of Public Health Science, Karolinska Institutet, Solnavägen 1E, 104 31 Stockholm, Sweden.
- Center for Social Sustainability, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, 141 52 Huddinge, Sweden.
| | - Hélio Manhica
- Department of Public Health Science, Karolinska Institutet, Solnavägen 1E, 104 31 Stockholm, Sweden.
| | - David Gunnarsson
- School of Historical and Contemporary Studies, Södertörn University, Alfred Nobels Allée 7, 141 89 Huddinge, Sweden.
| | - Göran Ståhle
- School of Historical and Contemporary Studies, Södertörn University, Alfred Nobels Allée 7, 141 89 Huddinge, Sweden.
| | - Sofia Larsson
- Department of Health Sciences, Swedish Red Cross University College, Hälsovägen 11, 141 57 Huddinge, Sweden.
| | - Fredrik Saboonchi
- Department of Health Sciences, Swedish Red Cross University College, Hälsovägen 11, 141 57 Huddinge, Sweden.
- Division of Insurance medicine, Department of Clinical Neuroscience, Karolinska Institutet, Berzelius Väg 3, 171 77 Stockholm, Sweden.
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Byrskog U, Ahrne M, Small R, Andersson E, Essen B, Adan A, Ahmed FH, Tesser K, Lidén Y, Israelsson M, Åhman-Berndtsson A, Schytt E. Rationale, development and feasibility of group antenatal care for immigrant women in Sweden: a study protocol for the Hooyo Project. BMJ Open 2019; 9:e030314. [PMID: 31371301 PMCID: PMC6677950 DOI: 10.1136/bmjopen-2019-030314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Somali-born women comprise a large group of immigrant women of childbearing age in Sweden, with increased risks for perinatal morbidity and mortality and poor experiences of care, despite the goal of providing equitable healthcare for the entire population. Rethinking how care is provided may help to improve outcomes. OVERALL AIM To develop and test the acceptability, feasibility and immediate impacts of group antenatal care for Somali-born immigrant women, in an effort to improve experiences of antenatal care, knowledge about childbearing and the Swedish healthcare system, emotional well-being and ultimately, pregnancy outcomes. This protocol describes the rationale, planning and development of the study. METHODS AND ANALYSIS An intervention development and feasibility study. Phase I includes needs assessment and development of contextual understanding using focus group discussions. In phase II, the intervention and evaluation tools, based on core values for quality care and person-centred care, are developed. Phase III includes the historically controlled evaluation in which relevant outcome measures are compared for women receiving individual care (2016-2018) and women receiving group antenatal care (2018-2019): care satisfaction (Migrant Friendly Maternity Care Questionnaire), emotional well-being (Edinburgh Postnatal Depression Scale), social support, childbirth fear, knowledge of Swedish maternity care, delivery outcomes. Phase IV includes the process evaluation, investigate process, feasibility and mechanisms of impact using field notes, observations, interviews and questionnaires. All phases are conducted in collaboration with a stakeholder reference group. ETHICS AND DISSEMINATION The study is approved by the Regional Ethical Review Board, Stockholm, Sweden. Participants receive information about the study and their right to decline/withdraw without consequences. Consent is given prior to enrolment. Findings will be disseminated at antenatal care units, national/international conferences, through publications in peer-reviewed journals, seminars involving stakeholders, practitioners, community and via the project website. Participating women will receive a summary of results in their language.
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Affiliation(s)
- Ulrika Byrskog
- School of Education, Health and Social sciences, Dalarna University, Falun, Sweden
| | - Malin Ahrne
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Rhonda Small
- Mother and Child Health Research, La Trobe University, Melbourne, Victoria, Australia
| | - Ewa Andersson
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Birgitta Essen
- Womens and Childrens Health, Uppsala University, Uppsala, Sweden
| | - Aisha Adan
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Fardosa Hassen Ahmed
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Karin Tesser
- Antenatal Care Clinic, Domnarvet, Borlänge, Sweden
| | | | | | | | - Erica Schytt
- Centre for Clinical Research Dalarna-Uppsala University, Falun, Sweden
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Riggs E, Yelland J, Szwarc J, Duell-Piening P, Wahidi S, Fouladi F, Casey S, Chesters D, Brown S. Afghan families and health professionals' access to health information during and after pregnancy. Women Birth 2019; 33:e209-e215. [PMID: 31097412 DOI: 10.1016/j.wombi.2019.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/17/2019] [Accepted: 04/18/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Having a baby in a new country can be challenging, especially if unable to communicate in a preferred language. The aim of this paper is to explore the provision of health information for Afghan women and men during pregnancy, childbirth and the first year after birth in Melbourne, Australia. METHODS Community engagement underpinned the study design. Qualitative study with bicultural researchers conducting semi-structured interviews. Interviews and focus groups were also conducted with health professionals. RESULTS Sixteen Afghan women and 14 Afghan men with a baby aged 4-12 months participated. Thirty four health professionals also participated. Verbal information provided by a health professional with an interpreter was the most common way in which information was exchanged, and was generally viewed favourably by Afghan women and men. Families had limited access to an interpreter during labour and some families reported difficulty accessing an interpreter fluent in their dialect. Availability of translated information was inconsistent and health professionals occasionally used pictures to support explanations. Women and men were unsure of the role of health professionals in providing information about issues other than pregnancy and infant wellbeing. CONCLUSION Both individual and health system issues hinder and enable the availability and use of information. Consistent, understandable and 'actionable' information is required to meet the needs of diverse families. Health professionals need to be supported with adequate alternatives to written information and access to appropriate interpreters. Inconsistent provision of information is likely to contribute to low health literacy and poor maternal and child health outcomes.
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Affiliation(s)
- Elisha Riggs
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, Australia; General Practice and Primary Health Care Academic Centre, University of Melbourne, 200 Berkeley Street, Carlton, Victoria, Australia.
| | - Jane Yelland
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, Australia; General Practice and Primary Health Care Academic Centre, University of Melbourne, 200 Berkeley Street, Carlton, Victoria, Australia.
| | - Josef Szwarc
- Victorian Foundation for Survivors of Torture, 4 Gardiner Street, Brunswick, Victoria, Australia.
| | - Philippa Duell-Piening
- Victorian Foundation for Survivors of Torture, 4 Gardiner Street, Brunswick, Victoria, Australia.
| | - Sayed Wahidi
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, Australia.
| | - Fatema Fouladi
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, Australia.
| | - Sue Casey
- Victorian Foundation for Survivors of Torture, 4 Gardiner Street, Brunswick, Victoria, Australia.
| | - Donna Chesters
- Victorian Foundation for Survivors of Torture, 4 Gardiner Street, Brunswick, Victoria, Australia.
| | - Stephanie Brown
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, Australia; General Practice and Primary Health Care Academic Centre, University of Melbourne, 200 Berkeley Street, Carlton, Victoria, Australia; Departments of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville, Victoria 3052, Australia.
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Navodani T, Gartland D, Brown SJ, Riggs E, Yelland J. Common maternal health problems among Australian-born and migrant women: A prospective cohort study. PLoS One 2019; 14:e0211685. [PMID: 30742634 PMCID: PMC6370277 DOI: 10.1371/journal.pone.0211685] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/19/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Migrant women of non-English speaking background make up an increasing proportion of women giving birth in high income countries, such as Australia, Canada and the United Kingdom. The aim of this study was to assess the prevalence of common physical and psychosocial health problems during pregnancy and up to 18 months postpartum among migrant women of non-English speaking background compared to Australian-born women. METHODS Prospective pregnancy cohort study of 1507 nulliparous women. Women completed self-administered questionnaires or telephone interviews in early and late pregnancy and at 3, 6, 9, 12 and 18 months postpartum. Standardised instruments were used to assess incontinence, depressive symptoms and intimate partner violence. FINDINGS Migrant women of non-English speaking background (n = 243) and Australian-born mothers (n = 1115) reported a similar pattern of physical health problems during pregnancy and postpartum. The most common physical health problems were: exhaustion, back pain, constipation and urinary incontinence. Around one in six Australian-born women (16.9%) and more than one in four migrant women (22.5%) experienced intimate partner abuse in the first 12 months postpartum. Compared to Australian-born women, migrant women were more likely to report depressive symptoms at 12 and 18 months postpartum. CONCLUSION Physical and mental health problems are common among women of non-English speaking background and Australian-born women, and frequently persist up to 18 months postpartum. Migrant women experience a higher burden of postpartum depressive symptoms and intimate partner violence, and may face additional challenges accessing appropriate care and support.
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Affiliation(s)
- Tharanga Navodani
- Intergenerational Health Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Ministry of Health, Colombo, Sri Lanka
| | - Deirdre Gartland
- Intergenerational Health Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Stephanie J. Brown
- Intergenerational Health Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department General Practice and Primary Health Care Academic Centre, University of Melbourne, Parkville, Victoria, Australia
| | - Elisha Riggs
- Intergenerational Health Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department General Practice and Primary Health Care Academic Centre, University of Melbourne, Parkville, Victoria, Australia
| | - Jane Yelland
- Intergenerational Health Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department General Practice and Primary Health Care Academic Centre, University of Melbourne, Parkville, Victoria, Australia
- * E-mail:
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Giallo R, Riggs E, Lynch C, Vanpraag D, Yelland J, Szwarc J, Duell-Piening P, Tyrell L, Casey S, Brown SJ. The physical and mental health problems of refugee and migrant fathers: findings from an Australian population-based study of children and their families. BMJ Open 2017; 7:e015603. [PMID: 29151045 PMCID: PMC5702027 DOI: 10.1136/bmjopen-2016-015603] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 10/06/2017] [Accepted: 10/18/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The aim of this study was to report on the physical and mental health of migrant and refugee fathers participating in a population-based study of Australian children and their families. DESIGN Cross-sectional survey data drawn from a population-based longitudinal study when children were aged 4-5 years. SETTING Population-based study of Australian children and their families. PARTICIPANTS 8137 fathers participated in the study when their children were aged 4-5 years. There were 131 (1.6%) fathers of likely refugee background, 872 (10.7%) fathers who migrated from English-speaking countries, 1005 (12.4%) fathers who migrated from non-English-speaking countries and 6129 (75.3%) Australian-born fathers. PRIMARY OUTCOME MEASURES Fathers' psychological distress was assessed using the self-report Kessler-6. Information pertaining to physical health conditions, global or overall health, alcohol and tobacco use, and body mass index status was obtained. RESULTS Compared with Australian-born fathers, fathers of likely refugee background (adjusted OR(aOR) 3.17, 95% CI 2.13 to 4.74) and fathers from non-English-speaking countries (aOR 1.79, 95%CI 1.51 to 2.13) had higher odds of psychological distress. Refugee fathers were more likely to report fair to poor overall health (aOR 1.95, 95% CI 1.06 to 3.60) and being underweight (aOR 3.49, 95% CI 1.57 to 7.74) compared with Australian-born fathers. Refugee fathers and those from non-English-speaking countries were less likely to report light (aOR 0.25, 95% CI 0.15 to 0.43, and aOR 0.30, 95% CI 0.24 to 0.37, respectively) and moderate to harmful alcohol use (aOR 0.04, 95% CI 0.10 to 0.17, and aOR 0.14, 95% CI 0.10 to 0.19, respectively) than Australian-born fathers. Finally, fathers from non-English-speaking and English-speaking countries were less likely to be overweight (aOR 0.62, 95% CI 0.51 to 0.75, and aOR 0.84, 95% CI 0.68 to 1.03, respectively) and obese (aOR 0.43, 95% CI 0.32 to 0.58, and aOR 0.77, 95% CI 0.61 to 0.98, respectively) than Australian-born fathers. CONCLUSION Fathers of refugee background experience poorer mental health and poorer general health than Australian-born fathers. Fathers who have migrated from non-English-speaking countries also report greater psychological distress than Australian-born fathers. This underscores the need for primary healthcare services to tailor efforts to reduce disparities in health outcomes for refugee populations that may be vulnerable due to circumstances and sequelae of forced migration and to recognise the additional psychological stresses that may accompany fatherhood following migration from non-English-speaking countries. It is important to note that refugee and migrant fathers report less alcohol use and are less likely to be overweight and obese than Australian-born fathers.
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Affiliation(s)
- Rebecca Giallo
- Healthy Mothers Healthy Families Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, Royal Children’s Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Elisha Riggs
- Healthy Mothers Healthy Families Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, Victoria, Australia
| | - Claire Lynch
- Healthy Mothers Healthy Families Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Dannielle Vanpraag
- Healthy Mothers Healthy Families Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Jane Yelland
- Healthy Mothers Healthy Families Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, Victoria, Australia
| | - Josef Szwarc
- The Victorian Foundation for Survivors of Torture, Brunswick, Australia
| | | | - Lauren Tyrell
- The Victorian Foundation for Survivors of Torture, Brunswick, Australia
| | - Sue Casey
- The Victorian Foundation for Survivors of Torture, Brunswick, Australia
| | - Stephanie Janne Brown
- Healthy Mothers Healthy Families Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, Royal Children’s Hospital, The University of Melbourne, Parkville, Victoria, Australia
- Department of General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, Victoria, Australia
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Riggs E, Rajan S, Casey S, Kilpatrick N. Refugee child oral health. Oral Dis 2016; 23:292-299. [PMID: 27385659 DOI: 10.1111/odi.12530] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/01/2016] [Indexed: 11/30/2022]
Abstract
The number of people forced to flee their homes and move around the world is increasing rapidly. Such refugee populations are not only more likely to have poor physical, mental and social health outcomes but also to experience difficulties accessing health services in their new country. In particular, children from refugee backgrounds are at increased risk of poor oral health which in time is associated with poor adult oral health and impacts on child health (e.g. growth and development) and well-being. To date, there is little evidence about the nature and extent of their oral health problems nor interventions to improve their oral health status. This article summarises the evidence surrounding the oral health status of children from refugee backgrounds. In addition, a systematic review of the international literature over the past 10 years is presented which identifies interventions to improve the oral health of these vulnerable paediatric populations. Based on this evidence, potential strategies available to dental service providers to optimise provision of responsive dental care are discussed.
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Affiliation(s)
- E Riggs
- Healthy Mothers Healthy Families, Murdoch Childrens Research Institute, The Royal Children's Hospital, Victoria, Australia.,General Practice and Primary Health Care Academic Centre, University of Melbourne, Victoria, Australia
| | - S Rajan
- Melbourne Dental School, The University of Melbourne, Melbourne, Victoria, Australia
| | - S Casey
- Sector Development & Partnerships, Foundation House, The Victorian Foundation for Survivors of Torture Inc, Melbourne, Victoria, Australia
| | - N Kilpatrick
- Cleft Services, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Victoria, Australia
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Riggs E, Yelland J, Szwarc J, Wahidi S, Casey S, Chesters D, Fouladi F, Duell-Piening P, Giallo R, Brown S. Fatherhood in a New Country: A Qualitative Study Exploring the Experiences of Afghan Men and Implications for Health Services. Birth 2016; 43:86-92. [PMID: 26616739 DOI: 10.1111/birt.12208] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Fathers of refugee background are dealing with multiple, interrelated stressors associated with forced migration and establishing their lives in a new country. This has implications for the role of men in promoting the health and well-being of their families. METHODS Afghan community researchers conducted interviews with 30 Afghan women and men who had recently had a baby in Australia. Interviews and focus groups were conducted with health professionals working with families of refugee background. RESULTS Fourteen men, 16 women, and 34 health professionals participated. Afghan men reported playing a major role in supporting their wives during pregnancy and postnatal care, accompanying their wives to appointments, and providing language and transport support. Although men embraced these roles, they were rarely asked by health professionals about their own concerns related to their wife's pregnancy, or about their social circumstances. Perinatal health professionals queried whether it was their role to meet the needs of men. CONCLUSION There are many challenges for families of refugee background navigating maternity services while dealing with the challenges of settlement. There is a need to move beyond a narrow conceptualization of antenatal and postnatal care to encompass a broader preventive and primary care approach to supporting refugee families through the period of pregnancy and early years of parenting. Pregnancy and postnatal care needs to be tailored to the social and psychological needs of families of refugee background, including men, and incorporate appropriate language support, in order to improve child and family health outcomes.
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Affiliation(s)
- Elisha Riggs
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, Vic., Australia.,General Practice and Primary Health Care Academic Centre, University of Melbourne, Parkville, Vic., Australia
| | - Jane Yelland
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, Vic., Australia.,General Practice and Primary Health Care Academic Centre, University of Melbourne, Parkville, Vic., Australia
| | - Josef Szwarc
- Victorian Foundation for Survivors of Torture, Brunswick, Vic., Australia
| | - Sayed Wahidi
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, Vic., Australia
| | - Sue Casey
- Victorian Foundation for Survivors of Torture, Brunswick, Vic., Australia
| | - Donna Chesters
- Victorian Foundation for Survivors of Torture, Brunswick, Vic., Australia
| | - Fatema Fouladi
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, Vic., Australia
| | | | - Rebecca Giallo
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, Vic., Australia
| | - Stephanie Brown
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, Vic., Australia.,General Practice and Primary Health Care Academic Centre, University of Melbourne, Parkville, Vic., Australia.,School of Population and Global Health, University of Melbourne, Parkville, Vic., Australia
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14
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Yelland J, Riggs E, Szwarc J, Casey S, Duell-Piening P, Chesters D, Wahidi S, Fouladi F, Brown S. Compromised communication: a qualitative study exploring Afghan families and health professionals' experience of interpreting support in Australian maternity care. BMJ Qual Saf 2015; 25:e1. [PMID: 26089208 DOI: 10.1136/bmjqs-2014-003837] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 05/30/2015] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Difficulties associated with communication are thought to contribute to adverse perinatal outcomes experienced by refugee background women living in developed countries. This study explored Afghan women and men's experience of language support during pregnancy, labour and birth, and health professionals' experiences of communicating with clients of refugee background with low English proficiency. METHODS Interviews were conducted with (1) Afghan women and men in the first year after having a baby in Australia, by multilingual, bicultural researchers and (2) midwives and medical practitioners providing care to families of refugee background. Analysis was conducted thematically. RESULTS Sixteen Afghan women, 14 Afghan men, 10 midwives, five medical practitioners and 19 community-based health professionals (refugee health nurses, bicultural workers, counsellors) providing maternity or early postnatal care participated. Midwife and medical informants concurred that accredited interpreters are generally booked for the first pregnancy visit, but not routinely used for other appointments. Very few Afghan participants reported access to on-site interpreters. Men commonly interpreted for their wives. There was minimal professional interpreting support for imaging and pathology screening appointments or during labour and birth. Health professionals noted challenges in negotiating interpreting services when men were insistent on providing language support for their wives and difficulties in managing interpreter-mediated visits within standard appointment times. Failure to engage interpreters was apparent even when accredited interpreters were available and at no cost to the client or provider. CONCLUSIONS Improving identification of language needs at point of entry into healthcare, developing innovative ways to engage interpreters as integral members of multidisciplinary healthcare teams and building health professionals' capacity to respond to language needs are critical to reducing social inequalities in maternal and child health outcomes for refugee and other migrant populations.
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Affiliation(s)
- Jane Yelland
- Healthy Mothers Healthy Families, Murdoch Childrens Research Institute, Parkville, Victoria, Australia Department of General Practice and Primary Health Care, University of Melbourne, Parkville, Victoria, Australia
| | - Elisha Riggs
- Healthy Mothers Healthy Families, Murdoch Childrens Research Institute, Parkville, Victoria, Australia Department of General Practice and Primary Health Care, University of Melbourne, Parkville, Victoria, Australia
| | - Josef Szwarc
- Victorian Foundation for Survivors of Torture, Brunswick, Victoria, Australia
| | - Sue Casey
- Victorian Foundation for Survivors of Torture, Brunswick, Victoria, Australia
| | | | - Donna Chesters
- Victorian Foundation for Survivors of Torture, Brunswick, Victoria, Australia
| | - Sayed Wahidi
- Department of General Practice and Primary Health Care, University of Melbourne, Parkville, Victoria, Australia
| | - Fatema Fouladi
- Department of General Practice and Primary Health Care, University of Melbourne, Parkville, Victoria, Australia
| | - Stephanie Brown
- Healthy Mothers Healthy Families, Murdoch Childrens Research Institute, Parkville, Victoria, Australia Department of General Practice and Primary Health Care, University of Melbourne, Parkville, Victoria, Australia School of Population Health, University of Melbourne, Parkville, Victoria, Australia
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Yelland J, Riggs E, Szwarc J, Casey S, Dawson W, Vanpraag D, East C, Wallace E, Teale G, Harrison B, Petschel P, Furler J, Goldfeld S, Mensah F, Biro MA, Willey S, Cheng IH, Small R, Brown S. Bridging the Gap: using an interrupted time series design to evaluate systems reform addressing refugee maternal and child health inequalities. Implement Sci 2015; 10:62. [PMID: 25924721 PMCID: PMC4425879 DOI: 10.1186/s13012-015-0251-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 04/18/2015] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The risk of poor maternal and perinatal outcomes in high-income countries such as Australia is greatest for those experiencing extreme social and economic disadvantage. Australian data show that women of refugee background have higher rates of stillbirth, fetal death in utero and perinatal mortality compared with Australian born women. Policy and health system responses to such inequities have been slow and poorly integrated. This protocol describes an innovative programme of quality improvement and reform in publically funded universal health services in Melbourne, Australia, that aims to address refugee maternal and child health inequalities. METHODS/DESIGN A partnership of 11 organisations spanning health services, government and research is working to achieve change in the way that maternity and early childhood health services support families of refugee background. The aims of the programme are to improve access to universal health care for families of refugee background and build organisational and system capacity to address modifiable risk factors for poor maternal and child health outcomes. Quality improvement initiatives are iterative, co-designed by partners and implemented using the Plan Do Study Act framework in four maternity hospitals and two local government maternal and child health services. Bridging the Gap is designed as a multi-phase, quasi-experimental study. Evaluation methods include use of interrupted time series design to examine health service use and maternal and child health outcomes over a 3-year period of implementation. Process measures will examine refugee families' experiences of specific initiatives and service providers' views and experiences of innovation and change. DISCUSSION It is envisaged that the Bridging the Gap program will provide essential evidence to support service and policy innovation and knowledge about what it takes to implement sustainable improvements in the way that health services support vulnerable populations, within the constraints of existing resources.
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Affiliation(s)
- Jane Yelland
- Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Parkville, 3052, , VIC, Australia.
- Department of General Practice and Primary Health Care Academic Unit, University of Melbourne, Parkville, VIC, Australia.
| | - Elisha Riggs
- Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Parkville, 3052, , VIC, Australia.
- Department of General Practice and Primary Health Care Academic Unit, University of Melbourne, Parkville, VIC, Australia.
| | - Josef Szwarc
- Victorian Foundation for Survivors of Torture, Brunswick, VIC, Australia.
| | - Sue Casey
- Victorian Foundation for Survivors of Torture, Brunswick, VIC, Australia.
| | - Wendy Dawson
- Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Parkville, 3052, , VIC, Australia.
| | - Dannielle Vanpraag
- Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Parkville, 3052, , VIC, Australia.
| | - Chris East
- Monash Women's Maternity Services, Monash Health, Clayton, VIC, Australia.
- School of Nursing and Midwifery, Monash University, Clayton, VIC, Australia.
- The Ritchie Centre, Monash University, Clayton, VIC, Australia.
| | - Euan Wallace
- Monash Women's Maternity Services, Monash Health, Clayton, VIC, Australia.
- The Ritchie Centre, Monash University, Clayton, VIC, Australia.
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia.
| | - Glyn Teale
- Women's and Children's Services, Western Health, Sunshine, VIC, Australia.
- Department Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia.
| | - Bernie Harrison
- Maternal and Child Health, City of Greater Dandenong, Dandenong, VIC, Australia.
| | - Pauline Petschel
- Maternal and Child Health, City of Wyndham, Wyndham, VIC, Australia.
| | - John Furler
- Department of General Practice and Primary Health Care Academic Unit, University of Melbourne, Parkville, VIC, Australia.
| | - Sharon Goldfeld
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia.
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
| | - Fiona Mensah
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC, Australia.
| | - Mary Anne Biro
- School of Nursing and Midwifery, Monash University, Clayton, VIC, Australia.
| | - Sue Willey
- School of Nursing and Midwifery, Monash University, Clayton, VIC, Australia.
| | - I-Hao Cheng
- South Eastern Melbourne Medicare Local, Dandenong, VIC, Australia.
- Southern Academic Primary Care Research Unit, Monash University, Dandenong, VIC, Australia.
| | - Rhonda Small
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia.
| | - Stephanie Brown
- Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Parkville, 3052, , VIC, Australia.
- Department of General Practice and Primary Health Care Academic Unit, University of Melbourne, Parkville, VIC, Australia.
- School of Population Health, University of Melbourne, Parkville, VIC, Australia.
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