The Roles of Acculturation and Pre-migration Experiences in Influencing the Confidence of Vietnamese Parents in Vaccine Use Among Adolescents

Vaccine confidence is a critical antecedent of vaccine uptake. Little research has examined vaccine confidence among Asian communities, particularly the associations with acculturation and pre-migration experiences. We explored this issue among U.S. Vietnamese parents. Our study uses an explanatory sequential mixed-methods design to investigate the influence of American acculturation, Vietnamese acculturation, and pre-migration experiences on U.S. Vietnamese parents' vaccine confidence for their adolescents. A cross-sectional web-based survey (n = 408) was followed by semi-structured interviews (n = 32). Quantitative analysis showed that many participants reported high or complete trust in scientists involved in vaccine development (61%), federal agencies responsible for vaccine safety monitoring and licensure (53%), the CDC (62%), and the FDA (58%). High or complete trust in scientists was associated with a higher Vietnamese acculturation score [aRR = 1.20 (1.03-1.40)], while trust in federal government agencies was associated with English medical proficiency [aRR = 1.42 (1.15-1.76)]. Qualitative findings provided deeper insights, with many parents expressing trust in vaccine efficacy, safety, and the rigorous development and approval process. Pre-migration experiences in Vietnam had mixed influences on vaccine confidence. Some participants cited positive experiences with the national immunization program, while others were influenced by negative vaccine-related injury stories. Newer immigrants reported limited familiarity with U.S. health authorities. Language preferences (Vietnamese versus English) for vaccine information varied. Our study highlights the complex interplay of acculturation, cultural identity, language, and historical experiences in shaping vaccine confidence among U.S. Vietnamese parents and emphasizes the need to take these factors into account with tailored public health strategies.

"It's different here" Afghan refugee maternal health experiences in the United States

BACKGROUND

The number of Afghan families in the US has grown over the past two decades, yet there is a paucity of research focused on their maternal healthcare experiences. Afghan families have one of the highest fertility rates in the world and typically have large families. As the US faces rising maternal mortality rates, it is crucial to understand factors that affect health outcomes for culturally distinct groups. We aimed to better understand Afghan women's maternal health experiences in South Texas as a step toward designing culturally sensitive care.

METHODS

Using a qualitative descriptive design, twenty Afghan women who gave birth in the US within the past 2 years participated in audio-recorded interviews. The first and second authors conducted each interview using a semi-structured interview guide. The authors used an in vivo coding method and qualitative content analysis of the transcribed narrative data.

RESULTS

We identified three broad categories with corresponding sub-categories: 1) Maternal Healthcare Experiences: pregnancy, birthing, and postpartum, 2) Communication: language barrier, relationship with husband, and health information seeking, 3) Access to Care: transportation and financing healthcare. The participants expressed perspectives of gratefulness and positive experiences, yet some described stories of poor birth outcomes that led to attitudes of mistrust and disappointment. Distinct cultural preferences were shared, providing invaluable insights for healthcare providers.

CONCLUSIONS

The fact that the Afghan culture is strikingly different than the US mainstream culture can lead to stereotypical assumptions, poor communication, and poor health outcomes. The voices of Afghan women should guide healthcare providers in delivering patient-centered, culturally sensitive maternity care that promotes healthy families and communities.

The role of community engagement toward ensuring healthy lives: a case study of COVID-19 management in two Ghanaian municipalities

Introduction

Community engagement is one of the important requirements for strengthening health delivery in communities in a bid to achieve sustainable development goal 3, target 3.3 (SDG 3.3). The World Health Organization has strongly encouraged the use the five levels of community engagement, which are informing, consulting, planning, collaborating, and empowering communities in order to build resilience and to enable them contribute to the fight against diseases and for the uptake of health interventions. This study sought to explore and describe from the view of government institutions in Ghana how they engaged communities in COVID- 19 management and vaccine acceptance and how the communities within two municipalities also perceived the engagement process as well as the lessons that can be learned in engaging communities to deal with other health challenges and interventions toward the attainment of SDG 3 target 3.3.

Materials and methods

This case study qualitative research project employed in-depth interviews among 36 respondents composed of government officials (the Ghana Health Service (GHS), the Information Services Department (ISD), the National Commission on Civic Education (NCCE) and two Municipal Assemblies), and community leaders and 10 focus group discussions among 87 men and women most of whom were natives and some migrants in two administrative municipalities in Ghana. Data were collected from June to September 2021. Audio interviews were transcribed and uploaded to Nvivo 12 to support triangulation, coding, and thematic analysis. Ethical approval was obtained from the University of Health and Allied Sciences' Research Ethics Committee and all COVID-19 restrictions were observed.

Results

The findings revealed that all the four government institutions educated and informed the communities within their municipalities on COVID-19 management and vaccine acceptance. However, the Ghana Health Service was the most effective in the engagement spectrum of the other four; consulting, involving, collaborating, and empowering communities in the process of COVID-19 management and vaccine acceptance. The GHS achieved that through its CHPS program, which ensured a decentralized health service provision system with multiple programs and leveraging on its multiple programs to reach out to the communities. Government institutions such as the NCCE and the ISD faced challenges such as limited funding and support from the government to be able to carry out their tasks. Additionally, they were not involved with the communities prior to the pandemic and for that matter, they did not have access to community systems such as committees, and existing groups to facilitate the engagement process.

Discussion

Using communities to support Ghana's attainment of the SDG 3 target 3.3 is possible; however, the government needs to provide funds and resources to the institutions responsible to enable them to carry out community engagement effectively. Also, promoting decentralization among institutions can strengthen community engagement processes. It is important that state institutions continue to strategize to empower communities in order to promote their participation in healthcare interventions and in the fight against infectious diseases in Ghana.

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

BACKGROUND

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

METHODS

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

FINDINGS

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

CONCLUSION

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

Is non-medical use normal? Normalisation, medicalisation and pharmaceutical consumption

The theory of the normalisation of youth drug use in advanced capitalist societies has had an enduring legacy in contemporary drug scholarship. While the literature on the normalisation of 'illicit' drugs is well developed, less has been written about application of the theory to emerging discourse of pharmaceutical 'abuse', and how this might necessitate different thinking around what can be considered normal consumption. Pharmaceuticals are not directly associated with criminality, and their use does not traditionally attract stigma. In fact, social science scholarship has illustrated how many substances deemed illicit are normalised in the context of an ever-growing set of medical treatments. This paper explores the assumptions about legality, sociality and pleasure which sit behind the drug normalisation thesis, by reflecting on the relevance of drug normalisation in relation to pharmaceuticals, as well as examining scholarship on the medicalisation of society and qualitative research on non-medical use to illustrate the parallel processes of normalisation that apply to pharmaceuticals. The paper argues that questions of normalisation in relation to pharmaceutical use require a deeper engagement with the normative expectations we attach to pleasure, consumption and medicine, and the way this is structured by proximity to medical authority, whiteness and middle-classness.

Barriers and facilitators experienced by migrants and refugees when accessing pharmaceutical care: A scoping review

BACKGROUND

Pharmacists in the community are often among the first health professionals encountered by new arrivals. Their accessibility and the longevity of the relationship gives pharmacy staff unique opportunities to work with migrants and refugees to meet their health needs. While the language, cultural and health literacy barriers that cause poorer health outcomes are well documented in medical literature, there is a need to validate the barriers to accessing pharmaceutical care and to identify facilitators for efficient care in the migrant/refugee patient-pharmacy staff interaction.

OBJECTIVE

The purpose of this scoping review was to investigate the barriers and facilitators that migrant and refugee populations experience when accessing pharmaceutical care in host countries.

METHODS

A comprehensive search of Medline, Emcare on Ovid, CINAHL and SCOPUS databases, guided by the PRISMA-ScR statement, was undertaken to identify the original research published in English between 1990 and December 2021. The studies were screened based on inclusion and exclusion criteria.

RESULTS

A total of 52 articles from around the world were included in this review. The studies revealed that the barriers to migrants and refugees accessing pharmaceutical care are well documented and include language, health literacy, unfamiliarity with health systems, and cultural beliefs and practises. Empirical evidence was less robust for facilitators, but suggested strategies included improvement of communication, medication review, community education and relationship building.

CONCLUSIONS

While barriers experienced are known, there is a lack of evidence for facilitators for provision of pharmaceutical care to refugees and migrants and poor uptake of available tools and resources. There is a need for further research to identify facilitators that are effective in improving access to pharmaceutical care and practical for implementation by pharmacies..

Community engagement initiatives in primary health care to achieve universal health coverage: A realist synthesis of scoping review

BACKGROUND

Community engagement (CE) is an essential component in a primary health care (PHC) and there have been growing calls for service providers to seek greater CE in the planning, design, delivery and evaluation of PHC services. This scoping review aimed to explore the underlying attributes, contexts and mechanisms in which community engagement initiatives contribute to improved PHC service delivery and the realisation of UHC.

METHODS

PubMed, PsycINFO, CINAHL, Cochrane Library, EMBASE and Google Scholar were searched from the inception of each database until May 2022 for studies that described the structure, process, and outcomes of CE interventions implemented in PHC settings. We included qualitative and quantitative studies, process evaluations and systematic or scoping reviews. Data were extracted using a predefined extraction sheet, and the quality of reporting of included studies was assessed using the Mixed Methods Appraisal Tool. The Donabedian's model for quality of healthcare was used to categorise attributes of CE into "structure", "process" and "outcome".

RESULTS

Themes related to the structural aspects of CE initiatives included the methodological approaches (i.e., format and composition), levels of CE (i.e., extent, time, and timing of engagement) and the support processes and strategies (i.e., skills and capacity) that are put in place to enable both communities and service providers to undertake successful CE. Process aspects of CE initiatives discussed in the literature included: i) the role of the community in defining priorities and setting objectives for CE, ii) types and dynamics of the broad range of engagement approaches and activities, and iii) presence of an on-going communication and two-way information sharing. Key CE components and contextual factors that affected the impact of CE initiatives included the wider socio-economic context, power dynamics and representation of communities and their voices, and cultural and organisational issues.

CONCLUSIONS

Our review highlighted the potential role of CE initiatives in improving decision making process and improving overall health outcomes, and identified several organisational, cultural, political, and contextual factors that affect the success of CE initiatives in PHC settings. Awareness of and responding to the contextual factors will increase the chances of successful CE initiatives.

Barriers adult refugees face to community health and patient engagement: a systematic review

Meeting the health needs of refugee populations and increasing access to healthcare remains a challenge for healthcare systems globally. As such, community health and patient engagement are increasingly recommended strategies to address health-related issues among refugees. This systematic review aims to identify the reported barriers that adult refugees encounter with community health and patient engagement. Data sources included MEDLINE, Embase, APA PsycINFO, CINAHL, and Core Collection (Web of Science), yielding 1156 records. After removing duplicates and two levels of screening, 18 studies were selected for qualitative analysis. The barriers were conceptualised as cultural norms, pre-departure history, education, language proficiency, stigma, racism, social support, and multi-factorial barriers. These barriers can be addressed to improve rapport with refugees and the quality of community health and patient engagement initiatives.

Community Health Worker Program Outcomes for Diabetes and Hypertension Control in West Bank Refugee Camps: A Retrospective Matched Cohort Study

INTRODUCTION

Community health worker (CHW) programs have proven effective in improving diabetes control in many locations and settings, but data on feasibility and efficacy are lacking in the Middle East and settings of chronic violence. A Palestinian CHW program, Health for Palestine (H4P), addresses chronic diseases in West Bank refugee camps. Our study assesses the feasibility and effectiveness of the program's diabetes and hypertension interventions.

METHODS

Data on home visits, patient retention, and blood pressure were extracted from the CHW records and analyzed. To assess diabetic patient progress, we conducted a retrospective matched cohort study using data obtained from a United Nations (UN) clinical database to analyze the trajectory of hemoglobin A1c (A1c) values. Thirty of the 47 diabetic patients in the H4P CHW program met study inclusion criteria and were each matched with 3 patients from the Bethlehem UN clinic (n=120). We tested for significance using multivariable linear regression with robust standard errors.

RESULTS

The average number of home visits per patient per month was 7.3 (standard deviation=4.1), and the patient retention rate was 100% over an average of 11.2 months. For hypertension patients in the CHW program (n=33), mean systolic blood pressure decreased by 7.3 mmHg (95% confidence interval [CI]=1.93, 12.25; P=.009) and mean diastolic blood pressure by 4.3 mmHg (95% CI=0.80, 7.91; P=.018) from March 2018 to November 2019. On average, diabetic patients within the CHW group experienced a 1.4 point greater decline in A1c per year compared to those in the non-CHW group, after adjusting for potential confounders (95% CI=-0.66, -2.1; P<.001).

DISCUSSION

The results suggest that CHW accompaniment may be an effective model for improving diabetes and hypertension control in refugee camps experiencing direct violence and extreme adversity. A low exclusion cut-off for A1c (≤6.4%) may underestimate the program's impact.

Access to Vaccination among Disadvantaged, Isolated and Difficult-to-Reach Communities in the WHO European Region: A Systematic Review

Vaccination has a significant impact on morbidity and mortality. High vaccination coverage rates are required to achieve herd protection against vaccine-preventable diseases. However, limited vaccine access and hesitancy among specific communities represent significant obstacles to this goal. This review provides an overview of critical factors associated with vaccination among disadvantaged groups in World Health Organisation European countries. Initial searches yielded 18,109 publications from four databases, and 104 studies from 19 out of 53 countries reporting 22 vaccine-preventable diseases were included. Nine groups representing the populations of interest were identified, and most of the studies focused on asylum seekers, refugees, migrants and deprived communities. Recall of previous vaccinations received was poor, and serology was conducted in some cases to confirm protection for those who received prior vaccinations. Vaccination coverage was lower among study populations compared to the general population or national average. Factors that influenced uptake, which presented differently at different population levels, included health service accessibility, language and vaccine literacy, including risk perception, disease severity and vaccination benefits. Strategies that could be implemented in vaccination policy and programs were also identified. Overall, interventions specific to target communities are vital to improving uptake. More innovative strategies need to be deployed to improve vaccination coverage among disadvantaged groups.

How Are Non-Medical Settlement Service Organizations Supporting Access to Healthcare and Mental Health Services for Immigrants: A Scoping Review

Following resettlement in high-income countries, many immigrants and refugees experience barriers to accessing primary healthcare. Local non-medical settlement organizations, such as the Local Immigration Partnerships in Canada, that support immigrant integration, may also support access to mental health and healthcare services for immigrant populations. This scoping review aims to identify and map the types and characteristics of approaches and interventions that immigrant settlement organizations undertake to support access to primary healthcare for clients. We systematically searched MEDLINE, Social Services Abstracts, CINAHL, and PsycInfo databases from 1 May 2013 to 31 May 2021 and mapped research findings using the Social-Ecological Model. The search identified 3299 citations; 10 studies met all inclusion criteria. Results suggest these organizations support access to primary healthcare services, often at the individual, relationship and community level, by collaborating with health sector partners in the community, connecting clients to health services and service providers, advocating for immigrant health, providing educational programming, and initiating community development/mobilization and advocacy activities. Further research is needed to better understand the impact of local non-medical immigrant settlement organizations involved in health care planning and service delivery on reducing barriers to access in order for primary care services to reach marginalized, high-need immigrant populations.

Policies and initiatives/programs that promote health and self-care in asylum seekers living in high income countries: a narrative review

Purpose

This paper aims to identify health-care entitlements that exist for asylum seekers with chronic non-communicable disease (CNCD) that promote their health and self-care, and to explore health policies, initiatives and programmes with the potential to foster self-care in this populace.

Design/methodology/approach

Narrative review of literature conducted by searching EMBASE, CINAHL, WEB OF SCIENCE and PSYCINFO databases for articles published from 2010 to 2021. Included articles focussed on policies, programmes or initiatives with the potential to promote health in adult asylum seekers residing in high-income countries. Studies inclusive of other migrant groups such as undocumented migrants and those with mental health conditions were excluded. Eleven studies fitting the inclusion criteria were assessed against the study objectives.

Findings

Free access to health-care services and pharmaceutical products, free access to food banks and supermarket model food banks, English and cooking lessons, community integration training sessions and culturally competent health-care workers were found to promote health and self-care. There is little research on self-care and health promotion in adult asylum seekers with CNCD. CNCDs represent high burden of disease in asylum seekers but have a low priority in reported research.

Originality/value

This narrative review is the first to explicitly focus on asylum seekers in high-income countries with CNCD, excluding mental health conditions, and to explore initiatives, programmes and policies that enhance health promotion to facilitate self-care in this populace.

Are we on the same page? Mental health literacy and access to care: a qualitative study in young Hazara refugees in Melbourne

Hazaras, mostly aged <30 years, constituted the greatest number of people resettled under Australia's migration resettlement between 2009 and 2013. This group is at high risk of mental health issues due to pre- and post-forced migration experiences. This study explored the understanding of mental health and barriers to accessing primary mental health care in young Hazara refugees in Melbourne. Seventeen Hazaras aged 18-30 years were recruited for two sex-segregated focus groups; two individual semistructured interviews were also conducted (with one male and one female participant). Discussions were audiotaped, transcribed and analysed thematically. Participants had varied perspectives on mental health issues stemming from historical and current beliefs. Lack of knowledge and concerns over confidentiality within Hazaras were considered major barriers to seeking help. Community education through existing community groups and through the women could potentially help overcome barriers to mental health access by young Hazaras.

Too long to wait: South Asian migrants' experiences of accessing health care in Australia

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.

Integration Experiences of Former Afghan Refugees in Australia: What Challenges Still Remain after Becoming Citizens?

This paper explores, analyses, and documents the experiences of Afghan-Australians who arrived in Australia as refugees and were granted citizenship after living in Australia for several years. This research adopted a mixed method of qualitative and quantitative approaches and surveyed 102 people, interviewed 13 participants, and conducted two focus-groups within its research design. Analysis of data indicates that former Afghan refugees gradually settled down and integrated within Australian society. They value safety and security, open democracy and orderly society of Australia, as well as accessing to education and healthcare services and opportunity for social mobility. However, since the integration is a long process, they are also facing some challenges in this area. Findings of this study show that Afghan-Australians require more support from Australian governments to overcome some of these challenges particularly securing employment within their area of interests and professional occupations that they have qualifications and experiences from Afghanistan. They are also experiencing broader challenges in the area of socio-cultural issues within Australian society. Since the Afghan community is an emerging community in Western Australia, they require more support from local government to enhance their ethnic cohesion and solidarity.

Addressing the challenges to skin health of refugees and migrants in the WHO European region

The prevalence of dermatological disease and skin conditions is a significant issue facing refugees and migrants in the WHO European Region. Displaced populations in particular are vulnerable to dermatological diseases, due to the often poor conditions in which they live and transit through at different stages of their journey. Exposure to adverse weather conditions and heightened risk for injuries and violence are also potential causes for skin conditions and abnormalities. Through a review of published literature focusing on refugee and migrant health, this paper outlines the prevalence of skin conditions and dermatological diseases among these populations, and the impact of migration and displacement on susceptibility for them. It then discusses some of the challenges associated with managing skin conditions and highlights key opportunities to strengthen the integration of skin health within health care for migrants and refugees in the WHO European Region.

Using a mobile application to detect health needs among children and adolescents who are newly arrived migrants in Europe

BACKGROUND

Unprecedented numbers of migrants have arrived in Europe, including children and adolescents. Little is known about their unique health needs. Prospective data collection has been sparse. Mobile applications may help to facilitate global health surveillance.

METHODS

A pre-validated survey instrument was converted into a mobile application covering self-reported exposures and disruptions of healthcare before/during migration, communicable and non-communicable diseases. Participation was voluntary, anonymous and confidential.

RESULTS

Data were obtained from 405 migrant children and adolescents in Berlin, Germany, between 7 October 2015 and 15 March 2016 (median age 19 years, range: 1-24; 80.7% males) with the majority from Syria (62.5%), Afghanistan (9.1%) and Iraq (8.2%). In total, 55% were without family, 64% registered asylum-seekers with access to healthcare; 54% had seen a doctor since arrival, with colds or respiratory complaints (37.5 and 13.6%), followed by pain (26.7%) gastrointestinal (12.4%) and skin problems (11.1%). Underlying conditions were reported in 15.6%, predominantly asthma. Overall, 73% reported being up-to date on immunizations, but only 22% held a vaccination record with 46.4% having lost it during migration.

CONCLUSIONS

The lack of medical and immunization records among newly arrived migrants provides a challenge to healthcare systems. Mobile applications offer rapid screening tools in times of crisis, helping stakeholders with timely information.

Community-Based Healthcare for Migrants and Refugees: A Scoping Literature Review of Best Practices

BACKGROUND

Strengthening community-based healthcare is a valuable strategy to reduce health inequalities and improve the integration of migrants and refugees into local communities in the European Union. However, little is known about how to effectively develop and run community-based healthcare models for migrants and refugees. Aiming at identifying the most-promising best practices, we performed a scoping review of the international academic literature into effective community-based healthcare models and interventions for migrants and refugees as part of the Mig-HealthCare project.

METHODS

A systematic search in PubMed, EMBASE, and Scopus databases was conducted in March 2018 following the PRISMA methodology. Data extraction from eligible publications included information on general study characteristics, a brief description of the intervention/model, and reported outcomes in terms of effectiveness and challenges. Subsequently, we critically assessed the available evidence per type of healthcare service according to specific criteria to establish a shortlist of the most promising best practices.

RESULTS

In total, 118 academic publications were critically reviewed and categorized in the thematic areas of mental health (n = 53), general health services (n = 36), noncommunicable diseases (n = 13), primary healthcare (n = 9), and women's maternal and child health (n = 7).

CONCLUSION

A set of 15 of the most-promising best practices and tools in community-based healthcare for migrants and refugees were identified that include several intervention approaches per thematic category. The elements of good communication, the linguistic barriers and the cultural differences, played crucial roles in the effective application of the interventions. The close collaboration of the various stakeholders, the local communities, the migrant/refugee communities, and the partnerships is a key element in the successful implementation of primary healthcare provision.

Understanding oral health help-seeking among Middle Eastern refugees and asylum seekers in Australia: An exploratory study

OBJECTIVES

Andersen's behavioural model of healthcare utilization is one of the most commonly used frameworks for help-seeking across a broad range of health areas, including oral health. The Model has been used in a wide range of previous studies to explore and understand oral health service use among both general populations and ethnic minorities. However, no research has explored its utility in understanding refugees' and asylum seekers' oral health help-seeking. As such, this study aimed to improve understanding of Middle Eastern refugees' and asylum seekers' oral health help-seeking and to determine the utility of Andersen's Model in this context.

METHODS

Interviews were conducted with 26 participants: 20 refugees and asylum seekers, and six oral health practitioners. Results were analysed using thematic analysis.

RESULTS

The results indicated that systemic barriers were of particular concern for refugees and asylum seekers in relation to oral healthcare access. Other components supported previous research concerning the domains of the Model, with additions in relation to acculturation and previous experiences of dental care either in home or resettlement contexts.

CONCLUSIONS

Overall, this study highlights the need for a tailored approach to understanding oral health help-seeking for refugees and asylum seekers, who have particular dental care needs. Resettlement policies should consider system-level barriers to accessing dental services when considering access to health services more generally for refugees and asylum seekers.

Building capacity in primary health care to respond to the needs of asylum seekers and refugees in Melbourne, Australia: the 'GP Engagement' initiative

Asylum seekers and refugees experience poorer health than the broader Australian population. Universal primary healthcare services play an integral role in supporting and optimising the health and wellbeing of these communities. However, clinical-level issues frequently compromise the quality of care provided to these groups. The 'GP Engagement' initiative, implemented in the south-eastern region of Melbourne, aimed to build capacity within universal primary health care to respond to the needs of asylum seekers and refugees. This involved engaging general practice clinics, resourcing them with tools and frameworks, and undertaking collaborative problem-solving on refugee issues. Evaluation methods included: rigorous record keeping; pre- and post-practice assessments guided by a self-reported '12-Point Checklist'; and participant feedback. Findings from 57 participating health professionals indicated changes in the way that GPs work with asylum seekers and refugees. 'GP Engagement' suggests that it is possible to build primary healthcare responsiveness to asylum seekers and refugees through a strategic regional approach that is firmly grounded in evidence-based practice and considerate of the requirements and constraints of GPs.

A Scoping Review and Conceptual Model of Social Participation and Mental Health among Refugees and Asylum Seekers

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.

Community engagement with refugee-background communities around health: the experience of the Group of 11

There is a growing population of people from refugee backgrounds settling in Australia. They have often been forced to flee from their homes in violent circumstances and may have spent many years in refugee camps with poor health support. There are multiple barriers to their effective access to health services. Community engagement with this community can be tokenistic and difficult to effect. This paper highlights the importance of developing a meaningful strategy for community engagement that is not 'one-size-fits-all', which is achieved over time. There is a rich resource available to health practitioners if engagement with refugee-background communities is managed according to the set of trauma-informed and structural principles outlined in this paper.

What determines immigrant caregivers' adherence to health recommendations from child primary care services? A grounded theory approach

AIM

To investigate the diversity and specificity of the determinants of immigrant caregivers' adherence to child primary care (CPC) health recommendations.

BACKGROUND

Immigrant caregiver's adherence to CPC health recommendations is of utmost importance to minimize their children's health-related vulnerabilities. Some research has been conducted on the determinants of immigrants' access to health services, but much less is known about the determinants of their adherence to health professionals' recommendations once they get there, especially in a primary health care context. This study contributes to bridge these gaps.

METHODS

Interviews and focus groups were conducted, with immigrant and non-immigrant caregivers living in Portugal (n=35), from heterogeneous socioeconomic backgrounds. Focus group and individual interview scripts were developed to explore caregivers' understanding and use of CPC services and, particularly, their adherence to CPC recommendations. A socio-demographic questionnaire was also administered. Qualitative data were analyzed using a grounded theory methodology.

FINDINGS

'Adherence to CPC health recommendations' is a core and multidimensional concept. Several determinants were identified at individual, interpersonal, organizational and structural levels. Some determinants were highlighted both by immigrant and non-immigrant caregivers: valuing children's health, usefulness of recommendations, perceived health-care professionals' competence, central role of vaccination in CPC and caregivers' socio-economic conditions. Other determinants were specifically mentioned by immigrant caregivers: expectations about traditional versus pharmacological treatments, cultural mismatches in children's care practices, perceived quality of Portuguese CPC services versus CPC from countries of origin. These results provide innovative theoretical and empirical contributions to the field of primary health care and, particularly, to immigrant caregivers' adherence behaviors. Implications for research on treatment adherence in primary care contexts, the development of interventions that promote caregivers' adherence to CPC health recommendations and for child protection will be discussed.

Improving the capacity of community-based workers in Australia to provide initial assistance to Iraqi refugees with mental health problems: an uncontrolled evaluation of a Mental Health Literacy Course

BACKGROUND

Australia is a multicultural nation with a humanitarian program that welcomes a large number of Iraqi refugees. Despite the high prevalence of trauma related disorders, professional help-seeking in this group is very low. This study sought to evaluate a face-to-face mental health literacy (MHL) Course that teaches community-based workers how to provide initial help to Iraqi refugees with depression and post-traumatic stress disorder (PTSD) related problems.

METHODS

An uncontrolled pre, post and follow-up design was used to measure improvement in MHL in community-based workers assisting Iraqi refugees.

RESULTS

Eighty-six participants completed the pre- and post-training questionnaires. Forty-five (52%) completed all 3-time point questionnaires. Fifty-six percent (48/86) of participants were able to correctly recognise 'PTSD' as the problem depicted in a vignette before the training. This increased to 77% (66/86) after training and was maintained at follow-up with 82% (37/45) correctly recognising the problem (p = 0.032). Recognition of depression also increased from 69% (59/86) at pre-training to 83% (71/86) after training and to 82% (37/45) at follow-up. There was a significant increase in perceived helpfulness of professional treatments for depression after training (p < 0.001 at post-training, p = 0.010 at follow-up). Significant changes were reported in confidence of participants when helping an Iraqi refugee with PSTD (p < 0.001 at post-training, p < 0.001 at follow-up) and depression (p < 0.001 at post-training, p = 0.003 at follow-up). A decrease were also found on social distance mean scores associated with PTSD (p = 0.006 at post-training, p < 0.001 at follow-up) and depression (p = 0.007 at follow-up). Changes were not significant following training for offering help and helping behaviours in both PSTD and depression vignettes and, the 'dangerous/unpredictable' subscale in the depression vignette.

CONCLUSION

This training is a recommendable way to improve and better equip staff on how to respond to mental health crises and offer Mental Health First Aid in a culturally sensitive manner to Iraqi refugees.