Elisha Riggs

Improving the reporting of public health intervention research: advancing TREND and CONSORT

BACKGROUND Evidence-based public health decision-making depends on high quality and transparent accounts of what interventions are effective, for whom, how and at what cost. Improving the quality of reporting of randomized and non-randomized study designs through the CONSORT and TREND statements has had a marked impact on the quality of study designs. However, public health users of systematic reviews have been concerned with the paucity of synthesized information on context, development and rationale, implementation processes and sustainability factors. METHODS This paper examines the existing reporting frameworks for research against information sought by users of systematic reviews of public health interventions and suggests additional items that should be considered in future recommendations on the reporting of public health interventions. RESULTS Intervention model, theoretical and ethical considerations, study design choice, integrity of intervention/process evaluation, context, differential effects and inequalities and sustainability are often overlooked in reports of public health interventions. CONCLUSION Population health policy makers need synthesized, detailed and high quality a priori accounts of effective interventions in order to make better progress in tackling population morbidities and inequalities. Adding simple criteria to reporting standards will significantly improve the quality and usefulness of published evidence and increase its impact on public health program planning.

Accessing maternal and child health services in Melbourne, Australia: Reflections from refugee families and service providers

BackgroundOften new arrivals from refugee backgrounds have experienced poor health and limited access to healthcare services. The maternal and child health (MCH) service in Victoria, Australia, is a joint local and state government operated, cost-free service available to all mothers of children aged 0–6 years. Although well-child healthcare visits are useful in identifying health issues early, there has been limited investigation in the use of these services for families from refugee backgrounds. This study aims to explore experiences of using MCH services, from the perspective of families from refugee backgrounds and service providers.MethodsWe used a qualitative study design informed by the socioecological model of health and a cultural competence approach. Two geographical areas of Melbourne were selected to invite participants. Seven focus groups were conducted with 87 mothers from Karen, Iraqi, Assyrian Chaldean, Lebanese, South Sudanese and Bhutanese backgrounds, who had lived an average of 4.7 years in Australia (range one month-18 years). Participants had a total of 249 children, of these 150 were born in Australia. Four focus groups and five interviews were conducted with MCH nurses, other healthcare providers and bicultural workers.ResultsFour themes were identified: facilitating access to MCH services; promoting continued engagement with the MCH service; language challenges; and what is working well and could be done better. Several processes were identified that facilitated initial access to the MCH service but there were implications for continued use of the service. The MCH service was not formally notified of new parents arriving with young children. Pre-arranged group appointments by MCH nurses for parents who attended playgroups worked well to increase ongoing service engagement. Barriers for parents in using MCH services included access to transportation, lack of confidence in speaking English and making phone bookings. Service users and providers reported that continuity of nurse and interpreter is preferred for increasing client-provider trust and ongoing engagement.ConclusionsAlthough participants who had children born in Melbourne had good initial access to, and experience of, using MCH services, significant barriers remain. A systems-oriented, culturally competent approach to service provision would improve the service utilisation experience for parents and providers, including formalising links and notifications between settlement services and MCH services.

Supporting schools to create an inclusive environment for refugee students

In a context of increasing numbers of refugees and asylum seekers globally, recognition of the importance of the school environment for promoting successful settlement outcomes and inclusion for refugee-background young people is growing. Yet schools may be poorly equipped to recognise and respond to the multiple challenges faced by children and young people who must learn a new language while grappling with unfamiliar educational and social systems. Refugee-background students often have minimal or significantly disrupted formal education prior to arrival in their new country. Young people, and sometimes their families, may lack literacy in first languages and many are coping with the impacts of trauma associated with forced displacement. Evidence for effective interventions in schools that promote an inclusive learning environment is scarce. This paper presents the results of an evaluation of the School Support Programme operating in schools in Victoria, Australia. The programme is provided to networks of schools in a region and facilitates partnerships between schools and agencies and provides a holistic model for a whole-school approach focused on the learning, social and emotional needs of refugee-background students. The evaluation concluded that the programme provides an appropriate and feasible model that supports the capacity of schools to provide an inclusive education for this group.

Parental self-efficacy and oral health-related knowledge are associated with parent and child oral health behaviors and self-reported oral health status.

OBJECTIVES This study sought to advance understanding of the influence of psychosocial factors on oral health by examining how parental self-efficacy (with regard to acting on their childs oral health needs) and oral health knowledge relate to parental and child oral health behaviors and self-rated oral health. METHODS Parents of children in grades 0/1 and 5/6 (n = 804) and children in grades 5/6 (n = 377, mean age 11.5 ± 1.0, 53.9% female) were recruited from a stratified random sample of 11 primary (elementary) schools. Participants completed surveys capturing psychosocial factors, oral health-related knowledge, and parental attitudes about oral health. Parents also rated their own oral health status and the oral health of their child. Correlations and logistic regression analysis (adjusted for socioeconomic status, child age, and gender) examined associations between psychosocial factors and the outcomes of interest (parent and child behaviors and self-rated oral health status). RESULTS Higher parental self-efficacy was associated with more frequent toothbrushing (by parent and child), and more frequent visits to a dental professional. These associations were particularly strong with regard to dental visits for children, with parents with the highest tertile for self-efficacy 4.3 times more likely to report that their child attended a dentist for a checkup at least once a year (95%CI 2.52-7.43); and 3 times more likely to report their child brushing their teeth at least twice a day (Adjusted Odds Ratio 3.04, 95%CI 1.64-5.64) compared with those parents in the lowest tertile for self-efficacy. No associations with oral health knowledge were found when examined by tertile of increasing knowledge. CONCLUSIONS Oral health self-efficacy and knowledge are potentially modifiable risk factors of oral health outcomes, and these findings suggest that intervening on these factors could help foster positive dental health habits in families.

Indigenous child health research: a critical analysis of Australian studies

Objectives : To conduct a critical and systematic analysis of descriptive studies regarding the health, development and wellbeing status of Indigenous children in Australia and to map them according to 1) Reported Indigenous involvement in the research process; 2) Domains of the life‐course model of health; and 3) Geographical location of the Indigenous child population sample.

Impact of an oral health intervention on pre-school children <3 years of age in a rural setting in Australia

Aim:  Australian pre‐school children living in rural areas experience higher levels of dental caries than those in metropolitan areas. This may be because of a lack of community water fluoridation. The aim of this study was to evaluate the effectiveness of a community‐based intervention to improve the oral health of children in non‐fluoridated rural Victoria, Australia.

Bridging the Gap: using an interrupted time series design to evaluate systems reform addressing refugee maternal and child health inequalities

BackgroundThe 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/designA 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.DiscussionIt 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.

How do Australian maternity and early childhood health services identify and respond to the settlement experience and social context of refugee background families

BackgroundRefugees have poor mental, social and physical health related to experiences of trauma and stresses associated with settlement, however little is known about how refugee families experience maternity and early childhood services. The aim of this study was to explore the responsiveness of health services to the social and mental health of Afghan women and men at the time of having a baby.MethodParticipatory methods including community engagement and consultation with the Afghan community and service providers in Melbourne, Australia. Bicultural researchers conducted interviews with Afghan women and men who had recently had a baby. Interviews and focus groups were also conducted with health professionals working in the region.ResultsThirty interviews were conducted with Afghan women and men who had recently had a baby. Thirty-four health professionals participated in an interview or focus group.Afghan women and men reported significant social hardship during the period before and after having a baby in Australia, but were rarely asked about their social health by maternity and early childhood services.Most health professionals recognised that knowledge and understanding of their client’s migration history and social circumstances was relevant to the provision of high quality care. However, inquiring about refugee background, and responding to non-clinical needs of refugee families was challenging for many health professionals. Factors that made it more difficult for health professionals to engage with Afghan families in pregnancy included limited understanding of the context of migration, dependency of many Afghan women on their husband for interpreting, short appointments, and the high likelihood of seeing different health professionals at each antenatal visit. Community-based maternal and child health nurses had more scope to work with interpreters, and build relationships with families, providing a stronger foundation for identifying and responding to complex social circumstances.ConclusionThere are significant challenges in providing comprehensive, high quality primary health care for Afghan families accessing Australian maternity and early childhood services. The limited capacity of public maternity services to identify families of refugee background and provide tailored service responses are contributing to inequitable maternal and child health outcomes for families of refugee background.

Over and undernutrition in the children of Australian immigrants: Assessing the influence of birthplace of primary carer and English language use at home on the nutritional status of 4–5-year-olds

OBJECTIVE To document the relationship between childhood nutrition status and ethnicity (defined as the birthplace of primary carer and English language use at home) using a nationally representative sample of 4- to 5-year-old children. DESIGN AND PARTICIPANTS Cross-sectional population survey of 4 983 4- to 5-year-old children (2 537 boys and 2 446 girls) as part of Wave 1 (2004) of the Longitudinal Study of Australian Children. MAIN OUTCOME MEASURES Overweight/obesity and thinness using the newly published body mass index cut-off points of Cole (2007). RESULTS In total, 20.6% (95%CI 19.5, 21.7) of children aged 4 to 5 years were estimated to be overweight or obese, while 1.0% (95%CI 0.8, 1.3) was thin. Unadjusted analyses showed a significant relationship between childhood overweight/obesity and primary carers country of birth (chi2=15.9, p<0.01), but the significance became minimal after adjusting for socio-economic and demographic factors. The adjusted model suggests that boys of primary carers born in Europe (excluding UK and Ireland) were less likely to be overweight/obese than boys whose primary carers were born in Australia, but the overall effect size was negligible. No difference was found for girls. In addition, boys who mainly spoke English at home were less likely to be overweight/obese (OR=0.49; 95%CI 0.27, 0.88; p=0.017) and thin (OR=0.27; 95%CI 0.12, 0.62; p=0.002) than boys who spoke a language other than English at home. No difference was found for girls. CONCLUSIONS There is a relationship between main language spoken at home and nutritional status in 4-5-year-old boys but not girls. The use of English language at home may be a protective factor for normal weight in young boys. After adjustment for socio-economic and demographics characteristics, there was a negligible relationship between overweight/obesity in children and their primary carers country of birth.

Compromised communication: a qualitative study exploring Afghan families and health professionals’ experience of interpreting support in Australian maternity care

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 mens 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.