Linda Murray

The Experiences of African Women Giving Birth in Brisbane, Australia

Our purpose in this research was to uncover first-person descriptions of the birth experiences of African refugee women in Brisbane, Australia, and to explore the common themes that emerged from their experiences. We conducted semistructured interviews with 10 African refugees who had given birth in Brisbane. Essences universal to childbirth such as pain, control, and experiences of caregivers featured prominently in participants’ descriptions of their experiences. Their experiences, however, were further overshadowed by issues such as language barriers, the refugee experience, female genital mutilation (FGM), and encounters with health services with limited cultural competence.

The Challenges of Participant Photography: A Critical Reflection on Methodology and Ethics in Two Cultural Contexts.

Photovoice and photo-elicitation are two common methods of participant photography used in health research. Although participatory photography has many benefits, this critical reflection provides fellow researchers with insights into the methodological and ethical challenges faced when using such methods. In this article, we critically reflect on two studies that used participatory photography in different cultural contexts. The first study used photo-elicitation to investigate mothers’ experiences of infant settling in central Vietnam. The second study used photovoice to explore pregnant embodiment in Australia. Following a discussion of the literature and a detailed overview of the two studies, we examine the methodological challenges in using participant photography before, during and after each study. This is followed by a discussion of ethical concerns that arose in relation to the burden of participation, confidentiality, consent, and the photographing of families and children. To conclude, we highlight implications for using participatory photography in other settings.

Learning global health: a pilot study of an online collaborative intercultural peer group activity involving medical students in Australia and Indonesia

BackgroundThere is limited research to inform effective pedagogies for teaching global health to undergraduate medical students. Theoretically, using a combination of teaching pedagogies typically used in ‘international classrooms’ may prove to be an effective way of learning global health. This pilot study aimed to explore the experiences of medical students in Australia and Indonesia who participated in a reciprocal intercultural participatory peer e-learning activity (RIPPLE) in global health.MethodsSeventy-one third year medical students (49 from Australia and 22 from Indonesia) from the University of Tasmania (Australia) and the University of Nusa Cendana (Indonesia) participated in the RIPPLE activity. Participants were randomly distributed into 11 intercultural ‘virtual’ groups. The groups collaborated online over two weeks to study a global health topic of their choice, and each group produced a structured research abstract. Pre— and post-RIPPLE questionnaires were used to capture students’ experiences of the activity. Descriptive quantitative data were analysed with Microsoft Excel and qualitative data were thematically analysed.ResultsStudents’ motivation to volunteer for this activity included: curiosity about the innovative approach to learning; wanting to expand knowledge of global health; hoping to build personal and professional relationships; and a desire to be part of an intercultural experience. Afer completing the RIPPLE program, participants reported on global health knowledge acquisition, the development of peer relationships, and insight into another culture. Barriers to achieving the learning outcomes associated with RIPPLE included problems with establishing consistent online communication, and effectively managing time to simultaneously complete RIPPLE and other curricula activities.ConclusionsMedical students from both countries found benefits in working together in small virtual groups to complement existing teaching in global health. However, our pilot study demonstrated that while intercultural collaborative peer learning activities like RIPPLE are feasible, they require robust logistical support and an awareness of the need to manage curriculum alignment in ways that facilitate more effective student engagement.

Exclusive breastfeeding and the acceptability of donor breast milk for sick, hospitalized infants in Kupang, Nusa Tenggara Timur, Indonesia: a mixed-methods study

Background: The eastern Indonesian province of Nusa Tenggara Timur (NTT) has an infant mortality rate of 45 per 1000, higher than the national average (28/1000). Exclusive breastfeeding, important for improving newborn and infant survival, is encouraged among hospitalized infants in Kupang, the provincial capital of NTT. However, barriers to hospitalized infants receiving breast milk may exist. Objectives: This study explored the barriers and enablers to exclusive breastfeeding among sick and low birth weight hospitalized infants in Kupang, NTT. The attitudes and cultural beliefs of health workers and mothers regarding the use of donor breast milk (DBM) were also explored. Methods: A mixed-methods study using a convergent parallel design was conducted. A convenience sample of 74 mothers of hospitalized infants and 8 hospital staff participated in semi-structured interviews. Facility observational data were also collected. Analysis was conducted using Davis’s barrier analysis method. Results: Of the 73 questionnaires analyzed, we found that 39.7% of mothers retrospectively reported exclusively breastfeeding and 37% of mothers expressed breast milk. Expressing was associated with maternal reported exclusive breastfeeding χ2 (1, N = 73) = 6.82, P = .009. Staff supported breastfeeding for sick infants, yet mothers could only access infants during set nursery visiting hours. No mothers used DBM, and most mothers and staff found the concept distasteful. Conclusions: Increasing mothers’ opportunities for contact with infants is the first step to increasing exclusive breastfeeding rates among hospitalized infants in Kupang. This will facilitate mothers to express their breast milk, improve the acceptability of DBM, and enhance the feasibility of establishing a DBM bank.

ASPIRE: A multi-site community-based participatory research project to increase understanding of the dynamics of violence against immigrant and refugee women in Australia

BackgroundOne in three women around the world are or have been subjected to violence. This includes in Australia, where violence against women is an urgent public health and human rights issue. Immigrant and refugee women who have resettled in Australia are known to face barriers accessing services aimed at preventing and responding to family violence. However there is little evidence about the contexts, nature and dynamics of violence against immigrant and refugee women to inform appropriate responses to enhance their safety and well-being. The ASPIRE project will address this gap by identifying opportunities for the development of responsive local and community-based interventions for family violence against immigrant and refugee women, contributing to the currently limited Australian research in this area.Methods/DesignThis participatory research project will work with communities in eight geographic locations (two inner-city, three outer-suburban, and three regional) across two states (Victoria and Tasmania), to generate evidence about immigrant and refugee women’s experiences in a range of settings. The project will engage stakeholders and communities through extensive consultation prior to data collection and by facilitating community members’ participation in generating and analysing data. A mix of qualitative methods will be used to generate rich data about the family, cultural and place-based contexts that shape the prevalence and dynamics of violence against immigrant and refugee women; women’s prevention and help-seeking efforts; and community attitudes about and responses to violence across a range of cultural groups. Methods include in-depth interviews with women who have experienced family violence, key informant interviews with local community service providers, focus group discussions with men and women from predominant cultural groups that have migrated to areas covered by the research sites, and Photovoice with community leaders. Bilingual health educators will contribute to development of the research approach, the collection and analysis of data, and the dissemination of findings.DiscussionFindings from this two-year study will be disseminated to communities, service providers and policy-makers, providing evidence to inform culturally-appropriate prevention and support interventions, and building local communities’ awareness and capacity to respond to violence against immigrant and refugee women.

Perceived barriers to managing medications and solutions to barriers suggested by Bhutanese former refugees and service providers

Introduction: The purpose of this study was to explore perceived barriers to managing medications and potential solutions to such barriers among Bhutanese former refugees and service providers in Tasmania, Australia. Method: Thirty Bhutanese former refugees and service providers recruited through community health programs participated in a community-based participatory research design. Data were elicited through a structured focus group process and analyzed using content analysis. Results: Perceived barriers to managing medications included language barriers, low health literacy, and culturally unresponsive interactions with services. Themes identifying potential solutions to barriers referred to the functional health literacy of individuals (providing reassurance, checking understanding, and involving support networks) and creating supportive health care environments (consistent service providers, culturally responsive care, assistance navigating services, using trained interpreters). Discussion: Creating environments conducive to interactive and critical health literacy about medications is as important for culturally congruent care as supporting the functional health literacy of individuals.

HealthLit4Kids study protocol; crossing boundaries for positive health literacy outcomes

BackgroundHealth attitudes and behaviours formed during childhood greatly influence adult health patterns. This paper describes the research and development protocol for a school-based health literacy program. The program, entitled HealthLit4Kids, provides teachers with the resources and supports them to explore the concept of health literacy within their school community, through classroom activities and family and community engagement.MethodsHealthLit4Kids is a sequential mixed methods design involving convenience sampling and pre and post intervention measures from multiple sources. Data sources include individual teacher health literacy knowledge, skills and experience; health literacy responsiveness of the school environment (HeLLO Tas); focus groups (parents and teachers); teacher reflections; workshop data and evaluations; and children’s health literacy artefacts and descriptions. The HealthLit4Kids protocol draws explicitly on the eight Ophelia principles: outcomes focused, equity driven, co-designed, needs-diagnostic, driven by local wisdom, sustainable, responsive, systematically applied. By influencing on two levels: (1) whole school community; and (2) individual classroom, the HealthLit4Kids program ensures a holistic approach to health literacy, raised awareness of its importance and provides a deeper exploration of health literacy in the school environment. The school-wide health literacy assessment and resultant action plan generates the annual health literacy targets for each participating school.DiscussionHealth promotion cannot be meaningfully achieved in isolation from health literacy. Whilst health promotion activities are common in the school environment, health literacy is not a familiar concept. HealthLit4Kids recognizes that a one-size fits all approach seldom works to address health literacy. Long-term health outcomes are reliant on embedded, locally owned and co-designed programs which respond to local health and health literacy needs.

The effectiveness of student-run organizations within global health promotion initiatives

Introduction: This commentary describes a student-led project that distributed long-lasting insecticide-treated nets in Masaka, Uganda. The role of student-led initiatives in global health promotion projects is also discussed. Methods: A survey of 213 net recipients was conducted after a 12-month period to evaluate malaria prevention knowledge, and net use and maintenance. Results: Only 4.7% of recipients could not recall any malaria prevention methods. Seventy percent of pregnant women and 86.5% of children under five slept under a net the previous night. Only two households (0.9%) no longer possessed a net, and nets were not used in 2.3% of houses. Household observation revealed 17.4% of nets had at least one problem that would compromise effectiveness. Conclusions: Student-led projects can play an important role in effectively preventing malaria. However coordination with existing programs, targeting hard-to-access groups, and training of students overcomes some common limitations of such student-led initiatives.