Closing the miscommunication gap: A user guide to developing picture-based communication tools for Aboriginal and Torres Strait Islander peoples in emergency departments.

OBJECTIVE: To document an illustration-based methodology for culturally safe communication between Indigenous patients and clinicians in an urban ED. METHODS: We co-designed a pre-ED visual tool to minimise miscommunication when triaging First Nations patients. Our steps included establishing project governance, conducting a literature review, obtaining ethics approval and designing illustrations. We then consulted relevant stakeholders, finalised the resource and contributed to the evidence base and to knowledge exchange. RESULTS: Co-design is an important principle in reducing miscommunication and ensuring cultural safety in EDs. CONCLUSIONS: Co-design methodologies can guide improvements in culturally safe clinical communication with First Nations patients in EDs.

Understanding mental health and its determinants from the perspective of adolescents: A qualitative study across diverse social settings in Indonesia.

Poor mental health is a leading contributor to the burden of disease experienced by adolescents, including in resource constrained settings. However, little is known about how adolescents in these countries conceptualise mental health and its determinants which is essential to informing effective responses. This study aimed to explore how adolescents in Indonesia (a populous and rapidly developing country) conceptualise mental health and what they identify as important determinants. Eight focus group discussions (FGDs) were conducted with 86 Indonesian adolescents (aged 16-18 years), sampled from schools and community settings from Jakarta and South Sulawesi. FGDs were recorded, transcribed, translated and thematically analysed. Mental health was recognised as a significant concern by adolescents in Indonesia. Good mental health was conceptualised as emotional wellbeing and happiness. By contrast, poor mental health was predominantly described in terms of substantial mental illness manifesting as behavioural and physical disturbance. Further, poor mental health only happened to 'other' people, with stigmatising views prevalent. Absent from the discussions were common symptoms of poor mental health (stress, loneliness, poor sleep) and common mental disorders (e.g. depression, anxiety) or a conceptualisation that reflected poor mental health to be a normal human experience. Discussions around determinants of poor mental health suggested that family connections (particularly with parents), school pressures, and adverse exposures on social media were important drivers of poor mental health, with religion also surfacing as an important determinant. In highlighting mental health as an important issue for Indonesian adolescents, this study provides a foundation for targeted responses.

Early Childhood Nutritional Implications of the Rise in Factory Employed Mothers in Rural Cambodia: A Qualitative Study.

OBJECTIVES: Limited research has been conducted on the maternal and child health situation of garment factory workers in Cambodia. This qualitative study investigated the health-seeking behaviours for maternal and infant care of female garment factory workers in Kampong Tralach district, Cambodia. METHODS: We conducted 54 in-depth interviews, six focus group discussions and observed two factories. Participants were pregnant women and mothers of infants who have worked in factories, young women currently working in factories, caregivers of children, village leaders, healthcare workers, and factory managers. Deductive and inductive thematic analysis was performed. RESULTS: The women were accessing regular antenatal and facility-based delivery care. Most factory managers provided maternity leave, and some also provided leave for regular antenatal (ANC) visits. Women often returned to work 2 months post-delivery and this triggered the cessation of exclusive breastfeeding. Feeding was also compromised for the 6-12 months old children as carers, delayed the introduction of complementary feeds. Factories were equipped with childcare and breastfeeding spaces, however these were not used due to both feasibility issues and distrust of factory management. Instead, grandmothers were the preferred childcare providers. CONCLUSIONS FOR PRACTICE: Current factory policies regarding ANC, maternity leave and childcare provisions are context insensitive to rural workers who live far from the workplace to avail themselves of mandated ANC leave or breastfeeding breaks. Our study suggest that the increasing number of young women working in garment factories is compromising the early nutrition of their children, with a reduction in exclusive breastfeeding and inadequate complementary feeding.