Enhancing general practice referrals for women of refugee background to maternity care.

This paper presents the findings from a quality improvement project implemented by a maternity hospital located in a region of high refugee settlement. The project was designed to improve the completeness of general practice referral information to enable triage to maternity care that would best meet the needs of women of refugee background. Referral information included four data items - country of birth, year of arrival in Australia, language spoken and interpreter required - used in combination to provide a proxy measure of refugee background. A communication strategy and professional development activity engaged general practitioners (GPs) in the rationale for collecting the four data items on a new referral form. Audits of referrals to the maternity hospital before, and at two time points following the quality improvement activity, indicated that very few referrals were completed on the new form. There were modest improvements in the recording of two items - country of birth and interpreter required. Overall, two-thirds of referrals did not contain information on interpreter requirements. Changing practice will require a more cohesive approach involving GPs in the co-design of the form and development of the quality improvement strategy.

Cultural safety and belonging for refugee background women attending group pregnancy care: An Australian qualitative study.

BACKGROUND: Refugee women experience higher incidence of childbirth complications and poor pregnancy outcomes. Resettled refugee women often face multiple barriers accessing pregnancy care and navigating health systems in high income countries. METHODS: A community-based model of group pregnancy care for Karen women from Burma was co-designed by health services in consultation with Karen families in Melbourne, Australia. Focus groups were conducted with women who had participated to explore their experiences of using the program, and whether it had helped them feel prepared for childbirth and going home with a new baby. RESULTS: Nineteen women (average time in Australia 4.3 years) participated in two focus groups. Women reported feeling empowered and confident through learning about pregnancy and childbirth in the group setting. The collective sharing of stories in the facilitated environment allowed women to feel prepared, confident and reassured, with the greatest benefits coming from storytelling with peers, and developing trusting relationships with a team of professionals, with whom women were able to communicate in their own language. Women also discussed the pivotal role of the bicultural worker in the multidisciplinary care team. Challenges in the hospital during labor and birth were reported and included lack of professional interpreters and a lack of privacy. CONCLUSION: Group pregnancy care has the potential to increase refugee background women's access to pregnancy care and information, sense of belonging, cultural safety using services, preparation for labor and birth, and care of a newborn.

Bridging the language gap: a co-designed quality improvement project to engage professional interpreters for women during labour.

Objective The aim of the study was to improve the engagement of professional interpreters for women during labour. Methods The quality improvement initiative was co-designed by a multidisciplinary group at one Melbourne hospital and implemented in the birth suite using the plan-do-study-act framework. The initiative of offering women an interpreter early in labour was modified over cycles of implementation and scaled up based on feedback from midwives and language services data. Results The engagement of interpreters for women identified as requiring one increased from 28% (21/74) at baseline to 62% (45/72) at the 9th month of implementation. Conclusion Improving interpreter use in high-intensity hospital birth suites is possible with supportive leadership, multidisciplinary co-design and within a framework of quality improvement cycles of change. What is known about the topic? Despite Australian healthcare standards and policies stipulating the use of accredited interpreters where needed, studies indicate that services fall well short of meeting these during critical stages of childbirth. What does the paper add? Collaborative approaches to quality improvement in hospitals can significantly improve the engagement of interpreters to facilitate communication between health professionals and women with low English proficiency. What are the implications for practice? This language services initiative has potential for replication in services committed to improving effective communication between health professionals and patients.

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

BACKGROUND: Often 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. METHODS: We 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. RESULTS: Four 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. CONCLUSIONS: Although 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.