Developing multi-language maternal health education videos for refugee and migrant women in southeast Melbourne.

PROBLEM: In Australia, many women from refugee and migrant backgrounds experience significant health disparities and barriers to care and poor health literacy negatively influences their maternal and infant health outcomes. Improving health literacy improves these outcomes yet can be time consuming and difficult to provide within the confines of current models of maternity care. INTRODUCTION: Each year, more than 9000 women give birth across Monash Health's three maternity sites within one large public health service, located in Melbourne. Almost 60% of these women were born in non-English speaking countries and approximate 10% request the use of an interpreter at some point throughout their maternity experience. This project aimed to co-design animated videos focused on preconception, pregnancy, and postnatal care with women from refugee and migrant backgrounds. METHODS: The authors utilised previously prioritised maternity education needs as a starting point for design workshops undertaken with healthcare staff and women from the end-user communities. Over three workshops, sixteen healthcare staff volunteered to map or provide feedback on key touch points and barriers to quality, respectful care from the preconception period until six months postnatal. Arabic- and Dari-speaking women, led by bicultural educators, were all paid to user test these posters and the subsequently developed videos. RESULTS: The process utilised within this project yielded five posters, four videos and four important recommendations in maternity care to incorporate in the education posters and videos, which both healthcare workers and the Arabic- and Dari-speaking women referenced at each mapping and user testing session. These included (1) explaining maternity care (appointment, tests, diet, medications etc.); (2) culturally informed models of care; (3) recognising the role of the support person; and (4) the impact of COVID-19 on health provision and access. DISCUSSION: Maternal health literacy is a known predictor of perinatal outcomes. Globally, women report wanting more guidance and clearer understanding of what is taking place throughout their perinatal journey. This desire for knowledge is no different for women from non-English speaking backgrounds in Australia, though it may require more time and investment by health providers and educators. These posters and videos offer an attempt to support women, particularly women from refugee and migrant backgrounds, who require further healthcare explanations, to complement their current models of care, in a medium that is accessible and appropriate for them.

Empathy and journey mapping the healthcare experience: a community-based participatory approach to exploring women's access to primary health services within Melbourne's Arabic-speaking refugee communities.

Objectives: This community-based participatory research focused on physical and social barriers to healthcare for refugee women in Melbourne, Australia.Design: Women from non-English speaking backgrounds explored the meaning and impact of their health journeys through group surveys, Photovoice and GIS go-alongs. This empathy-building research also explored acceptability, desirability and feasibility of mHealth solutions to improve access to primary healthcare services.Results: Refugee women reported low utilisation of preventive healthcare services including limited awareness of cervical or breast screening.Conclusions: Phone ownership and health information searches online indicate mHealth solutions are feasible and acceptable to improve healthcare access, literacy and autonomy within this population.

The Prevalence of Clinical Characteristics of Polycystic Ovary Syndrome among Indigenous Women: A Systematic Search and Review of the Literature.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among reproductive-aged women; however, to date there has been no synthesis of the burden of PCOS specifically among indigenous women. We aimed to systematically identify and collate studies reporting prevalence and clinical features of PCOS among indigenous women worldwide. We performed a comprehensive search of six databases (Ovid MEDLINE, MEDLINE In Process & Other Non-Indexed Citations, EMBASE, EBM reviews, CINAHL, and SCOPUS) supplemented by gray literature searches and the screening of reference lists. A narrative synthesis was conducted. Fourteen studies met inclusion criteria; however, one was excluded as it assessed only children and adolescents younger than 15 years, with limited clinical relevance. Studies examined indigenous women from Australia, Sri Lanka, New Zealand, and the United States. Prevalence of PCOS was reported in only four studies and ranged from 3.05% for women in Sri Lanka to 26% for women in Australia. All included studies reported on at least one clinical feature of PCOS. Of the studies that reported on a comparison group from the same country, there was evidence of more severe features in indigenous women from New Zealand and the United States. The limited evidence available warrants further investigation of the burden of PCOS in indigenous women to build the knowledge base for effective and culturally relevant management of this condition.

Evaluating human-centred design for public health: a case study on developing a healthcare app with refugee communities.

BACKGROUND: Australian women from migrant and refugee communities experience reduced access to sexual and reproductive healthcare. Human-centred design can be a more ethical and effective approach to developing health solutions with underserved populations that are more likely to experience significant disadvantage or social marginalisation. This study aimed to evaluate how well Shifra, a small Australian-based not-for-profit, applied human-centred design when developing a web-based application that delivers local, evidence-based and culturally relevant health information to its non-English speaking users. METHODS: This study undertook a document review, survey, and semi-structured interviews to evaluate how well Shifra was able to achieve its objectives using a human-centred design approach. RESULTS: A co-design process successfully led to the development of a web-based health app for refugee and migrant women. This evaluation also yielded several important recommendations for improving Shifra's human-centred design approach moving forward. CONCLUSIONS: Improving refugees' access to sexual and reproductive health is complex and requires innovative and thoughtful problem solving. This evaluation of Shifra's human-centred design approach provides a helpful and rigorous guide in reporting that may encourage other organisations undertaking human-centred design work to evaluate their own implementation.

Australian women from non-English speaking migrant and refugee communities face reduced access to sexual and reproductive healthcare and many then go on to experience poor health outcomes as a result. There is an urgent need for new approach to improve access to healthcare for underserved communities, one that centres these women in the process of finding, developing and disseminating the solutions themselves. Human-centred design can be a more ethical and effective methodology in working with communities to develop these health solutions.This study aimed to evaluate how well Shifra, a small Australian-based not-for-profit focused on improving access to healthcare for refugees and new migrants, undertook human-centred design approach when developing a Smartphone app that delivers local, safe and culturally relevant health information to non-English speaking Australians. The authors interviewed refugees, health and social sector experts and computer programmers involved in creating Shifra to evaluate how well they used human-centred design to achieve its goals. This evaluation found that Shifra's approach was successful whilst also highlighting several important recommendations for improving collaborative efforts with refugee communities. These findings could help other projects also seeking to undertake an authentic community co-design process.

Cost Effectiveness of Antenatal Lifestyle Interventions for Preventing Gestational Diabetes and Hypertensive Disease in Pregnancy.

BACKGROUND: Lifestyle interventions (diet, physical activity and/or behavioural) to optimise gestational weight gain can prevent adverse maternal outcomes such as gestational diabetes, pre-eclampsia and caesarean section. OBJECTIVE: We aimed to model the cost effectiveness of lifestyle interventions during pregnancy on reducing adverse maternal outcomes. METHODS: Decision tree modelling was used to determine the cost effectiveness of lifestyle interventions compared with usual care on preventing cases of gestational diabetes and hypertensive disease in pregnancy. Participants were pregnant women receiving routine antenatal care in secondary and tertiary care hospitals. The main outcome measures were cases of gestational diabetes and/or hypertensive disease in pregnancy prevented, costs, and incremental cost-effectiveness ratios. Analysis was conducted from the perspective of the Australian healthcare system, with a time horizon of early pregnancy to discharge after birth. RESULTS: Women in the intervention group were 2.25% less likely to have gestational diabetes and/or hypertensive disease in pregnancy (9.53%) compared with the control group (11.78%). Intervention costs were Australian dollars (AUD) 228 per person. Costs were AUD33 per person higher in the intervention group (AUD8281) than the control group (AUD8248). The incremental cost-effectiveness ratio was AUD1470 per case prevented. Sensitivity analysis showed that base-case results were robust. In the probabilistic sensitivity analysis, 44.8% of data points fell within the north-east quadrant, and 52.2% in the south-east quadrant (cost saving), with a 95% confidence interval ranging from AUD - 50,018 to 32,779 per case prevented. CONCLUSIONS: While there is no formally accepted cost-effectiveness threshold for willingness-to-pay to prevent an adverse maternal event, the cost per person receiving a lifestyle intervention compared with controls was close to neutral, and therefore likely to be cost effective. Exploration of the cost effectiveness of different lifestyle delivery modes across various models of antenatal care is now required. Future cost-effectiveness studies should investigate longer time horizons, quality-adjusted life-years and productivity loss. TRIAL REGISTRATION: Not applicable.

Perspectives on preconception health among migrant women in Australia: A qualitative study.

BACKGROUND: Cultural beliefs, practices and experiences significantly influence pregnancy preparation. Limited in-depth information exists regarding how women from migrant and refugee backgrounds (migrant women) prepare for pregnancy. This study explored pregnancy planning, preconception lifestyles, awareness, experiences and healthcare needs of migrant women in Australia. METHODS: Semi-structured interviews and focus groups were conducted with 25 women recruited through a diverse community in Melbourne, Australia (November 2017-February 2018). Discussions explored pregnancy planning, preconception health awareness, experiences and information needs. Qualitative data was analysed iteratively, through content and thematic analysis. FINDINGS: Four themes were identified: pregnancy planning experiences and perspectives, preconception health awareness and behaviours, social and cultural influences on pregnancy planning, and health information needs. Women had limited understanding of the concept or importance of preconception health, limited access to preconception health information and most women with children had experienced at least one unplanned pregnancy. Cultural mores constrained community discussion of preconception health in the context of sexual and reproductive health. Social factors emerged as predominant preconception concerns. Women reported wanting more information on preconception health through multiple, broad-reaching avenues, paired with timely, sensitive healthcare engagement. CONCLUSION: Information for women addressing preconception health and pregnancy planning is limited. Our study demonstrates additional cultural and social nuances that need to be understood when working with migrant women. Discomfort raising reproductive and preconception health discussions with healthcare providers was a reported concern. Integration of culturally-sensitive preconception care within routine client assessments warrants exploration. Emphasis of the importance of preconception care for all women is needed.