Qualitative Case Study: A Pilot Program to Improve the Integration of Care in a Vulnerable Inner-City Community.

Introduction: There is a strong correlation between vulnerable populations and poor health outcomes. Growing evidence suggests that person-centred interventions using 'link workers' can support communities to navigate and engage with health and community services, leading to improved health service access. We describe the initial phase and qualitative evaluation of a Healthy Living Program, supported by a link worker role. The Program aimed to improve health service access for residents of an Australian inner-city suburb. Methods: To inform future program development, semi-structured interviews were conducted with clients and stakeholders (n = 21). The interviews were analysed thematically to understand program impact, success factors, constraints and potential improvements. Results: Key themes relating to impacts were a new model of working with community, improved access to services, and responsiveness to community need. Key factors for success included being a trusted, consistent presence, having knowledge of the community and health system, and successful engagement with the community and stakeholders. The constraints included difficulty influencing health system change and lack of community input. Suggested improvements were expanding the service, enhancing health system change and increasing community involvement. Conclusion: Knowledge gained from this study will inform future integrated approaches in health districts to address health inequities in areas of need.

Supporting Newly Arrived Migrant Mothers: A Pilot Health Literacy Intervention.

Experiencing migration can create or exacerbate vulnerability to ill health, particularly during pregnancy and new motherhood. Providing a culturally appropriate health literacy intervention to new migrant families may increase social support and the skills and confidence to access health care services and information. This study developed and piloted a health literacy intervention, in the form of culturally redesigned new parent classes, in a culturally diverse location in Australia. The intervention was delivered over a 4-week period by Child and Family Health Nurses, with the help of interpreters and Bilingual Community Researchers, to Bangladeshi and Mandarin-speaking Chinese mothers and grandmothers with a baby age 0 to 1 year. A mixed-methods evaluation was conducted to measure (1) recruitment and attendance of participants, (2) feasibility of the intervention, (3) health literacy of participants, and (4) provider understanding of barriers to health care access. Thirty participants were recruited, and 18 women attended at least three of the four group sessions. Nurses viewed the program as being within the scope of their usual role, demonstrating intervention feasibility. Health literacy scores were higher post-intervention than pre-intervention. Nurses described having increased awareness of barriers to health care access after facilitating the intervention. The program has potential to be scaled up to other areas and languages. [HLRP: Health Literacy Research and Practice. 2021;5(3):e201-e207.].

Access to appropriate health care for non-English speaking migrant families with a newborn/young child: a systematic scoping literature review.

BACKGROUND: Recently arrived culturally and linguistically diverse migrant mothers in Western Industrialised Nations are less likely to access health care and are more likely to report negative healthcare experiences than more established migrant or non-migrant populations. This is particularly an issue in Australia where nearly half of all Australians were born overseas or have at least one parent born overseas. METHODS: A systematic scoping review was conducted to identify a) the main enablers and barriers to accessing appropriate health care for migrant families with a new baby/young child who speak a language other than English, and b) the effectiveness of interventions that have been tested to improve access to appropriate health care for this group. Three academic databases (CINAHL, Medline and ProQuest) were searched, with additional publications identified through expert knowledge and networks. Data was extracted and analysed according to the Access framework, which conceptualises access to health care as being generated by the interaction of dimensions of accessibility of services (supply side) and abilities of potential users (demand side). RESULTS: A total of 1964 records were screened for eligibility, with nine of these included in the review. Seven studies only described barriers and enablers to health care access, one study reported on an evaluation of an intervention and one study described the barriers and enablers and the evaluation of an intervention. This review identified that the most significant barriers occurred on the supply side, within the 'appropriateness' domain. Overall, the most frequently cited barrier was a lack of cultural sensitivity/understanding of different cultural practices (five studies). The most significant enablers also occurred on the supply side, but within the 'acceptability' domain. The most frequently cited enabler was cultural sensitivity and understanding. CONCLUSIONS: There is a dearth of evaluated interventions in the peer reviewed literature to improve appropriate access to postnatal care for migrant families who speak a language other than English. The literature focuses on identifying barriers and enablers to access to healthcare for this population group. Interventions which aim to address barriers within the 'appropriateness' dimension may have the greatest impact on access.

Culturally Diverse Patient Experiences and Walking Interviews: A Co-Design Approach to Improving Organizational Health Literacy.

People from diverse cultural and linguistic backgrounds are more likely to have low health literacy and less appropriate access to health services than other Australians. Interventions to improve health literacy have demonstrated moderate improvements in health service use. Most of these interventions focus on simplifying communication as opposed to navigation support. A comprehensive and multilevel response is required if the health care system and organizations are to be more responsive to different levels of health literacy. This includes obtaining feedback from patients on their experience of accessing health care. This study piloted the use of a co-design process to develop a culturally appropriate mechanism of elucidating the perspectives of community members of culturally diverse groups on their experiences of accessing a health service to identify the strengths and weaknesses of an organization's health literacy. This co-design process involved the adaptation of an existing "Walking Interview" tool to the location and language groups being targeted, as well as determining the process for recruiting participants and conducting the walking interviews. The interviews provided valuable insights into the experiences of culturally diverse groups in accessing Canterbury Hospital and identified areas for improvement, such as clearer signage and access to interpreter services. [HLRP: Health Literacy Research and Practice. 2019;3(4):e238-e242.].