Article

Access to breast cancer screening — perception, and perceived barriers among older Bhutanese refugee women resettled in Australia: a qualitative study

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  • University of New England
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... Many women had heard about BCS, but some of them did not know about the biannual check-up (Kwok et al., 2020;Ogunsiji et al., 2017;Parajuli et al., 2019;Robinson et al., 2016). Older women showed less understanding of the reason for the screening (Tatari et al., 2020). ...
... In several studies, the women included were under the impression that a mammography was not necessary unless you had symptoms (Hulme et al., 2016;March et al., 2018;Parajuli et al., 2019;Tatari et al., 2020;Wang et al., 2019). Strengths and limitations with mammography were in some groups not clearly understood. ...
... The fear of pain was connected with previous experiences and aggressive or harsh care workers (Bhargava, Hofvind, & Moen, 2019;Hulme et al., 2016). Mammography was also described as embarrassing or shameful since they must undress (Parajuli et al., 2019;Robinson et al., 2016). Women who did not speak the language of the country described that not being able to express their worries or concerns during the procedure was unpleasant and weird (Parajuli et al., 2019). ...
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Aim: The aim of this study was to summarize the latest research reports about immigrant women and attendance in breast cancer screening. Design: Scoping review. Methods: Literature searches were made in CINAHL, PubMed, Web of Science, Google Scholar, Oatd and Oalster. Twenty-three articles were included in the study. Data were analysed with inductive content analysis. Results: Out of data four main categories were formed: attendance rates, incidence, barriers and facilitators, and knowledge and perception. The results show that attendance rates, barriers and facilitators for attendance, knowledge and experience of breast cancer and breast cancer screening differ between several factors such as the woman's migrant background, country of origin, religion, length of stay in the new home country and sociodemographic factors.
... Of the 28 studies, 13 were conducted in the USA [48, 53, 55-57, 59-61, 63, 69, 72-74], two each in Australia [62,64], Jordan [52,68], Lebanon [49,50] and Canada [70,71], one each in Congo [66], Israel [54], Netherlands [67], Pakistan [65], South Korea [65], Thailand [47] and one was a multi country study which included Bangladesh, Jordan, Djibouti, Kenya, Malaysia and Uganda [51]. ...
... Studies were qualitative (n = 16), cross sectional surveys (n = 8) and mixed methods; a combination of either focus group discussions (FGDs) or semi structured interviews and surveys (n = 4). Of those using qualitative methods, nine involved FGDs [49,50,53,[55][56][57][59][60][61], four semi structured interviews [49,52,58,63], three indepth/key informant interviews [47,56,64], three both FGDs and in-depth interviews [48,51,54] and one used a novel storytelling method [62]. Of the 12 studies using quantitative methods, nine used face-to-face interview based surveys in respondents' homes [47,51,65,66,68,70,73] or in a medical clinic [72] and one used an online survey [57]. ...
... Five studies included perspectives of HCPs (not further specified) [48,51,74] and one each of physicians [54] and nurses [50]. Ethnic groups included Somali /Somali Bantu in seven studies [48,53,55,56,60,72,73], Syrian [49,50,52] and Bhutanese [57,59,64] in three studies each, and one each in Afghani [65], Albanian [70], Burmese [59], Cambodian [47], Congolese [66], Eritrean [54], Iraqi [61], North Korean [58], Palestinian [68], West African [62] or a combination of these ethnic groups [51,63,67,69,71]. Participants' ethnicity was not described in one study [74]. ...
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Background Globally, the number of forcibly displaced women is growing. Refugee and displaced women have poorer health outcomes compared to migrant and host country populations. Conflict, persecution, violence or natural disasters and under-resourced health systems in their country of origin contribute to displacement experiences of refugee and displaced women. Poor health outcomes are further exacerbated by the migration journey and challenging resettlement in host countries. Preventive sexual and reproductive health (SRH) needs of refugee and displaced women are poorly understood. The aim was to synthesise the evidence about access to preventive SRH care of refugee and displaced women. Methods A systematic review of qualitative, quantitative and mixed methods studies of women aged 18 to 64 years and health care providers' (HCPs’) perspectives on barriers to and enablers of SRH care was undertaken. The search strategy was registered with PROSPERO in advance of the search (ID CRD42020173039). The MEDLINE, PsycINFO, Embase, CINAHL, and Global health databases were searched for peer-reviewed publications published any date up to 30th April 2020. Three authors performed full text screening independently. Publications were reviewed and assessed for quality. Study findings were thematically extracted and reported in a narrative synthesis. Reporting of the review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Results The search yielded 4083 results, of which 28 papers reporting 28 studies met inclusion criteria. Most related to contraception and cervical or breast cancer screening. Three main themes and ten subthemes relating to SRH care access were identified: interpersonal and patient encounter factors (including knowledge, awareness, perceived need for and use of preventive SRH care; language and communication barriers), health system factors (including HCPs discrimination and lack of quality health resources; financial barriers and unmet need; HCP characteristics; health system navigation) and sociocultural factors and the refugee experience (including family influence; religious and cultural factors). Conclusions Implications for clinical practice and policy include giving women the option of seeing women HCPs, increasing the scope of practice for HCPs, ensuring adequate time is available during consultations to listen and develop refugee and displaced women’s trust and confidence, strengthening education for refugee and displaced women unfamiliar with preventive care and refining HCPs’ and interpreters’ cultural competency. More research is needed on HCPs’ views regarding care for refugee and displaced women.
... Faith as a protective measure, along with the conceptualization of health or the process of illness as attributable to sacred will 42,50,65 and seeking care only with symptoms, 57,65 hinder preventive health seeking. 38,41,51e53,58 Stigma around SRH and sexual activity discourages single women from seeking care 49,55,56 and contraception, 40,43,47 while cultural practices, such as female genital circumcision modesty related to, and traditional medicine use 45,72 prevent women from seeking SRH care. ...
... Studies identified lack of knowledge and awareness as a barrier to accessing SRH. Migrants' limited knowledge about sexuality and their SRH needs (family planning, cervical cancer screening, and HIV/AIDS) 40,44e46,50,52,58,60,70,74 and benefits and availability of SRH preventive services 38,42,57,65,67 hinder their access to SRH care. 48,51,55,62 These challenges are closely tied to navigating the healthcare system. ...
Article
Objectives: Addressing migrant population's sexual health needs is essential, given the high vulnerability of this population, especially during migratory trajectories and when accessing health care in destination countries. The aim of this scoping review is to identify and describe the structural and intermediary determinants and their dimensions, which negatively influence sexual healthcare access in migrant population in the world in the last 20 years. Study design: Scoping review. Methods: The search strategy was carried out in the databases PubMed/MEDLINE, Web of Science, EMBASE, and CINAHL. The inclusion criteria were primary studies published in English or Spanish from 2000 to 2022, describing determinants or barriers to access to sexual health for international migrants, refugees, and asylum seekers. The construction of the results was based on the social determinants of health framework. Results: A total of 44 studies were included. Thirteen categories that negatively affect access to sexual health in migrants were identifieddstructural determinants: language and communication barriers, religious and cultural values, VIH stigma and discrimination, irregular migration status, financial constraints , racism and discrimination, gender inequalities, and lack of knowledge and awareness about sexuality and sexual health; and intermediary determinants: financial health coverage, privacy and confidentiality, health system navigation; health system and facilities, and psychosocial factors. Conclusion: The most relevant dimensions identified as barriers to access to health services were "cul-ture and societal values" and "health system". Identifying the determinants that affect migrants' access to sexual health is relevant for the formulation of public policies with sociocultural relevance and an intersectional and human rights approach.
... All partners shared a common goal to improve the health of the community and, as a team, they agreed on a research focus to better understand maternal health concerns among Bhutanese refugees. Refugee newcomer women in particular, often lack maternal health literacy (Parajuli, Horey, & Avgoulas, 2019) specifically needed to navigate the complex United States healthcare system. Thus, the CBPR research was developed to address Bhutanese refugee women's maternal health status post resettlement. ...
Article
Reflexivity, an important component of qualitative inquiry generally, gains additional significance in community-based participatory research (CBPR). The varying partnerships among researchers, community partners, and community members are strengthened when a co – learning, reflective model is applied. The use of reflective field notes can be a powerful tool to help achieve this end. In this article, we describe the dynamics of community-engaged research team where members applied a co-learning model to reflect upon their positionality in the community and in research. Using reflective field notes examined through a narrative approach to the PI’s time in the field, we assess these positionalities through the relationships between CBPR work and power relations. The reflective practice embedded in the CBPR process brought these power relations to our attention. We then turned to the literature on power relations to better understand what was occurring in the study. The current case details the additional complexity that occurs when issues of language, translation, gender, and culture are introduced. Thus, this paper is a reflective analysis of a bilingual researcher’s experience in the field specific to cross-cultural CBPR work.
Article
Issue addressed: Women from refugee backgrounds have poorer health outcomes than host country populations. People from Myanmar, most of whom are from the Karen ethnic minority constitute one of the largest groups of humanitarian visa entrants to Australia since 2015. Barriers to and enablers of preventive sexual and reproductive health (SRH) for this group of women are poorly understood. The objective is to establish the preventive SRH care needs and experiences of Karen women from refugee backgrounds living in Australia. Methods: A qualitative study using semi-structured interviews was conducted with a purposive sample of Karen women. A bi-cultural worker assisted in recruitment and interpreting during data collection. All interviews were conducted in Karen language with a bi-cultural worker interpreting into English during the interview. Audio recordings of English dialogue were transcribed verbatim. Thematic analysis was used to analyse and report data. Results: Thirteen women were interviewed. Five major themes were identified: (1) prevention awareness including lack of access to education and knowledge of services pre-arrival; appreciation of the new health system; limited vaccination knowledge, (2) perceived need for prevention including consequences of not screening; health care provider (HCP) attendance, (3) health information seeking including providing a comprehensive approach to information delivery; trusted sources of information, (4) barriers including missed opportunities; communication, language, illiteracy; lack of continuity of care and, (5) enablers including HCP' characteristics; peer support and individual responsibility. Conclusion: Findings from this study indicate that to improve access to preventive SRH services a multi-component strategy is needed. Provision of preventive SRH information using a multi-pronged approach; peer and community support interventions; and HCPs offering services and information opportunistically would benefit Karen women unfamiliar with preventive SRH care. SO WHAT?: Primary prevention services and education codesigned with community members may be effective in improving Karen women's access to SRH care.
Article
Addressing migrant population's sexual health needs is essential, given the high vulnerability of this population, especially during migratory trajectories and when accessing health care in destination countries. The aim of this scoping review is to identify and describe the structural and intermediary determinants and their dimensions, which negatively influence sexual healthcare access in migrant population in the world in the last 20 years.
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Introduction: Mammography screening programs have been implemented in European countries as prevention tools aimed at reducing breast cancer mortality through early detection in asymptomatic women. Nordic countries (Denmark, Finland, Iceland, Norway, Sweden, the Faroe Islands, and Greenland) demonstrated high participation rates; however, breast cancer mortality could be limited by further optimizing screening. This review aimed to explore factors that affect women's participation in mammography screening in Nordic countries. Method: A systematic review of segregated mixed research synthesis using a deductive approach was conducted. The following databases and platforms were searched to identify relevant studies: CINAHL with Full Text (EBSCOHost), MEDLINE (EBSCOHost), PsycInfo (ProQuest), Scopus (Elsevier) and Web of Science Core Collection (SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH, and ESCI). The Critical Appraisal Skills Program was used for quality assessment. The Health Promotion Model was applied to integrate findings from qualitative and qualitative research. All methodological steps followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: The final selection (16 articles) included studies from three Nordic countries: Denmark (four quantitative studies), Norway (one qualitative and four quantitative studies), and Sweden (three qualitative and seven quantitative studies). Sixty-three factors were identified as barriers, facilitators, or factors with no influence. Conclusion: A substantial number of obtained factors, spread across a wide spectrum, describe (non-)participation in mammography screening as a versatile phenomenon. Implications for practice: The findings of this review could benefit the mammography staff and providers regarding possible interventions aimed at improving screening participation rates.
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This paper explores the critical roles of researchers in research involving vulnerable populations. Its purpose is to reflect on the complex nature of vulnerability of Bhutanese refugee women who had resettled in Australia involved in research looking at the barriers to accessing preventive cancer screening. First, we describe the vulnerabilities considered prior to the research study and the actions taken to protect participants while the study was conducted. Second, we discuss those vulnerabilities that we did not anticipate, but were subsequently revealed during the study and consequently included in the study findings. These vulnerabilities should be considered for future research involving similar populations. It is important for researchers to use appropriate research designs that enable the voice of vulnerable people to be heard and to use research strategies that ensure findings are robust and participants are protected and empowered. Potential implications include the development of research practices that take account of the sources of vulnerabilities and consideration of how different vulnerabilities can evolve and affect findings and research recommendations.
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International evidence suggests migrants experience inequitable access, outcomes and treatment quality across the cancer care continuum. There is currently limited research assessing equity across the cancer care continuum for culturally and linguistically diverse migrants living in Australia. A detailed protocol and search strategy were developed and used to identify all relevant literature, utilising the Joanna Briggs Institute Reviewer’s Manual. Systematic searching was conducted via multiple databases and identified studies were screened against pre-identified inclusion and exclusion criteria. 71 studies met the inclusion criteria for analysis. Most studies examined cancer detection via screening. Very few studies examined cancer prevention, diagnosis, treatment or palliative care. Most studies focused on patient-sided barriers to care and there was a paucity of information regarding institutional barriers to health. Cancer-related outcomes were seldom examined, and most studies were qualitative or behavioral analysis. Results highlighted significant communication issues spanning the cancer care continuum and a context of inadequate support for both patients and clinicians. There is a demonstrable need to examine equity in access and outcomes for culturally and linguistically diverse cancer populations. This requires the identification of cancer-related disparities and an examination of institutional barriers to care. Through addressing this dearth of information, future research and health policy can support the operationalisation of health equity.
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Introduction: The aim of screening an asymptomatic population for cancer is to achieve better health outcomes, particularly a population survival benefit. Australia has three population screening programs: the National Cervical Screening Program (NCSP), BreastScreen Australia and the National Bowel Cancer Screening Program (NBCSP). Methods: We reviewed the history and development of the three programs. NCSP: Women have a Pap smear every 2 years from age 18–20, or 2 years after first becoming sexually active, until age 69. Since introduction of the NCSP, the cervical cancer incidence has halved, with an approximate 60% decrease in mortality. The screening participation rate approximates 57%, but is lower for Aboriginal and Torres Strait Islander women, women in remote areas, and women with lower socio-economic status. The National HPV (human papillomavirus) Vaccination Program, introduced in 2007, is expected to reduce the incidence of cervical cancer by a further 70% and has already reduced the incidence of high-grade lesions in girls. In 2017, testing for HPV every 5 years starting at age 25 will replace the Pap smear as the principal screening test. BreastScreen Australia: This program targets women aged 50–74. Over 20 years, mortality from breast cancer has decreased by 32% in response to screening and treatment advances. The participation rate is 56%. The major adverse impact of breast screening is overdiagnosis, estimated in Australia to be as low as 8% of detected cancers, but with estimates of up to 30% from some research. Women should be made aware of both the potential benefits and harms from screening. Genetic testing for BRCA1 and BRCA2 mutations in high-risk women leads to earlier screening. NBCSP: The NBCSP uses immunochemical faecal occult blood test (iFOBT) kits on stool samples to detect bleeding from the bowel. When rollout is complete in 2020, test kits will be sent every 2 years to people aged 50–74. People who test positive are followed up with a colonoscopy. The participation rate is currently 37%. The positivity rate is 7%, and stage 1 bowel cancer presentations have tripled since the program began. Conclusions: Research needs to focus on reducing mortality through increased screening participation and, in the future, obtaining guidance for customised screening from genomic testing.
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Bhutanese-Nepali refugees are one of the largest refugee groups to be resettled in the U.S. in the past decade. Cervical cancer is a leading cause of cancer disparity in this population, yet screening rates are suboptimal. Nepali-speaking interviewers administered a community health needs questionnaire to a convenience sample of Bhutanese-Nepali refugees in a Midwestern city between July to October of 2015. Descriptive statistics were used to describe socio-demographic characteristics, Pap smear beliefs, post-migration living difficulties, and screening status. Differences in Pap test uptake between groups were tested using t test and Chi square statistics. Of the 97 female participants, 44.3% reported ever having had a Pap smear. Screening rates were lowest among women who did not know English at all. Most women had positive perceptions of Pap smears (80%) and 44.4% had received a Pap test recommendation from their healthcare provider, family, or friends. Pap testing was significantly higher among those who had positive perceptions (58.3 vs. 11.1% for women of negative perception, p = 0.01) and those who had received a recommendation (87.5 vs. 18.6% for women who had no recommendations, p < 0.001). Significant predictors of having a Pap smear were having a healthcare provider/family/friends recommendation (OR 65.3, 95% CI 11.4-373.3) and greater number of post-migration living difficulties (OR 1.18, 95% CI 1.02-1.37). The results of this study have important implications for the development of cervical cancer prevention programs targeting Bhutanese-Nepali refugees. Providing cancer prevention interventions early in the resettlement process could impact Pap test uptake in this population.
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Background The aim of this study was to survey refugees and asylum-seekers attending a Refugee Health Service in Melbourne, Australia to estimate the prevalence of psychiatric disorders based on screening measures and with post-traumatic stress disorder (PTSD) specifically highlighted. A secondary aim was to compare the prevalence findings with Australian-born matched comparators from the 2007 National Survey of Mental Health and Well-Being. Methods We conducted a cross-sectional survey of 135 refugees and asylum-seeker participants using instruments including Kessler-10 (K10) and PTSD-8 to obtain estimates of the prevalence of mental disorders. We also performed a comparative analysis using matched sets of one participant and four Australian-born residents, comparing prevalence results with conditional Poisson regression estimated risk ratios (RR). ResultsThe prevalence of mental illness as measured by K10 was 50.4%, while 22.9% and 31.3% of participants screened positive for PTSD symptoms in the previous month and lifetime, respectively. The matched analysis yielded a risk ratio of 3.16 [95% confidence interval (CI): 2.30, 4.34] for abnormal K10, 2.25 (95% CI: 1.53, 3.29) for PTSD-lifetime and 4.44 (95% CI: 2.64, 7.48) for PTSD-month. Conclusions This information on high absolute and relative risk of mental illness substantiate the increased need for mental health screening and care in this and potentially other refugee clinics and should be considered in relation to service planning. While the results cannot be generalised outside this setting, the method may be more broadly applicable, enabling the rapid collection of key information to support service planning for new waves of refugees and asylum-seekers. Matching data with existing national surveys is a useful way to estimate differences between groups at no additional cost, especially when the target group is comparatively small within a population.
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Rates of mammography screening for breast cancer are disproportionately low in certain subgroups including low-income and immigrant women. The purpose of the study was to examine differences in rates of appropriate breast cancer screening (i.e., screening mammography every 2 years) among Ontario immigrant women by world region of origin and explore the association between appropriate breast cancer screening among these women groups and individual and structural factors. A cohort of 183,332 screening-eligible immigrant women living in Ontario between 2010 and 2012 was created from linked databases and classified into eight world regions of origin. Appropriate screening rates were calculated for each region by age group and selected sociodemographic, immigration, and healthcare-related characteristics. The association between appropriate screening across the eight regions of origin and selected sociodemographic, immigration, and health-related characteristics was explored using multivariate Poisson regression. Screening varied by region of origin, with South Asian women (48.5%) having the lowest and Caribbean and Latin American women (63.7%) the highest cancer screening rates. Factors significantly associated with lower screening across the world regions of origin included living in the lowest income neighborhoods, having a refugee status, being a new immigrant, not having a regular physical examination, not being enrolled in a primary care patient enrollment model, having a male physician, and having an internationally trained physician. Multiple interventions entailing cross-sector collaboration, promotion of patient enrollment models, community engagement, comprehensive and intensive outreach to women, and knowledge translation and transfer to physicians should be considered to address screening disparities among immigrant population. Consideration should be given to design and delivery of culturally appropriate and easily accessible cancer screening programs targeted at high- risk immigrant subgroups, such as women of South Asian origin, refugees, and new immigrants.
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The objective of this study was to document barriers to care, help-seeking behaviors, and the impact of a community-based patient navigation intervention on patient activation levels among Bhutanese refugees in the U.S. Data sources comprised 35 intake and 34 post-intervention interviews with program participants, 14 intake and 14 post-intervention interviews with patient navigators, and 164 case notes. Textual data were analyzed using the constant comparison method. Patient activation level was assessed at both time points. Participants had limited English proficiency (97 %), limited literacy (69 %), and the lowest level of patient activation (69 %). Participants routinely experienced complex insurance access, coverage, and payment problems and had limited healthcare-related life skills. Help-seeking began within social networks, with high reliance on bilingual, literate family members perceived to have experience with "the system." Help-seeking was not stigmatized and was instead consistent with societal norms valuing mutual assistance. Participants preferred helpers to act as proxies and required repeated social modeling by peers to gain confidence applying healthcare-related life skills. Following the intervention, only one-third reported the lowest level of patient activation (35 %) and one-third were highly activated (32 %). Bhutanese refugees overcome healthcare access barriers by seeking help from a network of support that begins within the community. Community health workers serving as patient navigators are readily sought out, and this approach is concordant with cultural expectations for mutual assistance. Community health workers serving immigrant groups should model healthcare-related life skills in addition to providing direct assistance.
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Background: One well-accepted strategy for optimising outcomes in mammographic breast cancer screening is to improve communication with women about screening. It is not always clear, however, what it is that communication should be expected to achieve, and why or how this is so. We investigated Australian experts' opinions on breast screening communication. Our research questions were: 1 What are the views of Australian experts about communicating with consumers on breast screening? 2 How do experts reason about this topic? Methods: We used a qualitative methodology, interviewing 33 breast screening experts across Australia with recognisable influence in the Australian mammographic breast cancer screening setting. We used purposive and theoretical sampling to identify experts from different professional roles (including clinicians, program managers, policy makers, advocates and researchers) with a range of opinions about communication in breast screening. Results: Experts discussed the topic of communication with consumers by focusing on two main questions: how strongly to guide consumers' breast cancer screening choices, and what to communicate about overdiagnosis. Each expert adopted one of three approaches to consumer communication depending on their views about these topics. We labelled these approaches: Be screened; Be screened and here's why; Screening is available please consider whether it's right for you. There was a similar level of support for all three approaches. Experts' reasoning was grounded in how they conceived of and prioritised their underlying values including: delivering benefits, avoiding harms, delivering more benefits than harms, respecting autonomy and transparency. Conclusions: There is disagreement between experts regarding communication with breast screening consumers. Our study provides some insights into this persisting lack of consensus, highlighting the different meanings that experts give to values, and different ways that values are prioritised. We suggest that explicit discussion about ethical values might help to focus thinking, clarify concepts and promote consensus in policy around communication with consumers. More specifically, we suggest that decision-makers who are considering policy on screening communication should begin with identifying and agreeing on the specific values to be prioritised and use this to guide them in establishing what the communication aims will be and which communication strategy will achieve those aims.
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Refugee young people have been identified as a group with high risk for mental health problems, due to their experience of trauma, forced migration, and stressors associated with settlement. A high prevalence of mental health problems is reported in this group, however some research suggests refugee young people have low rates of mental health service access. There is little information available on barriers and facilitators to mental service delivery for this group. Using data from 15 focus groups and five key informant interviews with a total of 115 service providers from 12 agencies in Melbourne, Australia, this paper explores barriers and facilitators to engaging young people from refugee backgrounds with mental health services. Eight key themes emerged: cultural concepts of mental health, illness, and treatment; service accessibility; trust; working with interpreters; engaging family and community; the style and approach of mental health providers; advocacy; and continuity of care. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
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Over 25% of the Australian population are immigrants, and are less active participants in cancer screening programmes. Most immigrants live in urban areas of Australia, but a significant proportion (~20%), live in regional areas. This study explored differences in cancer screening participation by place of birth and residence. Self-reported use of mammogram, faecal occult blood test (FOBT), and/or prostate specific antigen (PSA) tests was obtained from 48,642 immigrants and 141,275 Australian-born participants aged 50 years or older in the 45 and Up Study (New South Wales, Australia 2006-2010). Poisson regression was used to estimate relative risks of test use, adjusting for key socio-demographic characteristics. Overall, immigrants from Asia and Europe were less likely to have had any of the tests in the previous two years than Australian-born participants. Regional Australian-born participants were more likely to have had any of the tests than those living in urban areas. Regional immigrant participants were more likely to have had an FOBT or PSA test than those living in urban areas, but there were no differences in mammograms. This report identifies key immigrant groups in urban and regional areas that policymakers and healthcare providers should target with culturally appropriate information to promote cancer screening.
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There is a growing recognition of the complexity surrounding multiple axes or dimensions of social identity and how they intersect to influence the health of immigrant and refugee women. The concept of intersectionalities of influence is particularly relevant in addressing diversity in nursing research. The purpose of this paper is to theorize and operationalize the concept in mental health promotion research with immigrant and refugee women. At the conceptual level, the authors propose an approach to inquiry that is informed by critical scholarship and draws from postcolonial and feminist perspectives. At the operational level, they apply an ecosystemic framework to help locate individual health issues within the familial, community, and social realms. They introduce Participatory Action Research as a way of putting these concepts into action within the research process. Their aim is to introduce a new way of inquiry that can benefit immigrant and refugee women while furthering the nursing agenda for community-based research.
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Background: Refugees in Australia experience barriers in accessing healthcare services. The aim of this study was to analyse the factors influencing Afghan refugees' access to general practice. Methods: A qualitative study on a single general practice in south-east Melbourne in 2013 was conducted. Data were collected using individual, semi-structured interviews and field observations. Data were analysed thematically and informed by the Penchansky and Thomas concept of access. Results: The general practice utilised multiple strategies to improve access for refugees. Nevertheless, persistent barriers included language and cultural differences at reception, difficulties with transport to the practice, long wait times and the cost of care. Discussion: This case study highlights the benefits of providing affordable, co-located, culturally responsive services with integrated interpreter and settlement agency support. Increasing the use of interpreters and translated materials at reception, and improving the coordination of patient transport assistance could enhance refugees' access to general practice.
Article
The low uptake of preventive services in disadvantaged communities is a continuing challenge to public health. Women refugee communities are particularly vulnerable populations, and disparities in both preventive care and breast cancer screening have been documented sparsely. The objective of this qualitative study was to explore Bosnian, Iraqi, and Somali women refugees' beliefs about preventive care and breast cancer screening to inform future community interventions and best practices. In an urban community health center, 57 interviews with Bosnian, Somali, and Iraqi women refugees were conducted by native language speakers. Interview transcripts were coded and analyzed according to best practices for thematic and content analysis. The responses of three groups were compared. Similarities across participants included barriers to care such as fear of pain and diagnosis, modesty, and work and childcare commitments; facilitative factors such as outreach efforts, appointment reminders, and personal contact from health providers; perceptions of how the American medical infrastructure compared with inadequacies in their home countries; and positive attitude toward U.S. health professionals. Differences that emerged among groups were: varying degrees of medical exposure to doctors in home countries, the impact of war on health systems; and understanding preventive breast care. Taken together, duration of time in United States and prior exposure to Western medicine account for differences in refugee women's knowledge of preventive care. Understanding population-specific health beliefs, health information, and behavior are crucial for designing tailored prevention programs for refugee women. Copyright © 2015 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
Article
This article discusses the photo-elicitation interview (PEI), a qualitative methodology, by addressing its fundamentals, providing examples of how to use it, and arguing its benefits and potential challenges. In PEIs, researchers introduce photographs into the interview context. The photographs used in PEIs can originate from the interviewee or the researcher. Researchers can use photographs as a tool to expand on questions and simultaneously, participants can use photographs to provide a unique way to communicate dimensions of their lives. Featured, in detail, are school ethnography and inner-city childhood studies that used PEIs.
Article
This paper presents an in-depth, idiographic study illustrating how chronic benign low back pain may have a serious debilitating impact on the sufferer's sense of self. Semi-structured interviews were conducted with six patients and the resultant transcripts subjected to interpretative phenomenological analysis. The analysis points to the powerful ways in which chronic pain has negative impact on patients’ self and identity. This impact is made worse in the public arena. Some of the participants describe how the ensuing derogatory self image also seems to lead to their directing negative affect towards other people. The results section gives a detailed account of these processes at work. The results are then considered in relation to relevant constructs in the extant literature, including work on illness and identity, shame and acceptance.
Article
South Asian (SA) immigrants (from Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, and Sri Lanka) constitute the fastest growing of all Asian American immigrants to the United States, with a growth rate of 106% from 1990 to 2001. Data are lacking on health behaviors of this population subgroup, including cancer-related information. : The purpose of this study was to assess rates and correlates of breast and cervical cancer screening in a community sample of SAs. Participants were recruited from among attendees of 3 community-based agency programs. Data were collected in English, Hindi, and Gujarati from a convenience sample of 198 participants. Two-thirds of the sample (n = 127, 65.5%) had ever had a mammogram, whereas only a third (n = 65, 32.8%) had ever had a Papanicolaou smear or vaginal examination. Several predisposing factors (eg, country of birth, years in the United States, acculturation, age, and acknowledged barriers to screening) were significant predictors of breast and cervical screening, whereas the only enabling factor was past screening behavior. Additional study is warranted on cultural aspects of cancer screening behaviors. These data are formative on facilitators and barriers to mammogram and Papanicolaou test completion among these understudied minority women. Nurses who practice in primary care may begin to target health education based on sociodemographics of SA women and emphasize discussion of barriers to screening.
Article
With 28% of Australia's population having a culturally and linguistically diverse (CALD) background, the health system faces an increasing challenge to provide accessible and culturally competent health care. The view that all CALD communities are homogenous and solutions can be developed for the entire nation is detrimental. Despite available health services, CALD communities are reluctant to use them due to cultural differences, perceived racism and misunderstandings leading to the existing health disparities. Therefore, gathering data from four prominent CALD communities, such as the Sudanese, Afghani, Pacific Islander and Burmese communities in Logan, Queensland, about how they perceive and use health services can provide insightful information towards development of a service model that will better suit these CALD communities. The objective of the study was to examine the extent to which four prominent CALD communities (Sudanese, Afghani, Pacific Islander and Burmese) access and use health services in Logan, Queensland. Six focus group interviews using interpreters were conducted in English with Sudanese, Afghani, Pacific Islander and Burmese people. The results indicated that even long-standing CALD communities, such as the Pacific Islander people, were unfamiliar with health services and experienced difficulties accessing appropriate health care. Most wanted doctors to use traditional healing methods alongside orthodox medicine, but did not feel respected for their beliefs. Language difficulties impeded communication with health professionals who were hindered by ineffective use of interpreters. In conclusion, a clear role for bilingual community-based navigators was identified by CALD participants to address concerns about the health system, and to improve accessibility and health service usage.
About Breast Screening
  • Breastscreen Australia
BreastScreen Australia. About Breast Screening. BreastScreen Australia; 2018 [cited 2018 12 September 2018]. Available from: http:// cancerscreening.gov.au/internet/screening/publishing.nsf/Content/ breast-screening-1.
Wholesale movement of Bhutanese refugees to US to end (so they say!). Refugee resettlement watch 2017
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Corcoran A. Wholesale movement of Bhutanese refugees to US to end (so they say!). Refugee resettlement watch 2017. Available from https:// refugeeresettlementwatch.wordpress.com/tag/bhutanese-refugees accessed 2 February 2018.
NVivo 11 essentials: Your guide to the world' s most powerful data analysis Software 2nd edn
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Edhlund B, McDougall A. NVivo 11 essentials: Your guide to the world' s most powerful data analysis Software 2nd edn. Stallarholmen, Sweden: Form & Kunskap AM; 2017.
Excuse me, do any of you ladies speak English?' Perspectives of refugee women living in South Australia: barriers to accessing primary health care and achieving the quality use of medicines
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Clark A, Gilbert A, Rao D, Kerr L. 'Excuse me, do any of you ladies speak English?' Perspectives of refugee women living in South Australia: barriers to accessing primary health care and achieving the quality use of medicines. Aust J Primary Health 2014; 20(1):92-7.