A narrative synthesis of the impact of primary health care delivery models for refugees in resettlement countries on access, quality and coordination.

INTRODUCTION: Refugees have many complex health care needs which should be addressed by the primary health care services, both on their arrival in resettlement countries and in their transition to long-term care. The aim of this narrative synthesis is to identify the components of primary health care service delivery models for such populations which have been effective in improving access, quality and coordination of care. METHODS: A systematic review of the literature, including published systematic reviews, was undertaken. Studies between 1990 and 2011 were identified by searching Medline, CINAHL, EMBASE, Cochrane Library, Scopus, Australian Public Affairs Information Service - Health, Health and Society Database, Multicultural Australian and Immigration Studies and Google Scholar. A limited snowballing search of the reference lists of all included studies was also undertaken. A stakeholder advisory committee and international advisers provided papers from grey literature. Only English language studies of evaluated primary health care models of care for refugees in developed countries of resettlement were included. RESULTS: Twenty-five studies met the inclusion criteria for this review of which 15 were Australian and 10 overseas models. These could be categorised into six themes: service context, clinical model, workforce capacity, cost to clients, health and non-health services. Access was improved by multidisciplinary staff, use of interpreters and bilingual staff, no-cost or low-cost services, outreach services, free transport to and from appointments, longer clinic opening hours, patient advocacy, and use of gender-concordant providers. These services were affordable, appropriate and acceptable to the target groups. Coordination between the different health care services and services responding to the social needs of clients was improved through case management by specialist workers. Quality of care was improved by training in cultural sensitivity and appropriate use of interpreters. CONCLUSION: The elements of models most frequently associated with improved access, coordination and quality of care were case management, use of specialist refugee health workers, interpreters and bilingual staff. These findings have implications for workforce planning and training.

'You're less complete if you haven't got a can in your hand': alcohol consumption and related harmful effects in rural Australia: the role and influence of cultural capital.

AIMS: This study aimed to explore rural Australians' perceptions of social and cultural factors influencing alcohol use in their communities. METHODS: Semi-structured interviews exploring rural community key informants' (n = 46) perceptions of social and cultural factors influencing alcohol consumption in their community were conducted. A narrative analysis identified cultural capital as a salient concept for explaining how rural community life is created and sustained via drinking practices. RESULTS: Themes relating to participants' accounts of learning to drink, normal drinking; exclusion because of not drinking and problematic drinkers are described. CONCLUSION: In rural communities, beliefs and values about drinking as a positive social practice are transmitted, rewarded and reproduced across multiple groups and settings, reinforcing that drinking is an integral part of Australian rural culture. Drinking is so important that engaging in drinking practices creates and sustains cultural capital. As a result, alcohol-related harm is of little concern to rural dwellers.

Examining the Relationship Between Sleep-Related Infant Deaths and Social Determinants of Health in Urban Communities.

In 2017, sleep-related infant deaths (SRID) accounted for about 3600 deaths in the USA. The SRID rate for African American infants (186. 41 per 100,000 live births) is more than twice that of Caucasian American infants (85. 43 per 100,000 live births) (Centers for Disease and Prevention, July 2020). PURPOSE: The purpose of this article is to develop a case for considering the relationship between racial disparities in SRID and social determinants of health (SDOH) in impoverished communities. The later has been related to chronic stress impacting biological and psychological functioning. The authors advocate that undesirable SDOH be regarded when developing safe sleep strategies for at risk communities, since chronic stress can impact psychological and biologic functioning, possibly manifesting in inconsistent safe sleep practices by caregivers. METHODS: An adapted environmental scan (AES), using SRID and SDOH data from impoverished communities, was used to illustrate the comparison of SRID and SDOH in contrasting Baltimore neighborhoods. RESULTS: The AES revealed a match between disparities in SRID and SDOH (e.g., educational achievement, unemployment, poverty, poor housing, and violence). The comparison between the SDOH and SRID increases together for named impoverished neighborhoods, as compared to those with low SRID rates in Baltimore. CONCLUSION: Rather than limit safe sleep interventions to crib and infant sleeper give-aways, for example, hazardous SDOH seen in impoverished communities should be addressed. We posit that these results will stimulate discussion for well-placed and financed programs, along with policies that focus on decreasing SRID by improving poor SDOH.

Outcomes of participation objective, participation subjective (POPS) measure following traumatic brain injury.

PRIMARY OBJECTIVE: To investigate the participation of adults living with traumatic brain injury in regional and rural NSW as measured by the Participation Objective Participation Subjective (POPS) measure. RESEARCH DESIGN: A quantitative survey of a single cohort as the first of a two phase mixed methods study. METHODS AND PROCEDURES: One hundred and thirty-one adults with a TBI were recruited through eight rural brain injury rehabilitation programmes in NSW. These adults completed a range of survey instruments, including the POPS. MAIN OUTCOMES AND RESULTS: The POPS measure supported findings from other research that identified varying impacts of TBI. However, in contrast to other studies, there was no correlation between participation scores and age, gender, time since injury and severity of injury. CONCLUSIONS: The findings from this study suggest that the issue of participation of adults with TBI living in non-metropolitan areas needs to be further researched.

'Mind you, there's no anaesthetist on the road': women's experiences of labouring en route.

INTRODUCTION: The aim of this article was to learn from women in rural New South Wales (NSW) Australia, their experiences of labouring en route to birth in a centralised maternity unit. METHODS: This qualitative study was exploratory and descriptive. It was part of a larger project that explored women's experiences when they birthed away from their rural communities. Participants were recruited from communities all over rural NSW where a maternity unit had closed. Forty-two female participants and three of their male partners shared their stories of 73 labours and births. This article draws on data collected during in-depth interviews with 12 participants and one partner who shared their experiences of labouring en route to a centralised maternity service. Interviews were audiotaped and transcribed verbatim for the purpose of thematic analysis. Exemplars, using the participants' own words and highlighting story are identified as a tool used for data synthesis and presentation. RESULTS: Two themes were identified. These relate to the way the risk of dangerous road travel is ignored in obstetric risk discourse, and the deprivations experienced when women labour en route. An unexpected finding was the positive nature of one woman's experience of birthing by the side of the road. CONCLUSIONS: Many participants questioned why they needed to risk unsafe road travel when their preference was to labour and birth in their local communities with a midwife.

'You have to face your mistakes in the street': the contextual keys that shape health service access and health workers' experiences in rural areas.

INTRODUCTION: Rural healthcare provision is limited in many areas because of workforce recruitment and retention issues. Pharmacists and social workers are examples of allied health professionals who play vital roles in the provision of rural health care. Personal factors including an individual's fit with a local community and their professional role were explored to determine the way they affect access to rural health care. DESIGN: Accidental sampling then 11 qualitative interviews with pharmacists and social workers. SETTING: Six rural communities with populations less than 5000, New South Wales, Australia. METHODOLOGY: Deductive and inductive analysis of data. RESULTS: Exploration of health work in small rural towns identified that participants' work and personal experiences are affected by their professional role and associated tasks, and by the way the community perceives that role. Social workers are likely to provide outreach or visiting services and use different professional networks than pharmacists. Social workers tend to perceive their client's problems as related to poverty and rural decline with limited options for successful intervention through the health system. Pharmacists are confident in their role as treatment providers and have a thorough knowledge of their own community, although they use a limited range of other local healthcare providers, tending to rely on doctors. Access to healthcare services is affected by organisational strategies to manage demand on services, privacy and confidentiality and the community's perception of the effectiveness of the service and the individual worker. Local knowledge and local context shaped the services pharmacists and social workers provided, and the way they managed their personal and professional activities in a small community. CONCLUSION: Access to rural health services is affected by an individual's concerns about privacy and confidentiality, by the reputation of the healthcare worker and by the value system of the health worker. Different professions use different networks of health care, subsequently approaching rural social conditions and their related problems from diverse perspectives. This influences the health worker's experience of effectiveness in their professional role and the way they manage their high degree of visibility in small communities. IMPLICATIONS: The need for a systematic evaluation of health service access emphasising the particular aspects of local rural context is highlighted. Such a work should include investigation of multidisciplinary models of service provision. This will optimise the range of health care available to small rural communities.

Globalisation, rural restructuring and health service delivery in Australia: policy failure and the role of social work?

The impacts of globalisation and rural restructuring on health service delivery in rural Australia have been significant. In the present paper, it is argued that declining health service access represents a failure of policy. Rural communities across the world are in a state of flux, and Australia is no different: rural communities are ageing at faster rates than urban communities and young people are out-migrating in large numbers. During the past 5 years, rural Australia has also experienced a severe and widespread drought that has exacerbated rural poverty, and impacted on the health and well-being of rural Australians. Australian governments have responded to globalising forces by introducing neoliberal policy initiatives favouring market solutions and championing the need for self-reliance among citizens. The result for rural Australia has been a withdrawal of services at a time of increased need. This paper addresses the social work response to these changes.

Brutal neglect: Australian rural women's access to health services.

Access to health services in rural Australia has been particularly problematic because of the vast geographical areas and the sparse population distribution across the inland. The focus on health servicing has been very much on primary health care with most attention being giving to the distribution of doctors in rural Australia. This study takes a closer look at rural health servicing through the eyes of women in rural Australia. Drawing on a survey of 820 women, the study revealed that a focus on primary health care may be resulting in a lack of attention to women's health in areas, such as maternity models of care, domestic violence and mental health. The study also reveals the disquiet of Australian rural women at the poor state of health services.

Rural male suicide in Australia.

The rate of suicide amongst Australia's rural men is significantly higher than rural women, urban men or urban women. There are many explanations for this phenomenon including higher levels of social isolation, lower socio-economic circumstances and ready access to firearms. Another factor is the challenge of climate transformation for farmers. In recent times rural areas of Australia have been subject to intense climate change events including a significant drought that has lingered on for over a decade. Climate variability together with lower socio-economic conditions and reduced farm production has combined to produce insidious impacts on the health of rural men. This paper draws on research conducted over several years with rural men working on farms to argue that attention to the health and well-being of rural men requires an understanding not only of these factors but also of the cultural context, inequitable gender relations and a dominant form of masculine hegemony that lauds stoicism in the face of adversity. A failure to address these factors will limit the success of health and welfare programs for rural men.

Australian Aboriginal kinship: a means to enhance maternal well-being.

BACKGROUND: The relocation of women from their rural communities to birth in a centralised hospital is becoming increasingly common as maternity units close in rural areas of Australia. The significance for Aboriginal women when they are denied the support of kin around the time of birth but have that support re-established postnatally is explored. METHODS: This paper gathered data from multiple sources including in-depth interviews with three Aboriginal mothers and one partner; observational field notes; and during debriefing, the knowledge and experience of an Aboriginal midwife. Thematic analysis was utilised to both explore and critique the collected data. FINDINGS AND DISCUSSION: Aboriginal women are particularly disadvantaged by maternity unit closures in rural areas of the south eastern Australian state of New South Wales (NSW). However, contrary to the expectation that this would result in postnatal mental health problems, the support the Aboriginal participants in this study received from kin may have had a mediating effect which enhanced their well-being and possibly prevented mental ill health. RECOMMENDATIONS: Recommendations relate to strategies and policies that have the potential to increase community governance and feelings of cultural safety for Aboriginal childbearing women living in rural areas. CONCLUSION: While the practice of forcing Aboriginal women to relocate around the time of birth has a negative impact on perinatal health outcomes, kinship support may be a mediating factor.

'You can drop dead': midwives bullying women.

BACKGROUND: This paper describes how women experienced what came to be labelled as 'bullying' by a small number of midwives when they were evacuated from their rural and remote areas of NSW, Australia to a maternity unit to birth. RESEARCH QUESTION: What is the experience of women who are required to travel away from their NSW rural/remote communities to birth? PARTICIPANTS AND METHODS: Forty-two participants together with a number of their partners/support people were interviewed in depth for this qualitative, exploratory study. Upon thematic analysis of the transcribed interviews, an unexpected finding was that four participants (plus one partner) described experiences which were interpreted as bullying, by a small number of midwives working with them. Women identifying as Aboriginal were especially likely to share stories of midwifery bullying. RESULTS, DISCUSSION AND CONCLUSION: Emotional and cultural safety of women must be a prime consideration of midwives. Strategies to reverse power differentials between midwives and women are urgently required to eradicate bullying by any midwife.