Inequitable treatment as perceived by international medical graduates (IMGs): a scoping review.

OBJECTIVES: This scoping review seeks to detail experiences of inequitable treatment, as self-reported by international medical graduates (IMGs), across time and location. DESIGN: Scoping review. SEARCH STRATEGY: Three academic medical databases (MEDLINE, SCOPUS and PSYCINFO) and grey literature (GOOGLE SCHOLAR) were systematically searched for studies reporting first-hand IMG experiences of perceived inequitable treatment in the workplace: discrimination, prejudice or bias. Original (in English) qualitative, quantitative, mixed studies or inquiry-based reports from inception until 31 December 2022, which documented direct involvement of IMGs in the data were eligible for inclusion in the review. Systematic reviews, scoping reviews, letters, editorials, news items and commentaries were excluded. Study characteristics and common themes were identified and analysed through an iterative process. RESULTS: We found 33 publications representing 31 studies from USA, Australia, UK, Canada, Germany, Finland, South Africa, Austria, Ireland and Saudi Arabia, published between 1982 and 2022. Common themes identified by extraction were: (1) inadequate professional recognition, including unmatched assigned work or pay; (2) perceived lack of choice and opportunities such as limited freedoms and perceived control over own future; (3) marginalisation-subtle interpersonal exclusions, stereotypes and stigma; (4) favouring of local graduates; (5) verbal insults, culturally or racially insensitive or offensive comments; and (6) harsher sanctions. Other themes identified were effects on well-being and proposed solutions to inequity. CONCLUSIONS: This study found evidence that IMGs believe they are subject to numerous common inequitable workplace experiences and that these experiences have self-reported repercussions on well-being and career trajectory. Further research is needed to substantiate correlations and causality in relation to outcomes of well-being and differential career attainment. Furthermore, research into support for IMGs and the creation of more equitable workforce environments is also recommended.

Lessons learnt from pandemic research with refugee communities.

Culturally and linguistically diverse (CALD) people are subject to many inequities worldwide, and research is no exception. We report lessons learnt as researchers conducting a qualitative study during the coronavirus disease 2019 (COVID-19) pandemic involving participants of refugee backgrounds. We found that despite the best intentions of the research team, a variety of factors in methodology and data collection presented unexpected barriers for our studied population. We share our reflections to assist others in their research endeavours. Researchers and institutions have a moral obligation to provide research practices that are both suitable and beneficial to the community. Collaborating with community members in the research process allows researchers to create ethically sound, practical studies with maximum utility.

Factors contributing to the sharing of COVID-19 health information amongst refugee communities in a regional area of Australia: a qualitative study.

BACKGROUND: The COVID-19 pandemic has had a disproportionate impact on culturally and linguistically diverse (CALD) groups worldwide. Newly emerging CALD populations formed by recently arrived refugees are predisposed to even greater health disadvantages due to complexities of the refugee experience. The aim of this study was to explore how culture, refugee experiences and existing relationships shaped what COVID-19 messages were listened to and shared during the early-mid phases of the pandemic. The work focused on three newly emerging refugee groups in the Hunter New England region, Australia: Afghan, Congolese and Syrian communities. METHODS: Qualitative, semi-structured interviews were conducted to explore the experiences and stories of 15 adult community members, nine influential members and six service providers. All community members arrived in Australia on or after January 2014. Interpreter-assisted interviews were conducted with small groups or individuals, audio-recorded and transcribed verbatim in English. Three levels of thematic data analysis were employed to uncover the important issues and experiences of the participants. RESULTS: Three key themes and several subthemes were identified. The themes were: 1) Experience as a refugee uniquely influences COVID-19 message communication; 2) Refugee groups use diverse practices when accessing and sharing COVID-19 messages; and 3) Official government messages could be improved by listening and tailoring to community needs. CONCLUSIONS: Effective health messaging relies on reaching communities in a culturally acceptable and meaningful way. Official COVID-19 messages can be tailored to engage newly emerging communities by improving the quality of the content, delivery and format whilst working collaboratively with communities and trusted service providers. Further mutual research is needed to understand emerging communities' viewpoints. The use of culturally informed approaches is recommended.

Identifying domestic violence and sexual assault presentations at a regional Australian hospital emergency department: Comparative analysis of domestic violence and sexual assault cases.

OBJECTIVE: To map the main characteristics of and differences between domestic violence and sexual assault cases presenting to a hospital emergency department in Australia. METHODS: This retrospective observational cross-sectional study presents a snapshot of domestic violence and sexual assault cases presenting to the emergency department of a regional tertiary Australian hospital between 1 January 2018 and 31 December 2018. Data were extracted from the health district electronic information system for all eligible females. All data were checked for completeness and discrepancies by researchers before analysis. RESULTS: 42/105 (40%) sexual assault cases and 27/56 (48%) domestic violence cases reported mental health issues. More than half of the sexual assault and domestic violence cases had recurrent presentations to emergency department (51%; 54/105% and 52%; 29/56, respectively); most injuries were classed as severe. 92/105; 88% of sexual assault and 41/56; 73% of domestic violence victims were referred to related services. CONCLUSION: Clinical health staff, particularly those working in emergency department, can play crucial roles in identifying cases of domestic violence and sexual assault. Domestic violence training for clinicians and routine domestic violence screening in hospital emergency department is recommended to enhance early intervention.

Ezidi voices: The communication of COVID-19 information amongst a refugee community in rural Australia- a qualitative study.

BACKGROUND: There is growing evidence that government health information related to COVID-19 has failed to adequately reach culturally and linguistically diverse (CALD) populations in Australia. Refugees are a unique sub-set of the CALD communities and are subject to numerous barriers preventing adequate health care, both pre- and post-migration. The barriers are accentuated during emergencies, such as a pandemic, as a result of an intersection of various social and economic inequalities. The recently resettled Ezidi refugee community in a regional area of Australia is an example of a community sitting at the intersection of various inequities and thus at greater risk from COVID-19. The purpose of this study is to describe the experiences of the Ezidi in a regional area with COVID-19 information and how this has been communicated to and shared within this group; what barriers the community may experience in accessing COVID-19 information; and how the government-led COVID-19 information communication could be improved. METHODS: This qualitative study was designed to explore the perceptions and views of the Ezidi and service providers regarding COVID-19 messaging. Multicultural and Refugee Health staff facilitated interviews with four local service providers and ten Ezidi community members, including seven influential leaders. Thematic analysis was employed across individual, pair and group data analysis. Similar categories were grouped into themes. RESULTS: The main findings of the study are: the refugee experience influences the communication of COVID-19 messages; cultural, social and gender norms influence responses to COVID-19; trusted individuals and service providers are key in communities' uptake of COVID-19 messages; currently available governmental COVID-19 information resources and sharing strategies were found unhelpful and inappropriate; COVID-19 communiqués and message delivery for this regional minority refugee community can be improved. CONCLUSION: The recently resettled Ezidi community, and likely other similar communities, would benefit from tailored engagement by government organisations, as well as settlement services to improve the communication of COVID-19 health information and reduce related inequities.