RESUMEN

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.

Asunto(s)

Refugiados , Australia , Bután , Femenino , Humanos , Investigación Cualitativa , Investigadores , Poblaciones Vulnerables

RESUMEN

Background: Cervical cancer screening rates are low among refugee populations who have resettled in Australia, including among Bhutanese women who are at increased risk of cervical cancer. Understanding the barriers to accessing preventive health care is an important starting point to changing health behaviours. Objective: To identify perceived barriers to accessing cervical cancer screening programs among Bhutanese refugee women in Australia. Method: In-depth interviews with 30 Bhutanese refugee women resettled in Melbourne, Australia were analysed using an Interpretative Phenomenological Analysis (IPA) framework. Findings: A strong overarching theme was evident; health-seeking behaviour among the Bhutanese refugee women was strongly associated with symptoms and can be described as 'no symptoms- no check-up'. Three major contributors to health behaviour were: poor knowledge, cultural motivations and refugee experience. Poor knowledge was a consequence of low health literacy and lack of information. Cultural motivations included the notion of the sacred body and related stigmas, and strong faith in doctors. A set of latent themes associated with health professional behaviour was also identified in the experiences women recounted: screening was not offered; opportunistic screening occurred without education; and the use of interpreters was inappropriate and involved a mix of failure to use publicly available trained interpreters and informal use of family members. A contrary theme was also evident among younger educated women: changing awareness. Conclusion: Health professionals in the countries of resettlement need greater awareness of the barriers to health-seeking behaviours among refugee populations: cultural influences and norms; poor knowledge of health services and health systems; and poor practice by health professionals.

Asunto(s)

Características Culturales , Detección Precoz del Cáncer/psicología , Tamizaje Masivo/psicología , Refugiados/psicología , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/etnología , Neoplasias del Cuello Uterino/psicología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Australia/etnología , Bután/etnología , Detección Precoz del Cáncer/estadística & datos numéricos , Femenino , Grupos Focales , Humanos , Tamizaje Masivo/estadística & datos numéricos , Persona de Mediana Edad , Investigación Cualitativa , Refugiados/estadística & datos numéricos , Adulto Joven

RESUMEN

PURPOSE: The purpose of this paper was to explore what a refugee women's health screening program would look like if the views of Bhutanese refugee women were incorporated into service design and the approaches to targeting access to cervical and breast cancer screening. METHODS: Qualitative study, used in-depth interviews with 30 Bhutanese refugee women resettled in Melbourne, Australia. RESULTS: Two practice models were identified by refugee women: a doctor-initiated model involving opportunistic screening during consultations for other purposes; and a group screening model. Participants emphasised the need for a supportive environment with culturally appropriate services, community education and peer networks to encourage and facilitate their participation in cervical and breast cancer screening services. General practitioners can provide guidance, opportunistic screening that includes education, and advice about follow-up. The need for the routine use of professional interpreter services was reinforced. CONCLUSION: Available cervical and breast cancers screening services are not attuned to refugee women's views where this study focuses attention on the roles and practices of doctors in preventive health care for refugee women. Merging their perspectives with those of providers and policymaker's can fill the existing gaps and support to formulate the new interventions that will improve women's access to such preventative services. SO WHAT?: Refugee women resettled in high income countries are less likely to attend preventive cancer screening programs than other women, so we need to understand how to motivate them to seek regular check-ups. In this study Bhutanese refugee women resettled in Melbourne, Australia said that group screening or doctor-led care would be appealing to them.

Asunto(s)

Neoplasias de la Mama , Refugiados , Neoplasias del Cuello Uterino , Bután , Neoplasias de la Mama/diagnóstico , Detección Precoz del Cáncer , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Investigación Cualitativa , Neoplasias del Cuello Uterino/diagnóstico

RESUMEN

Objective The aim of this study was to provide an overview of the previously reviewed research literature to identify barriers and facilitators to health service utilisation by refugees in resettlement countries. Methods An overview of systematic reviews was conducted. Seven electronic databases (Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, ProQuest Central, Scopus, EBSCO and Google Scholar) were searched for systematic reviews of barriers and facilitators to health-seeking behaviour and utilisation of health services by refugees following resettlement. The two authors independently undertook data selection, data extraction and quality assessment using a validated tool. Results Nine systematic reviews covered a range of study areas and refugee populations. Barriers to health service utilisation fell into three broad areas: (1) issues related to refugees, including refugee characteristics, sociocultural factors and the effects of previous experiences; (2) issues related to health services, including practice issues and the knowledge and skills of health professionals; and (3) issues related to the resettlement context, including policies and practical issues. Few facilitators were identified or evaluated, but these included approaches to care, health service responses and behaviours of health professionals. Conclusions Barriers to accessing health care include refugee characteristics, practice issues in health services, including the knowledge and skills of health professionals, and the resettlement context. Health services need to identify barriers to culturally sensitive care. Improvements in service delivery are needed that meet the needs of refugees. More research is needed to evaluate facilitators to improving health care accessibility for these vulnerable groups. What is known about the topic? Refugee health after resettlement is poor, yet health service use is low. What does this paper add? Barriers to accessing health services in resettlement countries are related not only to refugees, but also to issues regarding health service practices and health professionals' knowledge and skill, as well as the context of resettlement. Few facilitators to improving refugee access to health services have been identified. What are the implications for practitioners? The barriers associated with health professionals and health services have been linked to trust building, and these need to be addressed to improve accessibility of care for refugees.

Asunto(s)

Utilización de Instalaciones y Servicios , Humanos , Refugiados , Revisiones Sistemáticas como Asunto

RESUMEN

This systematic narrative review of qualitative studies examined health service barriers and facilitators in Australia for refugees after resettlement. Twelve qualitative studies published between 2006 and 2017 involving more than 500 participants were included in the review. Approximately half of all participants were healthcare professionals. A meta-synthesis approach was used to compare and combine findings from across studies. Few facilitators were identified. Barriers to accessing health services were commonly attributed to refugees, but several barriers were associated with healthcare professionals and health services. Barriers attributed to healthcare professionals included gaps in knowledge and skills; poor cultural competency; poor communication skills; and time constraints. Understanding such barriers is the first step in developing strategies to overcome them. The skills and knowledge of healthcare professionals are important to facilitating access to healthcare among this vulnerable population.