Community health workers (CHWs) as healthcare navigators in Australian general practice to help patients from culturally and linguistically diverse backgrounds access health and social care services

Introduction Patients from culturally and linguistically diverse (CALD) backgrounds, particularly those suffering from chronic diseases often face difficulties accessing health and social care services in Australia. The research presented in this thesis explored the feasibility and acceptability of involving community health workers (CHWs) as bilingual community navigators (BCNs) in Australian general practice to help patients from CALD backgrounds to access health and social care services. Methods This research was conducted in selected general practices in Sydney where most patients and their doctors speak a language other than English. A multiphase mixed method design was used. The first phase involved scoping the navigation needs and potential roles of CHWs by interviewing general practice staff from five selected general practices. The next phase involved codesign of a navigation model of care. In the third phase of the research, 12 CHWs were recruited and trained as BCNs. Three of them were placed in two general practices with patients from specific CALD backgrounds. The final phase involved an evaluation of the feasibility and acceptability of the intervention. This was accomplished through quantitative analysis of a record of services provided by BCNs, and post-intervention qualitative interviews with patients, their caregivers, practice staff and BCNs. Results In the initial scoping exercise, I identified barriers faced by patients from CALD backgrounds in accessing care, and potential roles for BCNs in addressing some of these barriers. Informed by this and using a codesign process, a navigation model of care was developed and 12 CHWs completed training and assessment. Subsequently, three of the 12 BCNs were placed in two bilingual practices (one Samoan and one Chinese) for ten weeks to provide navigation assistance. The BCNs served 95 patients, providing help with referral (52.6%), information about appointments (46.3%), local resources (12.6%) and available social benefits (23.2%), through particularly addressing communication barriers. Overall, BCNs fitted in well within the practice and were accepted by patients and practice staff. A felt need for the services by patients, the recruitment of BCNs from the relevant CALD communities and the motivation and training of BCNs, facilitated their success. Major barriers to implementation included: lack of awareness of BCNs’ roles among some patients and practice staff, lack of information about local culture specific health and social services, and the busy schedule of BCNs. Limited funding support and a short project timeframe were major limitations. Conclusion Overall, the intervention was feasible to implement and acceptable to patients and practice staff. This role could help address current workforce shortages in Australian general practice, increase representation of CALD groups in the health workforce and improve equity of access for patients from CALD backgrounds in the health system. However, sustainability depends on establishing an organizational base for the training and certification of the BCNs, and on funding. Future research is needed to demonstrate the intervention’s effectiveness and cost-effectiveness and its applicability to other cultural groups and in other general practice settings

Community health navigators in Australian general practice: an implementation study

Background Patient health navigators have an emerging role in assisting people to connect with health and social care services especially those experiencing language and communication barriers. A challenge with navigator programs is sustaining their implementation. This study evaluated the implementation and sustainability of bilingual community navigators (BCNs) in multilingual general practices in Sydney and their impact on patient access. The hypothesis was that the use of bilingual navigators within multilingual practices would be acceptable and feasible, improve patient access to appropriate care and staff workload, and reduce health inequities. Methods Patient referral information was collected and analysed descriptively. Interviews were conducted with practice staff, patients, and navigators after 10-week placements and analysed thematically using Normalisation Process Theory. Results A total of 110 patients were referred to navigators who assisted with booking appointments, accessing community resources, and translating and explaining information. Interviews were undertaken with four navigators, three patients, three carers, and four GPs. Practice participants could see the benefits of the BCNs and were motivated to engage with them, especially with GP endorsement. However, not all understood the navigator competencies and roles. In some practices, the population needs and the scheduling of appointments and staff routines could have aligned better, which constrained referrals and continued navigator involvement. Conclusions This study demonstrates the potential role of navigators in addressing navigation challenges experienced by culturally and linguistically diverse patients in general practice. More effort is needed to tailor attachments to the unique needs of the patient population and practice schedule. Sustainability requires ongoing funding and broad institutional support

Community Health Workers Can Provide Psychosocial Support to the People During COVID-19 and Beyond in Low- and Middle- Income Countries

The COVID-19 pandemic has been the most challenging public health issue which not only affected the physical health of the global population but also aggravated the mental health conditions such as stress, anxiety, fear, depression and anger. While mental health services are seriously hampered amid this COVID-19 pandemic, health services, particularly those of Low- and Middle- Income Countries (LMICs) are looking for alternatives to provide psychosocial support to the people amid this COVID-19 and beyond. Community Health Workers (CHWs) are an integral part of the health systems in many LMICs and played significant roles such as health education, contact tracing, isolation and mobilization during past emergencies and amid COVID-19 in many LMICs. However, despite their potentials in providing psychosocial support to the people amid this COVID-19 pandemic, they have been underutilized in most health systems in LMICs. The CHWs can be effectively engaged to provide psychosocial support at the community level. Engaging them can also be cost-saving as they are already in place and may cost less compared to other health professionals. However, they need training and supervision and their safety and security needs to be protected during this COVID-19. While many LMICs have mental health policies but their enactment is limited due to the fragility of health systems and limited health care resources. CHWs can contribute in this regard and help to address the psychosocial vulnerabilities of affected population in LMICs during COVID-19 and beyond

Gestational diabetes mellitus (GDM) and adverse pregnancy outcome in South Asia: a systematic review

Introduction The prevalence of gestational diabetes mellitus (GDM) is increasing in developing countries including the South Asian Nations. The current study aimed to examine the association of GDM with adverse pregnancy outcomes from foetal and maternal perspectives in South Asia. Methods A systematic review was conducted including primary studies published since January 2020 from South Asian countries. Following electronic databases were searched to locate the articles: MEDLINE, EMBASE and EMCARE. Data were extracted using a customized extraction tool and methodological quality of the included studies was assessed using modified Effective Public Health Practice Project (EPHPP) quality assessment tool. Narrative synthesis was performed as statistical pooling was not possible due to the heterogeneous nature of the studies. Results Eight studies were included in the review. Overall, the review found a positive correlation between GDM and adverse foetal outcomes such as macrosomia, neonatal hyperglycaemia, intrauterine growth retardation (IUGR), stillbirths and low birthweight (LBW), but the findings were not conclusive. GDM was also positively associated with preeclampsia but the association between GDM and C-section delivery was not conclusive. Conclusion Policymakers, public health practitioners and researchers in South Asia should take in to account the link between GDM and adverse pregnancy outcomes while designing interventions to promote maternal health in South Asia. Researchers should focus on conducting longitudinal studies in future to clearly understand the epidemiology and pathobiology of this issue.gold open acces

The Role of Family Support in the Self-Rated Health of Older Adults in Eastern Nepal: Findings from a Cross-Sectional Study

BACKGROUND: Nepal\u27s low fertility rate and increasing life expectancy have resulted in a burgeoning older population. For millennia, filial piety shaped family cohesion and helped Nepali older adults achieve positive outcomes, but recently, it has been eroding. Furthermore, there are not enough institutional support options or alternatives to family-based care to deal with the biosocial needs of older adults. This study explored the association between family support and self-rated health among Nepali older adults. METHODS: A community-based cross-sectional survey in eastern Nepal\u27s two districts, Sunsari and Morang, interviewed 847 older adults (≥ 60 years). The final analytical sample was 844. Participants were asked whether they received assistance with various aspects of daily life and activities of daily living from their families. Multivariable logistic regression examined the association between family support and self-rated health. RESULTS: Participants who received support with various aspects of daily life had 43% higher odds of good health, but after adjusting for control variables, the result only approached statistical significance (p = 0.087). Those who received family assistance with activities of daily living had nearly four times higher odds (OR: 3.93; 95% CI: 2.58 - 5.98) of reporting good health than participants who lacked this support. CONCLUSIONS: Given the important role of family support in Nepali older adults\u27 health, government programs and policies should create a conducive environment to foster family-based care until more comprehensive policies for older adults\u27 care can be put into effect. The results of this study can also help shape the global aging environment by highlighting the need for family support in older care, particularly in low-income nations with declining traditional care systems and weak social security policies

Men’s knowledge and awareness of maternal, neonatal and child health care in rural Bangladesh: a comparative cross sectional study

Abstract Background The status of men’s knowledge of and awareness to maternal, neonatal and child health care are largely unknown in Bangladesh and the effect of community focused interventions in improving men’s knowledge is largely unexplored. This study identifies the extent of men’s knowledge and awareness on maternal, neonatal and child health issues between intervention and control groups. Methods This cross sectional comparative study was carried out in six rural districts of Bangladesh in 2008. BRAC health programme operates ‘improving maternal, neonatal and child survival’ intervention in four of the above-mentioned six districts. The intervention comprises a number of components including improving awareness of family planning, identification of pregnancy, providing antenatal, delivery and postnatal care, newborn care, under-5 child healthcare, referral of complications and improving clinical management in health facilities. In addition, communities are empowered through social mobilization and advocacy on best practices in maternal, neonatal and child health. Three groups were identified: intervention (2 years exposure); transitional (6 months exposure) and control. Data were collected by interviewing 7,200 men using a structured questionnaire. Results Men prefer to gather in informal sites to interact socially. Overall men’s knowledge on maternal care was higher in intervention than control groups, for example, advice on tetanus injection should be given during antenatal care (intervention = 50%, control = 7%). There were low levels of knowledge about birth preparedness (buying delivery kit = 18%, arranging emergency transport = 13%) and newborn care (wrapping = 25%, cord cutting with sterile blade = 36%, cord tying with sterile thread = 11%) in the intervention. Men reported joint decision-making for delivery care relatively frequently (intervention = 66%, control = 46%, p &lt; 0.001). Conclusion Improvement in men’s knowledge in intervention district is likely. Emphasis of behaviour change communications messages should be placed on birth preparedness for clean delivery and referral and on newborn care. These messages may be best directed to men by targeting informal meeting places like market places and tea stalls. </jats:sec

Water Quality Index for measuring drinking water quality in rural Bangladesh: a crosssectional study

Background: Public health is at risk due to chemical contaminants in drinking water which may have immediate health consequences. Drinking water sources are susceptible to pollutants depending on geological conditions and agricultural, industrial, and other man-made activities. Ensuring the safety of drinking water is, therefore, a growing problem. To assess drinking water quality, we measured multiple chemical parameters in drinking water samples from across Bangladesh with the aim of improving public health interventions. Methods: In this cross-sectional study conducted in 24 randomly selected upazilas, arsenic was measured in drinking water in the field using an arsenic testing kit and a sub-sample was validated in the laboratory. Water samples were collected to test water pH in the laboratory as well as a sub-sample of collected drinking water was tested for water pH using a portable pH meter. For laboratory testing of other chemical parameters, iron, manganese, and salinity, drinking water samples were collected from 12 out of 24 upazilas. Results: Drinking water at sample sites was slightly alkaline (pH 7.4 \ub1 0.4) but within acceptable limits. Manganese concentrations varied from 0.1 to 5.5 mg/L with a median value of 0.2 mg/L. The median iron concentrations in water exceeded WHO standards (0.3 mg/L) at most of the sample sites and exceeded Bangladesh standards (1.0 mg/L) at a few sample sites. Salinity was relatively higher in coastal districts. After laboratory confirmation, arsenic concentrations were found higher in Shibchar (Madaripur) and Alfadanga (Faridpur) compared to other sample sites exceeding WHO standard (0.01 mg/L). Of the total sampling sites, 33 % had good-quality water for drinking based on the Water Quality Index (WQI). However, the majority of the households (67 %) used poor-quality drinking water. Conclusions: Higher values of iron, manganese, and arsenic reduced drinking water quality. Awareness raising on chemical contents in drinking water at household level is required to improve public health