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      The Building Blocks for Successful Hub Implementation for Migrant and Refugee Families and Their Children in the First 2000 Days of Life

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          ABSTRACT

          Background and Objective

          Migrant and refugee women, families, and their children can experience significant language, cultural, and psychosocial barriers to engage with child and family services. Integrated child and family health Hubs are increasingly promoted as a potential solution to address access barriers; however, there is scant literature on how to best implement them with migrant and refugee populations. Our aim was to explore with service providers and consumers the barriers, enablers, and experiences with Hubs and the resulting building blocks required for acceptable Hub implementation for migrant and refugee families.

          Design, Setting and Participants

          This project was undertaken in Sydney, New South Wales, in communities characterised by cultural diversity. In this qualitative study, we used semi‐structured interviews guided by the consolidated framework for implementation research, with service providers from health and social services (32 participants) and migrant and refugee parents (14 parents) of children who had accessed Hubs.

          Research and Discussion

          Our initial qualitative data themes were developed into step‐by‐step building blocks, representing a way to address contextual determinants to establish and sustain a Hub that can support migrant and refugee families. These include the setting‐up phase activities of buy‐in and partnership development, which outlines mechanisms to foster collective action and collaboration between health and social services. Following this, our orientation model articulates the need to establish Hub coordination and navigation, activities that enhance a Hub's relevance for migrant and refugee families and ongoing integration mechanisms, such as engagement of same‐language general practitioners. This is the first study to explore the building blocks required for acceptable Hub implementation to meet the needs of migrant and refugee families in the first 2000 days of a child's life—a critical time to optimise child development and health.

          Patient or Public Contribution

          The research questions were developed based on qualitative research undertaken with Hub participants, community members, and service providers. The original investigator team had a consumer representative who has since relocated and consultation was undertaken with local Hub partner services. The researchers also consulted multicultural health services, including cultural support workers, to ensure research materials were culturally nuanced. Patients or participants have not directly been involved in the current study design.

          Clinical Trial Registration

          This trial was registered with the Australian New Zealand Clinical Trials (ACTRN12621001088831).

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          Most cited references49

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          Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science

          Background Many interventions found to be effective in health services research studies fail to translate into meaningful patient care outcomes across multiple contexts. Health services researchers recognize the need to evaluate not only summative outcomes but also formative outcomes to assess the extent to which implementation is effective in a specific setting, prolongs sustainability, and promotes dissemination into other settings. Many implementation theories have been published to help promote effective implementation. However, they overlap considerably in the constructs included in individual theories, and a comparison of theories reveals that each is missing important constructs included in other theories. In addition, terminology and definitions are not consistent across theories. We describe the Consolidated Framework For Implementation Research (CFIR) that offers an overarching typology to promote implementation theory development and verification about what works where and why across multiple contexts. Methods We used a snowball sampling approach to identify published theories that were evaluated to identify constructs based on strength of conceptual or empirical support for influence on implementation, consistency in definitions, alignment with our own findings, and potential for measurement. We combined constructs across published theories that had different labels but were redundant or overlapping in definition, and we parsed apart constructs that conflated underlying concepts. Results The CFIR is composed of five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. Eight constructs were identified related to the intervention (e.g., evidence strength and quality), four constructs were identified related to outer setting (e.g., patient needs and resources), 12 constructs were identified related to inner setting (e.g., culture, leadership engagement), five constructs were identified related to individual characteristics, and eight constructs were identified related to process (e.g., plan, evaluate, and reflect). We present explicit definitions for each construct. Conclusion The CFIR provides a pragmatic structure for approaching complex, interacting, multi-level, and transient states of constructs in the real world by embracing, consolidating, and unifying key constructs from published implementation theories. It can be used to guide formative evaluations and build the implementation knowledge base across multiple studies and settings.
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            Migrants’ and refugees’ health status and healthcare in Europe: a scoping literature review

            Background There is increasing attention paid to the arrival of migrants from outwith the EU region to the European countries. Healthcare that is universally and equably accessible needs to be provided for these migrants throughout the range of national contexts and in response to complex and evolving individual needs. It is important to look at the evidence available on provision and access to healthcare for migrants to identify barriers to accessing healthcare and better plan necessary changes. Methods This review scoped 77 papers from nine European countries (Austria, Cyprus, France, Germany, Greece, Italy, Malta, Spain, and Sweden) in English and in country-specific languages in order to provide an overview of migrants’ access to healthcare. The review aims at identifying what is known about access to healthcare as well as healthcare use of migrants and refugees in the EU member states. The evidence included documents from 2011 onwards. Results The literature reviewed confirms that despite the aspiration to ensure equality of access to healthcare, there is evidence of persistent inequalities between migrants and non-migrants in access to healthcare services. The evidence shows unmet healthcare needs, especially when it comes to mental and dental health as well as the existence of legal barriers in accessing healthcare. Language and communication barriers, overuse of emergency services and underuse of primary healthcare services as well as discrimination are described. Conclusions The European situation concerning migrants’ and refugees’ health status and access to healthcare is heterogeneous and it is difficult to compare and draw any firm conclusions due to the scant evidence. Different diseases are prioritised by different countries, although these priorities do not always correspond to the expressed needs or priorities of the migrants. Mental healthcare, preventive care (immunization) and long-term care in the presence of a growing migrant older population are identified as priorities that deserve greater attention. There is a need to improve the existing data on migrants’ health status, needs and access to healthcare to be able to tailor care to the needs of migrants. To conduct research that highlights migrants’ own views on their health and barriers to access to healthcare is key.
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              Perinatal health outcomes and care among asylum seekers and refugees: a systematic review of systematic reviews

              Background Global migration is at an all-time high with implications for perinatal health. Migrant women, especially asylum seekers and refugees, represent a particularly vulnerable group. Understanding the impact on the perinatal health of women and offspring is an important prerequisite to improving care and outcomes. The aim of this systematic review was to summarise the current evidence base on perinatal health outcomes and care among women with asylum seeker or refugee status. Methods Twelve electronic database, reference list and citation searches (1 January 2007–July 2017) were carried out between June and July 2017. Quantitative and qualitative systematic reviews, published in the English language, were included if they reported perinatal health outcomes or care and clearly stated that they included asylum seekers or refugees. Screening for eligibility, data extraction, quality appraisal and evidence synthesis were carried out in duplicate. The results were summarised narratively. Results Among 3415 records screened, 29 systematic reviews met the inclusion criteria. Only one exclusively focussed on asylum seekers; the remaining reviews grouped asylum seekers and refugees with wider migrant populations. Perinatal outcomes were predominantly worse among migrant women, particularly mental health, maternal mortality, preterm birth and congenital anomalies. Access and use of care was obstructed by structural, organisational, social, personal and cultural barriers. Migrant women’s experiences of care included negative communication, discrimination, poor relationships with health professionals, cultural clashes and negative experiences of clinical intervention. Additional data for asylum seekers and refugees demonstrated complex obstetric issues, sexual assault, offspring mortality, unwanted pregnancy, poverty, social isolation and experiences of racism, prejudice and stereotyping within perinatal healthcare. Conclusions This review identified adverse pregnancy outcomes among asylum seeker and refugee women, representing a double burden of inequality for one of the most globally vulnerable groups of women. Improvements in the provision of perinatal healthcare could reduce inequalities in adverse outcomes and improve women’s experiences of care. Strategies to overcome barriers to accessing care require immediate attention. The systematic review evidence base is limited by combining heterogeneous migrant, asylum seeker and refugee populations, inconsistent use of definitions and limited data on some perinatal outcomes and risk factors. Future research needs to overcome these limitations to improve data quality and address inequalities. Systematic registration Systematic review registration number: PROSPERO CRD42017073315. Electronic supplementary material The online version of this article (10.1186/s12916-018-1064-0) contains supplementary material, which is available to authorized users.
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                Author and article information

                Contributors
                michael.hodgins1@unsw.edu.au
                Journal
                Health Expect
                Health Expect
                10.1111/(ISSN)1369-7625
                HEX
                Health Expectations : An International Journal of Public Participation in Health Care and Health Policy
                John Wiley and Sons Inc. (Hoboken )
                1369-6513
                1369-7625
                10 January 2025
                February 2025
                : 28
                : 1 ( doiID: 10.1111/hex.v28.1 )
                : e70082
                Affiliations
                [ 1 ] Population Child Health Research Group School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales Sydney Australia
                [ 2 ] Community Paediatrics Research Group Faculty of Medicine and Health, The University of Sydney Sydney Australia
                [ 3 ] Child, Youth and Family Services Population and Community Health, South Eastern Sydney Local Health District Sydney Australia
                [ 4 ] Counterpoint Consulting Pty Ltd Sydney Australia
                [ 5 ] Health Economics, Psychiatry and Mental Health University of New South Wales Sydney Australia
                [ 6 ] Translational Health Research Institute Western Sydney University Sydney Australia
                [ 7 ] UNSW Medicine and Health University of New South Wales Sydney Australia
                [ 8 ] Child, Youth and Family Primary and Community Health, North Sydney Local Health District Sydney Australia
                [ 9 ] School of Business, Western Sydney University Sydney Australia
                [ 10 ] Discipline of Psychiatry and Mental Health/School of Clinical Medicine, UNSW Medicine & Health University of New South Wales Sydney Australia
                [ 11 ] Academic Unit of Infant Child and Adolescent Psychiatry Services, South Western Sydney Local Health District Sydney Australia
                [ 12 ] Transforming early Education and Child Health (TeEACH) Western Sydney University Sydney Australia
                [ 13 ] School of Clinical Medicine, Discipline of Psychiatry and Mental Health University of New South Wales Sydney Australia
                [ 14 ] Neuroscience Research Australia Sydney Australia
                [ 15 ] Discipline of Women's Health, School of Clinical Medicine, UNSW Medicine and Health University of New South Wales Sydney Australia
                [ 16 ] University of Technology Sydney Sydney Australia
                [ 17 ] University of Stellenbosch Stellenbosch South Africa
                [ 18 ] Ingham Institute for Applied Medical Research Western Sydney University Sydney Australia
                [ 19 ] Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Medicine and Health University of New South Wales Sydney Australia
                [ 20 ] Karitane Sydney Australia
                [ 21 ] Community Paediatrics South Western Sydney Local Health District Sydney Australia
                [ 22 ] NSW Agency for Clinical Innovation Sydney Australia
                [ 23 ] Sydney Institute Women, Children and their Families Sydney Australia
                [ 24 ] Community Paediatrics, Sydney Local Health District Sydney Australia
                Author notes
                [*] [* ] Correspondence: Michael Hodgins ( michael.hodgins1@ 123456unsw.edu.au )

                Author information
                http://orcid.org/0000-0001-9177-3428
                https://orcid.org/0000-0001-6436-4936
                https://orcid.org/0000-0002-9959-2442
                https://orcid.org/0000-0002-2520-8890
                http://orcid.org/0000-0001-5767-1794
                https://orcid.org/0000-0001-6296-8306
                https://orcid.org/0000-0002-7812-8077
                https://orcid.org/0000-0002-9361-4874
                https://orcid.org/0000-0002-7351-8922
                https://orcid.org/0000-0003-2149-5834
                https://orcid.org/0000-0002-8601-3587
                https://orcid.org/0000-0001-6202-6685
                https://orcid.org/0000-0002-4546-3231
                https://orcid.org/0000-0002-6954-5071
                Article
                HEX70082
                10.1111/hex.70082
                11721473
                39792575
                34394563-abd2-410c-aa38-b530dd25db60
                © 2025 The Author(s). Health Expectations published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 18 June 2024
                : 09 February 2024
                : 12 October 2024
                Page count
                Figures: 1, Tables: 0, Pages: 10, Words: 7560
                Funding
                Funded by: This project was funded by the NSW Health Translational Research Grants Scheme. In kind support was also provided by the Early Life Determinants of Health Group, Maridulu Budyari Gumal, the Sydney Partnership for Health, Education, Research and Enterprise (SPHERE).
                Categories
                Original Article
                Original Article
                Custom metadata
                2.0
                February 2025
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.5.2 mode:remove_FC converted:10.01.2025

                Health & Social care
                child and family health,child development,continuity of care,culturally and linguistically diverse,health services,infant health,migrants,resources for child health

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