Social Policy Research Centre, University of New South Wales, Sydney, NSW, 2052, Australia.
Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, 2052, Australia.
BMC Public Health. 2023 Dec 21;23(1):2557. doi: 10.1186/s12889-023-17448-z.
Primary health care [PHC] services with general practitioners (GPs) as the first point of access to health care services for people from refugee backgrounds in Australia can play a crucial role in building health literacy and promoting access to culturally appropriate services. To achieve equitable access and engagement, services and systems must be responsive to diverse health literacy and cultural needs. This study aims to explore how primary health services respond as a system and organisation to the health literacy and cultural needs of people from refugee backgrounds in Australia.
This exploratory qualitative study involved 52 semi-structured interviews among 19 Africans from refugee backgrounds, 14 service providers, including GPs and nurses, and 19 other stakeholders, such as service managers/directors. Participants resided in New South Wales, Victoria, and Queensland. Interviews were audio-recorded, transcribed, and coded into QSR NVivo 12. Data analysis was guided by reflexive thematic analysis.
Three interrelated themes were identified from the data relating to the health literacy and cultural responsiveness of PHC systems and services. The first theme, 'variable and ad hoc organisational response to health literacy and culturally responsive care,' demonstrated that some organisations did not systematically address the inherent complexity of navigating the health system nor the capacity of services and providers to respond to the cultural needs of people from refugee backgrounds. The second theme, 'individual provider responsibility,' captured the individual providers' interpersonal and relational efforts in supporting the health literacy and cultural needs of people from refugee backgrounds based on their motivation and adaptation. The third theme, 'refugee patient responsibility,' encapsulated people from refugee backgrounds' adaptations to and learning of the health system to navigate and access services.
Health literacy and culturally responsive practices need to be systematised by PHC organisations to be implemented and sustained over time. There is a need for diversity in the organisational leadership and health care workforce, organisational commitment, health literacy and culturally responsive care policies, provider training, and auditing practice as essential components of the change process. Engaging with refugee communities would allow services to focus on people from refugee backgrounds' needs by design.
在澳大利亚，以全科医生（GP）为第一接触点的初级卫生保健（PHC）服务可以在提高健康素养和促进获得文化上合适的服务方面发挥关键作用。为了实现公平获得服务和参与，服务和系统必须对不同的健康素养和文化需求做出反应。本研究旨在探讨澳大利亚的初级卫生服务如何作为一个系统和组织来满足难民背景人群的健康素养和文化需求。
这是一项探索性的定性研究，在新南威尔士州、维多利亚州和昆士兰州，对 19 名来自难民背景的非洲人、14 名服务提供者（包括全科医生和护士）和 19 名其他利益相关者（如服务经理/主管）进行了 52 次半结构化访谈。访谈进行了录音、转录，并使用 QSR NVivo 12 进行了编码。数据分析遵循反思性主题分析。
从数据中确定了与初级卫生保健系统和服务的健康素养和文化响应能力相关的三个相互关联的主题。第一个主题是“PHC 系统和服务对健康素养和文化响应性护理的可变和临时组织反应”，表明一些组织没有系统地解决在卫生系统中导航的固有复杂性，也没有解决服务和提供者应对难民背景人群文化需求的能力。第二个主题是“个体提供者的责任”，体现了个体提供者基于动机和适应，在支持难民背景人群的健康素养和文化需求方面所做的人际和关系努力。第三个主题是“难民患者的责任”，概括了难民背景人群为了在卫生系统中导航和获得服务而进行的适应和学习。
PHC 组织需要将健康素养和文化响应实践系统化，以便随着时间的推移得到实施和维持。组织领导和医疗保健劳动力、组织承诺、健康素养和文化响应性护理政策、提供者培训和审计实践的多样性是变革过程的必要组成部分。与难民社区接触将使服务能够通过设计关注难民背景人群的需求。
