School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
BMJ Open. 2024 Sep 20;14(9):e083454. doi: 10.1136/bmjopen-2023-083454.
Refugees resettled in Australia may experience significant physical, mental and emotional health issues on arrival and difficulty accessing mainstream healthcare that often demands specialised services. It is not known if and how refugee health needs and service use change over time and generations, how this compares with the broader Australian population and what level of resourcing is required to maintain specialised services. There is also a significant knowledge gap concerning the resources and skills of refugees that can be harnessed to sustain the health and well-being of individuals and communities. Such knowledge gaps impede the ability of the health system to deliver responsive, efficient, acceptable and cost-effective care and services and limit the engagement of refugees in the coproduction of these services.
This study will be the first to provide comprehensive, longitudinal, population-based evidence of refugee health, service use and the accumulated resources or assets related to positive health and well-being (compared with data on deficits, illness and death) across the lifespan and generations. This will enable a comprehensive understanding of the relationships among assets, health status, service gaps and behaviours. We will identify the assets contributing to increased capacities to protect and promote health. This evidence is essential for planning health prevention programmes.This project has three phases: (1) employ national linked datasets to examine the health and social outcomes of refugees in Australia; (2) engage with refugees in a participatory manner to map the social, economic, organisational, physical and cultural assets in their communities and deliver an integrated model of health; and (3) codesign a roadmap of agreed actions required to attain health and well-being in communities and indicators to assess outcomes.
Ethics and procedures-phase I:Ethical approval for phase I was gained from the Australian Bureau of Statistics (ABS) for Person Level Integrated Data Asset microdata (unit record data) via the ABS DataLab and the NSW Population and Health Services Research Ethics Committee (2023ETH01728), which can provide a single review of multijurisdictional data linkage research projects under the National Mutual Acceptance Scheme. This will facilitate approval for the Victorian and ACT datasets. The ABS will be the integrating/linkage authority. The Centre for Health Record Linkage (CHeReL) and the Victorian Data Linkage Unit will prepare a data extract representing all data records from the dataset to provide to the ABS for linkage.Ethics and procedures-phases 2 and 3:Written consent will be obtained from all participants, as well as consent to publish. We have obtained ethical approval from the University of Technology Sydney Medical Research Ethics Committee; however, as we deepen our consultation with community members and receive input from expert stakeholders, we will likely seek amendments to hone the survey and World Café questions. We will also need to provide flexible offerings that may extend to individual interviews and online interactions.
This innovative approach will empower refugees and put them at the centre of their health and decision-making.
在澳大利亚重新安置的难民在抵达时可能会经历重大的身体、心理和情感健康问题，并且难以获得通常需要专门服务的主流医疗保健。目前尚不清楚难民的健康需求和服务使用是否会随着时间的推移和代际变化而变化，以及与更广泛的澳大利亚人口相比如何，以及维持专门服务需要多少资源。此外，关于难民可以利用哪些资源和技能来维持个人和社区的健康和福祉，这方面也存在着重大的知识差距。这些知识差距阻碍了卫生系统提供响应迅速、高效、可接受和具有成本效益的护理和服务的能力，并限制了难民参与这些服务的共同生产。
这项研究将首次提供全面、纵向、基于人群的难民健康、服务使用以及与积极健康和福祉相关的累积资源或资产的证据（与缺陷、疾病和死亡数据相比）跨越整个生命周期和世代。这将使我们能够全面了解资产、健康状况、服务差距和行为之间的关系。我们将确定有助于提高保护和促进健康能力的资产。这些证据对于规划健康预防计划至关重要。该项目有三个阶段：（1）利用国家链接数据集来研究澳大利亚难民的健康和社会结果；（2）以参与式的方式与难民合作，绘制他们社区的社会、经济、组织、物理和文化资产图，并提供健康综合模式；（3）共同设计实现社区健康和福祉所需的商定行动路线图和评估结果的指标。
第一阶段的伦理和程序：第一阶段的伦理批准已通过澳大利亚统计局 (ABS) 通过 ABS DataLab 和新南威尔士州人口和卫生服务研究伦理委员会（2023ETH01728）获得个人层面综合数据资产微观数据（单位记录数据），这可以为国家相互接受计划下的多司法管辖区数据链接研究项目提供单一审查。这将促进对维多利亚州和 ACT 数据集的批准。ABS 将是整合/链接权威机构。健康记录链接中心 (CHeReL) 和维多利亚州数据链接部门将准备一个代表数据集所有数据记录的数据提取，以供 ABS 链接。第二和第三阶段的伦理和程序：将从所有参与者那里获得书面同意，以及发表同意。我们已获得悉尼科技大学医学研究伦理委员会的伦理批准；然而，随着我们与社区成员进行深入协商并收到专家利益相关者的意见，我们可能会寻求修订以完善调查和世界咖啡屋的问题。我们还将需要提供灵活的服务，可能包括个人访谈和在线互动。
这种创新方法将赋予难民权力，使他们成为自己健康和决策的中心。
