Search

Background: As almost half of all refugees currently under United Nations protection are from Afghanistan or Iraq and significant numbers have already been resettled outside the region of origin, it is likely that future research will examine their resettlement needs. A number of methodological challenges confront researchers working with culturally and linguistically diverse groups; however, few detailed articles are available to inform other studies. The aim of this paper is to outline challenges with sampling and recruitment of socially invisible refugee groups, describing the method adopted for a mixed methods exploratory study assessing mental health, subjective wellbeing and resettlement perspectives of Afghan and Kurdish refugees living in New Zealand and Australia. Sampling strategies used in previous studies with similar refugee groups were considered before determining the approach to recruitment Methods: A snowball approach was adopted for the study, with multiple entry points into the communities being used to choose as wide a range of people as possible to provide further contacts and reduce selection bias. Census data was used to assess the representativeness of the sample. Results: A sample of 193 former refugee participants was recruited in Christchurch (n = 98) and Perth (n = 95), 47% were of Afghan and 53% Kurdish ethnicity. A good gender balance (males 52%, females 48%) was achieved overall, mainly as a result of the sampling method used. Differences in the demographic composition of groups in each location were observed, especially in relation to the length of time spent in a refugee situation and time since arrival, reflecting variations in national humanitarian quota intakes. Although some measures were problematic, Census data comparison to assess reasonable representativeness of the study sample was generally reassuring. Conclusions: Snowball sampling, with multiple initiation points to reduce selection bias, was necessary to locate and identify participants, provide reassurance and break down barriers. Personal contact was critical for both recruitment and data quality, and highlighted the importance of interviewer cultural sensitivity. Cross-national comparative studies, particularly relating to refugee resettlement within different policy environments, also need to take into consideration the differing pre-migration experiences and time since arrival of refugee groups, as these can add additional layers of complexity to study design and interpretation. [ABSTRACT FROM AUTHOR]

Background: Afghan and Iraqi refugees comprise nearly half of all those currently under United Nations protection. As many of them will eventually be resettled in countries outside the region of origin, their long term health and settlement concerns are of relevance to host societies, and will be a likely focus for future research. Since Australia and New Zealand have both accepted refugees for many years and have dedicated, but different settlement and immigration policies, a study comparing the resettlement of two different refugee groups in these countries was undertaken. The purpose of this article is to describe the instrument selection for this study assessing mental health and psychological well being with Afghan and Kurdish former refugees, in particular to address linguistic considerations and translated instrument availability. A summary of instruments previously used with refugee and migrant groups from the Middle East region is presented to assist other researchers, before describing the three instruments ultimately selected for the quantitative component of our study. Findings: The Kessler-10 Psychological Distress Scale (K10), General Perceived Self-Efficacy Scale (GPSE), and Personal Well-Being Index (PWI) all showed good reliability (Cronbach's alphas of 0.86, 0.89 and 0.83 respectively for combined language versions) and ease of use even for pre-literate participants, with the sample of 193 refugees, although some concepts in the GPSE proved problematic for a small number of respondents. Farsi was the language of choice for the majority of Afghan participants, while most of the Kurds chose to complete English versions in addition to Farsi. No one used Arabic or Turkish translations. Participants settled less than ten years were more likely to complete questionnaires in Farsi. Descriptive summary statistics are presented for each instrument with results split by gender, refugee group and language version completed. Conclusion: This paper discusses instrument selection for Farsi and Arabic speaking refugee participants from the Middle East and Afghanistan, concluding that the Kessler-10, GPSE scale and PWI were suitable for use with these groups. Suitable language translations are freely available. Our experience with these instruments may help inform other studies with these vulnerable groups. [ABSTRACT FROM AUTHOR]

Background: Indigenous peoples in developed countries have reduced life expectancies, particularly from chronic diseases. The lack of access to and take up of palliative care services of Indigenous peoples is an ongoing concern. Objectives: To examine and learn from published studies on provision of culturally safe palliative care service delivery to Indigenous people in Australia, New Zealand (NZ), Canada and the United States of America (USA); and to compare Indigenous peoples' preferences, needs, opportunities and barriers to palliative care. Methods: A comprehensive search of multiple databases was undertaken. Articles were included if they were published in English from 2000 onwards and related to palliative care service delivery for Indigenous populations; papers could use quantitative or qualitative approaches. Common themes were identified using thematic synthesis. Studies were evaluated using Daly's hierarchy of evidence-for-practice in qualitative research. Results: Of 522 articles screened, 39 were eligible for inclusion. Despite diversity in Indigenous peoples' experiences across countries, some commonalities were noted in the preferences for palliative care of Indigenous people: to die close to or at home; involvement of family; and the integration of cultural practices. Barriers identified included inaccessibility, affordability, lack of awareness of services, perceptions of palliative care, and inappropriate services. Identified models attempted to address these gaps by adopting the following strategies: community engagement and ownership; flexibility in approach; continuing education and training; a whole-of-service approach; and local partnerships among multiple agencies. Better engagement with Indigenous clients, an increase in number of palliative care patients, improved outcomes, and understanding about palliative care by patients and their families were identified as positive achievements. Conclusions: The results provide a comprehensive overview of identified effective practices with regards to palliative care delivered to Indigenous populations to guide future program developments in this field. Further research is required to explore the palliative care needs and experiences of Indigenous people living in urban areas. [ABSTRACT FROM AUTHOR]

Background: The epidemiology of atrial fibrillation (AF) among Indigenous minorities in affluent countries is poorly delineated, despite the high cardiovascular disease burden in these populations. We undertook a systematic scoping review examining the epidemiology of AF in the Indigenous populations of Australia, Canada, New Zealand (NZ) and the United States (US)., Methods: PubMed, Scopus, EMBASE and CINAHL-Plus databases were systematically searched in May 2014. Supplementary full-text searches of Google Scholar and government website searches were also undertaken., Results: Key findings from 27 publications with diverse aims and methods were included. Small studies from Canada and NZ suggest higher AF prevalence in Indigenous than other populations. However, this was not reflected in a large sample of US male military veterans. No data were identified on community-based incidence rates of AF in Indigenous populations. Australian and Canadian studies indicate higher first-ever and overall AF hospitalisation rates among Indigenous than other populations, at younger ages and with more comorbidity. Studies in stroke, heart failure and other clinical groups demonstrate AF as a common comorbidity, with AF possibly more prevalent at younger ages in Indigenous people. Indigenous patients have similar early post-hospitalisation adjusted mortality but higher 1-year risk-adjusted mortality than non-Indigenous patients., Conclusions: No clear epidemiological pattern of AF frequency across the considered Indigenous populations emerges from the limited available evidence. AF should be included in key conditions reported in national surveillance reports, although Indigenous identifiers are required in administrative data from Canada and the US. Sufficiently powered, community-based studies of AF epidemiology in diverse Indigenous populations are needed.

As self efficacy beliefs help determine an individual's response to challenging situations, we explored the impact of the refugee experience on efficacy beliefs and their contribution to resettlement. General self efficacy (GSE) was assessed in 186 resettled Afghan and Kurdish refugees against a range of personal and temporal variables. Although no differences in GSE in relation to temporal factors were noted, significant relationships between self efficacy, lower psychological distress and higher subjective well being were evident. The findings suggest that GSE, because of its positive association with mental health and well being, is a variable worthy of further examination in refugees. In addition to ensuring a supportive environment for learning English, proactive employment strategies should be encouraged. Further research examining the use of successful refugee role models to promote self efficacy, enhance motivation for learning and ensure newly arrived refugees view resettlement as a challenge, rather than a threat, is recommended.

Objective: To examine the resettlement experiences and provide data of well being and psychological distress for Afghan and Kurdish refugees settled between eight and 20 years in New Zealand and Australia., Methods: Participants completed the Kessler-10 Psychological Distress Scale (K10) and Personal Well Being Index (PWI) for subjective well being. A mixed methods approach was used, with participants also discussing during interview resettlement difficulties, quality of life (QOL) and sources of stress., Results: Data from 81 Muslim participants is reported; all spoke English, were generally well educated with 88% having secondary or tertiary level education, and the majority of those resettled before 2001 lived in Perth. Although psychological distress levels were mostly within the low-moderate risk range, significant differences were observed by gender and employment status. Participants identified a range of ongoing stressors with unemployment of particular concern. Social isolation and a sense that they would never really 'fit in' was also reported by some. Participants particularly valued the safety and improved quality of life in their host communities., Conclusions: Despite their appreciation of the overall resettlement experience, too much time to introspect, separation from family, status dissonance and still occasionally feeling overwhelmed by resettlement challenges is a long-term ongoing reality for some former refugees., Implications: Former refugees continue to struggle with unemployment, possible discrimination and loss of status long-term., (© 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia.)

Indigenous people throughout the world suffer a higher burden of disease than their non-indigenous counterparts contributing to disproportionate rates of disability. A significant proportion of this disability can be attributed to the adverse effects of smoking. In this paper, we aimed to identify and discuss the key elements of individual-level smoking cessation interventions in indigenous people worldwide. An integrative review of published peer-reviewed literature was conducted. Literature on smoking cessation interventions in indigenous people was identified via search of electronic databases. Documents were selected for review if they were published in a peer-reviewed journal, written in English, published from 1990-2010, and documented an individual-level intervention to assist indigenous people to quit smoking. Studies that met inclusion criteria were limited to Australia, New Zealand, Canada, and the USA, despite seeking representation from other indigenous populations. Few interventions tailored for indigenous populations were identified and the level of detail included in evaluation reports was variable. Features associated with successful interventions were integrated, flexible, community-based approaches that addressed known barriers and facilitators to quitting smoking. More tailored and targeted approaches to smoking cessation interventions for indigenous populations are required. The complexity of achieving smoking cessation is underscored as is the need to collaboratively develop interventions that are acceptable and appropriate to local populations.

Objective: Cancer among Indigenous populations in the developed world appears to have increased over past few decades. This article explores issues related to cancer among the Indigenous populations of Australia, Canada, New Zealand and the US and examines variations in the epidemiology, Indigenous peoples' perceptions about cancer and potential effects on care-seeking behaviour., Methods: A search of peer-reviewed journal articles, government reports, published and unpublished theses and other grey literature was undertaken using electronic databases and citation snowballing. Both epidemiological and qualitative studies were included., Results: Cancer in Indigenous populations in these four countries is characterised by high incidence and mortality rates for specific cancers and lower survival rates as a result of late diagnosis, lower participation and poorer compliance with treatment. A higher prevalence of many cancer risk factors occurs across these populations. Fear of death, fatalism, payback, shame and other spiritual and cultural issues are reported in the few qualitative studies examining Indigenous beliefs and understanding of cancer which undoubtedly influences participation in cancer screening and treatment., Conclusions and Implications: The holistic approach (physical, mental, emotional and spiritual) to healing and well-being, and the concept that individual, family and community are inseparable underpin Indigenous care-seeking behaviour. Further community-based research is needed to increase understanding of the needs of Indigenous people with cancer, and to guide policy and practice towards more supportive and effective care.