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In an attempt to reduce the rates of stillbirth at term among South-Asian born women, Victoria's largest maternity service, Monash Health, implemented a new clinical guideline in 2017 that recommended additional earlier, twice weekly monitoring to assess fetal wellbeing from 39 weeks for South-Asian women. In acknowledging the importance of woman centred, culturally responsive care, this study aimed to understand South-Asian women's, experiences, of the additional earlier fetal monitoring.An exploratory qualitative study was conducted using semi-structured phone interviews six weeks postpartum, across June and July 2021, with South-Asian born women who underwent the earlier monitoring from 39 weeks. Women were asked questions regarding their understanding of the monitoring, their experiences of the monitoring process and any impact the monitoring or results had on their pregnancy, labour and birth. Interviews were recorded and transcribed verbatim. Data were analysed using a thematic approach and an inductive coding strategy.Seventeen women from India, Sri Lanka, Pakistan and Afghanistan were interviewed. the main themes were i: gaining peace of mind, need for better communication, did the women really have a choice? and comparisons to maternity care in the country of origin. Women experienced positive reassurance of their baby's well-being from the monitoring and were happy with the earlier, extra care. However, women described receiving variable explanations of the purpose of the monitoring. Ineffective communication and logistical barriers were highlighted to negatively impact women's ability to engage in shared decision making and their overall experience of the earlier monitoring.The additional monitoring is reported by these women to have an overall positive impact on their maternity care. Future work should explore the experiences of non-English speaking South-Asian women and those who declined monitoring.

The COVID-19 pandemic has deeply impacted patient and family communication and patient- and family-centred care in the intensive care unit (ICU). A new role-the ICU Family Liaison Nurse (FLN)-was introduced in an Australian metropolitan hospital ICU to facilitate communication between patient and family and ICU healthcare professionals, although there is limited knowledge about the impact of this from the ICU healthcare professionals' perspectives.The aim of this study was to explore the impact of the ICU FLN role on communication with patients and their family during the COVID-19 pandemic, from the ICU healthcare professionals' perspectives.A qualitative descriptive study was conducted. Seven participants including ICU FLNs, ICU doctors, nurses, and social workers who worked with the ICU FLNs were interviewed. Thematic analysis was used to analyse the data.Two main themes related to the ICU FLN role were identified. First, the COVID-19 pandemic posed challenges to patient and family communication, but it also created opportunities to improve patient and family communication. Second, the ICU FLN role brought beneficial impacts to the ICU healthcare professionals' workflow and work experience, as well as patient and family communication. The ICU FLN role has potential benefits that extend beyond the pandemic.We found that during the COVID-19 pandemic, the ICU FLN role was acceptable, beneficial, and appreciated from the ICU healthcare professionals' perspectives. Further research should continue the evaluation of the ICU FLN role during and post the pandemic.

Objective The COVID-19 pandemic has seen a rapid adoption of telehealth consultations, potentially creating new barriers to healthcare access for racial/ethnic minorities. This systematic review explored the use of telehealth consultations for people from racial/ethnic minority populations in relation to health outcomes, access to care, implementation facilitators and barriers, and satisfaction with care. Materials and Methods This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis and the Joanna Briggs Institute Manual for Evidence Synthesis. Five major databases were searched to identify relevant studies. Screening, full-text review, quality appraisal, and data extraction were all completed independently and in duplicate. A convergent integrated approach to data synthesis was applied with findings reported narratively. Results A total of 28 studies met the inclusion criteria. Telehealth-delivered interventions were mostly effective for the treatment/management of physical and mental health conditions including depression, diabetes, and hypertension. In several studies, telehealth improved access to care by providing financial and time benefits to patients. Technological difficulties were the main barriers to effective telehealth consultation, although overall satisfaction with telehealth-delivered care was high. Discussion Telehealth-delivered care for racial/ethnic minorities offers promise across a range of conditions and outcomes, particularly when delivered in the patient’s preferred language. However, telehealth may be problematic for some due to cost and limited digital and health literacy. Conclusion The development and implementation of guidelines, policies, and practices in relation to telehealth consultations for racial/ethnic minorities should consider the barriers and facilitators identified in this review to ensure existing health disparities are not exacerbated.

Settler colonisation continues to cause much damage across the globe. It has particularly impacted negatively on Indigenous peoples' health and wellbeing causing great inequity. Health professional education is a critical vehicle to assist in addressing this; however, non-Indigenous educators often feel unprepared and lack skill in this regard. In this qualitative study, 20 non-Indigenous nursing, physiotherapy and occupational therapy educators in Australia were interviewed about their experiences and perspectives of teaching Indigenous health. Findings from the inductive thematic analysis suggest educators require skill development to: identify their discomfort in teaching cultural safety; contextualise the sources of this discomfort and; reflect on how this understanding can improve their teaching. Additionally, educators require professional training to become practitioners of cultural humility and to be facilitators and colearners (rather than experts) of the Aboriginal-led curriculum. Of relevance to this is educator training in how to decentre non-Indigenous needs and perspectives. Educators can also renew their teaching practices by understanding what a dominant settler paradigm is, identifying if this is problematically present in their teaching and knowing how to remedy this. Crucial to improved cultural safety teaching is institutional support, which includes Indigenous leadership, institutional commitment, relevant policies, and well-designed professional development.

Anatomy educators are often at the forefront of adopting innovative and advanced technologies for teaching, such as artificial intelligence (AI). While AI offers potential new opportunities for anatomical education, hard lessons learned from the deployment of AI tools in other domains (e.g., criminal justice, healthcare, and finance) suggest that these opportunities are likely to be tempered by disadvantages for at least some learners and within certain educational contexts. From the perspectives of an anatomy educator, public health researcher, medical ethicist, and an educational technology expert, this article examines five tensions between the promises and the perils of integrating AI into anatomy education. These tensions highlight the ways in which AI is currently ill-suited for incorporating the uncertainties intrinsic to anatomy education in the areas of (1) human variations, (2) healthcare practice, (3) diversity and social justice, (4) student support, and (5) student learning. Practical recommendations for a considered approach to working alongside AI in the contemporary (and future) anatomy education learning environment are provided, including enhanced transparency about how AI is integrated, AI developer diversity, inclusion of uncertainty and anatomical variations within deployed AI, provisions made for educator awareness of AI benefits and limitations, building in curricular "AI-free" time, and engaging AI to extend human capacities. These recommendations serve as a guiding framework for how the clinical anatomy discipline, and anatomy educators, can work alongside AI, and develop a more nuanced and considered approach to the role of AI in healthcare education.

Background In the International Year of the Nurse and Midwife 2020, nurses in Australia and around the world are being encouraged to lend their voices to lead change. The COVID-19 global health crisis has highlighted the critical role of nurses in our community in ensuring that the challenges to our health care system are being met and overcome. It has also brought attention to existing health inequities in our community, in particular the poorer health of refugees, some culturally and linguistically diverse communities and Aboriginal and Torres Strait Islander peoples. Aim To call on nurses and nurse leaders to take greater action to improve health equity. Methods This paper presents a discussion with regard to the importance of equitable and safe clinical practice and the urgent need to address organisational and system-level barriers to the provision of equitable health care. Findings Clinicians’ abilities and capacities to provide equitable care is ultimately shaped by health care organisations and the broader historical, political, social and economic context of our community. Discussion Equity should not only be reflected in clinical practice, but also in organisational policies and procedures, embedded in key performance indicators and supported by adequate funding and resources. Conclusion Systemic inadequacies are likely to be further amplified during times when the health system is under additional pressure. Nurses and nurse leaders should take this opportunity to reflect upon the integral role they play in addressing organisational and system-level change to ensure equity in health care delivery. We call on nurse leaders and the nursing profession to lead us all to a more equitable health care system and society.

Despite Australia’s and Victoria’s stated commitment to promoting multiculturalism and equality, and to eradicating racism, our knowledge about the nature, extent and impact of different forms of racism on diverse populations is not as well-developed as it should be. Stakeholders addressing racism increasingly recognise that anti-racism initiatives must rely on robust scholarly evidence and high-quality data. Yet existing data have serious limitations. We report on a stocktake review of racism data collected nationally in Australia and with a specific focus on Victoria. We provide a comprehensive overview, summary and synthesis of quantitative data on racism, identify gaps in racism data collection, analysis and uses, and make recommendations on bridging those data gaps and informing anti-racism action and policy. Overall, the review examines data collected by 42 survey-based, quantitative studies, discussed in over 120 publications and study materials, and 13 ongoing data collection initiatives, platforms and projects. Based on the review, we identified eight gaps to racism data collection and analysis and to collection methodologies. We recommend four interconnected ways to fill racism data gaps for anti-racism researchers, organisations and policymakers: 1) Further analyse existing data to address critical questions about racism; 2) Collect and analyse additional data; 3) Enhance data availability and integration; and 4) Improve policies that relate to the collection, analysis, reporting and overall management of racism data.

To examine the prevalence of young childrens’ reported experiences of racial discrimination and to assess whether discriminatory experiences vary by gender, religion and country of birth. Data came from Speak Out Against Racism (SOAR), a cross-sectional study of 4664 public school students in grades 5–9 in two Australian states in 2017. An adaption of the Adolescent Discrimination Distress Index (ADDI), as a measure of discrimination, was used across four Indigenous and ethnic categories (Indigenous, Asian and non-Asian visible minorities, Anglo/European). Effect-measure modification (EMM) examined how experiences of racial discrimination across ethnic groups varied by gender, country of birth and religion. A sizeable proportion (40%) of students reported experiencing racial discrimination. Indigenous, Asian and non-Asian visible minority students reported higher rates of experiencing racial discrimination than their Anglo-European peers. Male students reported higher rates of experiencing racial discrimination than female students. Foreign-born students reported experiencing racial discrimination more often than native-born students, and both Christian and religious minorities experienced racial discrimination more often than students identifying with the dominant “No religion” group. The findings highlight the prevalence of racial discrimination among adolescents and how gender, country of birth and religion can increase risk of these experiences.

Racism is a key driver of the social, political, and economic injustices that cause and maintain health inequities. Over centuries and across continents, racism has become deeply ingrained within societies. Therefore, we believe that it is our professional and ethical obligation as scientists, and public health scholars specifically, to address racism head on in order to ameliorate racialized health disparities. We argue that greater focus is needed on addressing racism rather than race and how race is described or defined. We offer input from public health scholarship to help bioethicists and other scientists contribute to addressing racism. To do so effectively and comprehensively, public health scholars, bioethicists, and other scientists should work together to identify and implement equity-driven collaborations to eliminate the deleterious effects of racism on individuals, families, and communities.

Background: Domestic/family homicide (D/FH) is a global social, economic and public health problem. To date, the research studies into risk factors associated with D/FH has largely focused on intimate partner homicide (IPH). A more contemporary approach recognizes that D/FH extends beyond the intimate partner relationship. This systematic review sought to identify and quantify the individual, relationship, community and societal factors in the empirical evidence literature on D/FH. Methods: Eight electronic databases were searched from January 1999 to December 2020. Published journal articles on studies of D/FH were included if the study included victims and/or perpetrator of D/FH, reported risk and/or protective factors associated with D/FH, reported primary data and was published in English. Factors were descriptively synthesized by the categories of the social ecological model and D/FH sub-type. Results: Three hundred and forty published articles met the inclusion criteria. From 1999 to 2020 the number of articles on D/FH increased globally from 10 to 40 respectively, declining to 23 in 2020. Almost half of the articles examined populations located in the Americas (160, 47.1%), predominately the United States and the majority of articles used quantitative designs (277, 81.5%). The forms of homicide more commonly studied were intimate partner (171, 50.3%), and filicide (98, 28.8%). Approximately 90% of articles reported individual victim and perpetrator factors, 64.7% examined relationship factors, 17.9% examined community factors and 15.6% examined societal factors. Conclusion: To inform universal and targeted D/FH elimination and prevention strategies, more research across different regions and a greater emphasis on community and societal-level factors is needed.

ObjectiveTo determine the prevalence of direct and vicarious racial discrimination experiences from peer, school and societal sources, and examine associations between these experiences and socioemotional and sleep outcomes.MethodsData were analysed from a population representative cross-sectional study of n=4664 school students in years 5–9 (10–15 years of age) in Australia. Students reported direct experiences of racial discrimination from peers, school and societal sources; vicarious discrimination was measured according to the frequency of witnessing other students experiences of racial discrimination. Students self-reported on the Strengths and Difficulties Questionnaire, with the total difficulties, conduct, emotional and prosocial behaviour subscales examined. Sleep problems included duration, latency, and disruption.Results41.56% (95% CI 36.18 to 47.15) of students reported experiences of direct racial discrimination; Indigenous and ethnic minority students reported the highest levels. 70.15% (95% CI 63.83 to 75.78) of students reported vicarious racial discrimination. Direct and vicarious experiences of racial discrimination were associated with socioemotional adjustment (eg, for total difficulties, total direct racism: beta=3.77, 95% CI 3.11 to 4.44; vicarious racism: beta=2.51, 95% CI 2.00 to 3.03). Strong evidence was also found for an effect of direct and vicarious discrimination on sleep (eg, for sleep duration, total direct: beta=−21.04, 95% CI −37.67 to −4.40; vicarious: beta=−9.82, 95% CI −13.78 to −5.86).ConclusionsExperiences of direct and vicarious racial discrimination are common for students from Indigenous and ethnic minority backgrounds, and are associated with socioemotional and sleep problems in adolescence. Racism and racial discrimination are critically important to tackle as social determinants of health for children and adolescents.

Cardiometabolic disease is a leading cause of adult morbidity and mortality globally. There is considerable evidence that childhood adversity is associated with markers of cardiometabolic disease risk in childhood, including obesity, blood pressure trajectories, and chronic inflammation. Experiences of racial discrimination may be an important, yet under explored, form of childhood adversity influencing childhood cardiometabolic risk. This study aimed to examine associations between self-reported racial discrimination and cardiometabolic risk markers among children. A total of 124 children (73 female) aged 11.4 years (SD 0.71) participated in the study. Most children (n = 79) identified as being from an Indigenous or an ethnic minority background. Markers of cardiometabolic risk were BMI, waist circumference, weight height ratio, systolic and diastolic blood pressure, and five inflammatory markers (C-reactive protein (CRP), Interleukin (IL)-1β, IL-6, IL-8, and TNF-α). Results showed that two or more reported experiences of racial discrimination were associated with increased BMI z-score (Beta 0.58, 95% CI 0.18, 0.99), waist circumference (Beta 4.91 cm, 95% CI 0.71, 9.1), systolic blood pressure (Beta 2.07 mmHg, 95% CI 0.43, 3.71) and IL-6 (Beta 0.13, 95% CI 0.00, 0.27) and marginally associated with TNF-α (Beta 0.22, 95% CI −0.09, 0.54) after adjusting for socio-demographic covariates. Findings from this study suggest the need to address racism and racial discrimination as important social determinants of cardiometabolic risk and of the inequitable burden of cardiometabolic disease experienced by those from Indigenous and minoritized ethnic backgrounds. Refereed/Peer-reviewed

ObjectiveThe COVID-19 pandemic has seen a rapid adoption of telehealth consultations, potentially creating new barriers to healthcare access for racial/ethnic minorities. This systematic review explored the use of telehealth consultations for people from racial/ethnic minority populations in relation to health outcomes, access to care, implementation facilitators and barriers, and satisfaction with care.Materials and MethodsThis review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis and the JBI Manual for Evidence Synthesis. Five major databases were searched to identify relevant studies. Screening, full-text review, quality appraisal and data extraction were all completed independently and in duplicate. A convergent integrated approach to data synthesis was applied with findings reported narratively.ResultsA total of 28 studies met the inclusion criteria. Telehealth-delivered interventions were mostly effective for the treatment/management of physical and mental health conditions including depression, diabetes and hypertension. In several studies, telehealth improved access to care by providing financial and time benefits to patients. Technological difficulties were the main barriers to effective telehealth consultation, although overall satisfaction with telehealth-delivered care was high.DiscussionTelehealth-delivered care for racial/ethnic minorities offers promise across a range of conditions and outcomes, particularly when delivered in the patient’s preferred language. However, telehealth may be problematic for some due to cost and limited digital and health literacy.ConclusionThe development and implementation of guidelines, policies and practices in relation to telehealth consultations for racial/ethnic minorities should consider the barriers and facilitators identified in this review to ensure existing health disparities are not exacerbated.

Background Racism has been identified as a major source of injustice and a health burden in Australia and across the world. Despite the surge in Australian quantitative research on the topic, and the increasing recognition of the prevalence and impact of racism in Australian society, the collective evidence base has yet to be comprehensively reviewed or meta-analysed. This protocol describes the first systematic review and meta-analysis of racism in Australia at the national level, focussing on quantitative studies. The current study will considerably improve our understanding of racism, including its manifestations and fluctuation over time, variation across settings and between groups, and associations with health and socio-economic outcomes. Methods The research will consist of a systematic literature review and meta-analysis. Searches for relevant studies will focus on the social and health science databases CINAHL, PsycINFO, PubMed and Scopus. Two reviewers will independently screen eligible papers for inclusion and extract data from included studies. Studies will be included in the review and meta-analysis where they meet the following criteria: (1) report quantitative empirical research on self-reported racism in Australia, (2) report data on the prevalence of racism, or its association with health (e.g. mental health, physical health, health behaviours) or socio-economic outcomes (e.g. education, employment, income), and (3) report Australian data. Measures of racism will focus on study participants’ self-reports, with a separate analysis dedicated to researcher-reported measures, such as segregation and differential outcomes across racial/ethnic groups. Measures of health and socio-economic outcomes will include both self-reports and researcher-reported measures, such as physiological measurements. Existing reviews will be manually searched for additional studies. Study characteristics will be summarised, and a meta-analysis of the prevalence of racism and its associations will be conducted using random effects models and mean weighted effect sizes. Moderation and subgroup analyses will be conducted as well. All analyses will use the software CMA 3.0. Discussion This study will provide a novel and comprehensive synthesis of the quantitative evidence base on racism in Australia. It will answer questions about the fluctuation of racism over time, its variation across settings and groups, and its relationship with health and socio-economic outcomes. Findings will be discussed in relation to broader debates in this growing field of research and will be widely disseminated to inform anti-racism research, action and policy nationally. Systematic review registration PROSPERO CRD42021265115.

People seeking asylum are at risk of receiving poorer quality healthcare due, in part, to racist and discriminatory attitudes, behaviours and policies in the health system. Despite fleeing war and conflict; exposure to torture and traumatic events and living with uncertainty; people seeking asylum are at high-risk of experiencing long-term poor physical and mental health outcomes in their host country. This article aims to raise awareness and bring attention to some common issues people seeking asylum face when seeking healthcare in high-income countries where the health system is dominated by a Western biomedical view of health. Clinical case scenarios are used to highlight instances of racist healthcare policies and practices that create and maintain ongoing health disparities; limited access to culturally and linguistically appropriate health services, and lack of trauma-informed approaches to care. Nurses and midwives can play an important role in countering racism in healthcare settings; by identifying and calling out discriminatory practice and modelling tolerance, respect and empathy in daily practice. We present recommendations for individuals, organisations and governments that can inform changes to policies and practices that will reduce racism and improve health equity for people seeking asylum.

IntroductionRacism is a critical determinant of health and health inequities for children and youth. This protocol aims to update the first systematic review conducted by Priestet al(2013), including a meta-analysis of findings. Based on previous empirical data, it is anticipated that child and youth health will be negatively impacted by racism. Findings from this review will provide updated evidence of effect sizes across outcomes and identify moderators and mediators of relationships between racism and health.Methods and analysisThis systematic review and meta-analysis will include studies that examine associations between experiences of racism and racial discrimination with health outcomes of children and youth aged 0–24 years. Exposure measures include self-reported or proxy reported systemic, interpersonal and intrapersonal racism. Outcome measures include general health and well-being, physical health, mental health, biological markers, healthcare utilisation and health behaviours. A comprehensive search of studies from the earliest time available to October 2020 will be conducted. A random effects meta-analysis will examine the average effect of racism on a range of health outcomes. Study-level moderation will test the difference in effect sizes with regard to various sample and exposure characteristics. This review has been registered with the International Prospective Register of Systematic Reviews.Ethics and disseminationThis review will provide evidence for future research within the field and help to support policy and practice development. Results will be widely disseminated to both academic and non-academic audiences through peer-review publications, community summaries and presentations to research, policy, practice and community audiences.PROSPERO registration numberCRD42020184055.

Background Racism and racial discrimination are fundamental causes and determinants of health and health inequalities globally, with children and adolescents particularly vulnerable. Racial discrimination is a common stressor in the lives of many children and adolescents, with growing evidence of negative associations between racial discrimination and multiple domains of child and adolescent health. Addressing racism and racial discrimination must be core public health priorities, even more so among children and young people. Schools are key settings in the lives of children and adolescents and become increasingly more important to identity formation. School communities, teachers and peers greatly influence children and adolescents’ beliefs about race and difference. Schools are therefore key sites for the delivery of population-based programs to reduce racism and promote proactive bystander behaviour and healthy resistance to racism among all children and adolescents as well as among the adults. Methods This study examines the feasibility and acceptability of the ‘Speak Out Against Racism (SOAR)’ program, a whole of school, multi-level, multi-strategy program that aimed to promote effective bystander responses to racism and racial discrimination in primary schools. A mixed-methods, quasi-experimental design was used. Students in Years 5 and 6 (10–12 years) across six schools completed surveys pre- and post- intervention (N = 645; 52% female; 6% Indigenous, 10% Middle Eastern, African, Latinx or Pacific Islander, 21% Asian, 52% Anglo/European). Focus groups with students and interviews with staff collected qualitative data about their experiences of the program and their views about the program’s perceived need, implementation, impacts and suggested improvements. Results Quantitative data showed student prosocial skills and teacher inter-racial climate improved in intervention schools compared to comparison schools. Qualitative data highlighted teacher attitudinal and behaviour change regarding racism, and student reduced interpersonal racial discrimination, improved peer prosocial norms, commitment to anti-racism, knowledge of proactive bystander responses and confidence and self-efficacy to intervene to address racism. Conclusions This study provides quantitative evidence of the potential of the SOAR program to improve the prosocial skills of students and their perceptions of the inter-racial school climate provided by their teachers. This program also provided qualitative evidence of the potential to promote teacher and student attitudinal and behavioural change. Further refinement and testing of the program in a large scale implementation trial is recommended.

Patients from racial/ethnic minority backgrounds can experience racism and race-based discrimination in the health system, enduring unfair and inferior treatment that negatively affects physical and mental health and well-being and may, in some cases, lead to premature and avoidable death. Racism within the health system also acts as a deterrent to health care access because individuals may choose to avoid healthcare settings for fear of repeated exposure to racism. Racism and its impacts in health are well documented and health care-related regulatory organisations and antidiscrimination commissions in Australia are the recipients of racism complaints that occur within the health system. However, the extent and nature of complaints of racism in healthcare settings (i.e. self-reported incidents of racism) and how they are managed by regulatory organisations and antidiscrimination commissions are not well understood. This paper provides a summary of existing approaches to complaints in the Australian health system related to healthcare regulatory organisations and antidiscrimination commissions. We offer recommendations for improvements to data collection and dissemination of racism complaints to better understand the nature and extent of racism and race-based discrimination in the health system, and thus inform changes to process and practices that will reduce the incidence of racism and improve health outcomes. What is known about the topic? Patient complaints of racism in the health system are received by health care-related regulatory organisations and antidiscrimination commissions. However, the extent and nature of the complaints of racism in healthcare settings and how they are managed are not well understood. What does the paper add? This paper provides a summary of existing approaches to complaints in the Australian health system related to healthcare regulatory organisations and antidiscrimination commissions. We identify ways that existing complaints processes and mechanisms can be strengthened to enhance the safety and quality of patient care. What are the implications for practitioners? Practitioners, healthcare managers and policy makers can enhance existing complaints processes and mechanisms in order to improve the collection and use of healthcare racism complaints that can inform strategies to reduce healthcare racism and improve patient care.

This paper points to a number of areas where racism data remain under-collected, including gaps that should be filled as a matter of urgency in the context of COVID-19. Jehonathan Ben, Amanuel Elias, Mandy Truong, Fethi Mansouri, Nida Denson, Yin Paradies

Background Religious-based hate crimes are on the rise worldwide. However, the relationship of religious discrimination on health and well-being, especially earlier on the lifecourse, is largely understudied. This study examines the prevalence of religious discrimination and the relationship it has on social-emotional adjustment and sleep outcomes among a diverse sample of students in Australia. Methods Data came from Speak Out Against Racism, a population-representative cross-sectional study of 4664 public school students in grades 5–9 in Australia in 2017. An adaption of the Adolescent Discrimination Distress Index (ADDI), was used to derive four measures of religious discrimination (peer, school, societal and the sum of those as a “total” score). The Strengths and Difficulties Questionnaire measured the total difficulties, conduct, emotional, and prosocial behavior subscales. Measures of sleep outcomes included duration, latency, and disruption. Results 27 % (95 % CI 22.82, 31.12) of students reported experiences of direct total religious discrimination with higher levels being reported by students identifying as a religious minority. There was strong evidence that experiences of religious discrimination (across all four sources) was related to all measures of socioemotional adjustment and sleep outcomes. Discussion Religious discrimination is an understudied form of social disadvantage that has implications for adolescents’ development, health and well-being. Conclusion: More programs, particularly in the school-context, address religious-based discrimination may reduce inequities in health., Highlights • There is a noted gap in population health research examining how religion operates as a structural determinant of health. • The relationship between discrimination and indicators of health and wellbeing have been understudied among young children. • Religious discrimination is associated with poor indicators of social-emotional adjustment across all four measures. • Religious discrimination is associated with adverse sleep outcomes (duration and latency) among young school-aged children.

IntroductionThere is a growing body of research showing associations between experiences of racism and poor health and wellbeing outcomes for children and adolescents. The aim of this review protocol is to update the first systematic review conducted by Priest et al. 2013, including a meta-analysis of findings. Based on previous empirical data, it is anticipated that child and adolescent health will be negatively impacted by racism. This review will provide updated evidence of effect sizes across outcomes and identify moderators and mediators of relationships.Methods and analysisThis systematic review and meta-analysis will include studies that explore associations between experiences of racism and racial dissemination with health outcomes of children and adolescents aged 0- 24 years of age from any racial/ethnic/cultural group. Outcome measures include general health and wellbeing, physical health, mental health, healthcare utilisation and health behaviours. Exposure measures include self- reported and proxy reported personal experiences of racism and reported experiences of vicarious racism. The authors will conduct a comprehensive search of studies from the earliest time available to September 2020. All relevant studies will be screened with data extraction, quality appraisal and publication bias conducted independently by at least two authors.Ethics and DisseminationThis review will provide evidence for future research within the field and help to support policy and practice development. Results from this systematic review and meta-analysis will be widely disseminated to both academic and non-academic audiences.Ethics approval is not required as this is a review of existing empirical findings.Article Summary-This is an updated systematic review which aims to update the findings from the first international review conducted by Priest et al. 2013. However, it is the first meta-analysis to be conducted exploring the relationship between racism and health in child and adolescent from all ethnic/racial/cultural backgrounds.-This systematic review will show the health effects of racial discrimination on child and adolescent health, the key pathways by which racial discrimination influences these outcomes and identify potential moderators and mediators.-Findings from this systematic review and meta-analysis will be used to provide recommendations for future research and inform the development of effective evidence-based strategies for addressing racism and ameliorating its harmful effects.-This systematic review has a bias towards papers published in English as this review will only search studies published in English, meaning that studies not-published in English will not be included in this review. By doing so this review may not include all findings of all relevant studies.

This study examines the feasibility and acceptability of ‘Speak out against racism (SOAR)’ program to promote effective bystander responses to racism in Australian primary schools. A mixed-methods, quasi-experimental design was used. Students in Years 5 and 6 (10-12 years) across six schools completed surveys pre- and post-intervention (N=645; 52% female, 6% Indigenous, 10% Middle Eastern, African, Latinx, Pacific Islander, 21% Asian, 52% Anglo/European). Quantitative data showed student prosocial skills and teacher inter-racial climate improved in intervention schools compared to comparison schools. Qualitative data highlighted teacher attitudinal and behaviour change regarding racism, and student reduced interpersonal racial discrimination, improved peer prosocial norms, commitment to anti-racism, knowledge of proactive bystander responses and confidence and self-efficacy to intervene to address racism.

Family and domestic violence (FDV) is a major public health and social issue that is associated with a range of physical, mental and behavioural health outcomes. Religion and faith are powerful and influential in shaping the lives of many individuals and societies, in addition to the social practices, norms and structures that are significant in understanding and responding to FDV. This qualitative study aims to deepen understanding of the influence of religious beliefs and values on attitudes and beliefs of FDV among culturally diverse faith communities in Australia. Interviews and focus groups were conducted with 64 participants from a diverse range of cultural and religious backgrounds which included faith leaders, community members and FDV sector workers. Six main themes were identified describing attitudes, beliefs and knowledge about FDV: 1) Faith and religion do not condone violence; 2) Awareness of FDV is increasing, yet remains often poorly understood; 3) FDV is still a taboo topic; 4) Denial and defensiveness about FDV persist; 5) Patience, endurance and forgiveness is often prioritised over safety; 6) Gender roles and norms founded on religious beliefs and interpretations underpin many FDV understandings and responses. These findings demonstrate the tensions between expressions of faith and attitudes to women and FDV. Further exploration of these issues within specific faith communities, as well as how to support and engage with these communities in increasing understandings of FDV and developing effective responses, is needed in the Australian context.

To examine the prevalence of young childrens' reported experiences of racial discrimination and to assess whether discriminatory experiences vary by gender, religion and country of birth.Data came from Speak Out Against Racism (SOAR), a cross-sectional study of 4664 public school students in grades 5-9 in two Australian states in 2017. An adaption of the Adolescent Discrimination Distress Index (ADDI), as a measure of discrimination, was used across four Indigenous and ethnic categories (Indigenous, Asian and non-Asian visible minorities, Anglo/European). Effect-measure modification (EMM) examined how experiences of racial discrimination across ethnic groups varied by gender, country of birth and religion.A sizeable proportion (40%) of students reported experiencing racial discrimination. Indigenous, Asian and non-Asian visible minority students reported higher rates of experiencing racial discrimination than their Anglo-European peers. Male students reported higher rates of experiencing racial discrimination than female students. Foreign-born students reported experiencing racial discrimination more often than native-born students, and both Christian and religious minorities experienced racial discrimination more often than students identifying with the dominant "No religion" group.The findings highlight the prevalence of racial discrimination among adolescents and how gender, country of birth and religion can increase risk of these experiences.

Racism is a key driver of the social, political, and economic injustices that cause and maintain health inequities. Over centuries and across continents, racism has become deeply ingrained within societies. Therefore, we believe that it is our professional and ethical obligation as scientists, and public health scholars specifically, to address racism head on in order to ameliorate racialized health disparities. We argue that greater focus is needed on addressing racism rather than race and how race is described or defined. We offer input from public health scholarship to help bioethicists and other scientists contribute to addressing racism. To do so effectively and comprehensively, public health scholars, bioethicists, and other scientists should work together to identify and implement equity-driven collaborations to eliminate the deleterious effects of racism on individuals, families, and communities.

Cultural competence is an important aspect of health service access and delivery in health promotion and community health. Although a number of frameworks and tools are available to assist health service organizations improve their services to diverse communities, there are few published studies describing organizational cultural competence assessments and the extent to which these tools facilitate cultural competence. This article addresses this gap by describing the development of a cultural competence assessment, intervention, and evaluation tool called the Cultural Competence Organizational Review (CORe) and its implementation in three community sector organizations. Baseline and follow-up staff surveys and document audits were conducted at each participating organization. Process data and organizational documentation were used to evaluate and monitor the experience of CORe within the organizations. Results at follow-up indicated an overall positive trend in organizational cultural competence at each organization in terms of both policy and practice. Organizations that are able to embed actions to improve organizational cultural competence within broader organizational plans increase the likelihood of sustainable changes to policies, procedures, and practice within the organization. The benefits and lessons learned from the implementation of CORe are discussed.

According to the 2011 Australian Census, over 26 per cent of the population were born overseas.2013 Sixty‐seven per cent of recent arrivals and 49 per cent of longer‐standing migrants speak a langu...

Racial discrimination is increasingly recognised as a determinant of racial and ethnic health inequalities, with growing evidence of strong associations between racial discrimination and adult health outcomes. There is a growing body of literature that considers the effects of racial discrimination on child and youth health. The aim of this paper is to provide a systematic review of studies that examine relationships between reported racial discrimination and child and youth health. We describe the characteristics of 121 studies identified by a comprehensive search strategy, including definitions and measurements of racial discrimination and the nature of reported associations. Most studies were published in the last seven years, used cross-sectional designs and were conducted in the United States with young people aged 12-18 years. African American, Latino/a, and Asian populations were most frequently included in these studies. Of the 461 associations examined in these studies, mental health outcomes (e.g. depression, anxiety) were most commonly reported, with statistically significant associations with racial discrimination found in 76% of outcomes examined. Statistically significant associations were also found for over 50% of associations between racial discrimination and positive mental health (e.g. self esteem, resilience), behaviour problems, wellbeing, and pregnancy/birth outcomes. The field is currently limited by a lack of longitudinal studies, limited psychometrically validated exposure instruments and poor conceptualisation and definition of racial discrimination. There is also a need to investigate the complex and varying pathways by which reported racial discrimination affect child and youth health. Ensuring study quality in this field will allow future research to reveal the complex role that racial discrimination plays as a determinant of child and youth health.

Are we doing all we can to identify and provide eye care to those individuals and groups in our community who have poor vision and eye disease? It has been almost twenty years since two significant...

Health and social service agencies need to be responsive to the healthcare requirements of culturally and linguistically diverse (CALD) groups in the community. This is a challenging proposition, particularly due to shifting demographics in developed Western countries such as Australia. Organisations that strive for cultural competence can potentially reduce the barriers associated with inequitable access to services by CALD groups. Community health services play a vital role in the provision of culturally competent health services to people from CALD groups. Additional research related to cultural competence in the community health context is needed. Thus, the aim of this paper is to explore the positioning of cultural competence within community health from multiple perspectives using a qualitative case study of a community health service located in Victoria, Australia. The findings suggest that if the essential needs of clients are met, regardless of cultural background (e.g. able to communicate with staff, trust and a respectful and caring environment), then issues related to cultural background may be of less significance for some clients.

Background Cultural competency is a recognized and popular approach to improving the provision of health care to racial/ethnic minority groups in the community with the aim of reducing racial/ethnic health disparities. The aim of this systematic review of reviews is to gather and synthesize existing reviews of studies in the field to form a comprehensive understanding of the current evidence base that can guide future interventions and research in the area. Methods A systematic review of review articles published between January 2000 and June 2012 was conducted. Electronic databases (including Medline, Cinahl and PsycINFO), reference lists of articles, and key websites were searched. Reviews of cultural competency in health settings only were included. Each review was critically appraised by two authors using a study appraisal tool and were given a quality assessment rating of weak, moderate or strong. Results Nineteen published reviews were identified. Reviews consisted of between 5 and 38 studies, included a variety of health care settings/contexts and a range of study types. There were three main categories of study outcomes: patient-related outcomes, provider-related outcomes, and health service access and utilization outcomes. The majority of reviews found moderate evidence of improvement in provider outcomes and health care access and utilization outcomes but weaker evidence for improvements in patient/client outcomes. Conclusion This review of reviews indicates that there is some evidence that interventions to improve cultural competency can improve patient/client health outcomes. However, a lack of methodological rigor is common amongst the studies included in reviews and many of the studies rely on self-report, which is subject to a range of biases, while objective evidence of intervention effectiveness was rare. Future research should measure both healthcare provider and patient/client health outcomes, consider organizational factors, and utilize more rigorous study designs.

This study is an investigation of how Australian and New Zealand schools of optometry prepare students for culturally competent practice. The aims are: (1) to review how optometric courses and educators teach and prepare their students to work with culturally diverse patients; and (2) to determine the demographic characteristics of current optometric students and obtain their views on cultural diversity.All Australian and New Zealand schools of optometry were invited to participate in the study. Data were collected with two surveys: a curriculum survey about the content of the optometric courses in relation to cultural competency issues and a survey for second year optometry students containing questions in relation to cultural awareness, cultural sensitivity and attitudes to cultural diversity.Four schools of optometry participated in the curriculum survey (Deakin University, Flinders University, University of Melbourne and University of New South Wales). Sixty-three students (22.3 per cent) from these four schools as well as the University of Auckland participated in the student survey. Cultural competency training was reported to be included in the curriculum of some schools, to varying degrees in terms of structure, content, teaching method and hours of teaching. Among second year optometry students across Australia and New Zealand, training in cultural diversity issues was the strongest predictor of cultural awareness and sensitivity after adjusting for school, age, gender, country of birth and language other than English.This study provides some evidence that previous cultural competency-related training is associated with better cultural awareness and sensitivity among optometric students. The variable approaches to cultural competency training reported by the schools of optometry participating in the study suggest that there may be opportunity for further development in all schools to consider best practice training in cultural competency.

Introduction Inequalities are evident in early childhood caries rates with the socially disadvantaged experiencing greater burden of disease. This study builds on formative qualitative research, conducted in the Moreland/Hume local government areas of Melbourne, Victoria 2006–2009, in response to community concerns for oral health of children from refugee and migrant backgrounds. Development of the community-based intervention described here extends the partnership approach to cogeneration of contemporary evidence with continued and meaningful involvement of investigators, community, cultural and government partners. This trial aims to establish a model for child oral health promotion for culturally diverse communities in Australia. Methods and analysis This is an exploratory trial implementing a community-based child oral health promotion intervention for Australian families from refugee and migrant backgrounds. Families from an Iraqi, Lebanese or Pakistani background with children aged 1–4 years, residing in metropolitan Melbourne, were invited to participate in the trial by peer educators from their respective communities using snowball and purposive sampling techniques. Target sample size was 600. Moreland, a culturally diverse, inner-urban metropolitan area of Melbourne, was chosen as the intervention site. The intervention comprised peer educator led community oral health education sessions and reorienting of dental health and family services through cultural Competency Organisational Review (CORe). Ethics and dissemination Ethics approval for this trial was granted by the University of Melbourne Human Research Ethics Committee and the Department of Education and Early Childhood Development Research Committee. Study progress and output will be disseminated via periodic newsletters, peer-reviewed research papers, reports, community seminars and at National and International conferences. Trial registration number Australian New Zealand Clinical Trials Registry (ACTRN12611000532909).

Although considered a key driver of racial disparities in healthcare, relatively little is known about the extent of interpersonal racism perpetrated by healthcare providers, nor is there a good understanding of how best to measure such racism.This paper reviews worldwide evidence (from 1995 onwards) for racism among healthcare providers; as well as comparing existing measurement approaches to emerging best practice, it focuses on the assessment of interpersonal racism, rather than internalized or systemic/institutional racism.The following databases and electronic journal collections were searched for articles published between 1995 and 2012: Medline, CINAHL, PsycInfo, Sociological Abstracts. Included studies were published empirical studies of any design measuring and/or reporting on healthcare provider racism in the English language. Data on study design and objectives; method of measurement, constructs measured, type of tool; study population and healthcare setting; country and language of study; and study outcomes were extracted from each study.The 37 studies included in this review were almost solely conducted in the U.S. and with physicians. Statistically significant evidence of racist beliefs, emotions or practices among healthcare providers in relation to minority groups was evident in 26 of these studies. Although a number of measurement approaches were utilized, a limited range of constructs was assessed.Despite burgeoning interest in racism as a contributor to racial disparities in healthcare, we still know little about the extent of healthcare provider racism or how best to measure it. Studies using more sophisticated approaches to assess healthcare provider racism are required to inform interventions aimed at reducing racial disparities in health.

Background: There is growing awareness that cultural background influences health beliefs and practices and can impact on the patient–practitioner encounter. However, in relation to optometry there is little known about the implications of cultural diversity for clinical decision-making and how optometrists address culturally based understandings of health. This pilot study examines how culturally based differences in health practices and beliefs impact on patient–optometrist interactions and how optometrists negotiate and manage these differences. Methods: Semi-structured interviews were conducted with 10 optometrists. A qualitative analysis was undertaken regarding the optometrists' experiences of cultural diversity and how these impact their decision-making and clinical interactions. Results: Emergent themes were: 1 Culture can influence and impact on patient–optometrist clinical encounters. 2 Culturally based differences in health practices and beliefs can have a negative impact on clinical encounters. 3 Culturally based differences, beliefs and values (related to eye health) can be difficult to negotiate. 4 Optometrists might benefit from additional training and strategies to deal with culturally based differences in health beliefs and practices. Conclusions: This pilot study provides data about some of the issues that arise as a result of cultural differences between patients and health care practitioners. The findings from this study contribute to an understanding of the impact of cultural diversity and might assist the development of training and further research in the area.

Background Racism is increasingly recognized as a key determinant of health. A growing body of epidemiological evidence shows strong associations between self-reported racism and poor health outcomes across diverse minority groups in developed countries. While the relationship between racism and health has received increasing attention over the last two decades, a comprehensive meta-analysis focused on the health effects of racism has yet to be conducted. The aim of this review protocol is to provide a structure from which to conduct a systematic review and meta-analysis of studies that assess the relationship between racism and health. Methods This research will consist of a systematic review and meta-analysis. Studies will be considered for review if they are empirical studies reporting quantitative data on the association between racism and health for adults and/or children of all ages from any racial/ethnic/cultural groups. Outcome measures will include general health and well-being, physical health, mental health, healthcare use and health behaviors. Scientific databases (for example, Medline) will be searched using a comprehensive search strategy and reference lists will be manually searched for relevant studies. In addition, use of online search engines (for example, Google Scholar), key websites, and personal contact with experts will also be undertaken. Screening of search results and extraction of data from included studies will be independently conducted by at least two authors, including assessment of inter-rater reliability. Studies included in the review will be appraised for quality using tools tailored to each study design. Summary statistics of study characteristics and findings will be compiled and findings synthesized in a narrative summary as well as a meta-analysis. Discussion This review aims to examine associations between reported racism and health outcomes. This comprehensive and systematic review and meta-analysis of empirical research will provide a rigorous and reliable evidence base for future research, policy and practice, including information on the extent of available evidence for a range of racial/ethnic minority groups