Report on Improving Health Outcomes In Migrant Populations

1.0 Executive Summary/ Abstract

The report emphasises the numerous difficulties that migrants and refugees encounter while trying to access and use the Australian healthcare system, which has a negative impact on their health. Language and communication problems are acknowledged as significant obstacles that cause misinterpretations of health-related data and the postponement of vital medical interventions. With programs like the Cultural Respect Framework and the National Safety and Quality Health Service Standards supporting healthcare that respects and accommodates various cultural norms, cultural competency emerges as a critical answer. Furthermore, a lack of health literacy exacerbates these problems, making it difficult for migrant communities to comprehend and successfully use healthcare services. 

The My Health Record program intends to empower migrants digitally but must solve privacy issues and linguistic limitations. The role of nurses in enhancing migrant patients' healthcare outcomes is emphasised. They play a crucial role in delivering patient-centred care that is culturally competent, navigating linguistic challenges, and connecting patients with support systems. Nurses can considerably reduce healthcare disparities by addressing linguistic obstacles, boosting health literacy, and creating cultural competency. Australian healthcare can work toward attaining health equity for its various migrant populations by tackling these interconnected issues and using the skills of healthcare professionals, especially nurses.

2.0 Introduction

The global landscape is marked by an unprecedented movement of people, with migration becoming an integral part of contemporary society. In August 2021, there were 3.0 million permanent migrants in Australia (Australian Bureau of Statistics, 2023). The healthcare sector is tasked with addressing the unique challenges migrants face in accessing and receiving adequate healthcare. Within this complex web of factors influencing migrant healthcare outcomes, nursing professionals occupy a crucial role (Walton-Roberts, 2023). Refugees and migrants encounter unique situations that could affect how they fare with their health. In order to address the health requirements of the migrant and refugee population and to improve the planning and execution of health care services, it is crucial to understand trends of health outcomes and service usage among this population (Australian Institute of Health and Welfare [AIHW], 2023). This report delves into the multifaceted factors that impact the healthcare outcomes of migrants, with a specific focus on the vital contributions of nursing roles in enhancing healthcare outcomes for patients with a migrant background. Recommendations for practice adjustments will be explored to promote enhancing migrant health outcomes in Australia by examining pertinent literature.

3.0 Literature Review

3.1 Introduction

To address the variables influencing health outcomes in immigrant communities in Australia, a detailed literature review was conducted (Nutbeam & Lloyd, 2021). This required thoroughly examining relevant databases using the standards and keywords listed in Table 1 in the appendices. For reference, a brief synopsis of the studies cited will be included in Appendix B. The following section will explain this thorough research's significant results and conclusions. To address this difficulty in healthcare policy and practice, this study intends to shed light on the crucial problem of health literacy among migrant groups in Australia

3.2 Review Question & Objectives 

The research question of the literature review: What are the key factors impacting healthcare outcomes for individuals with a migrant background, and how can nurses play a role in improving healthcare outcomes when caring for patients with migrant background? The goal of the review will be to identify and carefully evaluate the key factors influencing healthcare outcomes for immigrants living in Australia and to talk about nurses' roles in enhancing health outcomes. 

3.3 Inclusion criteria & Exclusion criteria

Studies involving migrant populations living in Australia published in English between 2019 and 2023 met the inclusion requirements. Additionally, there were publications on nursing roles in providing care for patients with migrant backgrounds as well as articles on healthcare outcomes. Grey literature, publications published in languages other than English, studies published prior to 2019, research published before 2019, articles irrelevant to healthcare outcomes or nursing responsibilities in migrant care, and articles not including the migrant population in Australia were among the studies that were removed. 

3.4 Databases 

To find suitable peer-reviewed publications, a precise and thorough search of the Pubmed and MEDLINE databases was conducted. The analysis was rigorously backed by top academic sources, which raised the study's credibility and integrity. The in-depth analysis and inclusion of peer-reviewed literature improved the study. This provided the study with a solid foundation for the validity and plausibility of its findings, which might be essential for increasing scientific understanding.

3.5 Searching keywords 

The chosen keywords involved migrant healthcare outcomes, migrant health disparities, cultural competence, language barriers, access to healthcare, cultural competence, digital health, healthcare communication, and migrant health promotion. 

3.6 Searching outcome

The search revealed 12 related papers, all of which focused on the obstacles affecting migrants' health outcomes in Australia and were written in English between 2019 and 2023. These publications, which will be part of the upcoming literature review, will offer insightful information about the difficulties this demographic group encounters in the Australian healthcare system. 

3.7 Findings

Data extraction

Marcus et al. (2022) conducted a study in New South Wales, Australia, with the objective of investigating dental care trends and predictors in the CALD (Culturally and Linguistically Diverse) and non-CALD populations. Their findings indicated that foreign-born individuals who do not speak English, CALD migrants, and economically disadvantaged individuals are more likely to underutilise dental services. Abdi et al. (2019) researched New South Wales and Victoria, Australia, to examine immunisation beliefs among East African populations. The study identified obstacles such as low-risk perception and language limitations affecting these communities' immunisation rates. Radhamony et al. (2023) conducted a study in Victoria, Australia, to understand the need for mental health services from the perspectives of CALD communities. Their research highlighted key themes and sub-themes related to mental health issues, including barriers like socio-cultural factors, language, and stigma. 

Adhikari et al. (2021) researched Australia to determine the factors affecting South Asian migrants' access to healthcare. They found that this group's long wait times, private healthcare costs, and communication challenges due to sociocultural differences were barriers to healthcare access. These findings emphasise the need for addressing these specific access issues. Olcoń et al. (2023) conducted a study in South Wales, Australia, to compare the cultural sensitivity of health policy with the experiences of maternal healthcare providers working with migrant and refugee mothers. The study identified structural impediments to culturally competent services and the effects of implementation flaws. This research highlights the importance of aligning policy with on-the-ground healthcare practices. Billet et al. (2022) researched Australia to understand women's experiences with migrant and refugee backgrounds in maternity care. Their findings highlighted conflicts between cultural standards, discrimination, care choices, and healthcare trust issues. This study underscores the need for culturally sensitive maternity care.

An investigation by Wechkunanukul et al. (2022) into racial differences in using ambulances and seeking medical assistance was done in Australia. The study discovered that migrant patients were less likely to receive fast treatment for chest pain, exposing ethnic and cultural differences in how often people seek medical care. South Australia was the focus of research by Javanparast et al. (2020) to examine CALD populations' difficulties in obtaining healthcare. They highlighted potential hurdles, including language problems and healthcare providers that lack cultural awareness. The importance of enhancing cultural competence in healthcare delivery is shown by this study. In order to understand the barriers limiting humanitarian migrants from properly utilising settlement services, Abood et al. (2023) looked at Australia. They discovered that the information quality that remained after migration was frequently inadequate and heavily reliant on digital literacy, emphasising the necessity for more readily available information sources.

In order to evaluate the cultural compatibility of immunisation assistance for refugee and immigrant communities, Abdi et al. (2020) conducted research in Australia. Their findings indicated that these people lacked internet literacy, highlighting the significance of easily accessible and culturally appropriate immunisation options. African immigrants in South Australia encounter difficulties in accessing mental health care, according to research done by Fauk et al. (2021). Their research found that major obstacles to obtaining mental health services included a lack of digital health literacy, a poor grasp of the healthcare system, and cultural ignorance. Taye et al. (2022) conducted research in Brisbane, Australia, to examine the epidemiology and health literacy of migrant patients with viral hepatitis from CALD backgrounds. The study found that a lack of health literacy and knowledge about healthcare systems were potential barriers to accessing appropriate healthcare services for this group.

3.8 Language and communication barriers

All of the studies examined the idea that language and communication barriers make it difficult for migrants and refugees living in Australia to access, understand and put into practice health-related information. This leads to poor health outcomes. The vast majority of the published articles concentrated on the value of culturally competent personnel in reducing health disparities for migrants and refugees and fostering Australia's multicultural society (Adhikari et al., 2021)

3.9 Cultural competency and health outcomes

Several articles in the literature review examined how migrants migrating to a country with a Westernised perspective on medicine significantly impacting the healthcare system can affect cultural approaches to wellness and health. As a result, limited health literacy and misunderstandings of healthcare procedures may cause reluctance to seek medical attention and noncompliance with prescribed treatments, harming migrant populations' health outcomes (Billet et al., 2022)

3.10 Lack of health literacy

The lack of knowledge and awareness with respect to health literacy as a means for migrant population groups to access and navigate health-related services and information was a significant topic of discussion in the literature review. They talked about using culturally relevant programs that support migrant populations' access, collaboration, and involvement in digital literacy to improve health literacy and migrant health outcomes. These programs also incorporate inclusive language and personalised resources (Stanzel et al., 2021).

4.0 Discussion

These issues include erroneous interpretation of health information, trouble navigating complicated healthcare systems, disregard for prescribed treatments, and delay in receiving critical medical interventions (Radhamony et al., 2023). The Australian government has issued Language Services Guidelines to address these problems. These principles guarantee good communication between those who are illiterate in the primary language and those who provide healthcare services (Australian Government, 2019). A vital component of this system is the availability of interpreting services around-the-clock, including those certified by the National Accreditation Authority for Translators and Interpreters (NAATI). This access guarantees that Australians who do not speak English in hospital settings can quickly obtain interpretation services, fostering clear and accurate transmission of medical information. Insufficient health literacy levels, often exacerbated by communication barriers, pose significant challenges for migrant populations, resulting in adverse health outcomes (NAATI, 2023). 

To enhance migrants' health outcomes in Australia and their capacity to obtain and comprehend healthcare, cultural competency is crucial (Javanparast et al., 2020). For instance, the Australian Commission on Safety and Quality in Health Care (ACSQHC)'s National Safety and Quality Health Service Standards (NSQHS) promote cultural competency in healthcare. These standards aim to help healthcare institutions provide safe, superior, and culturally sensitive treatment to various patient groups, including migrants (ACSQHC, 2021). Additionally, the Cultural Respect Framework for Aboriginal and Torres Strait Islander Health 2016–2026 emphasises the value of providing care sensitive to cultural norms and expands its application to Indigenous people. Healthcare professionals may empower migrant and Indigenous populations to actively participate in their health by identifying and respecting cultural variances and customs. This will increase health literacy and improve overall health outcomes. Including cultural competency in healthcare practices recognises migrant communities' diversity and fosters an atmosphere of inclusivity, trust, and respect (Wechkunanukul et al., 2022)

Providing better access, efficacy, empowerment of patients, and data exchange, health literacy is essential to contemporary healthcare. However, health literacy is frequently lacking among migrants and refugees due to a lack of knowledge and awareness (Fauk et al., 2021). With the help of Australia's My Health Record initiative, anyone can access their medical records digitally and online (Australian Digital Agency, 2023). Migrants and refugees may experience challenges despite being often advantageous because of language issues, a lack of digital health literacy, and worries about security and privacy Marcus et al. (2022). Additional efforts include providing multicultural or multilingual assistance, such as translated information and interpreter services (Abdi et al., 2019). For instance, community outreach initiatives like Digital Health Literacy for Migrants and Refugees educate these communities on digital health tools while promoting digital literacy and empowerment (NSW Government, 2022).

5.0 Recommendations

Nurses are critical in enhancing healthcare outcomes for patients from migrant backgrounds by delivering culturally competent and patient-centred care. Effective communication is one of the most essential parts of this position (Antón-Solanas et al., 2022). For migrant patients to grasp their diagnoses, treatment plans, and medication schedules, nurses must overcome linguistic hurdles. Studies have demonstrated that providing care to patients in their preferred language, or language-concordant care, results in better adherence to medical advice and better health outcomes (Arora et al., 2021). Additionally, nurses need to be culturally aware and respectful of their patients' various beliefs, values, and traditions. This includes awareness of cultural health traditions and preferences, significantly impacting a patient's treatment compliance and healthcare decisions (Nursing and Midwifery Board of Australia [NMBA], 2016). 

To guarantee that patients receive equitable care, they must cooperate with other medical specialists. In addition, providing culturally competent care can improve healthcare outcomes and access for migrant groups (White et al., 2019). Promoting preventative care and health education catering to the particular requirements of migrant communities is another way that nurses can contribute to better healthcare outcomes (Jongen et al., 2018). Nurses can help patients find local resources and support services, improving their well-being. According to Javanparast et al. (2020), connecting migrants with support networks and culturally appropriate organisations is necessary to guide them through the healthcare system and offer vital social assistance.

6.0 Conclusion

In conclusion, there is a critical need to address the relationship between various factors and migrant health outcomes in Australia. Particularly among migrants, there is an elevated incidence of inadequate health literacy, emphasising the need for focused interventions. Language and communication issues highlight the importance of hiring healthcare professionals who communicate effectively with patients from migrant backgrounds. Cultural competence—as demonstrated by norms like the Cultural Respect Framework and the National Safety and Quality Health Service Standards—is essential to resolve inequities in health. The lack of health literacy is growing, and platforms like the My Health Record program attempt to empower migrants online. Nurses play a critical role in reducing these inequities through linguistic assistance, culturally specific treatment, and training in cultural competency. With the help of nurses, Australia may improve migrant health outcomes and attain health equity by emphasising linguistic barriers, health literacy, cultural perceptions and competence.

7.0 References

Abdi, I., Menzies, R., & Seale, H. (2019). Barriers and facilitators of immunisation in refugees and migrants in Australia: An east-African case study. Vaccine, 37(44), 6724-6729. https://doi.org/10.1016/j.vaccine.2019.09.025

Abdi, I., Murphy, B., & Seale, H. (2020). Evaluating the health literacy demand and cultural appropriateness of online immunisation information available to refugee and migrant communities in Australia. Vaccine, 38(41), 6410-6417. https://doi.org/10.1016/j.vaccine.2020.07.071

Abood, J., Green, J., Polonsky, M. J., Woodward, K., Tadjoeddin, Z., & Renzaho, A. M. (2023). The importance of information acquisition to settlement services literacy for humanitarian migrants in Australia. Plos One, 18(1), e0280041. https://doi.org/10.1371/journal.pone.0280041

Adhikari, M., Kaphle, S., Dhakal, Y., Duwadi, S., Subedi, R., Shakya, S., & Khadka, M. (2021). Too long to wait: South Asian migrants’ experiences of accessing health care in Australia. BMC Public Health, 21(1), 1-11. https://doi.org/10.1186/s12889-021-12132-6

Antón-Solanas, I., Rodríguez-Roca, B., Vanceulebroeck, V., Kömürcü, N., Kalkan, I., Tambo-Lizalde, E., & Subirón-Valera, A. B. (2022). Qualified Nurses’ Perceptions of Cultural Competence and Experiences of Caring for Culturally Diverse Patients: A Qualitative Study in Four European Countries. Nursing Reports, 12(2), 348-364.  https://doi.org/10.3390/nursrep12020034

Arora, A. K., Ortiz-Paredes, D., Engler, K., Lessard, D., Mate, K. K., Rodriguez-Cruz, A., & Lebouché, B. (2021). Barriers and facilitators affecting the HIV care cascade for migrant people living with HIV in organization for economic co-operation and development countries: a systematic mixed studies review. AIDS patient care and STDs, 35(8), 288-307. https://doi.org/10.1089/apc.2021.0079

Australian Bureau of Statistics. (2023). Permanent migrants in Australia. https://www.abs.gov.au/statistics/people

Australian Commission on Safety and Quality in Health Care [ACSQHC]. (2017). National safety and quality health service standards (2nd ed.). https://www.safetyandquality.gov.au/sites/default/files/migrated/National-Safety-and-Quality-Health-Service-Standards-second-edition.pdf

Australian Digital Agency. (2023). My health record. https://www.digitalhealth.gov.au/initiatives-and-programs/my-health-record

Australian Government. (2019). Australian Government language services guidelines. https://immi.homeaffairs.gov.au/settlement-services-subsite/files/language-services-guidelines.pdf

Australian Institute of Health and Welfare [AIHW]. (2023). Refugee and humanitarian entrant health. https://www.aihw.gov.au/reports-data/population-groups/cald-australians/refugee-and-humanitarian-entrant-health

Billett, H., Corona, M. V., & Bohren, M. A. (2022). Women from migrant and refugee backgrounds’ perceptions and experiences of the continuum of maternity care in Australia: A qualitative evidence synthesis. Women and Birth, 35(4), 327-339.https://doi.org/10.1016/j.wombi.2021.08.005

Camit, M. C. (2021). Health communication and social media in multicultural Australia: The experiences of CALD community leaders in using social media to improve health outcomes for their communities (Doctoral dissertation). https://opus.lib.uts.edu.au/handle/10453/149018

Fauk, N. K., Ziersch, A., Gesesew, H., Ward, P., Green, E., Oudih, E., & Mwanri, L. (2021). Migrants and service providers’ perspectives of barriers to accessing mental health services in south australia: A case of african migrants with a refugee background in south australia. International Journal of Environmental Research and Public Health, 18(17), 8906. https://doi.org/10.3390/ijerph18178906

Gallegos, D., Do, H., To, Q. G., Vo, B., Goris, J., & Alraman, H. (2021). The effectiveness of living well multicultural‐lifestyle management program among ethnic populations in Queensland, Australia. Health Promotion Journal of Australia, 32(1), 84-95.  https://doi.org/10.1002/hpja.329

Harrison, R., Walton, M., Chauhan, A., Manias, E., Chitkara, U., Latanik, M., & Leone, D. (2019). What is the role of cultural competence in ethnic minority consumer engagement? An analysis in community healthcare. International Journal for Equity in Health, 18, 1-9. https://doi.org/10.1186/s12939-019-1104-1

Javanparast, S., Naqvi, S. K. A., & Mwanri, L. (2020). Health service access and utilisation amongst culturally and linguistically diverse populations in regional South Australia: A qualitative study. Rural and Remote Health, 20(4), 1-15. https://doi.org/10.22605/RRH5694

Jongen, C., McCalman, J., Bainbridge, R., & Clifford, A. (2018). Cultural competence in health: A review of the evidence. https://doi.org/10.1007/978-981-10-5293-4

Marcus, K., Balasubramaniam, M., Short, S., & Sohn, W. (2022). Cultural and linguistic disparities in dental utilisation in New South Wales, Australia. Community Dental Health, 39(2), 123-128. https://doi.org/10.1922/CDH_00275Marcus06

National Accreditation Authority for Translators and Interpreters. (2023). About us. https://www.naati.com.au/about-us/

NSW Government. (2022). Increasing digital health literacy in refugee communities. https://www.health.nsw.gov.au/multicultural/Documents/literature-review-swslhd.pdf

Nursing and Midwifery Board of Australia [NMBA]. (2016). Registered nurse standards for practice. https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-for-practice.aspx

Nutbeam, D., & Lloyd, J. E. (2021). Understanding and responding to health literacy as a social determinant of health. Annu Rev Public Health, 42(1), 159-73. https://nursing.jhu.edu/wp.pdf

Olcoń, K., Rambaldini-Gooding, D., & Degeling, C. (2023). Implementation gaps in culturally responsive care for refugee and migrant maternal health in New South Wales, Australia. BMC Health Services Research, 23(1), 1-12. https://doi.org/10.1186/s12913-023-09066-7

Radhamony, R., Cross, W. M., Townsin, L., & Banik, B. (2023). Perspectives of culturally and linguistically diverse (CALD) community members regarding mental health services: A qualitative analysis. Journal of Psychiatric and Mental Health Nursing. https://doi.org/10.1111/jpm.12919

Tang, C., Tian, B., Zhang, X., Zhang, K., Xiao, X., Simoni, J. M., & Wang, H. (2019). The influence of cultural competence of nurses on patient satisfaction and the mediating effect of patient trust. Journal of advanced nursing, 75(4), 749-759.  https://doi.org/10.1111/jan.13854

Taye, B. W., Valery, P. C., Liddle, B., Woodward, A. J., Sackey, D., Williams, S., & Clark, P. J. (2022). Fitting health care to people: understanding and adapting to the epidemiology and health literacy of people affected by viral hepatitis from culturally and linguistically diverse migrant backgrounds. Journal of Immigrant and Minority Health, 24(5), 1196-1205. https://doi.org/10.1007/s10903-021-01305-5

Walton-Roberts, M. (2023). Global Health Worker Migration: Problems and Solutions. Elements in Global Development Studies. https://doi.org/10.1017/9781009217781

Wechkunanukul, K. H., Ullah, S., & Beilby, J. (2022). Variation in seeking care for cardiovascular disease and ambulance utilization among migrants in Australia: Time, ethnicity, and delay (TED) study III. International Journal of Environmental Research and Public Health, 19(3), 1516. https://doi.org/10.3390/ijerph19031516

White, J., Plompen, T., Tao, L., Micallef, E., & Haines, T. (2019). What is needed in culturally competent healthcare systems? A qualitative exploration of culturally diverse patients and professional interpreters in an Australian healthcare setting. BMC Public Health, 19, 1-8. https://doi.org/10.1186/s12889-019-7378-9

8.0 Appendices

Appendix A:

Table 1: Search criteria for literature review

Research literature search criteria

Appendix B: Search Synopsis

A summary of the studies cited showed that there were 12 research papers in all. In order to uncover controlling norms of practice and guidelines that endorse the findings in the literature, a manual search of the electronic grey literature was also carried out.

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