Melbourne School of Population and Global Health - Theses
Permanent URI for this collection
Search Results
1 - 3 of 3
-
ItemA multi-level examination of cultural competence in community health: an organisational case study( 2016)It is widely recognised both within Australia and internationally that consideration of cultural issues in health care is important in meeting the health needs of culturally and linguistically diverse groups. Increasing cultural competence depends on a multi-dimensional approach that addresses individual, professional, organisational, and systemic competence. Knowledge about organisational best practice related to cultural competence is still emerging and there is a strong need for further research. Accordingly, the purpose of this PhD study is to address several gaps in the evidence base by contributing a deeper understanding of cultural competence and to provide evidence and guidelines to inform organisational cultural competence assessments. First, it aims to further our understanding of cultural competence within the community health context. Second, it aims to examine the outcomes and implications of conducting an organisational cultural competence assessment at a community health service. And, third, to evaluate the utility of an organisational assessment tool. The conceptual framework underpinning this research consists of several interdisciplinary frameworks and models, namely: the social ecological model, health promotion principles, cultural competence frameworks and Andersen’s behavioural model of health service use. Several frameworks and models were used in respect to the different aspects of the research. This PhD study adopts a qualitative approach to explore cultural competence within a community health service from client/carer, provider and organisational perspectives using semi-structured interviews and process evaluation. Findings of this study indicate that participants considered the practice of providing culturally competent health services to be multi-dimensional and multi-level. Most staff participants viewed cultural competence as being an important aspect of their work; however, they also identified that at times there were challenges in providing culturally competent care. Decisions made by clients/carer participants to use health care services are based on multiple factors, of which culture may be one. Client/carer participants were more likely to identify other non-culturally related potential barriers to service use such as: long waiting lists, lack of knowledge of services available, language and communication difficulties, and procedural issues such as making appointments. From study findings, a conceptual model was developed encompassing key issues impacting health service utilisation for culturally and linguistically diverse groups to inform design of interventions and/or further research to improve cultural competence within health care settings. Study findings also highlighted that the implementation of an organisational assessment of cultural competence at a community health service was a highly complex undertaking. Factors such as leadership, staff engagement, organisational inertia, organisational culture and resourcing were viewed as potential barriers or facilitators to the implementation of a cultural competence assessment tool and subsequent organisational efforts to improve cultural competence. Consideration of organisational factors, such as those highlighted by study findings, can inform the implementation of future organisational cultural competence assessments. Additionally, findings regarding the evaluation of a cultural competence assessment tool indicated that despite the challenges and limitations of the tool, it was found to be an important mechanism to facilitate organisational reflexivity. In particular, it enabled identification of organisational strengths and gaps to provide an impetus for action to improve organisational cultural competence. The findings can be used to inform the future development and refinement of such tools to improve their effectiveness, accuracy and relevance.
-
ItemDevelopment and evaluation of a training program in cross-cultural psychiatric assessment for crisis assessment and treatment teams (CATTs)( 2005-02)The aim of the current project was to improve the cross-cultural clinical competence of mental health staff in Victoria’s Crisis Assessment and Treatment Teams (CATTs) by developing, delivering and evaluating a training program in Cross-Cultural Psychiatric Assessment (CPA). The project was guided by a program logic framework. A literature review demonstrated cross-cultural differences in manifestations of mental disorders and disparities in mental health service provision to racial and ethnic groups, suggesting clinician bias, unfamiliarity with cross-cultural manifestations, or delayed help-seeking by ethnic groups. No research has been identified into crisis service provision to ethnic communities. (For complete abstract open document)
-
ItemAddressing child oral health inequalities in refugee and migrant communities( 2010)Good health is vital for successful settlement for people from refugee and migrant backgrounds newly arrived in developed countries. Such good health enables them to deal effectively with the challenges of settling in a new country and to participate fully in economic, social, cultural and community life. Although in the developed world there have been dramatic improvements in child oral health over the past thirty years, there is a widening gap of oral health inequalities experienced by some communities. In developed countries, it is suggested that disadvantaged children, including those of refugee and migrant backgrounds, experience up to 70 per cent more dental caries than the rest of the population. Moreover, there is strong evidence that severe dental decay that is experienced early in a child’s life is an extremely debilitating disease with lifelong consequences. Despite clear evidence of consistent health inequities for refugee and migrant communities, there is little knowledge to assist in the understanding of the social and cultural determinants of child oral health in these communities. Community-based participatory research is an ideal approach for engaging and empowering communities to improve their health, in a sensitive and appropriate manner. However, strategies and methods informing participative research with refugee and migrant communities are limited. Past research has often excluded these communities due to perceived methodological difficulties. This research proposes to address these gaps in the evidence by exploring the social and cultural influences of child oral health in refugee and migrant communities. This will inform the development of culturally competent intervention strategies to address these significant inequalities. This research will demonstrate a commitment to working in partnership with the communities at all stages of the research process. Accordingly, this PhD has the following objectives: - To systematically review the evidence-base of the oral health status, practices and environments for children from migrant and refugee backgrounds in Australia, and internationally - To work within a culturally competent framework to explore the social, cultural and environmental determinants of oral health of children and families in refugee and migrant communities - To identify the strategies for a feasible, acceptable and culturally appropriate oral health promotion intervention for children and families of refugee and migrant communities A systematic review of all national and international child oral health research undertaken with refugees and migrants was conducted. A total of 48 studies were included. In all studies that had a comparison group, child oral health for refugees and migrants was worse than that of the host or comparison population. The review identified that there are few community-based intervention research studies addressing child oral health inequalities and that the research is of limited cultural competence. In response, Teeth Tales was developed. This is a community-based participatory research study working in partnership with a community health services and cultural organisations. The study involved working with Iraqi, Lebanese and Pakistani communities in Melbourne. Eleven focus groups and seven interviews were conducted with people from these cultural backgrounds. Five interviews were also conducted with a range of health care professionals. Four broad categories of results were identified: ‘Child Oral Health’, ‘Service Use’, ‘Migration and Settlement’, and ‘Community Solutions’. This thesis has been successful in generating new knowledge about sociocultural differences in child oral health using culturally competent strategies. This in turn has informed the development of culturally competent intervention strategies. These strategies include a peer education program, and a reorientation of universal primary health and social health systems to become culturally competent. A further outcome of this thesis is the successful funding for the implementation and evaluation of the community-based intervention, from the Australian Research Council, 2010-2013. Furthermore, this study has demonstrated that oral health research with refugee and migrant communities can be conducted in a culturally competent manner. The consideration and application of a social model of health and social theory further informs the study. Critically, in terms of both ethics and rigour within an overall cultural competence framework, the contributions of this study are all firmly based on strong collaborative partnerships with cultural and community organisations throughout the research process. This adds further weight to the validity of the findings and to the contributions of the study.