Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Implementation Science
Published in: Implementation Science 1/2015

Open Access 01-12-2015 | Study protocol

Bridging the Gap: using an interrupted time series design to evaluate systems reform addressing refugee maternal and child health inequalities

Authors: Jane Yelland, Elisha Riggs, Josef Szwarc, Sue Casey, Wendy Dawson, Dannielle Vanpraag, Chris East, Euan Wallace, Glyn Teale, Bernie Harrison, Pauline Petschel, John Furler, Sharon Goldfeld, Fiona Mensah, Mary Anne Biro, Sue Willey, I-Hao Cheng, Rhonda Small, Stephanie Brown

Published in: Implementation Science | Issue 1/2015

Login to get access

Abstract

Background

The risk of poor maternal and perinatal outcomes in high-income countries such as Australia is greatest for those experiencing extreme social and economic disadvantage. Australian data show that women of refugee background have higher rates of stillbirth, fetal death in utero and perinatal mortality compared with Australian born women. Policy and health system responses to such inequities have been slow and poorly integrated. This protocol describes an innovative programme of quality improvement and reform in publically funded universal health services in Melbourne, Australia, that aims to address refugee maternal and child health inequalities.

Methods/design

A partnership of 11 organisations spanning health services, government and research is working to achieve change in the way that maternity and early childhood health services support families of refugee background. The aims of the programme are to improve access to universal health care for families of refugee background and build organisational and system capacity to address modifiable risk factors for poor maternal and child health outcomes. Quality improvement initiatives are iterative, co-designed by partners and implemented using the Plan Do Study Act framework in four maternity hospitals and two local government maternal and child health services.
Bridging the Gap is designed as a multi-phase, quasi-experimental study. Evaluation methods include use of interrupted time series design to examine health service use and maternal and child health outcomes over a 3-year period of implementation. Process measures will examine refugee families’ experiences of specific initiatives and service providers’ views and experiences of innovation and change.

Discussion

It is envisaged that the Bridging the Gap program will provide essential evidence to support service and policy innovation and knowledge about what it takes to implement sustainable improvements in the way that health services support vulnerable populations, within the constraints of existing resources.
Literature
1.
Marmot M. Fair society, healthy lives. London, UK: The Marmot Review; 2010.
2.
World Health Organisation. Closing the gap in a generation: health equity through action on the social determinants of health. Report from the Commission on Social Determinants of Health. Geneva: WHO; 2008.
3.
Jefferis BJ, Power C, Hertzman C. Birth weight, childhood socioeconomic environment, and cognitive development in the 1958 British birth cohort study. BMJ. 2002;325(7359):305.CrossRefPubMedPubMedCentral
4.
Kuh D, Ben-Shlomo Y. A life course approach to chronic disease epidemiology. 2nd ed. Oxford: Oxford University Press; 2004.CrossRef
5.
Dowling B, Powell M, Glendinning C. Conceptualising successful partnerships. Health Soc Care Community. 2004;12(4):309.CrossRefPubMed
6.
Scott KM, Von Korff M, Angermeyer MC, Benjet C, Bruffaerts R, de Girolamo G, et al. Association of childhood adversities and early-onset mental disorders with adult-onset chronic physical conditions. Arch Gen Psychiatry. 2011;68(8):838–44.CrossRefPubMedPubMedCentral
7.
Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998;14(4):245–58.CrossRefPubMed
8.
Li Z, Zeki R, Hilder L, Sullivan E. Australia’s mothers and babies 2011. Perinatal statistics series no. 28. Cat. no. PER 59. Canberra: AIHW National Perinatal Epidemiology and Statistics Unit; 2013.
9.
Shonkoff JP, Garner AS. The lifelong effects of early childhood adversity and toxic stress. Pediatrics. 2012;129(1):232–46.CrossRef
10.
Paxton G, Smith N, Win A, Mulholland N, Hood S. Refugee Status Report. Melbourne DEECD: A report on how refugee children and young people in Victoria are faring; 2011
11.
Gibson-Helm M, Teede H, Block A, Knight M, East C, Wallace EM, et al. Maternal health and pregnancy outcomes among women of refugee background from African countries: a retrospective, observational study in Australia. BMC Pregnancy Childbirth. 2014;14(1):392.CrossRefPubMedPubMedCentral
12.
Porter M, Haslam N. Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: A meta-analysis. JAMA. 2005;294(5):602–12.CrossRefPubMed
13.
Richardson S, Stack S, Moskos M, Lester L, Healy J, Miller-Lewis L. The changing settlement experience of new migrants. Interwave comparisons for cohort 1 and 2 of the LSIA. Report to the Department of Immigration and Multicultural and Indigenous Affairs: National Institute of Labour Studies Flinders University,, 2004.
14.
Ackerman LK. Health problems of refugees. J Am Board Fam Pract. 1997;10(5):337–48.PubMed
15.
Allotey P. Travelling with “excess baggage”: health problems of refugee women in Western Australia. Women Health. 1999;28(1):63–81.CrossRef
16.
Biggs B, Skull S. Refugee health: clinical issues. In: Allotey P, editor. The health of refugees: public health perspectives from crisis to settlement. Melbourne: Oxford University Press; 2003. p. 54–67.
17.
Oldenburg B, McGuffog ID, Turrell G. Socioeconomic determinants of health in Australia: policy responses and intervention options. Med J Aust. 2000;172(10):489–92.PubMed
18.
Wong W, LaVeist T, Sharfstein J. Achieving health equity by design. JAMA. March 9 2015. Doi:10.1001/jama.2015.2434
19.
Ager A, Strang A. Understanding integration: a conceptual framework. J Refugee Studies. 2008;21(2):166–91.CrossRef
20.
Correa-Velez I, Barnett AG, Gifford S. Working for a better life: Longitudinal evidence on the predictors of employment among recently arrived refugee migrant men living in Australia. International Migration. May 8 2013. Doi: 10.1111/imig.12099.
21.
Victorian Department of Health. The Victorian refugee and asylum seeker health action plan 2014–2018. Melbourne: Victorian Government; 2014.
22.
Victorian Foundation for the Survivors of Torture. Rebuilding shattered lives. Melbourne: Victorian Foundation for Survivors of Torture; 1998.
23.
Victorian Foundation for Survivors of Torture. Raising children in Australia. A resource kit for early childhood services working with parents from African backgrounds. Melbourne, Victorian Foundation for Survivors of Torture; 2007.
24.
Network VRH. Maternity care for women from refugee backgrounds: Discussion paper. Victorian Foundation for Survivors of Torture: Melbourne; 2012.
25.
Yelland J, Riggs E, Wahidi S, Fouladi F, Casey S, Szwarc J, et al. How do Australian maternity and early childhood health services identify and respond to the settlement experience and social context of refugee background families? BMC Pregnancy Childbirth. 2014;14(1):348.CrossRefPubMedPubMedCentral
26.
Riggs E, Davis E, Gibbs L, Block K, Szwarc J, Casey S, et al. Accessing maternal and child health services in Melbourne Australia: reflections from refugee families and service providers. BMC Health Serv Res. 2012;12:117.CrossRefPubMedPubMedCentral
27.
Yelland J, Riggs E, Fouladi F, Wahidi S, Chesters D, Casey S, et al. Having a baby in a new country: the experience of Afghan women, men and stakeholders. Final Report. 2013
28.
Riggs E, Yelland J, Szwarc J, Casey S, Chesters D, Duell-Piening P, et al. Promoting the inclusion of Afghan women and men in research: reflections from research and community partners involved in implementing a 'proof of concept.'. Int J Equity Health. 2015;14(1):13.
29.
30.
Wyndham City Council. Cultural diversity policy and action plan 2008–2010. Melbourne: Social Planning Unit Social Development Department; 2008
31.
Levesque JF, Harris MF, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health. 2013;12:18.CrossRefPubMedPubMedCentral
32.
Villar J, Ba’aqeel H, Piaggio G, Lumbiganon P, Belizán JM, Farnot U, et al. WHO antenatal care randomised trial for the evaluation of a new model of routine antenatal care. Lancet. 2001;357(9268):1551–64.CrossRefPubMed
33.
Alexander GR, Kotelchuck M. Assessing the role and effectiveness of prenatal care: history, challenges, and directions for future research. Public Health Rep. 2001;116:306–16.CrossRefPubMedPubMedCentral
34.
Hollowell J, Oakley L, Kurinczuk JJ, Brocklehurst P, Gray R. The effectiveness of antenatal care programmes to reduce infant mortality and preterm birth in socially disadvantaged and vulnerable women in high-income countries: a systematic review. BMC Pregnancy Childbirth. 2011;11:13.CrossRefPubMedPubMedCentral
35.
Raatikainen K, Heiskanen N, Heinonen S. Under-attending free antenatal care is associated with adverse pregnancy outcomes. BMC Public Health. 2007;7(1):268.CrossRefPubMedPubMedCentral
36.
Victorian Department of Education and Early Childhood Development. Maternal and child health service: practice guidelines. Melbourne: Office for Children; 2009.
37.
Ekman B, Pathmanathan I, Liljestrand J. Integrating health interventions for women, newborn babies, and children: a framework for action. Lancet. 2008;372(9642):990–1000.CrossRefPubMed
38.
Frenk J. Reinventing primary health care: the need for systems integration. Lancet. 2009;374(9684):170–3.CrossRefPubMed
39.
Psaila K, Schmied V, Fowler C, Kruske S. Discontinuities between maternity and child and family health services: health professional’s perceptions. BMC Health Serv Res. 2014;14(1):4.CrossRefPubMedPubMedCentral
40.
Victorian Department of Education and Early Childhood Development. Starting out strong: giving Victoria’s children a great start through better maternal and child health. Melbourne: Department of Education and Early Childhood Development; 2014.
41.
42.
Kerber KJ, de Graft-Johnson JE, Bhutta ZA, Okong P, Starrs A, Lawn JE. Continuum of care for maternal, newborn, and child health: from slogan to service delivery. Lancet. 2007;370(9595):1358–69.CrossRefPubMed
43.
Paxton G. Methodology, Victorian child and data sources. Melbourne: Victorian Government Department of Education and Early Childhood Development; 2011
44.
Paxton GA, Kay MP, Correa-Velez I. Lost and found: improving ascertainment of refugee-background Australians in population datasets. Med J Aust. 2012;197(10):552–3.CrossRefPubMed
45.
Gibson-Helm M, Boyle J, Block A, Teede H. Use of country of birth as an indicator of refugee background in health datasets. BMC Med Res Methodol. 2014;14:27.CrossRefPubMedPubMedCentral
46.
Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82(4):581–629.CrossRefPubMedPubMedCentral
47.
Wandersman A, Duffy J, Flaspohler P, Noonan R, Lubell K, Stillman L, et al. Bridging the gap between prevention research and practice: the interactive systems framework for dissemination and implementation. Am J Community Psychol. 2008;41(3):171–81.CrossRefPubMed
48.
Langley G, Moen R, Nolan K, Nolan T, Norman C, Provost L. The improvement guide: a practical approach to enhancing organizational performance. San Francisco CA: Jossey-Bass; 2009.
49.
Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O, Peacock R. Storylines of research in diffusion of innovation: a meta-narrative approach to systematic review. Soc Sci Med. 2005;61:417–30.CrossRefPubMed
50.
Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50.CrossRefPubMedPubMedCentral
51.
Yelland J, Sutherland G, Brown S. Postpartum anxiety, depression and social health: findings from a population-based survey of Australian women. BMC Public Health. 2010;11:196.
52.
Brown S, Yelland J, Sutherland G, Baghurst P, Robinson J. Stressful life events, social health issues and low birthweight in an Australian population-based birth cohort: challenges and opportunities in antenatal care. BMC Public Health. 2011;11(196).
53.
Donner A. Sample size requirements for stratified cluster randomization designs. Stat Med. 1992;11(6):743–50.CrossRefPubMed
54.
Frison L, Pocock SJ. Repeated measures in clinical trials: analysis using mean summary statistics and its implications for design. Stat Med. 1992;11(13):1685–704.CrossRefPubMed
55.
Vaeth M, Skovlund E. A simple approach to power and sample size calculations in logistic regression and Cox regression models. Stat Med. 2004;23(11):1781–92.CrossRefPubMed
56.
Green J, Willis K, Hughes E, Small R, Welch N, Gibbs L, et al. Generating best evidence from qualitative research: the role of data analysis. Aust N Z J Public Health. 2007;31(6):545–50.CrossRefPubMed
57.
World Health Organisation. How health systems can address health inequalities linked to migration and ethnicity. Copenhagen: WHO Regional Office for Europe; 2010.
58.
58. National Health and Medical Research Council. Ethical considerations in quality assurance and evaluation activities. Canberra: Australian Government; 2014.
59.
60.
Wildridge V, Childs S, Cawthra L, Madge B. How to create successful partnerships—a review of the literature. Health Info Libraries J. 2004;21:3–19.CrossRef
61.
Bunce AE, Gold R, Davis JV, McMullen CK, Jaworski V, Mercer M, et al. Ethnographic process evaluation in primary care: explaining the complexity of implementation. BMC Health Serv Res. 2014;14(1):607.CrossRefPubMedPubMedCentral
Metadata
Title
Bridging the Gap: using an interrupted time series design to evaluate systems reform addressing refugee maternal and child health inequalities
Authors
Jane Yelland
Elisha Riggs
Josef Szwarc
Sue Casey
Wendy Dawson
Dannielle Vanpraag
Chris East
Euan Wallace
Glyn Teale
Bernie Harrison
Pauline Petschel
John Furler
Sharon Goldfeld
Fiona Mensah
Mary Anne Biro
Sue Willey
I-Hao Cheng
Rhonda Small
Stephanie Brown
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2015
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/s13012-015-0251-z

Other articles of this Issue 1/2015

Implementation Science 1/2015 Go to the issue

Debate

What’s in a mechanism? Development of a key concept in realist evaluation

Research

Implementation of a cystic fibrosis lung transplant referral patient decision aid in routine clinical practice: an observational study

Short report

Research funders’ roles and perceived responsibilities in relation to the implementation of clinical research results: a multiple case study of Swedish research funders

Methodology

What is the extent and quality of documentation and reporting of fidelity to implementation strategies: a scoping review

Study protocol

Implementing tobacco use treatment guidelines in community health centers in Vietnam

Erratum

Erratum to: ‘Exploring the function and effectiveness of knowledge brokers as facilitators of knowledge translation in health related settings: a systematic review and thematic analysis’