Community-focused solutions to health literacy challenges

The period of early childhood development sets the trajectory for the entire life course and is a critical period to intervene to reduce health inequity. However, for new migrant parents with young children, the double burden of adjusting to parenthood while learning how to live in a foreign country makes it extremely difficult to know how to find and access appropriate healthcare services.

Healthdirect Australia has collaborated with several organisations, including the Health Equity Research and Development Unit (HERDU) associated with the University of New South Wales (UNSW), to pilot a world-first health literacy program in Canterbury, NSW, an area with a large migrant population — more than 56 per cent of residents were born overseas¹.

Identifying the need for health literacy support in Canterbury

Between 2013-2017, clinicians working at Canterbury Hospital observed unusually high numbers of children aged 0-4 presenting to the emergency department in the after-hours period.

This observation triggered a 2017 study by HERDU which found that new migrant parents in Canterbury were returning to the hospital where their children were born when they had general health concerns². The study also found that these patients were missing opportunities to attend other services at a more convenient time due to their lack of understanding of what was appropriate and available².

In response to the study and to support new migrant families access appropriate healthcare at the times they need it, Healthdirect Australia funded a health literacy program which was developed by HERDU and implemented and evaluated in 2019.

Health literacy program: design and implementation

The health literacy program was designed to improve access to health information, health services and social support for new migrant mothers³ — specifically Bangladeshi and Mandarin-speaking Chinese mothers, the two largest migrant groups having children at Canterbury Hospital in 2017.

To inform the design of the program, a literature review was conducted to identify enablers, barriers and interventions to improve access to health care for migrant families. The major barriers identified were communication difficulties and a lack of cultural appropriateness³. Cultural humility and sensitivity, including the use of bicultural, lay health workers and interpreters, as well as social support including multicultural mothers' groups were identified as key enablers³.

The program consisted of re-designed new parent classes for Bangladeshi and Chinese mothers and grandmothers. These classes were delivered by a Child and Family Health Nurse with an interpreter and aimed to improve understanding of how to access health services, information and social support. Cultural support workers were employed to provide advice in the lead up to classes, identify and recruit attendants, and provide support during classes. These workers were crucial in facilitating successful recruitment and high attendance over the four-weeks the classes were held.

Health literacy program: key outcomes

Participants found the classes both useful and beneficial, and reported increased confidence in accessing health information, managing health issues and accessing social support³.

Initial findings also indicate that the program successfully educated mothers about alternatives to attending the emergency department for non-urgent care during business hours and in the after-hours period. The evaluation found that women who attended the classes also benefited from increased levels of health literacy³.

The Child and Family Health Nurses described their increased cultural knowledge and awareness as a result of facilitating the classes, while still being able to work within their usual scope of practice.

The pilot intervention was designed to use existing infrastructure and frameworks to deliver valuable information and resources to communities in need. It has demonstrated that with simple tweaks to the content to ensure cultural appropriateness, and the employment of interpreters and cultural support workers, existing parenting classes can be tailored to become accessible to migrant parents.

Multilingual resources

In addition to the pilot intervention program, the 2017 study led to Healthdirect Australia working with HERDU, the Sydney Local Health District (SLHD), health professionals and consumer representatives to develop a range of co-designed, culturally appropriate resources in languages other than English that Australian residents most commonly speak at home: Mandarin, Cantonese, Arabic, Bengali and Vietnamese.

The resources are available in multiple formats — videos, webpages, posters and brochures — covering simple messages such as: 'What care do I need?' and 'The role of a GP'. The topics were chosen to explain fundamental aspects of the Australian health system. They are intended to improve people's health literacy and confidence in accessing appropriate primary care for themselves and their families. The resources were distributed to participants of the new parent classes and can be used in a range of situations across the Australian health system where language is a barrier.

Health professionals are encouraged to make these resources available to their patients. Free downloads and an order form for printed materials are available on the healthdirect website.

¹ Australian Bureau of Statistics: 2016 Census Quick Stats.

² Page, J., Harris, E., Sharma, N. (2018). After-hours attendance of paediatric patients at Canterbury Hospital Emergency Department: Final report. Health Equity Research and Development Unit, University of New South Wales, Sydney.

³ Dougherty, L., Riley, A., Harris, M. and Lloyd, J. (2019). Supporting newly arrived migrant parents in Australia: a pilot health literacy project: Evaluation report. Health Equity Research and Development Unit, Sydney Local Health District/University of New South Wales, Sydney.