title: Accessing maternal and child health services in Melbourne, Australia: reflections from refugee families and service providers.
abstract: BACKGROUND
  Often new arrivals from refugee backgrounds have experienced poor health and limited access to healthcare services. The maternal and child health (MCH) service in Victoria, Australia, is a joint local and state government operated, cost-free service available to all mothers of children aged 0-6 years. Although well-child healthcare visits are useful in identifying health issues early, there has been limited investigation in the use of these services for families from refugee backgrounds. This study aims to explore experiences of using MCH services, from the perspective of families from refugee backgrounds and service providers.
  
  
  METHODS
  We used a qualitative study design informed by the socioecological model of health and a cultural competence approach. Two geographical areas of Melbourne were selected to invite participants. Seven focus groups were conducted with 87 mothers from Karen, Iraqi, Assyrian Chaldean, Lebanese, South Sudanese and Bhutanese backgrounds, who had lived an average of 4.7 years in Australia (range one month-18 years). Participants had a total of 249 children, of these 150 were born in Australia. Four focus groups and five interviews were conducted with MCH nurses, other healthcare providers and bicultural workers.
  
  
  RESULTS
  Four themes were identified: facilitating access to MCH services; promoting continued engagement with the MCH service; language challenges; and what is working well and could be done better. Several processes were identified that facilitated initial access to the MCH service but there were implications for continued use of the service. The MCH service was not formally notified of new parents arriving with young children. Pre-arranged group appointments by MCH nurses for parents who attended playgroups worked well to increase ongoing service engagement. Barriers for parents in using MCH services included access to transportation, lack of confidence in speaking English and making phone bookings. Service users and providers reported that continuity of nurse and interpreter is preferred for increasing client-provider trust and ongoing engagement.
  
  
  CONCLUSIONS
  Although participants who had children born in Melbourne had good initial access to, and experience of, using MCH services, significant barriers remain. A systems-oriented, culturally competent approach to service provision would improve the service utilisation experience for parents and providers, including formalising links and notifications between settlement services and MCH services.
authors.affiliation: The Jack Brockhoff Child Health and Wellbeing Program, The McCaughey Centre, The University of Melbourne, Melbourne, Australia. elisha.riggs@mcri.edu.au
authors.forename: Elisha
authors.initials: E
authors.lastname: Riggs
authors.forename: Elise
authors.initials: E
authors.lastname: Davis
authors.forename: Lisa
authors.initials: L
authors.lastname: Gibbs
authors.forename: Karen
authors.initials: K
authors.lastname: Block
authors.forename: Jo
authors.initials: J
authors.lastname: Szwarc
authors.forename: Sue
authors.initials: S
authors.lastname: Casey
authors.forename: Philippa
authors.initials: P
authors.lastname: Duell-Piening
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Waters
mesh_terms: D000328:Adult; D001071:Appointments and Schedules; D001315:Australia; D002648:Child; D003150:Community Health Workers / Q000193:education / Q000458:organization & administration / Q000523:psychology; D055812:Community-Based Participatory Research; D003159:Community-Institutional Relations; D003266:Continuity of Patient Care / Q000458:organization & administration; D054521:Cultural Competency; D005192:Family Health / Q000208:ethnology; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D008430:Maternal-Child Health Centers / Q000458:organization & administration*; D008611:Mentors / Q000193:education; D011320:Primary Health Care / Q000379:methods* / Q000592:standards; D016730:Program Development; D036301:Qualitative Research; D012036:Refugees / Q000523:psychology* / Q000706:statistics & numerical data; D000078329:Workforce