Chona Hannah

Refugees experience traumatic life events with impacts amplified in regional and rural areas due to barriers accessing services. This study examined the factors influencing the lived experience of resettlement for former refugees in regional Launceston, Australia, including environmental, social, and health-related factors. Qualitative interviews and focus groups were conducted with adult and youth community members from Burma, Bhutan, Sierra Leone, Afghanistan, Iran, and Sudan, and essential service providers (n = 31). Thematic analysis revealed four factors as primarily influencing resettlement: English language proficiency; employment, education and housing environments and opportunities; health status and service access; and broader social factors and experiences. Participants suggested strategies to overcome barriers associated with these factors and improve overall quality of life throughout resettlement. These included flexible English language program delivery and employment support, including industry-specific language courses; the provision of interpreters; community events fostering cultural sharing, inclusivity and promoting well-being; and routine inclusion of nondiscriminatory, culturally sensitive, trauma-informed practices throughout a former refugee’s environment, including within education, employment, housing and service settings.

Objective: To examine the resettlement experiences of former refugees living in regional Australia, focusing on mental health and mental health and support services, including barriers to access.Design: A phenomenological approach utilising a combination of six qualitative, semi‐structured, face‐to‐face focus groups (n = 24) and seven individual interviews. Data were analysed thematically using NVivo 10 software.Setting: Launceston, Tasmania.Participants: Adult and youth former refugees from Afghanistan, Bhutan, Burma, Sierra Leone, Sudan and Iran, and essential service providers, residing in Launceston.Main outcome measures: Participants were asked about experiences of resettlement and mental health.Results: Participants reported that their mental health had improved since resettlement; however, major stressors impacted mental health and resettlement included employment and housing access and mastering the English language. Past experiences continued to impact current functioning, with trauma commonly experienced intergenerationally through parenting and attachment and ongoing trauma and feelings of guilt and responsibility experienced with families left behind. Participants noted barriers to accessing services: (a) Language difficulties including lack of interpreters; and (b) lack of culturally sensitive and trauma‐informed practices. Discrimination was experienced through the inconsistent provision of interpreters and lack of due consideration of cultural and religious differences. The use of children as interpreters enhanced a number of risk including miscommunication of medical information, exposure to age‐inappropriate information and the resulting increased risk of trauma for the child.Conclusion: Culturally sensitive, trauma‐informed and discrimination‐free practices should be employed across services, where Western‐views surrounding this medical model are not imposed, cultural differences are respected, and timely access to interpreters was provided.

The National Primary Health Care Strategy in Australia recommends primary health care services need to be clinically and culturally appropriate and delivered in a timely and affordable manner. However simultaneously recognised, access is still inequitable in among various population groups and many areas of Australia. Geographical Information System (GIS) have been used to explore geographical health disparities, planning health care service delivery and provide data in a meaningful way to inform public health strategies. Moreover, GIS has also been used to spatially analyse, measure and provide insight into a population’s accessibility to health care services. A literature search was conducted to identify studies which examined primary health care accessibility using GIS techniques among various urban and rural populations. A limited number of studies demonstrated in addition to distance; time; and location, low socioeconomic status, Culturally and Linguistically Diverse (CALD) background among other factors influences health care access. In addition, other factors were identified to impact health care access, which is an individualised process, influenced by individual characteristics, beliefs, attitudes, and an individual’s activity space. As health care accessibility becomes more prominent within policy, among practitioners and increasingly researched, it has the potential to move beyond recognising areas of poor accessibility among individuals and communities. With a greater integration of both spatial and aspatial data, the process has the likelihood, to provide greater insight into patient behaviour, public perception, amelioration service quality and improve population health and wellbeing.