There is a growing literature on the influences of cultural knowledge and practices on health literacy, as well as how people’s specific communities and backgrounds affect their health literacy in new environments. Although this literature is growing, little is known about how the health knowledge of African refugees influences their experiences with Australian health care, how their health literacy changes as they learn more about Australian systems, and how they use their health literacy to support and improve their health when health systems do not meet their knowledge and needs. This qualitative study explored health literacy among African refugees by highlighting their knowledge, culturally and religiously creative health practices in Australia. This study draws on 19 semi-structured face-to-face interviews conducted with a culturally and linguistically diverse sample of African refugees from nine countries living in southwestern Sydney, Australia, between March and December 2022. Audio-recorded, semi-structured interviews were transcribed verbatim and coded into QSR NVivo 12. A constant comparative and thematic analysis method-guided data analysis. Three themes were identified, demonstrating the multifaceted connections between health literacy, culture, religion, experiences, and language. First, African refugees’ knowledge of health systems could not be easily used in Australia because systems were different, and Australian health systems were not set up to support other groups/various types of health literacy. The second theme was that health knowledge is multidimensional, with heterogeneous determinants and information sources influencing diverse culturally and religiously conditioned, constructed, and bound health practices. In theme three, African refugees’ complex thoughts, decisions, and actions to enhance their health and health literacy after resettling in Australia demonstrated that health information meaning, and knowledge are created and distributed across social networks and relationships. The findings offer a needed social-cultural re-framing of health literacy to describe and capture health care practices and beliefs of cultural groups such as African refugees in Australia. Expanding health literacy to include social and cultural dimensions could strengthen African refugee patients’ knowledge about the health system and empower health care services and providers to adapt their processes, structures and procedures to different health literacy states and levels.

Background The COVID-19 pandemic, extreme weather events, and the Russian invasion of Ukraine have highlighted global food system vulnerabilities and a lack of preparedness and prospective planning for increasingly complex disruptions. This has spurred an interest in food system resilience. Despite the elevated interest in food system resilience, there is a lack of comparative analyses of national-level food system resilience efforts. An improved understanding of the food system resilience landscape can support and inform future policies, programs, and planning. Methods We conducted a cross-country comparison of national-level food system resilience activities from Australia, Aotearoa New Zealand, Sweden, and the United States. We developed upon and adapted the resilience framework proposed by Harris and Spiegel to compare actions derived from thirteen national food system resilience documents. We coded the documents based on the actions taken by the governments including: the food system resilience attributes utilized, the part of the food supply chain, the specific shocks or stressors, the implementation level, the temporal focus of action, and the expected impact on food security. We analyzed and compared countries’ coded categories and subcategories, and category combinations. Results The results showed that these countries are addressing some of the same issues, are using multi-pronged policy actions to address food system resilience issues, and are focused on both retrospective reviews and prospective models of disruptive events to inform their decisions. Some work has been done towards preparing for climate change and other natural disasters, and less preparing has been done for other shocks or stressors. Conclusions This paper develops and applies a framework rooted in literature to understand the content of national-level food system resilience documents. The analysis identified potential gaps, concentrations, and themes in national food systems resilience. The framework can be applied to augment existing policy, create new policy, as well as to supplement and complement other existing frameworks.

BackgroundPrimary health care is the first point of contact for patients from refugee backgrounds in the Australian health system. Sociocultural factors, including beliefs and value systems, are salient determinants of health literacy and access to primary health care services. Although African refugees in Australia have diverse sociocultural backgrounds, little is known about the influence of sociocultural factors on their experiences of accessing primary health care services. Guided by the theoretical framework of access to health care, this study examined from the perspective of African refugees how culturally and religiously conditioned, constructed and bound health beliefs, knowledge and practices influence their experiences of access to, acceptance and use of primary health care services and information in Australia.MethodsThis exploratory, qualitative study involved 19 African refugees from nine countries living in New South Wales, Australia. Semi-structured interviews were conducted and recorded using Zoom software. The interviews were transcribed verbatim and analysed using a bottom-up thematic analytical approach for theme generation.ResultsFour main themes were identified. The themes included: participants' experiences of services as inaccessible and monocultural and providing information in a culturally unsafe and insensitive manner; the impact of the clinical care environment; meeting expectations and needs; and overcoming access challenges and reclaiming power and autonomy through familiar means. The findings generally support four dimensions in the access to health care framework, including approachability, acceptability, availability and accommodation and appropriateness.ConclusionAfrican refugees experience significant social and cultural challenges in accessing primary health care services. These challenges could be due to a lack of literacy on the part of health services and their providers in servicing the needs of African refugees. This is an important finding that needs to be addressed by the Australian health care system and services. Enhancing organisational health literacy through evidence-informed strategies in primary health systems and services can help reduce disparities in health access and outcomes that may be exacerbated by cultural, linguistic and religious differences.

Abstract Background Organisational health literacy is a promising area of research that enables a focus on how systems and services can be designed in ways that are responsive to populations with varying states and levels of health literacy, knowledge, and practices, including African refugees. The challenge is how organisations and professionals do this in practice, and research in this area is in its early stages. This qualitative study examined barriers to implementing health literacy responsive care practices in primary health care settings in Australia. It also offered suggestions to potentially address the barriers to improving organisational health literacy. Methods Refugees (n = 19), primary health care professionals (n = 14), and other key stakeholders (n = 19) were recruited through convenience and snowball strategies from three states in Australia: New South Wales, Victoria, and Queensland. All but one participant was interviewed face-to-face via Zoom. Semi-structured interview guides were used to guide the conversations. Transcriptions from audio recordings were analysed using directed content analysis. Results Thirteen themes were extracted from the data. Themes were organised into the following categories: structural and systemic, organisational context, individual professional level, individual patient level, and socio-community level. Major structural and system-level factors affecting organisational health literacy included rigid systems and structures and limited time. Key organisation-level factors included inflexible organisational processes and policies, institutionalised othering, discrimination and racism, and lack of interpreters. Individual professional factors were poor communication with patients and cultural knowledge gaps. Linguistic issues and service mistrust were key individual patient-level factors. Socio-community factors included limited community engagement. Participants identified potential solutions to help services navigate out of the barriers and improve their response to health literacy. Conclusion The findings suggest that mainstream services and organisations could improve timely and appropriate health care access and utilisation for refugees through strategies such as designing services and health literacy programs with refugee communities, promoting health literacy champions in the workforce, integrating health literacy and culturally responsive care plans and strategies into organisational priorities.

Background The COVID-19 pandemic, extreme weather events, and the Russian invasion of Ukraine have highlighted global food system vulnerabilities and a lack of preparedness and prospective planning for increasingly complex disruptions. This has spurred an interest in food system resilience. Despite the elevated interest in food system resilience, there is a lack of comparative analyses of national-level food system resilience efforts. An improved understanding of the food system resilience landscape can support and inform future policies, programs, and planning. Methods We conducted a cross-country comparison of national-level food system resilience activities from Australia, Aotearoa (New Zealand), Sweden, and the United States. We developed upon and adapted the resilience framework proposed by Harris and Spiegel to compare actions derived from thirteen national food system resilience documents. We coded the documents based on how the governments determined actions by food system resilience attribute utilized, part of the food supply chain, specific shocks or stressors, implementation level, the temporal focus of action, and the expected impact on food security. We analyzed and compared countries’ coded categories, subcategories, and category combinations. Results The results showed that countries are using multi-pronged policy actions to address food system resilience issues and are focused on both retrospective reviews and prospective models of disruptive events to inform their decisions. Some work has been done towards preparing for climate change and other natural disasters, but not as much for other shocks or stressors. Conclusions The analysis identified potential gaps, concentrations, and themes in national food systems resilience. The framework can be applied to augment existing policy, create new policy, as well as to supplement and complement other existing frameworks.

Background Primary health care [PHC] services with general practitioners (GPs) as the first point of access to health care services for people from refugee backgrounds in Australia can play a crucial role in building health literacy and promoting access to culturally appropriate services. To achieve equitable access and engagement, services and systems must be responsive to diverse health literacy and cultural needs. This study aims to explore how primary health services respond as a system and organisation to the health literacy and cultural needs of people from refugee backgrounds in Australia. Methods This exploratory qualitative study involved 52 semi-structured interviews among 19 Africans from refugee backgrounds, 14 service providers, including GPs and nurses, and 19 other stakeholders, such as service managers/directors. Participants resided in New South Wales, Victoria, and Queensland. Interviews were audio-recorded, transcribed, and coded into QSR NVivo 12. Data analysis was guided by reflexive thematic analysis. Findings Three interrelated themes were identified from the data relating to the health literacy and cultural responsiveness of PHC systems and services. The first theme, ‘variable and ad hoc organisational response to health literacy and culturally responsive care,’ demonstrated that some organisations did not systematically address the inherent complexity of navigating the health system nor the capacity of services and providers to respond to the cultural needs of people from refugee backgrounds. The second theme, ‘individual provider responsibility,’ captured the individual providers’ interpersonal and relational efforts in supporting the health literacy and cultural needs of people from refugee backgrounds based on their motivation and adaptation. The third theme, ‘refugee patient responsibility,’ encapsulated people from refugee backgrounds’ adaptations to and learning of the health system to navigate and access services. Conclusion Health literacy and culturally responsive practices need to be systematised by PHC organisations to be implemented and sustained over time. There is a need for diversity in the organisational leadership and health care workforce, organisational commitment, health literacy and culturally responsive care policies, provider training, and auditing practice as essential components of the change process. Engaging with refugee communities would allow services to focus on people from refugee backgrounds’ needs by design.

Background Australia has one of the highest rates of overweight and obesity in the developed world, and this increasing prevalence and associated chronic disease morbidity reinforces the importance of understanding the attitudes, views, and experiences of patients and health providers towards weight management interventions and programs. The purpose of this study was to investigate patients, family practitioners and family practice nurses’ perceptions and views regarding the receipt or delivery of weight management within the context of the HeLP-GP intervention. Methods A nested qualitative study design including semi-structured interviews with family practitioners ( n = 8), family practice nurses ( n = 4), and patients ( n = 25) attending family practices in New South Wales ( n = 2) and South Australia ( n = 2). The patient interviews sought specific feedback about each aspect of the intervention and the provider interviews sought to elicit their understanding and opinions of the strategies underpinning the intervention as well as general perceptions about providing weight management to their patients. Interviews were recorded and transcribed verbatim, and coding and management conducted using NVivo 12 Pro. We analysed the interview data using thematic analysis. Results Our study identified three key themes: long-term trusting and supportive relationships (being ‘in it for the long haul’); initiating conversations and understanding motivations; and ensuring access to multi-modal weight management options that acknowledge differing levels of health literacy. The three themes infer that weight management in family practice with patients who are overweight or obese is challenged by the complexity of the task and the perceived motivation of patients. It needs to be facilitated by positive open communication and programs tailored to patient needs, preferences, and health literacy to be successful. Conclusions Providing positive weight management in family practice requires ongoing commitment and an open and trusting therapeutic relationship between providers and patients. Behaviour change can be achieved through timely and considered interactions that target individual preferences, are tailored to health literacy, and are consistent and positive in their messaging. Ongoing support of family practices is required through funding and policy changes and additional avenues for referral and adjunctive interventions are required to provide comprehensive weight management within this setting.

Background Globally, Primary Health Care (PHC) is recognised as central to improving health for all, yet COPD patients in Nepal are not receiving adequate PHC, because of limitations in the six building blocks of the health system as proposed by World Health Organisation in 2007. Therefore, there is a need to strengthen the capacity of community-level health institutions and health professionals by facilitating integrated care to improve self-management support for COPD patients. Objectives We aimed to develop and prototype a model of care linking primary and tertiary care components to improve self-management practices (SMPs) of COPD patients in Nepal. Methods Based on a survey and qualitative study in 2018, we have developed integrated care and intervention to address locally identified problems. We refined our model (prototyping) in two small stakeholders meeting and a final co-design workshop in May-June 2019 with 60 stakeholders consisting of patients, carers, providers, researchers, and policymakers. During the co-design workshop, a series of presentation and a 50-minute brainstorming session was conducted in groups of six participants to collect their inputs on the proposed model of care and intervention components. Results Through a facilitated workshop using consensus decision making, patients, local government, primary health care workers, policymakers, academics, and community representatives worked together to refine an integrated model of care. The resultant integrated model will include: screening of COPD at the community and management of symptomatic patients at primary health care, establishing referral pathway for severe cases to tertiary level health care and establishing community care. Our presentation will include: steps in the co-design process and results from prototyping with stakeholders. Conclusion Our integrated, contextually-appropriate model of care and intervention should improve the quality of care and quality of life for COPD patients. Lesson learned Engagement of patient, carers, providers, and policymakers in developing a model of care creates a sense of ownership among the stakeholders. Suggestions for future research This refined Integrated Self-management Intervention Program will be tested to improve SMPs, quality of care, and quality of life for COPD patients.

Background Globally, Primary Health Care (PHC) is recognised as central to improving health for all, yet COPD patients in Nepal are not receiving adequate PHC, because of limitations in the six building blocks of the health system as proposed by World Health Organisation in 2007. Therefore, there is a need to strengthen the capacity of community-level health institutions and health professionals by facilitating integrated care to improve self-management support for COPD patients. Objectives We aimed to develop and prototype a model of care linking primary and tertiary care components to improve self-management practices (SMPs) of COPD patients in Nepal. Methods Based on a survey and qualitative study in 2018, we have developed integrated care and intervention to address locally identified problems. We refined our model (prototyping) in two small stakeholders meeting and a final co-design workshop in May-June 2019 with 60 stakeholders consisting of patients, carers, providers, researchers, and policymakers. During the co-design workshop, a series of presentation and a 50-minute brainstorming session was conducted in groups of six participants to collect their inputs on the proposed model of care and intervention components. Results Through a facilitated workshop using consensus decision making, patients, local government, primary health care workers, policymakers, academics, and community representatives worked together to refine an integrated model of care. The resultant integrated model will include: screening of COPD at the community and management of symptomatic patients at primary health care, establishing referral pathway for severe cases to tertiary level health care and establishing community care. Our presentation will include: steps in the co-design process and results from prototyping with stakeholders. Conclusion Our integrated, contextually-appropriate model of care and intervention should improve the quality of care and quality of life for COPD patients. Lesson learned Engagement of patient, carers, providers, and policymakers in developing a model of care creates a sense of ownership among the stakeholders. Suggestions for future research This refined Integrated Self-management Intervention Program will be tested to improve SMPs, quality of care, and quality of life for COPD patients.

Background Globally, Primary Health Care (PHC) is recognised as central to improving health for all, yet COPD patients in Nepal are not receiving adequate PHC, because of limitations in the six building blocks of the health system as proposed by World Health Organisation in 2007. Therefore, there is a need to strengthen the capacity of community-level health institutions and health professionals by facilitating integrated care to improve self-management support for COPD patients. Objectives We aimed to develop and prototype a model of care linking primary and tertiary care components to improve self-management practices (SMPs) of COPD patients in Nepal. Methods Based on a survey and qualitative study in 2018, we have developed integrated care and intervention to address locally identified problems. We refined our model (prototyping) in two small stakeholders meeting and a final co-design workshop in May-June 2019 with 60 stakeholders consisting of patients, carers, providers, researchers, and policymakers. During the co-design workshop, a series of presentation and a 50-minute brainstorming session was conducted in groups of six participants to collect their inputs on the proposed model of care and intervention components. Results Through a facilitated workshop using consensus decision making, patients, local government, primary health care workers, policymakers, academics, and community representatives worked together to refine an integrated model of care. The resultant integrated model will include: screening of COPD at the community and management of symptomatic patients at primary health care, establishing referral pathway for severe cases to tertiary level health care and establishing community care. Our presentation will include: steps in the co-design process and results from prototyping with stakeholders. Conclusion Our integrated, contextually-appropriate model of care and intervention should improve the quality of care and quality of life for COPD patients. Lesson learned Engagement of patient, carers, providers, and policymakers in developing a model of care creates a sense of ownership among the stakeholders. Suggestions for future research This refined Integrated Self-management Intervention Program will be tested to improve SMPs, quality of care, and quality of life for COPD patients.

Background People with chronic obstructive pulmonary disease (COPD) in Nepal are not receiving adequate support to self-manage their chronic conditions, and primary health care can play a key role in the effective management of these. In this study, we aimed to develop a model of care, using a co-design approach, for delivering evidence-based biomedical and psycho-social care to support self-management for people with multi-morbid COPD in rural Nepal. Methods A co-design approach, guided by the five stages of the design thinking model, was used for this study. Layering on “empathize” and “define” phases, we ideated a model of care that was further refined in a “prototype” stage, which included a series of consultative meetings and a 1-day co-design workshop with stakeholders. This co-design process involved a wide range of stakeholders from Nepal, including people with COPD and their families, community representatives, local government representatives, primary care practitioners, community health workers, policymakers, state-level government representatives and academics. Results Through our co-design approach, a model of integrated care for delivering evidence-based biomedical and psycho-social care to support self-management for people with multi-morbid COPD was designed. The integrated model of care included: screening of the community members aged > 40 years or exhibiting symptoms for COPD and management of symptomatic patients within primary health care, establishing referral pathways for severe cases to and from secondary/tertiary-level health care and establishing a community-based support system. It involved specific roles for community health workers, patients and their caregivers and community representatives. It was built on existing services and programmes linking primary health care centres and tertiary-level health facilities. Conclusion The co-design approach is different from the currently dominant approach of rolling out models of care, which were designed elsewhere with minimal community engagement. In our study, the co-design approach was found to be effective in engaging various stakeholders and in developing a model of care for rural Nepal. This grassroots approach is more likely to be acceptable, effective and sustainable in rural Nepal. Further research is required to test the effectiveness of an integrated model of care in delivering self-management support for people with multi-morbid COPD in rural Nepal.

Experiencing migration can create or exacerbate vulnerability to ill health, particularly during pregnancy and new motherhood. Providing a culturally appropriate health literacy intervention to new migrant families may increase social support and the skills and confidence to access health care services and information. This study developed and piloted a health literacy intervention, in the form of culturally redesigned new parent classes, in a culturally diverse location in Australia. The intervention was delivered over a 4-week period by Child and Family Health Nurses, with the help of interpreters and Bilingual Community Researchers, to Bangladeshi and Mandarin-speaking Chinese mothers and grandmothers with a baby age 0 to 1 year. A mixed-methods evaluation was conducted to measure (1) recruitment and attendance of participants, (2) feasibility of the intervention, (3) health literacy of participants, and (4) provider understanding of barriers to health care access. Thirty participants were recruited, and 18 women attended at least three of the four group sessions. Nurses viewed the program as being within the scope of their usual role, demonstrating intervention feasibility. Health literacy scores were higher post-intervention than pre-intervention. Nurses described having increased awareness of barriers to health care access after facilitating the intervention. The program has potential to be scaled up to other areas and languages. [HLRP: Health Literacy Research and Practice. 2021;5(3):e201-e207.].

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)The IJIC 20th Anniversary Issue was published in 2021.

Objective To understand the feasibility and acceptability of a co-design approach to developing an integrated model of healthcare for people with multi-morbid chronic obstructive pulmonary disease (COPD) in rural Nepal.Settings A rural setting of Nepal.Participants Data collection included five video recordings, five key informant interviews and observation notes from a final co-design workshop that involved a total of 68 stakeholders: persons with COPD and their family members; healthcare providers, including respiratory physicians; local community leaders; representatives from local, provincial and federal government; academics; and representatives from non-government organisations.Primary and secondary outcome measure(s) Feasibility and acceptability of using a co-design approach to develop an integrated model of care for people with multi-morbid COPD in rural Nepal.Results Our qualitative evaluation of the Hasso Plattner’s co-design process found that all stakeholders (including people with COPD/community members, primary care practitioners and local government/senior health officials) were actively engaged in and significantly contributed to the process of co-design. Four main themes were identified which determined the feasibility and acceptability of the resulting integrated model of care: engagement of stakeholders, factors contributing to the co-design, consequences of the co-design process, and challenges and opportunities learnt by the researchers and participants in the co-design process. Based on the relationship between the four main themes emerging from this research, we developed an evaluation framework to guide the co-design of a health service innovation.Conclusion Our study demonstrated the feasibility and acceptability of the Hasso Plattner’s co-design process. Our findings suggest that this co-design approach can be useful and acceptableto local communities and government agencies. It enabled the meaningful contribution of adiverse group of stakeholders in the design and delivery of health services in low-income and middle-income countries.

Evidence of a social gradient in health literacy has been found in all reported national population surveys. Health literacy is a midstream determinant of health but not a panacea for addressing health inequities created by the maldistribution of opportunity and resources. It is possible to optimize the contribution health literacy makes in mediating the causes and effects of established social determinants of health. Existing interventions demonstrate the feasibility of improving health literacy among higher-risk populations, but research remains underdeveloped and effects on health inequity are largely untested. Future health literacy intervention research should focus on ( a) improving the quality of health communication that reaches a diversity of populations, especially by improving frontline professional skills and support; ( b) enabling people to develop transferable skills in accessing, understanding, analyzing, and applying health information; and ( c) ensuring that priority is proportionate to need by reaching and engaging the population groups who are disproportionately affected by low health literacy.

OBJECTIVE:To understand the facilitators and barriers to the self-management of chronic obstructive pulmonary disease (COPD) in rural Nepal.SETTINGS:Community and primary care centres in rural Nepal.PARTICIPANTS:A total of 14 participants (10 people with COPD and 4 health care providers) were interviewed.PRIMARY AND SECONDARY OUTCOME MEASURES:People with COPD and healthcare provider's experience of COPD self-management in rural Nepal.RESULTS:Facilitators and barriers affecting COPD self-management in Nepal operated at the patient-family, community and service provider levels. People with COPD were found to have a limited understanding of COPD and medications. Some participants reported receiving inadequate family support and described poor emotional health. At the community level, widespread use of complementary and alternative treatment was found to be driven by social networks and was used instead of western medicine. There were limited quality controls in place to monitor the safe use of alternative treatment. While a number of service level factors were identified by all participants, the pertinent concerns were the levels of trust and respect between doctors and their patients. Service level factors included patients' demands for doctor time and attention, limited confidence of people with COPD in communicating confidently and openly with their doctor, limited skills and expertise of the doctors in promoting behavioural change, frustration with doctors prescribing too many medicines and the length of time to diagnose the disease. These service level factors were underpinned by resource constraints operating in rural areas. These included inadequate infrastructure and resources, limited skills of primary level providers and lack of educational materials for COPD.CONCLUSIONS:The study findings suggest the need for a more integrated model of care with multiple strategies targeting all three levels in order to improve the self-management practices among people with COPD.

Background Chronic Obstructive Pulmonary Disease (COPD) is a progressive and debilitating condition that affects individuals’ quality of life. COPD self-management and supports provided by carers is key to the quality of life people living with COPD. Health literacy (HL) and Patient Activation (PA) are main drivers of self-management practices (SMPs). However, their contribution remains to be fully explored. This study aimed to examine the level of self-management practices, and the relationship with socio-demographic factors, HL and PA among multi-morbid COPD patients from rural Nepal. Methods This is a cross-sectional study conducted between July 2018 and January 2019. Patients completed a survey, including Self-management Practices questionnaire (SMPQ), five domains of the Health Literacy Questionnaire (HLQ), and Patient Activation Measure (PAM). The relationship between HL, PAM, and SMPs was examined using univariate statistics. Multivariable analysis was conducted to identify the factors associated with SMPs. Results A total of 238 patients responded to the study. The mean score of SMPQ was 45.31(SD = 9.00). The HLQ and PAM scores were positively correlated with the total score of SMPQ. Low level of SMPs were found to be positively associated with being uneducated (β = − 0.43, p = .001), having a low family income (β = − 5.22, p = .002), and, negatively associated with the presence of more than one co-morbidity (β = 3.58, p = 0.007) after controlling for other socio-demographic variables in the multivariable analysis. Conclusion The overall SMPs among this sample of Nepalese with COPD were low. Our findings highlight the need to implement a self-management intervention program involving patient activation and health literacy-focused activities for COPD, creating a support system for patients from low-income families and low education.

Background Recently arrived culturally and linguistically diverse migrant mothers in Western Industrialised Nations are less likely to access health care and are more likely to report negative healthcare experiences than more established migrant or non-migrant populations. This is particularly an issue in Australia where nearly half of all Australians were born overseas or have at least one parent born overseas. Methods A systematic scoping review was conducted to identify a) the main enablers and barriers to accessing appropriate health care for migrant families with a new baby/young child who speak a language other than English, and b) the effectiveness of interventions that have been tested to improve access to appropriate health care for this group. Three academic databases (CINAHL, Medline and ProQuest) were searched, with additional publications identified through expert knowledge and networks. Data was extracted and analysed according to the Access framework, which conceptualises access to health care as being generated by the interaction of dimensions of accessibility of services (supply side) and abilities of potential users (demand side). Results A total of 1964 records were screened for eligibility, with nine of these included in the review. Seven studies only described barriers and enablers to health care access, one study reported on an evaluation of an intervention and one study described the barriers and enablers and the evaluation of an intervention. This review identified that the most significant barriers occurred on the supply side, within the 'appropriateness' domain. Overall, the most frequently cited barrier was a lack of cultural sensitivity/understanding of different cultural practices (five studies). The most significant enablers also occurred on the supply side, but within the 'acceptability' domain. The most frequently cited enabler was cultural sensitivity and understanding. Conclusions There is a dearth of evaluated interventions in the peer reviewed literature to improve appropriate access to postnatal care for migrant families who speak a language other than English. The literature focuses on identifying barriers and enablers to access to healthcare for this population group. Interventions which aim to address barriers within the 'appropriateness' dimension may have the greatest impact on access.

Self-management (SM) includes activities that patients initiate and perform in the interest of controlling their disease and maintaining good health and well-being. This review examines the health literacy and patient activation elements of self-management interventions for Chronic Obstructive Pulmonary Diseases (COPD) patients. We investigated the effects of the intervention on health-related quality of life, self-efficacy, depression, and anxiety among people with COPD. We conducted a systematic review of studies evaluating the efficacy of self-management interventions among COPD patients that also included health literacy or patient activation as keywords. Four electronic databases Medline, EMBASE, PsycINFO, and Google Scholar, were searched to identify eligible studies. These studies were screened against predetermined inclusion criteria. Data were extracted according to the review questions. Twenty-seven studies met the criteria for inclusion. All of the included studies incorporated health literacy components and focused on COPD and self-management skills. Three studies measured health literacy; two showed improvements in disease knowledge, and one reported a significant change in health-related behaviors. Seventeen studies aimed to build and measured self-efficacy, but none measured patient activation. Eleven studies with multicomponent interventions showed an improvement in quality of life. Six studies that focused on specific behavioral changes with frequent counseling and monitoring demonstrated improvement in self-efficacy. Two interventions that used psychosocial counseling and patient empowerment methods showed improvement in anxiety and depression. Most self-management interventions did not measure health literacy or patient activation as an outcome. Successful interventions were multicomponent and comprehensive in addressing self-management. There is a need to evaluate the impact of comprehensive self-management interventions that address and measure both health literacy and patient activation on health outcomes for COPD patients.