ABSTRACT Background Migrants in Australia experience persistent cancer‐equity gaps, with later‐stage diagnoses linked to low screening participation. This study aimed to co‐design cancer screening interventions with migrant and refugee communities to promote equitable participation and reduce disparities in bowel, cervical and breast cancer screening in New South Wales, Australia. Methods Using stratified convenience sampling, 90 first‐generation Middle Eastern and Sub‐Saharan African migrants across five NSW regions participated in 10 face‐to‐face nominal group technique sessions to elicit and rank intervention priorities. Results Participants identified 24 priority actions for bowel cancer screening, 11 for breast, and eight for cervical cancer, grouped into intervention domains. Bowel cancer drew the broadest response, spanning cancer literacy, policy reform, community action, and monitoring and evaluation. Breast cancer priorities centred on literacy and policy, while cervical cancer input focused on literacy and behavioural confidence. Increasing cancer literacy, shifting behaviours and enacting supportive policy reform emerged as consistent priorities across all three cancers. Conclusion Improving migrant and refugee participation across all three screening programs requires culturally grounded interventions that build cancer literacy and leverage trusted networks including peers, community champions and frontline health workers. Settlement programs, community organisations and schools provide critical infrastructure for sustained screening education, while policy reforms including age threshold reductions, incentive mechanisms and improved access support are essential to achieving equitable outcomes. Patient or Public Contribution Migrants with lived experience, cancer caregivers and community champions played a central role in setting priorities and co‐designing intervention options.

Background Effective pandemic plans must be applicable to all members of our communities. However, people from multicultural communities with diverse language needs often engage with a wide range of organisations and individuals when seeking information during a pandemic or health emergency. Despite this, there is limited evidence on levels of trust and the influence of these sources on promoting community engagement with pandemic preparedness activities in high-income settings. Methods A cross-sectional survey was conducted among members of ethnic minority communities in Australia who self-identified with one or more of six selected language or cultural groups. The survey, available in translated online and paper formats, incorporated several validated instruments and included both closed and open-ended items. Cross-tabulation analyses were used to examine associations between participant characteristics and levels of trust in community organisations and community leaders during the COVID-19 pandemic. Results 590 completed responses were included in the study. Participants were aged between 18 and ≥95 years old and identified as: Arabic (28.7%), Chinese (24.7%), Bangladeshi (22.3%), Pasifika (10%), Nepalese (8.2%) or Ezidi (6.1%). Predictors of moderate-to-very high trust in community-based organisations (CBOs) included participants who had arrived in Australia ≥20 years ago and had previously sought information from community groups, local councils and community workers. Likewise, moderate-to-very high trust in community leaders was more common among those who were more willing to seek assistance, arrived in Australia ≥20 years ago, were aged between 35 and 44 and had higher trust in community groups. Conclusions Results indicated that trust in CBOs and community leaders was associated with willingness to seek assistance, satisfaction with communication efforts, trusted local councils and longer settlement in Australia; however, these associations may not reflect the reach or influence of community organisations and leaders across all ethnic minority groups.

Background Refugees resettled in Australia may experience significant physical, mental and emotional health issues on arrival and difficulty accessing mainstream healthcare that often demands specialised services. It is not known if and how refugee health needs and service use change over time and generations, how this compares with the broader Australian population and what level of resourcing is required to maintain specialised services. There is also a significant knowledge gap concerning the resources and skills of refugees that can be harnessed to sustain the health and well-being of individuals and communities. Such knowledge gaps impede the ability of the health system to deliver responsive, efficient, acceptable and cost-effective care and services and limit the engagement of refugees in the coproduction of these services.Methods This study will be the first to provide comprehensive, longitudinal, population-based evidence of refugee health, service use and the accumulated resources or assets related to positive health and well-being (compared with data on deficits, illness and death) across the lifespan and generations. This will enable a comprehensive understanding of the relationships among assets, health status, service gaps and behaviours. We will identify the assets contributing to increased capacities to protect and promote health. This evidence is essential for planning health prevention programmes.This project has three phases: (1) employ national linked datasets to examine the health and social outcomes of refugees in Australia; (2) engage with refugees in a participatory manner to map the social, economic, organisational, physical and cultural assets in their communities and deliver an integrated model of health; and (3) codesign a roadmap of agreed actions required to attain health and well-being in communities and indicators to assess outcomes.Ethics and dissemination Ethics and procedures—phase I:Ethical approval for phase I was gained from the Australian Bureau of Statistics (ABS) for Person Level Integrated Data Asset microdata (unit record data) via the ABS DataLab and the NSW Population and Health Services Research Ethics Committee (2023ETH01728), which can provide a single review of multijurisdictional data linkage research projects under the National Mutual Acceptance Scheme. This will facilitate approval for the Victorian and ACT datasets. The ABS will be the integrating/linkage authority. The Centre for Health Record Linkage (CHeReL) and the Victorian Data Linkage Unit will prepare a data extract representing all data records from the dataset to provide to the ABS for linkage.Ethics and procedures—phases 2 and 3:Written consent will be obtained from all participants, as well as consent to publish. We have obtained ethical approval from the University of Technology Sydney Medical Research Ethics Committee; however, as we deepen our consultation with community members and receive input from expert stakeholders, we will likely seek amendments to hone the survey and World Café questions. We will also need to provide flexible offerings that may extend to individual interviews and online interactions.Discussion This innovative approach will empower refugees and put them at the centre of their health and decision-making.

Medicare is central to accessing health care in Australia, yet many asylum seekers are ineligible for this scheme. In NSW, Medicare ineligible asylum seekers have some access to public health care under the Medicare Ineligible Asylum Seekers - Provision of Specified Public Health Services policy. This policy was updated in November 2020 to clarify services where a fee waiver applies for asylum seekers without Medicare. We examined the experiences of Medicare ineligible asylum seekers in accessing health care in New South Wales (NSW) in light of the revised policy. Employing qualitative methods, we conducted semi-structured interviews with asylum seekers (n = 7) and service providers (n = 6) in South Western Sydney. The interviews were analysed using thematic analysis and the socio-ecological model was used to interpret the data. Participants identified that chronic and mental health conditions are the main health issues for asylum seekers. Factors across the four levels of the socio-ecological model were identified as influencing the health care of asylum seekers, including a lack of awareness about health care rights at the individual level, support from relatives and friends at the interpersonal level, providers' lack of awareness of fee waivers at the organizational level and limited access to primary health care at the policy level. The results imply that Medicare ineligible asylum seekers in NSW do not have optimal access to health care which may worsen existing health disparities. Educational initiatives that improve service providers' and asylum seekers' awareness of the revised policy are needed to improve asylum seeker health equity in NSW.

Background: Emerging evidence suggests that the COVID-19 pandemic is widening pre-pandemic health, social, and economic inequalities between refugees, migrants, and asylum seekers and the general population. This global scoping review examined the impact of the pandemic on community-based asylum seekers and undocumented migrants in high- and upper-middle-income countries. Methods: We conducted a systematic search of peer-reviewed articles in PubMed, Scopus, Web of Science, and ProQuest Central. We applied Katikireddi's framework of understanding and addressing inequalities to examine the differential impact of the pandemic across exposure, vulnerability to infection, disease consequences, social consequences, effectiveness of control measures, and adverse consequences of control measures. Results: We included 32 articles in the review. The analysis showed that asylum seekers and undocumented migrants experienced greater exposure to the COVID-19 virus and higher infection rates. They also experienced differential social consequences in the form of job loss and lost and/or reduced work hours. The effectiveness of pandemic response measures on asylum seekers and undocumented migrants was also affected by pre-pandemic social and economic marginalisation, exclusion from pandemic-induced policy measures, lack of appropriate pandemic communication, and variable trust in governments and authority. Pandemic control measures had greater adverse consequences on asylum seekers and undocumented migrants than the general population, with the majority of studies included in this review reporting worsened mental health and social isolation conditions and reduced access to health care. Conclusions: Asylum seekers and undocumented migrants experienced a disproportionate impact of the COVID-19 pandemic across the six thematic areas of comparison. Policies that reduce exposure and vulnerability to the infection, grant equitable access to health and social care, and build capacities and resilience, are critical to enable asylum seekers and undocumented migrants to cope with and recover from pre-pandemic and pandemic-induced inequalities.

Objectives: Achieving high vaccination coverage is a critical strategy to reducing the spread of COVID-19 infection. This study, undertaken before the Delta variant outbreak, aimed to understand potential drivers and barriers influencing COVID-19 vaccine uptake for refugees. Methods: Four focus group interviews were conducted with 37 refugees from four language groups (Arabic, Dari, Dinka and Karen). Data were analysed thematically. Results: Willingness to accept COVID-19 vaccines was associated with participants' perceptions of disease severity, and benefits such as increased immunity against COVID-19 disease and prevention of the spread of the disease. Cues for increasing individual willingness to get vaccinated included obtaining information from trusted sources and community engagement. By contrast, information gaps on vaccines compounded by misinformation on social media contributed to a reluctance to be vaccinated. Conclusion: As this study was conducted before the Delta variant outbreak, participants' stance on COVID-19 vaccines may have changed. However, addressing vaccine literacy needs for this group remains an on-going priority. Health promotion initiatives must be tailored to the different socio-cultural contexts of each community. Implications for public health: Engagement with refugee populations is critical for optimising access and uptake of vaccines to protect health, prevent death and ensure that control of the pandemic is equitable. This may also provide valuable public health lessons for other marginalised populations.

Importance:Resettled refugees in high-income countries represent a vulnerable population. It is known that refugees have high rates of trauma-related mental health issues; however, ad hoc research has generally revealed low rates of health services use among refugees. Such research usually samples a population at a single point in time and is based on targeted surveys. Because refugee populations change over time, such research becomes expensive and time-consuming for agencies interested in routinely publishing statistics of mental health services use among refugees. The linking of large administrative data sets to establish rates of use of mental health services among resettled refugees is a flexible and relatively inexpensive approach. Objective:To use data linkage to establish rates of mental health services use among resettled refugees relative to the general population. Design, Setting, and Participants:This cross-sectional study implemented data linkage from the Refugee Health Nurse Program for 10 050 refugees who resettled in Sydney, Australia, from October 23, 2012, to June 8, 2017, with data concerning use of community mental health services and mental health hospitalization from New South Wales Health databases. Data were analyzed between June 1, 2019, and December 31, 2021. Main Outcomes and Measures:Rates of service contacts with community mental health services among the resettled refugees were compared with those of the general population by age, sex, and the most common International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, diagnosis codes. Length of community mental health service sessions and rates of mental health hospitalizations were also compared. Results:Among the 255 resettled refugees who had contacts with community mental health care services and were not missing data (median age, 35 [range, 4-80] years; 117 [64%] male and 138 [54%] female), 153 (60%) were born in Iraq and 156 (61%) were Arabic speaking. This population was less likely to use mental health services than the general population and had shorter community mental health consultations. The rate of contacts with community mental health services for depressive disorders among the resettled refugee population was 40% (95% CI, 33%-46%) lower than that among the general population. Rates of same-day hospitalization per 10 000 person-years were not significantly different between the refugee population (4 [95% CI, 2-8]) and the general Australian population (7 [95% CI, 7-7]). However, the refugee population was 17% (95% CI, 6%-29%) more likely than the general Australian population to interact with the community mental health system for severe stress- and adjustment disorder-related diagnoses. Conclusions and Relevance:These findings suggest that refugees who have resettled in Australia tend to use fewer mental health services than the general population except for services devoted to stress- and adjustment disorder-related diagnoses. These findings also suggest that it is possible to successfully leverage data linkage to study patterns of mental health services use among resettled refugees.

There is increasing evidence on the positive outcomes of engaging students and community partners in medical education, especially in achieving social accountability. However, less is known about the steps through which these engagements are established. This paper outlines twelve tips on establishing a robust and enduring partnership with students and community partners in medical education, using examples from the Western Sydney University School of Medicine. While context is paramount in any engagement program, these tips are formulated to be transferable to medical education settings in different countries, education systems, and the broader context of health professional education.

OBJECTIVES:To examine whether primary care outreach facilitation improves the quality of care for general practice patients from refugee backgrounds. DESIGN:Pragmatic, cluster randomised controlled trial, with stepped wedge allocation to early or late intervention groups. SETTING, PARTICIPANTS:31 general practices in three metropolitan areas of Sydney and Melbourne with high levels of refugee resettlement, November 2017 - August 2019. INTERVENTION:Trained facilitators made three visits to practices over six months, using structured action plans to help practice teams optimise routines of refugee care. MAJOR OUTCOME MEASURE:Change in proportion of patients from refugee backgrounds with documented health assessments (Medicare billing). Secondary outcomes were refugee status recording, interpreter use, and clinician-perceived difficulty in referring patients to appropriate dental, social, settlement, and mental health services. RESULTS:Our sample comprised 14 633 patients. The intervention was associated with an increase in the proportion of patients with Medicare-billed health assessments during the preceding six months, from 19.1% (95% CI, 18.6-19.5%) to 27.3% (95% CI, 26.7-27.9%; odds ratio, 1.88; 95% CI, 1.42-2.50). The impact of the intervention was greater in smaller practices, practices with larger proportions of patients from refugee backgrounds, recent training in refugee health care, or higher baseline provision of health assessments for such patients. There was no impact on refugee status recording, interpreter use increased modestly, and reported difficulties in refugee-specific referrals to social, settlement and dental services were reduced. CONCLUSIONS:Low intensity practice facilitation may improve some aspects of primary care for people from refugee backgrounds. Facilitators employed by local health services could support integrated approaches to enhancing the quality of primary care for this vulnerable population. TRIAL REGISTRATION:Australian New Zealand Clinical Trials Registry, ACTRN12618001970235 (retrospective).

Background: In New South Wales (NSW), the use of mainstream early childhood nursing services by families of refugee background is limited. Our aims were to describe a targeted Early Childhood Nurse Program after its first 12 months of operation, including staff impressions of achievements and how the program might be improved. Methods: Routinely collected data over a 12-month period (1 March 2017 to 28 February 2018) was extracted and analysed using SPSS V25. Qualitative data collection consisted of discussions with the program's early childhood nurses to identify relevant service delivery and clinical themes, and potential areas for improvement. Results: A total of 260 children of refugee background under 6 years of age were seen by the program, being 98% of those referred. At first visit, 25% of children were under 12 months of age. The top three countries of birth were Iraq (41.2%), Australia (21.5%) and Syria (15.8%). Asylum seekers accounted for nearly one third of those seen. More than half of the children seen required referral to at least one other service. Reported program achievements included increased accessibility of healthcare in the early years, culturally appropriate service provision, and early identification and intervention for child and maternal health issues. Areas for program improvement were enhanced data management and increased resources. Conclusion: The program is improving access and care for vulnerable refugee and asylum seeker children in the community. It can serve as a model for implementing refugee and asylum seeker specific early childhood services, state-wide and nationally. (C) 2019 Australian College of Nursing Ltd. Published by Elsevier Ltd.

Background Refugee populations have particularly high rates of mental health problems, including Posttraumatic Stress Disorder (PTSD) and depression. However, uptake of mental health care may be low even when severe depression and PTSD symptoms are present in individuals following resettlement. This is likely due, at least in part, to cultural influences on refugees’ knowledge and beliefs about mental health problems and their treatment. We sought to provide preliminary evidence for the effectiveness of a culturally tailored mental health promotion program for Arabic-speaking refugees. Methods A total of 33 Arabic-speaking refugees resettled in South Western Sydney were recruited and completed intervention which consisted of weekly three-hour sessions for 4 weeks delivered in Arabic. Key aspects of mental health literacy, help-seeking intentions and levels of general psychological distress were assessed, by means of a self-report survey, pre-intervention, (immediately) post-intervention and 3 months following intervention. Results Of the 33 participants that completed the intervention, 31 completed the immediate post-intervention survey and 29 completed the 3 months follow-up survey. Improvements in most aspects of mental health literacy assessed were found immediately post-intervention and at follow-up, although only changes relating to stigmatising attitudes were statistically significant. Additionally, a statistically significant decrease in participants’ levels of general psychological distress was observed immediately following the intervention, and this decrease was sustained at follow-up. Conclusion While further research employing a more rigorous study design and larger sample size will be needed, results of this initial trial suggest that a culturally tailored mental health promotion program targeting key aspects of mental health literacy can improve the mental health of Arabic-speaking refugees resettled in a Western nation.

The aim of this study is to compare the prevalence of chronic disease risk factors in humanitarian arrivals to Sydney, New South Wales (NSW) with the Australian Indigenous and non-Indigenous populations aged 35-44 years. Data on risk factors collected from 237 refugees presenting to the NSW Refugee Health Service (RHS) from January 2015 to August 2016 were retrospectively analysed and compared with data from the Australian Health Surveys, 2011-13 for the Indigenous and non-Indigenous Australian populations. This study found significantly higher levels of triglycerides (z = 3; 95% CI, 0.16-0.26); hypertension (z = 3.2; 95% CI, 0.17-0.29); and smoking (z = 3.5; 95% CI, 0.27-0.33) in refugees compared with the general Australian population. The Indigenous population had significantly higher levels of triglycerides (z = 4; 95% CI, 0.16-0.26); body mass indexes (BMIs) (z = 3.3; 95% CI 0.58-0.72); and smoking (z = 5.4; 95 CI 0.27-0.33) compared with refugees. Based on the study findings, screening for chronic disease risk factors from age 35 years may be warranted in all humanitarian arrivals to Australia, along with dietary and lifestyle advice.

Background Australia is one of many nations struggling with the challenges of delivering quality primary health care (PHC) to increasing numbers of refugees. The OPTIMISE project represents a collaboration between 12 organisations to generate a model of integrated refugee PHC suitable for uptake throughout Australia. This paper describes the methodology of one component; an outreach practice facilitation intervention, directed towards improving the quality of PHC received by refugees in Australian general practices. Methods Our mixed methods study will use a cluster stepped wedge randomised controlled trial design set in 3 urban regions of high refugee resettlement in Australia. The intervention was build upon regional partnerships of policy advisors, clinicians, academics and health service managers. Following a regional needs assessment, the partnerships reached consensus on four core areas for intervention in general practice (GP): recording of refugee status; using interpreters; conducting comprehensive health assessments; and referring to refugee specialised services. Refugee health staff trained in outreach practice facilitation techniques will work with GP clinics to modify practice routines relating to the four core areas. 36 general practice clinics with no prior involvement in a refugee health focused practice facilitation will be randomly allocated into early and late intervention groups. The primary outcome will be changes in number of claims for Medical Benefit Service reimbursed comprehensive health assessments among patients identified as being from a refugee background. Changes in practice performance for this and 3 secondary outcomes will be evaluated using multilevel mixed effects models. Baseline data collection will comprise (i) pre-intervention provider survey; (ii) two surveys documenting each practices’ structure and approaches to delivery of care to refugees. De-identified medical record data will be collected at baseline, at the end of the intervention and 6 and 12 months following completion. Discussion OPTIMISE will test whether a regionally oriented practice facilitation initiative can improve the quality of PHC delivered to refugees. Findings have the potential to influence policy and practice in broader primary care settings. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12618001970235 , 05/12/2018, Retrospectively registered. Protocol Version 1, 21/08/2017.

Refugee health is a topical and important issue.Although psychological issues are well described, and refugees from certain regions are at risk of a range of infectious diseases, many people from refugee backgrounds also experience chronic physical diseases and/or live with a disability. 1 Their health status has evolved in the context of organised violence marked by persecution, forced exile from their homelands, and grief and loss at many levels.Resettlement in a new country has its own challenges, often prolonged. 2here are some differences between the needs of asylum seekers and those of refugees who enter Australia as part of its humanitarian migration program.However, asylum seekers and refugees share many common concerns, especially long-term conditions such as psychological distress associated with their experiences and the uncertainty of life in Australia. 3Ngo and colleagues explore the detection rates for health conditions screened after arrival in Australia, and the importance of tailoring screening to refugees' migration history and risk.This is especially important for refugees from Middle Eastern countries such as Syria, whose risk profile is different to those from traditional refugee source countries.Despite the politics in Australia, there is genuine goodwill and concern to ensure that people from refugee backgrounds get the care and support they need.However, realising this objective is challenging.One major reason is the fragmentation that can occur between specialised refugee services and mainstream, public and nongovernment health and welfare services.Over time, this can create discontinuities that may lead to refugees' health and social needs being overlooked and neglected.Because of their lower health literacy, refugees are especially vulnerable to these gaps.Key requirements for better integrated care include good professional relationships between providers, effective communication and sharing of information, and clear and supported pathways between services.This issue of Public Health Research & Practice contains examples of where this integration works at the international level.Martin and Douglas describe the international cooperation involved in premigration screening, especially between the US, UK, Australia, Canada and New Zealand.Pottie and colleagues illustrate the high level of collaboration between government, nongovernment, private and professional organisations in Canada in providing primary care for refugees.

BACKGROUND AND AIM Transition of asylum seekers from special-purpose health services to mainstream primary care is both necessary and difficult. This study explores the issues encountered by asylum seekers undergoing this transition in Sydney, Australia. METHODS Qualitative semistructured interviews were conducted with nine asylum seeker patients and nine staff working in the sector. RESULTS Asylum seekers faced significant challenges in the transition to mainstream primary care. Contributing factors included the complexity of health and immigration systems, the way in which asylum seeker-specific services provide care, lack of understanding and accommodation by mainstream general practioner (GP) services, asylum seekers' own lack of understanding of the health system, mental illness, and social and financial pressures. CONCLUSIONS There is a need for better preparation of asylum seekers for the transition to mainstream primary care. Mainstream GPs and other providers need more education and support so that they can better accommodate the needs of asylum seeker patients. This is an important role for Australia's refugee health services and Primary Health Networks.

Objectives: To describe the prevalence of certain health conditions in newly arrived refugees to Sydney, Australia, and thereby help inform screening practices. Study type:A clinical audit of routinely collected pathology results.Methods: Demographics and pathology results from a nurse-led health assessment program for newly arrived refugees during 2013 and 2014 were analysed.Prevalences of screened conditions were calculated, and compared by country of birth and other demographic features.A specific category was created for those from Middle Eastern countries, for comparative analysis.Results: Pathology results were analysed for 3307 people from 4768 seen by the assessment program (69.4%).Anaemia was found in 6% of males and 7.6% of females.Vitamin D deficiency (<50 nmol/L) was detected in 77.5%.Chronic hepatitis B was found in only 1.7% but in more than 10% of people from Burmese and Tibetan backgrounds.Strongyloides seropositivity was found in 4%.Among the subset tested for hepatitis C antibody, 0.5% were positive.No human immunodeficiency virus (HIV) infections were detected.More than 75% of the study population was from Middle Eastern countries.Compared with refugees from other regions, this subset had less anaemia (in females), more vitamin D deficiency, less chronic hepatitis B and less strongyloides seropositivity. Conclusions:People from refugee backgrounds have differing risks of conditions, based on demographics, migration history and prior screening.Postarrival testing should be tailored to each family and individual.Results of screening should be constantly reviewed and the approach updated based on findings.We support, in particular, the Canadian approach of only retesting HIV in refugees from countries with a high prevalence of infection (>1%).

BACKGROUND:Refugees are at risk of being under-immunised in their countries of origin, in transit and post-resettlement in Australia. Whilst studies have focused on identifying barriers to accessibility of health services among refugees, few focus on providers' perspectives on immunisation service delivery to this group. Health service providers are well placed to provide insights into the pragmatic challenges associated with refugee health service delivery, which can be useful in identifying strategies aimed at improving immunisation coverage among this group. METHODS:A qualitative study involving 30 semi-structured interviews was undertaken with key stakeholders in immunisation service delivery across all States and Territories in Australia between December 2014 and December 2015. Thematic analysis was undertaken. RESULTS:Variability in accessing program funding and vaccines, lack of a national policy for catch-up vaccination, unclear roles and responsibilities for catch-up, a lack of a central immunisation register and insufficient training among general practitioners were seen as the main challenges impacting on immunisation service delivery for refugees. CONCLUSIONS:This study provides insight into the challenges that impact on effective immunisation service delivery for refugees. Deliberate strategies such as national funding for relevant vaccines, improved data collection nationally and increased guidance for general practitioners on catch-up immunisation for refugees would help to ensure equitable access across all age groups.

INTRODUCTION:In 2009, the Australasian Society of Infectious Diseases published guidelines on the post-arrival health assessment of recently arrived refugees. Since then, the number of refugees and asylum seekers reaching Australia has increased substantially (17 555 refugees in 2015-16) and the countries of origin have changed. These groups are likely to have had poor access to health care pre-arrival and, consequently, are at risk of a range of chronic and infectious diseases. We established an advisory group that included infectious diseases physicians, general practitioners, public health specialists, paediatricians and refugee health nurses to update the 2009 guidelines.Main recommendations: All people from refugee-like backgrounds, including children, should be offered a tailored comprehensive health assessment and management plan, ideally within 1 month of arrival in Australia. This can be offered at any time if initial contact with a GP or clinic is delayed. Recommended screening depends on history, examination and previous investigations, and is tailored based on age, gender, countries of origin and transit and risk profile. The full version of the guidelines is available at http://www.asid.net.au/documents/item/1225.Changes in management as a result of this guideline: These guidelines apply to all people from refugee-like backgrounds, including asylum seekers. They provide more information about non-communicable diseases and consider Asia and the Middle East as regions of origin as well as Africa. Key changes include an emphasis on person-centred care; risk-based rather than universal screening for hepatitis C virus, malaria, schistosomiasis and sexually transmissible infections; updated immunisation guidelines; and new recommendations for other problems, such as nutritional deficiencies, women's health and mental health.

BACKGROUND:Resettled refugees are a vulnerable group for mental health problems and in particular, trauma-related disorders. Evidence suggests that poor 'mental health literacy' (MHL) is a major factor in low or inappropriate treatment-seeking among individuals with mental health problems. This study sought to determine the beliefs regarding the causes of and risk factors for post-traumatic stress disorder (PTSD) amongst two resettled refugee groups in Australia.METHODS:Utilising a culturally adapted MHL survey method, 225 Iraqis and 150 Afghans of refugee background were surveyed.RESULTS:Approximately 52% of the Iraqi participants selected 'experiencing a traumatic event' as the 'most likely' cause for the clinical vignette, whereas 31.3% of the Afghan sample selected 'coming from a war torn country' as their top cause. While both groups identified being 'born in war torn country' as the most likely risk, at 34.4 and 48% of the Iraqis and Afghans respectively, differences regarding other risk factors selected were noted.CONCLUSIONS:The results of this study indicate the need for culturally sensitive health promotion and early intervention programs seeking to improve MHL relating to PTSD in resettled refugee populations. There is also a need for mental health services to recognise that variation in MHL may be a function of both the cultural origin of a refugee population and their resettlement experiences. Such recognition is needed in order to bridge the gap between Western, biomedical models for mental health care and the knowledge and beliefs of resettled refugee populations.