Mental health problems are prevalent among migrants living in Australia. This study aims to investigate the social determinants of mental health problems among Nepalese migrants living in Australia. An online Qualtrics survey was conducted with 252 Nepalese adults in Australia between April and June 2025. The questionnaire included validated mental health screening tools, including Depression, Anxiety, and Stress Scale (DASS-21), Multidimensional Scale of Perceived Social Support (MSPSS), and Everyday Discrimination Scale (EDS). Data were analysed using Program for Statistical Analysis (PSPP), and bivariate analysis and multiple linear regression were performed. The mean age of participants was 30.6 ± 7.11 years. The prevalence of stress, anxiety, and depression was 40.5%, 22.6%, and 30.2%, respectively. In Model 1 (unadjusted for lifestyle behaviours), marital status (being married vs others) was negatively associated with stress (β = -0.23). Food insecurity was positively associated with stress (β = 0.27), anxiety (β = 0.22), and depression (β = 0.25). EDS scores showed positive associations with stress (β = 0.46), anxiety (β = 0.38), and depression (β = 0.39). In Model 2 (adjusted for the influence of lifestyle behaviours), being married remained as a significant negative predictor of stress (β = -0.06). Food insecurity also remained as a positive predictor of stress, anxiety, and depression (β = 0.26, 0.18, 0.24, respectively). Discrimination also remained as a positive predictor of stress, anxiety, and depression (β = 0.44, 0.52, 0.49, respectively). These findings underscore the need to develop culturally sensitive mental health programs among Nepalese migrants living in Australia.

INTRODUCTION:Cerebral palsy (CP) is the most common physical disability in childhood. Although an estimated 60 000 children live with CP in Vietnam, there is no national register to systematically collect data on the prevalence, risk factors or clinical profile of CP or service access. This paper outlines the protocol for establishing the Vietnam Cerebral Palsy Register (VCPR), a national register which will be co-designed by researchers and clinicians in collaboration with the Cerebral Palsy Family Association of Vietnam (CPFAV). The VCPR aims to inform service planning, policy and research through comprehensive, community-informed data collection. METHODS AND ANALYSIS:The VCPR will be developed by a consumer-clinician-researcher partnership. Initially, the VCPR will harmonise and pool data from two sources: (1) a hospital-based cohort of 765 children with CP identified at the National Children's Hospital in Hanoi (NCH) in 2017, and (2) members of the CPFAV, comprising over 4300 children with CP aged <18 years from 63 CPFAV hubs across Vietnam. Subsequently, standardised data for inclusion in the VCPR will prospectively be collected on children newly diagnosed with CP at NCH and other healthcare settings and on children newly referred to CPFAV.Data will be collected using an adapted version of the Australian CP register questionnaire through a combination of structured caregiver interviews, clinical assessments using validated tools and medical record review. Key demographic variables and information on CP type, motor severity-using the Gross Motor Function Classification System or Manual Ability Classification System, associated impairments (eg, vision, hearing, intellectual disabilities), condition at birth, congenital or other infections, vaccination, educational and nutritional status of the child, access to rehabilitation and family-related factors such as monthly household income, parental education and occupation and maternal health during pregnancy will be collected. The VCPR will contribute data to the Global Low- and Middle-Income Country Cerebral Palsy Register. ETHICS AND DISSEMINATION:Ethics approval has been obtained from Vietnamese and Australian institutions, whose role is to provide ethical oversight and research governance for the PhD project supporting the VCPR. Written informed consent will be obtained from primary caregivers for data collection, secure storage, access to relevant health records, verification with health professionals and future research contact, with no identifiable data disclosed.Involvement of people with lived experience of CP is central to the VCPR and leaders and members of the CPFAV will contribute to co-design, governance, participant engagement and dissemination. Findings will be shared regularly with families, clinicians, policymakers and researchers through CPFAV communications, peer-reviewed publications, national and international conferences and the VCPR website to inform equitable service planning, policy and future research.

This study aims to assess the status of health-related quality of life (HRQOL) and its associated factors in people with Type 2 diabetes mellitus (T2DM) in Nepal. HRQOL of 481 participants with T2DM in Kavrepalanchok and Nuwakot was measured using European Quality of life Visual Analogue Scale (EQVAS) and European Quality of life 5 dimensions (EQ5D) index from the EQ5D-3L tool. Associated correlates of T2DM were examined using linear regression analyses. The study participants generally reported higher HRQOL. Being 60 years or older was associated with a significantly lower EQVAS whereas, urban residence, higher education, testing glycated haemoglobin regularly were significantly associated with a higher EQVAS. Not having depressive symptoms was significantly associated with higher EQVAS and EQ5D-3L index. Encouraging screening of depressive symptoms, improving awareness on the importance of regular blood glucose monitoring and T2DM self-management education should be incorporated within primary diabetes care to improve HRQOL in Nepal.

ABSTRACTBackgroundThe rising prevalence of obesity and type 2 diabetes (T2DM) is a significant public health concern, particularly in low‐ and middle‐income countries. This study aimed to explore the association between physical activity levels, overweight/obesity, and T2DM in a nationwide survey of Nepalese adults.MethodsThis was a secondary analysis of the 2019 non‐communicable diseases (NCD) risk factors STEPS survey conducted in Nepal. Demographic and anthropometric data, body mass index (BMI) and T2DM status were collected along with assessment of physical activity using Global Physical Activity Questionnaire (GPAQ). A two‐stage data analysis was conducted, first using descriptive statistics to summarize participant characteristics and differences across BMI and T2DM status, and then applying multivariate analyses to assess associations between physical activity levels, BMI and T2DM.ResultsOf the 5284 participants included, 28.0% had overweight/obesity, 5.8% had obesity, and 6.5% had T2DM. The mean age of the participants was 40.1 years (95% CI: 39.8–40.6), and 63.9% were female. The overall physical activity energy expenditure was higher in the lean group (BMI < 25 kg/m2) compared to the those with overweight/obesity, and among participants without T2DM compared to those with T2DM. Sedentary behavior was more common among individuals with overweight/obesity and T2DM. A higher proportion of participants with low physical activity was observed in the overweight/obesity group compared to the lean group (8.9% vs. 6.3%) and the T2DM group compared to the non‐T2DM group (11.7% vs. 6.7%). Low physical activity was associated with overweight/obesity (OR:1.4; 95% CI:1.1–1.8), obesity (OR:2.1; 95% CI:1.5–2.3), T2DM (OR:1.6; 95% CI:1.1–2.3) and T2DM in the presence of obesity (OR:3.6; 95% CI:1.7–7.8).ConclusionThis study highlights the low rates of physical activity and higher rates of sedentary behavior among adults with overweight/obesity and T2DM in Nepal. Public health interventions promoting physical activity and reducing sedentary behavior may help reduce the burden of these NCDs.

People living with type 2 diabetes mellitus (T2DM) are likely to develop oral health problems, and vice versa. The burden of oral health and T2DM is increasing, especially in low- and middle-income countries. Access to oral health care remains a challenge in many countries, including Nepal. This study examined the challenges and opportunities for engaging community health workers (CHWs) in promoting oral health care among people with T2DM in Nepal. This study used a qualitative research design using key informant interviews (KIIs) and in-depth interviews (IDIs) responding to open ended questions. Data were collected from health facilities across two districts, Kavrepalanchowk and Kathmandu. The IDIs were conducted with CHWs, including health assistants (n = 7) and community medical assistants (n = 4) from rural and semi-urban areas, while the KIIs were conducted with policy makers and health managers at central level (n = 7). Data was analysed thematically. The participants highlighted the importance and need for providing integrated oral health services at the primary care level. However, they pointed the challenges including (i) lack of policies, guidelines and provision of oral health care, especially for people with T2DM, (ii) lack of capacity on oral health among the CHWs, and (iv) inadequate resources and supplies at primary health care settings. These gaps presented opportunities to develop targeted policies and CHW training by ensuring continuous supervision and appropriate incentivisation, facilitating the integration of oral health care at primary health care level in Nepal. The findings of study highlight the potential for engaging CHWs to deliver oral health services for people with T2DM at the primary health care level in Nepal. Strengthening the health system and building capacity of CHWs, along with continued supervision, incentivisation and supply of adequate resources could facilitate the integration of oral health services into primary health care settings in Nepal.

PURPOSE:To examine rehabilitation service use and associated factors among children with cerebral palsy (CP) in Vietnam. MATERIALS AND METHODS:This study uses data from hospital-based surveillance of children with CP who attended the National Children's Hospital, Hanoi between June and November 2017 using methodology modeled on the Pediatric Active Enhanced Disease Surveillance system in Australia. Descriptive statistics, exact tests, and logistic regression were used. RESULTS:Of 765 children with CP, 92.6% received rehabilitation services. The median age at first receipt of rehabilitation service was nine months. Physiotherapy (94.3%) was the most common service, followed by advice on treatment (21.5%), rehabilitation childcare, psychological counseling for parents and assistive devices (11.5%). Among children who received rehabilitation services, the majority (88.8%) received them at home.Lack of awareness of rehabilitation (98.2%) was the main barrier to service access. In univariate analysis, younger age (p < 0.01), no intellectual impairment (p < 0.001), Gross Motor Function Classification System levels IV-V (p < 0.05), and wasted weight-for-height (p < 0.05) were significantly associated with limited service use. In multivariate analysis, no intellectual impairment and wasted weight-for-height remained significant (p < 0.05). CONCLUSION:While most children accessed rehabilitation services, younger age, severe motor impairment, and malnutrition were associated with limited access to these services.

People from migrant, non-English-speaking backgrounds face a variety of challenges when settling in Australia. Although evidence suggests that alcohol and other drug (AOD) use among this group is lower than among the general population, individuals from these communities are at increased risk of mental health issues and racial discrimination, which are known risk factors for increased use of alcohol and other drugs. This study aimed to address current gaps in the literature by using a qualitative methodology to explore the lived experiences of AOD clients who are from migrant, non-English-speaking backgrounds in terms of access to and utilization of AOD services. Eighteen AOD service users and ten service providers (i.e., health clinicians) were interviewed for the study. In this article, we present stories that, collectively, represent the group of AOD service users and their experiences of AOD services as individuals from "culturally and linguistically diverse" backgrounds. We complement those stories with the views provided by health professionals who work providing AOD services. We present these stories organized into three main themes: intersectionality of vulnerabilities, risky environments, and institutional stigma. The stories are interweaved with our theoretical analysis of the material collected through the interviews using a structural vulnerability lens. We conclude that using "culture" as a marker to determine the quality and provision of services or to somehow specialize delivery can be problematic if there is little acknowledgement of the forces that are at play to homogenize health and healthcare provision.

BACKGROUND:Migration involves a risk of mental health problems, including stress, anxiety, and depression. This study systematically reviewed social determinants of mental health problems among South Asian migrants living in industrialized countries. METHODS:Four databases (PubMed, CINAHL, EMBASE, and PsycINFO) were searched for observational studies published between 2000 and 2025. The social ecological model was used as a theoretical framework. Studies that included adult South Asian migrants using validated mental health tools were included. Social determinants of mental health were identified through extraction of social factors that demonstrated statistically significant associations with mental health problems. The study protocol was registered in PROSPERO and followed PRISMA guidelines. RESULTS:Seventeen studies met the inclusion criteria. The prevalence of stress, anxiety, and depression ranged from 23% to 59%, 20% to 50%, and 9% to 47%, respectively. Common social determinants of mental health problems were age, gender, marital status, social support, language, education, and employment. Being older, female, unmarried, or unemployed or having less social support or lower education, or facing language barriers were major factors influencing mental health problems. CONCLUSIONS:The findings warrant the development and implementation of policies focused on addressing these social determinants of mental health problems and improving access to and utilization of mental health services.

Background Community-based health behavioural interventions have effectively reduced the glycated haemoglobin level (HbA1c) among individuals with type 2 diabetes mellitus (T2DM). However, there is no evidence of such interventions in improving the healthcare utilisation in under-resourced settings. Therefore, this study aimed to assess the effect of intervention in improving the visits to health facilities and specialists and reducing emergency department visits and hospital admissions among people with T2DM in Nepal. Methods A cluster-randomised controlled trial was conducted in the Kavrepalanchowk and Nuwakot districts of Nepal, enrolling 481 people with clinically diagnosed type 2 diabetes, aged 30-70 years. A total of 30 study sites across two districts were randomly allocated into 15 intervention groups and 15 control groups. The participants in the intervention group received a community health worker and peer supporter-led health behavioural intervention for 6 months. The primary outcome of the study (health facility visits, specialist visits, emergency visits and hospital admissions) were assessed at baseline and 6 months post-intervention. Results Intervention participants reported a higher increase in health facility visits, specialist visits, emergency visits and hospital admissions by 7.2%, 13.5%, 1.3% and 0.4% respectively, compared to control participants. However, these changes were not statistically significant. Visits to health facilities significantly increased, but only among intervention participants attending more sessions (adjusted odds ratio [AOR] = 1.16, 95% CI:1.05-1.28). Approximately half (45.4%) of the intervention participants attended six or fewer intervention sessions out of twelve. Conclusion While the intervention had a positive effect on healthcare use in general, this was only significant in those with higher exposure to the intervention sessions. As such, efforts should be made that increase adherence and retention to the intervention sessions to maximise the benefit of this health behavioural intervention in improving healthcare service utilisation among individuals with type 2 diabetes in Nepal.

Long-term cost-effectiveness analyses of health behaviour interventions to effectively manage type 2 diabetes mellitus (T2DM) in low-income countries are crucial for minimising economic burden and optimising resource allocation. Therefore, this study aimed to estimate the long-term cost-effectiveness of implementing a health behaviour intervention to manage T2DM in Nepal. A Markov model in combination with a decision tree was developed to compare the costs and outcomes of the health behaviour intervention against usual care among 481 (238-intervention and 243-control) participants from healthcare system and societal perspectives. The model integrates empirical trial data, with published data to inform parameters not collected during the trial. The model estimated costs, quality-adjusted life years (QALYs) and cost-effectiveness over 5 years, 10 years, 20 years, 30 years and a lifetime time horizons with 3

Health behavioural interventions led by community health workers (CHWs) and peer supporters effectively promote self-care behaviours among people with type 2 diabetes mellitus (T2DM). Few such interventions have been conducted in low-income countries including in Nepal. This study assessed the effectiveness of a community-based behavioural intervention with CHWs and peer supporters in promoting the self-care behaviours of people with T2DM in Nepal. The cluster randomised controlled trial was conducted with 481 participants with T2DM in the Kavrepalanchowk and Nuwakot districts of Nepal. The intervention included 12 educational sessions on different key components of diabetes management and was implemented over 6 months. The primary outcomes (dietary intake, physical activity, medication intake, blood glucose monitoring and foot care) were assessed at baseline and 6 months post-intervention. The intervention effect was analysed using the generalised estimating equation (GEE) based on the intention-to-treat (ITT) principle. The mean (SD) age of the study participants was 54.4 (9.4) years and most of them were males (52.8 https://www.anzctr.org.au

Introduction Type 2 diabetes mellitus (T2DM) is among the most common Noncommunicable diseases (NCDs), responsible for an estimated 2 million deaths in 2019. The prevalence of T2DM is increasing in low- and middle-income countries including Nepal. The practice of good self-care behaviours (i.e., physical activity, dietary habits, adherence to medication, blood glucose monitoring, and foot care) plays a vital role in managing disease conditions. This study aims to assess the practice of self-care behaviours and their associated factors among people with T2DM in Nepal. Methods Data on self-care behaviours were assessed from 481 adults (aged 30–70 years) with T2DM from two districts (Kavrepalanchowk and Nuwakot) in Nepal. Self-care behaviours (dietary habits, physical activity, medication adherence, blood glucose monitoring, and foot care) were assessed using pre-tested and interviewer-administered questionnaires. Multiple logistic regression analysis was used to determine the factors associated with self-care behaviours. Results Physical activity (80 %) was the most practiced self-care behaviour followed by a healthy diet (49.9 %), medication adherence (48.2 %), blood glucose monitoring (32.2 %), and foot care (1.7 %). Significant associations for age and area of residence were observed for physical activity. Religion and not using tobacco were associated with a healthy diet. Educational status and blood glucose level were associated with blood glucose monitoring. Alcohol use and comorbid conditions were associated with medication adherence. Conclusion Adherence to a healthy diet, medication, blood glucose monitoring, and foot care were still inadequate among the people with T2DM in Nepal. This implies the need for designing and implementing socially and culturally accepted diabetes self-management programs to empower and motivate people with T2DM to self-manage their disease conditions.

Aim To describe the immunization status of children with CP in Vietnam and identify factors associated with vaccine non-uptake in this group. Methods We conducted an active prospective case ascertainment of children with cerebral palsy (CP) attending the National Children’s Hospital in Hanoi between June to November 2017, following the model proposed by the Paediatric Active Enhanced Disease Surveillance system in Australia. All children were assessed by trained paediatricians at the hospital and their immunization history was recorded. Results Data were collected from 765 children with CP (median age = 1.7 years, IQR = 2.7 years). Of these children, 82.7% were fully immunized for their age (compared to 96.4% of the general child population) according to the Vietnamese Expanded Programme on Immunization (EPI) schedule. A BCG vaccination scar was present in 94.0% of children with CP, and 95.9% of eligible children had received the measles-rubella vaccine as part of the national campaign (compared with 96.0% and 98.2% of the general population respectively). Incomplete vaccination according to the EPI was associated with younger age, living in an earth/sand house, homebirth, low-level maternal education, being diagnosed with CP before the age of three, having bilateral CP, having associated impairments (i.e., epilepsy, intellectual, visual, speech), being at level IV-V on the Gross Motor Function Classification System, and being undernutrition. Conclusion This is the first study to document the immunization status of children with CP in Vietnam. A large proportion had not received the measles-rubella vaccine and 17.3% were not fully immunized. To increase vaccination coverage, interventions and strategies are required to ensure that all children with CP have equitable access to early diagnosis, immunization, health education programs, outreach programs, and frequent follow-up. Early diagnosis and focused intervention in early life could further improve vaccination coverage in children with CP.

Abstract Background Prevention of type 2 diabetes is becoming an urgent public health concern in low and middle-income countries (LMICs). However, there is currently no evidence of a cost-effective approach of health behaviour interventions from community settings in low-income countries like Nepal. Therefore, this study aimed to assess the within-trial economic evaluation of a health behaviour intervention compared with usual care for managing type 2 diabetes in a community setting in Nepal. Methods We randomly assigned 30 clusters comprising 481 patients with type 2 diabetes of which 15 to a health behaviour intervention (n = 238 patients) and 15 to the usual care (n = 243 patients). Patients in the intervention group received community health workers-led intensive training for diabetes self-management along with regular phone calls and ongoing support from peer supporters. Costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER) as costs per QALYs gained were assessed after 6-month from a healthcare system perspective. Probabilistic sensitivity analysis was conducted using 10,000 Monte Carlo simulations to assess the impact of uncertainty of cost-effectiveness analysis under the threshold of three times gross domestic product (GDP) per capita for Nepal (i.e., US $4,140). Results Over the 6-month, the intervention yielded an incremental cost of US $28.55 (95% CI = US $21.26 to US $35.84) per person and an incremental QALYs of 0.0085 (95% CI = -0.0106 to 0.0275) per person. The ICER associated with the health behaviour intervention was US $3,358.82 (95% CI = US $-2005.66 to US $3,974.54) per QALY gained, which was below the estimated threshold, indicating a cost-effective approach with a net monetary benefit of US $6.64 (95% CI = US $-22.62 to US $78.01). Furthermore, the probabilistic sensitivity analysis consisting of 10,000 Monte Carlo simulations indicates that the intervention being cost-effective at the given threshold was 89.63%. Conclusions Health behaviour interventions in community settings are a cost-effective approach to manage type 2 diabetes, offering good value for money. However, more studies focused on long-term follow-up across diverse setting of LMICs should be warranted to assess the maximum impact of such interventions. Trial registration Australia and New Zealand Clinical Trial Registry (ACTRN12621000531819) Registered on 6th May 2021.

Background The Australian population aged 70 and above is increasing and imposing new challenges for policy makers and providers to deliver accessible, appropriate and affordable health care. We examine pre-COVID patterns of health loss between 1990 and 2019 to inform policies and practices. Methods Using the standardised methodology framework and analytical strategies from GBD 2019 methodologies, we estimated mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life years (DALYs), life expectancy at age 70 and above (LE-70), and healthy life expectancy (HALE-70) in Australia comparing them globally and with high socio-demographic index (SDI) groups. Findings DALY rates have been improving steadily over the past 30 years among Australians aged 70 and above. Decreases in DALY rates were primarily attributed to a fall in YLLs attributable to cardiovascular diseases (60%) and chronic respiratory disorders (30.2%) and transport injuries (56.9%), while the non-fatal burden remained stable from 1990 to 2019. According to the DALY rates, the top five leading causes are ischemic heart disease, Alzheimer's disease, COPD, stroke, and falls, where falls exhibited the largest increase since 1990. Interpretation This study provides an in-depth report on the main causes of mortality and disability in Australia's population aged 70 and above. It sheds light on the shifts in burden over three decades, emphasising the need for the Australian health system to enhance its readiness in addressing the escalating demands of an ageing population. These findings establish pre-COVID baseline estimates for Australia's population aged 70 and above, informing healthcare preparedness. Copyright (c) 2024 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Background Good oral health is an important part of healthy ageing, yet there is limited understanding regarding the status of oral health care for older people globally. This study reviewed evidence (policies, programs, and interventions) regarding oral health care for older people. Methods A systematic search of six databases for published and grey literature in the English language by the end of April 2022 was undertaken utilising Arksey and O’Malley’s scoping review framework. Results The findings from oral health policy documents ( n = 17) indicated a lack of priorities in national health policies regarding oral health care for older people. The most common oral health interventions reported in the published studies ( n = 62) included educational sessions and practical demonstrations on oral care for older adults, nurses, and care providers. Other interventions included exercises of facial muscles and the tongue, massage of salivary glands, and application of chemical agents, such as topical fluoride. Conclusion There is currently a gap in information and research around effective oral health care treatments and programs in geriatric dental care. Efforts must be invested in developing guidelines to assist both dental and medical healthcare professionals in integrating good oral health as part of healthy ageing. Further research is warranted in assessing the effectiveness of interventions in improving the oral health status of the elderly and informing approaches to assist the integration of oral health into geriatric care.

Global healthcare systems have faced unprecedented strain due to the COVID-19 pandemic, with a profound impact on individuals with non-communicable diseases (NCDs), a scenario particularly pronounced in low-income countries like Nepal. This study aimed to understand the experiences of and challenges faced by patients with NCDs in Nepal during the pandemic, focusing on healthcare service availability and identifying factors affecting healthcare use, with the goal of being prepared for future emergencies. This study utilized a telephonic survey of 102 patients with NCDs and 10 qualitative interviews with healthcare providers in the Kavrepalanchok and Nuwakot districts of Nepal. We used mixed methods, with both qualitative and quantitative approaches. Specifically, multiple correspondence analysis, hierarchical cluster analysis, and classification tree analysis were used as exploratory methods. The study revealed that while 69.6% of the participants reported no difficulty in obtaining medication, other questions revealed that 58.8% experienced challenges in accessing routine medical care. Major barriers, such as fear of infection, unavailability of medicine in rural areas, and lack of transportation, were found through the qualitative interviews. Meanwhile, participants identified innovative strategies, such as telemedicine and community-based awareness programs, as potential facilitators for addressing barriers that arise during pandemic situations such as COVID-19. The COVID-19 pandemic exacerbated challenges in accessing healthcare services for patients with NCDs in Nepal. Our findings suggest the need to design and implement telemedicine services for patients with NCDs, as well as community-based programs that aim to improve health literacy, encourage healthy behavior, prevent development of NCDs, and ensure continuity of care during such crises, especially in countries with limited resources.

Australia welcomes significant numbers of humanitarian arrivals every year. Over 24,000 South Sudanese have come to Australia in the last two decades, and most faced difficulties during the settlement process. The aim of this study was to understand the barriers and challenges that have impacts on settlement and integration experiences among South Sudanese refugees in Australia. Further, this explored the factors influencing the social and cultural integration of South Sudanese refugees living in Australia for more than five years. This study used a phenomenological approach with purposive and snowball sampling to recruit 26 participants who self-identified as South Sudanese refugees. Participants were recruited via community networks and were invited to participate in a semi-structured interview. The interviews were conducted by a bilingual interviewer and were analysed thematically. Participants' experiences portrayed the complexities of integrating into a new society and experienced multiple challenges and barriers. Despite this identity dilemma, they showed a consensus about the experiences of coming to and living in Australia with close association with a group identity. While there are positive elements of the integration experience, inter-generational conflicts require further investigation. Government and settlement organisations need to make an effort to understand the context while developing appropriate processes.

This study aims to assess the utilization of health care services and its associated factors among people with type 2 diabetes mellitus (T2DM) in Nepal. Data on the utilization of health care services were assessed in 481 adults aged 30 to 70 years with T2DM in Nepal. Multiple logistic regression analysis was performed to determine the factors associated with the utilization of health care services. Over 6 months, 66.1% of participants visited health care facilities or health service providers, followed by specialist visits (3.5%), hospitalization (2.1%), and emergency department visits (1.9%). Visit to health care facilities was significantly higher among those aged 50 to 59 (ORA: 1.64, CI: [1.01, 2.67]), practicing Hinduism (ORA: 2.4, CI: [1.20, 4.81]), and earning NRs >= 30 000 (>= USD 226.10) (ORA: 1.82, CI: [1.05, 3.15]) as compared to those aged >= 60, practicing other religions, and with monthly family income NRs <= 10 000 (<= USD 75.37), respectively. The utilization of health care services among people with T2DM in Nepal was reasonably low. Identifying the underlying causes of low use of health care services is of great importance to bridge the gap in using health care services for management of diabetes.