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P2.04 Title a clinical investigation to improve reproductive health service delivery in primary care to refugees from burma
  1. Amita Tuteja1,
  2. Lena Sanci1,
  3. Lester Mascarenhas2,
  4. Elisha Riggs3,
  5. Lynette O Dwyer2,
  6. Van Villet Katrina Sangster3,
  7. Kim Mcguiness2,
  8. Meredith Temple-Smith1
  1. 1Department of General Practice, University of Melbourne, Australia
  2. 2Isis Primary Care, Hoppers Crossing, Australia
  3. 3Murdoch’s Children Research Institute, Royal Children’s Hospital, University of Melbourne

Abstract

Introduction In 2014–2015, Australia granted over 2000 humanitarian visas to people from Burma. During initial refugee health assessments conducted at local health centres, primary care practitioners (PCP) observed that these refugees are quiet, modest and polite; rarely acknowledge sexual health problems and typically answer in the affirmative. Consequently, PCP found it challenging to understand their health needs. Our study aimed to gain insight into how migration affected the reproductive health needs of this group, their ability to access an unfamiliar health system, and to identify elements of a sexual health service model for adaptation to refugee communities.

Methods As we targeted the sensitive needs of a marginalised population we selected qualitative techniques, and conducted 27 semi-structured interviews on sexual health consultations with PCP involved with refugees from Burma. Interviews were audio-recorded and transcribed. Research team members reached consensus on coding, content and thematic analysis and key results.

Results Preliminary analysis suggested six consultation related themes: interpretation, language and euphemisms, culture and beliefs, power dynamics, role of family and low levels of health literacy. Overall, effective communication was the key to successful reproductive health consults. For instance, picture a genital examination with an interpreter on the speaker phone at a distance from the examining couch and practitioner interpreter and patient speaking loudly to communicate the steps of speculum examination. Secondly community leaders often serve as interpreters raising serious privacy concerns in sexual health related problems.

Conclusion The needs of the refugee patient cannot always be ascertained through the biomedical lens. PCP need assistance to contextualise ‘behind the scene’ communication dynamics involved in sexual health consults. Humanising perspectives can assist in overcoming barriers. Patient’s must be given a choice of interpreter in sexual and reproductive health consultations in refugee settings.

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