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Background Australian women from migrant and refugee communities experience reduced access to sexual and reproductive healthcare. Human-centred design can be a more ethical and effective approach to developing health solutions with underserved populations that are more likely to experience significant disadvantage or social marginalisation. This study aimed to evaluate how well Shifra, a small Australian-based not-for-profit, applied human-centred design when developing a web-based application that delivers local, evidence-based and culturally relevant health information to its non-English speaking users. Methods This study undertook a document review, survey, and semi-structured interviews to evaluate how well Shifra was able to achieve its objectives using a human-centred design approach. Results A co-design process successfully led to the development of a web-based health app for refugee and migrant women. This evaluation also yielded several important recommendations for improving Shifra’s human-centred design approach moving forward. Conclusions Improving refugees’ access to sexual and reproductive health is complex and requires innovative and thoughtful problem solving. This evaluation of Shifra’s human-centred design approach provides a helpful and rigorous guide in reporting that may encourage other organisations undertaking human-centred design work to evaluate their own implementation.

Background Lifestyle interventions (diet, physical activity and/or behavioural) to optimise gestational weight gain can prevent adverse maternal outcomes such as gestational diabetes, pre-eclampsia and caesarean section. Objective We aimed to model the cost effectiveness of lifestyle interventions during pregnancy on reducing adverse maternal outcomes. Methods Decision tree modelling was used to determine the cost effectiveness of lifestyle interventions compared with usual care on preventing cases of gestational diabetes and hypertensive disease in pregnancy. Participants were pregnant women receiving routine antenatal care in secondary and tertiary care hospitals. The main outcome measures were cases of gestational diabetes and/or hypertensive disease in pregnancy prevented, costs, and incremental cost-effectiveness ratios. Analysis was conducted from the perspective of the Australian healthcare system, with a time horizon of early pregnancy to discharge after birth. Results Women in the intervention group were 2.25% less likely to have gestational diabetes and/or hypertensive disease in pregnancy (9.53%) compared with the control group (11.78%). Intervention costs were Australian dollars (AUD) 228 per person. Costs were AUD33 per person higher in the intervention group (AUD8281) than the control group (AUD8248). The incremental cost-effectiveness ratio was AUD1470 per case prevented. Sensitivity analysis showed that base-case results were robust. In the probabilistic sensitivity analysis, 44.8% of data points fell within the northeast quadrant, and 52.2% in the southeast quadrant (cost saving), with a 95% confidence interval ranging from AUD − 50,018 to 32,779 per case prevented. Conclusions While there is no formally accepted cost-effectiveness threshold for willingness-to-pay to prevent an adverse maternal event, the cost per person receiving a lifestyle intervention compared with controls was close to neutral, and therefore likely to be cost effective. Exploration of the cost effectiveness of different lifestyle delivery modes across various models of antenatal care is now required. Future cost-effectiveness studies should investigate longer time horizons, qualityadjusted life-years and productivity loss. Trial Registration Not applicable. Helena Teede and Zanfina Ademi shared joint senior authorship.

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Background: Australian women from migrant and refugee communities experience reduced access to sexual and reproductive healthcare. Human-centred design is an ethical and effective approach to developing health solutions with underserved populations that are more likely to experience significant disadvantage or social marginalisation. This study aimed to evaluate how well Shifra, a small Australian-based not-for-profit, applied human-centred design when developing a web-based application that delivers local, evidence-based and culturally relevant health information to its non-English speaking users. Methods: This study undertook a document review, survey and semi-structured interviews to evaluate how well Shifra was able to achieve its objectives using a human-centred design approach. Results: A co-design process successfully led to the development of a web-based health app for refugee and migrant women. This evaluation also yielded several important recommendations for improving Shifra’s human-centred design approach moving forward. Conclusions: Improving refugees’ access to sexual and reproductive health is complex and requires innovative and thoughtful problem solving. This evaluation of Shifra’s human-centred design approach provides a helpful and rigorous guide in reporting that may encourage other organisations undertaking human-centred design work to evaluate their own implementation. Keywords: human-centred design; design thinking; refugee health; evaluation Plain language summary: Australian women from non-English speaking migrant and refugee communities face reduced access to sexual and reproductive healthcare and many then go on to experience poor health outcomes as a result. There is an urgent need for new approach to improve access to healthcare for underserved communities, one that centres these women in the process of finding, developing and disseminating the solutions themselves. Human-centred design is an ethical and effective methodology to working with communities to develop these health solutions. This study aimed to evaluate how well Shifra, a small Australian-based not-for-profit focused on improving access to healthcare for refugees and new migrants, undertook human-centred design approach when developing a Smartphone app that deliver local, safe and culturally relevant health information to non-English speaking Australians. The authors interviewed refugees, health and social sector experts and computer programmers involved in creating Shifra to evaluate how well they used human-centred design to achieve its goals. This evaluation found that Shifra’s approach was successful whilst also highlighting several important recommendations for improving collaborative efforts with refugee communities. These findings could help other projects also seeking to undertake an authentic community co-design process.

BackgroundAs of June 2020, there were more than 79.5 million people displaced from their homes globally. Despite significantly different lived experiences, health literacy is poor within most displaced communities, contributing to low awareness and uptake of healthcare services and poor health outcomes as a result. Co-designing health interventions with communities is not a new concept however it is experiencing a significant increase in interest and support within the global health movement and areas of health equity in particular. This scoping review examines the current literature and gaps related to co-designing health interventions with refugees in order to increase health literacy; provide health services; and/or build quantitative data on health needs specific to refugee communities.MethodsThe following three questions were drafted and incorporated into a PICO framework.1. What literature exists surrounding co-designing health interventions with refugee populations?2. What effect (if any) do existing co-designed health interventions have on health outcomes (as defined above) within refugee populations?3. What gaps persist in co-designing health interventions with refugee communities? Key search terms were developed aiming to locate academic literature located within a Venn diagram of three categories: health, refugees and co-design. ResultsCombined searches uncovered a total of 1,804 articles following removal of duplications. 1,750 articles were excluded following screening of title and abstract leaving a shortlist of 54 articles. Only 10 of these articles met PICO criteria and nine of these focused exclusively on co-designing health interventions with refugee populations applied qualitative techniques. Only one article addressed all three health outcomes listed in the inclusion criteria above and half the articles did not discuss intervention outcomes or include any form of process evaluation.ConclusionsThis scoping review presents an opportunity to explore the intersection of collaborative design and health innovation with refugee communities. To ensure health interventions improve health outcomes, communities directly affected by displacement must be supported to authentically participate in, and where possible lead, efforts to co-design within this context. Future research efforts should expand to focus on evaluating the outcomes of ethical, meaningful and representative collaboration.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among reproductive-aged women; however, to date there has been no synthesis of the burden of PCOS specifically among indigenous women. We aimed to systematically identify and collate studies reporting prevalence and clinical features of PCOS among indigenous women worldwide. We performed a comprehensive search of six databases (Ovid MEDLINE, MEDLINE In Process & Other Non-Indexed Citations, EMBASE, EBM reviews, CINAHL, and SCOPUS) supplemented by gray literature searches and the screening of reference lists. A narrative synthesis was conducted. Fourteen studies met inclusion criteria; however, one was excluded as it assessed only children and adolescents younger than 15 years, with limited clinical relevance. Studies examined indigenous women from Australia, Sri Lanka, New Zealand, and the United States. Prevalence of PCOS was reported in only four studies and ranged from 3.05% for women in Sri Lanka to 26% for women in Australia. All included studies reported on at least one clinical feature of PCOS. Of the studies that reported on a comparison group from the same country, there was evidence of more severe features in indigenous women from New Zealand and the United States. The limited evidence available warrants further investigation of the burden of PCOS in indigenous women to build the knowledge base for effective and culturally relevant management of this condition.

BACKGROUND Australian women from migrant and refugee communities report less sexual and reproductive health (SRH) awareness. They experience reduced access to SRH-specific care as well as culturally-relevant support that could assist them to make evidence-based decisions about their own health and service utilisation. Addressing public health problems through human-centred design (HCD) is an ethical and effective approach to developing solutions with underserved populations that are more likely to experience significant disadvantage or social marginalisation. OBJECTIVE This study aimed to evaluate the HCD approach that Shifra, a small Australian-based not-for-profit focused on improving access to healthcare for refugees and new migrants, undertook in developing a web-based application to deliver local, evidence-based and culturally relevant SRH information to its users. The evaluation focused on the following three questions: 1. To what extent did Shifra complete all the steps of the design thinking process shown? 2. To what extent did the final Shifra app incorporate the contributions of all co-designers? 3. To what extent were the co-designers satisfied with the process? METHODS The primary data for the first question involved a thorough review of all of Shifra’s organisational documents. Since there is a notable lack of validated tools evaluate HCD projects a maturity rubric was designed to synthesise the findings from the document review. This rubric was developed through consultation and several iterations of feedback from the expert panel were used to improve the usability, completeness and level of detail of the rubric. RESULTS A co-design process was successfully applied to the development of a web-based app for refugee and migrant women in reproductive health. This evaluation also yielded several important recommendations for improving Shifra’s HCD approach moving forward, findings that can be applied to other projects seeking to undertake an authentic community co-design process. First, with so many people of diverse backgrounds contributing to the project, clear communication about roles and expectations is critical. Second, it is important to set realistic expectations and role clarifications with co-designers. Third, it is important not to view all end users as interchangeable. Finally, by setting aside adequate time to develop collaborative relationships amongst all co-design groups the HCD process is an opportunity to give power and control back to the end user population for whom one is designing the health intervention. CONCLUSIONS Improving refugees’ access to SRH is complex and multidimensional and requires innovative and thoughtful problem solving. HCD is one way to address complex problems in an ethical and effective way and it is how Shifra chose to approach the development of its solution to this problem. This evaluation of Shifra’s HCD approach provides a helpful and rigorous guide in reporting that may encourage other organisations undertaking HCD work to evaluate their own implementation. CLINICALTRIAL N/A