Study protocol for a real-world evaluation of an integrated child and family health hub for migrant and refugee women

Abstract

IntroductionContinuity of child and family healthcare is vital for optimal child health and development for developmentally vulnerable children. Migrant and refugee communities are often at-risk of poor health outcomes, facing barriers to health service attendance including cultural, language, limited health literacy, discrimination and unmet psychosocial needs. ‘Integrated health-social care hubs’ are physical hubs where health and social services are co-located, with shared referral pathways and care navigation.AimOur study will evaluate the impact, implementation and cost-benefit of the First 2000 Days Care Connect (FDCC) integrated hub model for pregnant migrant and refugee women and their infants.Materials and methodsThis study has three components. Component 1 is a non-randomised controlled trial to compare the FDCC model of care with usual care. This trial will allocate eligible women to intervention and control groups based on their proximity to the Hub sites. Outcome measures include: the proportion of children attending child and family health (CFH) nurse services and completing their CFH checks to 12 months of age; improved surveillance of growth and development in children up to 12 months, post partum; improved breastfeeding rates; reduced emergency department presentations; and improved maternal well-being. These will be measured using linked medical record data and surveys. Component 2 will involve a mixed-method implementation evaluation to clarify how and why FDCC was implemented within the sites to inform future roll-out. Component 3 is a within-trial economic evaluation from a healthcare perspective to assess the cost-effectiveness of the Hubs relative to usual care and the implementation costs if Hubs were scaled and replicated.Ethics and disseminationEthical approval was granted by the South Eastern Sydney Local Health District Human Research Ethics Committee in July 2021 (Project ID: 020/ETH03295). Results will be submitted for publication in peer-reviewed journals and presented at relevant conferences.Trial registration numberACTRN12621001088831.

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“…Data collection for the qualitative interviews and focus groups will continue until data saturation- no new themes pertaining to the research objectives are identified with subsequent interviews. However, from previous experience, we will contact at least 40 practitioners, managers and families/carers across the three sites, ensuring diversity with regard to practice and role [ 36 ].…”

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“…fostering relationships between service providers and service users to improve the cultural responsiveness of services [39,59,60,71]. Their support and education can increase health literacy, reinforce the importance of maternal and CFH health, and child developmental assessments, in order to optimise health outcomes [20,72]. Importantly, memories associated with pregnancy, birth, and early parenting are often powerful and long lasting [73], these experiences can in uence how women and families perceive and engage with health services in the future [20,74].…”