Barriers In Accessing Services Research Articles

THRIVING IN MOTION – YOUTH MOVES: MOVEMENT FOR YOUTH MENTAL HEALTH PROGRAM

CASE SETTING A Western Australia community exercise initiative supporting vulnerable youth experiencing poor mental health. Led by professionals and peers, our program offers a non-judgmental space for exercise and education, addressing discrimination, isolation, and service access barriers. Addressing a lack of physical activity options for at-risk groups, the program targets individuals affected or at risk of mental health disorders, recognizing that a quarter of youth face such challenges. TREATMENT An 8-week evidence-based program integrating mixed movement and education in alternative or education support settings. Tailored for at risk youth, the goal is to directly improve mental and physical health literacy, and social outcomes of participants through diverse exercise opportunities to manage and maintain thriving mental health. Specifically, we delivered and evaluated the feasibility of the program for at risk youth. RESULTS Since 2022, Thriving has delivered 43 8-week programs directly impacting 855 vulnerable youth in various metro (13) and regional (2) Western Australian locations, totalling 20, 860 exercise therapy hours. Forty-two collaborative partnerships and 15 staff have been involved in delivery. On average 85% of participants reported a score higher than 3/5 for program enjoyment, 80% of participants reported a score higher than 3/5 for motivation to return. REFLECTIONS/LEARNINGS Despite the abundance of community-based exercise and sporting organizations, a significant gap exists in their ability to address the needs of vulnerable youth, stemming from insufficient specialized skills and training. Informed by the achievements and insights of prior collaborations and projects, our program focuses on establishing inclusive activity environments for youth in low participation groups. Building on successful community relationships, we strive to encourage disengaged youth, allies, friends and families by offering tailored opportunities and pathways for meaningful exercise participation.

Online Bilingual Co-Design: Developing Resources with People with Disability and Family Members from Refugee Backgrounds

People with disability from Syrian and Iraqi refugee backgrounds living in Australia have limited access to information and resources in Arabic language. Our study aim was to use a co-design process to create a suite of Arabic-language resources to increase information access and build capacity of people with disability and family members from refugee backgrounds to use services, and of disability and refugee services to provide relevant support. Following a rapid literature review about access to supports and services for people with disability from refugee backgrounds, workshops were held with 38 people with disability and family members from Syrian and Iraqi refugee backgrounds to identify service access barriers. An online bi-lingual co-design group involving six people with disability and family members, six service providers and four researchers then developed resource content and formats to address identified barriers. Professional video production companies developed the visual resources. A co-developed dissemination plan ensured the resources reached target audiences. This paper details the PAR bilingual co-design method used and explains how using this method resulted in an active and equitable partnership through which all members’ capacity and understanding was built resulting in a range of practical resources for use by those who reported a need but limited access.

Connecticut Implements a Team-Based Approach to Cardiovascular Disease Prevention Using Community Health Workers and Mobile Medical Devices.

The Connecticut Department of Public Health's Early Detection and Prevention Program uses an integrated approach to deliver breast and cervical cancer screening services, cardiovascular disease risk assessment, health coaching, and the identification of social determinants of health to women from economically disadvantaged and minority communities. Statewide contracted providers who represent twenty hospitals and their fee-for-service providers employ community health workers (CHWs) to conduct outreach, screening assessments using mobile medical devices, and risk reduction counseling in community settings to reduce service access barriers, while also engaging eligible women who may not typically frequent clinical services. Mobile medical screening devices enhance healthcare accessibility by enabling screenings to be conducted in a participants preferred setting, whether it is a clinic or within the community, with the added benefit of delivering rapid screening results. Utilizing these results, CHWs provide risk reduction counseling to develop individualized health action plans at the outreach session.

Migration and health study: a socio-ecological analysis of sexual health among migrants in Manitoba, Canada

BackgroundTo develop effective public health policies, programs, and services tailored to the unique sexual health needs of migrant populations, it is essential to understand the myriad socio-ecological factors that influence their sexual health. This qualitative community-based participatory study aimed to explore factors influencing migrants’ sexual health at different socio-ecological levels in a Canadian setting.MethodsParticipants (n = 34) from African, Caribbean, Black; Latin American; South Asian; Middle Eastern, as well as East and Southeast Asian communities were recruited across Manitoba using printed flyers, community organizations, and social media. Individual interviews, conducted in English, French, Mandarin, Cantonese, Tagalog, Arabic, Swahili, and Tigrinya languages, explored questions relating to sexual health and experiences with service providers. Data were analyzed using reflexive thematic analysis and socio-ecological systems theory.ResultsThe study uncovered a range of individual, interpersonal, institutional, and socio-structural factors that affect the sexual health of migrants in Manitoba. Individual factors such as sexual health knowledge and testing practices, interpersonal factors like the type of sexual partnerships, institutional factors such as sexual health information needs, language, and service access barriers, and structural-level factors like gender norms and HIV stigma exerted a significant influence on the sexual health practices of study respondents. Sexual health awareness was influenced by various factors including length of time in Canada and involvement in community-based services. Study respondents identified issues related to access to HIV testing and sexual health information, as well as language barriers, racism in healthcare, and HIV stigma. Gender and social norms played a significant role in discouraging communication about sex and safer sex practices.ConclusionsThe study highlights the complex interplay of factors that influence the sexual health of migrants, and the need for targeted sexual health awareness campaigns and provision of sexual health information in languages spoken by migrants. Public health interventions focused on improving the sexual health outcomes for migrants should consider the socio-ecological elements identified in this study. These findings can inform public health campaigns to increase access to services and address sexual health inequities among migrant communities in Canada.

Emotional work of getting help: a qualitative analysis of caregiver-perceived barriers to responding to childhood adversity

ObjectiveTo explore caregivers’ experiences and challenges of accessing help for adversity across both health and social care sectors.DesignQualitative study design using semistructured interviews to explore how caregivers accessed services across...

The Impacts and Vulnerabilities for People Living with Spinal Cord Injury and Their Service Systems of the COVID-19 Pandemic in Queensland, Australia

As part of a larger study examining the perceived impacts of health system stress in Queensland, Australia, caused by the COVID-19 pandemic, this study explored the experiences and perspectives of a sample of people with spinal cord injury (SCI) and critical stakeholders to identify secondary complications, access concerns, and potential solutions in the context of the pandemic. This study utilised a multimethods qualitative design. Thirty-four people with SCI completed an online survey between August and November 2021, recruited from an online Spinal Life Australia Peer Support Group. Sixteen SCI expert stakeholders, recruited from the Queensland Spinal Cord Injuries Services, consumer support organisations, and funding agencies, participated in one of two expert stakeholder forums in September 2021, focusing on impacts of the pandemic on the services they provided. Survey and forum results were analysed thematically. Results highlighted service disruption wherein people with SCI faced difficulty accessing health and community services (including rehabilitation) and personal supports. Reduced access led to secondary complications in physical health, psychosocial, and occupational domains. Solutions for safeguarding access to care, including action-ready back-up plans, effective technology and training, collaboration of service networks, and forward planning for system disruption, consumables access, staff support, and advocacy are required to best support vulnerable populations and the supporting staff in times of crisis. In conclusion, COVID-19 disrupted access to specialist SCI and mainstream health, rehabilitation, and social care services, resulting in functional decline and physical and psychosocial complications. While people with SCI and their service providers attempted to innovate and solve problems to overcome service access barriers, this is not possible in all situations. Improved planning and preparation for future system disruptions mitigates risks and better protects vulnerable populations and service providers in times of severe system stress.

Online counselling for family carers of people with young onset dementia: The RHAPSODY-Plus pilot study.

Compared to late life dementia, Young Onset Dementia (YOD) has its own distinct challenges, including a lack of specialised and age-appropriate support services. Carers of people with YOD experience higher levels of psychological and physical symptoms, and lower quality of life. This study (RHAPSODY-Plus) assessed the acceptability and feasibility of combining RHAPSODY (Research to Assess Policies and Strategies for Dementia in the Young; a web-based information and skill-building programme for carers of people with YOD) with individually tailored support sessions with health professionals (a social worker and a clinical psychologist) provided via online videoconferencing. Participants (n = 20) were informal carers aged over 18 years, who were caring for a person with YOD (either Alzheimer's disease or frontotemporal dementia type). Participants used the RHAPSODY programme for 4 weeks, then attended 2 support sessions. Participants and the health professionals then attended individual feedback sessions. Feedback was collected via open-ended and Likert-style questions. The majority of carers rated the RHAPSODY-Plus programme as good to very good, demonstrating a high level of acceptability. Positive feedback about the programme included being able to receive personal advice additionally to the information provided in RHAPSODY. The healthcare professionals also thought the programme was acceptable and beneficial for access to support. Some limitations in the feasibility of videoconferencing included network and technical issues and the loss of non-verbal communication. This online pilot study had a high level of acceptability, demonstrating the potential of an individualised multi-modal intervention for carers of people with YOD which offers opportunities to overcome geographical and service access barriers.

Risks and Barriers in Substitute Care for the Children of Parents with Serious Mental Illness: A Mixed-Method Study in Kerala, India.

Mental illness in parents impairs their parenting capability, which has a lifelong detrimental impact on their children's physical and psychological health. In the current Indian context, due to weak social security nets, family is the only plausible intervention to ensure adequate substitute child care. Therefore, this study explores various risk factors and barriers to providing substitute family care. We used a mixed-method approach to gather information from 94 substitute family caregivers. Quantitative screening data were collected from four hospitals using a clinical data mining tool and an interview guide to gather caregiver perspectives on economic, familial, and social risks and barriers associated with caring. We used thematic analysis to consolidate the qualitative findings. Most of the substitute caregivers were females from low-income households. The study identified 11 sub-themes and 23 specific themes associated with risks and barriers to substitute care. These themes fell into four broad areas: economic, familial, school-related risks, and specific cultural and service access barriers. Focus on economic interventions is likely to result in strengthening the substitute family caregiver. The paradigmatic shift of treatment focus from the patient to the entire household would benefit the children just as it does the patient.

South Asian youth mental health in Peel Region, Canada: Service provider perspectives.

The Peel Region of Toronto, Canada is home to over a third of the province's South Asian population. Youth are at a vulnerable time period in terms of their mental health. South Asian youth populations may face additional challenges to their mental health such as acculturative stress, intergenerational conflict, and racism and discrimination. This qualitative study set out to understand the mental health concerns and service access barriers experienced by South Asian youth populations in the Peel Region of Toronto, Canada from the perspective of mental health service providers. In-depth semi-structured interviews were carried out with mental health service providers (n = 22) who work with South Asian youth living in Peel Region. Thematic analysis was used to elucidate themes related to mental health stressors and service access barriers experienced by youth. According to mental health service providers, South Asian youth navigate a number of unique stressors related to the domains of culture, religion, and family dynamics, experiences of discrimination, the impact of migration, beliefs around mental illness and help-seeking, help-seeking trajectories and therapy recommendations, and lastly, sex differences. Mental health service providers outlined steps needed to effectively address the unique mental health challenges, best practice guidelines, and recommendations for working with South Asian youth, families, and communities to provide a practical and nuanced overview on how a multi-level strategy for mental health care can effectively meet the needs of South Asian youth populations.

Changes in utilisation of optometry services with a non-targeted publicly-funded health care voucher system

ABSTRACT Clinical relevance Understanding the impact of a health care voucher scheme and service access barriers could facilitate optometry service promotion to the older population. Background A voucher is one strategy to improve the utilisation of the different health care services available in the private sector. This study aims to explore how a health care voucher system for older people impacts utilisation of optometry services from the perspective of service users and service providers. Methods People aged 65 years or above were recruited to fill in a structured questionnaire studying the usage characteristics and access barriers of optometry services and the health care voucher. Views from the optometrists about the voucher scheme were collected by questionnaire. Results A total of 1156 valid questionnaires from eligible voucher users was collected. Results showed that 53.7% (621/1156) of participants had used optometry services within the past 2 years. Lack of familiarity with services provided, professional fees, and prices of spectacles were the main barriers to using optometry services. Of those participants who had used the voucher for optometry services previously, 80.4% (284/353) had an eye examination in the past 2 years. Among 389 optometrists who participated in the study, over 80% agreed that the voucher scheme improved awareness of major eye conditions and access to prescription spectacles when necessary. Conclusion The health care voucher for older people improved access to optometry services. Access could be further improved by increasing price transparency of professional services and prescription spectacles. Responses from optometry service providers supported the view that the voucher scheme improved access to, and utilisation of, preventive care services.

A qualitative descriptive study of a novel nurse-led skin cancer screening model in rural Australia

BackgroundPeople residing in rural areas have higher rates of skin cancer and face barriers to accessing care. Models of skin cancer care addressing the specific needs of rural communities and overcoming specific challenges are required, but literature is scarce. This study aimed to describe the elements of a nurse-led skin cancer model in rural Victoria using qualitative methodology and programme logic to inform implementation and ongoing sustainability.MethodsQualitative descriptive design. Semi-structured interviews were conducted with key stakeholders involved in the skin cancer model, namely health service executive management, clinical staff, and administration staff. Interviews were audio-recorded and transcribed verbatim. Transcripts were thematically analysed independently by two researchers before themes were compared and refined. A programme logic model was developed to organise themes into contextual elements, inputs, activities and anticipated outcomes; it was also used as a visual tool to aid discussions with key stakeholders. Member checking of the logic model occurred to verify interpretation. This programme logic model will be refined throughout the implementation phase, and again after three years of service delivery.ResultsEight stakeholders participated in interviews. Thematic analysis identified three major themes: the influence of the local rural context, the elements of the model, and “making it happen’. These major themes and accompanying sub-themes were mapped to the programme logic model by contextual elements (rural locale, health service access barriers, burden of disease), key inputs (promotion, human resources including appropriate nurse training and leadership) and ‘making it happen’ (governance including referral pathways, flexible and sustained funding, and partnerships). The anticipated outcomes identified include skin cancer care delivered locally, timely access, career development for nurses, and decreased skin cancer burden.ConclusionAn initiative that is place-based and community driven in response to consumer demand addresses key system barriers to earlier detection of skin cancers. It is anticipated to result in flow-on reductions in skin cancer disease burden. Programme logic was useful to both describe the initiative and as a visual tool for discussions, with the potential to inform wider health service efforts to address system barriers and bottlenecks.

Educators, parents prefer schools play larger role in youth MH

With school openings just around the corner, and amid a national emergency in youth mental health, a new study has found that the majority of parents—citing cost and service access barriers—are looking to schools to provide their children with mental health support. Additionally, the majority of educators surveyed said they want to help solve the youth mental health crisis.

Structural and social inequities contribute to pockets of low childhood immunisation in New South Wales, Australia

IntroductionChildhood immunisation is a safe and effective way to protect children and communities from serious diseases. In Australia childhood immunisation is generally well accepted with high coverage rates however pockets of low coverage exist. Authors conducted five previous studies in New South Wales which found socio-economic disadvantage, gender inequity, health service access barriers and under-utilisation of immunisation data, rather than ideological opposition, contributed to children’s incomplete vaccination. Material and MethodsCommon findings across those five studies were identified. Additional literature was reviewed using a number of lenses, underpinned by a social determinants of health framework. ResultsThe lensed approach allowed further exploration of the impact of financial stress, poor mental health, drug and alcohol problems, domestic violence, assumed gender roles, lack of culturally acceptable health care for Indigenous families, geography and changes to immunisation policies on families and how this may have contributed to pockets of low immunisation coverage. Social and structural inequities were revealed. These often contributed to conflicting priorities that meant children’s immunisations fell behind. DiscussionStrategies to address inequities may include reorientation of existing community based child health services to include flexible options such as drop in clinics, outreach services, home visiting and ensuring Indigenous families have access to culturally safe and acceptable services. Assistance with transport would further improve access to services. Better use of immunisation data can aid in the identification of pockets of low coverage and monitor and evaluate service effectiveness. ConclusionsGreater awareness of social and structural barriers and their impact on families can inform the design of tailored strategies that address the needs of disadvantaged children and families. Without efforts to overcome the inequities that contribute to low immunisation coverage, the status quo persists, leaving children and communities at risk of vaccine preventable diseases.

P.088 Family identified barriers to accessing services for children with attention deficits and neurodevelopmental disorders

Background: Obtaining early intervention services is crucial for improving outcomes in children with neurodevelopmental disorders (NDDs) such as Autism or Attention Deficit/Hyperactivity Disorder. Identifying barriers in accessing services in the healthcare system is necessary to optimize the Patient and Family-Centered Care approach. Methods: Parents of children with an NDD co-occurring with attention deficits were recruited from the Neurodevelopmental Attention Clinic at the Alberta Children’s Hospital. Parents completed a semi-structured interview and the Barriers to Accessing Services (BAS) questionnaire. Results: Nine families participated representing 10 children. Interviews were evenly spread between biological mothers and fathers. All children had attention deficits; 4 children were also diagnosed with Autism and 5 with “other” neurologic conditions. The two barriers most identified by families (67%) through the BAS questionnaire were “Didn’t know where to find help” and “Steps to seek help are too overwhelming”, consistent with information obtained in the interview. Conclusions: Children with an NDD and attention deficits often have complex medical needs. Parents have identified challenges initiating, and navigating the many steps involved to secure services. We will collect information from more families to determine how services for children with complex medical needs can become more accessible.

Experiences of and attitudes towards HIV testing for Asian, Black and Latin American men who have sex with men (MSM) in the SELPHI (HIV Self\u2010Testing Public Health Intervention) randomized controlled trial in England and Wales: implications for HIV self-testing

BackgroundHIV self-testing (HIVST) could play an important role in improving access to testing and therefore reducing inequalities related to late diagnosis of HIV, while also improving access to HIV prevention interventions such as HIV pre-exposure prophylaxis. This study sought to understand the potential role of HIVST by exploring the experiences of Asian, Black and Latin American men who have sex with men (MSM) accessing the gay scene and the circulation of HIV testing norms; experiences of accessing HIV testing services; HIVST acceptability and preferences for intervention adaptations.MethodsTwenty-nine qualitative interviews were conducted with Asian, Black and Latin American MSM who had participated in SELPHI, an HIVST randomised controlled trial. Topics included HIV testing history, HIV testing patterns, experiences of accessing sexual health services, mental health, engagement with HIVST and SELPHI, and experiences of the gay scene. Interviews were audio recorded, transcribed and then analysed using a thematic framework.ResultsThe gay scene was identified as an important site for learning about HIV and being exposed to norms reinforcing the importance of protective behaviours. However, experiences of discomfort due to perceptions of ‘whiteness’ on the scene or experiences of racism may hinder the protective function the scene could play in developing norms influencing HIV testing behaviour. Discomfort in clinic waiting rooms was identified as a substantial barrier to accessing clinical services and many interviewees expressed preferences regarding the personal characteristics of healthcare providers. HIVST was found to be acceptable and some interviewees suggested potential adaptations of the HIVST offer, such as packaging HIVST with at home sexually transmitted infections testing options.ConclusionsHIVST responds to some service access barriers experienced by Asian, Black and Latin American MSM. The decoupling of HIV testing and clinic attendance may be particularly valuable for MSM of minority ethnic backgrounds who are likely to experience anxiety and discomfort in clinic waiting rooms more acutely than White MSM due to concerns around implied disclosure. This suggests that HIVST may have the potential to increase testing uptake and frequency, particularly for those with complex relationships with clinical services.Trial RegistrationSELPHI was prospectively registered with the ISRCTN (ref: ISRCTN 20312003).

Post-acute health care needs of people with head and neck cancer: Mapping health care services, experiences, and the impact of rurality.

BackgroundPeople with head and neck cancer (HNC) have complex health care needs; however, limited evidence exists regarding the nature or patterns of service access and use. This study explored the post‐discharge health care needs and experiences of individuals with HNC from metropolitan and rural areas.MethodsHealth care appointments and services accessed by people with HNC were collated for 6‐month post‐treatment. Data analysis of the whole cohort examined patterns of access while journey mapping integrated participants' experiences of recovery.ResultsThe 6‐month service access journey was mapped for 11 people. Rural participants attended a significantly greater number of appointments (p = 0.012), higher canceled/missed appointments (p = 0.013), and saw more professionals (p = 0.007). Rural participants reported higher stress and burden due to service access barriers and unmet needs.ConclusionsMultiple challenges and inequities exist for rural people with HNC. Findings inform opportunities to enhance the post‐treatment recovery of people with HNC in rural areas.

Veteran families with complex needs: a qualitative study of the veterans\u2019 support system

BackgroundFamilies with complex needs face significant challenges accessing and navigating health and social services. For veteran families, these challenges are exacerbated by interactions between military and civilian systems of care, and the density of the veterans’ non-profit sector. This qualitative study was designed to gather rich, detailed information on complex needs in veteran families; and explore service providers’ and families’ experiences of accessing and navigating the veterans’ support system.MethodsThe study comprised participant background questionnaires (n = 34), focus groups with frontline service providers (n = 18), and one-on-one interviews with veteran families (n = 16) in Australia. The semi-structured focus groups and interviews were designed to gather rich, detailed information on four study topics: (i) health and wellbeing needs in veteran families; (ii) service-access barriers and facilitators; (iii) unmet needs and gaps in service provision; and (iv) practical solutions for improving service delivery. The study recruited participants who could best address the focus on veteran families with complex needs. The questionnaire data was used to describe relevant characteristics of the participant sample. The focus groups and interviews were audio-recorded, transcribed, and a reflexive thematic analysis was conducted to identify patterns of shared meaning in the qualitative data.ResultsBoth service providers and families found the veterans’ support system difficult to access and navigate. System fragmentation was perceived to impede care coordination, and delay access to holistic care for veteran families with complex needs. The medico-legal aspects of compensation and rehabilitation processes were perceived to harm veteran identity, and undermine health and wellbeing outcomes. Recovery-oriented practice was viewed as a way to promote veteran independence and self-management. Participants expressed a strong preference for family-centred care that was informed by an understanding of military lifestyle and culture.ConclusionThe health and wellbeing needs of veteran families intensify during the transition from full-time military service to civilian environments, and service- or reintegration-related difficulties may emerge (or persist) for a significant period of time thereafter. Veteran families with complex needs are unduly burdened by care coordination demands. There is a pressing need for high-quality implementation studies that evaluate initiatives for integrating fragmented systems of care.

Telepractice Delivery of an Autism Communication Intervention Program to Parent Groups

BackgroundSocial communication is a core challenge for children with autism and research confirms that early intervention positively impacts developmental outcomes. Families often experience barriers when accessing early intervention such as service availability, cost, and geographical location. Telepractice intervention has been used effectively with individual families to help overcome service barriers and to assist service access. This research investigated an expanded telepractice approach involving delivery of a manualized communication intervention to groups of parents. The research evaluated parent and child communication outcomes following participation in a telepractice-delivered, Hanen More Than Words (HMTW) group program. MethodA single case experimental design involving a multiple-baseline-across-groups was implemented with 11 mother–child dyads. Quantitative analyses investigated both parent and child interactive communication behaviours during baseline, intervention, and post-intervention research phases. ResultsResults demonstrated improved parental responsiveness and increased child social communication behaviour following participation in the telepractice-delivered HMTW. Changes in parent and child communication behaviour were maintained during the post-intervention phase. ConclusionsThe results support the application of telepractice for delivering a group-based early intervention training program. Expanding telepractice service delivery from individual to group-based intervention has the potential to increase service choice for families and to mitigate service access barriers.

The utility of physiotherapy assessments delivered by telehealth: A systematic review.

BackgroundTelehealth use is increasing due to its ability to overcome service access barriers and provide continued care when disease transmission is of concern. However, little is known of the validity, reliability and utility of performing physiotherapy assessments using synchronous forms of telehealth across all physiotherapy practice areas. The aim of this systematic review was to determine the current clinometric value of performing physiotherapy assessments using synchronous forms of telehealth across all areas of physiotherapy practice.MethodsA comprehensive search of databases (PubMed/MEDLINE, The Cochrane Library, Embase and EBSCO) was undertaken to identify studies investigating the clinometric value of performing physiotherapy assessments using synchronous forms of telehealth across all physiotherapy practice areas. Following selection, a quality appraisal was conducted using the Brink and Louw or Mixed Methods Appraisal Tool. Evidence regarding validity, reliability and utility of synchronous telehealth physiotherapy assessments was extracted and synthesised using a critical narrative approach.ResultsThirty-nine studies conducted in a variety of simulated (n = 15) or real-world telehealth environments (n = 24), were included. The quality of the validity, reliability and utility studies varied. Assessments including range of movement, muscle strength, endurance, pain, special orthopaedic tests (shoulder/elbow), Berg Balance Scale, timed up and go, timed stance test, six-minute walk test, steps in 360-degree turn, Movement Assessment Battery for Children (2nd Edition), step test, ABILHAND assessment, active straight leg raise, and circumferential measures of the upper limb were reported as valid/reliable in limited populations and settings (many with small sample sizes). Participants appeared to embrace telehealth technology use, with most studies reporting high levels of participant satisfaction. If given a choice, many reported a preference for in-person physiotherapy assessments. Some inconsistencies in visual/auditory quality and challenges with verbal/non-verbal communication methods were reported. Telehealth was considered relatively cost-effective once services were established.ConclusionsPerforming physiotherapy assessments using synchronous forms of telehealth appears valid and reliable for specific assessment types in limited populations. Further research is needed in all areas of physiotherapy practice, to strengthen the evidence surrounding its clinometric value. Clinicians contemplating using this assessment mode should consider the client/family preferences, assessment requirements, cultural needs, environment, cost considerations, access and confidence using technology.Protocol registrationPROSPERO: CRD42018108166.

Improved childhood immunization coverage using the World Health Organization’s Tailoring Immunization Programmes guide (TIP) in a regional centre in Australia

In 2017 the World Health Organization’s Tailoring Immunization Programmes guide (TIP) was used to identify pockets of low immunization coverage in Australia. The regional centre of Maitland had high numbers and rates of children who were overdue for scheduled vaccinations (2016, n = 344, 37.7%). Families were not opposed to immunization but had conflicting priorities or experienced service access barriers. A tailored strategy was developed including friendly, personalised reminders, outreach appointments and home visiting for those families most in need. Research translation was not quick and easy. A process evaluation identified areas where more support was needed to advance the strategy. Coverage rates have increased from 62.3% (2016) to 86.2% (2020). The number of overdue children has decreased even during COVID-19 restrictions when health services expected families would avoid primary care services. The TIP approach is valuable for improving childhood immunization coverage and is being utilised in other communities with low coverage.