Stakeholder Advisory Committee Research Articles

A narrative synthesis of the impact of primary health care delivery models for refugees in resettlement countries on access, quality and coordination.

IntroductionRefugees have many complex health care needs which should be addressed by the primary health care services, both on their arrival in resettlement countries and in their transition to long-term care. The aim of this narrative synthesis is to identify the components of primary health care service delivery models for such populations which have been effective in improving access, quality and coordination of care.MethodsA systematic review of the literature, including published systematic reviews, was undertaken. Studies between 1990 and 2011 were identified by searching Medline, CINAHL, EMBASE, Cochrane Library, Scopus, Australian Public Affairs Information Service – Health, Health and Society Database, Multicultural Australian and Immigration Studies and Google Scholar. A limited snowballing search of the reference lists of all included studies was also undertaken. A stakeholder advisory committee and international advisers provided papers from grey literature. Only English language studies of evaluated primary health care models of care for refugees in developed countries of resettlement were included.ResultsTwenty-five studies met the inclusion criteria for this review of which 15 were Australian and 10 overseas models. These could be categorised into six themes: service context, clinical model, workforce capacity, cost to clients, health and non-health services. Access was improved by multidisciplinary staff, use of interpreters and bilingual staff, no-cost or low-cost services, outreach services, free transport to and from appointments, longer clinic opening hours, patient advocacy, and use of gender-concordant providers. These services were affordable, appropriate and acceptable to the target groups. Coordination between the different health care services and services responding to the social needs of clients was improved through case management by specialist workers. Quality of care was improved by training in cultural sensitivity and appropriate use of interpreters.ConclusionThe elements of models most frequently associated with improved access, coordination and quality of care were case management, use of specialist refugee health workers, interpreters and bilingual staff. These findings have implications for workforce planning and training.

Improving stakeholder knowledge and agency image through collaborative planning

Public participation affects stakeholder knowledge and opinions concerning other stakeholders, managers, and resources as well as management decisions. We analyzed participants' knowledge and opinions at the beginning and at the conclusion of a collaborative process to develop a management plan for black bears (Ursus americanus) in Virginia during 1999–2001. We administered identical surveys pre- and post-planning to stakeholders involved in the process: members of a stakeholder advisory committee (active participants, n=15), members of 3 stakeholder organizations with representatives on the committee (passive participants, total n=647), and agency staff (n=21). Both active and passive participation influenced stakeholders' knowledge and opinions concerning black bears and their management. Stakeholders' knowledge of black bears and bear management, and their image of bear managers, improved during the planning process. Stakeholder support for controversial management strategies (e.g., use of lethal methods to address bear problems) increased. Active participation apparently influenced opinions more than passive participation. Extensive interaction among advisory committee members resulted in greater tolerance for views of other stakeholder groups. Opinions of agency staff regarding bear management and stakeholder involvement in decision-making apparently were reinforced. This study demonstrates the utility of active participation, indirect involvement through interaction with active participants, and direct mailings in educating and improving relationships with and among various stakeholders.