A breakthrough in the search for indicators of child risk

A recent piece of research we completed in partnership between our Jack Brockhoff Child Health and Wellbeing Program and the Victorian Department of Education and Training has revealed a breakthrough in the search for risk indicators of child developmental, emotional and … Continue reading

Reblog: Separation during disasters may have a lasting impact, even when there’s a happy ending

Originally posted on International Society for Traumatic Stress Studies Blog Posted 12 January 2016 by Colin Gallagher, PhD and Karen Block, PhD A compelling footnote to the recent Paris attacks was Facebook’s activation of its “Safety check” feature, which encouraged … Continue reading


You may know that Sunday 15 June to Saturday 21 June 2014 is Refugee Week. Held annually in Australia to coincide with World Refugee Day on the 20th June, Refugee Week is Australia’s peak annual activity to raise awareness about issues affecting refugees and celebrate the positive contributions made by refugees to Australian society.

The Refugee Council of Australia (RCA) has chosen ‘Restoring Hope’ as the theme for this year’s Refugee Week to remind us that ‘while a refugee’s journey begins with danger, it also begins with hope. Refugees flee their homelands not only because they fear persecution, but also because they have hope: they hope to find freedom from persecution, and safety and security for themselves and their families; they hope to be given a chance to start a new life and recover from past trauma’.

The RCA also makes the point that the theme calls attention to the role of countries that offer protection to refugees and provide them with an opportunity to rebuild their lives and restore hope for a future free from fear, persecution, violence and insecurity. Despite fluctuating (and recently, increasingly harsh) policies of deterrence towards asylum seekers who arrive in Australia by boat, our government also offers permanent settlement to between 13,000 and 14,000 refugees annually through the UNHCR (United Nations High Commissioner for Refugees) resettlement program. While permanent settlement offers opportunities for a new life, it is also accompanied by significant challenges. Refugees settling in Australia come from diverse backgrounds but face a common need to deal with experiences of loss, family disruption, long periods in refugee camps or seeking asylum and the trauma that forced them to flee their homes. Following resettlement, they must negotiate a new language and culture, unfamiliar health, education and welfare systems and are also likely to experience social isolation, poverty and discrimination. Over 40% of people settling in Australia from refugee backgrounds are under the age of 18 and some of these face additional obstacles associated with disrupted – or even non-existent – formal education, prior to arrival.

We know that despite these challenges, most refugee settlers go on to become successful and productive members of Australian society. We also know that providing appropriate support, particularly in the early stages of settlement, can be crucial to enable this to happen. I, along with others in the Jack Brockhoff Child Health and Wellbeing Program are engaged in a number of projects where we work in partnership with others across the University and with community organisations to investigate and promote conditions that support refugee-background children and families to overcome barriers to social inclusion, participation and wellbeing.

Completed projects include evaluations we have conducted of programs such as Ucan2 – which assists young people transitioning from language schools and centres into mainstream education settings – and the Foundation House School Support Program – which supports schools to provide an inclusive environment for refugee-background children and families. We have also explored barriers for refugee-background parents in accessing Maternal and Child Health Services and investigated ways to support driver education for refugees settling in regional Victoria.

Current projects include an exploration of the experiences of refugee-background parents and young children who attend supported playgroups run by Save the Children Australia, and a new project focused on sports participation as a means to promoting social inclusion and wellbeing for refugee-background children. We are also about to begin a project looking at ways the University of Melbourne can provide enhanced opportunities and support to tertiary students from refugee-backgrounds.

Underpinning all of these projects is the understanding that improving support for those new to Australia can make all the difference when it comes to them being able to create the new life that they hope for. Some of the remarkable stories of Australians from diverse backgrounds who first came here as refugees with hope for a better future have been collected by Melbourne University’s Researchers for Asylum seekers. You can read some of those stories celebrating their lives and contributions here.

Written by Dr Karen Block
Research Fellow, Jack Brockhoff Child Health & Wellbeing Program
The University of Melbourne


World Refugee Day http://stories.unhcr.org/?_ga=1.91771994.1973195338.1402975368

Restoring Hope http://www.refugeeweek.org.au/

Resettlement program http://www.unhcr.org/pages/4a16b1676.html

Ucan2 http://www.unhcr.org/pages/4a16b1676.html

School Support Program http://www.tandfonline.com/doi/abs/10.1080/13603116.2014.899636#.U6DBJChhsTB

Maternal and Child Health http://www.biomedcentral.com/1472-6963/12/117

Driver education https://www104.griffith.edu.au/index.php/inclusion/article/view/440

Refugee-background parents and young children http://www.socialequity.unimelb.edu.au/the-lived-experience-of-refugee-background-children-in-australia/

Here http://www.ras.unimelb.edu.au/stories.html

What’s complexity got to do with health? It’s complex…

Still defrosting from my visit to Washington DC, I’ve reflected on the conference that I’ve just attended in complexity, inequalities and health. Sound complex? Well, here’s a simple summary that’s not as snow-covered as I have been over the past few days. But why waste your coffee time reading this article? Well, this might give you some insights about the perspectives and methods emerging from leading researchers working in complex systems, health and inequalities, as well as the investments in the area from the main health policy agency in the US.

  • “Complex Systems, Health Disparities & Population Health: Building bridges”

http://conferences.thehillgroup.com/UMich/complexity-disparities-populationhealth/agenda.html This conference was organised by the USA’s Network on Inequalities, Complexity and Health (NICH) and hosted by the National Institutes of Health (NIH) on campus in Bethesda, Maryland, USA. Not much tweeting throughout the two days, but I did start a hashtag that was picked up: #NICHconference


  • The socio-ecological model of health lives on

As with most quality public health conferences, we saw the socio-ecological model in the opening comments. And one of the authors of papers about the socio-ecological model was present! It is a crucial framework by which we think, talk, measure, and report – important to communicate the individual, interpersonal, organisational, community and social policy impacts upon health of populations globally. It shows the complexity of health determinants, simply.

  • Complex systems theory challenges our thinking about how health is constructed

To begin we heard the nuts and bolts of complex systems science as it applies to health, and a message that the “find it, fix it” approach to public health isn’t working. If traditional approaches were effective, we wouldn’t have epidemics of non-communicable disease and unfair health inequalities.  Unbalanced investment exists in most contexts – for example in the USA they know that 40% of health problems are socially determined, 50% behavioural and only 10% due to health care. However, only 3% is spent on societal and individual-level prevention strategies (complex solutions), whilst 97% is spent on health care (simple solutions).

  • Complex systems science reorients our thinking about how to act to improve health

We can always interrogate the ‘why’ of health issues and inequalities. A person smokes because it’s socially acceptable, affordable, possible to do where they live, work/learn and play, and because cigarettes are available– actively marketed by for-profit companies. Food supply was given as another example. The production, marketing, acquisition, distribution, retail, purchasing and consumption of food is dynamic and depends on many factors such as market forces, housing, economics and built environment. Consider that the majority of countries in the world have McDonalds in urban areas; and, that the majority of countries have 50% of their population housed in urban areas.  What influences do these factors have on healthy food supply and access? Then how does that affect health and lifespan? As you can see, it’s complex. Check out this paper by Sandro Galea for more: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3134519/  


  • Everything should be made as simple as possible, but not simpler

One speaker articulated that using simple interventions to address complex health issues is likely to fail. It’s a bit like King Canute ‘ordering back the tide’ – with health interventions and measurements, we can’t simply push against how things go naturally in a system, we need to identify multiple points and levers for interventions at different socio-ecological levels. Similarly, intervention research in this area can’t continue to be ‘linear’ and use averages for estimating effects –we need to capture heterogeneity. It’s tempting and logical to believe that if the parts get better (e.g. risk factors) then the whole will get better (e.g. populations), but change is contextually dependent. The response to multiple interventions will be very different than the totality of responses to each intervention separately. In other words, the whole is greater than the sum of its parts!


Image from: http://canute2.sealevelrise.info/slr/Story%20of%20Canute

  • When it’s all ‘too complex’, or when there’s no ‘real’ data?

Try simulating or modelling data! There are often times when observed health issues are ‘too hard’ to disentangle from the modifiers and contextual factors. Modelling epidemiological associations between factor X (e.g. fast food) and factor Y (e.g. heart disease) may not reveal the nuances of what produced the issue in the first place – the causes of the causes.  The same goes for evaluating multifaceted interventions across the many socio-ecological levels – it’s hard to measure each and every factor that might have had an impact upon the observed outcomes, and then to attribute causation. Thus, we are often without empirical data that integrates the diversity of elements in a system, so it’s hard to prove what determinants to target. Also, limited quality evidence exists on processes and effectiveness of complex interventions, so we’re often ‘working in the gaps’.  Synthetic estimates can be produced by building simulation models, guided by existing data, evidence and theory. Models can control experimental conditions in a complex system, which is obviously impossible to do in ‘real world’ observational studies. Also, and rather compellingly, we heard that standard statistical approaches can’t examine feedback and adaptive mechanisms between environments and individuals/agents – whereas computational modelling can. This recent paper by Amy Auchincloss et al provides a recent example, with links between neighbourhood resources and obesity under study: http://onlinelibrary.wiley.com/doi/10.1002/oby.20255/full

  • Methods for research of complex systems, health determinants and impacts

The main methods presented in the presentations and posters included system dynamics, social network analysis (SNA), agent based modelling (ABM), and discrete event modelling. These methods, having emerged from complex systems science, are being applied to public health research. The methods were described as tools to help us make sense of the interactions within complex systems, and the impacts that interventions might have on health and inequalities.  For a primer, see the take-home messages from Nathan Osgood below, refer to a recent paper by Doug Luke and Katherine Stamatakis – these sources will be eminently better than my interpretation would be! http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3644212/pdf/nihms414057.pdf   


  • What are some of the applications for simulation and modelling research?

For the most part, the presentations and posters highlighted a series of examples of modelling research studies that explored a range of factors related to health inequalities at the individual, institutional and neighbourhood level. Mostly, this provided case studies for how inequalities are produced, but some focused on estimating potential effects of interventions.

  • Examples of data simulation/modelling studies

At the individual and community level, an ABM explored differential effects of alcohol outlet density restrictions and policing upon alcohol-related violence and homicide among white Americans and African-Americans. A simulation study explored potential effects of upstream policy on Healthy eating and Physical activity, finding proof of concept that it may be more effective to target neighbourhood factors, not race, in reducing disparities in some contexts. At the population level, a case study from New Zealand was described, conducted when the earthquakes in 2011 interrupted the annual census, and modelled data was used to predict ongoing trends in primary health care access among Maori and Pacific Islander populations.

  • Progress and pitfalls for complex systems methods in public health

Collectively, from this conference it seems that certain systems science methods may tell us more about the nuanced factors causing health inequalities. It may also help reveal leverage points and suggest how to tailor interventions. But as with all research, challenges and limitations remain with these methods. These studies require interdisciplinary teams to ensure sufficient expertise in epidemiology, mathematics, computer programming, geography, public health and urban planning. Working together is essential –from observational research to computational modelling, the first step is a doozy!

Another challenge highlighted was that ultimately, we need to be able to link the models to ‘real’ data, to ensure their validity. Involvement of community stakeholders and decision-makers in the process was discussed only briefly, but this would appear to be a key step in verifying models. Community physician and systems scientist Kurt Stange described a great example of a participatory process of community stakeholder involvement in model planning and development. This may be a good point for us to start, to ensure that we ‘keep it real’.


  • Closing thoughts from a complexity novice

From a KTE perspective, I would think that external validity would be a key challenge for the application of this research, which may be difficult to reconcile. The conference left me pondering how do we use the evidence generated for decision-making? How can we be sure that modelled data reflects what’s in the ‘real world’? A discussion on using these models to guide policy was led by Complex dynamics researcher Ross Hammond, and NIH program director Stephen Marcus, which began to raise these questions. I would imagine, as for research evidence generated through ‘traditional’ methods, that a similar approach to knowledge translation and exchange would be required for evidence generated through modelling.

So after that, a penny for your thoughts? Leave a comment if you’re using/exploring these methods!


Written by Dr Tahna Pettman

Research fellow: Public Health Evidence and Knolwedge translation
Evaluation fellow: CO-OPS collaboration

The Jack Brockhoff Child Health & Wellbeing Program.
The University of Melbourne
e: tpettman@unimelb.edu.au


Highlights from a rookie researcher’s first conference.

A few weeks ago I attended the conference Progress 2013 (http://progress2013.org.au/). The first of its kind in Australia, it brought together progressive left thinkers with not-for profit organizations, unions, private industry and experts in the health and environment sector. Its aim was to talk about the issues that will define Australia’s not-for profits and social movements for the years to come. As a recent graduate, this was my first ever conference and a chance to understand how people from all over the workforce come together to share skills, nut out ideas and most importantly – network. This blog post will cover some of the major highlights from the conference and touch on some of the lessons I learnt, from the perspective of a budding young researcher.


Highlight no 1.
To begin, one of the major highlights for me was listening to rock star academic and expert on the social determinants of health, Richard Wilkinson (http://www.ted.com/talks/richard_wilkinson.html), speak about the importance of understanding how income inequality affects health and wellbeing. Wilkinson, author of ‘The Spirit level’ and co-founder of The Equality Trust (http://www.equalitytrust.org.uk), researches the problems of inequality in society and produces evidence-based arguments to support social movements for change. In particular, Wilkinson drew attention to the problem that health and wellbeing in high and middle income countries is worse for all when the gap between the rich and poor is greater. Data was collated to demonstrate that even in high income countries as measured by Gross Domestic Product (GDP), population levels of health and wellbeing are influenced by income inequality. Therefore, the average wellbeing of societies is not dependent on gross national income and the rhetoric of economic growth but rather the relation between each other within society itself. This trend also occurs in child health and wellbeing, mental health, drug abuse and obesity – proving the tangible effect that inequality has in society. Some factors Wilkinson attributed as the drivers of negative health in unequal societies include status anxiety, stress, mistrust and dominance caused by a competitive consumer based economy. Wilkinson therefore advocated for a more inclusive society where value is placed on the way we relate to one another and where possible to harness positive social relations, such as friendship. Although these insights seem somewhat intuitive, I was taken aback by how relevant it is to continue to produce evidence that highlights this problem. When considering health and wellbeing, Wilkinson makes us think about the less visible effects of how we relate to one another and re-establishes the importance of family, friendship and positive social interaction to maintaining a sustainable quality of life.


Highlight no 2.

Another highlight was the talk given by Anat Shenker-Osorio, a communications expert and researcher who authored the book ‘Don’t Buy It: The Trouble with Talking Nonsense about the Economy’. Her work looks at how people understand issues, such as the economy or climate change, through the words used to narrate them. Without getting too bogged down in detail, the gist of her research suggests that you can reliably persuade or change a person’s thinking about an issue depending on the words used to describe it. For example, immigration. A study was conducted to measure how people responded to immigrants depending on whether they were framed as either a burden or a resource. The findings showed that when immigrants were talked about in a positive framing, by expressing what they bring to society and not what they lack, people’s acceptance of immigrants were overall more favourable. Shenker-Osorio argues that by literally changing the words we use to speak about an issue, we can also influence how people think about it, having repercussions for politics and policy. Something to think about when writing the next report or talking at a conference about a sticky issue. Frame it positively and you will have people receive it much more favorably.

Highlight no 3.

Arguably one of the best parts of Progress 2013 however, was the chance to mingle with those I consider some of my professional role models. As I mentioned above, this was my first ever conference, so the task of introducing yourself to those you admire is quite daunting. However, after a few awkward first conversations I learnt the following things;

  1. Go with a plan. Since time is scarce at these events and the professionals you meet talk to so many different individuals every day, working out a plan of who you want to speak to and what you want to speak to them about prior to the meeting is essential. This way, you won’t get caught in a conversation about the weather and how good the muffins are, but instead get to use your limited time to your best advantage.
  2. Don’t be scared to introduce yourself. As daunted as you might be about shaking hands with someone you find just a huge bit intimidating because of their greatness, it never hurts to just introduce yourself and say you are a huge admirer of their work. A few times I saw rock star academics on their lonesome at the coffee table, probably because everyone was too in awe to say hi.
  3. When in doubt ask questions. When you have reached your small talk capacity and feel like the conversation is drying out, ask questions of them. People love to talk about themselves and asking them questions about themselves shows that a) you have a strong interest and b) that you are engaged in what they do.

Written by Hannah Morrice
Research Assistant, Jack Brockhoff Child Health & Wellbeing Program
The University of Melbourne
e: hannah.morrice@unimelb.edu.au

Large reductions in child overweight and obesity in intervention and comparison communities 3 years after a community project

Research paper title: Large reductions in child overweight and obesity in intervention and comparison communities 3 years after a community project
Between 2003-2006 the Be Active Eat Well (BAEW) Obesity prevention programme was implemented in Colac, a rural township in the Barwon South West region of Victoria. The programme used a multi-setting, mutli-strategy approach to reduce unhealthy weight gain in children aged 4-12 years. Three years after completion in 2009, an evaluation was undertaken to measure the impacts of the intervention.
Working with our colleagues at Deakin Univeristy we are delighted that the findings of the study have now been published.
The paper discusses the significant results identified 3 years post completion of the BAEW intervention and the spillover effect in the surrounding areas. The main and interesting finding of the papers is that,compared with 2003, the 2009 prevalence of overweight/obesity was significantly lower.

The paper can be viewed here: http://goo.gl/HQYszV  

Is PowerPoint dead? No but your presentation just might be!

Important health warning:

Have you ever been presenting at a seminar or conference and noticed your audience exhibiting one or more of the following symptoms?

  • Constant yawning
  • Slumping in their chair
  • Excessive mobile phone texting, tweeting and/or Facebooking
  • Sleeping, and in some cases snoring
  • In the worst case scenario, not even showing up at all

If you answered yes to one or more of these symptoms, your audience is exhibiting Soporific Seminar Syndrome (SSS). This is a very serious yet common disorder with one in five people in Australia suffering from it. The scary part is YOU may be the cause of this!

But how you ask? Your research is interesting, you are a great presenter and use more than one tone in your voice, you have accompanying slides… so why are you making your audience suffer?

Well luckily, I’m here to help!

Researchers have discovered the reason for SSS is Poorly Designed PowerPoint Presentations (or PDPPP). Luckily the condition can be reversed with a straightforward treatment – effective design. Please follow these simple tips so together we can rid the world of SSS.

1. Cut down on clutter

It is a common misconception presenters have that they need to put EVERY single word they are saying into their PowerPoint presentation. If it’s not every single word, it’s lines and lines of dot points. Your audience is trying to listen to you and read your slides at the same time. They are going to get distracted and confused if you have too much information and your slides are too cluttered. It’s even worse if you flick through your slides so quickly, they don’t even finish reading! Solution, cut down on the clutter. Chose one dot point that complements what you are talking about and stick with that! Better still use a photo. Your audience will have your full attention, and hopefully better understand and absorb what you are speaking about.


2. Use large readable words

This point goes hand in hand with the last. There is no point having small text that people won’t be able to see at the back of the room. Instead of losing their attention, lose the clutter and write with large readable words. The text below is size 18 compared to size 90. As a rule of thumb, never go under size 24 pt.


3. Pick the right colours

Colours that look good on your computer screen don’t always look effective on the big screen. Avoid using light colours on a white background and vise versa. Use contrasting colours for your background and text and avoid using more than 4-5 colours in total. If in doubt, stick with the basics – black and white! Finally, if you have the facilities, go and test your presentation on the projector.


4. Maximise the use of photos.

I can’t stress this point enough. Do as the late Steve Jobs would of done.

Have you ever watched one of his presentations and seen the screen full of dot point and sentences? No. He uses one image to illustrate exactly what he is talking about. And it’s memorable!


Image curiosity of http://www.smh.com.au/digital-life

If you do intend to use photos, don’t crop it and place it in the corner, squeezed in amongst your dot points, maximize its use. Make it a full screen image and incorporate minimal text around it, if at all.


5. Use simple fonts.

This one is pretty self-explanatory. Steer away from detailed and fancy fonts. They look messy and cluttered on screen and make it harder for your audience to read. Stick with a sans serif font like Gill Sans, Geneva or Arial to name a few.


One last piece of advice, if you want your audience to engage more, set up a hashtag (for example #endingSSS) and encourage people to tweet with the hashtag during your seminar. People will be engaged (and not falling asleep), asking questions and promoting your research and research program.   

This special concoction of remedies will hopefully ameliorate the symptoms of SSS, acting through the PDPPP pathway. By eradicating Poorly Designed PowerPoint Presentations we will be free to live in a world where all presentations are engaging, enabling us to be inspired by our new learnings and tackle some real life health issues!


Written by Alana Pirrone-Savona
Media & Communications Officer for the Jack Brockhoff Child Health & Wellbeing Program
The University of Melbourne


Connect with us on

Facebook: http://www.facebook.com/BrockhoffChildResearch

Twitter: https://twitter.com/BrockhoffTeam


Health in Orphanages Project (HOPe)

A few years ago while studying the oral health of school children in Kerala, India, one of the schools I visited was a boarding school for orphaned children. It was obvious from just observing these children and through dental examinations that the health of these orphaned children was a lot worse than children from the non-orphanage schools in my study. While at the time I was doing my masters degree and did not have the liberty to pursue this issue further, I made a mental note that when I had settled down in my career I would re-visit this issue. Fast forward to 2013 (five years since I visited the orphanage in Kerala) and we (my wife and I) have set up the Health in Orphanages Project (HOPe), with support from University researchers and community partners, to explore the health of children residing in orphanages in India.

So what is an orphan – United Nations Children’s Fund (UNICEF) defines an orphan as not only a child who has lost one or both parents but also those who have lost a father but have a surviving mother or have lost their mother but have a surviving father (1, 2). It is estimated that, as of 2010, there were 132 million orphaned children across the globe (about 2% of the world’s population), a shocking number. Of these children, 69 million were located in Asia, 53 million in Sub-Saharan Africa, and 10 million in Latin America and the Caribbean. India alone is home to 32 million orphaned children (~ 2.6% of India’s population or 7.5% of India’s child population). Yet it is quite rare for the local populace in India to encounter these children in their normal lives. The social structure in India has ensured that these children are a hidden and socially stigmatised community.


Photo of an orphanage from my last trip to India

In spite of such large numbers the available information on the health of children residing in orphanages, particularly in India, is very limited. The available information gave us some insight into the health of these children but again highlighted the need to work with this hidden section of the community that we call the ‘disadvantaged among the disadvantaged’. A parent-child relationship is important for the mental and physical development of the child and the absence of this relationship can be detrimental to their health. Such a separation can negatively impact on various aspects of their development, particularly in relation to their psychosocial, emotional and cognitive skills. The social disadvantage is due to the lack of social and cultural identity that growing up in a family would provide. A joint report by UNICEF, UNAIDS & USAID on orphaned children state that institutional care such as orphanages can be detrimental to the child’s development as they socially isolate the children, discourage autonomy, put the children at risk of losing their family and community identities, and fail to provide any mechanism to support a child’s emotional or mental needs (1). As a result of these issues, orphaned children generally have poor oral health; poor mental health; are malnourished; have low immunity; are prone to medical conditions such as HIV, cardiomyopathy, fetal alcohol syndrome, hepatitis C, otitis media & congenital adrenal hyperplasia; and recurrent episodes of diarrhoea, fever & cough (3, 5-10). These children, particularly girls, are at a high sexual risk which includes having sex at an earlier age, pregnancy and the risk of contracting HIV/AIDS (11-15). Also common among orphaned children are behavioural and cognitive issues such as thought problems, rebellious nature, aggression and being withdrawn (6, 7, 17). A study of children in Romanian orphanages found that due to ‘global neglect’ (when deprivation occurs in more than one domain of child development, such as language, touch and family support) the brain size of orphaned 3-year-olds was significantly smaller when compared to that of a normal child of the same age (16).

So it is quite evident that these children face additional challenges that impact on their health and wellbeing. However, without sufficient country/location specific evidence local program planners and policy makers will not be able to make a case for targeted interventions. We aim to provide this evidence and use the information from this research to determine the future direction of the project. Our first stage will be to explore the health issues affecting children residing in orphanages in the State of Kerala, which is located on the south-west coast of India. At present there are approximately 400 registered orphanages in the State of Kerala alone, with on average 100 children per orphanage (18). We envisage that through HOPe we will be able to provide the evidence needed to progress towards healthier and more socially inclusive environments for these children.

About the author: Bradley Christian is a Research Fellow at the Jack Brockhoff Child Health and Wellbeing Program, working on Teeth Tales – a community based oral health promotion intervention for pre-school children from a refugee and migrant background. Brad is a dentist with specialist training in Dental Public Health whose research interests are around social disadvantage, children and oral health.



  1. UNAIDS, UNICEF, USAID. Children on the Brink 2004: A joint report of new orphan estimates and a framework for action2004.
  2. UNICEF. Orphans. UNICEF Press Centre; 2012 [cited 2012]; Available from: http://www.unicef.org/media/media_45279.html.
  3. Thielman N, Ostermann J, Whetten K, Whetten R, O’Donnell K, the Positive Outcomes for Orphans (POFO) Research Team. Correlates of Poor Health among Orphans and Abandoned Children in Less Wealthy Countries: The Importance of Caregiver Health. PLoS ONE 7(6) 2012;7(6):e38109.
  4. International Institute for Population Sciences (IIPS) and Macro International. National Family Health Survey (NFHS-3), 2005-2006 India. Mumbai IIPS2007.
  5. Watts H, Gregson S, Saito S, Lopman B, Beasley M, Monasch R. Poorer health and nutritional outcomes in orphans and vulnerable young children not explained by greater exposure to extreme poverty in Zimbabwe. Tropical Medicine and International Health. 2007;12(5):584-93.
  6. Erol N, Simsek Z, Munir K. Mental health of adolescents reared in institutional care in Turkey: challenges and hope in the twenty-first century. Eur Child Adolesc Psychiatry. [Research Support, N.I.H., Extramural]. 2010 Feb;19(2):113-24.
  7. Hermenau K, Hecker T, Ruf M, Schauer E, Elbert T, Schauer aM, et al. Childhood adversity, mental ill-health and aggressive behavior in an African orphanage: Changes in response to trauma-focused therapy and the implementation of a new instructional system. Child and Adolescent Psychiatry and Mental Health 2011, 5:29. 2011;5(29).
  8. Khare V, Koshy A, Rani P, Srilata S, Kapse SC, Agarwal A. Prevelance of Dental caries and Treatment needs among the orphan children and adolescents of Udaipur district, Rajasthan, India. The Journal of Contemporary Dental Practice. 2012;13(2):182-7.
  9. Lassi ZS, Mahmud S, Syed EU, Janjua NZ. Behavioral problems among children living in orphanage facilities of Karachi, Pakistan: comparison of children in an SOS Village with those in conventional orphanages. Soc Psychiatry Psychiatr Epidemiol 2011;46:787-96.
  10. Johnson DE, Traister M, Iverson S, Dole K, Hostetter MK, Miller LC. HEALTH STATUS OF US ADOPTED CHINESE ORPHANS. .  1996 Abstracts The American Pediatric Society and The Society for Pediatric Research (1996) 39, 135–135; doi:101203/00006450-199604001-008151996.
  11. Birdthistle I, Floyd S, Machingura A, Mudziwapasi N, Gregson S. From affected to infected? Orphanhood and HIV risk among female adolescents in urban Zimbabwe. AIDS 2008;2008:759-66.
  12. Dunbar M, Maternowska M, Kang K, Laver S, Mudekunye-Mahaka I. Findings from SHAZ!: a feasibility study of a microcredit and life-skills HIV prevention intervention to reduce risk among adolescent female orphans in Zimbabwe. J Prev Interv Community 2010;38:147-61.
  13. Gregson S, Nyamukapa C, GP GG, M MW, JJ JL, et al. HIV infection and reproductive health in teenage women orphaned and made vulnerable by AIDS in Zimbabwe. AIDS Care. 2005;17.
  14. S SK, Dunbar M, Minnis A, Medlin C, Gerdts C, NS Padian NS (2008) Poverty gi, and women’s risk of human immunodeficiency virus/AIDS. Ann N Y Acad Sci 1136: 101–110. Poverty, gender inequities, and women’s risk of human immunodeficiency virus/AIDS. Ann N Y Acad Sci. 2008;1136:101-10.
  15. Mmari K. Exploring the relationship between caregiving and health: Perceptions among orphaned and non-orphaned adolescents in Tanzania. Journal of Adolescence. 2011;34:301-9.
  16. Perry BD. Childhood experience and the expression of genetic potential: What childhood neglect tells us about nature and nurture. Brain and Mind. 2002;3(1):79-100.
  17. Baguma P.  Assessment of psychosocial support programmes for orphans/vulnerable children in Uganda. International Journal of Psychology. 2012;47(1):467-77.
  18. List of charitable institutions.  Thiruvananthapuram: Department of Social Welfare;  [cited 2011]; Available from: http://www.old.kerala.gov.in/dept_socialwelfare/Grant-in-aid.htm.

Research with culturally and linguistically diverse communities

Encouraging people to participate in research can be a tough gig. We are usually asking people to volunteer their time just for a small piece of information, which is sometimes only relevant and generalisable if large numbers provide this same, small piece of information. As researchers we know the enormous value that gathering this information can have to inform change at the policy, practice and the community level. But the general population sometimes does not place the same value on research or understand how important the research and outcomes can be. So, how do we encourage people to participate in research? And in particular, how do we encourage those from culturally and linguistically diverse backgrounds, where research may not be a common concept or practice.

I am currently working on a large scale child oral health research project entitled ‘Teeth Tales’, being conducted in partnership with government and community agencies  and Australian families from refugee and migrant backgrounds. Oral health is included in the Victorian Health and Wellbeing Plan 2011 – 2015 as a priority area for preventative health, as it is one of the most preventable diseases, particularly for children. Tooth decay is Victoria’s most prevalent health problem, with more than half of all children and almost all adults affected (1). Initial qualitative research was conducted with mothers from Lebanese, Iraqi and Pakistani backgrounds exploring oral health practices, beliefs and service needs. We learnt about many cultural differences and the real interest these communities have to learn more about keeping their children’s teeth healthy. From this earlier research, a community-based trial was developed to include an oral health education program for parents delivered by a trained educator from the same cultural background. This peer educator is able to talk about traditional beliefs and practices and introduce parents to the key Dental Health Services Victoria oral health messages of ‘Eat Well, Drink Well, Clean Well and Stay Well’. The program also included a site visit to local dental and family services. In addition to this education program, local services underwent a review of their practices to improve their competence in dealing with culturally diverse communities.

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Photo from:  http://www.dshs.state.tx.us/dental/promo_oh.shtm

For this trial we recruited Lebanese, Iraqi and Pakistani families in metropolitan Melbourne with children aged 1 – 4 years. We wanted to make sure that the research was as useful and relevant to families as possible so we sought the advice and expertise of relevant cultural organisations. They provided guidance on the cultural practices and beliefs of the target cultural groups, and the cultural appropriateness of our research methodology. They also helped us to recruit families, conduct the trial, interpret the findings and they provided language assistance. If it wasn’t for these partnerships we may have been lucky to recruit 10 families rather than the over 500 families who ended up participating! The advice and support of these cultural partners is invaluable when trying to recruit families with a refugee or migrant background, some of whom may be unfamiliar with research conduct, health promotion and the Australian health system.

In order to evaluate the success of the program we needed to check children’s teeth before and after the trial, as well as ask parents to complete a questionnaire. The free dental screenings for the children proved to be a key incentive for parents to register for the study. Oral health is one of the most contentious current health issues in Australia as access to fast, affordable dental care is often not available. The private dental system is run as a business and many walk out of the service with an expensive bill. The public dental system has huge waiting lists and strict eligibility for access. We found that many parents were not aware that children and refugee and asylum seekers in Victoria are considered a priority group for public dental services access. So when our study offered a free dental screening for children many families jumped at the opportunity!

The strategies outlined above helped us to successfully recruit over 500 families into our study. Engaging culturally and linguistically diverse groups in research can be difficult, but is very important, particularly for health services that need to respond to the evolving health needs of refugee and migrant and groups.

To read more about the ‘Teeth Tales’ study please visit:  http://mccaugheycentre.unimelb.edu.au/research/current/intergenerational_health/teeth_tales

Blog by Dana Young

Research Fellow, Child Public Health

The University of Melbourne

e: dana.young@unimelb.edu.au


  1. NACOH. 2004, Healthy mouths healthy lives: Australia’s National Oral Health Plan 2004-2013. Adelaide, National Advisory Committee on Oral Health, Australian Health Ministers’ Advisory Council.