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This research aimed to inform approaches to increase access to secure housing and improve mental health outcomes for migrants from culturally and linguistically diverse backgrounds (hereafter migrants) who are generally invisible in health and social policy and service provision in Western Australia. We used semi-structured, in-depth interviews (n  = 11) and interpretative phenomenological analysis to explore service provider experiences and perspectives of issues impacting service provision and the needs of migrants in this context. Five superordinate themes reveal complex experiences for both service providers and the migrants with whom they work. Findings reflect tensions between contemporary notions of choice and control and a social service system that is difficult to navigate, reflects systemic racism and appears to rely heavily on the non-government sector. Insights have important and practical implications for health promotion policy, practice and research. Recommendations include improvements to housing access, provision, funding and policies; addressing service barriers via staff training and more accessible community resources; and co-design and community outreach approaches. [ABSTRACT FROM AUTHOR]

Western Australia criminalises sex work whilst some other Australian jurisdictions have decriminalised the industry. This article examines the role of Western Australia's legislation in reinforcing stigma and discrimination of sex workers. It draws on stigma and discrimination-specific results from open-ended survey responses and interview data collected as part of a larger cross-sectional mixed-methods study. Experiences and/or anticipation of stigma and discrimination resulted in some sex workers concealing their involvement in sex work from family, friends and their home communities. This was a major barrier to accessing health care and protective services and impacted negatively on their mental health and wellbeing. There is a need for policy change and support to shift society's perception of sex work to that of a legitimate occupation to decrease sex workers' experiences of stigma and discrimination and improve their access to and utilisation of health care and protective services. These findings highlight the need for the decriminalisation of the Western Australian sex industry and the development of training programmes for police and healthcare workers to reduce the stigma and discrimination experienced by sex workers in these settings. [ABSTRACT FROM AUTHOR]

Best practice in sex work research advocates for a 'nothing about us without us' methodology. This study employed sex workers as peer researchers to assist in evaluating the sexual health outcomes and well-being of sex workers in Western Australia. All eight peer researchers were invited to reflect on their experiences as peer researchers through semi-structured interviews, and seven peer researchers participated. Giving sex workers a voice and the opportunity to facilitate change for their peers was the primary driver for participation. Some peer researchers from English speaking backgrounds experienced challenges engaging and communicating with study participants for whom English was not their first language. Others experienced role conflict on hearing viewpoints contrary to their own beliefs. Access to support from the project team and other peer researchers was a key enabler for undertaking the peer researcher role. The majority of peer researchers were motivated to participate in the research by the possibility of future changes to sex work-related legislation, and support for sex workers based on the research findings. Research partnerships with peer researchers that offer employment throughout the research process, including co-authorship of journal articles, opportunities for leadership roles and collaboration in research translation activities can increase research impact. [ABSTRACT FROM AUTHOR]

Sexual health promotion and Relationships and Sexuality Education (RSE) are influenced by interrelated social and cultural factors, particularly in a rural setting. This paper reports on findings from interviews with young people when asked about experiences and perspectives accessing RSE and sexual health services in a small rural Australian town. Fifteen young people (16–24 years) participated in semi-structured focus groups and interviews. Data was analysed and coded with four key themes emerging: relevant and credible sexual health education; make it easy; GP accessibility; and discreet condom supply. The findings of this study have practical implications when addressing community level sexual health and RSE needs. [ABSTRACT FROM AUTHOR]

Background There is limited information available about the health and wellbeing of male sex workers in Australia and globally. This study therefore was conducted to survey male sex workers in Western Australia as part of a broader study investigating the health and safety of sex workers in Western Australia.Methods: Male sex workers were surveyed using a modified survey instrument that had been used in a study undertaken in 2006. Survey respondents were recruited by word-of-mouth, social media, advertisements in gay press and in person. In-depth interviews with a small number of male sex workers were also conducted.Results: Fifty-eight men responded to the survey. The majority of survey respondents (42/58, 72%) were aged ≤35 years and a high proportion (50/58, 86%) worked privately at least some of the time. Seventy-two per cent (33/46) reported consistently using condoms during anal sex and 22% (11/51) during oral sex with clients. The consistent use of condoms with partners outside of work was associated with consistent use of condoms with clients. Forty per cent (23/58) of respondents reported currently using tobacco and 47% (25/53) reported harmful drinking at least weekly. The majority of respondents reported that sex work enhanced their wellbeing, with negative effects being largely due to stigma and discrimination, and the uncertainty related to not having a steady income.Conclusion: The study findings point to the need for peer outreach and support, interventions to improve the broader health of male sex workers and decriminalisation of sex work in Western Australia. [ABSTRACT FROM AUTHOR]

Background: Nurse-supported shared care services for patients living with hepatitis C have been implemented in some regional areas of Western Australia to provide access to local treatment and care services for patients and to improve currently low levels of treatment uptake. This study collected data from health professionals involved in managing the care of patients living with hepatitis C and from patients engaged in regional nurse-supported hepatitis C shared care services in Western Australia.Methods: Key informant qualitative interviews were conducted with health professionals in regions operating a nurse-supported shared care service and in regions without this service. Patients engaged in the shared care program at the time of the study were invited to complete a short questionnaire.Results: Nurse-supported shared care services reduced patient transport costs to tertiary centres, accelerated access to treatment and delivered >98% compliance with treatment schedules. Patients engaged with regional hepatitis C shared care services expressed high levels of satisfaction and indicated that they would delay treatment if it was not available locally. Telehealth support from tertiary liver clinics and allied health services were available to health professionals engaged in regional shared care services and were used effectively. There was limited participation by general practitioners in regional hepatitis C shared care services and regional patients' access to treatment was influenced by the availability and capacity of health professionals. Uptake of treatment and engagement in the regional shared care program was limited for Aboriginal people and younger people although these groups had the highest rates of hepatitis C notifications in Western Australia.Discussion: The patients consulted for this study preferred to access hepatitis C treatment and care locally rather than travel to tertiary liver clinics, up to 1500 kilometres away. The reasons for limited engagement in the shared care program by some groups with high rates of hepatitis C notifications requires further investigation. Health professionals identified several benefits of the shared care program including continuity of care for patients, shorter waiting times, longer appointment times and high levels of treatment compliance.Conclusions: Hepatitis nurses in regional areas can coordinate effective patient treatment and care when supported by treatment protocols and access to physicians and liver specialists, including through telehealth. Treatment and care options to suit individual preferences are required to avoid further stigmatising marginalised groups. The role of primary care in facilitating hepatitis C treatment uptake should be explored further including strategies for improving the participation of general practitioners in regional shared care services. [ABSTRACT FROM AUTHOR]

This paper explores the intersections of migration, gender, and sexual health with Indonesian women living in Perth, Western Australia. The study was part of a larger participatory action research project to co-design an intervention to increase HIV testing in migrant Indonesian women. Unstructured interviews were conducted with adult Indonesian women ( n = 10) on their experiences of migration and sexual health. Zimmerman's migration phases (pre-departure and travel, destination, and return) provided a framework to conceptualize women's migration journeys. We found that women's migration journeys were shaped by gender, with male-led migration often reinforcing gender norms. Structural and sociocultural factors (including visa status) influenced women's sense of belonging while living in Australia, such as help-seeking behaviour and engagement in sexual relationships. Intersecting factors of gender, culture, and the migration process should be considered when designing public health interventions to improve women's sexual health, in particular migration policies and procedures.

Background: Notification rates of gonorrhoea in Australia for heterosexual young adults rose by 63% between 2012 and 2016. In Western Australian major cities, there was a 612% increase among non-Aboriginal females and a 358% increase in non-Aboriginal males in the ten-year period 2007-2016. A qualitative public health investigation was initiated to inform appropriate action., Methods: Eighteen semi-structured telephone interviews were conducted with non-Aboriginal heterosexual young adults aged 18-34 years living in Perth, Western Australia, who had recently been notified to the Department of Health with gonorrhoea, to explore the context of their sexual interactions and lifestyles which could have predisposed them to contracting gonorrhoea. Data were thematically analysed., Results: Common themes were having several casual sexual partners, limited communication between sexual partners about condom use or sexual history prior to engaging in sexual activity, inconsistent condom use, normalisation of some sexually transmissible infections amongst young people, and poor understandings and assessment of sexually transmissible infection risk., Conclusion: The findings support public health interventions that focus on communication between sexual partners and shifting of risk perceptions in sexual health education programs, ensuring accessibility of quality sexual health information, increasing condom accessibility and acceptability, and on strategies for addressing misperceptions of young people in relation to sexually transmitted infections., (© Commonwealth of Australia CC BY-NC-ND.)

Introduction: There is recognition of the importance of comprehensive relationships and sexuality education (RSE) throughout the school years worldwide. Interventions have found some positive outcomes; however, the need for a greater focus on positive sexuality and relevant contemporary issues has been identified by teachers and students. The Curtin RSE Project provides training for teachers and preservice teachers and supports schools through training and advice to implement comprehensive school health promotion (CSHP) focusing on RSE allowing schools to develop programmes relevant to their school community. To examine contemporary phenomenon within a real word context, a case study design will be used to measure implementation. This paper will describe the protocol for a multiple, embedded case study to measure the implementation of CSHP focusing on RSE in a purposive sample of Western Australian schools., Methods and Analysis: This mixed methods study will include a multiple, embedded case study. Schools (n=3-4) will be purposively selected from within Western Australia based on their capacity to commit to implementing RSE as a case study school. Data will be collected from students (Grade 6 for primary school; Grades 7-12 for secondary school); teachers and other key staff and parents. Methods include school climate and school curriculum audits, documentation (collected with key staff at baseline and annually), interviews (parents and teachers at Year 2), focus groups (students at Year 2) and an online student survey (collected with students baseline and annually)., Ethics and Dissemination: School principals will provide consent for school participation and staff and parents will provide individual consent. Student assent and parental consent will be obtained for student participants. Results will be disseminated through open-access reports, peer-reviewed journals and conference presentations., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: HIV notifications among people born in sub-Saharan Africa and South-East Asia have increased in Australia in the last decade. People born in these regions have the highest rates of HIV diagnosis by region of birth and are overrepresented in late or advanced presentation of HIV infection., Methods: This study developed and tested a questionnaire for reliability through test-retest. A cross-sectional survey using intercept and online recruitment of HIV knowledge and use of health services was then undertaken among people born in sub-Saharan Africa and South-East Asia, who had arrived in Australia less than 10 years ago and were living in Western Australia (n = 209). Results were reported on by gender and length of time in Australia., Results: Participants had a reasonable knowledge of HIV transmission, but held a number of incorrect beliefs. Two-thirds (65%) of participants reported a barrier to accessing health services in Australia. Just over a third (34%) of participants had ever tested for HIV, despite indicating that they believed HIV testing was important., Conclusions: This project indicates a very low rate of HIV testing among this priority population. Further action is required to improve early diagnosis of HIV and reduce onward transmission of HIV infection within these communities. SO WHAT?: We need targeted interventions that extend beyond knowledge to increase HIV testing rates among this population., (© 2018 Australian Health Promotion Association.)

In order to explore the impact of potential new technologies in the area of prenatal screening, we conducted a baseline study using qualitative interviews to explore women's attitudes and knowledge regarding current and future prenatal screening technology and methods. Three cohorts were interviewed, including healthy women without children, healthy women with healthy children, and healthy women with children who have de novo genetic disorders. This study aimed to assess the baseline understanding and attitudes of women in Western Australia. Women from each cohort demonstrated adequate knowledge of the differences between screening and diagnostic tests, but were mostly unaware of the conditions for which screening is currently available except Down syndrome. Women who had children with de novo genetic conditions were generally aware of more genetic conditions than women with or without healthy children. Most women recognised the genetic basis for the conditions mentioned. Two thirds of women understood that Down syndrome is a chromosomal condition; just one third recognised that the phenotype is variable. Most women expressed a positive attitude towards Down syndrome. Social acceptance of children with Down syndrome was commonly mentioned as a concern. While the majority of women with children supported screening for Down syndrome, they emphasised that it must be an autonomous choice. General knowledge of genetic conditions illustrated that women are exposed to diverse conditions from lived experience as well as the media.

Objectives: This study aimed to develop and validate an online instrument to: (1) identify common alcohol-related social influences, norms and beliefs among adolescents; (2) clarify the process and pathways through which proalcohol norms are transmitted to adolescents; (3) describe the characteristics of social connections that contribute to the transmission of alcohol norms; and (4) identify the influence of alcohol marketing on adolescent norm development., Setting: The online Youth Alcohol Norms Survey (YANS) was administered in secondary schools in Western Australia PARTICIPANTS: Using a 2-week test-retest format, the YANS was administered to secondary school students (n=481, age=13-17 years, female 309, 64.2%)., Primary and Secondary Outcome Measures: The development of the YANS was guided by social cognitive theory and comprised a systematic multistage process including evaluation of content and face validity. A 2-week test-retest format was employed. Exploratory factor analysis was conducted to determine the underlying factor structure of the instrument. Test-retest reliability was examined using intraclass correlation coefficient (ICC) and Cohen's kappa., Results: A five-factor structure with meaningful components and robust factorial loads was identified, and the five factors were labelled as 'individual attitudes and beliefs', 'peer and community identity', 'sibling influences', 'school and community connectedness' and 'injunctive norms', respectively. The instrument demonstrated stability across the test-retest procedure (ICC=0.68-0.88, Cohen's kappa coefficient=0.69) for most variables., Conclusions: The results support the reliability and factorial validity of this instrument. The YANS presents a promising tool, which enables comprehensive assessment of reciprocal individual, behavioural and environmental factors that influence alcohol-related norms among adolescents., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Issue Addressed: The evaluation of health promotion training for the Western Australian (WA) Aboriginal maternal and child health (MCH) sector., Methods: Fifty-one MCH professionals from five regions in WA who attended one of three health promotion short courses in 2012-2013 were invited to complete an online survey or a telephone interview, between 4 to 17 months post-course. Respondents were asked how they had utilised the information and resources from the training and to identify the enabling factors or barriers to integrating health promotion into their work practices subsequently., Results: Overall response rate was 33% (n=17); 94% of respondents reported they had utilised the information and resources from the course and 76% had undertaken health promotion activities since attending the course. Building contacts with other MCH providers and access to planning tools were identified as valuable components of the course. Barriers to translating knowledge into practice included financial constraints and lack of organisational support for health promotion activity., Conclusions: Health promotion training provides participants with the skills and confidence to deliver health promotion strategies in their communities. The training presents an opportunity to build health professionals' capacity to address some determinants of poor health outcomes among pregnant Aboriginal women and their babies. SO WHAT?: Training would be enhanced if accompanied by ongoing support for participants to integrate health promotion into their work practice, organisational development including health promotion training for senior management, establishing stronger referral pathways among partner organisations to support continuity of care and embedding training into MCH workforce curricula.

Issue Addressed: This paper reports on the process evaluation of the Same Sky project,1 which was aimed at developing regional community support programs for same sex attracted youth (SSAY) and their families in four regional sites in Western Australia. A multi-faceted approach modelled on successful urban outreach programs was used to build professional capacity and develop peer-based support programs in the community., Methods: A triangulated mixed methods evaluation design was implemented to capture various outputs and outcomes of the intervention strategies. Data were collected via interviews and questionnaires and by assessing community readiness through community participation and involvement in the programs and through demand for printed resources., Results: There was increased community awareness of same sex attraction issues and professional capacity to help SSAY regionally following training and distribution of printed resources. Improved alliances between regional and metropolitan service providers were also evident. Not all of the planned peer support interventions could be implemented. Drop-in centres and peer support groups proved particularly problematic to establish. Basing the project officer in one of the rural sites was notable in improving project progress., Conclusions: Some aspects of the urban outreach models for SSAY were transportable to rural areas, others were not. Some specific problems identified were a lack of community readiness, a distrust of 'outsiders' to the community, significant differences between the needs of SSAY across regional demonstration sites, and difficulties in engaging locally based volunteers and agencies to develop and run rural outreach services.