The Building Blocks for Successful Hub Implementation for Migrant and Refugee Families and Their Children in the First 2000 Days of Life.

BACKGROUND AND

objectiveMigrant and refugee women, families, and their children can experience significant language, cultural, and psychosocial barriers to engage with child and family services. Integrated child and family health Hubs are increasingly promoted as a potential solution to address access barriers; however, there is scant literature on how to best implement them with migrant and refugee populations. Our aim was to explore with service providers and consumers the barriers, enablers, and experiences with Hubs and the resulting building blocks required for acceptable Hub implementation for migrant and refugee families. DESIGN, SETTING AND

participantsThis project was undertaken in Sydney, New South Wales, in communities characterised by cultural diversity. In this qualitative study, we used semi-structured interviews guided by the consolidated framework for implementation research, with service providers from health and social services (32 participants) and migrant and refugee parents (14 parents) of children who had accessed Hubs. RESEARCH AND DISCUSSION: Our initial qualitative data themes were developed into step-by-step building blocks, representing a way to address contextual determinants to establish and sustain a Hub that can support migrant and refugee families. These include the setting-up phase activities of buy-in and partnership development, which outlines mechanisms to foster collective action and collaboration between health and social services. Following this, our orientation model articulates the need to establish Hub coordination and navigation, activities that enhance a Hub's relevance for migrant and refugee families and ongoing integration mechanisms, such as engagement of same-language general practitioners. This is the first study to explore the building blocks required for acceptable Hub implementation to meet the needs of migrant and refugee families in the first 2000 days of a child's life-a critical time to optimise child development and health. PATIENT OR PUBLIC CONTRIBUTION: The research questions were developed based on qualitative research undertaken with Hub participants, community members, and service providers. The original investigator team had a consumer representative who has since relocated and consultation was undertaken with local Hub partner services. The researchers also consulted multicultural health services, including cultural support workers, to ensure research materials were culturally nuanced. Patients or participants have not directly been involved in the current study design. CLINICAL

trial registrationThis trial was registered with the Australian New Zealand Clinical Trials (ACTRN12621001088831).