Primary healthcare providers' knowledge, practices and beliefs relating to preventive sexual and reproductive health care for women from refugee and asylum-seeking backgrounds in Australia: a national cross-sectional survey

Background. Many refugee women and women seeking asylum arrive in high-income countries with unmet preventive sexual and reproductive health (SRH) care needs. Primary healthcare providers (HCPs) are usually refugee and asylum seekers' first point of care. This study aimed to identify HCP characteristics associated with initiating conversations and discussing SRH opportunistically during other health interactions. Methods. An anonymous online survey was distributed nationally to representatives of health professional organisations and Primary Health Networks. Hierarchical logistic regression analysed factors including HCP demographics, knowledge and awareness, perceived need for training and professional experience with refugee women were included in the models. Results. Among 163 HCPs, those initiating conversations ranged from 27.3% (contraceptive care) to 35.2% (cervical screening). Opportunistic discussions ranged from 26.9% (breast screening) to 40.3% (contraceptive care). Positively associated factors included offering care to refugee women or women seeking asylum at least once every 2 months 7.64 (95% CI 2.41;24.22, P < 0.001); 2.82 (95% CI 1.07;740, P < 0.05), working part-time 8.01 (95% CI 2.34;27.86, P < 0.001); 2.43 (95% CI 1.02;5.76, P < 0.05) and having over 10 years of practice in Australia 2.20 (95% CI 0.71;6.87, P < 0.001); 0.40 (95% CI 1.66;0.95, P < 0.05). Barriers identified by HCPs included women's cultural beliefs (76%), lack of SRH knowledge (72.4%), religious beliefs (67.5%) and limited English-language skills (54.6%). Conclusions. Direct professional experience, frequency of service provision, years of practice, and part time work positively influence HCPs' SRH care practices. Enhancing bilingual health worker programs, outreach, education, and support for SRH and cultural competency training are essential to improving the preventive SRH care of refugee women and women seeking asylum.