Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Pregnancy apps are a booming global industry, with most pregnant women in developed countries now using them. From the perspective of health care and health information provision, this is both encouraging and unsettling; the demand indicates a clear direction for the development of future resources, but it also underscores the importance of processes ensuring access, reliability and quality control. Objective: This review provides an overview of current literature on pregnancy apps with the aim of describing: the ways in which apps and mhealth initiatives are used by women in general and those of a culturally and linguistically diverse (CALD) background; the utility and quality of information provided; and areas where more research, development and oversight are needed. Methods: A narrative review methodology was chosen for the study. Inclusion criteria were papers focussed on pregnancy app and mhealth usage and/or evaluation, and uptake among culturally and linguistically diverse populations. The date range of relevant identified publications was 2009 to 2017. Electronic searches were conducted using Pubmed and Google Scholar, with the addition of manual searches of reference lists. Results: We found that pregnancy apps are principally used to access pregnancy health and fetal development information. Data storage capability, interactive features/personalised tools, and social media features are also popular app features sought by women. There is evidence of lower rates of pregnancy app uptake among lower-income women and among those who do not speak English as a first language. Preliminary evidence indicates that a combination of technological, health literacy and/or language issues, may result in less accessibility by these groups, however further investigation is required. The small body of literature examining the effectiveness of mhealth initiatives for improving the understanding of pregnancy concepts and health outcomes is positive. A significant limitation of the health app industry in general is the lack of regulation in a commercially dominated field, making it difficult for users to assess the reliability of information being presented. Health professionals and users alike indicate a preference for pregnancy apps that are relevant to their local health care context and come from a trusted source.There is evidence of a need for greater health professional and institutional engagement in app development, as well as awareness of and guidance for women’s use of these resources. Conclusions: This is the first review of pregnancy app use, types of information provided and features preferred by pregnancy women in general and those of a CALD background. It indicates the demand for accessibility to accurate information that is relevant to the users’ community and their associated health services. Given the popularity of pregnancy apps, there is a huge potential for such apps to be used for the provision of accurate, evidence-based health information and it is hoped this review will inform their future development.

In East Timor, there have been centuries of contact between the strongly isolating Austronesian language Tetun Dili and the morphologically-rich Romance language Portuguese. In all this time, only one derivational morpheme has been borrowed into Tetun Dili for use with native lexicon. This is -dor, a transparent agentive suffix which neatly fits the word order and stress patterns of existing Tetun Dili agentive compounds. Tetun Dili has borrowed numerous nouns with this suffix. However when in combination with native roots, it has shifted in terms of its semantics, word class of the root and derivation, and even word status, bringing it more in line with pre-existing native agentive morphemes. In other words, Tetun’s strongly isolating nature has won, at least for now.

Objective: To identify health literacy issues when providing maternity care to culturally and linguistically diverse (CALD) women, and the strategies needed for health professionals to collaboratively address these issues. Methods: A qualitative case study design was undertaken at one large metropolitan Australian hospital serving a highly CALD population. Semistructured interviews were conducted with a range of maternity healthcare staff. The data were analysed thematically. The study is informed by a framework of cultural competence education interventions for health professionals and a health literacy framework. Results: Eighteen clinicians participated in the interviews (seven midwives, five obstetricians, five physiotherapists, one social worker, and one occupational therapist). Emergent themes of health literacy-related issues were: patient-based factors (communication and cultural barriers, access issues); provider-based factors (time constraints, interpreter issues); and enablers (cultural awareness among staff, technology). Conclusions: There are significant health literacy and systemic issues affecting the hospital’s provision of maternity care for CALD women. These findings, mapped onto the four domains of cultural competence education interventions will inform a technology-delivered health literacy intervention for CALD maternity patients. This approach may be applied to other culturally diverse healthcare settings to foster patient health literacy. What is known about the topic?: There are health inequities for pregnant women of culturally and linguistically diverse (CALD) backgrounds. Low health literacy compounded by language and cultural factors contribute to these inequities and access to interpreters in pregnancy care remains an ongoing issue. Pregnancy smart phone applications are a popular source of health information for pregnant women yet these apps are not tailored for CALD women nor are they part of a regulated industry. What does this paper add?: This paper provides clinician and language service staff perspectives on key health literacy issues that are both patient-based and provider-based. This research confirms that the complex interplay of social and practical factors contributes to and perpetuates low health literacy, creating barriers to health access; it also highlights several enablers for increasing CALD health literacy and access. These include greater health practitioner awareness and accommodation of CALD women’s needs and the provision of culturally and linguistically appropriate eHealth resources. What are the implications for practitioners?: eHealth resources are emerging as valuable enabling tools to address the health literacy and information needs of pregnant women. However, these resources need to be used adjunctively with health practitioner communication. Both resource developers and health practitioners need to understand issues affecting CALD patients and their needs. Developers need to consider how the resource addresses these needs. Training of health professionals about culture-specific issues may help to enhance communication with, and therefore health literacy among, individual cultural groups. Further, formalised language and interpreting training of bi- or multilingual health professionals is advised to ensure that they are able to interpret to a professional standard when called on to do so.

Background: Public health crises present challenges for providing accessible, timely, and accurate health information to culturally and linguistically diverse (CALD) communities. Aim: The aim of this qualitative project was to explore strategies used by CALD community organizations to improve communication about COVID-19 for their communities; we also aimed to identify gaps and challenges. Methods: We interviewed 16 representatives from Greek, Italian, and Chinese CALD organizations in Melbourne, Australia. The interviews were analyzed thematically. Results: Community leaders played a significant role in engaging their community members with accurate key health information. There were differences between language communities about preferred channels for receiving information. As the pandemic intensified, there was a shift from written communication to more interactive exchanges between authorities and community leaders. Discussion: The findings suggest effective public health communication is enhanced by the mediation and outreach strategies adopted by CALD community organizations; further, stakeholders need to be cognizant of heterogeneity of needs and preferences. This may optimize information dissemination to meet specific needs. Conclusions:The CALD organizations have developed communication strategies involving different kinds of mediation to reach specific sub-groups, especially the most vulnerable. These strategies can inform future public health engagement.

This exploratory study looks at evidence of merger between /el/ and /æl/ in Australian English, and the possible relationship between production and perception that might be involved in such a process. This merger appears to occur primarily in Victoria, although its regional distribution within that state still requires investigation. The phenomenon appears to be motivated by the interaction of three different phonetic processes: increasing lateral velarization; increasing vowel lowering; and misperception/misparsing of the phonetic signal. We focus here on the behaviour of a sample of native speakers from Warrnambool, a regional township in south-west Victoria. Given evidence that some speakers merge the vowels in /el/ and /æl/ while others do not, our participants are categorized as maintainers (those who keep /el/–/æl/ distinct) and combiners (those who merge /el/–/æl/), and we compare how the groups process /el/–/æl/ in perception. Overall results point to an association, according to category, between listeners' own production and perception of /el/–/æl/ in an identification task, although individual variability is also evident and needs to be understood.