By understanding stroke as a chronic disease, aftercare becomes increasingly important. For developing aftercare programs, the patients’ perspective regarding, for example, stroke-related symptoms and interactions with the healthcare system is necessary. Records from a local stroke pilot program were used to extract relevant topics from the patients’ perspective, as mentioned during a phone call two months after hospital discharge. Data from 157 patients with ischemic stroke or transient ischemic attack (TIA) were included. “Rehabilitation” was mentioned by 67.5% of patients, followed by “specialist physician”, “symptoms”, and “medication”. Compared with severely disabled patients, those with no relevant disability at hospital discharge mentioned “symptoms” significantly more often. Regarding rehabilitation, “outpatient care” was mentioned more often by patients in an inpatient setting, and 11.8% without rehabilitation mentioned “depression”. Patients in single-compared to multi-person households differed, for example, in the frequency of mentioning “specialist physicians” and gradually “outpatient care”. A multivariate model yielded associations between the disability at discharge and the probability of mentioning relevant topics afterward. This study provided insights into the patients’ perspective and identified topics that need attention while accompanying stroke and TIA patients after discharge. Further, the degree of disability at discharge might be helpful for planning individual aftercare. Stroke is characterized by the sudden onset of a focal neurological dysfunction due to infarction, caused by the occlusion of a cerebral vessel or hemorrhage, which is distinguished from transient ischemic attack (TIA) without structural damage . Based oDuring the last three decades, enormous efforts have been made toward improved acute stroke treatment. This resulted in advances allowing now the re-opening of occluded cerebral vessels by either intravenous thrombolysis  or endovRecently, stroke has been seen more and more as a chronic disease with a sudden onset and a variety of challenges in the long-term course after the event. This perspective strengthens the need for aftercare concepts that consider individual patient factors. The physician’s perspective on stroke aftercare traditionally involves a bundle of topics: Secondary prevention after an ischemic event is typically addressed by an individually adapted medication to interfere with the coagulation system, a modification of the lipid metabolism, treatment of arterial hypertension, lifestyle modifications for instance stop of nicotine consumption, or implementation of a healthy diet. Further, the modification of already existing risk factors is typically accompanied by the search for hardly detectable factors such as paroxysmal atrial fibrillation . AftercaHowever, existing aftercare frameworks often make it difficult for patients, carers, and involved health professionals to establish a well-coordinated, individually adapted process ,17,19. TAlong with the increasing awareness of stroke aftercare with its individual and structural challenges, initiatives such as the Stroke Action Plan for Europe were started recently by the European Stroke Organisation (ESO) and patient organization (SAFE) that highlight, among others, the patients’ perspective while focusing on the patients’ outcome and individual conditions in daily living . ConsequThis study aimed to identify existing topics in stroke aftercare from the patients’ perspective while using data from a demand-oriented and thus mainly unstructured stroke pilot program in a real-life setting starting shortly after an ischemic stroke or TIA. Factors that may affect the patients’ perspective, physical disability, the type of rehabilitation, and the social environment were considered.By applying a retrospective design, this study used data recorded during a local stroke pilot program. Patients with ischemic stroke or TIA treated at the Stroke Unit of the Department of Neurology at the University of Leipzig between January 2020 and January 2022 were offered support by stroke pilots. The support included individualized oral and written information related to the qualifying cerebrovascular event and was given during the hospital stay and later if necessary. After hospital discharge, patients had the opportunity to call the stroke pilots for further information or individual help regarding any content related to the qualifying event. Patients were informed that stroke pilots would contact them two months after hospital discharge for an unstructured interview addressing the current situation and individual problems and providing further help. The two stroke pilots were certified nurses, experienced in clinical stroke care, trained in care and case management (German Society for Care and Case Management), and received education in stroke aftercare (German Stroke Foundation) during the program.This study was conducted in accordance with the guidelines of the Declaration of Helsinki and was approved by the institutional review board of the Medical Faculty of the University of Leipzig (reference number 081/22-ek). Further, the study was registered in the German Clinical Trial Register (reference number DRKS00030540).From each patient who had participated in the local stroke pilot program, clinical , modifiTwo months after discharge, stroke pilots contacted patients by phone to lead unstructured interviews while trying to document all relevant content of the conversation. In order to extract key topics of these phone conversations, the paper-based transcripts of the unstructured interviews during phone calls between pilots and patients were analyzed. Keywords mentioned by patients during phone calls were identified from the transcripts and digitally listed for each patient. During this process, multiple different keywords for one patient could be recorded, while duplication of one keyword at the level of one patient was not allowed. Four persons (two stroke pilots and two physicians) re-assessed a list of all keywords assigned to patients and merged keywords covering overlapping topics if necessary while still trying to keep relevant fields specific and distinguishable, resulting in a list of possibly multiple keywords assigned to each respective patient. During the following analyses, keywords were used as representative topics.The study population’s clinical, socio-demographic, and rehabilitation-related characteristics were analyzed descriptively. For subgroup analyses, patients were categorized according to clinically and socio-demographically relevant factors. Factors represent the degree of disability or dependence in daily activities at hospital discharge (assessed by the mRS), the type of rehabilitation after hospital discharge, and the patients’ social environment (depicted by the number of persons living in the patients’ household).Topics mentioned in the overall study population or subgroup of patients were analyzed according to their frequencies, respectively, while for graphical illustration, the 10 most often mentioned topics were mapped. Pearson’s Chi-squared test of independence with Yates’ continuity correction (if applicable) was used to evaluate the association between mentioning a topic and belonging to a specific clinical or socio-demographic group. The influence of clinical or socio-demographic features at the time of hospital stay on the odds of mentioning a particular topic in the phone call two months later was assessed with multivariate logistic regression, and adjusted odds ratios were determined for features considered clinically or socio-demographically relevant factors.The significance level for all tests was 0.05, and a false discovery rate < 0.25 was adjusted using the Benjamini–Hochberg method. Analyses were performed with the software R version 4.2.1  with R SOf 175 patients who participated in the stroke pilot program, 157 patients (89.7%) could be reached by phone two months after discharge from the hospital and were included in the present study. Of these patients, three had a TIA (1.91%), while the majority of patients were diagnosed with an ischemic stroke as the qualifying event, characterized by a wide range of clinical affection at hospital admission (NIHSS ranging from 1 to 22) and different degrees of disability at hospital discharge (mRS ranging from 1 to 4) . RemarkaOverall, the most frequent topic in the study population was “rehabilitation”, as it was mentioned by nearly two-thirds of all patients, followed by medical topics such as “specialist physician”, “symptoms”, and “medication” . Less frp = 0.0001) during the phone call two months later. Patients with mRS > 1 mentioned “aids and appliances” (p = 0.0026), “outpatient care” (p = 0.0164), and “disability” (p = 0.0124) significantly more often than patients with mRS 0–1 at hospital discharge. Remarkably, topics such as “specialist physician”, “medication”, and “blood pressure” were mentioned gradually more often by patients with mRS > 1; however, it did not reach statistical significance. Expectedly, topics such as “sports” and “occupation” were mentioned gradually more often by patients with no or a non-relevant disability (mRS 0–1) at the time of hospital discharge.Distributions of topics were analyzed regarding subgroups considering the degree of disability, type of rehabilitation after hospital discharge, and the social environment. Around twice as many patients left the hospital with a relevant impairment in daily living (mRS > 1) compared to those with no or a non-relevant disability (mRS 0–1) . While “p = 0.0100). It was noticeable that topics such as “aids and appliances”, “disability”, and “therapy” were mentioned gradually more often in the inpatient rehabilitation group compared to the group covering outpatient rehabilitation; however, it did not reach statistical significance. Expectedly, the topics “sports” and “occupation” were gradually more often mentioned in the outpatient rehabilitation group. Remarkably, the topics “rehabilitation”, “symptoms”, and “special physician” represented the three most mentioned topics in the groups of patients receiving outpatient and inpatient rehabilitation, while patients with no rehabilitation mentioned “rehabilitation”, “specialist physician”, and “medication” as the three most mentioned topics, followed by “driving license”. However, with 11.8% in the group that had received no rehabilitation, “depression” was mentioned twice as often as in other groups, even though a statistically significant difference among the groups did not exist.Concerning rehabilitation, most patients had attended some form of a rehabilitation program after discharge from the hospital in either an inpatient or outpatient setting . When grp = 0.0377; p = 0.0490).Regarding the patients’ social environment, the number of persons living together with a patient in one household was considered for subsequent analyses while stratifying into a single-person and a multi-person household . TherebyThe impact of clinical and socio-demographic features such as disability at the time of discharge, type of rehabilitation promptly after discharge, and the number of persons living together with the patient on the probability of having mentioned one of the most frequent topics were assessed with a multivariate logistic regression and adjusted odds ratios. Iteratively for each of the most frequently mentioned topics, a model was fitted with mentioning the topic versus not mentioning the topic as the dependent dichotomous variable in the logistic regression. Age, sex, NIHSS at admission, number of secondary diagnoses per patient, number of cardiovascular risk factors per patient, days spent in hospital, NIHSS and mRS at the time of hospital discharge, number of prescribed medications at the time of discharge, type of rehabilitation after discharge, and number of persons living in patients’ household were included in each respective model as explaining variables  at hospital discharge significantly increased the probability of a patient having mentioned the topics “aids and appliances”, “disability”, and “driving license”, respectively, in the follow-up two months after hospital discharge . With evThis study was focused on stroke aftercare, which becomes increasingly important because the management of patients’ varying disabilities and individual problems in daily living is still challenging, while substantial progress concerning acute treatment was already achieved. Considering current initiatives such as the Stroke Action Plan for Europe and SAFE , this stObservations were based on a local stroke pilot program that starts during the hospital stay and includes a phone call two months after discharge from the hospital, where patients had been treated for the qualifying cerebrovascular event. The implementation of stroke pilots was driven by a previous initiative suggesting overall beneficial effects in stroke aftercare due to such pilots  and studIn the overall study population, patients most frequently mentioned the topic “rehabilitation”, which is likely related to the fact that most patients have already attended or still attended a rehabilitation program in an inpatient or outpatient setting at the time of the phone call. Although a rehabilitation program after a stroke is reasonable in most stroke cases from a medical point of view, as not only the reduction in neurological deficits is relevant, but risk factor control and lifestyle modifications also represent individual issues, access to rehabilitation seems to be different among countries. While in the present study, the high rate of people attending inpatient rehabilitation (about 58%) might indicate easy access in Germany, a review regarding regional differences described only a rate of 13% in Sweden and 57% in Israel . HoweverFrequent topics were also “specialist physician” and “medication”, representing typical elements of stroke aftercare. This finding might indicate that patients are aware of these topics, which could be seen as a success since these elements became part of the patients’ knowledge. The hypothesis that patients are particularly interested in their health might be supported by an observation made in another study looking at stroke patients supported by a message system, where most of them chose their health as a significant goal domain to be addressed in stroke aftercare . On the In the present study, about one-third of patients mentioned “symptoms” two months after discharge, indicating that a relevant proportion realized some kind of symptoms after that period, which appears relatively high when considering the low NIHSS and mRS, each with a mean of about 1.7, at the time of hospital discharge. On the other hand, persisting problems in patients with low or moderate deficits due to stroke were also described in other studies: For example, in a cohort of stroke patients with a median mRS of 2 at hospital discharge, a proportion of about 24% had an mRS of more than 2 after 12 months [By considering the degree of disability at hospital discharge, the type of rehabilitation, the social environment, and socio-demographic characteristics, this study suggested that these factors may impact the topics relevant from the patients’ perspective two months after stroke. Unexpectedly, the topic “symptoms” was mentioned significantly more often by patients with no or a non-relevant disability at hospital discharge than those with a more significant disability. One hypothesis might be that phenomena such as fatigue or impaired memory function, usually not seen as typical stroke-related symptoms such as hemiparesis or aphasia, have become relevant for daily living. Observations of the present study are in line with earlier findings, showing that the degree of disability and dependence on daily activities at the time of discharge are statistically related to long-term disability after stroke ,40. In dWhile applying a multivariate logistic regression model controlled for socio-demographic, clinical, and other factors, individual disability at hospital discharge seemed to provide a robust parameter that is statistically associated with the probability of mentioning topics such as disability, “aids and appliances”, and “driving license” during the period after hospital discharge.This study has some limitations: First, the retrospective design and the necessary data extraction from unstructured notes might have impacted the range and number of topics that became assessable for the analyses. Even though reviewers tried to merge overlapping topics and keep relevant fields distinguishable, opinions and topics could have been missed in the analysis because they might have been judged not specific enough. Moreover, quantitative analysis of topics did not account for a topic being mentioned multiple times by one patient during one phone call because the underlying, i.e., handwritten, transcripts were not reliable enough for such an analysis. While taking notes, stroke pilots could have missed specific words or phrases mentioned by patients, which then did not go into our analyses. Further, due to the necessary grouping of conversation topics, the direction of the association could be challenged. For example, it was not definite that mentioning “aids and appliances” implied demand in this area or was mentioned because no more need was present. Second, stroke pilots could have been biased in their conversation to generate topics depending on medical information from discharge. Moreover, certain patients’ topics could have been missed because conversations were led by phone and not present, enabling patients to conceal specific problems. If stroke pilots had visited patients at home, other requirements that patients did not actively mention by themselves could have been more obvious. In addition, further topics might have been generated by investigating the caregiver’s or professional’s opinion on the patients’ needs, which has been performed in earlier approaches ,44. ThirHowever, to the best of our knowledge, this is one of the first studies that identified topics during stroke aftercare directly from patients having experienced ischemic stroke or TIA and thus provides valuable insights into the patients’ perspective. Therefore, these insights can be used to improve existing or generate new initiatives in stroke aftercare, which is naturally individual and thus highly complex. In detail, persisting symptoms due to stroke, access to specialist physicians, and handling of medication or knowledge on it, together with the broad field of rehabilitative aspects, seem to represent topics that need further attention by persons involved in stroke aftercare or perhaps multi-professional programs accompanying stroke and TIA patients after hospital discharge. Furthermore, among factors that were easily assessable during the hospital stay, the degree of disability seems to represent a valuable parameter for adapting aftercare programs in a patient-centered way, as in the present study, this factor was identified to have a robust statistical relationship to topics that have become relevant during the following two months. Moreover, the type of rehabilitation and the social environment appear suitable for planning individual aftercare concepts and may help to guide post-discharge conversations between healthcare professionals and patients.


This study aimed to explore and understand the health promoting behaviors of low-income overweight and obese women in Korea.Data were collected from 10 low-income overweight and obese women working at a community self-sufficiency center through semi-structured in-depth interviews. Individual interviews were conducted and transcribed. Deductive content analysis was done, using the MAXQDA program.The health promoting behaviors practiced by low-income overweight and obese women were affected by intrapersonal, interpersonal, and organizational/community factors. Six categories were identified and two category clusters were derived that could best describe their health promoting experiences. As main category clusters, despite “feeling that the body and mind are not healthy” participants noted “difficulty maintaining a healthy lifestyle.” Overall, the participants had poor nutritional status, lacked physical activity, experienced much stress in intrapersonal level, and faced intrapersonal-level barriers to health promoting behaviors. Moreover, participants had a lack of personal will, and lack of specific information to practice health promoting behaviors, a lack of time, and too many overall burdens to earn a living for their family while trying to maintain health promotion behaviors.Lifestyle interventions for nutrition management, encouragement of physical activity, and stress management are needed for overweight and obese low-income women. In addition, social support and policies are needed to improve their living environment. Obesity can cause diseases such as type 2 diabetes, dyslipidemia, high blood pressure, and fatty liver . AccordiWomen tend to accumulate fat more easily because of changes in female hormones such as pregnancy, childbirth, and menopause, and because their basal metabolic rate and energy consumption are lower than that of men . The ratLow-income women had less access to fresh and healthy food and consumed more sodas, sugary drinks, and fast food . In addiIn the low-income class, women are identified as the most representative of health inequalities and have different and comprehensive problems, such as malnutrition and obesity . Low-incAccording to a study on the difference in health behavior among social classes, high-income women have high rates of health promotion behavior, such as non-smoking, physical activity, and medical checkups, while low-income obese women have poor regular exercise habits and low physical activity . In addiQualitative content analysis is a research method that draws valid inferences by objectively and systematically analyzing research data to understand the phenomenon to be explored. In qualitative content analysis, there are inductive and deductive methods. Among them, deductive content analysis is a useful method for retesting concepts in light of existing theories or hypotheses . In thisThe purpose of this study is to help understand low-income overweight and obese women and provide basic data for developing related nursing interventions. Therefore, this study aimed to explore how socioeconomically disadvantaged low-income overweight and obese women experience and practice health promoting behaviors. In particular, to understand what is difficult and what is helpful to maintain health promoting behaviors. The research question for this study is "How about health promotion behaviors experienced by low-income, overweight and obese women?’Ethics statement: This study was approved by the Institutional Review Board of Jeonbuk National University (2018-12-007-001). Informed consent was obtained from the participants.The research team is comprised of two individuals who work in academia and identify as female. Both have been registered nurses for 13 years (JHN) and 8 years (EJK) in women's health care settings. Interviews were done by an author holding a PhD who has experience or research using qualitative methodology with women (JHN), and the other author holds a master degree (EJK) and participated in workshops and seminars in qualitative research. One researcher (JHN) was employed as professor in women health nursing, and the other researcher (EJK) was research assistant. There was a no relationship established prior to study commencement between researchers and participants.Participants did not know about the researcher, but they were informed of the purpose of the interview. A reflection diary was kept with research team members to account for the researcher’s influence on the data. All decisions regarding data collection and analysis were discussed and agreed upon by the team members.This study is a descriptive qualitative study on the experiences of health promoting behaviors of low-income overweight and obese women. Descriptive research is the method of choice when a direct description of a phenomenon is required . This stSampling: Participants were selected via purposeful samplingMethod of approach: Study advertisement flyers were posted at a community self-sufficiency center in Jeonju, Korea. interview.Sample size/non-participants: Women aged 20 years or older, with a body mass index (BMI) of 23 kg/m2 or more, and earning less than the lower first quartile of household income  were invited to participate in in-depth interviews. Of the 15 women who agreed to the study, 10 remained after excluding four persons with a BMI of less than 23 kg/m2 and one who refused to meet for the interview.Setting of data collection: Interviews were conducted from August 28 to September 19, 2019, at a community self-sufficiency center in Jeonju, which helps the underprivileged who have difficulty finding work opportunities to work on their own and supports the conditions for stable economic activity.Presence of non-participants: There was nobody besides interviewers and participants during the interview.Description of sample: The mean (±standard deviation) age of the participants was 42.6 (±13.9) years with half in their 50s (n=5), and the mean BMI was 30.5 kg/m2 . All participants had a monthly household income of less than 1 million Korean won (roughly 900 US dollars), which was worse than the income level of the inclusion criteria  and each participant was interviewed once or twice.All interviews were recorded with separate consent of participants and transcribed verbatim immediately. In addition, nonverbal responses such as facial expressions and movements of the participants were noted in field notes and used for analysis. Interviews and analysis were performed simultaneously and saturation of the data was determined when new data were no longer available.All authors participated in data coding. The MAXQDA program  was used for content analysis.Derivation of themes: This study was analyzed via content analysis [analysis  “Maybe it's because I haven't eaten, so I can't well-balanced meals these days. I don't eat breakfast very well. I eat it simply to get by. I eat one meal a day. I don't eat vegetables and fruits.” "In the evening, though, I eat heartily with delivery food. I like spicy food so much; I eat spicy food and delivery food and eating out is frequent. This is my problem. I usually eat fried chicken and pizza for delivery. I eat a lot of fried chicken. I like to eat late at night.” .“I usually go around once during lunchtime. I walk along the riverside every day. I do not do any other physical activities.” “I'm stressed because my husband tells me to lose weight.” “I relieved my stress by eating.” I get stressed at work when people treat me rudely. “When I come home from work, I get tired and fall asleep or collapse. The road going up to the house is quite steep, so going up the house is a physical activity. I have never participated in a public health center health program. The health center was too far from my house.” “There are no parks or facilities to exercise near my house.” “I didn't know there was a health promotion program in healthcare center. Where do you get info for that?” “I am not financially wealthy. I cannot seem to live well. My family lives on what I earn alone. I have to take care of the children before myself, so I can't even think about physical activity. I thought the kids would die when I fell, so I just did whatever work I could get. It was hard because I had no living money. It's the same even now.” “Last year, I went to the gym for 3 months, and that was the only time I lost weight. The reason I can't keep doing this is that I don't have the will. I have thought that I have to do it if I have to, but it doesn't work well in action. The biggest problem is the lack of willpower.” “I know I need to exercise a lot, but I don't know how to do it. I wish someone could tell me how to exercise.” “I want to exercise. I want to try something other than walking. However, I do not know how to start. I have to work during the day. I don't have accurate medical knowledge, so I want to know about health information.” “There is no such person around. I have to take care of it  all by myself.” “It's annoying. Everything is bothering me. If I have someone, I cook, but there's no one by my side. These days, I don't cook, I just scoop it up alone, and it's become chronic. Also, my husband suddenly died, and I had nowhere to rely on, and it was hard. I had a hard time living. It's a little sad that all my family members are separated.” “I'm busy taking care of my work. I'm busy with work and housekeeping. I have to set aside time to exercise, but I have so much work to do that it’s hard to find time.” “Life itself is very difficult. My whole family lives on what I earn alone (suddenly crying).” (Participant 3; BMI, 30.4 kg/mThis study was conducted to explore and describe how low-income overweight and obese women in Korea experience their health promoting behaviors. The ten participants in this study frequently discussed emotional eating, overeating, and expressed experiences similar to reports in the literature for overweight and obese women of low economic status: nutritional instability , high raIn this regard, developing effective dietary intervention strategies are critical for low-income persons, to overcome patterns of monotonous food consumption and eating too much food with a high glycemic index and lipid content . Time-reMost of the participants in this study were in a state where they had to take on the role of a householder and make a living, and they experienced a lot of stress in this life. Therefore, spending time and money to exercise regularly or eating healthy food was different from the way of life that had to make a living. The life-course perspective acknowledges that poverty-related socioeconomic problems fuel poor health and, as a result, create cycles that are difficult to break. Nevertheless, the participants wanted changes to maintain a healthy lifestyle. Therefore, it is necessary to enhance health not only personal approaches to nutrition, physical activity, and stress management but also environmental and social approach of low-income obese and overweight women.The participants in this study mostly acknowledged their unhealthy health promoting behaviors. In this regard, the lack of will, health-related information, and economic power and support system required surrounding help and a support system. They indicated that with such a support system, their health promoting behavior can be improved. Most low-income obese women showed a tendency to do their best in their own environment to engage in health promoting behaviors. Examples noted were attempting to eat a variety of healthy foods, including vegetables, and maintaining physical health through regular walking instead of the gym, which they could not afford. However, it was difficult to maintain these health promoting behaviors by themselves owing to a lack of information. Therefore, it will be necessary to present accurate and detailed healthy lifestyle information, such as explaining the optimum intensity and timing of eating habits and physical activity necessary to maintain health promotion behaviors.Given that low-income women are affected by the information gap in exploring health-related information, because they often tend to rely on sources that they consider unreliable , this stLow-income, overweight and obese women reported that it was difficult to maintain a healthy life due to lack of support from their surroundings in a poor environment where exercise or medical services could not be used properly. In addition, economic barriers and lack of time due to having to work to maintain a livelihood were identified as interpersonal and organizational/community factors that made it difficult to perform health promoting behaviors. The necessity of visiting services to improve the health of these vulnerable people is suggested. Since the visiting service is said to be effective for family and maternal health , it willThe results of this study can help better inform health care workers who do not recognize various barriers to health promoting behaviors in low-income overweight and obese women . It is wThis study hfocused on low-income overweight and obese women in Korea, a country with national health insurance. Thus transferability to countries that have different health systems is limited. However, findings illustrate specific health promotion issues experienced by low-income overweight and obese women.In conclusion, the two category clusters of “feeling that the body and mind are not healthy” and “difficulty maintaining a healthy lifestyle” derived from participants suggest that devising and providing a lifestyle intervention that includesdetailed and realistic health-related information is needed for low-income overweight and obese women. Moreover, social support and policies that can alleviate larger socioeconomic barriers to health promotion are needed for these women.


Due to the diversity and range of services provided to humanitarian migrants during the settlement phase of migration, acquiring information across multiple service domains is intrinsic to the effective utilisation of settlement services. There are research gaps investigating how humanitarian migrants experience and navigate unfamiliar, multiple, and often complex information and service systems of host countries. This study seeks to understand the impediments to humanitarian migrants’ effective utilisation of information about settlement services and to identify strategies that can be implemented to overcome these barriers.Service providers were purposively recruited from organisations funded by the Australian Government to deliver settlement programs. The study applied an inductive thematic analysis approach to identify key themes that emerged from the data.From the perspective of service providers, the themed findings identified how humanitarian migrants gain knowledge about services, their information needs, information seeking practices and skills, and information specific to service domains. The findings illustrate the importance of acquiring information, knowledge, and skills across multiple information platforms and service domains as being integral to the effective utilisation of settlement services for humanitarian migrants. The study identifies systemic barriers to information and service access and suggests different strategies and approaches to improve access to context specific key information. The study identifies factors that inhibit the effectiveness of the Australian settlement service provision model and emphasises the need for targeted training of mainstream referral services. The study highlights the important role that settlement service providers play as mediators of information, adept at tailoring information to humanitarian migrants’ individual and community information needs.The findings provide important insights that highlight the different roles that policymakers, researchers, and service providers can play to inform new approaches that improve the effectiveness of information and settlement service provision, as part of contributing to optimum settlement outcomes for humanitarian migrants. Historically, major global migration and displacement events are triggered by conflict within and between countries, severe economic and political instability, and climate related disasters. In 2020, the United Nations reported that there were 26.4 million refugees globally, the highest number on record . In addiHost countries commonly provide a range of specialist services for humanitarian migrants (persons granted refugee status or another form of protection) to assist with their resettlement and integration. Settlement programs are an important part of host country’s migration policies to ensure humanitarian migrants adjust to the new environment and achieve full social and economic participation in their new society. Humanitarian migrants are considered to be most in need of settlement services due to the negative effects of their forced migration, experiences of war and persecution, torture and trauma, loss of family and friends, and physical and mental health issues . The conThe Australian Government funds four classifications of settlement services for humanitarian migrants: pre-arrival, on-arrival, post-arrival, and English language. This study focuses on the provision of the on-arrival ‘Humanitarian Settlement Program’ (HSP) and post-arrival ‘Settlement Engagement and Transition Support’ (SETS) program, available to humanitarian migrants for the first five years after arrival. Both programs are delivered to clients using a case-management, needs-based approach. The HSP program provides intensive foundational support for humanitarian migrants in the first 6–18 months from arrival . The SETTo achieve key settlement outcomes in all nine of the focus areas, it is necessary for humanitarian migrants to access, understand, and apply different sources of information across multiple service domains. The process of resettlement in a new country is a complex experience and is marked by the need to access new information relating to the social, cultural, economic, and political conditions of a new context, and to develop new information practices to engage with information through a variety of providers and formats ,12. KnowHumanitarian migrants’ information needs differ from other migrants due to pre-existing vulnerabilities and disadvantages related to their forced migration ,15. For Settlement service (SS) providers are generally the first point of contact for humanitarian migrants when they arrive in Australia, and the support they offer has a significant influence on humanitarian migrants’ future settlement outcomes . Abood eThere remains a research gap when investigating how humanitarian migrants experience and navigate unfamiliar, multiple, and often complex information and settlement service systems of host countries . Basic SThe concept of literacy has moved beyond the simple notion of the technical skills required for reading, writing and arithmetic (‘three Rs’), to a plural notion encompassing multiple forms of literacy related to both individual and social contexts. During the 1960 - 70s the concept of ‘functional literacy’ emerged as the notion of literacy was first expanded and linked with socio-economic development  (p:9). TIn 1994, the term ‘multiliteracies’ was coined by the New London Group, convened to consider literacy in relation to rapidly changing modes of communication and information . The con‘Literacy is the ability to identify, understand, interpret, create, communicate and compute, using printed and written materials associated with varying contexts. Literacy involves a continuum of learning in enabling individuals to achieve their goals, to develop their knowledge and potential, and to participate fully in their community and wider society.’  (p:13)It is important to acknowledge that both verbal (spoken language) and nonverbal (written language) communication is inextricably linked to attaining other literacies . Thus, aInformation literacy is an extension of the notion of functional literacy, and is commonly defined as the capacity to locate, evaluate, and use information to create new knowledge, and is considered a core adult life-long learning skill . The acqLike the concept of multiliteracies, information literacy represents multiple knowledges and literacies of information  that are context specific and dependent upon ‘complex networks of people’s interactions with analogue, digital, corporeal, and social information sources’  (p:5). LIn today’s digital era, digital literacy is inextricably linked to information literacy. Digital literacy refers to a core set of competencies that reflect a combination of knowledge and skills required for accessing and navigating digital sources of information and online services ,44. DigiInformation literacy and digital literacy are core components of SSL and to attaining other types of literacy, such as health, employment, and education, that are in turn vital to achieving key social and economic settlement outcomes . The evoThis qualitative study was part of a mixed methods research project investigating settlement services literacy among new migrants in two Australian states, New South Wales (NSW) and Victoria (VIC). The study was conducted in Greater Western Sydney, NSW, and Greater Melbourne, VIC, both recognised as ethnically diverse regions and prominent multicultural hubs in Australia .Settlement service providers were purposively recruited from organisations funded by the Australian Government to deliver HSP and/or SETS programs in the study locations. Organisations were invited to participate in the research study and to nominate an appropriate representative to take part in the interviews. Participants represented a range of roles working at different levels within their organisations, including roles in senior management ; program management ; and client services .The perspective of SS providers is most appropriate for this study as they are specialist workers actively involved in the provision of HSP and/or SETS programs, have oversight of the practical application of the SS provision model, are firsthand witnesses to the experiences and complexity of issues impacting different cohorts of humanitarian migrants, and have well established networks with the community and key stakeholders.This qualitative research study applied a grounded theory approach to data collection to inductively build a hypothesis, model, or theory from data ‘grounded’ in reality . QualitaAfter ethics approval (Western Sydney University Human Ethics Committee: H13063) was received, the interviews were conducted by two researchers, one in each state. Informed written consent was obtained from all participants for inclusion in the study. In-depth qualitative interviews with 26 service providers  were undertaken, representing 19 organisations in Greater Western Sydney (n = 8), and Greater Melbourne (n = 11) between October 2019 and January 2020. Participating organisations were community-based, not-for-profit; migrant specific (n = 11), mainstream (n = 4), diversity (n = 2), and faith-based (n = 2) services see . InterviData were analysed, coded, and managed with the assistance of NVivo 12 software. An inductive thematic analysis approach was applied to data analysis to allow for flexibility when identifying, analysing, and reporting themes and patterns within the data as they emerged . Braun aThe analysis of our findings identified four key themes. These were: (1) knowledge about services; (2) information needs; (3) information seeking practices and skills; and (4) information specific to service domains (i) education and training; (ii) employment; (iii) financial; (iv) health and wellbeing; (v) housing; (vi) transport; and (vii) legal. The themed findings identify barriers to information and interrelationships between service domains.SS providers in both states played a key role in actively providing information to humanitarian migrants about available SS, how to use, access, and navigate them. As a key component of the HSP and SETS program referral model, SS caseworkers routinely referred humanitarian migrants and their families to a range of specialist and mainstream services as needed. SS providers worked in partnership with a wide range of key stakeholders,  to deliver specialist information and education sessions outside of their expertise, remit, or funding capacity. SS providers acknowledged that understanding and navigating Australian service systems was often very challenging for humanitarian migrants, especially when humanitarian migrants were forced to navigate multiple service domains simultaneously. Some issues highlighted were:‘… the service delivery models aren’t consistent with what people, how people are going to engage. And two, people’s understanding or service literacy is so low it precludes them interacting effectively with those services.’ ‘Look the mainstream organisations are very difficult to access … The cultural competency of their frontline staff could also be issue for access. The location of where these organisations are located. Is it accessible by train or bus … The complexity is baffling…’ SS providers identified that humanitarian migrants had a general lack of knowledge or familiarity with the types of services available within service domains, what they were entitled to, and the eligibility criteria. SS providers needed to explain program specific concepts, such as home care or aged care packages, and provide information about the types of services available and what they provided. SS providers supported humanitarian migrants to navigate multiple service providers simultaneously, assisting with communication, and making appointments. One SS provider noted the need to develop resources that outlined available services, service pathways, and eligibility to simplify and improve information dissemination to humanitarian migrants. SS providers identified that providing information about services needed to be done in a sustained fashion and not as a one-off occurrence.‘… knowing about what services are available if you’re not aware of what’s available, such as settlement services. Then you’re going to take a lot longer to settle, because you’re not going to know about legal services or whatever else is out there … because people aren’t accessing the services, because they don’t know about them, or they’re forgetting. It needs to be drilled in; you can access these services for up to five years.’ Pre-migration and displacement experiences, country of origin, culture and traditions, age, gender, and mental health were identified by SS providers as the main factors determining individual humanitarian migrants’ information needs. Examples offered noted that:‘Someone who’s got mental issues, post-traumatic stress or just depression, their ability to retain information is going to be a challenge. They’ll learn it today; they’ll forget it tomorrow. So, repetition is pretty essential because they just can’t concentrate.’ ‘The Syrians … they speak four languages, they’re highly educated, they don’t actually need much of our support, they just need to be steered in the right direction … So, it’s a very different problem to the say someone coming from the Karen community who’s been born in a refugee camp, who’s only had school within a refugee camp … it’s their needs and settlement experience is quite different to someone … to another group so you can’t really generalise.’ Poor English language proficiency was considered by SS providers as the main barrier for humanitarian migrants when attempting to access information and services. SS providers regularly assisted humanitarian migrants by explaining different terminologies, reading letters, and completing forms. One SS provider shared their perspective about the importance of knowing the information needs of communities:‘You need to understand if, you know, the literacy level of the community you’re working with in terms of their own language. There’s no point giving them something in their language, which is great, if they can’t understand it. So, ensuring that the information is in an accessible format to the community is really, really important.’ SS providers noted the specific barriers to information for older women who were illiterate in their home language and had no prior experience of learning in a classroom environment:‘Older ladies that are 50, 60, 70 and they are busting to get out of the house. They’re socially isolated, we are challenging them with a whole bunch of different concepts … They’re hungry for information, but they’re scared of the formal… they just feel they’re too old for formal schooling. The formality of schooling, they just go, I’m too old.’ SS providers pointed out that the ‘bombardment’ of new information being provided to humanitarian migrants in the early stages of settlement caused information overload, resulting in many humanitarian migrants to ‘drop off’, feel overwhelmed, and not able to retain the information. SS providers shared their insights regarding humanitarian migrants’ information needs:‘So, what our experience is, when the refugee … arrives in Australia, there is information overload. Everybody wants to do everything with them … every information is being provided to them. So, there is only so much human brain can take.’ ‘Information sticks when it’s relevant to that point in your life.’ SS providers observed that humanitarian migrants’ information seeking practices in the early stages of migration were mainly reliant on family and their established community networks for access to culturally and linguistically accessible sources of information. Information was usually delivered through these networks in the humanitarian migrant’s home language and via ‘word of mouth’. SS providers noted that this information sharing practice was a significant contributor to humanitarian migrants’ acquisition of information. SS providers often worked in partnership with these community networks to promote and distribute important information. Barriers to providing information and communicating with humanitarian migrants were found to be mainly due to the lack of ‘language support’ available to SS providers. SS providers stated that the lack of access to free interpreting and translation services, limited translated resources (hardcopy and online), and limited access to bicultural workers, negatively impacted the quality of information and services that organisations provided, as well as the settlement experience and settlement outcomes of humanitarian migrants.SS providers identified that it was essential for humanitarian migrants to be ‘computer literate’ to navigate the online websites and portals of organisations to access multiple key services and sources of information. SS providers recognised that humanitarian migrants’ language proficiency was a key factor to accessing online information and services, especially when online information was available only in English. SS providers found that different cohorts of humanitarian migrants had varying skills when accessing digital information and services, noting that some humanitarian migrants had no prior experience using computers and the internet. SS providers actively supported the development of digital skills for humanitarian migrants by providing access to computer courses and assistance with online applications and website navigation:‘Language is an issue, and also now days, technology. A client who applies for citizenship, they have to go and pay online, and it is a big challenge. So, they have to come to us in order to do it online, because they have no idea about the terms used in there, for example, e-Me account…So sometimes this procedure takes hours and hours.’ sic] their website … you have to navigate the whole online portal which is extremely difficult … if you’re digitally literate … you’ve had that access to information. And then you can make a right choice about services.’ ‘Every organisation have [As integral to the SS provision model, SS providers in both states routinely referred humanitarian migrants to key mainstream services, such as education and training, employment, financial, health and wellbeing, housing, transport, and legal services. SS providers identified that each service domain’s information landscape comprised of specific knowledge and skill requirements (or literacies) necessary for humanitarian migrants to effectively navigate the services within each of these domains. A range of common context specific information topics were identified as relevant to all service domains see .SS providers delivered a broad range of information to humanitarian migrants to build their knowledge and understanding about the Australian education system and the different tiers of the education system , the types of education services and opportunities available, and to assist humanitarian migrants with the application and enrolment process. Information provided to humanitarian migrants included assessment of what education faculty or opportunity would be most appropriate for humanitarian migrants’ interests, skillset, and future job prospects, the costs involved, eligibility, how to access fee support, and to identify potential scholarships. Examples of education and training information needs of humanitarian migrants were reported as:‘In terms of higher education, yes, not knowing where to go and what’s most appropriate for their skills and is most likely to get them a job, that’s what we do a lot of, so, it’s not so much that they’re limited or unable to access higher education, it’s just knowing where to go.’ ‘For education around, early education in providing access to information is critical, and also not only once, but over a sustained period so that people have it ingrained, and they have the understanding they can access the opportunity at any time.’ Barriers to accessing relevant key information about education and training opportunities was described by SS providers as creating obstacles for humanitarian migrants as they struggled to navigate and utilise available services and programs. One SS provider offered an example outlining the complexity of information important for humanitarian migrants when considering enrolment at a university, that is, eligibility for fee loan schemes such as HECS (Higher Education Contribution Scheme) requires Australian citizenship, and humanitarian migrants need to be in Australia for four years before they can apply for citizenship, then the process can take 18 months. Another SS provider raised the point that education services needed to be more literate regarding the information needs of humanitarian migrants:‘I don’t think schools are educated enough about specifically newly arrived and refugees, about how to work with them, and how to get them engaged … So, I think that’s about the literacy … from the school’s perspective, that they need to become more literate about settlement and how to work with them and what services should be offered through the schools.’ The SS providers played an important role in assisting humanitarian migrants with gaining literacy around Australian employment systems and concepts. Pre-employment programs provided information to humanitarian migrants outlining Australian employment obligations and laws, taxation, superannuation, workers compensation, how to start a business in Australia, and workplace personal health and safety requirements. In partnership with TAFE , SS providers regularly held vocational courses and training, as well as field trips to workplaces to provide humanitarian migrants with practical insight into the kinds of work available. SS providers assisted humanitarian migrants to develop the knowledge and skills needed to gain employment such as writing resumes, how to address the job criteria, job interviews, how to search and apply for jobs online, how to attach their resume online, as well as ‘soft skills’ such as understanding Australian workplace culture.SS providers identified barriers to gaining employment for humanitarian migrants as further compounded by the lack of recognition of prior qualifications, not having local experience, and having no local employment history or local referees. Hence, employment literacy was found to be closely interrelated with aspects of education literacy. The complexity of bureaucratic systems and ‘red tape’ to access information regarding pathways to gaining recognition of prior qualifications and work experience was stated by SS providers as ‘rigorous’, ‘quite arduous’ and acted as additional ‘stressors’ for humanitarian migrants.SS providers in both states agreed that the system around employment support was not working for humanitarian migrants. The Australian job network providers funded to assist humanitarian migrants to find employment were regularly criticised by SS providers for their lack of effectiveness, lack of cultural and linguistic competency, and lack of understanding of humanitarian migrants’ information and digital literacy needs. SS providers identified multiple barriers to these employment services that negatively impacted humanitarian migrants’ service utilisation and experience:‘Certainly, job network providers, very difficult. It’s a distress for our clients. You know, they’re required or asked to commit to appointments, to look for work online. Many of my clients really need help with that, they haven’t got the confidence … You know, trying to navigate Australian concepts and systems. Very, very difficult … Especially with job active networks and if you don’t you’ll receive a letter from Centrelink saying your payments could be potentially cut off or you’re going to have to reapply, these are the requirements.’ ‘For example, client of mine, they say we are asked to go and look for a job. They’ve never touched a computer before, so they say, I sit in front of the computer with a blank mind for one hour … I’ve no idea how to look for a job. So she says I go and sit there for one hour and then I leave, so I can sign that I’ve been there.’ SS providers commonly tailored financial literacy programs to include a range of information about available financial supports and subsidies, welfare payment obligations, the Australian banking system, how to apply for a concession card, budgeting for utility costs and paying bills, energy use management (for electricity in particular), paying fines, no-interest loans, available emergency relief and vouchers , and understanding internet and phone contracts. Financial literacy programs included digital literacy skills to assist humanitarian migrants to navigate internet banking and online service systems as SS providers acknowledged that many government and social support services were only accessible online:‘… we run IT and computer classes. So, in those, for example, we teach them how to navigate the websites, how to improve their typing literacy, computer literacy … nowadays I mean lots of things are taking place online. So how to check your inbox, how to open an account. So, all these things in general in a way that contribute to their financial literacy.’ Financial literacy was found to be closely interrelated to employment, housing and education literacies as SS providers reported that many of humanitarian migrants were dependent on welfare payments as their main source of income in the early stages of settlement. SS providers considered money management skills as essential as many of humanitarian migrants were struggling to pay their bills and other essential living expenses. One SS provider noted that ‘some clients were paying almost 60% of their income in rent’ . Other SS providers pointed out that:‘… the unemployment rates in these cohorts is 90%. And if you are going to be on Centrelink (Government welfare service) income you’re going to live in poverty.’ ‘… also they’re trying to manage, work is a priority for them, housing’s a priority, financial stability, education is for their children certainly, and stability. That’s very problematic for that community.’ SS providers tailored financial literacy programs to respond to multiple socio-cultural and pre-migration factors of humanitarian migrants. Financial management programs were commonly targeted to women as SS providers acknowledged the cultural issues resulting from welfare payments being made directly to women:‘… communities … still have very strong patriarchal value sets. So, you get women with really low levels of financial capability … never really having had to budget. So, if you want you could buy something. You know, buy it on hire purchase, buy it, rent to buy. You know, and then realising that the $600 appliances are going to cost you three and a half thousand dollars by the time you’re finished paying for it. That stuff, which are unfamiliar constructs for people are problematic.’ ‘There is also issues around learning banking. Banking back home wasn’t an issue for some of the communities who are pastoralists or who are more into agriculture, and so storing money in the bank was not a need back home. Or even managing money was not a need, they managed other livestock, not money … There’s a lot of cultural issues that impact on financial literacy.’ Financial counselling was provided to humanitarian migrants facing financial strain as unexpected expenses (such as a serious illness or death in the family or needing to buy a car) or cultural and family obligations arose . Humanitarian migrants were made aware of the risks of using money lenders or ‘loan sharks’ and to signing contracts:‘… to educate them not to sign for those energy companies, they ask them to come and sign up, and they end up receiving bills from different companies, and they are worried.’ SS providers commonly referred humanitarian migrants to a wide range of health and wellbeing services. SS providers offered a variety of health-related information to humanitarian migrants via information sessions and workshops to help familiarise humanitarian migrants with the Australian health system, the types of services available, eligibility, referral processes, costs and subsidies, bulk billing, health insurance and Medicare , and how to access specialist and disability services. In partnership with health service providers, programs were commonly tailored to meet the needs of specific ethnic communities or different groups in the community to promote health literacy around cancer prevention, immunisation, Hepatitis, stress management, healthy foods, maintaining heart health, and diabetes. SS providers regularly held programs to promote humanitarian migrant’s engagement with services and knowledge around physical, mental, and sexual health, parenting, and healthy relationships.‘Health and doing, being able to identify health issues, mental health, physical health issues are a key component and then being able to facilitate access … we don’t provide the services, but we would act as a conduit between the existing services and all of those, you know, around primary health and mental health supports for people.’ Barriers to accessing health service information were found to be compounded by a range of cultural issues, language literacy, and factors related to humanitarian migrants’ employment and financial literacy:‘… like imagine a refugee with very low literacy. So, there are lots of misunderstandings … because they have low income, so they want to know which services are free for them and then how can they use them and where to go, how to contact. So, they finally contact, then they have a language problem, so there’s no proper interpreting access for them or understanding … some refugees are coming from a patriarchal community where men are the one who working and then maybe women, they may not have the green light from the husband to go out alone or they may have to, because of language they have to accompany a child to go to a service.’ To improve humanitarian migrants’ service literacy related to housing, SS providers promoted key information about rental bonds, tenancy agreements and contracts, and tenants’ rights and responsibilities:‘Like for example people that are renting houses and have people living in garages, not knowing that is not a habitat approved room … And people running businesses from home like childcare and all that sort of thing is also a problem … And because of the problems of not understanding the contractual obligations, sometimes properties get damaged, or they don’t get used according to the contract.’ SS providers noted that, as there was a long waiting list for community housing, humanitarian migrants were forced to look for accommodation in the commercial rental market. One SS provider identified numerous challenges that humanitarian migrants faced when accessing information about the commercial rental market:‘And it’s really difficult if you haven’t had a rental history, you know, rent receipts, to obtain a bond loan, how do I navigate that? Even online, everything’s online … if you do not know the alphabet and you at a keyboard or a tablet, it’s not going to really make much sense to you.’ Access to affordable housing was found to be reliant on factors related to employment and financial literacy, and interrelated to achieving other key settlement outcomes:‘Housing affordability, understanding Centrelink, needing advocacy around Centrelink, being unclear about their, the support they can and can’t receive … where can you get concessions, financial resilience’ ‘… accommodation is very expensive, the rent is very expensive, and taking a lot from their income. Most of them, they want private school … it’s culture shock. They still find it hard. So, the school, private schools take a lot from the budget.’ SS programs in both states provided key information related to transport literacy, such as how to use public transport  or Myki (VIC) public transport card), how to understand street signs, road rules and safety, child car seat restraints, concession cards, and a wide range of other related topics such as:‘… to give information sessions around … navigating Australia’s concepts and systems … we have … driving programmes … But firstly, our clients have to attend five sessions … we bring in Vic Roads, insurance companies to talk about … the importance of insurance, fines, civic compliance, what that looks like, what your obligations are before …. they can actually participate in the driving programme. ‘… they don’t use their Opal card properly. Either they don’t carry their concession card, they receive fines, and sometimes they just trespass over the gate and they think it’s OK, and when they receive a $200 fine, they come to us.’ Legal literacy of humanitarian migrants was supported by the delivery of legal orientation programs including information about Australian law and the justice system, migration law, child protection, family and civil law. SS providers promoted information about the types of legal services available and the eligibility criteria, such as matters for community legal centres vs private lawyers.‘… like the refugees, they’ve got some legal issues and then their understanding and the literacy is very low… So, our case workers … review that case, they can contact other providers, or they can contact maybe a lawyer, maybe professional in this regards, to help them … the legal system also looks very complicated for them.’ ‘What they are not aware is what services are there to represent them. Sometimes we get people coming to us and said I have to go to Court and said well you don’t have time, it’s tomorrow, you come today … So, I don’t think that there is a lot of awareness’ Information sessions regarding traffic rules and fines, drink driving and penalties, and how to apply for citizenship were also commonly presented. SS providers facilitated referrals for humanitarian migrants and would often help complete forms. SS providers would often speak on behalf of humanitarian migrants for the initial appointment to ensure that the issues were understood, and an interpreter was requested for future appointments. Limited access to free legal services forced humanitarian migrants to seek private solicitors or migration agents. One SS provider noted the key barriers to using private agents as:‘And one, it’s expensive. And two, there’s a lot of people that are real crooks. So, it slows down and complicates, you know, the process of getting family reunification, which then impedes and slows down the integration and settlement process.’ Our findings illustrate the importance of information acquisition for humanitarian migrants as key to the effective access and utilisation of SS. Basic SSL was found to be more complex than just knowing about what services are available, how to access, navigate, and utilise services. This study identifies multiple types of literacy associated within basic SSL. In addition to language literacy, functional literacies, that is, information literacy and digital literacy, were found to be integral to achieving basic SSL competency. Additionally, the SS provision model encompasses multiple key service domains, such as, education and training, employment, financial, health and wellbeing, housing, transport, and legal services see . TherefoAs illustrated in This study found that the language proficiency of humanitarian migrants was key to determining their ability to accessing information and impacted all aspects of their settlement experience and outcomes. Basic literacy skills of reading, writing and numeracy are indispensable for humanitarian migrants, particularly when acquiring knowledge and information associated with how to access different service domains . Hence, In addition to language proficiency, many humanitarian migrants’ information needs were found to be negatively impacted by a range of pre-migration, socio-cultural, and individual factors, such as mental health, gender, and age. SS providers were found to be effective in the assessment of humanitarian migrants’ individual and community information needs through the case-management and multi-stakeholder approach of the SS provision model. SS providers in both states worked in partnership with key stakeholders to effectively deliver service domain specific information to humanitarian migrants and to help build the knowledge and skills required to access available services and supports. SS providers applied strategies to meet identified information needs and practices of individual and communities, such as utilising ‘word of mouth’ networks for information dissemination or tailoring education programs to individual and socio-cultural needs.Information dissemination will continue to be impeded unless key barriers to information are addressed, such as, improving access to language supports and the development of resources (online and hard copy) that simplify and collate key information specific to service domains. Addressing systemic access barriers to mainstream referral services is key to the success of a multi-stakeholder approach. A recent systematic review investigating SSL for new migrants in high income host countries found that systemic barriers relating to navigation and access to complex service systems, lack of translated information, poor access to interpreters, and culturally inappropriate services were common across included studies . MainstrAs illustrated in The findings of this study, and as illustrated in Finally, and most importantly, the findings of this study illustrate the critical role that SS providers play as mediators of information, or what Barton refers to as ‘guiding lights’ . LiteracThis research study has several limitations to note. First, the study obtained data from organisations funded to deliver the HSP and SETS programs, therefore, the findings do not represent the viewpoints of other SS providers across the study locations, although we did include a broad cross-section of SS providers in the study locations. Second, this study does not include an investigation of the needs of eligible migrants that have not accessed SS or ineligible migrants that cannot access these programs. Thus, further work examining new migrants’ experiences of SS is needed. Third, SS providers were asked to report on their perspectives of humanitarian migrants’ experiences of SS and were not explicitly asked to report about their competence in undertaking program delivery. Inclusion of humanitarian migrants’ perspectives would serve to provide a more balanced analysis of the factors impacting SS provision and identify potential bias. However, as SS providers are migrant specialist workers, who have established networks and relationships with community representatives and other key stakeholders, they are well positioned to understand the expectations and experiences of humanitarian migrants. Finally, SS providers were not explicitly asked to answer questions in relation to SSL, information literacy, or the concept of multiliteracies. Instead, responses were analysed inductively as corresponding to references made about skills and knowledge required to access services and information, and as related to service domains represented in the data.Basic SSL competency for humanitarian migrants requires the implementation of a range of new strategies involving researchers, policymakers, service providers, and community members that are responsive to the local context, the target audience, and the Australian SS system environment. The application of the concept of multiliteracies to SS and information contexts ‘is useful to unpack the range of possible knowledge processes, to decide and justify what is appropriate for a subject or a learner, to track learner inputs and outputs, and to extend the pedagogical repertoires of teachers and the knowledge repertoires of learners’  (p:187).Assisting humanitarian migrants to develop competence and confidence to source, utilise, and engage with multiple formats of information will empower individuals and communities to achieve key settlement outcomes, and overall wellbeing.‘When individuals are able to augment their knowledge and understanding in terms of types of literacies and enhance their literacy skills, then they are able to promote welfare of their families and communities.’  (p:1)Empowerment of individuals is recognised as critical to ensuring services are culturally and linguistically responsive and appropriate to meet the diverse and often complex needs of new migrants accessing settlement services. Additionally, empowering humanitarian migrants in decision-making and encouraging the development of critical literacy skills has important implications for the scope, content, and delivery of information, services, and communication.The findings of this study highlight the importance of acquiring information, knowledge, and skills across multiple information landscapes and service domains as being integral to the effective utilisation of SS for humanitarian migrants. Our application of a literacy lens to a settlement service context provides an opportunity to identify and understand the complexity of essential information, the multiple types of literacies encompassed within basic SSL, and the interrelationships between service domains. The study highlights the important role that SS providers play as mediators of information, adept at tailoring information to humanitarian migrants’ individual and community linguistic, cultural, and pre- and post-migration information needs. The findings provide important insights relevant for policymakers, researchers, and service providers that can inform new approaches to improving the effectiveness of information dissemination and SS provision, as part of contributing to optimum settlement outcomes for humanitarian migrants.S1 File(PDF)Click here for additional data file.S2 File(DOCX)Click here for additional data file.S1 Data(ZIP)Click here for additional data file.