tag:theconversation.com,2011:/ca/topics/cald-70385/articlesCALD – The Conversation2023-09-14T20:04:56Ztag:theconversation.com,2011:article/2121912023-09-14T20:04:56Z2023-09-14T20:04:56ZMany migrants wait hours after a heart attack to seek help. Here’s what needs to change<figure><img src="https://images.theconversation.com/files/544485/original/file-20230824-27-vvvdnr.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C8179%2C5464&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Your chest tightens, like an elephant is sitting on it. Pain streaks down your arm and you break out in a cold sweat. You feel light-headed and you’re pretty sure you’re having a heart attack. So when do you call an ambulance?</p>
<p>You might think the answer is easy: straight away, right? It’s well known getting the right medical help early when you’re having a heart attack can be a life or death decision.</p>
<p>For many people from CALD (culturally and linguistically diverse) communities, however, the answer might be: hours and hours after the first symptoms strike. Our research has shown many migrants don’t seek help straight away.</p>
<p>Why do so many migrants wait so long to seek help or go to hospital after chest pains? And what can we do about it?</p>
<h2>What we know so far</h2>
<p>Our previous <a href="https://www.mdpi.com/1660-4601/19/3/1516">research</a>, based on a study involving more than 600 patients who presented at a hospital with chest pain, looked at how long they delayed seeking medical help and how long they delayed going to hospital. </p>
<p>We found a median pre-hospital delay time of six hours for Sub-Saharan African migrants. This compared with an overall median pre-hospital delay time of 3.7 hours across the whole group.</p>
<p>Importantly, decision time to seek help takes up to 83% of pre-hospital delay in migrant patients, compared to only 48% for Australian-born patients. </p>
<p>In other words, the delay was caused by the patient’s decision to wait before seeking help (as opposed to, say, traffic problems or an ambulance taking too long to arrive).</p>
<p>The median “decision time” was:</p>
<ul>
<li>4.5 hours for migrants from Sub-Saharan Africa</li>
<li>4.1 hours for migrants from the Middle East</li>
<li>3.9 hours for migrants from Southeast Asia</li>
<li>3.5 hours for migrants from Southern and Central Asia.</li>
</ul>
<p>By contrast, the median decision time for Australians was 1.5 hours. </p>
<h2>Why might some migrants delay seeking help for chest pains?</h2>
<p>Our subsequent <a href="https://atlasesaustralia.au/TED/atlas.html">research</a> has shown certain factors may influence how long a migrant waits to seek help after chest pains first appear. These include things such as:</p>
<ul>
<li>their ability to speak English</li>
<li>the type of visa they were on </li>
<li>whether or not they have Australian permanent residency.</li>
</ul>
<p>Non-English speaking migrants are more likely to wait hours before seeking help, while migrants from English-speaking backgrounds sought medical care more quickly.</p>
<p>People on skilled visas are much more likely to take more than an hour before deciding to go to hospital, as are people on family visas reuniting them with relatives already in Australia.</p>
<p>And once migrants do decide to seek medical help for chest pain, they often did not call an ambulance straight away. Rather, they often first opted to visit their family doctor or attempted to drive themselves to hospital. We found this was more common among migrants with limited English.</p>
<p>Those on humanitarian visas (refugees) tended to seek help sooner. This group is much more likely to have access to social supports and welfare services though special programs such as the <a href="https://www.refugeecouncil.org.au/srss/#:%7E:text=What%20is%20the%20Status%20Resolution,application%2C%20including%20people%20seeking%20asylum">Status Resolution Support Services</a> or state-based refugee health <a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/services/health+services+for/refugee+health+service">services</a>.</p>
<p>Migrants working in Australia on skilled visas, by contrast, may delay seeking help because they have no health insurance, are worried about their jobs or fear hefty ambulance fees or medical costs.</p>
<p>The video below features some of our interviewees explaining their thoughts on how they would respond if experiencing chest pains. Their faces are not shown to protect their identities; instead we used the image of a teddy bear because our research came to be known as the “Time, Ethnicity and Delay” study, or TED for short.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/vSJE9LkiXjI?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>One migrant chef we spoke to experienced chest pain and dizziness but kept working because he was afraid he might lose his job. He worried calling an ambulance would land him with a bill he couldn’t afford to pay.</p>
<p>Many people on family visas, particularly older migrants with limited English, worried about how to explain chest pain in an unfamiliar language and if they would be able to understand the doctor. </p>
<p>They often relied financially on younger family members and wanted to avoid being a “burden” to them by seeking help for their chest pain.</p>
<h2>What can be done?</h2>
<p>Our <a href="https://doi.org/10.1016/j.aucc.2016.04.002">long-running</a> <a href="https://doi.org/10.1016/j.ijcard.2016.06.244">research</a>, which involved consultation and collaboration with stakeholders and migrant communities in Australia, has revealed some startling inequities. </p>
<p>Some key interventions, however, would make a big difference.</p>
<p>These include:</p>
<ul>
<li><p>incorporating cultural and social factors into public campaigns and health promotions. This could include health promotion programs for specific cultural groups, and ensuring we have materials and outreach efforts in languages other than English</p></li>
<li><p>creating health-care apps in different languages to target people who feel more comfortable browsing an app for information than, say, making a phone call</p></li>
<li><p>improved cultural competence in health-care systems and incorporating these findings into health-care training</p></li>
<li><p>better education for CALD communities about how the health system works, especially soon after they arrive in Australia</p></li>
<li><p>greater awareness among health-care professionals of this pattern of delayed help-seeking by many migrants</p></li>
<li><p>targeted funding for research addressing the health inequities faced by disadvantaged populations</p></li>
<li><p>evaluating how access to key social security services is putting migrant lives at risk.</p></li>
</ul>
<p>This final point is crucial. Newly arrived migrants may face a <a href="https://www.servicesaustralia.gov.au/newly-arrived-residents-waiting-period?context=21986">wait</a> of between two and four years (depending on when they arrived) before they can fully access services such as the Commonwealth Seniors Health Card, the Low Income Health Care Card and unemployment benefits.</p>
<p>These long waiting periods widen the gap and worsen the health inequities in our society.</p><img src="https://counter.theconversation.com/content/212191/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hannah Wechkunanukul is on a committee of the Public Health Association of Australia (SA Brach), Australian Health Promotion Association (SA Brach).</span></em></p><p class="fine-print"><em><span>Philip Ayizem Dalinjong does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Your chest tightens, like an elephant is sitting on it. Pain streaks down your arm and you break out in a cold sweat. You feel light-headed and you’re pretty sure you’re having a heart attack. So when…Hannah Wechkunanukul, Associate Professor in Public Health, Torrens University AustraliaPhilip Ayizem Dalinjong, Lecturer and Researcher in Public Health, Torrens University AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2050122023-06-12T20:01:22Z2023-06-12T20:01:22ZA silver lining from the pandemic: how lockdowns helped kids learn the languages their parents speak<figure><img src="https://images.theconversation.com/files/524804/original/file-20230508-21-tsmues.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>None of us is a stranger to the downsides of the pandemic. For families with kids, kindergartens and schools closed during the lockdown, and parents had to manage schooling and working from home. </p>
<p>Yet there is a silver lining: <a href="https://www.degruyter.com/document/doi/10.1515/multi-2023-0011/html">our research</a> shows that, in families where a parent’s mother tongue is not the language spoken in wider society, children learned more about that language during lockdowns.</p>
<p>Let’s call the language these parents speak the “home language” and the language society uses the “societal language”. Take me as an example: at home I speak Shanghainese with my mum, Mandarin with dad, and Telepath with my cat. But in the community and at work, I speak English, the societal language. </p>
<p>To many multilingual families, our kids’ home language often comes second to the societal language, which dominates their language development as they grow up. When parents witness this transition, they fear their children will gradually lose the ability to use the language they speak. They fear that, as a consequence, their children will lose touch with their roots.</p>
<p>Along with my colleagues, <a href="https://linktr.ee/eligarciag">Elisabet García González</a> and <a href="https://www.hf.uio.no/multiling/english/people/core-group/elanza/index.html">Elizabeth Lanza</a>, we conducted a survey of around 200 multilingual families in Norway (published in the journal <a href="https://www.degruyter.com/document/doi/10.1515/multi-2023-0011/html">Multilingua</a>). Parents expressed their concerns about their children’s development of home and societal languages. For example, one said:</p>
<blockquote>
<p>Since our daughter mostly speaks [home language] with her father and [societal language] with me and at kindergarten (although her father and I exclusively speak [home language] to each other), her [home language] is generally less advanced than her [societal language] […]</p>
</blockquote>
<p>Multilingual children rarely use all their languages in the same contexts or with the same frequency. This is often perceived as being more or less “advanced” in one language than the other, but in reality multilingual speakers use their languages as best fits their needs. </p>
<p>Despite these concerns, there was a silver lining. Our study found children’s home language literacy improved during the pandemic. The parents who reported the concern above later said: </p>
<blockquote>
<p>We’ve clearly noticed that her spoken [home language] has developed during the lockdown.</p>
</blockquote>
<p>Another family told us: </p>
<blockquote>
<p>With the two-year-old, I noticed an improvement in her [home language] vocabulary while kindergarten was closed.</p>
</blockquote>
<p>What is the reason for this improvement in the home language? As one family shared: </p>
<blockquote>
<p>My children started to be interested and speak more [home language] during the lockdown. Assume this is a result of (us) working from home for an international company and them hearing mum use this (home) language.</p>
</blockquote>
<p>Another said: </p>
<blockquote>
<p>My kids have started using more [home language] in their [societal language] speech with parents and each other during the lockdown, because they are watching more YouTube and playing Minecraft, Animal Crossing and Zelda. Words from the games are difficult to translate into [societal language].</p>
</blockquote>
<p>Our statistical analyses had something even more interesting to say: the improvement of a child’s home language made their parents feel more positive about their children being multilingual. Parents see it as a source of wellbeing, especially when they notice their child is picking up their mother tongue. Overall, family relationships, resilience, cultural connection and hope are boosted even in the darkest days of the pandemic.</p>
<p>Is this at the expense of the societal language, one may ask? Indeed, some parents were worried about the development of kids’ societal language, especially when it was not spoken at home. Others said the societal language was still being used during the lockdown, such as in online media. One parent said: </p>
<blockquote>
<p>My son is a bit behind the level of the class. He really improved his [societal language] reading during the lockdown, since we had more time to individually support him in a positive way. Before, he was much more negative.</p>
</blockquote>
<p>Another family told us: </p>
<blockquote>
<p>The difference (in language use) was noticeable when the kindergarten reopened. [Societal language] came back for the kids as easily as restarting to ride a bike.</p>
</blockquote>
<p>The societal language is often strong in young children – sometimes so strong that it can bully the home language into a corner. The key task for many multilingual families is not so much to find a balance between the two languages, but to make sure the home language is being actively used and not being overshadowed by the societal language.</p>
<p>Unity is important in society. Being able to speak a common language is important, but equity and diversity are important too. The ability to speak one’s mother tongue can become a source of belonging and wellbeing. </p>
<p>In addition, children growing up in a culturally and linguistically diverse environment tend to be more flexible. Their neurocognitive plasticity shines across developmental domains, from <a href="https://doi.org/10.1177/1367006914566082">language learning</a> to <a href="https://doi.org/10.1007/s10339-016-0780-7">music perception</a>.</p>
<p>So the pandemic lockdowns were bad, but not all bad. Our kids adapt and adjust to the new environment, and can surprise us with stronger skills that make mum and dad proud.</p><img src="https://counter.theconversation.com/content/205012/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Liquan Liu receives funding from uropean Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No. 798658 hosted by Center for Multilingualism across the Lifespan at the University of Oslo, financed by Research Council of Norway through its Centers of Excellence funding scheme grant agreement No. 223265; and from Western Sydney University School of Psychology 20820 83181.
The corresponding academic publication will be published on journal Multilingua. DOI details to be added. Co-authors are Elisabet Garcia Gonzalez and Elizabeth Lanza.</span></em></p>Amid all the stresses of lockdowns, our research found there was some good news: children had the chance to better develop their home language.Liquan Liu, Senior lecturer, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1885302022-08-22T01:29:30Z2022-08-22T01:29:30Z‘Use it or lose it’ – getting NDIS funding is only half the battle for participants<figure><img src="https://images.theconversation.com/files/480012/original/file-20220819-18-8jxot8.jpg?ixlib=rb-1.1.0&rect=844%2C35%2C5137%2C2901&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://images.pexels.com/photos/4058222/pexels-photo-4058222.jpeg?auto=compress&cs=tinysrgb&w=1260&h=750&dpr=2">Pexels/Cliff Booth</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Around <a href="https://www.aihw.gov.au/reports/disability/people-with-disability-in-australia/contents/people-with-disability/prevalence-of-disability">4.5 million Australians</a> live with disability but less than 13% of them are covered by the National Disability Insurance Scheme (NDIS). Getting into the scheme is one thing. But many NDIS participants find using their funding is yet another. </p>
<p><a href="https://disability.unimelb.edu.au/home/projects/collaborative-research/ndis-plan-utilisation">Our research</a> indicates a major issue in terms of the fairness of the scheme is less in the allocation of funding but more about whether people are able to spend their funding. </p>
<p>Some groups – particularly people living in regional or remote areas or Aboriginal and Torres Strait Islander people – are less able to use their budgets. But there are ways to make the NDIS more equitable. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ndis-fraud-reports-reveal-the-schemes-weakest-points-188746">NDIS fraud reports reveal the scheme's weakest points</a>
</strong>
</em>
</p>
<hr>
<h2>Using an NDIS plan</h2>
<p>When accepted onto the NDIS, participants develop a plan that sets out the goals they want to work towards, and the supports needed to achieve them. This comes with an associated budget to spend on different supports. </p>
<p>Most plans last around 12 months before they are reviewed, but they can last as long as <a href="https://ourguidelines.ndis.gov.au/your-plan-menu/creating-your-plan/plan-duration-guidance">three years in some cases</a>. </p>
<p>If the funding associated with a plan is not all spent, the funds don’t roll over into the next plan and are returned to the scheme. </p>
<p>At a subsequent review there will be discussion about why the funds weren’t used. If a person <a href="https://ourguidelines.ndis.gov.au/how-ndis-supports-work-menu/reasonable-and-necessary-supports/how-we-work-out-if-support-meets-funding-criteria/what-else-do-you-need-know-about-working-out-if-supports-meet-funding-criteria">consistently doesn’t use</a> all their funds, they might find future budgets are reduced. </p>
<p>Given the <a href="https://theconversation.com/what-we-know-about-the-ndis-cuts-and-what-theyll-mean-for-people-with-disability-and-their-families-179748">widely reported cuts</a> to NDIS plans, some participants are <a href="https://www.smh.com.au/national/more-stress-more-waste-the-fight-for-the-future-of-the-ndis-20220429-p5ah6f.html">concerned</a> under-spending might lead to future plan cuts. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1547771534428610563"}"></div></p>
<h2>Why people don’t spend their allocation</h2>
<p>There are a <a href="https://disability.unimelb.edu.au/home/projects/collaborative-research/ndis-plan-utilisation">range of reasons</a> why people don’t manage to use all their budget allocation. </p>
<p>The NDIS is complex to navigate, and people may not fully understand their plan or the system. There might not be the providers available to meet a person’s needs or it might be difficult to find and secure appropriate providers. Similar schemes overseas show people are unlikely to use their entire budgets – they might hold some portion back “for a rainy day” or their needs might change or not eventuate as anticipated.</p>
<p>The previous federal government argued the NDIS was <a href="https://theconversation.com/dehumanising-and-a-nightmare-why-disability-groups-want-ndis-independent-assessments-scrapped-156941">inequitable</a>, suggesting those in richer areas were receiving larger budgets than those in poorer areas. </p>
<p>It proposed to reform the scheme by introducing Independent Assessments, which it argued would produce fairer plan amounts by assessing each participant using the same suite of functional assessment tools. But this proposed reform <a href="https://theconversation.com/ndis-independent-assessments-are-off-the-table-for-now-thats-a-good-thing-the-evidence-wasnt-there-164163">was dropped</a> after backlash from the disability community who believed the tools would not produce the intended effects and that this might be an attempt to cut scheme costs. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-the-ndis-needs-to-do-to-rebuild-trust-in-the-words-of-the-people-who-use-it-185880">What the NDIS needs to do to rebuild trust, in the words of the people who use it</a>
</strong>
</em>
</p>
<hr>
<h2>Tracking under-use</h2>
<p>One way to measure the under-use of NDIS funding is to explore the utilisation rate. This refers to a comparison of the dollar value of individual budgets against the overall amount expended on supports.</p>
<p>Latest <a href="https://www.ndis.gov.au/about-us/publications/quarterly-reports">NDIS data</a> shows the national average utilisation rate is 75%. </p>
<p>This measure is only an average, and there are many participants with very low utilisation – 32% of participants spend less than 50% of their budgets. People in some areas spend less than others. For example, East Arnhem in the Northern Territory has an average utilisation rate of 47%.</p>
<p>We also see variation in utilisation within budgets. NDIS plans contain three different categories of funding: core supports for everyday activities, capacity building supports to help build independence and skills, and capital supports to purchase equipment and home or vehicle modifications. </p>
<p>While the national average utilisation rate for core supports is 81%, capacity building stands at <a href="https://www.ndis.gov.au/about-us/publications/quarterly-reports">59% and capital at 56%</a>. Many people have reported challenges in getting home modifications and high-cost equipment approved even when these are in their plans. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1553915920229203973"}"></div></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/people-with-intellectual-disability-can-be-parents-and-caregivers-too-but-the-ndis-doesnt-support-them-186742">People with intellectual disability can be parents and caregivers too – but the NDIS doesn't support them</a>
</strong>
</em>
</p>
<hr>
<h2>Some groups use more than others</h2>
<p>As part of ongoing research, <a href="https://disability.unimelb.edu.au/home/projects/collaborative-research/ndis-plan-utilisation">we compared</a> groups of NDIS participants to better understand differences in plan allocation and spending. We focused on groups more likely to face inequity in utilisation and where wider social inequities are present. </p>
<p>We looked at plan size and spending separately. We did this because an increase in utilisation could occur if plans are reduced but spending remains the same. </p>
<p>We compared plan size and spending for participants from culturally and linguistic diverse backgrounds, Aboriginal and Torres Strait Islander people and according to where people live. We considered factors such as age to ensure comparisons were “like with like”. </p>
<p>We found participants from culturally and linguistic diverse backgrounds backgrounds and Aboriginal and Torres Strait Islander people received larger plans than other NDIS participants. But they spent a similar amount, despite having bigger budgets. This resulted in lower levels of utilisation. </p>
<p>Inequities also vary by disability group. We found spending and utilisation was low across the board for people with psychosocial disability (such as schizophrenia, bipolar disorder and social anxiety disorders). </p>
<p>In a <a href="https://disability.unimelb.edu.au/home/projects/collaborative-research/ndis-plan-utilisation">study</a> of Victorian NDIS data, we found participants living in regional and remote areas receive less funding. They also spend less of their allocated funding compared to people who live in large urban centres. Some of this may be due to challenges of “thin markets”, where insufficient providers are available in an area. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/indigenous-people-with-disabilities-face-racism-and-ableism-whats-needed-is-action-not-another-report-187528">Indigenous people with disabilities face racism and ableism. What's needed is action not another report</a>
</strong>
</em>
</p>
<hr>
<h2>What can be done?</h2>
<p>One of the <a href="https://theconversation.com/with-a-return-to-labor-government-its-time-for-an-ndis-reset-183628">election commitments</a> of the Labor government was to increase the number of providers in regional areas. This would address “<a href="https://www.ndis.gov.au/community/research-and-evaluation/markets-and-innovations-our-research">thin markets</a>” – where there is a gap between participant needs and their use of funded supports. But it should be done in a meaningful way so providers and services are appropriate to their local communities. </p>
<p>Another way to help participants access services is to increase use of NDIS support coordinators. These workers who are funded via the person’s plan can help participants connect with NDIS providers and understand the scheme. This can act as an additional source of help to be able to find suitable providers and to be able to use their plans in buying services. </p>
<p>Our <a href="https://disability.unimelb.edu.au/home/projects/collaborative-research/ndis-plan-utilisation">modelling</a> shows increasing the use of support coordinators could increase plan utilisation and reduce inequities for Aboriginal and Torres Strait Islander people, culturally and linguistically diverse participants, people from low socioeconomic backgrounds and those with psychosocial disabilities.</p><img src="https://counter.theconversation.com/content/188530/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Helen Dickinson receives funding from Australian Research Council, National Health and Medical Research Council, Commonwealth government, CYDA and WISE.</span></em></p><p class="fine-print"><em><span>George Disney has received funding for commissioned research from the Department of Social Services and the Victorian Department of Families Fairness and Housing. </span></em></p>Some NDIS participants worry if they don’t spend their annual funds, they won’t be offered the same supports in their next plan – and it’s harder for some to use what they’ve been allocated.Helen Dickinson, Professor, Public Service Research, UNSW SydneyGeorge Disney, Research Fellow, Social Epidemiology, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1871642022-07-25T01:59:09Z2022-07-25T01:59:09ZRefugee and migrant women are often excluded from mainstream domestic violence services and policy<figure><img src="https://images.theconversation.com/files/475350/original/file-20220721-16-g59b1i.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4415%2C2121&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>In Australia, the discussion around gendered violence is increasingly focused on diversity. However, policy and services continue to be based mostly on the experiences of white, Anglo-settler women.</p>
<p>Our <a href="https://www.tandfonline.com/doi/full/10.1080/07256868.2022.2102598">research</a>, published in the <a href="https://www.tandfonline.com/doi/full/10.1080/07256868.2022.2102598">Journal of Intercultural Studies</a>, involved interviews with 31 frontline workers. These workers came from mainstream domestic violence organisations, refugee resettlement organisations, and migrant organisations who support women experiencing violence. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/she-beams-goodness-and-light-rosemarys-way-is-about-a-hero-transforming-the-lives-of-migrant-and-refugee-women-159124">'She beams goodness and light': Rosemary's Way is about a hero transforming the lives of migrant and refugee women</a>
</strong>
</em>
</p>
<hr>
<h2>Blaming ‘culture’</h2>
<p>Our research revealed domestic and family violence in refugee and migrant communities is often racialised and blamed on “culture”. </p>
<p>Some workers indicated “culture” contributed to refugee or ethnic minority women “putting up with” violence, where Anglo-settler Australian women would, apparently, not.</p>
<p>One Anglo-settler worker from a mainstream domestic violence organisation said:</p>
<blockquote>
<p>Maybe they’re not used to having freedoms and rights and protection […] I’ve just noticed that women from perhaps African countries or Middle Eastern countries, possibly refugee women […] have a much higher tolerance I would say to violence […] they put up with a lot before reaching out.</p>
</blockquote>
<p>When white women seem to “put up with” violence, the conversation is not about their “culture”. Instead, the focus is on what might prevent them from leaving. </p>
<p>That includes <a href="https://theconversation.com/why-doesnt-she-just-leave-the-realities-of-escaping-domestic-violence-29537">economic vulnerabilities and homelessness</a>, and fear for their or their children’s safety. It includes worries that the law and police may not be <a href="https://www.researchgate.net/publication/254092424_Seeking_Help_for_Intimate_Partner_Violence_Victims%27_Experiences_When_Approaching_the_Criminal_Justice_System_for_IPV-Related_Support_and_Protection_in_an_Australian_Jurisdiction">able to protect them</a>. </p>
<p>Instead of focusing on systemic problems and broader social inequalities, many blame women’s cultural backgrounds as the reason for them not engaging with mainstream services.</p>
<p>That’s despite <a href="https://www.mcwh.com.au/the-muses-project-multicultural-and-settlement-services-supporting-women-experiencing-violence/">evidence</a> migrant and refugee women experiencing violence often encounter particular barriers – such as deportation threats, and financial or language barriers – when they do reach out. </p>
<h2>Critiquing the ‘culturally and linguistically diverse’ tag</h2>
<p>The category of “<a href="https://www.researchgate.net/publication/329041447_The_%27Culturally_and_Linguistically_Diverse%27_CALD_label_A_critique_using_African_migrants_as_exemplar">culturally and linguistically diverse</a>” reinforces the idea culture is something possessed by foreigners, refugees or ethnic minorities – rather than something all Australians have.</p>
<p>Quite a few service workers used “Australian” to refer to white Anglo-settlers, when actually <a href="https://www.abc.net.au/news/2022-06-28/census-2021-data-shows-a-changed-australia/101177152">people of diverse ethnicities and identities</a> are obviously Australian too. </p>
<p>The vague term “culturally and linguistically diverse” can set ethnic and cultural minorities apart from the majority. It can also homogenise them into a single, broad category. This can create the perception a single intervention will work for the entire group. </p>
<p>Domestic violence organisations, even migrant-specific ones, don’t have to collect client data on ethnicity, country of birth or visa pathways. Refugees and migrants are usually categorised simply as “culturally and linguistically diverse”. This limits our understanding of the unique experiences and needs of <a href="https://theconversation.com/one-third-of-migrant-and-refugee-women-experience-domestic-violence-major-survey-reveals-163651">refugee and migrant women</a>. </p>
<p>It’s time we critically reflected on whether the “culturally and linguistically diverse” terminology <a href="https://www.voced.edu.au/content/ngv%3A38576">is still useful</a>, or just entrenching inequalities.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/475302/original/file-20220721-15-h7fwgk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/475302/original/file-20220721-15-h7fwgk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/475302/original/file-20220721-15-h7fwgk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/475302/original/file-20220721-15-h7fwgk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/475302/original/file-20220721-15-h7fwgk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/475302/original/file-20220721-15-h7fwgk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=533&fit=crop&dpr=1 754w, https://images.theconversation.com/files/475302/original/file-20220721-15-h7fwgk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=533&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/475302/original/file-20220721-15-h7fwgk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=533&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The vague term ‘culturally and linguistically diverse’ can set ethnic and cultural minorities apart from the majority.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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</figure>
<h2>Overwhelming small, migrant-led service providers</h2>
<p>Instead of integrating diverse perspectives and needs into mainstream services and policy, a range of culturally and linguistically diverse-specific services have emerged. </p>
<p>“Mainstream” (typically Anglo-settler) Australians are usually referred to “mainstream” services. “Culturally and linguistically diverse” peoples are increasingly referred to “culturally and linguistically diverse” services.</p>
<p>Yes, there are few other options for services aiming to tailor support to cultural minorities. But we identified a number of consequences. </p>
<p>This approach seems to deepen assumptions and stereotyping based on “culture”. Workers in migrant services said they had clients referred to them only because the client was not fluent in English (even though all services can engage interpreters).</p>
<p>Some workers from cultural minority heritage said they were expected to take clients from cultural minority backgrounds on the assumption they shared their experiences or history. </p>
<p>Culturally and linguistically diverse-specific services are often small and underfunded compared to mainstream services. </p>
<p>This practice of referring refugee and migrant women can overwhelm smaller, migrant-led services. It also deprives mainstream workers of learning from women from diverse backgrounds.</p>
<p>We should stop referring women based on cultural stereotypes, or assuming that working with refugee and migrant women is not the job of mainstream services.</p>
<h2>It’s time for change</h2>
<p>Culture is often blamed for domestic violence in refugee and migrant communities. </p>
<p>The category “culturally and linguistically diverse” continues to reinforce assumptions. This contributes to “othering” and can lead to small services being overstretched.</p>
<p>It’s time the voices of refugee and migrant women experiencing domestic violence are heard and <a href="https://edspace.american.edu/culturallysustainingclassrooms/wp-content/uploads/sites/1030/2017/09/Mapping-the-Margins.pdf">recognised in mainstream policies and programs</a>. Policies and services should critically reflect on the cultures and inequalities within mainstream systems.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/temporary-migrants-are-people-not-labour-46941">Temporary migrants are people, not 'labour'</a>
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</em>
</p>
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<img src="https://counter.theconversation.com/content/187164/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jenny Maturi has worked in domestic violence and refugee resettlement organisations, and was employed by a mainstream domestic violence organization while conducting this research (up until January 2020). While contacts helped to get the participation of some organisations for this research, most interview participants were unknown to the researcher. </span></em></p><p class="fine-print"><em><span>Jenny Munro receives funding from the Australian Research Council. </span></em></p>In Australia, the discussion around gendered violence is increasingly focused on diversity. However, policy and services continue to be based mostly on the experiences of white, Anglo-settler women.Jenny Maturi, Post Doctoral Research Fellow, School of Historical and Philosophical Inquiry, The University of QueenslandJenny Munro, Lecturer, School of Social Science, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1671802021-09-24T01:37:36Z2021-09-24T01:37:36ZBuilding trust with migrant and refugee communities is crucial for public health measures to work<figure><img src="https://images.theconversation.com/files/422596/original/file-20210922-17-wiu9jl.jpg?ixlib=rb-1.1.0&rect=8%2C26%2C5982%2C1841&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/wear-mask-collage-multiethnic-people-protective-1855056271">Shutterstock</a></span></figcaption></figure><p>During COVID-19 we’ve seen <a href="https://www.abc.net.au/news/2021-07-23/covid-19-racism-australia-report-racial-hatred-pandemic/100316184">racism and discrimination</a> against migrant and refugee communities erode trust between them and authorities.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1420883184695136256"}"></div></p>
<p>So as the Delta variant spreads, we must find ways to build that trust.</p>
<p>With greater trust, we can improve contact tracing and the chance of people following public health advice. This is essential if we are to help prevent more infection, illness and death.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/i-will-never-come-to-australia-again-new-research-reveals-the-suffering-of-temporary-migrants-during-the-covid-19-crisis-143351">'I will never come to Australia again': new research reveals the suffering of temporary migrants during the COVID-19 crisis</a>
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</p>
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<h2>More racism and discrimination</h2>
<p><a href="https://eccv.org.au/wp-content/uploads/2020/07/ECCV-Issues-Brief_Racism-during-COVID19.pdf">COVID-19 has exacerbated</a> existing tensions between some migrant and refugee communities and parts of the wider population, including government and health authorities.</p>
<p>Migrants have been <a href="https://www.redcross.org.au/getmedia/0a4ca4bb-c5b9-4b6b-89e9-ff90df3a01fc/Australian-Red-Cross-COVID-19-TempVisa-Report-web.pdf.aspx">blamed for spreading COVID-19</a>; international students <a href="https://www.sbs.com.au/news/racism-has-impacted-a-quarter-of-australia-s-international-students-during-the-pandemic/7ca33035-e4ae-4fa4-a969-bcc20c48c6c9">have faced racism</a>, and have reported <a href="https://internationaleducation.gov.au/International-network/Australia/InternationalStrategy/EGIProjects/Documents/ORYGEN%20-%20International%20Student%20Mental%20Health%20and%20Physical%20Safety%20June%202020.pdf">poor</a> mental and physical health; and people of Chinese background or those of “east Asian appearance” <a href="https://www.theguardian.com/australia-news/2020/jul/24/asian-australians-threatened-and-spat-on-in-racist-incidents-amid-coronavirus">have suffered</a> racist slurs and physical attacks.</p>
<p>Then there are the refugee communities of non-English speaking backgrounds. Many have arrived after experiencing war and human rights abuses by other governments only to face tough social distancing restrictions and the use of <a href="https://theconversation.com/using-military-language-and-presence-might-not-be-the-best-approach-to-covid-and-public-health-166019">police and military to enforce lockdowns</a> in Australia.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/using-military-language-and-presence-might-not-be-the-best-approach-to-covid-and-public-health-166019">Using military language and presence might not be the best approach to COVID and public health</a>
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</em>
</p>
<hr>
<p>This has led to <a href="https://www.redcross.org.au/getmedia/0a4ca4bb-c5b9-4b6b-89e9-ff90df3a01fc/Australian-Red-Cross-COVID-19-TempVisa-Report-web.pdf.aspx">some concerns</a> <a href="https://www.kaldorcentre.unsw.edu.au/publication/covid-19-some-issues-asylum-seekers-and-refugees-australia">about being</a> reported to government, having their visa cancelled, being detained or deported.</p>
<p>As a result of this past trauma and the risk of losing their temporary visa status, some people have been <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1753-6405.13134">reluctant to participate in contact tracing</a> and follow public health advice.</p>
<p>Making matters worse has been <a href="https://www.sbs.com.au/news/peta-credlin-apologises-for-inaccurately-blaming-south-sudanese-for-coronavirus-outbreak/c4ff46a9-8031-4314-b49a-ff5902133ed1">some media outlets</a> and <a href="https://www.crisconsortium.org/blog/resilience-and-social-cohesion-in-a-post-covid-world-multicultural-youth-perspectives">social media</a> sharing racist and harmful stereotypes.</p>
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<h2>Understand diversity</h2>
<p>Building trust requires recognising the diversity of communities. For example, the phrase “culturally and linguistically diverse” is often used to describe migrant and refugee communities of non-English speaking backgrounds. While the phrase has merit in some situations, it disguises differences between and among communities.</p>
<p>For instance, the term “migrant” refers to <a href="https://academic.oup.com/heapro/article/28/3/466/634183?login=true">people who have chosen to move</a> from one country or area to another. Migrants can include international students, business owners, professionals and those wanting to work and join family already living in Australia.</p>
<p>In contrast, refugees arrive after <a href="https://pubmed.ncbi.nlm.nih.gov/33090214/">suffering from psychological distress and trauma</a> due to war, torture and/or conflict. Some refugees may have lower levels of education, literacy and financial support.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-can-governments-communicate-with-multicultural-australians-about-covid-vaccines-its-not-as-simple-as-having-a-poster-in-their-language-156097">How can governments communicate with multicultural Australians about COVID vaccines? It's not as simple as having a poster in their language</a>
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</em>
</p>
<hr>
<p>Any projects aimed at <a href="https://www.vu.edu.au/sites/default/files/Sending%20the%20right%20message.pdf">communicating health information</a> with such communities need to learn about the variations and differences within and between them. Differences include varying levels of education, language and literacy skills, <a href="https://academic.oup.com/heapro/article/28/3/466/634183?login=true">preferences in old and new media</a>, and differing cultural understandings of health.</p>
<p>Some communities have a more <a href="https://pubmed.ncbi.nlm.nih.gov/26068509/">communal approach to health</a>, which influences how to best share information. Rights and access to government supports also differ, including <a href="https://www.ijhpm.com/article_4027.html">employment support and Medicare</a>.</p>
<h2>Engage with communities</h2>
<p>We can improve contact tracing, the sharing of public health advice and, most importantly, build trust, by <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-1352-y">better engaging</a> <a href="https://www.ceh.org.au/wp-content/uploads/2019/10/Consumer-Participation-and-CALD-Communities-ST-20191016.pdf">with communities</a>. </p>
<p>This means <a href="https://www.vu.edu.au/sites/default/files/Sending%20the%20right%20message.pdf">involving communities</a> in decision-making and how services are developed and delivered. Governments and health agencies should engage with communities and <a href="https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2019_018.pdf">ask them</a> what skills and support they need to manage the pandemic and daily life.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/28170406/">Bilingual community facilitators</a>, also known as <a href="https://www.cmy.net.au/wp-content/uploads/2020/02/Addressing-the-Strengths-and-Complexities-of-Bicultural-Youth-and-Family-.pdf">bicultural community workers</a>, <a href="https://www.speakmylanguageradio.com/facilitatorbios">may be needed</a>. These <a href="http://fecca.org.au/wp-content/uploads/2017/12/Australias-bilingual-and-bicultural-workforce-Report-2017.pdf">help bring together</a> community members and health agencies to moderate discussions, hold workshops, develop solutions and build relationships and trust for the long term. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-asked-multicultural-communities-how-best-to-communicate-covid-19-advice-heres-what-they-told-us-142719">We asked multicultural communities how best to communicate COVID-19 advice. Here's what they told us</a>
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</em>
</p>
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<h2>Know there’s more going on</h2>
<p>We can also build trust by improving access to training, education, employment, affordable housing and other social factors. These can <a href="https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1">help improve health outcomes</a>.</p>
<p>Without appropriate support and tailored health communications it’s more likely people will be forced to break COVID restrictions, like going to work when sick, or gather in family groups for support. Without understanding or trusting public health advice, contract tracing for COVID is much harder.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-some-people-dont-want-to-take-a-covid-19-test-141794">Why some people don't want to take a COVID-19 test</a>
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</em>
</p>
<hr>
<h2>Help grow stronger communities</h2>
<p>Communities of people with <a href="https://pubmed.ncbi.nlm.nih.gov/24297008/">migrant</a> and <a href="https://ijmhs.biomedcentral.com/articles/10.1186/s13033-021-00485-9">refugee</a> backgrounds can be supported to find their <a href="https://www.oecd.org/cfe/leed/44681969.pdf">own solutions</a> to the challenges and opportunities of everyday life.</p>
<p>This “capacity building” might include holding <a href="https://pubmed.ncbi.nlm.nih.gov/24297008/">workshops with families</a>, or supporting young people to <a href="https://myan.org.au/with-young-people/">develop their abilities as leaders</a>. For this to happen, governments need to work closely with <a href="https://fecca.org.au/grants/">non-government organisations</a>.</p>
<p>Such programs would help build stronger relationships within Australian society that help more people feel like they belong. With stronger relationships and <a href="https://pubmed.ncbi.nlm.nih.gov/30212870/">greater capacity in communities</a> to deal with health issues, more people are likely to trust the procedures of contact tracing and public health advice.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/understanding-how-african-australians-think-about-covid-can-help-tailor-public-health-messaging-164398">Understanding how African-Australians think about COVID can help tailor public health messaging</a>
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</em>
</p>
<hr>
<h2>Where to now?</h2>
<p>Health agencies, governments and others working with people from refugee and migrant communities can make real and positive differences by helping to build trust with migrant and refugee communities of non-English speaking backgrounds.</p>
<p>Our challenge now is doing this gradually and with care.</p>
<p>More respectful and sensitive engagement could be one of the most important ways we reduce the terrible illness and death from COVID, and combat the stigma and racism that has come with it.</p><img src="https://counter.theconversation.com/content/167180/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Devaki Monani has previously received funding from NSW Multicultural Health Communication Service </span></em></p><p class="fine-print"><em><span>Ben O'Mara has previously received funding from VicHealth, the Department of Heath and Ageing and the Australian and New Zealand School of Government. O'Mara also works as the Information Resources Manager at Motor Neurone Disease Australia.</span></em></p><p class="fine-print"><em><span>Gemma Carey does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Without appropriate support, it’s more likely people will break COVID restrictions, for example go to work, or gather in family groups for support.Devaki Monani, Lecturer, Social Work, Charles Darwin UniversityBen O'Mara, Adjunct Research Fellow, Swinburne University of TechnologyGemma Carey, Associate Professor, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1653072021-07-30T04:42:31Z2021-07-30T04:42:31ZNo wonder people are confused. Most official COVID vaccine advice is way too complex<figure><img src="https://images.theconversation.com/files/413894/original/file-20210730-21-1ip43oh.jpg?ixlib=rb-1.1.0&rect=2%2C0%2C995%2C667&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/beautiful-elderly-woman-looking-smartphone-288866810">from www.shutterstock.com</a></span></figcaption></figure><p>As Sydney’s COVID-19 outbreak continues to grow, the message has shifted to urgently “get the jab”. And people’s motivation to get vaccinated <a href="https://www.abs.gov.au/statistics/people/people-and-communities/household-impacts-covid-19-survey/latest-release">is increasing</a>.</p>
<p>But with ever-changing advice, many people are confused about which vaccine they’re eligible for and where to get an appointment.</p>
<p><a href="https://www.mja.com.au/journal/2021/coronavirus-covid-19-vaccination-information-must-pay-attention-health-literacy">Our recent review</a>, which has been accepted for publication in the Medical Journal of Australia, shows information for the public about COVID vaccines is too complex to read, understand and act upon. It’s even more complex than other COVID public health advice, such as for physical distancing or masks. </p>
<p>Then there’s the results of <a href="https://mfr.au-1.osf.io/render?url=https://osf.io/ehvxm/?direct%26mode=render%26action=download%26mode=render">our recent survey</a>, which has yet to be peer reviewed, of where people from culturally and linguistically diverse (CALD) communities get their COVID information from. This finds a huge diversity of sources, beyond official government websites. So we need to tailor communications to these communities via channels people actually use.</p>
<p>Taken together, our research shows we are still missing clear and consistent communication about COVID vaccines all Australians can understand and act on.</p>
<h2>No wonder people are confused</h2>
<p>We looked at publically available COVID-19 information from government websites from Australia (federal and three states), the United Kingdom, New Zealand, and three international public health agencies (including the World Health Organization).</p>
<p>Most public information was above the recommended reading level for the general population (<a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/6dead9da-d1c2-4cbf-9568-74d2131df162/EngagingwithConsumersCarersandCommunityGuide%26Resources_Apr+2021+%281%29.pdf?MOD=AJPERES&amp;CACHEID=ROOTWORKSPACE-6dead9da-d1c2-4cbf-9568-74d2131df162-nzJQsT1">8th grade</a>). </p>
<p>In Australia, information was commonly written at postgraduate level. This means it is too difficult for people with average reading ability to understand. It’s likely even harder for the <a href="https://www.abs.gov.au/ausstats/abs@.nsf/mf/4233.0">9 million Australians</a> who have lower health literacy.</p>
<p>Vaccination information from the <a href="https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines">federal government website</a> was the only Australian material to adequately outline the action or steps readers needed to take to get vaccinated. Websites from all three states (New South Wales, Queensland, Victoria) we reviewed did not.</p>
<p>This means there has been little progress nationally or internationally in terms of improving the readability of written COVID-19 information <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2769382">since April 2020</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/yes-adult-literacy-should-be-improved-but-governments-can-make-their-messages-easier-to-read-right-now-164621">Yes, adult literacy should be improved. But governments can make their messages easier to read right now</a>
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</p>
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<h2>Culturally and linguistically diverse Australians</h2>
<p>Our review does not begin to capture the additional limitations of COVID-19 communications for CALD communities. </p>
<p>People from CALD backgrounds form a significant and growing share of Australia’s population. For instance, <a href="https://www.swslhd.health.nsw.gov.au/pdfs/SWS%20Our%20Health%20in%20brief.pdf">43% of the population</a> of southwest Sydney (one of the focuses of the current COVID-19 outbreak) was born overseas; up to 71% in certain local government areas speak a language other than English at home.</p>
<p>Yet, translated information and communications about COVID-19 have been sparse, intermittent and not all has <a href="https://www.abc.net.au/news/2020-11-19/government-used-google-translate-for-nonsensical-covid-19-tweet/12897200">been appropriate</a>. The original source materials in English are too complex, official translators are not used, and/or translations are not reviewed to make sure the information makes sense.</p>
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<h2>There has been some progress</h2>
<p>We’ve had some progress this week. Press briefings, crucially important for keeping up-to-date about new rules and regulations, have only in the past few days been <a href="https://www.sbs.com.au/news/sbs-is-now-interpreting-nsw-covid-19-press-conferences-live-in-languages-other-than-english">made available</a> in any other language than English.</p>
<p>Similarly, the online <a href="https://covid-vaccine.healthdirect.gov.au/?lang=en">vaccination eligibility checker</a> has only just been translated into 15 other languages. However, the online vaccine clinic finder, which you reach at end of the vaccine eligibility checker, remains only in English. </p>
<p>More positively, a <a href="https://www.mhcs.health.nsw.gov.au/glossary/covid-19-glossary">COVID-19 vaccination glossary</a> (with clear descriptions of complex vaccine terms) is now available in 29 languages.</p>
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<h2>But more work is needed</h2>
<p>However, more work is needed to ensure COVID information is “distributed widely” to CALD communities via the most appropriate channels, as recommended in the Australian government’s <a href="https://www.health.gov.au/sites/default/files/documents/2021/02/covid-19-vaccination-program-culturally-and-linguistically-diverse-communities-implementation-plan_0.pdf">own plan</a>.</p>
<p>Our <a href="https://mfr.au-1.osf.io/render?url=https://osf.io/ehvxm/?direct%26mode=render%26action=download%26mode=render">recent survey</a> of over 700 CALD community members in Greater Western Sydney showed just over half (about 54%) of participants used official government sources to find out about COVID-19. However, this varied greatly between language groups, reaching as low as 29% for some. </p>
<p>Social media (52%), family and friends (33%), and community sources (26%) were also common pathways for seeking out information about COVID. Many sought in-language communication from overseas. For some of these groups, official sources appear less accessible or useful. </p>
<p>So work is clearly needed to distribute tailored communications via channels people actually use.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/multilingual-australia-is-missing-out-on-vital-covid-19-information-no-wonder-local-councils-and-businesses-are-stepping-in-141362">Multilingual Australia is missing out on vital COVID-19 information. No wonder local councils and businesses are stepping in</a>
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<h2>What actually works?</h2>
<p>We know how to communicate public health messages clearly for <a href="https://www.croakey.org/an-urgent-call-for-governments-to-improve-pandemic-communications-and-address-health-literacy-concerns/">diverse communities</a>. We can:</p>
<ul>
<li><p><a href="https://www.cdc.gov/other/pdf/everydaywordsforpublichealthcommunication.pdf">use</a> everyday words for all public health communication</p></li>
<li><p><a href="http://www.online-utility.org/english/readability_test_and_improve.jsp">test readability levels</a> of written documents</p></li>
<li><p><a href="https://www.ahrq.gov/sites/default/files/publications/files/pemat_guide.pdf">check the “actionability” of instructions</a> (whether there are clear instructions of what to do next)</p></li>
<li><p>use <a href="https://www.sciencedirect.com/science/article/pii/S073839912030197X?dgcid=rss_sd_all">pictures, icons </a>or animations.</p></li>
</ul>
<p>We know it is possible to successfully implement these strategies. Our review identified 12 “easy-to-read” <a href="https://www.health.gov.au/sites/default/files/documents/2021/07/covid-19-vaccination-side-effects-you-might-have-after-your-vaccination-easy-read.pdf">materials</a> written at a lower reading grade that were easier to understand.</p>
<p>However, these were rare, difficult to find on official websites and often poorly signposted. For instance, some were on pages labelled for “<a href="https://www.coronavirus.vic.gov.au/information-people-disability-coronavirus-disease-covid-19">people with disability</a>”. </p>
<p>We need concerted action to ensure materials such as these become the “rule” rather than the exception. Plain language and in-language information simply cannot be an afterthought or “optional extra” if we are to achieve the <a href="https://theconversation.com/australia-shouldnt-open-up-before-we-vaccinate-at-least-80-of-the-population-heres-why-165073">80% or higher</a> vaccination rates needed to end lockdowns and return to some semblance of normal.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australia-shouldnt-open-up-before-we-vaccinate-at-least-80-of-the-population-heres-why-165073">Australia shouldn't ‘open up’ before we vaccinate at least 80% of the population. Here's why</a>
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<img src="https://counter.theconversation.com/content/165307/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Danielle Marie Muscat receives funding from Western Sydney Local Health District through a Westmead Fellowship (Early Career Researcher). </span></em></p><p class="fine-print"><em><span>Julie Ayre, Kirsten McCaffery, and Olivia Mac do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Our research shows we are still missing clear and consistent communication about COVID vaccines all Australians can understand and act on.Danielle Marie Muscat, Post-Doctoral Research Fellow, University of SydneyJulie Ayre, Post Doctoral Research Fellow, University of SydneyKirsten McCaffery, NHMRC Principal Research Fellow, University of SydneyOlivia Mac, Research fellow, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1560972021-03-01T04:39:58Z2021-03-01T04:39:58ZHow can governments communicate with multicultural Australians about COVID vaccines? It’s not as simple as having a poster in their language<p>Australia launched its COVID-19 vaccination campaign last week, beginning with frontline workers in hotel quarantine, health care and aged care.</p>
<p>But one critical question is whether the immunisation program will meet the needs of people from culturally and linguistically diverse (CALD) backgrounds.</p>
<p>People from CALD backgrounds form a significant and growing share of Australia’s frontline workforce. This is especially true for aged, disability and community care, as well as hotel quarantine. </p>
<p>For example, 37% of Australian frontline care workers were <a href="https://www.arts.unsw.edu.au/sites/default/files/documents/Migrant%20Workers%20in%20Frontline%20Care.pdf">born overseas</a> according to 2016 statistics. Around 28% are from non‐English‐speaking backgrounds.</p>
<p>Others may have low health literacy skills or find it challenging to track down and understand information about COVID vaccines. Lower health literacy is associated with a <a href="https://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(20)30559-4.pdf">reluctance to accept vaccines</a>. Recent studies also suggest those who speak a language other than English at home are <a href="https://www.medrxiv.org/content/10.1101/2021.02.17.21251957v1">less willing</a> to get vaccinated than those who speak English only. </p>
<p>It’s critical we deliver a program aligned with the needs of CALD communities to ensure high levels of public confidence in the COVID vaccine rollout.</p>
<p>To achieve this, in February the federal government <a href="https://www.health.gov.au/resources/publications/covid-19-vaccination-program-culturally-and-linguistically-diverse-communities-implementation-plan">released a plan</a> to ensure COVID vaccine rollout information and services are accessible for CALD communities.</p>
<p>The plan outlines the need for clear messaging that’s inclusive, tailored and translated. It also emphasises the importance of working with community leaders and multicultural community organisations. </p>
<p><a href="https://sph.med.unsw.edu.au/sites/default/files/sphcm/News/Enhancing-supporting-COVID-19-vaccination-program.pdf">Our new research</a>, published today, supports the actions outlined in the plan but also highlights areas needing more focus.</p>
<p>We interviewed people working in multicultural and refugee agencies, as well as stakeholders in CALD community organisations, to understand barriers around communication and engagement during the pandemic.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/can-i-choose-what-vaccine-i-get-what-if-i-have-allergies-or-side-effects-key-covid-vaccine-rollout-questions-answered-155649">Can I choose what vaccine I get? What if I have allergies or side-effects? Key COVID vaccine rollout questions answered</a>
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</em>
</p>
<hr>
<h2>Information gaps</h2>
<p>Our research found gaps in information available during the pandemic. For example, there have been delays in making translations available.</p>
<p>Many people have sought information and news from their countries of origin to fill these gaps. This information may be irrelevant to the Australian situation, or contradictory to local recommendations. </p>
<p>There’s a divide between governments and individuals, with some people feeling like they’ve been left behind. Issues such as an inability to navigate government websites or difficulties accessing support have contributed to this divide.</p>
<p>Translated COVID information hasn’t always <a href="https://www.abc.net.au/news/2020-11-19/government-used-google-translate-for-nonsensical-covid-19-tweet/12897200">been appropriate</a> for people with low literacy or low health literacy levels. This stems from the original source materials in English not being suitable, or translations not being reviewed to make sure the information makes sense.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1329142181118894085"}"></div></p>
<p>Newly arrived migrant communities are most in need, as many don’t have established networks to support them. Translated resources have mostly been developed for larger, established CALD groups rather than new and emerging communities. There’s been a lack of tailoring in how messages and information are communicated, and ethnic newspapers and media haven’t been effectively used. </p>
<p>Some people are worried they’ll lose their jobs if they refuse to get vaccinated. The challenge is they don’t have anyone to ask questions of, and are unable to access trustworthy material online.</p>
<p>One issue that was repeatedly raised was burnout experienced by community leaders and other stakeholders. These leaders are asked to repeatedly translate, turn “government speak into community speak”, spread messages and answer questions. They take on this role in addition to their normal responsibilities, with little to no financial support and often with an emotional burden.</p>
<p>The federal government’s plan recognises we need to work with community leaders, but little detail has been provided about whether support, training or resources will be available.</p>
<figure class="align-center ">
<img alt="Health-care worker giving patient a vaccine" src="https://images.theconversation.com/files/386874/original/file-20210228-21-1ihw1bi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/386874/original/file-20210228-21-1ihw1bi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/386874/original/file-20210228-21-1ihw1bi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/386874/original/file-20210228-21-1ihw1bi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/386874/original/file-20210228-21-1ihw1bi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/386874/original/file-20210228-21-1ihw1bi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/386874/original/file-20210228-21-1ihw1bi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Community leaders play a crucial role in disseminating COVID information, but they need to be adequately supported or they risk burning out.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Here’s how things could change</h2>
<p>Beyond the need to support community leaders, we also heard from participants about ways to improve communication and vaccine delivery. </p>
<p>Our research team makes a number of recommendations, including the need to:</p>
<ul>
<li><p>identify other community ambassadors and provide training to build their knowledge and confidence</p></li>
<li><p>employ bilingual engagement officers from local communities, to support action being taken by communities themselves. Similar engagement officers have been used to support participation in Australian Bureau of Statistics data collection. <a href="http://mccsa.org.au/2020/10/become-a-census-engagement-manager/">Census engagement officers</a> work within communities telling people about the census and ensuring everyone can take part and get the help they need. Internationally, this strategy has been used to promote <a href="https://www.tandfonline.com/doi/full/10.1080/02589001.2020.1746747">HIV testing and counselling</a> by encouraging community members to talk about the issues</p></li>
<li><p>invite local CALD communities to initiate and host forums in media of their choice, and to ensure government officials are available to answer questions</p></li>
<li><p>develop a glossary of immunisation terms. This would enable standard terminology relevant to COVID for community organisations, community and faith-based leaders, translators and interpreters</p></li>
<li><p>set up vaccination clinics in locations where communities feel safe. This could include outdoor facilities, sports clubs, community centres, faith-based locations and schools. Ensure there are transport options available</p></li>
<li><p>undertake ongoing surveys to capture how CALD communities feel, think and act in relation to the Australian COVID vaccination program. Tailoring messages will only be effective when informed by the issues that communities are actually concerned about </p></li>
<li><p>and support alliances between immunisation experts and those working in refugee health and multicultural services.</p></li>
</ul>
<p>Participants repeatedly used the phrase “community ownership” during the interviews. It’s critical to genuinely engage communities in the development and testing of communication messages, images and videos. It’s also critical we work with different communities to identify the best ways to pass on information.</p>
<p>And when it comes down to it, <a href="https://www.huffingtonpost.com.au/entry/coronavirus-australia-multicultural_au_5ef41498c5b66c312681ee10">word of mouth messages</a> and conversations may be the most effective way to get people involved with the COVID vaccine program.</p>
<p>By supporting the development of community ambassadors to address misinformation and concerns about vaccine safety at a local level, the government will have the best chance of ensuring information reaches those who need it.</p><img src="https://counter.theconversation.com/content/156097/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Holly Seale receives funding from the NHMRC and has previously received funding for investigator driven research and workshop delivery from Sanofi Pasteur and Seqirus. She is the Deputy Chair of the Collaboration on Social Science and Immunisation. </span></em></p><p class="fine-print"><em><span>Abela Mahimbo has received funding from GSK for investigator driven research.</span></em></p><p class="fine-print"><em><span>Ben Harris-Roxas receives funding from NSW Health and the National Health and Medical Research Council. In the past he has received funding from the Australian Research Council, the World Health Organization, the Australian Government Department of Health, the Public Health Agency of Canada, the Heart Foundation, NPS MedicineWise, the Sax Institute and the City of Gold Coast.</span></em></p><p class="fine-print"><em><span>Nadia Chaves has previously received funding from the National Health and Medical Research Council, Monash University and the Victorian Department of Health. Nadia also works as a senior medical advisor in the Department of Health Victoria. The information in this article has not been obtained through her department of health role.</span></em></p>Our new research found gaps in COVID information available to culturally and linguistically diverse communities. But there are ways we can improve — because community ownership is crucial.Holly Seale, Associate professor, UNSW SydneyAbela Mahimbo, Lecturer in Public Health, University of Technology SydneyBen Harris-Roxas, Associate Professor, UNSW SydneyNadia Chaves, Casual Academic, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1149172019-06-13T02:10:16Z2019-06-13T02:10:16ZOur culture affects the way we look after ourselves. It should shape the health care we receive, too<figure><img src="https://images.theconversation.com/files/277343/original/file-20190531-69055-yf9kqq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Australia is a multicultural society, and our health services need to be designed accordingly.</span> <span class="attribution"><span class="source">From shutterstock.com</span></span></figcaption></figure><p><em>This article is the final part in a series, <a href="https://theconversation.com/au/topics/where-culture-meets-health-70226">Where culture meets health</a>.</em></p>
<hr>
<p>For South Asians, there’s a distinct difference between “rice with curry” and “curry with rice”. When we spoke to <a href="https://www.sciencedirect.com/science/article/pii/S019566631730716X?via%3Dihub">Indian and Sri Lankan migrants</a> with type 2 diabetes and heart disease, they told us the advice they received on ways to reduce the quantity of staples like rice in their diet was difficult to implement. </p>
<p>This was because it doesn’t match with their perception of a “proper” meal – that is, a lot of rice and a little bit of curry. Receiving dietary advice not tailored to their cultural needs created a feeling that clinicians didn’t understand the social value they placed on traditional foods. </p>
<p>This acted as a barrier to effectively managing their diets, and in turn, their conditions.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australias-ethnic-face-is-changing-and-so-are-our-blood-types-113454">Australia’s ethnic face is changing, and so are our blood types</a>
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<p>While <a href="https://www.abs.gov.au/ausstats/abs@.nsf/lookup/Media%20Release3">Australia’s multiculturalism</a> enhances the fabric of society, the health outcomes of some of Australia’s culturally and linguistically diverse groups <a href="https://www.sciencedirect.com/science/article/pii/S019566631730716X?via%3Dihub">are poor in comparison</a> to the majority population. We looked at type 2 diabetes and heart disease partly because these conditions are experienced more commonly in migrant groups.</p>
<p>Importantly, people from culturally and linguistically diverse backgrounds tend to have <a href="https://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Main+Features20June+2009">lower levels of health literacy</a> than people born in Australia. People with lower health literacy are <a href="https://journals.sagepub.com/doi/full/10.1177/0017896918792700">less likely to access health care</a>, and more likely to mismanage chronic health conditions (for example, by misinterpreting medical advice or medicine dosage instructions, or having a limited sense of severity of disease).</p>
<p>It’s imperative to consider cultural and language differences if we want to achieve the best health outcomes for our diverse population.</p>
<h2>Language is just the start</h2>
<p>Providing interpreting services in the patient’s language is important, but not the only consideration. Even when someone is well-versed in English, medical terminology or jargon can be hard to comprehend. </p>
<p>In addition, conceptualisations of health and illness and ways of expressing these vary across cultural and language groups.</p>
<p>For example, a common expression for psychosomatic symptoms (where there may be no disease, but physical symptoms such as nausea may be related to mental stress) in either Hindi or Punjabi, is <em>dil</em> (heart) <em>doob</em> (sinking) <em>raha hai</em> (is).</p>
<p>This <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC80253/">implies generalised illness</a>, but its direct English translation would be “a sinking heart”. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/nearly-1-in-4-of-us-arent-native-english-speakers-in-a-health-care-setting-interpreters-are-essential-115125">Nearly 1 in 4 of us aren't native English speakers. In a health-care setting, interpreters are essential</a>
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</em>
</p>
<hr>
<p>Another example is the <a href="https://theconversation.com/when-treating-sports-injuries-does-the-west-do-it-best-90526">use of ice</a> on an acute injury. This is often seen as going against traditional Chinese medicine principles, upsetting the balance between Yin and Yang energies.</p>
<p>So the focus needs to go beyond language and include broader cultural considerations. For health professionals, this can be achieved by establishing trust with the patient and their family. It means being attuned, respectful and responsive to cultural differences in understandings of disease.</p>
<h2>Can someone really be trained to be ‘culturally competent’?</h2>
<p>Cultural competency is the ability to work effectively with culturally and linguistically diverse populations.</p>
<p>Many professionals – not only health professionals – should now be aware of the term, with the recent proliferation of <a href="https://www.sbs.com.au/learn/cultural-competence-program">cultural competency training packages</a>. These programs are designed to train staff to become more culturally competent by providing information about various cultures.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/277821/original/file-20190604-69071-1hmd0sd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/277821/original/file-20190604-69071-1hmd0sd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/277821/original/file-20190604-69071-1hmd0sd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/277821/original/file-20190604-69071-1hmd0sd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/277821/original/file-20190604-69071-1hmd0sd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/277821/original/file-20190604-69071-1hmd0sd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/277821/original/file-20190604-69071-1hmd0sd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People from different cultural backgrounds have different understandings of health and illness.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
</figcaption>
</figure>
<p>While these training packages are a good source of information, whether completing the package is enough to deem a person “culturally competent” is questionable. </p>
<p>Many such packages are delivered within a short time frame, leaving little scope for individual learners to reflect on their practices and develop practical strategies around how they can be more culturally responsive. </p>
<p>And these packages <a href="https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-14-99">rarely include any follow-up assessments</a> or evaluation to ascertain if their completion actually promotes more culturally responsive clinical practice.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/between-health-and-faith-managing-type-2-diabetes-during-ramadan-115469">Between health and faith: managing type 2 diabetes during Ramadan</a>
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</em>
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<p>While mandating training is an efficient way to <a href="https://www.sciencedirect.com/science/article/pii/S147159530900047X?via%3Dihub">ensure practice improvement</a> and meet accreditation requirements, it can <a href="https://www.magonlinelibrary.com/doi/abs/10.12968/bjhc.2011.17.11.522">turn people away</a> from being engaged with the learning.</p>
<p>Instead of mandating training, the focus should be on facilitating staff engagement with diverse groups. This might include celebrating cultural diversity by perhaps holding a diversity day in the workplace, where people are encouraged to showcase their cultures through performances, food and traditional outfits. </p>
<p>People need to develop an interest in engaging with culturally and linguistically diverse groups before being motivated to complete training.</p>
<h2>Partnership and participation</h2>
<p>Apart from equipping staff with knowledge and skills, we need to create a safe and respectful environment where people from culturally and linguistically diverse communities feel empowered to voice their opinions.</p>
<p>Strong partnerships between government, organisations and communities should see a gradual improvement in the engagement of people from culturally and linguistically diverse communities in health-care activities.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/aboriginal-australians-want-care-after-brain-injury-but-it-must-consider-their-cultural-needs-115128">Aboriginal Australians want care after brain injury. But it must consider their cultural needs</a>
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<p>While cultural competency implies a skill that can be perfected, <a href="http://iaha.com.au/wp-content/uploads/2015/08/2015-IAHA-Cultural-Responsiveness-Framework-WEB.pdf">cultural responsiveness</a> suggests provision of culturally appropriate care is an ongoing process involving self reflection and lifelong learning. </p>
<p>So rather than striving to be culturally competent, it may be more realistic to work towards the provision of culturally responsive health services.</p><img src="https://counter.theconversation.com/content/114917/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>By working together with culturally and linguistically diverse groups, health services can position themselves to deliver culturally responsive care to our multicultural population.Sabrina Gupta, Associate lecturer, School of Psychology and Public Health, La Trobe UniversityClarice Tang, Senior lecturer in Physiotherapy, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1151252019-05-12T20:13:37Z2019-05-12T20:13:37ZNearly 1 in 4 of us aren’t native English speakers. In a health-care setting, interpreters are essential<figure><img src="https://images.theconversation.com/files/273712/original/file-20190509-183109-2wqvok.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Interpreters enable patients to be fully informed about their health condition and options for treatment.</span> <span class="attribution"><span class="source">From shutterstock.com</span></span></figcaption></figure><p><em>This article is the third part in a series, <a href="https://theconversation.com/au/topics/where-culture-meets-health-70226">Where culture meets health</a>.</em></p>
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<p>Almost <a href="http://www.abs.gov.au/ausstats/abs@.nsf/lookup/Media%20Release3">one quarter</a> of the Australian population speaks a language other than English at home. But health services in Australia are largely delivered in English only. </p>
<p>We know Australians from culturally and linguistically diverse backgrounds are <a href="https://www.tandfonline.com/doi/full/10.3109/09638288.2015.1062925?casa_token=6DPh6EAnh08AAAAA:40VGPHoQ40YQVjGxeOhSDd8iBfRK1LaWzygGoCaW-65BYWmZiM9mfHXuqySS7QmSZmQBdvu17q3GmBk">less likely to access health services</a>, which leads to poorer health outcomes. One major reason for this is the <a href="https://www.tandfonline.com/doi/full/10.3109/09638288.2015.1062925?casa_token=6DPh6EAnh08AAAAA:40VGPHoQ40YQVjGxeOhSDd8iBfRK1LaWzygGoCaW-65BYWmZiM9mfHXuqySS7QmSZmQBdvu17q3GmBk">language barrier</a> between health-care providers and consumers.</p>
<p>Access to interpreters in health care should be seen as a basic human right.</p>
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<p>
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Read more:
<a href="https://theconversation.com/translation-technology-is-useful-but-should-not-replace-learning-languages-85384">Translation technology is useful, but should not replace learning languages</a>
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</p>
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<h2>Interpreters benefit both patients and practitioners</h2>
<p>Interpreters are a vital bridge between health services and consumers. Interpreters enable consumers to be fully informed about their health condition and options for treatment.</p>
<p>They also give consumers a voice to express themselves freely in their dominant language. This means people can share exactly what they need to say to health-care professionals and can ask the questions they want answered. </p>
<p>Research has found the use of professional interpreters <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1955368/">improves the experience</a> of medical care for patients with limited English proficiency.</p>
<p>The use of professional interpreters <a href="https://www.researchgate.net/profile/Glenn_Flores/publication/221713079_Errors_of_Medical_Interpretation_and_Their_Potential_Clinical_Consequences_A_Comparison_of_Professional_Versus_Ad_Hoc_Versus_No_Interpreters/links/59ef2344aca2721ca5e7b949/Errors-of-Medical-Interpretation-and-Their-Potential-Clinical-Consequences-A-Comparison-of-Professional-Versus-Ad-Hoc-Versus-No-Interpreters.pdf">significantly reduces the risk</a> of communication errors that can lead to <a href="http://www.mighealth.net/eu/images/6/61/Flores1.pdf">negative clinical consequences</a>. Errors could include gaps in information about patient allergies, and instructions around the use of prescription medicines being misconstrued.</p>
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<p>
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Read more:
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<p>But failure to provide access to interpreters in health settings can <a href="http://fecca.org.au/wp-content/uploads/2015/06/FECCA-Mosaic-40_LR.pdf">literally be a matter of life or death</a>. </p>
<p>Particularly in an emergency, if a patient and their loved ones are unable to communicate details about the patient’s medical situation to the treating doctors, this may impact whether the patient receives appropriate and timely treatment. </p>
<p>In <a href="http://fecca.org.au/wp-content/uploads/2015/06/FECCA-Mosaic-40_LR.pdf">one case</a> in the United States, a hospital acted on advice provided by a Spanish-speaking family with limited English proficiency when admitting their son. A court found language confusion contributed to delayed diagnosis of a brain haemmorhage, which resulted in the patient becoming a paraplegic.</p>
<h2>But not everyone is given access to an interpreter</h2>
<p>Despite the benefits of using an interpreter, <a href="https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-018-3135-5">a recent study in a Sydney hospital</a> found although interpreters were required in 15.7% of admissions, just 3.7% of patients were actually provided with an interpreter.</p>
<p>A person who needs an interpreter <a href="http://www.publish.csiro.au/PY/PY10075">may not get one</a> because they’re deemed not to require the service, because an interpreter can’t be sourced <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4284281/">within the required timeframe</a> (for example, in emergency situations), or because there’s no interpreter available in the language or dialect required by the patient.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/273713/original/file-20190510-183083-t4704t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/273713/original/file-20190510-183083-t4704t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/273713/original/file-20190510-183083-t4704t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/273713/original/file-20190510-183083-t4704t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/273713/original/file-20190510-183083-t4704t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/273713/original/file-20190510-183083-t4704t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/273713/original/file-20190510-183083-t4704t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Patients who need interpreters aren’t always able to access them.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
</figcaption>
</figure>
<p>The use of interpreters in regional, rural and remote Australia may be even lower given the <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1440-1584.2000.tb00354.x">lack of available interpreters in those areas</a>. </p>
<p>When health professionals and consumers don’t speak the same language, delivering health services without an interpreter raises a number of ethical issues. </p>
<p>For example, if a person is unable to understand what is being said to them by a health-care practitioner, <a href="http://www.publish.csiro.au/PY/PY10075">they can’t give their informed consent</a>. Proceeding with any treatment without informed consent is in breach of the <a href="https://www.medicalboard.gov.au/documents/default.aspx?record=WD10%2F1277&dbid=AP&chksum=eNjZ0Z%2FajN7oxjvHXDRQnQ%3D%3D">code of conduct</a> of all health professions in Australia. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-cultural-assumptions-behind-western-medicine-7533">The cultural assumptions behind Western medicine</a>
</strong>
</em>
</p>
<hr>
<h2>Family members as interpreters</h2>
<p>The Australian government funds the provision of professional interpreters in health-care settings <a href="http://fecca.org.au/wp-content/uploads/2015/06/FECCA-Mosaic-40_LR.pdf">free of charge</a>. But professional interpreters are not always on hand when they are needed. This often results in the use of <a href="http://www.publish.csiro.au/PY/pdf/PY10075">family members as interpreters</a>. </p>
<p>This practice is fraught with issues and in some instances this can do <a href="http://fecca.org.au/wp-content/uploads/2015/06/FECCA-Mosaic-40_LR.pdf">more harm than good</a> for both the interpreter and the patient. </p>
<p>Relatives don’t have <a href="https://pdfs.semanticscholar.org/45d8/0d2e4a5c90165aa97c4fe44840e51ddd5b81.pdf">formal training as interpreters</a> and may not be familiar with the medical terminology being used or how to translate it. </p>
<p>Family members <a href="https://www.researchgate.net/profile/Janette_Vardy/publication/51216567_Interpretation_in_Consultations_With_Immigrant_Patients_With_Cancer_How_Accurate_Is_It/links/56e98c5708ae25ede8309847.pdf">may add their own interpretation or opinion</a> in the delivery of the message, thereby not delivering the message intended by the health-care practitioner or the patient.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/273717/original/file-20190510-183080-1x0tnhm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/273717/original/file-20190510-183080-1x0tnhm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/273717/original/file-20190510-183080-1x0tnhm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/273717/original/file-20190510-183080-1x0tnhm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/273717/original/file-20190510-183080-1x0tnhm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/273717/original/file-20190510-183080-1x0tnhm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/273717/original/file-20190510-183080-1x0tnhm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Children and teenagers often act as translators for their older relatives.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
</figcaption>
</figure>
<p>In many migrant families, <a href="https://www.jstor.org/stable/pdf/10.1525/sp.2003.50.4.505.pdf?casa_token=NPy--uoOIcUAAAAA:Oftz7TOvwhskv81y3ttj4qVP7gno8cbSCX_F9hNS4Xvsel3FYCjEFv6sI4ZRRV3Lv57gNo_JIqwu20gNBhVYPw1Fkwhxsz30KOchRr5Hl9XrkugZJYqbNA&seq=1#page_scan_tab_contents">children or young adults</a> have the best knowledge of English in the family and so are often called upon to be the interpreter. The use of underage interpreters raises further ethical issues as they are tasked with interpreting sensitive health information about a loved one. </p>
<p>So caution is needed when using family members as interpreters.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australias-ethnic-face-is-changing-and-so-are-our-blood-types-113454">Australia’s ethnic face is changing, and so are our blood types</a>
</strong>
</em>
</p>
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<h2>How can the use of interpreters be increased and improved?</h2>
<p>There are some key actions that should be taken to improve health-care experiences and outcomes for people with limited English proficiency.</p>
<p>First, training for both interpreters and health-care professionals is essential to develop skills for effective collaboration.</p>
<p>Second, there should be <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/1460-6984.12112">additional time allocated for appointments</a> where interpreters are used. This is because each sentence must be said twice during the exchange of information and time is needed for <a href="https://www.bookdepository.com/Collaborating-with-Interpreters-Translators-Henriette-W-Langdon/9781888222760?ref=grid-view">briefing and debriefing about the session</a>.</p>
<p>Third, health services need to collect accurate information to determine whether an interpreter <a href="https://www.ceh.org.au/assessing-the-an-interpreter/">is needed</a>. A person may present with functional English <a href="https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-018-3135-5">but still require an interpreter</a> for ease of communication given the complex terminology and the seriousness of medical conversations.</p>
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<p>
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Read more:
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<p>And finally, professionally trained interpreters must be available in the languages and dialects required. There are <a href="http://www.abs.gov.au/ausstats/abs@.nsf/lookup/Media%20Release3">more than 300 languages spoken in Australia</a> and many have multiple dialects.</p>
<p>Investment in interpreting services is essential to ensure the provision of equitable, high quality health care to all Australians. In a country where interpreters may improve care for one quarter of the population, we can’t afford not to.</p><img src="https://counter.theconversation.com/content/115125/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Verdon does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Interpreters are essential in providing ethical and high quality health care to Australia’s culturally and linguistically diverse population.Sarah Verdon, Research Fellow and Senior Lecturer in Speech and Language Pathology, Charles Sturt UniversityLicensed as Creative Commons – attribution, no derivatives.