Abstract
Background: As the rates of infection and mortality from COVID-19 have been higher in minority groups, the communication of health information in a way that is understood and accepted is of particular importance.Aims: To provide health professionals with a clinical practice guideline for clear and culturally sensitive communication of health information about COVID-19 to people of Indigenous and culturally and linguistically diverse (CALD) backgrounds.Assessment of Guideline Options: The authors conducted a review of the literature on health communication, and the guidelines were developed with particular reference to the SPIKES protocol of “breaking bad news” in oncology and the use of the DSM-5 Cultural Formulation Interview (CFI).Actionable Recommendations: The guideline combines two approaches, the Cultural Formulation Interview, developed for DSM-5, and the SPIKES protocol used for delivering “bad news” in oncology. The combined CFI-SPIKES protocol is a six-step clinical practice guideline that includes the following: (1) Set up (S) the interview; (2) Determine how the patient perceives the problem (P) using the Cultural Formulation Interview (CFI) to elicit the patient's cultural perception of the problem; (3) Obtain an invitation (I) from the patient to receive a diagnosis; (4) Provide the patient knowledge (K) of diagnosis in a non-technical way; (5) Address the patient's emotional reaction (E) to diagnosis; and (6) Provide the patient a summary (S) of healthcare and treatment.Conclusions and Relevance: This article presents guidelines for assessing the cultural dimensions of patients' understanding of COVID-19 and delivering diagnostic and treatment recommendations in ways that are culturally safe and responsive, such as: (a) suspending the clinician's own cultural biases to understand the explanatory models and cultural values of their CALD or Indigenous patients; (b) encouraging the use of interpreters or cultural brokers to ensure that that the message is delivered in a way that the patient can understand; and (c) encouraging CALD or Indigenous patient to take an active part in the solution and treatment adherence, to minimize transmission of COVID-19 in CALD and Indigenous communities.
Highlights
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, referred to as COVID-19) continues to spread worldwide
Contradictory health advice can have a particular effect on vulnerable populations such as Indigenous and Culturally and Linguistically Diverse (CALD) groups living in Western countries such as Australia, Europe, USA, and the UK, who are often suspicious of mainstream services, may have less access to health advice that they trust and often experience overcrowding and multigenerational households
Studies have found that cultural differences in explanatory models cultural values, preferences for doctorpatient relationships, the perception of racism and cultural biases, and linguistic barriers can have the effect of reinforcing stigma, increasing mistrust, and reducing access to medical treatment in CALD and Indigenous populations [4]
Summary
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, referred to as COVID-19) continues to spread worldwide. The only way of controlling the spread of COVID-19 is to reduce the rate of transmission through a combination of quarantine measures, social distancing, and vaccination. There has been considerable variation between countries and regions, such as, China, South Korea, Europe, Africa, and the US, in the recommendations and measures adopted to enforce social distancing, isolation and quarantine [3]. Unclear or contradictory communication that reinforces stigma and increases mistrust may contribute to people from Indigenous and CALD communities being less likely to adopt the recommended social distancing and isolation measures, not accessing testing for COVID-19, not cooperating with contact tracing, and not trusting vaccinations [5]. As the rates of infection and mortality from COVID-19 have been higher in minority groups, the communication of health information in a way that is understood and accepted is of particular importance
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