Engaging with Facebook Health Support Groups among Australian Culturally and Linguistically Diverse Populations.

There have been mixed research results when studying gambling problems in Culturally and Linguistically Diverse (CALD) communities in Australia and internationally. This study tests the feasibility of using nationally representative General Social Surveys for examining trends and patterns in gambling problems and other life stressors amongst the Australian CALD population. Two surveys were analysed to determine whether the CALD population experienced gambling problems and other life stressors at different levels to the non-CALD population, and to identify, using multivariable models, whether CALD related variables showed evidence of an association with reported gambling problems after adjustment for other covariates. There was no evidence that 2002 estimates of gambling problems were different in CALD and non-CALD populations. In 2006, there was evidence that gambling problems were lower in the CALD population compared with the non-CALD population (1.3% cf. 3.5%). In 2002 multivariable models there was no evidence of an association between CALD status or related variables with gambling problems, after adjustment for other variables. In 2006 multivariable models, there was evidence of an association between being the CALD population (protective), and being born in Oceania or New Zealand (risk) with gambling problems, after adjustment for other variables.

ABSTRACTSelf‐harm and suicide ideation are global health concerns, significantly impacting culturally and linguistically diverse (CALD) populations. Emergency departments (EDs) play a role in intervening following such presentations, yet there is limited research focusing on the CALD population's use of these services in Australia. This study aimed to explore patterns in ED use for self‐harm and suicide ideation, comparing CALD and non‐CALD persons in terms of service use, presentation themes and likelihood of repeat presentations. This was a cross‐sectional analysis of data from presentations for self‐harm and suicide ideation to the ED of a major metropolitan hospital in Victoria, Australia, from 2012 to 2019. The study used thematic analysis of triage notes, recurrent event analysis and logistic and linear regressions to compare CALD and non‐CALD presentations. CALD presentations comprised 1.3% (n = 202) of the total (n = 15 606). CALD presentations were more likely to occur during business hours, less likely to be triaged as urgent and more likely to result in ward admission. Occupation stressors were more common in CALD presentations. A lower likelihood of repeat presentations was observed among CALD persons. The study also highlighted the limitations of current data collection practices in capturing the full spectrum of CALD presentations. This study found variability in the recording of CALD status, warranting further investigation into how data collection in EDs may be improved. Increased ward admission rate and lower likelihood of repeat presentation by CALD persons also indicate that further research is required to understand help‐seeking and clinical decision‐making in the CALD population.

Studies consistently report longer prehospital delays in culturally and linguistically diverse (CALD) patients experiencing acute coronary syndrome (ACS). A scoping review was conducted to describe terms and methods used to define and identify CALD populations and summarize available evidence on factors related to prehospital delays in ACS studies involving CALD populations. We searched six electronic databases for published studies and Google Scholar for grey literature to identify studies on prehospital treatment-seeking in CALD immigrants experiencing ACS. We followed the Joanna Briggs Institute methodological framework for scoping review. Twenty-three studies met our eligibility criteria (quantitative n = 17; qualitative n = 6; mixed n = 1). Terms like ethnicity, migrant, or expatriate defined CALD populations. Most studies used a single indicator (e.g. country of birth) to identify CALD cohorts, and only two studies used a theoretical model related to treatment-seeking delays to guide data collection. Most factors affecting prehospital delays in CALD populations were similar to those reported in general populations. A unique finding was a difference in the language used to describe symptoms, which, when translated, changes their meaning and resulted in misinterpretation by healthcare providers [e.g. asfixiarse (translates as asphyxiate/suffocate) used for dyspnoea/shortness of breath in Hispanics]. Terms and methods used for defining and identifying CALD populations are inconsistent. Studies on factors affecting prehospital treatment-seeking in CALD ACS patients are limited. Future studies should use theoretical models related to treatment-seeking delays to comprehensively explore factors affecting prehospital delays. Additionally, researchers should consider self-reported or multiple indicators to determine CALD status.

Over the past few decades, Australia's population and multicultural landscape have changed significantly. The growing population of culturally and linguistically diverse (CALD) groups requires changes in the provision of health services to meet their special health needs. CALD populations face multiple challenges in accessing health services. Access to and utilisation of health services are multifaceted and are influenced by factors at individual, household and societal levels. Additionally, poor access to and utilisation of health services are affected by health systems, organisations and provider factors. Given the growing number and diversity of CALD populations in Australia, including in regional areas, a better understanding of these factors is crucial to identifying existing gaps and health service needs. This qualitative study aimed to explore factors affecting effective access to and utilisation of health services among CALD populations in the south and east regions of South Australia (SA). The 'access to health service' theoretical framework developed by Levesque and colleagues guided this study. A qualitative study was conducted between December 2018 and April 2019 through: (a) individual interviews with service providers (n=23); and (b) focus group discussions (n=4) with CALD populations in three regional towns in SA. Data from interview and focus group discussions were analysed using inductive and deductive analysis approaches. Poor health literacy among CALD populations, such as difficulties in searching and understanding health information, and seeking the right services at the right time, were significant barriers to effective navigation and utilisation of health services. Factors leading to low health literacy included language and communication problems, the complexity of the Australian health system, and poor availability of multilingual health materials to health providers and community members. Interpreting services were widely used to facilitate communication between patients and health providers, although these were inadequate and needed some improvements. A shortage and high turnover of health providers as well as distance and transport difficulties were major barriers to the accessibility of health services. Poor access to female-specific services to meet cultural needs in some population groups and the lack of cultural competency training were key issues reported in relation to acceptability and cultural appropriateness of health services. Additionally, the cost of services and poor service affordability hampered access to and utilisation of some services. Finally, broader social determinants of health such as poor housing and unemployment were reported as factors negatively affecting access to health services by CALD populations. This study revealed key factors facilitating or constraining access to and utilisation of health services by CALD populations living in regional SA. A combination of strategies at different levels of health services is required to ensure services are accessible, culturally appropriate, acceptable and affordable. Improving accessibility is necessary in order to reduce inequity in health access and outcomes among the growing CALD populations in Australia.

Background‘Culturally And Linguistically Diverse (CALD)’ populations have diverse languages, ethnic backgrounds, societal structures and religions. CALD populations have not experienced the same oral health benefits as non-CALD groups in Australia. However, the socio-demographic profile of Australian CALD populations is changing. This study examined how household income modifies the oral health of CALD and non-CALD adults in Australia.MethodsData were from two National Surveys of Adult Oral Health (NSAOH) conducted in 2004-06 (NSAOH 2004-06) and 2017-18 (NSAOH 2017-18). The outcome was self-reported number of missing teeth. CALD status was identified based on English not the primary language spoken at home and country of birth not being Australia. Social disadvantage was defined by total annual household income. Effect-measure modification was used to verify differences on effect sizes per strata of CALD status and household income. The presence of modification was indicated by Relative Excess Risk due to Interactions (RERIs).ResultsA total of 14,123 participants took part in NSAOH 2004-06. The proportion identifying as CALD was 11.7% and 56.7% were in the low-income group, and the mean number of missing teeth was 6.9. A total of 15,731 participants took part in NSAOH 2017-18. The proportion identifying as CALD was 18.5% and 38.0% were in the low-income group, and the mean number of missing teeth was 6.2. In multivariable modelling, the mean ratio (MR) for CALD participants with low household income in 2004-06 was 2% lower than the MR among non-CALD participants with high household income, with the RERI being − 0.23. Non-CALD participants from lower income households had a higher risk of having a higher number of missing teeth than low income CALD individuals (MR = 1.66, 95%CI 1.57–1.74 vs. MR = 1.43 95%CI 1.34–1.52, respectively). In 2017-18, the MR for CALD participants with low household income was 3% lower than the MR among non-CALD participants with high household income, with the RERI being − 0.11. Low income CALD participants had a lower risk of missing teeth compared to their non-CALD counterparts (MR = 1.43, 95% CI 1.34–1.52 vs. MR = 1.57, 95% CI 1.50–1.64).ConclusionsThe negative RERI values indicate that the effect-measure modification operates in a negative direction, that is, there is a protective element to being CALD among low income groups with respect to mean number of missing teeth.

Factors influencing organised faecal occult blood test screening participation in culturally and linguistically diverse populations: a scoping review

1587 Background: Culturally and linguistically diverse (CALD) populations and First Nations People are at-risk communities who face unique challenges in cancer diagnosis and management resulting in inequities. Optimal Care Pathways (OCP) established by Cancer Council Australia aim to address these disparities. The Breast cancer OCP outlines an integrated model of care with optimal timeframes such as time from general practitioner (GP) referral to specialist surgical review, time from decision to treat to surgery or neoadjuvant chemotherapy (NAC), and time from completion of NAC to surgery. Methods: Retrospective data was collected for all CALD (migrant from non-English speaking country and/or primary language identified as not English) and First Nations patients diagnosed with breast cancer treated at a regional centre in Australia (Townsville University Hospital) from 2018 – 2022. A comparison cohort (control) of consecutive non-CALD, non-First Nations patients was included. Data collected included patient demographics, tumour characteristics, stage, and identified timeframes which were compared with OCP. Results: 133 patients were included with 43 CALD (32%), 41 First Nations (31%) and 50 control (37%). CALD and First Nations cohorts had higher rates of stage IV disease at diagnosis (12 v 15%) compared to control cohort (0%). They were also more likely to be diagnosed via emergency department admission (CALD 16 v First Nations 7%) compared to control cohort (0%) suggesting later presentation. Of those referred through OCP defined GP pathway, a similar percentage were reviewed by specialist surgeon within optimal 2-week timeframe in all groups (CALD 47%; First Nations 39%; control 44%). Median time from decision to treat to surgery were longer in CALD versus control groups (19 v 13 days; p = 0.03), and in First Nations versus control groups (22 v 13 days; p = 0.02). Less CALD (89%, n = 24) and First Nations (82%, n = 18) patients underwent surgery within optimal 5-week timeframe compared to control (98%, n = 40). Similarly, median time from decision to treat to NAC were longer in CALD versus control groups (19 v 14 days; p = 0.05), and First Nations versus control groups (20 v 14 days; p = 0.03). Most patients (91%, n = 29) commenced NAC within optimal 4-week timeframe; 2 CALD and 1 First Nations patients did not. Median time from completion of NAC to surgery was longer in CALD versus control groups (29 v 24 days; p = 0.15), and in First Nations versus control groups (35 v 24 days; p = 0.04). Of those who recieved NAC, 100% CALD (n = 9), 69% First Nations (n = 9), and 89% control (n = 8) patients underwent surgery within optimal 4-week timeframe. Conclusions: Achievement of key OCP timeframes was lower in both CALD populations and First Nations People. Strategies need to be further developed to address the delays and health outcome disparities in these vulnerable cohorts.

Australia has one of the largest multicultural populations in the world, with cultural and linguistic diversity (CALD) a defining feature. CALD populations have unique identities and experiences of mental health and suicide, with multicultural differences, trauma and experiences of discrimination and stigma pertinent to effective suicide prevention approaches. Very little is known however about suicide and suicidality among this population in Australia. This systematic review explored literature on suicidality and suicide prevention in CALD communities as a means of informing suicide prevention research, policy and practice in the Australian context. Five electronic databases (Medline, PsycINFO, Embase, Emcare, and CINAHL) were searched. Studies were included if they examined factors associated with suicidality or described suicide prevention initiatives in CALD populations, and were conducted in OECD countries. Study quality was assessed using the CASP qualitative checklist for qualitative studies and the Quality Assessment Tool for quantitative studies. Thematic analysis was used to identify key themes in the included studies. Eighteen studies met the criteria for inclusion, including ten qualitative and eight quantitative studies. No Australian studies were identified. Key themes included acculturation difficulties, stigma, the influence of social networks and family, heterogeneity of CALD populations, and suggested prevention strategies. The review found no Australian studies looking at suicidality or suicide prevention in CALD communities. It highlights the need for a greater focus across policy, research and evaluation on suicide prevention in Australian CALD communities.

<h3>Background</h3> Australia is ethnically diverse, a quarter of the population are born overseas. It is recognised that ACP uptake in CALD population is poor. Reasons include lack of inlanguage resources and cultural differences including the notion of patient autonomy and the role of the family. <h3>Aim</h3> To determine the feasibility and uptake of ACP in the Greek and Italian born population presenting to the Austin hospital. <h3>Methods</h3> A prospective cohort study, competent Greek or Italian speaking patients aged &gt; 65 were offered ACP from a trained nurse facilitator. Inlanguage ACP brochures and ACP educated interpreters were provided. Control patients were competent English speaking patients. <h3>Results</h3> 25 Greek, 24 Italian and 63 English-speaking patients were recruited with similar demographics. Each group had a median of 2 visits and the median ACP conversation time was similar (88 mins- CALD versus 80). Interpreter services were utilised in 29% of conversations with no difference in outcomes. There was no difference in the rate of completion of Advance Care Directives (55% CALD, 56% Control). Involvement of the family was more prevalent with CALD patients and was associated with increased documentation of wishes. <h3>Discussion</h3> This study demonstrates that the myths regarding ACP in CALD patients, including a lack of interest, cultural differences and time taken, are not correct. Using a trained ACP facilitator and involving family, the acceptance of ACP, time taken to completion and documentation of wishes were all comparable to English speakers. <h3>Conclusion</h3> Given the appropriate resources CALD patients will use ACP services.

BackgroundLow-participation of culturally and linguistically diverse (CALD) patients in medical research remains a problem in migrant and refugee destination countries such as Australia. The aims of this study were to explore i) CALD persons’ perceptions and experiences of the medical system and medical research, in this case, older Italian Australians; and ii) the views of research professionals on CALD patient participation in medical research.Design and MethodsA qualitative study was conducted in Melbourne, Australia, in 2015 utilising in-depth interviews and focus groups with four stakeholder groups: older Italian Australians (n=21); adult children of older Italian Australians (n=10); hospital Human Research Ethics Committee administrators (n=4); and clinical researchers (n=4). The data were analysed for content and thematic analysis.ResultsThemes for the CALD and family group were getting by in medical interactions; receptivity to medical research: testing the waters; and, receptivity to technology for support: passive versus active. Themes for the researcher and HREC groups about CALD patient participation in research were: exclusion; cultural factors; and e-consent.ConclusionsOur findings from four stakeholder perspectives and experiences confirm that there were considerable cultural, linguistic, and resourcing barriers hindering the participation of older Italian-Australians in medical research. Furthermore, our findings showed that in this study setting there were few enabling strategies in place to address these barriers despite the national ethics guidelines for equitable participation in research. The findings informed the creation of a multimedia tool whose purpose is to address and improve representation of CALD groups in clinical research.Significance for public healthMany people from culturally and linguistically diverse (CALD) backgrounds remain excluded from medical research such as clinical trials due to a range of language and cultural factors that can be amplified when this population is ageing. This exclusion has implications for the ability of CALD populations to benefit from participating in medical research and for applying research findings to CALD populations. It is essential to develop and implement strategies to include CALD communities in medical research and to uphold the ethical obligation of obtaining informed consent to research. The findings of this study have guided the development of a tablet-based resource which can be used in clinical and community contexts to raise awareness about the purpose of medical research. The resource has been carefully designed to be appropriate for participants' cultural background as well as their preferred language and literacy level. Such a resource has potential to address some of the cultural and linguistic barriers to clinical trial participation of CALD populations.

In 2002, qualitative methods in the form of in-depth interviews and focus groups were used to gather data from culturally and linguistically diverse (CALD) population residents, service providers and key stakeholders across rural Victoria, to identify and describe barriers to the effective delivery of home services to people from CALD populations in rural Australia. Barriers to the provision of Home and Community Care (HACC) services to CALD populations in rural areas were not specific to HACC programs. For CALD residents, barriers included lack of information about the range of available services, cultural factors, and negative past and recent experiences in dealing with both the broader community and service providers. Service providers indicated lack of information about the profile of the local CALD population and lack of experience in working with these groups to be barriers. Communication was also an issue both for CALD residents and service providers, in terms of cultural factors and specific communication strategies such as inadequate printed material and under-utilisation of existing resources such as interpreter services. As one of the world?s most ethno-culturally diverse nations, Australia has a responsibility to provide health services that are culturally responsive and acceptable. Greater attention needs to be given to the needs of rural CALD population groups in accessing home services.

The majority of Australia's hepatitis B virus (HBV) burden is borne by culturally and linguistically diverse (CALD) populations, and antiviral treatment is the mainstay of intervention. Using modelling, we estimated the impact of targeted antiviral treatment scale‐up and changes in migration on HBV‐related mortality and HBV elimination in CALD populations in Australia. We fitted a deterministic mathematical model based on the natural history of HBV and the Australian migration effect in four CALD population groups according to country of birth. We used three antiviral treatment scale‐up scenarios: baseline (9.3% coverage); intermediate (coverage of 80% of patients eligible for antiviral therapy by 2030); and optimistic (coverage of 20% of all patients living with HBV by 2022). Our model predicted that if the baseline treatment is followed between 2015 and 2030, the number of chronic HBV cases and HBV‐related mortality will increase. Following the optimistic scale‐up, the number of new HBV cases could be reduced by 78%, 73%, 74% and 83% in people born in Asia‐Pacific, Europe, Africa and the Middle East, and Americas, respectively, between 2015 and 2030. An optimistic treatment scale‐up could result in a 19.2%–24.5% reduction in HBV‐related mortality and a 15%–25% reduction in HCC‐related mortality in CALD populations between 2015 and 2030. In conclusion, our findings highlight that targeted antiviral treatment for CALD populations provides significant health system benefits by reducing HBV‐related complications from cirrhosis and HCC. Expanded antiviral treatment programmes focusing on high‐prevalence CALD populations may be an effective strategy to reduce HBV‐related morbidity and mortality.

In acute coronary syndrome (ACS), emergency medical service (EMS) use reduces pre-hospital delay and increases the chances of survival. However, evidence regarding EMS use in culturally and linguistically diverse (CALD) patients is conflicting. This study aimed to i) examine whether EMS use in patients with ACS varies between CALD and non-CALD populations and ii) identify characteristics associated with EMS and non-EMS use in CALD patients. This is a retrospective analysis of ACS cases presented to emergency departments of public hospitals in Victoria, Australia between January 2016 and June 2021, as recorded in the Victorian Emergency Minimum Dataset maintained by the Victorian Department of Health. Country of birth, preferred language, and the need for an interpreter defined CALD status. Logistic regression was used to describe the characteristics associated with EMS and non-EMS use. Of the 51,101 eligible ACS cases, 15,580 (30.5%) were from the CALD group. EMS use was lower in CALD than in non-CALD groups (61.9% vs 65.3%; p<0.001; adjusted odds ratio [aOR] 0.78; 95% confidence Interval [CI] 0.75-0.81). In CALD patients, the odds of EMS use increased with advancing age, living alone (aOR 1.45; 95% CI 1.24-1.70), self-referral (aOR 4.53; 95% CI 3.97-5.17), hospital presentation in the year 2020 (aOR 1.16; 95% CI 1.03-1.31) or 2021 (aOR 1.20; 95% CI 1.30-1.39), and being diagnosed with acute myocardial infarction (aOR 1.36; 95% CI 1.26-1.39). Reduced odds of EMS use were associated with being born in Southeast Asia (aOR 0.71; 95% CI 0.57-0.89), Northeast Asia (aOR 0.57; 95% CI 0.42-0.77), and the Americas (aOR 0.59; 95% CI 0.43-0.80); speaking a South Asian language (aOR 0.65; 95% CI 0.51-0.83); and hospital presentation in summer (aOR 0.90; 95% CI 0.82-0.99). EMS use was lower in patients with ACS with CALD backgrounds. Our findings have identified CALD population subgroups to target with education.

Background: Underrepresented and underserved communities such as culturally and linguistically diverse (CALD) groups experience higher reported prevalence and severity of multimorbidity along with unmet social needs and disadvantages in accessing services. Minority populations report higher rates of emergency department presentations globally and nationally and it is understood that services are more frequently accessed on consumer initiative when problems become acute and critical, demonstrating significant barriers for early intervention. In Australia, most of the efforts to reduce over-utilisation of emergency care have focused on developing integrated health and social care approaches for the general population. There is little evidence available on how CALD populations are involved in the design and implementation of integrated care health and social care initiatives and how their needs are identified and addressed. Methods: A service mapping study informing the development of a framework for comparative analysis of integrated health and social care services targeting CALD populations will be sought. Semi-structured interviews, with key stakeholders and decision-makers representing health and social services, as well as document review, will inform the development of a map of integrated health and social care services available for individuals from culturally and linguistically diverse backgrounds. Core defining elements of the mapped services comprise the basis for the framework that enables comparison of level of integration with a CALD focus, including governance and partnerships, health and social care staff, financing and payment systems, and data sharing and use. Implications: This study will advance the understanding of how integrated health and social care policies (policy learning) and services are conceptualised, developed, and implemented at a local level (policy implementation) to address the needs of CALD populations. and how they can better respond to the health and social needs of CALD consumers.

PurposePeople of Culturally and Linguistically Diverse (CALD) backgrounds face disparities in cancer care. This scoping review aims to identify the breadth of international literature focused on cancer survivorship programs/interventions specific to CALD populations, and barriers and facilitators to program participation.MethodsScoping review included studies focused on interventions for CALD cancer survivors after curative-intent treatment. Electronic databases: Medline, Embase, CINAHL, PsycInfo and Scopus were searched, for original research articles from database inception to April 2022.Results710 references were screened with 26 included: 14 randomized (54%), 6 mixed-method (23%), 4 non-randomized experimental (15%), 2 qualitative studies (8%). Most were United States-based (85%), in breast cancer survivors (88%; Table 1), of Hispanic/Latinx (54%) and Chinese (27%) backgrounds. Patient-reported outcome measures were frequently incorporated as primary endpoints (65%), or secondary endpoints (15%). 81% used multi-modal interventions with most encompassing domains of managing psychosocial (85%) or physical (77%) effects from cancer, and most were developed through community-based participatory methods (46%) or informed by earlier work by the same research groups (35%). Interventions were usually delivered by bilingual staff (88%). 17 studies (77%) met their primary endpoints, such as meeting feasibility targets or improvements in quality of life or psychological outcomes. Barriers and facilitators included cultural sensitivity, health literacy, socioeconomic status, acculturation, and access.ConclusionsPositive outcomes were associated with cancer survivorship programs/interventions for CALD populations. As we identified only 26 studies over the last 14 years in this field, gaps surrounding provision of cancer survivorship care in CALD populations remain.Implications for cancer survivorsEnsuring culturally sensitive and specific delivery of cancer survivorship programs and interventions is paramount in providing optimal care for survivors from CALD backgrounds.