Sexual health literacy and education programs for culturally and linguistically diverse young people living in Australia, Canada, New Zealand, and the United Kingdom: a scoping review of content evaluations

Sexual health literacy is critical for young people to make informed decisions and access sexual and reproductive health services. In Türkiye, factors such as social stigma, lack of information, and cultural taboos and structural barriers may negatively affect young people's sexual and reproductive health service-seeking behaviors. The aim of this study is to determine the levels of sexual health literacy and sexual and reproductive health service seeking among Turkish youth, identify the factors affecting these levels, and to examine the relationship between sexual health literacy and service-seeking behavior. The cross-sectional descriptive study was completed with 512 young people aged 18-30 years in Türkiye using an online survey distributed via social media platforms. Data were collected using the Sexual Health Literacy Scale and the Sexual and Reproductive Health Service Seeking Scale. Descriptive statistics, t-test, one-way ANOVA, Pearson correlation, and linear regression analyses were used in the analysis of the data. Participants' sexual health literacy was found to be at a moderate level (50.09 ± 9.23), while service seeking was above moderate (37.62 ± 9.87). A positive relationship was found between sexual health literacy and service seeking (p < 0.05). According to regression analysis, sexual health literacy level and history of unwanted pregnancy were factors predicting service seeking (R²=0.125, F = 7.983, p < 0.001). The level of sexual health literacy was found to be associated with gender, income level, family type, parents' education level, receipt of sexual health education, active sexual life, contraceptive use, unwanted pregnancy, and sexually transmitted disease history. The level of service seeking was influenced by marital status, family type, parental education, sexual activity, sexually transmitted disease diagnosis, unwanted pregnancy, and the need for emergency contraception. Main barriers to service seeking were embarrassment (35%), not prioritizing sexual health (22.1%), minimizing the problem (21.5%), and lack of information (18%). This study shows that limited sexual health literacy may restrict Turkish youth's access to sexual and reproductive health services. Strengthening sexual health education, improving access to reliable online information, and fostering youth-friendly health services including guidance by nurses are essential. These measures can ensure equitable, inclusive, and effective sexual and reproductive health care.

Cancer presents a significant health challenge, particularly within culturally and linguistically diverse (CALD) populations. Religious, spiritual, and personal beliefs regarding illness may mitigate its psychological and physical impacts, varying with CALD status. This study aims to assess illness perceptions in Australian cancer patients from both CALD and Anglo-Australian backgrounds and to explore the associations between spiritual wellbeing and illness perceptions within these groups. Cross-sectional study, involving 119 cancer patients from CALD backgrounds (Arabic, Chinese, and Greek) and 50 Anglo-Australians. Spiritual wellbeing and cancer perception were assessed using the World Health Organization Quality of Life-Spirituality, Religiousness, and Personal Beliefs questionnaire and the revised Illness Perception Questionnaire, respectively. Linear regression models analyzed associations. CALD patients perceived their cancer as less enduring (β - 4.74, 95%CI - 6.16, - 3.31) and symptoms as less predictable (- 4.96, 95%CI - 6.12, - 3.86) compared to Anglo-Australians. They had lower confidence in medical interventions (- 2.96, 95%CI - 3.36, - 1.22) and poorer illness understanding (- 4.66, 95%CI - 5.83, - 3.49). In Greek-speaking patients, an increase in spiritual wellbeing was associated with less favourable perceptions of treatment controllability (β - 2.25, 95%CI - 4.39, - 0.09). Conversely, for Chinese-speaking patients, an increase in spiritual wellbeing was associated with improved illness perception across all domains except for consequences and emotional representation. However, no significant association was observed for Arabic patients. Differences in illness perceptions exist among CALD and Anglo-Australians. Spiritual wellbeing appears linked to more favourable perceptions; however, differential effects emerged among groups, emphasizing the need for culturally tailored interventions to improve outcomes.

BackgroundAustralia has a rich migration history, with one in three older people coming from a culturally and linguistically diverse (CALD) background. Patients from CALD backgrounds tend to present at later stages of their diseases but face difficulties accessing appropriate dementia care compared to English‐speaking patients. Limited literature exists on the clinical experience among CALD patients who have been historically underrepresented in dementia research. This study therefore aimed to investigate and describe the clinical characteristics and service provision for CALD patients presenting to the Memory Clinic at the Royal Melbourne Hospital, a tertiary hospital which serves a significant proportion of CALD patients.MethodA retrospective analysis was conducted. All consecutive patients who presented to the Memory Clinic between September 2016 and June 2018 were included. Data collected included patient demographics, medical history, cognitive test scores, neuropsychiatric symptoms, other clinical scales, clinical diagnoses, and length of follow up.ResultA total of 301 patients (mean age 78.8 ± 8.2; 55.8% female) were included and 48.5% were from a CALD background, the majority being Italian. Patients from CALD backgrounds were more likely to be living with family (73.3% vs 57.4%, OR [odds ratio] 2.1) and less likely to have attended education beyond primary level (26.7% vs 83.9%, OR 14.3). Cognitively, CALD patients had poorer performance on MMSE (median MMSE 18 vs 25) and were more likely to be diagnosed with dementia (46.6% vs 31.0%, OR 1.9) at their initial assessments. Additionally, CALD patients were less likely to be referred for neuropsychology (28.8% vs 50.3%, OR 0.40).ConclusionThe study findings highlight the differences in clinical characteristics as well as inherent issue of inequality in healthcare among patients from CALD backgrounds in an Australian clinical setting. Given the recent approval of disease‐modifying anti‐amyloid therapy in mild Alzheimer’s disease, more research is warranted to help diagnose dementia at earlier stages in CALD patients and ultimately promote more equitable and culturally inclusive dementia care.

Although many diabetes self-management apps exist, these are not tailored for people from culturally and linguistically diverse (CALD) backgrounds. This study aimed to explore GP perceptions of how diabetes app features could help GPs better support their patients from CALD backgrounds. Twenty-five semi-structured interviews with GPs in Western Sydney explored attitudes towards a proposed app's suitability for CALD patients. Interviews were audio-recorded, transcribed and coded using Framework Analysis. Theme 1 explored the implications of perceptions that patients' health literacy is dependent on the language used. Theme 2 explored the influence of messaging from sources that share the patient's language and culture (including misinformation from community sources). Theme 3 described the suitability of the app platform for CALD patients, and its potential challenges in this group. GPs perceived that a diabetes app could be useful for providing support to patients from CALD backgrounds. Findings suggest app features should be optimised to address existing challenges that GPs face and carefully consider strategies for recruiting CALD patients. It is important that GPs feel comfortable promoting an app to their CALD patients to help increase participation rates by people in the CALD community.

A significant proportion of health‐ and disability‐sector consumers in Australia speak a language other than English (LOTE) at home. Barriers to service access in culturally and linguistically diverse (CALD) populations are acknowledged; however, there is limited data to guide service delivery among care providers. The aims of the present study were to investigate the linguistic diversity of preschool‐aged children and families presenting for diagnostic assessment of developmental delay and disability at the Disability Specialist Unit, a multidisciplinary assessment service, and assess whether CALD status was associated with poorer service engagement. Specifically, it was hypothesized that CALD status would be associated with decreased likelihood of receiving intervention (particularly multidisciplinary intervention) and attending center‐based care, and an increased likelihood of requiring referral to access available government funding. A retrospective record audit was undertaken of 88 clients seen by the Disability Specialist Unit over a 12‐month period to collect information about CALD status (whether a LOTE was spoken at home) and a range of clinically relevant variables including clinical diagnosis/es, age at assessment, involvement with therapies, attendance at center‐based child care, and whether a referral to access government funding was required. Differences between CALD and non‐CALD groups were explored statistically via odds ratios and independent samples t test. Children from CALD backgrounds were significantly less likely than non‐CALD children to be engaged in multidisciplinary therapy at the time of assessment and significantly more likely to require support to access funding than children from non‐CALD families. Furthermore, children from CALD backgrounds were significantly more likely to receive a diagnosis of autism spectrum disorder and global developmental delay or ID. These findings suggest that children from CALD backgrounds are disadvantaged compared to non‐CALD children with respect to service access at the point of tertiary diagnostic evaluation of a developmental disability. Implications for service delivery are discussed.

Purpose: To examine whether differences in access to specialist disability services by people from culturally and linguistically diverse (CALD) backgrounds when compared with those born in Australia represent a service gap or the healthy migrant effect. Method: To use the latest disability statistics to measure the different rates of people with disability, and the rates of people with profound and severe disability, of people born in Australia and those born abroad; to compare the difference between those who mainly speak English with those who primarily speak a language other than English at home (LOTE); and examine the age-specific and standardised disability rates of these subgroups. Results: The rate of access of specialist disability services by people with disability who were from CALD backgrounds is highly disproportionate to their presence in the community. As a whole, people from CALD backgrounds have a similar level of disability as Australia-born people. They have a greater rate of profound and severe disability and a higher level of need for assistance in undertaking core activities. For younger age cohorts targeted by specialist disability services, there is little difference in the level of need for assistance between people from CALD backgrounds and the rest of community. Those people who mainly speak LOTE at home have a relatively higher level of need for assistance than those who speak mainly English at home. Conclusions: The paper reveals a substantial gap in specialist disability services between people from CALD and the broader community. This cannot be explained by the difference in the level of need for assistance between Australia-born and overseas-born populations, therefore raises some policy questions as to the barriers to the use of such services and how to effectively narrow the service access gap and improve utilisation rates.Implications for RehabilitationThe paper reveals a substantial accessibility gap in specialist disability services between people from culturally and linguistically diverse (CALD) backgrounds and the broader community in Australia.Rehabilitation is a large component of disability services. Therefore, understanding the gap, promoting the awareness of the services, developing appropriate and effective services to respond the need of people with disability from CALD backgrounds, are critically important to rehabilitation services and related research.

The purpose of this prospective study of 2180 consecutive index admissions to an acute geriatric service was to compare in-hospital outcomes of frail older inpatients born in non-English-speaking counties, referred to as culturally and linguistically diverse (CALD) countries in Australia, with those born in English-speaking countries. Multivariate logistic regression was used to model in-hospital mortality and new nursing home placement. Multivariate Cox proportional hazards regression was used to model length of stay. The mean age of all patients was 83years and 93% were admitted through the emergency department. In multivariate analyses, patients from CALD and non-CALD backgrounds were equally likely to die (CALD odds ratio [OR] 0.69, 95% confidence interval [95% CI] 0.44-1.10) and be newly placed in a nursing home (OR 0.75, 95% CI 0.51-1.12). Patients from CALD backgrounds unable to speak English were more likely to die (11.5% vs. 7.2%, p=0.02). While patients from CALD backgrounds had significantly shorter lengths of stay in univariate analysis (median 9days vs. 10days, p=0.02), this was not apparent in multivariate analysis (hazard ratio 1.02, 95% CI 0.91-1.14), where the ability to speak English proved to be a strong confounder. While most of the literature shows poorer outcomes of people from minority ethnic groups, our findings indicate that this is not necessarily the case. Developing culturally appropriate services may mitigate some of the adverse outcomes commonly associated with ethnicity. Our findings are particularly relevant to countries populated by multiple ethnic groups.

BackgroundWorldwide, the culturally and linguistically diverse (CALD) population is increasing, and is predicted to reach 405 million by 2050. The delivery of emergency care for the CALD population can be complex due to cultural, social, and language factors. The extent to which cultural, social, and contextual factors influence care delivery to patients from CALD backgrounds throughout their emergency care journey is unclear. Using a systematic approach, this review aims to map the existing evidence regarding emergency healthcare delivery for patients from CALD backgrounds and uses a social ecological framework to provide a broader perspective on cultural, social, and contextual influence on emergency care delivery.MethodsThe Joanna Briggs Institute (JBI) scoping review methodology will be used to guide this review. The population is patients from CALD backgrounds who received care and emergency care clinicians who provided direct care. The concept is healthcare delivery to patients from CALD backgrounds. The context is emergency care. This review will include quantitative, qualitative, and mixed-methods studies published in English from January 1, 2012, onwards. Searches will be conducted in the databases of CINAHL (EBSCO), MEDLINE (Ovid), Embase (Elsevier), SocINDEX (EBSCO), Scopus (Elsevier), and a web search of Google Scholar. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram will be used to present the search decision process. All included articles will be appraised using the Mixed Methods Appraisal Tool (MMAT). Data will be presented in tabular form and accompanied by a narrative synthesis of the literature.DiscussionDespite the increased use of emergency care service by patients from CALD backgrounds, there has been no comprehensive review of healthcare delivery to patients from CALD backgrounds in the emergency care context (ED and prehospital settings) that includes consideration of cultural, social, and contextual influences. The results of this scoping review may be used to inform future research and strategies that aim to enhance care delivery and experiences for people from CALD backgrounds who require emergency care.Systematic review registrationThis scoping review has been registered in the Open Science Framework https://doi.org/10.17605/OSF.IO/HTMKQ

Rates of self-harm among children and young people (CYP) have been on the rise, presenting major public health concerns in Australia and worldwide. However, there is a scarcity of evidence relating to self-harm among CYP from culturally and linguistically diverse (CALD) backgrounds. To analyse the relationship between self-harm-related mental health presentations of CYP to emergency departments and CALD status in South Western Sydney (SWS), Australia. We analysed electronic medical records of mental health-related emergency department presentations by CYP aged between 10 and up to 18 years in six public hospitals in the SWS region from January 2016 to March 2022. A multilevel logistic regression model was used on these data to assess the association between self-harm-related presentations and CALD status while adjusting for covariates and individual-level clustering. Self-harm accounted for 2457 (31.5%) of the 7789 mental health-related emergency department presentations by CYP; CYP from a CALD background accounted for only 8% (n = 198) of the self-harm-related presentations. CYP from the lowest two most socioeconomic disadvantaged areas made 63% (n = 1544) of the total self-harm-related presentations. Findings of the regression models showed that CYP from a CALD background (compared with those from non-CALD backgrounds) had 19% lower odds of self-harm (adjusted odds ratio 0.81, 95% CI 0.66-0.99). Findings of this study provide insights into the self-harm-related mental health presentations and other critical clinical features related to CYP from CALD backgrounds that could better inform health service planning and policy to manage self-harm presentations and mental health problems among CYP.

BackgroundAdvance care planning (ACP) describes the process of supporting individuals at any age or stage of health to consider and share their personal values, life goals, and preferences regarding future health care. Engaging in ACP is associated with better-quality of care in which people receive care in lines with their wishes, values and preferences. Direct translations of ACP guides and resources do not attend to the considerable inter- and intra-ethnic variations in cultural and religious or spiritual beliefs that shape preferences among people from culturally and linguistically diverse (CALD) backgrounds. ICanCarePlan is a three-year project that aims to determine the prevalence of ACP documentation among people from CALD backgrounds with cancer, identify resources available and their use to support ACP among CALD communities, identify barriers and facilitators of person-centred ACP, and to develop, through co-design with consumers and clinicians, approaches that enhance the process ACP for people from CALD backgrounds.MethodA mixed-method sequential approach will be used comprising of four studies. Study one is retrospective medical record review of approximately 1500 medical records to establish the prevalence of ACP documentation among CALD patient records in cancer services. Study two is a document analysis synthesising the resources available in the Australian health system to support ACP. Study three is a qualitative study with healthcare staff and consumers to explore barriers and enablers of person-centred ACP. Evidence generated from studies one to three will inform the conduct of co-design with stakeholders to develop approaches to improve ACP processes among CALD communities. Language, technical and financial support for meaningful involvement with consumers from CALD backgrounds throughout this project is outlined. A plan for distress management is also made due to sensitive nature of the topic. The research project has also established a project steering group consisting of three consumer members who are from CALD backgrounds.DiscussionThe project will address a national priority issue for a growing population of CALD communities in Australia. The project will provide novel evidence of ACP among CALD communities and novel strategies developed with stakeholders to enhance uptake and experiences of ACP.

ObjectiveTo develop an inclusive model of culturally sensitive support, using a specialist dementia nurse (SDN), to assist people with dementia from culturally and linguistically diverse (CALD) communities and their carers...

Australian children from culturally and linguistically diverse (CALD) backgrounds may be vulnerable to stresses involved with migration and acculturation, which can interact with risk factors and lead to psychological distress. The BRiTA Futures Primary School and Adolescent programs were designed to promote resilience and positive acculturation in children and young people from CALD backgrounds. This paper describes the BRiTA Futures program and profiles the demographic characteristics and levels of wellbeing and resilience among 117 BRiTA Primary School and 192 Adolescent participants attending BRiTA Futures programs in Queensland. A repeated measures design investigated changes in wellbeing and resilience between the commencement and conclusion of the program. Most participants were born overseas (Primary School 63%, Adolescent 81%) and spoke a language other than English (alone or in addition to English) at home (Primary School 83%, Adolescent 89%). Pre-program results showed considerable proportions of primary school children (between 8.8% and 20.2%) and adolescents (34.1%) with poor levels of wellbeing upon commencing the program. Upon completing the program, primary school participants showed significant improvements in global quality of life (P = 0.014) and weak evidence of improvements in resilience (P = 0.057). Adolescent participants showed significant improvement in wellbeing (P = 0.006) and weak evidence of improvement in resourcefulness (P = 0.079). The BRiTA Futures program fills an important service gap for young CALD people and shows some promising initial results. Future directions include developing an adult version of the program, and providing programs in other states. The purpose-designed resilience measures are undergoing further development. Immediate post-program data collection requires concerted effort to maximise completeness; longer-term follow-up should be pursued to investigate whether gains are sustained over time.

Little is known about the relationship between patients' cultural and linguistic backgrounds and patient activation, especially in people with diabetes and chronic kidney disease (CKD). We examined the association between culturally and linguistically diverse (CALD) background and patient activation and evaluated the impact of a codesigned integrated kidney and diabetes model of care on patient activation by CALD status in people with diabetes and CKD. This longitudinal study recruited adults with diabetes and CKD (Stage 3a or worse) who attended a new diabetes and kidney disease service at a tertiary hospital. All completed the patient activation measure at baseline and after 12 months and had demographic and clinical data collected. Patients from CALD backgrounds included individuals who spoke a language other than English at home, while those from non-CALD backgrounds spoke English only as their primary language. Paired t-tests compared baseline and 12-month patient activation scores by CALD status. Patients from CALD backgrounds had lower activation scores (52.1 ± 17.6) compared to those from non-CALD backgrounds (58.5 ± 14.6) at baseline. Within-group comparisons showed that patient activation scores for patients from CALD backgrounds significantly improved by 7 points from baseline to 12 months follow-up (52.1 ± 17.6-59.4 ± 14.7), and no significant change was observed for those from non-CALD backgrounds (58.5 ± 14.6-58.8 ± 13.6). Among patients with diabetes and CKD, those from CALD backgrounds report worse activation scores. Interventions that support people from CALD backgrounds with comorbid diabetes and CKD, such as the integrated kidney and diabetes model of care, may address racial and ethnic disparities that exist in patient activation and thus improve clinical outcomes. Patients, caregivers and national consumer advocacy organisations (Diabetes Australia and Kidney Health Australia) codesigned a new model of care in partnership with healthcare professionals and researchers. The development of the model of care was informed by focus groups of patients and healthcare professionals and semi-structured interviews of caregivers and healthcare professionals. Patients and caregivers also provided a rigorous evaluation of the new model of care, highlighting its strengths and weaknesses.

Simulation-based learning (SBL) is an important component in health professions education and serves as effective preparation or a substitution for clinical placements. Despite their widely accepted benefits, students from culturally and linguistically diverse (CALD) backgrounds may not experience the same learning outcomes from engaging in SBL as their local peers due to complex factors. Supporting students from CALD backgrounds in SBL is vital, not only to optimise their learning experiences and outcomes, but also ensure inclusive health professions education. While the literature on the participation of students from CALD backgrounds in SBL activities is emerging, this scoping review was conducted to (1) map the evidence on how SBL impacts the learning outcomes of health professions students from CALD backgrounds; and (2) understand how students from CALD backgrounds perceive their SBL experiences. Following Arskey and O'Malley's framework and Joanna Briggs Institute methodology for scoping reviews, a search was conducted in January 2024 using PubMed, Embase, CINAHL, Scopus, PsycINFO, and ERIC. Ten papers met the inclusion criteria. This review highlighted three themes: (1) diverse learning outcomes of SBL; (2) facing linguistic and cultural challenges that are inherent to SBL; and (3) preparation, reflection, and support to actively participate in SBL activities. This review indicates that SBL could enhance clinical skills and confidence in students from CALD backgrounds. However, well-designed SBL activities to meet the learning needs of students from CALD backgrounds are currently lacking and further research across broader health professions fields is needed.

Children from culturally and linguistically diverse (CALD) backgrounds are at risk of having developmental problems go undetected prior to starting school, and missing out on early intervention. Our aim was to explore the family and service characteristics, beliefs and experiences that influence the journey of families from CALD backgrounds in accessing developmental surveillance (DS) and early intervention services in south-eastern Sydney, Australia. This qualitative study used in-depth interviews conducted with 13 parents from CALD backgrounds and 27 health and early childhood professionals in Sydney. The Andersen Behavioural Model of Health Service Use (BM) was the underlying theoretical framework for thematic analysis. Family and service knowledge about early childhood development (ECD), community attitudes, social isolation and English language proficiency were dominant themes that impacted on the probability of families accessing services in the first place. Those that impeded or facilitated access were resources, extended family and social support, information availability, competing needs, complex service pathways and community engagement. There were variable practices of early detection through DS. Children from CALD backgrounds with developmental problems were perceived to miss out on DS and early intervention despite language delay being a key issue identified by participants. This study highlights the importance of increased community and family awareness and professional training in ECD; better coordination of health and early childhood services, with simpler referral pathways to early intervention to prevent children from CALD backgrounds 'slipping through the net'.