Why public health practitioners and researchers must stop using the term 'culturally and linguistically diverse (CALD)'.

Background and Aims Australia is one of the world's most culturally and linguistically diverse (CALD) nations, yet there is limited research on the characteristics and outcomes of CALD individuals undergoing kidney replacement therapy (KRT). This study aims to examine demographic and clinical characteristics, access to transplantation, and health outcomes of CALD patients receiving KRT in Australia over the past two decades. Method Data were obtained from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) between 1 January 2002 and 31 December 2023. Non-Indigenous adults who initiated KRT in Australia during the study period were included. Patients were categorised into three groups: 1) individuals born in Australia/New Zealand (Aus/NZ), 2) CALD English (born in predominantly English-speaking countries), and 3) CALD non-English (born elsewhere). Statistical analysis included chi-squared tests, multivariate regression, and Kaplan-Meier survival curves to evaluate characteristics and outcomes, including mortality and access to transplantation. Results The cohort consisted of 52,045 patients, 64% of whom were male, with a median age of 62 years, and predominance of Aus/NZ-born individuals. CALD non-English patients had a higher prevalence of diabetic kidney disease, were more likely to commence KRT on peritoneal dialysis and had lower rates of pre-emptive kidney transplant. They were also more likely to live in postcodes with higher socioeconomic disadvantage and in major cities. In contrast, CALD English patients were older at KRT initiation, had higher number of comorbidities and were more likely to be former smokers. Late referrals were relatively consistent across the groups. While native fistulas were the most common vascular access across all groups, they were slightly less frequent in CALD groups. Baseline characteristics are summarised in Table 1. Mortality was highest in CALD-English patients and lowest in CALD-Non-English patients, consistent across all initial KRT modalities (Fig. 1). Cardiovascular disease and withdrawal from dialysis were the leading causes of death, with withdrawal being more frequent in CALD English and Aus/NZ groups, while infections were more common in CALD non-English patients (Fig. 2). Medical comorbidities, age, smoking status, body mass index, living in postcodes with higher socioeconomic disadvantage, and remoteness were all significant predictors of waitlisting and death. After adjustment for the above factors, CALD non-English had higher likelihood of waitlisting (subdistribution hazard ratios (SHR) 1.33, 95% CI: 1.28–1.4) and lower likelihood of death (SHR 0.76, 95% CI 0.74–0.78) (P < 0.001). Conclusion This study highlights significant differences in the characteristics and outcomes of CALD patients receiving KRT in Australia. CALD non-English patients demonstrated a healthier profile, with higher likelihood of waitlisting for kidney transplantation and lower mortality rates compared to Aus/NZ and CALD English groups. These findings suggest a “healthy immigrant effect” for CALD non-English patients and aligns with the data from the 2021 Australian census, which reported that individuals born in Australia had the highest prevalence of at least one long-term health condition, followed by those born in England, the USA, Scotland, and New Zealand. Further research is warranted to explore barriers to pre-emptive transplant and vascular access use among CALD groups and to evaluate the impact of these disparities on long-term outcomes. A deeper understanding of cultural and systemic factors influencing KRT care may inform policies to ensure equitable access and improve outcomes for all patients. This study may pave the way for similar research in other countries to assess outcomes and patterns of CALD patients on KRT, helping to identify universal and region-specific factors that influence access to care and patient outcomes across diverse populations.

In multicultural and multilingual Australia, mental health practitioners (MHPs) are increasingly attending to the psychological needs of culturally and linguistically diverse (CALD) people. Most clinical interactions occur in English, which is the CALD clients’ non-native language, making it a challenging task for clients and practitioners. Language is the main vehicle of assessment, diagnosis, and treatment in most Western models of mental health care. Even so, minimal attention has been paid in policy, research, and practice to MHPs’ language diversity related competence to work effectively with CALD clients. To address this gap, this research aimed to conceptualise, define, and operationalise the novel construct of cross-lingual competence and to develop a reliable and valid psychometric instrument to measure it - the Cross-lingual Competence Scale (CLCS). This research was conceptually and theoretically grounded on Sue et al.’s (1996; 1982) metatheory of multicultural therapy and counselling and their tripartite model, and on research findings from the fields of multicultural psychotherapy and psycholinguistic. On these bases, the domains of awareness, knowledge and skills were argued to be central to the cross-lingual competence construct. Study 1 generated the initial set of items for the CLCS and explored its factor structure through exploratory factor analysis (EFA). Data was collected from in-training and fully registered MHPs (n = 155) in Australia through an online survey containing 61 items and additional measures of MHPs’ multicultural and general competence. Exploratory Factor Analysis did not support the hypothesised structure based on the tripartite conceptualisation; instead, a novel factorial structure representing three distinct concepts emerged: a. MHPs’ Self-perceptions of Competence (SPC); b. MHPs’ Knowledge of Barriers for Clients (KBC); and c. MHPs’ Knowledge of Barriers for MHPs (KBP). The emergent factor structure of the CLCS provided evidence of a new and strong organising concept for self-assessments of competence: self-perceptions of competence and factual knowledge. Importantly, the KBC and KBP subscales were positively associated to one another but unrelated to the SPC subscale, suggesting that the two overarching domains (perceptions and factual knowledge) are unrelated. Thus MHPs’ estimates of their own cross-lingual competence to effectively work with CALD clients were discrepant from their demonstrable knowledge necessary for competent work. The initial assessment of validity further highlighted this discrepancy showing that the SPC subscale converged with all criterion measures of competence reporting MHPs’ self-perceptions, while the KBC and KBP subscales did not. Study 2 aimed to confirm the factor structure of the CLCS and further assess its reliability and convergent validity in a new sample of Australian MHPs (n = 257). Through CFA competing models were tested. The findings from Study 2 closely replicated those of Study 1, supporting the hypothesis that the 3-factor structure would be the best fit for the data. This outcome lent support to the overarching distinction between self-perceptions and factual knowledge. The final version of the CLCS had 23 items and each subscale had good reliability and validity. Study 3 sought to identify predictors of MHPs’ cross-lingual competence as measured by the three subscales of the CLCS exploring the following individual characteristics: ethnic status, language status, professional status, exposure to work with CALD clients, and multicultural training. Based on the combined samples from studies 1 and 2 (n = 412) data was analysed through t-tests and hierarchical multiple regression. Study 3 results showed that MHPs who belonged to an ethnic minority, were bilingual, worked with CALD clients frequently, were fully registered, and had multicultural training reported higher levels of self-perceived competence than their counterparts. When analysed collectively, all these individual characteristics except for ethnic status, predicted MHPs’ self-perceptions of competence. On the other hand, knowledge of barriers for clients was only predicted by engagement with CALD clients, while knowledge of barriers for MHPs was predicted by engagement with CALD clients and language status. Indeed, engagement with CALD clients was the only significant predictor across all three subscales. Overall this research contributes to theory, research and practice of multicultural psychotherapy in several ways. First, it has contributed an innovative construct to the field of cross--cultural psychotherapy, cross--lingual competence. Second, it has developed a reliable and valid measure of MHPs’ cross-lingual competence composed of three subscales each one with good psychometric properties to be used for various purposes. Third, it has established cross-lingual competence as a construct that is related but distinct from multicultural competence requiring specific attention and assessment. Finally, it has shed light into individual characteristics that predict cross-lingual competence and potential means to promote cross-lingual competence among CALD and non-CALD MHPs. Theoretical and practical implications for future research into development and assessment of cross-lingual competence are discussed.

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.

Self-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.

Tobacco cessation and screening in CALD communities

This study details the results of a qualitative investigation into the role and importance of spirituality, religion and traditional healing, as perceived by mental health practitioners working with culturally and linguistically diverse (CALD) individuals. A qualitative method was used to extract deeper meaning from discussion content. This was considered particularly important in catering to CALD communities, both in terms of how well they understood the meanings of questions, and how well they conveyed their intended meanings in responses. The histories of many practitioner participants in this study were informed by ongoing conflict in their home countries, where they reported distrusting government-run institutions. Many of them entered this study still bearing the emotional effects from their experience of war, and many also struggled with language and other cultural differences. In addition, some had strained relations with medical systems in their countries of origin. The research design therefore allowed for subtle nuances to be expressed during focus group discussions, and was sensitive to the cultural and socio-political issues plaguing these communities, both in Australia and abroad. Close attention was paid to building rapport and creating a safe environment for the full participation of each person. This is why transcultural mental health as a treatment approach was utilised to meaningfully examine the context in which people exist and the local and global implications of being estranged from one’s homeland. Research addressing sensitive topics with people from CALD backgrounds can present challenges that are difficult to address using conventional methods, as many of these communities may feel over-researched in a way that sets them up to feel exploited and more vulnerable to Western influence. Many of these people speak English as a second language, and so may feel that since they have been accepted into this country, they cannot disagree with what medical personnel ask of them. The study was carried out using informal community collaboration, the key factor to the success of this research, which optimised the development of research questions and engendered a trusting research environment. Most research in this field to date has been conducted from the perspective of Western medical practice; however, in contrast, this study gains insight into the perspectives of a range of CALD communities, in terms of how they address mental health issues within their respective communities. The study combined perspectives from a range of mental health practitioner participants, including professional and para-professional mental health workers from both CALD and non-CALD backgrounds. Services provided by these groups are routinely accessed by CALD people at the onset of their wellbeing issues. Participants included government and non-government mental health practitioners from various academic disciplines, and there was a balanced representation of gender and country of origin. As immigration is taking place globally at an unprecedented rate, consumers from many CALD communities are presenting in mental health systems with a range of emotional needs. As a result, mental health services are finding themselves faced with assessment and treatment challenges. The immigrant journey consists of complex resettlement issues often associated with visa status, ongoing grief and loss issues, and trauma from leaving one’s homeland for a host of ecological, socio-political or religious reasons. Immigration is often accompanied by stressful adaptation to a new host environment, which can be challenging even if the migrant is welcomed by their new country and given all the benefits of being able to begin a new life there. This study demonstrated that mental health practitioners working with CALD clients should approach treatment while considering the acculturation process involved in resettlement, as this may be more traumatic for the individual or community when they are not accepted, directly or indirectly, by the host environment. Such a situation, in which the individual or community has been taken away from everything familiar to them, often leads to an existential crisis. Many of these individuals are placed in detention or are left within the wider Brisbane community with no financial benefits or resources. This heightens their reliance on a higher power, as many feel they are stripped bare of all earthly relationships and possessions and left with only their spiritual, religious and traditional dimensions. The data from this study show clear evidence for the importance of spirituality, religion and traditional healing in transcultural mental healthcare, while at the same time pointing to a level of reluctance on the part of practitioners and management to fully integrate these issues into their approach. The CALD participants overwhelmingly agreed that spirituality, religion and traditional healing were essential cultural entities which form the foundation for who they are as people, and to forego these practices in, of all places, mental healthcare, would be counterproductive. The results from this study have implications for current and future mental health practice, for mental health policy, for training of mental health personnel and for future research.

BackgroundKnowledge translation (KT) aims to facilitate the use of research evidence in decision making. Changes in technology have provided considerable opportunities for KT strategies to improve access and use of evidence in decision making by public health policy makers and practitioners. Despite this opportunity, there have been no reviews that have assessed the effects of digital technology-enabled KT (TEKT) in the field of public health.ObjectiveThis study aims to examine the effectiveness of digital TEKT strategies in (1) improving the capacity for evidence-based decision making by public health policy makers and practitioners, (2) changing public health policy or practice, and (3) changes in individual or population health outcomes.MethodsA search strategy was developed to identify randomized trials assessing the effectiveness of digital TEKT strategies in public health. Any primary research study with a randomized trial design was eligible. Searches for eligible studies were undertaken in multiple electronic bibliographic databases (Medical Literature Analysis and Retrieval System Online [MEDLINE], Excerpta Medica dataBASE [EMBASE], PsycINFO, Cumulative Index to Nursing and Allied Health Literature [CINAHL], and Scopus) and the reference lists of included studies. A hand search of 2 journals (Implementation Science and Journal of Medical Internet Research) and a gray literature search were also conducted. Pairs of independent review authors screened studies, assessed the risk of bias, and extracted data from relevant studies.ResultsOf the 6819 citations screened, 8 eligible randomized trials were included in the review. The studies examined the impact of digital TEKT strategies on health professionals, including nurses, child care health consultants, physiotherapists, primary health care workers, and public health practitioners. Overall, 5 of the interventions were web-training programs. The remaining 3 interventions included simulation games, access to digital resource materials and the use of tailored messaging, and a web-based registry. The findings suggest that digital TEKT interventions may be effective in improving the knowledge of public health professionals, relative to control, and may be as effective as a face-to-face KT approach. The effectiveness of digital TEKT strategies relative to a control or other digital KT interventions on measures of health professional self-efficacy to use evidence to enhance practice behavior or behavioral intention outcomes was mixed. The evidence regarding the effects on changes to health policy or practice following exposure to digital TEKT was mixed. No trials assessed the effects on individual or population-level health outcomes.ConclusionsThis review is the first to synthesize the effectiveness of digital TEKT interventions in a public health setting. Despite its potential, relatively few trials have been undertaken to investigate the impacts of digital TEKT interventions. The findings suggest that although a digital TEKT intervention may improve knowledge, the effects of such interventions on other outcomes are equivocal.

<h3>Abstract</h3> The concept of Culturally and Linguistically Diverse (CALD) populations is unique to Australia. It was introduced in 1996 and is intended to refer to ethno-cultural groups that are neither Aboriginal or Torres Strait Islander nor considered from mainstream English-speaking Anglo-Celtic backgrounds. CALD children have been identified as a priority population by the Australian government because they may experience inequities in health outcomes compared to Anglo-Australian children. Inequities in the health and wellbeing of CALD children are driven by myriad processes including racial discrimination, socioeconomic disadvantage, and limited access to health services. But who are CALD children? Despite the availability of statistical standards for data collection on CALD characteristics such as country of birth and language spoken, the concept itself lacks an official operational definition. Applying definitions specified by various organisations to data from the 2016 Australian Census, the estimated proportion of CALD children ranged from 11% to 44% of Australian children aged 0 to 17 years. There are few published studies on CALD children in Australian child health research, with most studies focused on refugees. There is no consensus on how CALD is defined in child health research in Australia. We propose several considerations in the use of the CALD concept in child health research. This includes adhering to the Australian Bureau of Statistics standards on Cultural and Linguistic Diversity, use of multiple indicators to identify CALD, and acknowledging the significant heterogeneity of CALD communities which may contribute to observed differences in health. If we are to advance health and well-being equity for CALD children, we need a more carefully considered and consistent approach to understanding which children are CALD.

BackgroundPeople of culturally and linguistically diverse (CALD) background face significant barriers in accessing effective health services in multicultural countries such as the United States, Canada, Europe and Australia. To address these barriers, government and nongovernment organisations globally have taken the approach of creating ethno-specific services, which cater to the specific needs of CALD clients. These services are often complementary to mainstream services, which cater to the general population including CALD communities.MethodsThis systematic review uses the Evidence Gap Map (EGM) approach to map the available evidence on the effectiveness of ethno-specific and mainstream services in the Australian context. We reviewed Scopus, Web of Science and PubMed databases for articles published from 1996 to 2021 that assessed the impact of health services for Australian CALD communities. Two independent reviewers extracted and coded all the documents, and discussed discrepancies until reaching a 100% agreement. The main inclusion criteria were: 1) time (published after 1996); 2) geography (data collected in Australia); 3) document type (presents results of empirical research in a peer-reviewed outlet); 4) scope (assesses the effectiveness of a health service on CALD communities). We identified 97 articles relevant for review.ResultsNinety-six percent of ethno-specific services (i.e. specifically targeting CALD groups) were effective in achieving their aims across various outcomes. Eighteen percent of mainstream services (i.e. targeting the general population) were effective for CALD communities. When disaggregating our sample by outcomes (i.e. access, satisfaction with the service, health and literacy), we found that 50 % of studies looking at mainstream services’ impact on CALD communities found that they were effective in achieving health outcomes. The use of sub-optimal methodologies that increase the risk of biased findings is widespread in the research field that we mapped.ConclusionsOur findings provide partial support to the claims of advocacy stakeholders that mainstream services have limitations in the provision of effective health services for CALD communities. Although focusing on the Australian case study, this review highlights an under-researched policy area, proposes a viable methodology to conduct further research on this topic, and points to the need to disaggregate the data by outcome (i.e. access, satisfaction with the service, health and literacy) when assessing the comparative effectiveness of ethno-specific and mainstream services for multicultural communities.

Participation of people from culturally and linguistically diverse (CALD) communities in public health research is often limited by challenges with recruitment, retention and second-language data collection. Consequently, people from CALD communities are at risk of their needs being marginalised in public health interventions. This paper presents intrinsic case analyses of two studies which were adapted to increase the cultural competence of research processes. Both cases were part of the Optimise study, a major mixed methods research study in Australia which provided evidence to inform the Victorian state government's decision-making about COVID-19 public health measures. Case study 1 involved the core Optimise longitudinal cohort study and Case study 2 was the CARE Victorian representative survey, an Optimise sub-study. Both case studies engaged cultural advisors and bilingual staff to adjust the survey measures and research processes to suit target CALD communities. Reflexive processes provided insights into the strengths and weaknesses of the inclusive strategies. Selected survey results are provided, demonstrating variation across CALD communities and in comparison to participants who reported speaking English at home. While in most cases a gradient of disadvantage was evident for CALD communities, some patterns were unexpected. The case studies demonstrate the challenge and value of investing in culturally competent research processes to ensure research guiding policy captures a spectrum of experiences and perspectives.

Objective To identify health literacy issues when providing maternity care to culturally and linguistically diverse (CALD) women, and the strategies needed for health professionals to collaboratively address these issues. Methods A qualitative case study design was undertaken at one large metropolitan Australian hospital serving a highly CALD population. Semistructured interviews were conducted with a range of maternity healthcare staff. The data were analysed thematically. The study is informed by a framework of cultural competence education interventions for health professionals and a health literacy framework. Results Eighteen clinicians participated in the interviews (seven midwives, five obstetricians, five physiotherapists, one social worker, and one occupational therapist). Emergent themes of health literacy-related issues were: patient-based factors (communication and cultural barriers, access issues); provider-based factors (time constraints, interpreter issues); and enablers (cultural awareness among staff, technology). Conclusions There are significant health literacy and systemic issues affecting the hospital's provision of maternity care for CALD women. These findings, mapped onto the four domains of cultural competence education interventions will inform a technology-delivered health literacy intervention for CALD maternity patients. This approach may be applied to other culturally diverse healthcare settings to foster patient health literacy. What is known about the topic? There are health inequities for pregnant women of culturally and linguistically diverse (CALD) backgrounds. Low health literacy compounded by language and cultural factors contribute to these inequities and access to interpreters in pregnancy care remains an ongoing issue. Pregnancy smart phone applications are a popular source of health information for pregnant women yet these apps are not tailored for CALD women nor are they part of a regulated industry. What does this paper add? This paper provides clinician and language service staff perspectives on key health literacy issues that are both patient-based and provider-based. This research confirms that the complex interplay of social and practical factors contributes to and perpetuates low health literacy, creating barriers to health access; it also highlights several enablers for increasing CALD health literacy and access. These include greater health practitioner awareness and accommodation of CALD women's needs and the provision of culturally and linguistically appropriate eHealth resources. What are the implications for practitioners? eHealth resources are emerging as valuable enabling tools to address the health literacy and information needs of pregnant women. However, these resources need to be used adjunctively with health practitioner communication. Both resource developers and health practitioners need to understand issues affecting CALD patients and their needs. Developers need to consider how the resource addresses these needs. Training of health professionals about culture-specific issues may help to enhance communication with, and therefore health literacy among, individual cultural groups. Further, formalised language and interpreting training of bi- or multilingual health professionals is advised to ensure that they are able to interpret to a professional standard when called on to do so.

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.

‘Prescriptions for Success’: a mixed methods exploration of engagement, learning and academic performance among successful CALD (culturally and linguistically diverse) and non-CALD pharmacy students at a research-intensive Australian university

Emergency Medical Service Use for Acute Coronary Syndrome in Culturally and Linguistically Diverse Immigrant Populations.

Clinical supervisors' perspectives of factors influencing clinical learning experience of nursing students from culturally and linguistically diverse backgrounds during placement: A qualitative study