Culturally And Linguistically Diverse Backgrounds Research Articles

What do women need to know about long-acting reversible contraception? Perspectives of women from culturally and linguistically diverse backgrounds.

To identify components of an online education intervention to improve preference for, and uptake of, long-acting reversible contraception in women from culturally and linguistically diverse backgrounds (CALD). Women from culturally and linguistically diverse (CALD) backgrounds have greater rates of unintended pregnancies than those born locally and are less likely to use long-acting reversible contraceptives (LARCs), which are highly effective at reducing unintended pregnancy. Increasing the uptake of LARC in women from CALD backgrounds may reduce the burden of unintended pregnancy in this high-risk group. An online education intervention has been shown to be effective at increasing preference for and uptake of LARC in young women. We aimed to describe what women from CALD backgrounds thought were the potentially effective components of an online education intervention to increase preference for, and uptake of, long-acting reversible contraception. This qualitative study involved semi-structured interviews with six Australian English-speaking women from each of Chinese, Indian, and Middle Eastern cultural backgrounds. Women were recruited through targeted Facebook advertising. Data were analysed using Braun and Clarke thematic analysis. A total of 18 participants were interviewed. We have demonstrated the importance of messages tailored to cultural values, translating the video, widening the target audience to both men and women and using specific social media platforms. For all women, the video needs to highlight the covertness of contraceptive methods, alongside stating cost and approach to access. For Indian women, the video needs to highlight the effect of LARC methods on the menstrual period for Indian women and include basic information on women's health. For Middle Eastern women the video should be explicit about LARC not equating to abortion and emphasise the low efficacy of natural contraceptive methods. For Chinese women, the video should address the misconception that hormones damage the body. Regarding delivery of the video, it should be translated and delivered by a female doctor from the same culture. For Chinese women, the video should include women from the same culture sharing anecdotes and use WeChat and Chinese schools as a platform for dissemination. For Middle Eastern and Indian women government websites should be used for dissemination. The video should be made available to all decision-makers in the reproductive planning process including male partners of Middle Eastern women, parents and peers of Chinese women, and for Indian women the male partner, family, and community leaders. There is a wide range of cultural adaptations that can be made to the online education videos about LARCs to improve uptake of LARCs and hence reduce the burden of unintended pregnancy in women from CALD grounds. SO WHAT?: Our findings will be used to modify an online education video about LARCs so that it is culturally appropriate for women from CALD backgrounds.

Inequity of antenatal influenza and pertussis vaccine coverage in Australia: the Links2HealthierBubs record linkage cohort study, 2012–2017

BackgroundPregnancy and early infancy are increased risk periods for severe adverse effects of respiratory infections. Aboriginal and/or Torres Strait Islander (respectfully referred to as First Nations) women and children in Australia bear a disproportionately higher burden of respiratory diseases compared to non-Indigenous women and infants. Influenza vaccines and whooping cough (pertussis) vaccines are recommended and free in every Australian pregnancy to combat these infections. We aimed to assess the equity of influenza and/or pertussis vaccination in pregnancy for three priority groups in Australia: First Nations women; women from culturally and linguistically diverse (CALD) backgrounds; and women living in remote areas or socio-economic disadvantage.MethodsWe conducted individual record linkage of Perinatal Data Collections with immunisation registers/databases between 2012 and 2017. Analysis included generalised linear mixed model, log-binomial regression with a random intercept for the unique maternal identifier to account for clustering, presented as prevalence ratios (PR) and 95% compatibility intervals (95%CI).ResultsThere were 445,590 individual women in the final cohort. Compared with other Australian women (n = 322,848), First Nations women (n = 29,181) were less likely to have received both recommended antenatal vaccines (PR 0.69, 95% CI 0.67–0.71) whereas women from CALD backgrounds (n = 93,561) were more likely to have (PR 1.16, 95% CI 1.10–1.13). Women living in remote areas were less likely to have received both vaccines (PR 0.75, 95% CI 0.72–0.78), and women living in the highest areas of advantage were more likely to have received both vaccines (PR 1.44, 95% CI 1.40–1.48).ConclusionsCompared to other groups, First Nations Australian families, those living in remote areas and/or families from lower socio-economic backgrounds did not receive recommended vaccinations during pregnancy that are the benchmark of equitable healthcare. Addressing these barriers must remain a core priority for Australian health care systems and vaccine providers. An extension of this cohort is necessary to reassess these study findings.

The experiences of women fromculturally and linguistically diverse backgrounds with gestational diabetes mellitus: A mixed methods systematic review.

Gestational diabetes mellitus (GDM) is experienced at a higher rate in women from culturally and linguistically diverse (CALD) backgrounds. The aim of this systematic review is to describe the experiences of women with GDM from CALD backgrounds and compare their experiences to women with GDM from non-CALD backgrounds. MEDLINE, EMBASE, PsycINFO, Scopus, WOS and CINAHL databases were searched for qualitative and quantitative studies which included data on the experiences of CALD background women with GDM during all stages of pregnancy. Quality appraisal utilized checklists for analytical cross-sectional studies and qualitative research. Thematic analysis was performed using nVivo software. Of the 3054 studies identified, 24 studies met the inclusion criteria. Data synthesis produced five key themes: (1) Response to diagnosis, (2) Experiences with self-management, (3) Interactions with the healthcare system, (4) Mental health challenges and (5) Facilitators and barriers to support. Women with GDM from CALD and non-CALD backgrounds similarly expressed mental health challenges, feeling burdened by recommendations, and challenges interacting with healthcare professionals (HCP). The major difference in experience was the cultural relevance of recommendations, especially related to diet recommendations. Gestational diabetes mellitus is a burdensome diagnosis for CALD and non-CALD women, with CALD women uniquely experiencing a lack of culturally relevant recommendations for self-management. The similarities and differences in experience call for optimisation of GDM management and support for women with GDM.

Barriers to and Facilitators of Digital Health Among Culturally and Linguistically Diverse Populations: Qualitative Systematic Review.

Health care systems have become increasingly more reliant on patients' ability to navigate the digital world. However, little research has been conducted on why some communities are less able or less likely to successfully engage with digital health technologies (DHTs), particularly among culturally and linguistically diverse (CaLD) populations. This systematic review aimed to determine the barriers to and facilitators of interacting with DHTs from the perspectives of CaLD population groups, including racial or ethnic minority groups, immigrants and refugees, and Indigenous or First Nations people. A systematic review and thematic synthesis of qualitative studies was conducted. Peer-reviewed literature published between January 2011 and June 2022 was searched across 3 electronic databases. Terms for digital health were combined with terms for cultural or linguistic diversity, ethnic minority groups, or Indigenous and First Nations people and terms related to barriers to accessing digital technologies. A qualitative thematic synthesis was conducted to identify descriptive and analytical themes of barriers to and facilitators of interacting with DHTs. Quality appraisal was performed using the Mixed Methods Appraisal Tool. Of the 1418 studies identified in the electronic search, a total of 34 (2.4%) were included in this review. Half of the included studies (17/34, 50%) were conducted in the United States. There was considerable variation in terms of the CaLD backgrounds of the participants. In total, 26% (9/34) of the studies focused on Indigenous or First Nations communities, 41% (14/34) were conducted among ethnic minority populations, 15% (5/34) of the studies were conducted among immigrants, and 18% (6/34) were conducted in refugee communities. Of the 34 studies, 21 (62%) described the development or evaluation of a digital health intervention, whereas 13 (38%) studies did not include an intervention but instead focused on elucidating participants' views and behaviors in relation to digital health. From the 34 studies analyzed, 18 descriptive themes were identified, each describing barriers to and facilitators of interacting with DHTs, which were grouped into 7 overarching analytical themes: using technology, design components, language, culture, health and medical, trustworthiness, and interaction with others. This study identified several analytic and descriptive themes influencing access to and uptake of DHTs among CaLD populations, including Indigenous and First Nations groups. We found that cultural factors affected all identified themes to some degree and that cultural and linguistic perspectives should be considered in the design and delivery of DHTs, with this best served through the inclusion of the target communities at all stages of development. This may improve the potential of DHTs to be more acceptable, appropriate, and accessible to population groups currently at risk of not obtaining the full benefits of digital health.

Describing homelessness risk among people from culturally and linguistically diverse backgrounds in Western Australia: A cluster analysis approach.

Housing is a social determinant of health. Migrants are at an increased risk of insecure housing, overcrowding, and homelessness which can lead to poor quality of life and well-being. This study aimed to identify clustering patterns of homelessness risks among people from culturally and linguistically diverse (CaLD) backgrounds in Western Australia (WA). Participants from CaLD backgrounds (n= 143, 81.8% male) were identified from secondary cross-sectional data sourced from Vulnerability Index Service Prioritisation Decision Assistance Tool (VI-SPDAT) surveys conducted with people experiencing homelessness in Perth, WA, between 2012 and 2020. A two-step cluster analysis was used to identify subgroups within the data, and chi-square tests compared demographic characteristics and drivers of homelessness among the determined clusters. Three distinct clusters were identified and labelled as 'high-risk group' (n= 50, 35.0%), 'medium-risk group' (n= 39, 27.3%) and 'low-risk group' (n= 47, 32.9%). The most vulnerable participants (with VI-SPDAT score ≥ 10) were all clustered in the 'high-risk group'. The analysis identified subgroups within and between CaLD populations and highlighted limitations with data collection instruments for measuring homelessness among these groups. SO WHAT?: To prevent health issues associated with homelessness and improve social determinants of health, improvements in research and service provision are recommended to facilitate equitable access to secure housing for people from CaLD populations.

The Complexities of Managing Gestational Diabetes in Women of Culturally and Linguistically Diverse Backgrounds: A Qualitative Study of Women’s Experiences

This study aimed to explore women's perspectives and experiences concerning how culture impacts the lifestyle management of gestational diabetes mellitus (GDM) in women of culturally and linguistically diverse (CALD) backgrounds. Women of any cultural background diagnosed with GDM within the previous 12 months were purposively recruited from two Australian metropolitan hospitals. Data collected using semi-structured interviews (n = 18) and focus groups (n = 15 women in three groups) were analysed using reflexive thematic analysis. Three themes were generated: "cultural beliefs and obligations impact lifestyle management of gestational diabetes", which describes how some cultures lack awareness about GDM, and modifications or restrictions were viewed as depriving the infant, but sometimes adaptions could be made so that a culturally appropriate meal was suitable for GDM management; "the relationship between cultural foods and gestational diabetes management", which discusses how important cultural foods may be incompatible with appropriate GDM management, so women worked to find solutions; "gestational diabetes education lacks cultural awareness and sensitivity", which illustrates how current education fails to address differences in cultural beliefs, language and eating practices. Cultural beliefs, obligations and food practices must be considered when assisting women of CALD backgrounds using lifestyle modification to manage GDM. GDM education must be culturally sensitive and competent and, where possible, be delivered by health professionals of a shared cultural group.

The Need for Integration of Religion and Spirituality into the Mental Health Care of Culturally and Linguistically Diverse Populations in Australia: A Rapid Review

Australia is a multicultural and linguistically diverse country. Despite the vital role of religion/spirituality in the mental health of people from culturally and linguistically diverse (CALD) backgrounds, it is not commonly included in their mental health care. A rapid review was conducted to critically evaluate the studies that identified relevant religious/spiritual aspects regarding mental health care for CALD communities. After a systematic search and screening, sixteen empirical studies were included. The findings of the review suggest that people from CALD backgrounds draw strength and comfort from their religion to support mental health. Religious/spiritual practices were identified as effective mental health strategies by CALD people. Religious leaders were noted to be important sources of mental health support and guidance for individuals from some CALD communities. Collaboration of religious leaders in the mental health care, and integration of religious/spiritual practices into mainstream mental health interventions, may improve mental health care for people with CALD backgrounds.

Educational Card Games: One Way of Assisting the Communication Skills Development of Nursing Students Whose First Language is Not English

Aim/Purpose. This study seeks to determine the impact of a card game intervention in improving the English verbal communication of nursing students from culturally and linguistically diverse backgrounds. Background. Many international students studying in Australia experience setbacks in their university studies due to English language difficulties. This paper outlines how an educational card game designed can be played by nursing students from culturally and linguistically diverse (CALD) backgrounds as an intervention for their English verbal communication development. Methodology. The study used a descriptive qualitative approach to analyse the learning experiences of forty-five (N=45) nursing students from CALD backgrounds undertaking their second semester at a metropolitan university in Victoria, Australia after being introduced to an educational card game developed by the first author. The card game was designed to explore the use of English pragmatic markers, which are words, phrases, or verbal cues that signal or emphasise the intentions of the speaker. Following the intervention, participants were queried in a survey about their experiences with English language speaking and how the game improved their verbal communication skills. Contribution. This paper provides knowledge about how a game can be designed to enhance the English verbal communication skills of nursing students from CALD backgrounds which could help them in their clinical placements and their adjustment into Australian society. Findings. Three intertwining themes that emerged from the data analysis were education content, skills development, and fun and creativity. These themes signify the importance of providing opportunities for learners to creatively practise the educational content in simulative contextualised situations within a safe, comfortable, and inclusive learning environment. Recommendations for Practitioners. Educators still need to consider the importance of inclusivity of students from culturally and linguistically diverse (CALD) backgrounds as part of successful integration into the culture of their host countries. Recommendations for Researchers. The findings emphasise the need for educators and researchers to understand the challenges facing these students in relation to marginalisation and discrimination and how they can design an intervention that is engaging and inclusive. Impact on Society. The findings also put forward the awareness of pragmatics as part of both English language learning and integration into the society of a host country as students learn how to express intention appropriately in various interactions. Furthermore, the themes presented in this paper suggest that not only should an educational game or an intervention contain relevant educational content and practical activities for skills development, but they must also be enjoyable by encouraging creativity and social interaction. Future Research. The results of this study also open possible future studies that involves the adaptation of a digital version of the card game or possible implementation of the game in other health professional programs in universities and other educational institutes.

'It's really important to be collaborating': Experiences of participatory research for Chinese and Vietnamese parents of autistic children.

Participatory research involves academic partners working together with the community that is affected by research to make decisions about that research. Such approaches often result in research that is more respectful of, and responsive to, community preferences - and is vital in the context of autism research with culturally and linguistically diverse (CALD) communities. Whilst participatory approaches are becoming more commonplace within CALD autism research, no studies have explored the experiences of being involved in autism research from the perspectives of CALD community partners over the course of a study. This paper intended to address this gap by reporting on the experiences of CALD parents of autistic children who were community partners in a 1-year Australian research project exploring home-school partnerships for CALD parents of autistic children. We aimed to: (1) report on how parents' involvement in the research process shaped the home-school partnerships study over time and (2) understand their experiences of being community partners on the home-school partnerships project. Using key principles of participatory approaches, we established Chinese and Vietnamese parent advisory groups to contribute to a project exploring home-school partnerships for parents of autistic children from CALD backgrounds in Australia. Advisory groups included parents of autistic children from Chinese/Vietnamese backgrounds, as well as interpreters, professionals and researchers. We documented how parents' participation as community partners shaped the home-school partnerships study over the course of the project. We also elicited parents' own views and experiences of being community partners through informal, open-ended questions at the beginning and end of the study. We found that parents' input fundamentally shaped the broader home-school partnership study, from meaningful, accurate translation of interview schedules through to making decisions regarding community-specific recommendations and dissemination plans. Parents themselves reported being keen to collaborate and to hear and share opinions for the purpose of the home-school partnership study - although they noted how emotionally difficult sharing their stories could be. While they initially had some concerns about combining being involved as a community partner with their existing responsibilities, ultimately, parents were surprised by the scope of the home-school partnership study and their level of involvement as community partners. Through hearing others' stories and sharing their own in advisory group meetings, parents reported ancillary benefits of their involvement, including increased self-advocacy and well-being. These findings show how research that is conducted in partnership with diverse members of the autism community has the capacity to improve the quality of the research and benefit community partners. This study clearly documents the benefits and potential challenges of participatory approaches with CALD communities. These findings emphasise to researchers and funders the importance of including extra time and money within budgets in order to produce meaningful research that is respectful and responsive to communities.

What Quality-of-Life Dimensions Are Most Important to Older Adults from Culturally and Linguistically Diverse Backgrounds Receiving Aged Care Services? An Exploratory Study.

There is little research on what aspects of quality of life (QoL) are most important to culturally and linguistically diverse (CALD) older adults. This study aimed to identify what QoL dimensions were most important to CALD older adults receiving aged care services, and therefore, how relevant a new six dimensions QoL instrument developed for use in aged care is to this population. A three-stage, mixed-methods study was undertaken. Stage 1: n = 3 focus groups with aged care providers. Stage 2: n = 30 semi-structured interviews with Italian-born older adults in ethno-specific residential aged care. Stage 3: survey of n = 63 older adults from mixed CALD backgrounds receiving community aged care services. Overall, older adults asserted the importance of the six dimensions of the new QoL instrument. The importance of 'identity' and 'purpose and meaning' were identified via the focus groups; however, the community-based CALD older adults identified these aspects of quality of life as more important than older Italians in residential care. Being in ethno-specific residential aged care where needs relating to language, food, and religion were met and they continued to live with others from their community may have meant that the meeting of cultural needs was more taken for granted.

Collateral positives of COVID-19 for culturally and linguistically diverse communities in Western Sydney, Australia.

To investigate whether culturally and linguistically diverse (CALD) communities in Western Sydney have experienced any positive effects during the COVID-19 pandemic, and if so, what these were. A cross-sectional survey with ten language groups was conducted from 21st March to 9th July 2021 in Sydney, Australia. Participants were recruited through bilingual multicultural health staff and health care interpreter service staff and answered a question, 'In your life, have you experienced any positive effects from the COVID-19 pandemic?' Differences were explored by demographic variables. Free-text responses were thematically coded using the Content Analysis method. 707 people completed the survey, aged 18 to >70, 49% males and 51% females. Only 161 (23%) of those surveyed reported any positive impacts. There were significant differences in the proportion of those who reported positives based on age (p = 0.004), gender (p = 0.013), language (p = 0.003), health literacy (p = 0.014), English language proficiency (p = 0.003), education (p = <0.001) and whether participants had children less than 18 years at home (p = 0.001). Content Analysis of open-ended responses showed that, of those that did report positives, the top themes were 'Family time' (44%), 'Improved self-care' (31%) and, 'Greater connection with others' (17%). Few surveyed participants reported finding any positives stemming from the COVID-19 pandemic. This finding is in stark contrast to related research in Australia with participants whose native language is English in which many more people experienced positives. The needs of people from CALD backgrounds must inform future responses to community crises to facilitate an equitable effect of any collateral positives that may arise.

“ESL teachers are looked down upon”: Understanding the lived experience of a first-year ESL teacher with culturally and linguistically diverse background

Research indicates many new English as a Second Language (ESL) teachers leave the profession within 5 years. However, limited research has focused on these teachers’ experiences and far fewer studies examined those with Culturally and Linguistically Diverse (CALD) backgrounds to identify what contributes to the high attrition rate. This narrative study captured the experience of a first-year ESL teacher with CALD backgrounds. Data were collected using a three-step interview approach over the course of 1 year. The data show the protagonist’s identity as an advocate for Emergent Bilinguals (EBs) began during his extended clinical practicum and was further driven by his CALD background, unsupportive colleagues, and the marginalized status of EBs and ESL teachers. Although he overcame numerous challenges, he ultimately left his ESL position due to his unsustainable low salary. The story confirmed current research regarding systematic barriers that may prevent CALD individuals from entering and staying in the ESL teaching field. Possible implications for teacher educators and policy makers are discussed.

Assessing children’s vocabulary: An exploratory cross-sectional survey of speech-language pathologists

Purpose Past research highlights the importance of evaluating word learning abilities to build understanding of an individual’s language-learning capacity and make evidence-informed decisions in speech-language pathology practice. However, little research has explored vocabulary and word learning assessment practices among speech-language pathologists (SLPs). This pilot, exploratory study aimed to explore current assessment practices and guide translation of research to practice among SLPs who work with children of all ages. Method SLPs (N = 127) from three predominantly English-speaking countries (Australia, USA, and UK) completed an online survey. The survey explored methods and purposes for assessing vocabulary knowledge and word learning skills via binary and multiple-choice questions. Responses to three open-ended questions were analysed using conventional content analysis. The survey also asked about perspectives regarding assessment practices with individuals from culturally and linguistically diverse (CALD) backgrounds. Result Of the surveyed SLPs, 118 (92%) reported using norm-referenced measures of vocabulary, with 27 reporting additional use of non-normed measures. Seventy-seven SLPs (61%) reported that they measure word learning skills, and 20 of these SLPs used dynamic assessment procedures to evaluate word learning. Responding SLPs across all three countries reported using vocabulary and word learning assessment data in a variety of ways (e.g. to support diagnostic decision-making). Regarding the use of standardised, norm-referenced vocabulary assessments with individuals from CALD backgrounds, SLPs reported concerns regarding poor cultural sensitivity and limited access to alternative methods. Conclusion The findings highlight the need for further development and dissemination of accessible resources to support SLPs’ implementation of word learning assessment, including resources for dynamic assessment. This is especially critical considering the established limitations associated with using standardised, norm-referenced tests with minority groups who are underrepresented in standardisation samples.

Barriers and facilitators to cervical cancer screening for women from culturally and linguistically diverse backgrounds; a qualitative study of GPs

ObjectiveTo explore general practitioners’ (GPs) perspectives on the barriers and facilitators to cervical cancer screening (CCS) for women from culturally and linguistically diverse (CALD) backgrounds.DesignQualitative descriptive study involving semi-structured interviews,...

Robotic technologies and well-being for older adults living at home

PurposeThe purpose of this study is to investigate the benefits for aged care providers of adding affordable robotic technology to their services packages to enhance the well-being of older adults from culturally and linguistically diverse (CALD) backgrounds who choose to live at home.Design/methodology/approachThis study, adopting a transformative service research lens, was performed with a group of older Australian adults from CALD backgrounds aged approximately 70 years. This study conducted four rounds of home trials with three different, commercially available robotic technologies from January to November 2020. Each trial lasted seven days.FindingsThe findings reveal that older adults from CALD backgrounds are open to learning about new technologies and can successfully interact independently with multiple robotic technologies in their own homes. The results indicate that robot technology has the potential to increase the well-being of older people by enhancing a sense of belonging, independence and quality of life while living at home.Research limitations/implicationsThis study shows a promising future involving the use of available technology to assist older people from CALD backgrounds to live better lives at home. Ageing at home can be central to a person’s sense of identity and independence, and this study is a big step towards a new aged care system desperately needed in a society with a rapidly ageing population.Originality/valueTo the best of the authors’ knowledge, this study is among the first to introduce three different commercially available robots, each designed to satisfy companionship, cleaning and/or communication needs in the homes of older adults from CALD backgrounds to increase their overall well-being.

Robotic Technologies and Well-being for Older Adults Living at Home

The purpose of this study is to investigate the benefits for aged care providers to add affordable robotic technology in their services packages to enhance the well-being of older adults from culturally and linguistically diverse (CALD) backgrounds who choose to live at home. This study, adopting a Transformative service research lens, was performed with a group of Australian older adults from CALD backgrounds aged on average 70 years old. In total, the study conducted four rounds of home trials with three different, commercially available robotic technologies from January to November 2020, each trial lasted seven days. The findings reveal that older adults from CALD backgrounds are open to learning about new technologies and can successfully interact independently with multiple robotic technologies in their own homes. Further, our results indicate that robot technology has the potential to increase the well-being of these older people. The results show that technology can enhance a sense of belonging, independence, and quality of life while living at home. Research limitations/implications - This study shows a promising future involving the use of available technology to assist older people from CALD backgrounds to lead a better life at home. Aging at home can be central to a person’s sense of identity and independence; this study is a big step towards a new aged care system that is sorely needed in a society that experiences a rapidly aging population.

Accessibility of web‐based health information for women in midlife from culturally and linguistically diverse backgrounds or with low health literacy

ObjectiveTo measure the accessibility of Australian web‐based health information for midlife women including those from culturally and linguistically diverse (CALD) backgrounds or with low health literacy. MethodsSearch terms relating to midlife health were entered into Google Australia to identify health information websites. The content of the first two results pages was assessed using the European Commission's quality criteria for health websites. Readability was assessed using the Flesch Readability Ease Score with Grade 8 accepted as the average Australian reading level. ResultsSixteen websites were evaluated. Accessibility scores ranged between 0 and 8. The Victorian Government's health website Better Health Channel and the Jean Hailes for Women's Health website contained the most accessible information, each scoring 8, but were both ‘difficult to read’ on the readability test. Four websites included written resources in languages other than English and two had information in audio‐visual format in languages other than English. ConclusionsThere is a gap in accessible online health information for Australian women from CALD backgrounds or those with low health literacy. Implications for public healthHealthy behaviour changes in midlife may lead to better health in older age. More accessible health information resources are needed for women in midlife from CALD backgrounds and those with low health literacy.

Access to health services among culturally and linguistically diverse populations in the Australian universal health care system: issues and challenges

BackgroundAbout half of first- or second-generation Australians are born overseas, and one-in-five speak English as their second language at home which often are referred to as Culturally and Linguistically Diverse (CALD) populations. These people have varied health needs and face several barriers in accessing health services. Nevertheless, there are limited studies that synthesised these challenges. This study aimed to explore issues and challenges in accessing health services among CALD populations in Australia.MethodsWe conducted a scoping review of the literature published from 1st January 1970 to 30th October 2021 in four databases: PubMed, Scopus, Embase, and the Web of Science. The search strategy was developed around CALD populations and the health services within the Australian context. We used Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines for selection and Arksey and O’Malley framework for analysis of relevant articles. A narrative synthesis of data was conducted using inductive thematic analysis approach. Identified issues and challenges were described using an adapted socioecological model.ResultsA total of 64 studies were included in the final review. Several challenges at various levels were identified to influence access to health services utilisation. Individual and family level challenges were related to interacting social and health conditions, poor health literacy, multimorbidity, diminishing healthy migrants’ effect. Community and organisational level challenges were acculturation leading to unhealthy food behaviours and lifestyles, language and communication problems, inadequate interpretation services, and poor cultural competency of providers. Finally, challenges at systems and policy levels included multiple structural disadvantages and vulnerabilities, inadequate health systems and services to address the needs of CALD populations.ConclusionsPeople from CALD backgrounds have multiple interacting social factors and diseases, low access to health services, and face challenges in the multilevel health and social systems. Health systems and services need to focus on treating multimorbidity through culturally appropriate health interventions that can effectively prevent and control diseases. Existing health services can be strengthened by ensuring multilingual health resources and onsite interpreters. Addressing structural challenges needs a holistic policy intervention such as improving social determinants of health (e.g., improving living and working conditions and reducing socioeconomic disparities) of CALD populations, which requires a high level political commitment.

Pedagogical challenges and practices in multicultural classrooms: a praxeological study

ABSTRACT This article addresses the pedagogical practices applied by teachers at pre and primary school level when working with children with culturally and linguistically diverse backgrounds (CALD) as well as potential challenges in a research collaboration between teachers and academics. A praxeological study was conducted with two preschool teachers and two primary school teachers participating. Additional data was obtained through interviews with the principals of the two participating schools. The aim of the study was for the teachers to reflect on their own practices, and in collaboration with the researcher, create and develop new knowledge and approaches on how to better respond to and work with their CALD students. Findings suggest that observed pedagogical practices, as well as the class and school environment, exhibited few characteristics of a culturally responsive pedagogy or cultural diversity. The principal’s encouragement and support seemed to be an influential factor regarding the teachers’ overall research experience and the teachers who felt more support from their principal during the research period reported more benefits from the study. The findings also reveal some of the challenges that can arise in a research collaboration between teachers and researchers, such as identifying shared goals and mutual understanding of important concepts.

The M-CHooSe pilot: the acceptability and utilisation of the nurse-led, general practice clinic co-located 'Mater CALD Healthcare Coordinator Service' for patients from multicultural backgrounds.

Patients from culturally and linguistically diverse (CALD) backgrounds often have unmet healthcare coordination needs. We aimed to evaluate the acceptability, utilisation and perceived benefits of the Mater CALD Health Coordinator Service (M-CHooSe), a pilot, nurse-led, general practice co-located, healthcare coordination service for patients from CALD backgrounds. M-CHooSe began in March 2020 at five Brisbane (Queensland) sites. Process and service user data were collected over 12months at one site. A survey evaluated primary healthcare professionals' perceived benefits of the service. Another survey of M-CHooSe nurses examined indicators of service complexity. In total, 206 individuals accessed M-CHooSe over the 12-month period. Commonly delivered services included health service advocacy, chart reviews and health system navigation, including addressing social determinants. M-CHooSe nurses reported frequently performing tasks such as following up with external health services and performing health and social care system coordination. M-CHooSe benefits reported by primary healthcare professionals included better patient access to external health services and improved patient understanding of their conditions and treatments. Patients were accepting of referrals to M-CHooSE. Primary healthcare professionals also reported a variety of benefits to themselves and their patients because of M-CHooSe. M-ChooSe highlights the potential of a healthcare coordination service for multicultural patients to improve healthcare equity, accessibility, and system efficiency. This project demonstrates the potential value of coordination services to increase patient access and uptake of existing health and social care services for modern Australian communities, thus improving the efficiency and effectiveness of our health system. Further investigations, including user experience, opinions and cost analyses, will be required to confirm the promising benefits of embedding M-CHooSe into usual care.