Culturally And Linguistically Diverse Communities Research Articles

A scoping review of the use of co-design methods with culturally and linguistically diverse communities to improve or adapt mental health services.

Mental health services are increasingly encouraged to use co-design methodologies to engage individuals and families affected by mental health problems in service design and improvement. This scoping review aimed to identify research that used co-design methods with Culturally and Linguistically Diverse (CALD) communities in mental health services, and to identify methodological considerations for working with this population. In October 2019, we searched five electronic databases (CINAHL, PsycINFO, EMBASE, MEDLINE, Web of Science) to identify papers published in which people from CALD backgrounds were engaged in the co-design of a mental health service or program. Searches were limited to peer-reviewed articles published in English in the last 25years (1993-2019). The search identified nine articles that matched the inclusion criteria. Using a scoping review methodology, the first author charted the data using extraction fields and then used qualitative synthesis methods to identify themes. Data were grouped into themes relevant to the research question. The two key themes relate first, to improving the experience for CALD communities when engaging in co-design research and second, to the development of co-design methods themselves. These findings support the need for further research into the transferability of co-design tools with CALD communities, particularly if co-design is to become a best practice method for service design and improvement. This scoping review identified methodological and practical consideration for researchers looking to use co-design with CALD communities for mental health service design, re-design or quality improvement initiatives. Further research is required to explore experiences of co-design methods, including documented protocols such as experience-based co-design, with CALD communities. This review indicates that explanatory models of mental health, community and co-design impact partnerships with CALD communities, and need to be understood to optimise the quality of these relationships when using co-design methods.

Improving Cultural Knowledge to Facilitate Cultural Adaptation of Pain Management in a Culturally and Linguistically Diverse Community.

Purpose: Health care disparities exist for people from culturally and linguistically diverse (CALD) communities. Addressing the cultural competence of health care providers could limit these disparities. The aim of this study was to improve cultural knowledge of and humility regarding pain in a CALD community. Method: This interpretive description qualitative study used focus group discussions (FGDs) to generate ideas about how South Asian culture could influence how health care providers manage pain. A total of 14 people with pain and of South Asian background (6 women and 8 men, aged 28-70 y) participated. Two investigators independently analyzed the data. This process involved repeatedly reading the transcripts, then manually sorting the key messages into categories. The investigators compared their categorizations and resolved differences through discussion. Next, similar categories and concepts were grouped into ideas (potential themes). These ideas, along with supporting categories and verbatim quotes, were presented to the full research team for feedback. After compiling the feedback, the ideas formed the thematic representation of the data. Results: The data from the FGDs revealed how pain management could be culturally adapted. The FGDs generated four themes about South Asian cultural perspectives that could influence the pain management experience for people living with pain: (1) cultural and linguistic impediments to communication, (2) understanding of pain in terms of the extent to which it interferes with function and work, (3) nurturing or personal attention as a marker of good care, and (4) value attributed to traditional ideas of illness and treatment. Conclusion: This study demonstrates how engaging with CALD people living with pain can lead to improved cultural knowledge and humility that can form the basis for adapting pain management. Through this process, it is more likely that a meaningful and client-centred pain management plan can be developed.

Suicidality and suicide prevention in culturally and linguistically diverse (CALD) communities: A systematic review

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

Implications for GP endorsement of a diabetes app with patients from culturally diverse backgrounds: a qualitative study.

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.

Older adults in disaster and emergency management: What are the priority research areas in Australia?

In Australia, the proportion of people aged over 65 years is increasing and the frequency and severity of natural hazard events are also increasing. Older adults are often identified as a vulnerable group in natural hazard events, but there has been relatively little research that focuses specifically on older adults and their capacities and needs. This paper describes stakeholder consultation undertaken to identify research priorities related to older adults and natural hazards in Australia, and compares this to current research literature on this topic identified in an initial scoping review. A two-phase modified Delphi study was undertaken with stakeholder organisations within Australia, including older adults' representative organisations, community services, and emergency services. Stakeholders (n = 112) first identified priority research areas and 649 distinct topics were suggested; thematic analysis was used to refine these to 19 research topic areas that were then rated and ranked for importance by stakeholders during phase two. The top five topic areas identified were ‘Communication and warnings,’ ‘Preparedness,’ ‘Awareness, behaviour and decision-making,’ ‘Culturally and Linguistically Diverse (CALD) communities,’ and ‘Community services and organisations’. While these topics are covered in some Australian literature, further research – particularly in relation to CALD communities, and community services/organisations – is needed. This study demonstrates the value of stakeholder engagement and the Delphi approach for identifying research priorities that can best address issues and concerns amongst diverse stakeholders. It also highlights that there is a need for further research with older adults, communities, and stakeholders to support preparedness, risk reduction, and resilience.

Carers of People with Mental Illness from Culturally and Linguistically Diverse Communities

ABSTRACTAustralia is a multicultural country and it is common for families from culturally and linguistically diverse (CALD) communities to care for their relatives with mental illness. However, there are limited Australian studies examining the experiences of informal carers of people with mental illness from CALD communities. A scoping review was conducted to search for peer-reviewed articles reporting the perception of carers regarding their caregiving experiences, wellbeing, and needs. Using cultural responsiveness as a conceptual framework, this study analysed the findings of the identified studies to generate themes. Findings show that carers experience severe caregiving challenges and face considerably poor culturally oriented services in mental health. Social work implications concerning the need to provide culturally responsive practice in mental health services are discussed.

Trends in acute stroke presentations to an emergency department: implications for specific communities in accessing acute stroke care services

Background and purposeSouth Western Sydney comprises of a culturally and linguistically diverse (CALD) and lower socioeconomic status population group within the state of New South Wales. Geographic location and sociodemographic...

Factors contributing to low readiness and capacity of culturally diverse participants to use the Australian national bowel screening kit.

Bowel screening is an effective way to promote early detection of bowel cancer. Culturally and linguistically diverse (CALD) people face considerable barriers to screening. This qualitative study explored perceptions towards, and usability of, Australia's national bowel screening kit with members of two migrant communities. Thirty-three people (aged 50-79 years) from Serbian and Macedonian communities in the Illawarra region in New South Wales, Australia, participated in one of five interactive focus group sessions. Sessions used innovative 'customer journey' techniques to understand participants' experience of each step of the faecal occult blood test process. Participants discussed knowledge of bowel cancer and attitudes to screening, and participated in a collective mock use of a test kit. Sessions were audio recorded, transcribed and thematically analysed by two researchers in collaboration with bicultural health workers. Multiple factors contributed to low readiness and capacity to use the kit, including limited promotion of the program in community languages, complicated and poorly sequenced kit instructions, and confusion around the order and labelling of kit components. Participants suggested several ways to improve kits to improve uptake by CALD communities. Simplified and targeted promotion of bowel screening programs in community languages, and improved kit design, may support participation of CALD populations in screening programs.

Family violence risk, migration status and ‘vulnerability’: hearing the voices of immigrant women

In this paper, we draw on accounts of family violence risk offered by women from culturally and linguistically diverse (CALD) communities living in Victoria Australia, and examine how women’s migration and experiences of difference impact on the risks they face from family violence. Women in refugee and immigrant communities are often understood as experiencing additional barriers and vulnerabilities when they face family violence; implicitly creating a deficit model of vulnerability attached to women’s intersectional marginalization particularly in terms of migration and service regimes. Yet when we focus on women’s own accounts of risk and safety, we argue that the ‘vulnerabilities’ these women experience are in fact predominantly created by service and legislative regimes that operate in terms of gender and migration. Rather than assuming that such vulnerabilities are inherent for women from CALD communities, we need to better recognise women’s own assessments of risk and their searches for safety. Service and legislative responses that can support rather than inhibit women’s efforts to secure their own safety are critical.

Fall prevention programs for culturally and linguistically diverse groups: program provider perspectives

ABSTRACT Objectives: Older people from culturally and linguistically diverse (CALD) backgrounds are one of the fastest growing and rapidly ageing population segments in Australia. This qualitative study aims to explore the experiences, needs and challenges that individual program providers encountered in implementing and delivering a fall prevention program for CALD groups and meeting the linguistic, cultural and contextual needs of the program participants. Design: Semi-structured in-depth interviews were conducted with a convenience sample of 24 program providers implementing, delivering or supporting fall prevention programs including Stepping On for CALD groups. Interview transcripts were analysed using thematic analysis. Results: Two major themes emerged: (1) extra layers of complexity are needed in program planning, delivery, recruitment and enabling participation of older people from CALD background and (2) program leaders ‘going the extra mile’ influences success of the program. Complexity included accommodating the linguistic and sociocultural needs in planning the programs, knowing and using the ‘right way’ to reach and deliver the program to CALD groups and understanding the nuances of facilitating program participation. While it was important to ensure the acceptability and accessibility of the program for the older people from diverse CALD communities, it was the drive and determination of the program leader and their striving for cultural relevance that made the program possible. Sustainability and wider implementation requires unique support and additional resources. Conclusion: These findings can be used by program providers, policy-makers and health researchers to improve the capacity of fall prevention programs to better respond to the growing diversity in needs and preferences among older populations in Australia and internationally.

A two-way street: reciprocal teaching and learning in refugee health.

The Water Well Project is a health promotion charity that aims to improve the health literacy of individuals of refugee, asylum seeker and migrant backgrounds. Health literacy is an important predictor of health status, but many Australians cannot demonstrate functional health literacy, and individuals from culturally and linguistically diverse (CALD) backgrounds are at higher risk of poor health literacy. The primary participants of The Water Well Project's health education sessions are individuals of refugee, asylum seeker and migrant background, who are at risk of increased morbidity and mortality due to a range of factors. Secondary participants are volunteer healthcare professionals who facilitate these sessions. Because the Water Well Project is a community-centric organisation, the content and delivery of education sessions is shaped by the health literacy needs of the participants. During each session, The Water Well Project aims for a ratio of two volunteer healthcare professionals to every 5-15 participants. Sessions are interactive, with the use of visual aids, and incorporate the services of a professional interpreter when required. Since 2011, over 300 education sessions have been delivered to more than 3000 participants with anticipated flow-on effects to family and friends. The sessions provide a unique opportunity for participants and volunteer healthcare professionals to simultaneously acquire valuable health literacy skills. For participants, this fosters an improved awareness of and trust in the healthcare system; for volunteer healthcare professionals, this affords the opportunity to contribute to the health of vulnerable populations while developing skills in working effectively with interpreters and CALD communities.

Barriers and facilitators to childhood obesity prevention among culturally and linguistically diverse (CALD) communities in Victoria, Australia

Objective:Childhood obesity is rising among culturally and linguistically diverse (CALD) groups who show poor engagement in obesity prevention initiatives. We examined the barriers and facilitators to the engagement of CALD communities in obesity prevention initiatives. Methods:We used the nominal group technique to collect data from 39 participants from Vietnamese, Burmese, African, Afghani and Indian origins living in disadvantaged areas of Victoria, Australia. Data analysis revealed ranked priorities for barriers and facilitators for CALD community engagement in obesity prevention initiatives. Results:CALD parents identified key barriers as being: competing priorities in the post‐migration settlement phase; language, cultural and program accessibility barriers; low levels of food and health literacy; junk food advertisement targeting children; and lack of mandatory weight checks for schoolchildren. Key facilitators emerged as: bicultural playgroup leaders; ethnic community groups; and school‐based healthy lunch box initiatives. Conclusion:This study has identified several policy recommendations including: the implementation of robust food taxation policies; consistent control of food advertising targeting children; improving CALD health literacy using bicultural workers; and matching health promotional materials with CALD community literacy levels. Implications for Public Health:These recommendations can directly influence public health policy to improve the engagement of CALD communities in obesity prevention services and ultimately reduce the widening obesity disparities in Australia.

Cultural Competence in the Treatment of Addictions: Theory, Practice and Evidence.

Culturally and linguistically diverse (CALD) populations often have high rates of addictive disorders, but lower rates of treatment seeking and completion than the mainstream population. A significant barrier to treatment is the lack of culturally relevant and appropriate treatment. A literature review was conducted to identify relevant literature related to cultural competence in mental health services delivery and specifically treatment for addictive disorders. Several theoretical models of cultural competence in therapy have been developed, but the lack of rigorous research limits the empirical evidence available. Research indicates that culturally competent treatment practices including providing therapy and materials in the client's language, knowledge, understanding and appreciation for cultural perspectives and nuances, involving the wider family and community and training therapists can enhance client engagement, retention and treatment outcomes for substance use and gambling. Further methodologically rigorous research is needed to isolate the impact of cultural competence for the treatment of addictions and guide research to determine treatment efficacy within specific CALD populations. Training therapists and recruiting therapists and researchers from CALD communities is important to ensure an ongoing focus and improved outcomes for CALD populations due to the importance of engaging these populations with addiction treatment. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message: The treatment needs of culturally diverse individuals with addictions are often not met. Theoretical models can guide therapists in incorporating cultural competence. Culturally targeted treatments increase recruitment, retention and treatment outcomes. Cultural competence includes matching clinicians and clients on linguistic and cultural backgrounds as well as being mindful of the impact of culture on client's experience of addiction problems. Few methodologically rigorous trials have been conducted to guide treatment practices and research needs to be incorporated into existing culturally relevant treatment services.

Exploring Service Providers' Perspectives in Improving Childhood Obesity Prevention among CALD Communities in Victoria, Australia.

BackgroundChildhood obesity rates have been increasing disproportionately among disadvantaged communities including culturally and linguistically diverse (CALD) migrant groups in Australia due to their poor participation in the available obesity prevention initiatives. We sought to explore service providers’ perceptions of the key factors influencing the participation of CALD communities in the existing obesity prevention services and the service requirements needed to improve CALD communities’ participation in these services.MethodsWe conducted a qualitative study using focus group discussions involving fifty-nine service providers from a range of services, who are involved in the health and wellbeing of children from CALD groups living in four socioeconomically disadvantaged areas in Victoria, Australia.ResultsThematic analysis of the data showed three major themes including community-level barriers to CALD engagement in childhood obesity prevention services; service-level barriers to the delivery of these services; and proposed changes to current childhood obesity prevention approaches. Integrating obesity prevention messages within existing programs, better coordination between prevention and treatment services and the establishment of a childhood obesity surveillance system, were some of the important changes suggested by service providers.ConclusionThis study has found that low CALD health literacy, lack of knowledge of cultural barriers among service providers and co-existing deficiencies in the structure and delivery of obesity prevention services negatively impacted the participation of CALD communities in obesity prevention services. Cultural competency training of service providers would improve their understanding of the cultural influences of childhood obesity and incorporate them into the design and development of obesity prevention initiatives. Service providers need to be educated on the pre-migratory health service experiences and health conditions of CALD communities to ensure equitable delivery of care. Collaborative approaches between health systems, immigrant services, early years’ services and community health services are urgently needed to address obesity-related disparities in Australia.

Effective CALD community health communication through research and collaboration: an exemplar case study

ABSTRACTHealth communication is identified as an important strategy in achieving health outcomes, particularly in supporting preventative approaches to combatting disease and ill health. In Australia’s multicultural society, health communication needs to address a number of culturally and linguistically diverse (CALD) communities in order to achieve health objectives and social equity. While cross-cultural and intercultural communications have been widely studied, research shows that health communication often fails to achieve its objectives, particularly in CALD communities. This analysis examines a case study that highlights three key ingredients of effective health communication targeting CALD communities – in-depth qualitative formative research, a collaborative community-based approach, and cultural competency. The case study not only reveals how a culture-centred approach and social ecology model of health communication achieved results that exceeded targets by up to 100% on a relatively small budget, but also revealed gaps in cultural competency that disadvantage some groups. This study contributes to health communication theory and practice, as well as public communication generally, by providing insights into ways to increase effectiveness as well as cost-efficiency, which in turn creates scalability and sustainability.

Examining Services Provided by a Japanese Organisation during and after the Boston Marathon Bombing

A diverse society requires culturally and linguistically appropriate support for all populations, especially in emergencies, which warrants contribution from culturally and linguistically diverse (CALD)-specific organisations. JB Line, Inc., a local nonprofit organisation serving Japanese, provided online information and in-person support to those affected by the Boston Marathon Bombing in 2013. Descriptive statistics of access to its social media combined with qualitative content analysis of its posts suggested CALD communities’ need for reliable and timely information in their native language, specifically regarding safety and mental health. Practical lessons for CALD-specific organisations included a need for cooperating with authoritative organisations, improving their visibility for wider distribution, and proactively reaching out to isolated populations.

Cancer screening education: can it change knowledge and attitudes among culturally and linguistically diverse communities in Queensland, Australia?

Issue addressed: Screening for cancer of the cervix, breast and bowel can reduce morbidity and mortality. Low participation rates in cancer screening have been identified among migrant communities internationally. Attempting to improve low rates of cancer screening, the Ethnic Communities Council of Queensland developed a pilot Cancer Screening Education Program for breast, bowel and cervical cancer. This study determines the impact of education sessions on knowledge, attitudes and intentions to participate in screening for culturally and linguistically diverse (CALD) communities living in Brisbane, Queensland.Methods: Seven CALD groups (Arabic-speaking, Bosnian, South Asian (including Indian and Bhutanese), Samoan and Pacific Island, Spanish-speaking, Sudanese and Vietnamese) participated in a culturally-tailored cancer screening education pilot program that was developed using the Health Belief Model. A pre- and post-education evaluation session measured changes in knowledge, attitudes and intention related to breast, bowel and cervical cancer and screening. The evaluation focussed on perceived susceptibility, perceived seriousness and the target population's beliefs about reducing risk by cancer screening.Results: There were 159 participants in the three cancer screening education sessions. Overall participants' knowledge increased, some attitudes toward participation in cancer screening became more positive and intent to participate in future screening increased (n=146).Conclusion: These results indicate the importance of developing screening approaches that address the barriers to participation among CALD communities and that a culturally-tailored education program is effective in improving knowledge, attitudes about and intentions to participate in cancer screening.So what?: It is important that culturally-tailored programs are developed in conjunction with communities to improve health outcomes.

Exploring the Delivery of Swimming and Water Safety Teacher Training to Culturally and Linguistically Diverse Communities

The dearth of information on the delivery of specific culturally and linguistically diverse (CALD) programs presents a major limitation in the effort to prevent drowning, particularly when drowning rates of people from countries other than Australia are increasing. This study describes programs delivered by the aquatic industry for CALD communities in New South Wales (NSW), explores what CALD communities believe their water safety education needs are, and evaluates AUSTSWIM’s current training methods to ascertain which is most effective when training candidates from CALD communities. We found an absence of specialized aquatic programs being run at aquatic facilities for CALD communities. Barriers to participation included a lack of understanding of the cultural perceptions toward water safety and the different emphasis on the need for swimming skills and water safety education. The likelihood of AUSTSWIM Teacher of Swimming and Water Safety candidates’ having successful aquatic training outcomes increases with a combined learning approach that pairs meaningful practical applications with ongoing mentor support. Engagement of CALD communities’ using these kind of water safety programs will be essential if Australia wants to reduce the drowning burden.

Engaging with culturally and linguistically diverse communities to reduce the impact of depression and anxiety: a narrative review.

Culturally and linguistically diverse (CALD) communities in Australia face significant challenges in terms of reducing barriers to information and support for depression and anxiety. Increased stigma surrounding mental ill-health in some cultures and related concerns about trust and confidentiality all impact upon timely access to information, services and support for consumers and carers from CALD backgrounds. For health services, there is a need to understand how to better engage CALD communities in mental healthcare. The objective of this narrative review was to identify examples of evidence-based, best practice for what works effectively for engaging with CALD communities to reduce the impact of depression and anxiety. In January 2014, we searched Academic Search Premier, CINAHL, Health-Source Consumer Edition, PsycARTICLES, PsycINFO (all databases within the EbscoHost platform) and PubMed for peer-reviewed articles published between 1994 and 2014. The search revealed a total of 706 records contained within the EbscoHost platform and 689 records in PubMed; 15 matched the inclusion criteria. Six key themes were identified: (i) setting the scene for engagement; (ii) cultural values and preferences; (iii) language considerations; (iv) 'engagers' in the therapeutic process; (v) opening out engagement to include others; and (vi) engaging through the use of technology and alternative mediums. The literature obtained provides a small body of evidence regarding approaches to engaging CALD communities, with findings highlighting the importance of processes which are tailored to the CALD community of interest and which take into account different cultural explanatory models of mental ill-health. Review findings are also discussed within the framework of intersectionality, in which broader structural inequalities and power imbalances - in areas such as gender and social class - collectively impact on help-seeking and mental health outcomes. This review supports further enquiry into how such societal issues influence engagement - and disengagement - in mental health services for CALD communities.

OA5 Empowering ten culturally and linguistically diverse communities in melbourne, australia, to access culturally responsive palliative care.

This project addresses low levels of awareness and use of palliative care among ten culturally and linguistically diverse (CALD) communities in Melbourne, Australia. To increase awareness, understanding and use of palliative care among the Arabic speaking, Chinese, Croatian, Greek, Italian, Macedonian, Maltese, Polish, Turkish and Vietnamese communities in Melbourne and to strengthen the provision of culturally responsive palliative care. In July 2013 the palliative care and ethnic peak bodies initiated a two-year project with 10 ethnic communities (5 per year) to deliver peer education sessions about palliative care in community languages. Adjunct activities include community engagement, relationship-building, media, cultural responsiveness education for palliative care services, and evaluation. As at mid-July 2014, feedback from 837 participants (80% of 1050 attendees) at 37 community education sessions for 4 CALD communities indicated that 68% did not know about palliative care before the session. 90% had learnt new information, 90% had an intention to tell friends and family about palliative care and 90% thought palliative care was a good idea. Updated results will be provided. Participatory and engagement strategies are needed to improve awareness of palliative care among CALD communities. The formation of community reference groups is a valuable strategy that respects community leadership, expertise and networks. The participation of CALD communities in tailoring education and information to meet specific cultural, spiritual and linguistic needs is essential. The participation of palliative care services in project activities is valued and strengthens relationships of trust and understanding.