Culturally And Linguistically Diverse Populations Research Articles

Screening tools for autism in culturally and linguistically diverse paediatric populations: a systematic review

BackgroundAutism Spectrum Disorder (ASD) has varying prevalence rates worldwide, often higher in culturally diverse populations. Cultural differences can affect autism symptom recognition. Language barriers and differing healthcare attitudes may delay diagnosis and intervention. Most autism screening tools were developed in Western, predominantly Caucasian populations, and their appropriateness in culturally and linguistically diverse (CALD) contexts remains uncertain. There is a lack of comprehensive data on the accuracy of these tools in identifying autism in culturally and linguistically diverse groups. Consequently, it is unclear whether current screening tools are culturally sensitive and appropriate.MethodsA research protocol was registered in PROSPERO (CRD42022367308). A comprehensive search of literature published from inception to October 2022 was conducted using the following databases: PubMed, Medline Complete, Scopus, PsychInfo and CINAHL Complete. The articles were screened using pre-determined inclusion and exclusion criteria. Data extracted included participant demographics, screening tool psychometric properties (validity, reliability, accuracy) and acceptability. A narrative synthesis approach was used.ResultsFrom the initial retrieval of 2310 citations, 51 articles were included for analysis. The studies were conducted in 32 different countries with screening tools in the following languages: Chinese, Spanish, Korean, Turkish, Arabic, Kurdish, Persian, Serbian, Italian, French, Sinhala, Taiwanese, Finnish, Northern Soho, Albanian, German, Japanese, Vietnamese, Farsi, Greek and English. There was no data on acceptability of the screening tools in CALD populations. Validity, reliability, and accuracy ranged from poor to excellent with consistently high performance by screening tools devised within the populations they are intended for.ConclusionsThe review evaluated autism screening tools in culturally diverse populations, with a focus on validity, reliability, and acceptability. It highlighted variations in the effectiveness of these tools across different cultures, with high performance by tools devised specifically for the intended population, emphasizing the need for culturally sensitive screening tools. Further research is needed to improve culturally specific, reliable autism screening tools for equitable assessment and intervention in diverse communities.

Social Characteristics of Culturally and Linguistically Diverse Cancer Patients Enrolled in Early Phase Clinical Trials in South Western Sydney

Introduction: Early phase clinical trials (EPCTs) enable access to novel therapies for patients who have exhausted standard of care treatment and contribute a crucial role in drug development and research. Culturally and linguistically diverse (CALD) or socially disadvantaged patients have notably lower rates of participation in these trials. We aimed to characterise the social and cultural demographics of patients enrolled on an EPCT in South Western Sydney. Methods: We conducted a 10-year retrospective review of patients enrolled on a EPCT at Liverpool Hospital. CALD patients were defined as those born overseas or whose preferred language was other than English. The patient residential address was used to calculate distance travelled, and the Index of Relative Socioeconomic Disadvantage (IRSD) and Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD) scores were calculated and used as a surrogate for socioeconomic status (SES). Results: Our study included 233 patients across 39 EPCTs. Ninety-one patients (39%) were identified as CALD. The median IRSD and IRSAD scores were 941 and 944, respectively, with 62.7–67.4% of patients residing in an area with greater disadvantage compared to the median of Australia. The median distance travelled was 17 kilometres with only 12% of participants travelling more than 50 km. CALD patients were more likely to reside in an area of low SES (OR 3.4, 95% CI: 1.8–6.5, p < 0.01) and travelled shorter median distances (10 vs. 23 km) when compared to non-CALD patients. Conclusion: Our study cohort contained a lower proportion of CALD patients and a higher SES than what we might have expected from our local population. Furthermore, there was a trend toward greater SES disadvantage (lower IRSD/IRSAD scores) for the CALD population. This study provides novel Australian data to support the underrepresentation of culturally diverse or disadvantaged patients on EPCTs. Future efforts should be made to reduce barriers to participation and improve equity in clinical trial participation.

Prehospital treatment-seeking for acute coronary syndrome in culturally and linguistically diverse immigrant populations: a scoping review.

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

Emergency Department Use Following Self-Harm and Suicide Ideation: An Analysis of the Influence of Cultural and/or Linguistic Diversity Using Data From the Self-Harm Monitoring System for Victoria (2012-2019).

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.

A Comparison of an Australian Observational Longitudinal Alzheimer's Disease Cohort to Community-Based Australian Data.

Observational Alzheimer's disease (AD) cohorts including the Australian, Biomarkers, Imaging and Lifestyle (AIBL) Study have enhanced our understanding of AD. The generalizability of findings from AIBL to the general population has yet to be studied. We aimed to compare characteristics of people with AD dementia in AIBL to 1) the general population of older Australians using pharmacological treatment for AD dementia, and to 2) the general population of older Australians who self-reported a diagnosis of dementia. Descriptive study comparing people aged 65 years of over (1) in AIBL that had a diagnosis of AD dementia, (2) dispensed with pharmacological treatment for AD in Australia in 2021 linked to the Australian census in 2021 (refer to as PBS/census), (3) self-reported a diagnosis of dementia in the 2021 Australian census (refer to as dementia/census). Baseline characteristics included age, sex, highest education attainment, primary language, and medical co-morbidities. Participants in AIBL were younger, had more years of education, and had a lower culturally and linguistically diverse (CALD) population compared to the PBS/census cohort and dementia/census cohort (mean age±standard deviation - AIBL 79±7 years, PBS/census 81±7, p < 0.001, dementia/census 83±8, p < 0.001; greater than 12 years of education AIBL 40%, PBS/census 35%, p = 0.020, dementia/census 29%, p < 0.001; CALD - AIBL 3%, PBS/census 20%, p < 0.001, dementia/census 22%, p < 0.001). Our findings suggest that care should be taken regarding the generalizability of AIBL in CALD populations and the interpretation of results on the natural history of AD.

Utilization of Emergency Medical Services by Culturally and Linguistically Diverse Patients: A Population-Based Retrospective Study

Objectives To compare emergency medical services (EMS) utilization between culturally and linguistically diverse (CALD) and non-CALD patients in Victoria, Australia. Methods A retrospective study of EMS attendances and transports in Victoria from January 2015 to June 2019, utilizing linked EMS, hospital emergency and admissions data. The CALD and non-CALD patients who received EMS care and transport to a Victorian public emergency department were included. The incidence of EMS use for CALD and non-CALD patients based on the 2016 Census population and expressed per 100,000 person-years. Results In 1,261,167 included patients, there were 272,100 (21.6%) CALD and 989,067 (78.4%) non-CALD patients. Before adjustment for age and sex, EMS utilization for CALD patients was 13% lower than non-CALD patients (incidence rate ratio [IRR] 0.87, 95% CI: 0.87–0.87). When stratified by age groups, CALD patients aged under 70 years had significantly lower rates of EMS utilization than non-CALD patients, while CALD patients aged 75 years or older were more likely than non-CALD patients to use EMS (IRR 1.08, 95% CI: 1.07–1.09). The CALD patients were less likely to utilize EMS for trauma/external injury (IRR = 0.67, 95% CI: 0.66–0.68) and mental health/alcohol/drug problems (IRR = 0.39, 95% CI: 0.38–0.40). After adjustment for differences in the age and sex distribution of CALD and non-CALD populations, CALD patients were 51% less likely to utilize EMS than non-CALD patients (IRR 0.49, 95% CI: 0.42–0.56). Conclusions The CALD patients used EMS less frequently than non-CALD patients with significant variation observed across age groups, countries of birth, and clinical presentation. Further research is needed to understand the factors that may be contributing to these disparities.

Healthcare delivery to patients from culturally and linguistically diverse backgrounds in emergency care: a scoping review protocol

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

To Reconstruct or Not to Reconstruct: Piloting a Vietnamese and Arabic Breast Reconstruction Decision Aid in Australia.

Currently, there are no resources to support culturally and linguistically diverse (CALD) women with breast cancer to make decisions about undergoing breast reconstruction (BR). This study evaluated the usability and acceptability of decision aids (DAs) for Vietnamese- and Arabic-speaking women. This two-phase qualitative recruited Vietnamese- (Phase 1) and Arabic-speaking (Phase 2) adult (age ≥ 18 years) women who were diagnosed with breast cancer and could read Vietnamese/Arabic. Women participated in either think-aloud telephone interviews (Phase 1) or semi-structured telephone interviews (Phase 2) and provided feedback on the DA. Interviews were audio-recorded, translated, and transcribed from Vietnamese/Arabic to English, and inductive thematic analysis was undertaken. Additionally, Arabic-speaking women completed the Preparation for Decision Making (PrepDM) scale in Round 2. Twenty-five women were recruited in two phases (Phase 1: Vietnamese-speaking women, n = 14; Phase 2: Arabic-speaking, n = 11). Three themes were developed in Phase 1: (1) DA content and reception; (2) linguistic attributes and cultural appropriateness; and (3) factors that improve the DAs' impact. Three themes were developed in Phase 2: (1) varying perceptions of DA content; (2) linguistic and cultural suitability of information; and (3) impact of DA on decision making. Women from both phases identified areas for improvement: minimising the use of medical terminology, considering the cultural taboos associated with the word 'breast', and addressing remaining information gaps. Both language DAs were generally perceived as acceptable and useful in providing information about BR options and prompting women's reflections about the suitability of BR as part of their treatment. The mean PrepDM score for Arabic-speaking women in Round 2 was 4.8/5 (SD = 0.3). Further work is needed to ensure that culturally adapted DAs take into account the myriad of information needs and health literacy levels. The key role of healthcare professionals in shared decision making among CALD populations should also be considered.

The protective effect of CALD identity in the presence of low income on missing teeth of Australian adults over time

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

Wellbeing programs for culturally and linguistically diverse population in Australia: barriers and improvements

ABSTRACT Objectives Despite the emphasis on the wellbeing of culturally and linguistically diverse (CALD) populations in Australia, programs that promote wellbeing are scarce. Wellbeing programs are often not developed empirically and under-utilised. The present qualitative study explored limitations of current wellbeing programs, refinements that are warranted, and barriers encountered when implementing these programs. Method Mental and allied health practitioners (N = 16), working with CALD populations in Australia participated in semi-structured online focus groups. Data were transcribed and analysed using thematic analysis. Results The generated themes identified limited funding as a major problem. Further weaknesses of existing programs and barriers that prevented CALD populations in engaging with these programs were highlighted. Features of an effective wellbeing program and strategies applied to implement the programs were identified. Theoretical and practical implications for developing and implementing wellbeing interventions for CALD Australians were discussed. Conclusions Significant dearth of research in this area and the necessity of further literature to identify the value of wellbeing interventions for CALD populations is emphasised.

Methods and tools to screen and assess risks for intimate partner violence among women from culturally and linguistically diverse backgrounds in six high-income countries: A scoping review

Abstract Purpose The purpose of this review is to collate literature on approaches to screening women from culturally and linguistically diverse (CaLD) backgrounds for experiences of intimate partner violence (IPV) and assessing risks, with a view to identifying examples of best practice and research gaps. Methods A scoping review methodology was adopted. Medline (Ovid), Embase, CINALH and CENTRAL databases were searched, with supplementary searches for grey literature. Results were independently screened by two reviewers. Studies were included if they focused on women from CaLD backgrounds living in Australia, Canada, Ireland, New Zealand, United Kingdom or United States of America being screened/assessed in a health setting in relation to IPV. Data on study characteristics and key findings were extracted and critical appraisal of study quality was performed. Results A total of n = 1,320 results were yielded. After deduplication, the titles and abstracts of n = 846 studies were screened. A total of n = 5 studies were included in the final analysis, and four screening or risk assessment tools/methods were assessed (Danger Assessment for Immigrant Women, Safe Start, Index of Spouse Abuse and Southern Asian Violence Screen). Conclusions Given the documented barriers to migrant help-seeking, screening and risk assessment has an important role to play in ensuring that women from CaLD backgrounds are linked into appropriate IPV support services in a timely manner. However, there is very limited evidence to demonstrate that existing screening/risk assessment tools and strategies meet the specific needs of CaLD populations, and more attention needs to be given to intersectional experiences of violence.

Integrated health and social care with a CALD focus: a service mapping study in Sydney Metropolitan

Background: Underrepresented and underserved communities such as culturally and linguistically diverse (CALD) groups experience higher reported prevalence and severity of multimorbidity along with unmet social needs and disadvantages in accessing services. Minority populations report higher rates of emergency department presentations globally and nationally and it is understood that services are more frequently accessed on consumer initiative when problems become acute and critical, demonstrating significant barriers for early intervention. In Australia, most of the efforts to reduce over-utilisation of emergency care have focused on developing integrated health and social care approaches for the general population. There is little evidence available on how CALD populations are involved in the design and implementation of integrated care health and social care initiatives and how their needs are identified and addressed.&#x0D; Methods: A service mapping study informing the development of a framework for comparative analysis of integrated health and social care services targeting CALD populations will be sought. Semi-structured interviews, with key stakeholders and decision-makers representing health and social services, as well as document review, will inform the development of a map of integrated health and social care services available for individuals from culturally and linguistically diverse backgrounds. Core defining elements of the mapped services comprise the basis for the framework that enables comparison of level of integration with a CALD focus, including governance and partnerships, health and social care staff, financing and payment systems, and data sharing and use. &#x0D; Implications: This study will advance the understanding of how integrated health and social care policies (policy learning) and services are conceptualised, developed, and implemented at a local level (policy implementation) to address the needs of CALD populations. and how they can better respond to the health and social needs of CALD consumers.

Breaking the barriers: overcoming dementia-related stigma in minority communities.

Dementia is a global health concern that affects individuals irrespective of their cultural or linguistic backgrounds. However, research has long recognized the pronounced stigma associated with dementia, particularly within Culturally and Linguistically Diverse (CALD) communities. This article seeks to summarize the underlying factors contributing to the heightened levels of dementia stigma within CALD communities, through a review of the literature. Our examination shows that cultural beliefs, language barriers, limited awareness, and the impact of migration on perceptions of aging and cognitive decline are contributing factors. Consequently, our analysis highlights the need for tailored, culturally appropriate interventions aimed at mitigating stigma and enhancing dementia care within CALD populations. Our proposed solutions, built on a social-ecological approach, highlights the critical role of collaborative efforts involving policymakers, healthcare providers, community organizations, and CALD community members in fostering a more dementia-inclusive society. This perspective piece aims to shed light on the distinct challenges faced by CALD communities, while advocating for a holistic approach to redefine perceptions and care strategies tailored to these populations.

Strategies to Improve Care in the Emergency Department for Culturally and Linguistically Diverse Adults: a Systematic Review.

The emergency department (ED) is an important gateway into the health system for people from culturally and linguistically diverse (CALD) backgrounds; their experience in the ED is likely to impact the way they access care in the future. Our review aimed to describe interventions used to improve ED health care delivery for adults from a CALD background. An electronic search of four databases was conducted to identify empirical studies that reported interventions with a primary focus of improving ED care for CALD adults (aged ≥ 18years), with measures relating to ED system performance, patient outcomes, patient experience, or staff experience. Studies published from inception to November 2022 were included. We excluded non-empirical studies, studies where an intervention was not provided in ED, papers where the full text was unavailable, or papers published in a language other than English. The intervention strategies were categorised thematically, and measures were tabulated. Following the screening of 3654 abstracts, 89 articles underwent full text review; 16 articles met the inclusion criteria. Four clear strategies for targeting action tailored to the CALD population of interest were identified: improving self-management of health issues, improving communication between patients and providers, adhering to good clinical practice, and building health workforce capacity. The four strategies identified provide a useful framework for targeted action tailored to the population and outcome of interest. These detailed examples show how intervention design must consider intersecting socio-economic barriers, so as not to perpetuate existing disparity. PROSPERO registration number: CRD42022379584.

Suitability of Computerised and Pencil‐and‐Paper Neuropsychological Assessments in Healthy Older Culturally and Linguistically Diverse Australians: The CogSCAN Study

AbstractBackgroundComputerised neuropsychological assessments (CNAs) are proposed as more accessible and culturally appropriate alternatives to traditional pencil‐and‐paper neuropsychological assessments (PnPAs) for diagnosing dementia in diverse populations. Whilst some PnPAs have demonstrated cultural and linguistic bias, research investigating the suitability of CNAs for culturally and linguistically diverse (CALD) individuals is limited, especially outside of the United States.MethodThis study compared cognitive performance in a heterogenous sample of older Australian CALD English‐speakers and an L1 English‐speaking background (ESB) sample. Cross‐sectional data were drawn from the ongoing CogSCAN Study. Participants were 212 community‐dwelling individuals aged 60‐95 years without a dementia diagnosis (159 ESB/53 CALD). Participants completed a PnPA and/or CNAs, sessions were counterbalanced accordingly. CNA sessions involved two of four commercially‐available CNAs in a randomised order. Differences in the level and pattern of cognitive performance between groups on two CNAs (CANTAB/Cogstate) and a comprehensive PnPA in English, controlling for sociodemographic and health factors, are reported here. Selection of key variables for examination were based on previous findings (PnPA) and test developer recommendations (CNAs).ResultSample characteristics are summarised in Table 1. CALD participants’ cognitive performance on individual tests (Figure 1) was largely comparable to ESB participants on PnPA and each CNA. Significant differences between groups, after Bonferroni correction for multiple comparisons, were observed for the Boston Naming Test (PnPA; a language test widely criticised for use with CALD populations due to culturally biased stimuli) and Rapid Visual Information Processing (CANTAB; a test of attention/processing speed). Among participants who completed PnPA and Cogstate, a significant interaction between group and assessment type on global cognitive performance was observed; ESB participants outperformed CALD participants on PnPA, but not on Cogstate (Figure 2). No significant main effects or interaction were observed in PnPA versus CANTAB.ConclusionThese results showed fewer and smaller discrepancies across groups and assessment types than has been found in previous literature with other CALD samples, perhaps reflecting higher levels of English proficiency, acculturation, and education in English than previous cohorts. Work in progress is investigating the influence of linguistic and acculturation factors on cognitive performance in a larger and more diverse sample.

Effective communication of COVID-19 vaccine information to recently-arrived culturally and linguistically diverse communities from the perspective of community engagement and partnership organisations: a qualitative study

BackgroundIn many high-income countries, COVID-19 has disproportionately impacted Culturally and Linguistically Diverse (CALD) communities. Barriers to engaging with essential health messaging has contributed to difficulties in following public health advice and exacerbated existing inequity in Australia. Research suggests that recently-arrived CALD populations are particularly vulnerable to misinformation and are more likely to experience vaccine hesitancy. The aim of this study was to explore the barriers and enablers to COVID-19 vaccination among recently-arrived CALD communities in Melbourne’s outer north and identify strategies to reduce hesitancy in this population.MethodsSemi-structured interviews were conducted with representatives from community organisations working with recently-arrived CALD communities in Melbourne’s north. This included a mix of peer (from the community) and health care workers.ResultsFifteen participants from community organisations participated in interviews. Thematic analysis identified four themes; (1) trusted sources, (2) accurate and culturally sensitive information, (3) supported pathways and (4) enablers to vaccination.ConclusionsParticipants reported a perceived lack of accurate, culturally sensitive health information and service provision as key barriers to vaccination in recently-arrived CALD communities. Participants identified a range of perceived enablers to increasing vaccination uptake in the communities they work with, including utilising established channels of communication and harnessing the communities’ strong sense of collective responsibility. Specific strategies to reduce vaccine hesitancy included identifying and utilising trusted sources (e.g. faith leaders) to disseminate information, tailoring health messages to address cultural differences, providing opportunities to contextualise information, and modifying service delivery to enhance cultural sensitivity. There is an urgent need for increased efforts from health and government agencies to build sustainable, collaborative relationships with CALD communities.

Tracking the settlement patterns of culturally and linguistically diverse (CALD) populations in Australia: A census-based study from 2001 to 2021

Tracking the settlement of culturally and linguistically diverse (CALD) populations serves as the foundation for population projection, urban planning, and policy making to achieve social justice, equity, and multicultural harmony. Drawing on census data in 2001, 2006, 2011, 2016 and 2021, our study contributes an Australian nationwide time-series study of the settlement of CALD populations at a fine neighbourhood level, enabling long-term tracking of changing settlement patterns and residential diversity and revealing potential drivers for such changes. Following segmented assimilation theory, we examine whether the CALD populations with higher education levels, higher socioeconomic status and better language skills may tend to partially move out and partially retain their ethnic concentrations, resulting in assimilation that occurs segmentally across urban fabrics. We find that both existing CALD communities and the formation of new CALD concentrations in peri-urban regions exhibit segmented assimilation over time. We also find the settlement patterns of CALD populations in urban areas are more diverse than in rural areas in most states/territories. Our study provides spatially explicit evidence with far-reaching policy implications for migration, place-based health, population and urban planning.

The relationship between fall incidents and place of birth in residential aged care facilities: a retrospective longitudinal cohort study

BackgroundOlder populations in residential aged care facilities (RACFs) in many immigrant-receiving countries are now being increasingly culturally and linguistically diverse (CALD). CALD populations require tailored social and health services to support their needs and improve health outcomes. Falls among the elderly are common and can have significant health and psychosocial consequences. There is some evidence to suggest that country of birth may influence risk of falls among older people, but such evidence has been scarce. This study aimed to determine the association between place of birth and the incidence of falls in RACFs.MethodsRoutinely collected incident data relating to 5,628 residents aged ≥ 65 years in 25 RACFs in Sydney, New South Wales, Australia were used. RACF residents were classified into two groups, Australia-born (N = 4,086) and overseas-born (N = 1,542). Overseas-born RACF residents were further categorised into two subgroups: overseas-English-speaking-country (N = 743) and overseas-non-English-speaking-country (N = 799). Outcomes measures were rate of all falls, injurious falls and falls requiring hospitalisation. Multilevel binary negative regression was used to examine the relationship between fall risk and place of birth.ResultsIncidence rates of all falls, injurious falls and falls requiring hospitalisation were 8.62, 3.72 and 1.07 incidents per 1,000 resident days, respectively, among the Australia-born RACF residents, but were higher at 11.02, 4.13 and 1.65, respectively, among the overseas-born RACF residents. Within those born overseas, fall rates were higher among the overseas-non-English-speaking-country-born residents (11.32, 4.29 and 2.22, respectively) than those overseas-English-speaking-country-born (10.70, 3.96 and 1.05, respectively). After controlling for confounders, the overseas-born RACF residents overall experienced a higher risk of all three types of falls (incidence rate ratios: [IRR] = 1.278, 95% confidence interval [CI] = 1.131, 1.443; injurious falls: IRR = 1.164 [95% CI = 1.013, 1.338]; falls requiring hospitalisation: IRR = 1.460 [95% CI = 1.199, 1.777]) than the Australia-born RACF residents. Among the overseas-born RACF residents, males, respite residents and those overseas-non-English-speaking-country-born experienced higher rates of falls.ConclusionsFall incidence in RACFs varies significantly by place of birth. With increasingly diverse RACF populations, fall intervention and prevention programs should consider cultural and linguistical backgrounds of RACF residents. Greater attention to understand the mechanisms for the differences by place of birth in risk profiles is warranted.

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.