Background
Methods
Focus groups
Selection criteria
Sample population
Data collection
Health professional interviews
Selection criteria
Interview methods
Data analysis and reporting
Ethics
Results
Study population
Focus groups
Focus Group | No. in group | Year of birth (range) | Years since arrival (median, range) | Spoken English proficiency | Highest education achievement | No. with disease |
---|---|---|---|---|---|---|
Arabic | 8 | 1954-1992 | 12 years, 1–37 years | All good or better | All high school or higher | 4 |
Sudanese | 11 | 1948-1977 | 6 years, 3–14 years | 4 poor or worse | 5 high school or lower | 10 |
Chinese | 9 | 1930-1983 | 5 years, 2–17 years | 2 poor or worse | All high school of lower | 3 |
Vietnamese | 12 | 1930-1969 | 14 years, 9–30 years | 5 poor or worse | 8 high school or lower | 6 |
Tongan | 10 | 1953-1977 | 19.5 years, 3–38 years | 3 poor or worse | 7 high school or lower | 4 |
Professional context of health providers
Code | Gender | Occupation | Institution | Ethnic background | Exposure to CALD communities |
---|---|---|---|---|---|
HP01 | female | Nutritionist | Population Health | Not CALD | Indirectly through project work |
HP02 | female | Anaesthetist, pre-admission | Public hospital | English | Directly, 20-30% |
HP03 | female | Nutritionist | Community & Primary Health services | Australian | Indirectly through consultation for resource development |
HP04 | male | GP | Community general practice | Australian (bilingual, Spanish) | Directly, 100% |
HP05 | female | GP | General Practice | Australian | Directly, <10% |
HP06 | female | Nutritionist | Population Health | Dutch | Indirectly, previous direct experience |
HP07 | female | Nurse (surgery) | Private hospital | Former Yugoslav | Directly, limited (<1%) |
HP08 | female | Audiologist | Public hospital | Australian | Directly,30-40% |
HP09 | female | Lifestyle management | Community Health | Caucasian | Directly,10-15% |
HP10 | female | GP | Private practice & refugee clinic | Australian (bilingual, Spanish) | Directly, 100% in refugee clinic, minority in general practice |
HP11 | male | Radiographer | Public hospital | Centro-eastern European | Directly, <10% patients |
HP12 | female | Occupational therapist | Community Health | Not CALD | Directly, 30-100% depending on project |
HP13 | female | Cardiac scientist | Public Hospital | Macedonian | Directly,15-20% |
HP14 | female | Coordinator, lifestyle programs | Community Health | Australian | Directly, 5-10% |
"“In general practice we are all individual…. I think our organisation deals better with people from our own culture than with people from CALD groups. It’s not on purpose, it’s just that they are a minority.” (HP10)"
Perception of disease in CALD communities
Chronic disease
Focus Group | Disease presence in focus group participants | Disease/symptom prevalence within ethnic community | Disease/symptom prevalence within youth of ethnic community | Health service familiarity |
---|---|---|---|---|
Arabic | In-Scope: Hypertension, Hypercholesterolaemia, Type 2 Diabetes Other: Arthritis, Asthma, Cancer | In-Scope & lifestyle: Type 2 Diabetes, Hypertension, Hypercholesterolaeia Other: Rheumatic heart disease, Cancer Mental Health: Depression, Stress | In-Scope: Other: AIDS, Asthma | Primary: Medical centres, GPs Specialist: general awareness Emergency & Tertiary: Hospitals Diagnostic: Pathology, Radiology Allied & Other Health: Pharmacy Community & NGO: Diabetes Centre, MCHW |
Sudanese | In-Scope: Hypertension, Hypercholesterolaemia, Type 2 Diabetes Other: Asthma, Cancer, Stroke, unspecified liver disease | In-Scope & lifestyle: Type 2 Diabetes, Hypertension, Hypercholesterolaemia Other: Asthma, Cancer, Infectious Diseases eg Hep B, Parasitic Diseases eg Malaria, Malnutrition, unspecified abdominal & back pain Mental Health: Depression, Chronic grief, Stress | In-Scope & lifestyle: Obesity Other: Asthma, Epilepsy, Infectious Diseases eg Hep B, Parasitic Diseases eg Malaria, Malnutrition Mental Health: Depression, Chronic grief, Stress | Primary: Medical centres, GPs Specialist: general awareness Emergency & Tertiary: Ambulance, Hospitals Allied & Other Health: Occupational Therapy, Dentistry, Mid-wifery Community & NGO: Community Health Centre, Arthritis, Asthma, Kidney & Heart Foundations, MCHW |
Chinese | In-Scope: Hypertension Other: Arthritis | In-Scope & lifestyle: unspecified chronic disease, Type 2 Diabetes, undefined kidney disease, Pulmonary emphysema, Overweight Other: Arthritis | In-Scope & lifestyle: Other: only undefined congenital conditions & arthritis mentioned | Primary: Medical centres, GPs Specialist: Gynaecology Emergency & Tertiary: Hospitals Diagnostic: Pathology, Radiology Allied & Other Health: Dentistry, Optometry, Pharmacy Mental Health: Psychology |
Vietnamese | In-Scope: Hypertension, Hypercholesterolaemia, Type 2 Diabetes Other: Arthritis, Stroke, Hepatitis B | In-Scope & lifestyle: unspecified chronic disease Other: Joint-related disorders, dementia Mental Health: Depression, Stress | In-Scope & lifestyle: Smoking & alcohol related diseases Other: Chronic back pain | Primary: GPs Specialist: general awareness Emergency & Tertiary: Hospitals Diagnostic: Pathology, Radiology Allied & Other Health: Physiotherapy, Podiatry, Dentistry, Optometry, Midwifery, Occupational Therapy, Acupuncture Community & NGO: Home nurse, Hot line health service, Community Health Centre, MCHW |
Tongan | None cited | In-scope & lifestyle: Overweight Hypertension, Type 2 Diabetes, Hypercholesterolaemia, Smoking & alcohol related disease Other: Cancer, Dementia Mental health: not different from broader community | In-scope & lifestyle: Overweight, alcohol related problems Other: Asthma, Eczema | Primary: Medical centre, GPs Emergency & Tertiary: Ambulance, Hospitals Allied: Physiotherapy Community & NGO: Community Health Centre Mental Health: Counselling, Psychiatry |
Chronic disease and the younger members of CALD communities
Perception of mental health problems in CALD communities
"“The war has affected us and many of us are traumatised and have gone through agony/suffering and torture, we came here with high hope of good opportunities unfortunately it did not work out as we expected due to cultural differences”. (Sudanese)"
"“They have a lot of traumatisation symptoms and it is a difficult task to ask them about the sort of sexual abuse or abuse when they were younger or their background, and then I am limited with the phone interpreter who’s often male asking them big questions.” (HP5)"
Familiarity with health services
Accessibility to health care services
EMERGENT THEMES | Arabic | Sudanese | Tongan | Chinese | Vietnamese | Health-care Providers |
---|---|---|---|---|---|---|
Proximity of health services | ||||||
Convenient | x | x | x | x | ||
Far away | x | x | ||||
Will travel to preferred provider | x | x | x | |||
Availability of Services | ||||||
Lack of available providers overall | x | x | x | x | x | |
Long waiting list for specialists | x | x | x | x | ||
Long waiting time for treatment in emergency departments | x | x | x | x | x | x |
Long operation waiting lists | x | x | x | |||
Shortage of beds in hospitals | x | x | x | |||
Lack of knowledge of health system/services | x | x | x | x | ||
Socioeconomic factors impacting on access to healthcare | ||||||
Expense of services | x | x | x | x | x | |
Expense of medication | x | x | x | |||
Restricted access to bulk-billing services | x |
Proximity of health services
Availability of services
"“a lot of people …not hav(ing) access to primary and secondary prevention of chronic disease.” (HP6) "
"“…in Brisbane, I think, there are four or five Spanish speaking doctors providing primary care.. I think they have difficulties with access”. (HP4) "
Socioeconomic factors affecting access
"“…a number of CALD people find it difficult to get a job, so financial income, financial problems, access to affordable and healthy food is also a problem…” (HP6) "
Perceptions of patient-provider interactions
EMERGENT THEMES | Arabic | Sudanese | Tongan | Chinese | Vietnamese | Health-care Providers |
---|---|---|---|---|---|---|
Communication problems between patient and provider | ||||||
Language Barrier | x | x | x | x | x | |
Medical Terminology | x | x | x | |||
Problems with interpreter | x | x | ||||
Not understanding accent of non-Western providers | x | |||||
Lack of translated &/or health-related information | x | x | x | x | x | x |
Cultural issues impacting on treatment | ||||||
General cultural misunderstanding on behalf of provider | x | x | x | x | ||
Cultural differences decreasing compliance to treatment | x | |||||
Outright Discrimination | x | x | x | |||
Feeling disrespected &/or undermined | x | x | ||||
Discriminated against by non-Western providers | x | x | ||||
General problematic patient-provider interactions | ||||||
Lack of professionalism on behalf of provider | x | x | x | x | ||
Erroneous diagnoses | x | x | x | |||
Problems with health provider not operating to appointment schedule | x | x | ||||
Patients not keeping appointments or often rescheduling | x | |||||
Lack of rapport | x | x | x | x | ||
Inadequate provision of information of diagnosis/therapy by health provider | x | x | x | x | x | |
Inadequate treatment in hospitals | x | x | ||||
Lack of training or referral services to enable delivery of appropriate care to trauma victims | x | |||||
Positive interactions between patient and provider | ||||||
Generally satisfied with treatment | x | x | x | x | x | |
Rapport established with provider | x | x | x | |||
Rewarding experience | x | |||||
Adequate provision of information regarding diagnosis/therapy by health provider | x | x | x | x |
Communication problems
"“Some receptionists are not friendly and are very rude especially when you cannot communicate properly due to language barrier of an African”. (Sudanese)"
"“…people from Logan drive to Stafford to see Tongan doctor. It is the elderly who want to speak in Tongan. A language issue…” (Tongan)"
"“The doctor will ask you to describe what kinds of pains you have - I don’t know how to do that. So language is an obstacle for me, there are some professional words I don’t know” (Chinese)"
"“…people therefore don’t do the proper treatment because they don’t quite understand what it’s about due to the, just because of the language barrier.” (HP9)"
"“We certainly have had conflict in the past with our qualified health professionals trying to assist and then the breakdown has been around the cultural worker...For example, I can say one sentence about chronic disease and then the health worker can spend fifteen minutes talking about the one sentence supposedly interpreting.” (HP14)"
"“…at least the interpreters should have some medical background…” (Chinese)"
The impact of cultural incompatibility
"“If there’s not cross understanding of the position of the patient, there can be miscommunication, misjudgement, and that can play a part as well….You don’t want your clinician to be making a judgement on something that’s actually a cultural issue rather than an attitude.” (HP8)"
" “…lack of cultural awareness for doctors, they don’t understand how I feel.” (Sudanese) to not sharing cultural norms with mainstream culture:"" “I think there maybe also a cultural difference, for Australian, people who provide the service they still have their own right you know don’t like the doctor or something like that, but in Asian cultures they can’t do that.” (Chinese), to expressing the need for the health professionals with same cultural background:""“Involve experiences health practitioners from the Sudanese community who have knowledge on tropical diseases or common diseases in Sudan and addition understands the culture.” (Sudanese)""“Big problem-we are black and doctor white”(Tongan) or at the institutional level with support staff and providers being perceived as “bureaucratic and discriminating.” (Vietnamese)."
Perception of lack of professionalism
"“My father had been seeing his GP for long time but no improvement in his health, one of the community members advised us to see another GP or a specialist. I took my father to a specialist and he was diagnosed …with cancer.” (Sudanese);""“Three GPs diagnosed three different things” (Tongan);"The inability or reluctance of health professionals to impart information regarding their diagnoses and treatments was stressed:"“.if you didn’t ask them you cannot get the answer. For some people who don’t go to the doctor usually, they don’t know how to ask these questions. In my view, the doctor should tell you how to prevent directly.” (Chinese)"
Learning together
"“The GP was patient with me and explained in depth and I was contented with the information”. (Sudanese)"
Suggestions to improve health care provision for CALD communities
SUGGESTIONS FOR IMPROVEMENTS | Arabic | Sudanese | Tongan | Chinese | Vietnamese | Health-care Providers |
---|---|---|---|---|---|---|
Increases in human resourcing | ||||||
More effective interpreters | x | x | x | x | x | |
More multicultural health professionals | x | x | x | x | x | |
More health providers in general | x | x | x | x | x | |
Increase in provision of health-related information | ||||||
General need for literacy | x | x | x | x | x | x |
Chronic disease | x | x | x | |||
Common disease in Australia | x | x | ||||
Epidemics | x | x | ||||
Prevention of back pain | x | |||||
Mental illness | x | |||||
Arthritis | x | |||||
Healthy lifestyle | x | x | ||||
Alternative therapy | x | |||||
Prevention/causes of illness | x | x | ||||
Health system | x | x | x | |||
Preferred medium of health-related information | ||||||
Brochures | x | x | ||||
TV/audio | x | x | x | |||
Radio | x | x | x | |||
Newspapers | x | x | ||||
Internet | x | x | x | |||
Preferred method of dissemination of health-related information | ||||||
Community associations/churches | x | x | x | x | x | x |
GP or other health provider | x | x | x | x | x | |
Government via community association or directly | x | x | x | x | x |
Improved interpreting services
Increasing the cultural sensitivity of the health care system
"”Australians are very ethnocentric and they’re not very culturally competent, the ones in Queensland anyway.” (HP3)""“Yes, sometimes the misunderstanding comes from cultural difference.” (Chinese)"
"“We need to train staff, but we must make sure that within our workforce we have more CALD people, more culturally diverse, so we can train staff that can work with CALD patients, but if we do not have those people, we need to work with the people from CALD groups to work in the area, primary and secondary prevention and treatment of chronic disease.” (HP6)"
"“…three doctors came for us but they couldn’t identify the problem until a Taiwanese doctor came. In only a few minutes he was clear about the problem.” (Chinese)""“The patient can have the confidence to communicate with GPs in regard to their conditions because someone who understands them is there and can help.” (Sudanese)""“Health promotion campaign developed by the Tongan community, more Tongan participate.” (Tongan)"
Improving health promotion and community services
"“…in terms of health, one of the better things would be to form community organisations that got people togetherrdquo; so “that (the) CALD community can actually change with the support of their family and community.” (HP4)"