Australia has one of the best health systems in the world, however significant proportions of our migrant population are unable to access the services they need.
Providing tangible resources to improve health literacy and support migrant communities to access Australia’s health system is a significant challenge. Healthdirect Australia is currently working on several projects to improve health literacy and health navigation needs through a range of co-designed, culturally sensitive and in-language resources. This initiative provides valuable opportunities for replication at scale across other Australian communities.
We are multicultural
Australians are privileged to live in a multicultural country. Almost half of us (45%) were either born overseas or have at least one parent who was born overseas.[i] More than a fifth (21%) speak a language other than English at home and, after English, the next most common languages spoken at home are Mandarin, Arabic, Cantonese and Vietnamese.
For many, language places a barrier between them and access to appropriate health services. Further, our health system may be structured differently to the countries where people have emigrated from.
Health literacy challenges
It is significant that 60% of people have low levels of health literacy. This can negatively impact people’s ability to navigate the health system, understand medical instructions and know when to seek support from health professionals. These people can experience poorer health due to difficulties with self-management of diseases or conditions or medication errors. They are also more likely to present as preventable hospital admissions. Low health literacy levels have also been shown to impact the safety and quality of healthcare and ultimately, contribute to higher healthcare costs.
For many, language places a barrier between them and access to appropriate health services. Further, our health system may be structured differently to the countries where people have emigrated from.
Understanding how culturally diverse communities access healthcare
In response to the findings of a 2017 study commissioned by Healthdirect Australia regarding the use of health services by culturally diverse communities[ii], broad insights were gained on how working with healthcare professionals who are connected to culturally diverse communities and are trusted, have the power to positively impact health literacy, accessibility and access to health services for these vulnerable groups.
Many people including those in culturally and linguistically diverse communities, do have a GP but in the after-hours period may revert to the place they know and trust: their local hospital.
Following discussions with the Health Equity Resource Development Unit (HERDU), University of New South Wales and Sydney Local Health District (SLHD), regarding findings from a recent study on paediatric presentations after-hours at Canterbury Hospital, Healthdirect Australia was invited to attend a round table meeting at Canterbury Hospital in 2018, about specific health needs in the local community. Representatives of the local culturally diverse community and health professionals confirmed that people presented at emergency departments after hours, as they simply did not know where else to go.
One speaker painted a strong image of isolation:
“Imagine being part of a rapidly growing culturally and linguistically diverse community in Australia, where you do not know how and where to access healthcare for your sick child or how to get to a health service without transport and how to communicate your concerns, without extended family or your partner, potentially the chief translator, who is likely to be at work.
Additionally, imagine that there is limited understanding of the complex Australian health landscape in your community, you feel there is no one to ask who will understand, and are fearful about not knowing how to navigate to the most appropriate service for your children’s health problems.
Your single point of trust may be the hospital where you had your children, so you return there.”
Creating messages to inform and change behaviour
Engagement with the SLHD and HERDU led Healthdirect Australia to work with health professionals and consumer representatives to develop a series of resources to provide in-language information for these groups, explaining fundamental aspects of the Australian health system.
We took a consumer-centric, co-design approach of content in various formats, including videos, posters, brochures and webpages. The main messages for this project were simple: What care do I need? and The role of a GP. The topics were chosen to have the most impact on improving baseline health literacy and helping people safely and appropriately navigate Australian health services.
It was noted during consumer testing that the concept of a GP was completely foreign to some groups and so the wording was amended to reflect a health professional they could relate to.
Healthdirect Australia has worked closely with the Federation of Ethnic Communities Councils of Australia (FECCA) to ensure all materials are culturally appropriate. They were also instrumental in ensuring the translations into each language are accurate to ensure they are understood and accepted by each cultural group. For example, it was noted during consumer testing that the concept of a GP was completely foreign to some groups and so the wording was amended to reflect a health professional they could relate to.
Each individual piece of content of was developed in accordance with our own Clinical Governance Framework and editorial guidelines to be safe, efficient, effective, appropriate, accessible, and accepted by consumers their communities and health professionals.
Getting the message across
Providing in-language messages to multiple cultural groups was challenging. The 2017 study on how people from culturally diverse backgrounds access healthcare also found that healthcare professionals are highly trusted sources of information. This informed our approach to focus on places where these trusted advisors could communicate the message.
We are encouraging health professionals to make resources available to their patients and community groups and will provide the videos, posters and brochures to GPs, health clinics and emergency department waiting rooms via Primary Health Networks, Local Health Districts and other health peak bodies. The resources are free of charge and downloads will be monitored to indicate usage.
Other less direct channels for getting the message across include community centres, immigration resources centres, immigration lawyers, universities, visa agencies and pharmacies.
A significant communication challenge is how to engage with consumers and provide opportunities for feedback in their language. In future planned work with multicultural communities, Healthdirect Australia will partner with local services to measure the success of our contribution to improving health literacy in culturally diverse communities. Evaluations will involve questionnaires, post-interventions surveys and focus groups.
Conclusion
Healthdirect Australia is mandated by the Australian Government to provide safe, high-quality health information, advice and services to all Australians. This means our resources must positively impact vulnerable and hard-to-reach groups, for whom improved health literacy may enable appropriate access to information and services and reduce poor health outcomes.
We’ve learnt a lot from successful collaboration and co-design with these communities, and the value of a ground-up approach. We aim to apply the same health literacy principles and approach to developing resources to other services managed under the Healthdirect Australia umbrella, such as Pregnancy, Birth and Baby. This will extend our reach to other groups who will benefit from better knowledge about our health system.
This article was coauthored with Meghan Mann
Meghan Mann has three decades of health experience ranging from clinical and senior health management roles. Meghan is a Speech Pathologist who specialised in the clinical treatment and management of head and neck cancers and acquired and degenerative neurological conditions. Recently she has moved to Healthdirect Australia initially as the Research and Evaluation Lead for the Company, and more recently moved in the Clinical Lead for a preventative health lifestyle coaching program spanning three states in Australia. Meghan is passionate about improving health outcomes for at risk communities through improving their health literacy.
[i] Estimated percentage of resident population at 30 June 2016 (Australian Bureau of Statistics)
[ii] Research to inform better engagement and acceptability with Aboriginal and Torres Strait Islander communities, culturally and linguistically diverse communities and people from low socio-economic backgrounds. 27 February 2017 – The Cultural and Indigenous Research Centre Australia (CIRCA)
