The Covid-19 pandemic has impacted us all in some way and has contributed to major changes in how we behave as humans that is not within our normal realm, such as the need to physical distance, sanitise regularly, and wear masks [1]. Australia documented its first confirmed case of Covid-19 on January 25, 2020, and by late March was experiencing nearly 500 cases per day. In May 2020, Australia’s Group of Eight leading universities released The “Roadmap to Recovery: A Report for the Nation” [2] to manage and recover from the Covid-19 pandemic with two recommended options for Australia’s pandemic response – an elimination strategy or a controlled adaption strategy; the Federal Government adopted a controlled adaption strategy. This strategy has been felt differently across the States of Australia with Victoria imposing the strictest restrictions. Clearly, there is a way to go on the road to recovery in Australia and this “story” is all too familiar in other countries globally. Despite the fact that the impacts of Covid-19 have clearly not be felt equally across all population groups. In the Report for the Nation, a number of key groups that require special considerations and support in the recovery phase of the response to Covid-19 were identified, including Aboriginal and Torres Strait Islander peoples, ethnic minority and culturally and linguistically diverse (CALD) groups (e.g., refugees and asylum seekers). Pervasive disadvantage in health and financial outcomes has been experienced by our most vulnerable populations. The need for effective treatments and preventive strategies for these key groups is therefore now critical.
… there is an urgent need for innovative and rigorous “real world” data collection…
Clearly, understanding how to prevent the spread of the virus, and treating and improving the lives of those infected requires translating knowledge into action, and implementing evidence-based interventions. Implementation science focuses on how to do this and is the “scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice, and, hence, to improve the quality and effectiveness of health services and care” [2]. Wensing et al. [1] make the strong point that, as the evidence on prevention and treatment becomes more consolidated, the guidance and regulations that have informed intervention implementation to date may need to change, with necessary adaptations made to existing interventions. Similarly, for interventions that have been challenging to implement into routine practice from the outset, there is an urgent need for innovative and rigorous “real world” data collection methodologies and efficient and effective data analyses that can rapidly inform administrative, clinical, and practice-based decision making [1]. This is particularly the case when mitigating the adverse impacts of interventions for Covid-19, such as inequalities in access to healthcare, or inequitable treatment for vulnerable populations.
Whilst dissemination of information that is translated into different languages is important in the communication of pandemic preventive strategies, information alone will not lead to behaviour change.[3] Effective mass public health communication requires an understanding of behavioural psychology principles as well as information about how to tailor key messages to the various populations within a society; there is no one size fits all approach for diverse populations.[4] This is even more the case when needing to embed trauma-responsive health-focused interventions that reach, and are well received, by our most vulnerable populations across and within social welfare and community service settings.[5] That is why, in the Report for the Nation a strong participatory and co-designed response was recommended. In relation to Covid-19, this is particularly important for behaviours such as getting tested if you have symptoms, physical distancing, sanitising, and wearing masks. Partnership with target populations helps to understand what drives these behaviours in order to engage diverse community members in effective behaviour change.[6] Indeed, partnerships between government, epidemiologist, health promotion and public health scientists, and social science, migration, and CALD scientists and professionals are equally as important as partnerships between government infectious disease, and medical and allied health scientists and professionals. For our vulnerable populations, social justice is central to public health and crucial for effective Covid-19 prevention, testing and treatment. [7, 8] However, ethical values and decision-making in the quest to combat the Covid-19 pandemic are often made in the absence of lived experience representation from socio-economically oppressed, marginalised and vulnerable groups and in the absence of consideration of the social determinants of health [8]. Hence, important policy decisions, such as triaging decisions in relation to critical care during Covid-19,[7] may be fraught with inequity and exacerbate social injustice because those who are historically oppressed and disadvantaged are usually not represented on policy advisory teams, or, as per the example provided here, on triage teams. [8]
The key is to tailor government communication initiatives…
Current attempts to communicate the recommendations of our Chief Medical Officers may not have/be reaching, and/or understood by, everyone in our community, especially people from CALD groups. We know there are dedicated websites, social media pages, and that COVID-19 information has been translated into languages that are spoken the most across our society. However, whilst driven from a public health perspective, effective communication at a national scale requires insights from behavioural sciences in order to help us slow and eradicate the spread of the virus. The key is to tailor government communication initiatives, so they are conveyed meaningfully and in a relevant way to those receiving the messages. Given the diversity across cultural groups in Australia, that means tailoring messages to reach and be understood by CALD people. Knowing how to best do this involves genuine co-design – collaborating with consumers and community to design solutions that solve problems in a way that values and meets their needs. In line with this advice for action, CALD community leaders and bi-cultural health workers in Australia have recommended that a national advisory body is established to advise authorities on public health messaging and interventions across CALD communities to ensure their voice is heard and understood.[6] In relation to communication of information and considering this from an equity lens, CALD community leaders in Melbourne, Australia, noted it is important to: (a) involve communities in designing and delivering messages; (b) tailor messages to community values; (c) use trusted messengers; (d) use communication channels that the target community can and do access; and, as noted above, (e) establish a national peak body for the health of CALD communities. [6]
References
1. Wensing M, Sales A, Armstrong R, Wilson P. Implementation Science in times of COVID-19. Implement Sci. 2020;15(1):42.
2. Group of Eight Australia. Covid-9 Roadmap to Recovery. A Report for the Nation. 2020. https://go8.edu.au/wp-content/uploads/2020/05/Go8-Road-to-Recovery.pdf. Accessed on 19 July 2020.
3. Kelly MP, Barker M. Why is changing health-related behaviour so difficult? Public health 2016;136:109-16.
4. Chambers DA. Considering the intersection between implementation science and Covid-19. Implement Sci. 2020;1:1-4.
5. Pizzirani B, Green (nee Cox) R, O’Donnell R, Skouteris H. Healthy Lifestyle Programs in out-of-home care: Implementing preventative trauma-informed approaches at scale. Aust Soc Work. 2020: 1-4.
6. Wild A, Kunstler B, Goodwin D, Skouteris H. We ask multicultural communities how to best communicate COVID-19 advice. Here’s what they told us. The Conversation [Internet]. 2020 [cited 2020 August 11]. Available from: https://theconversation.com/we-asked-multicultural-communities-how-best-to-communicate-covid-19-advice-heres-what-they-told-us-142719.
7. Emanuel EJ, Persad G, Upshur R, Thome B, Parker M, Glickman A, et al. Fair allocation of scarce medical resources in the time of COVID-19. N Engl J Med. 2020; 382(21):2049-55.
8. Stone JR. Social justice, triage, and Covid-19: Ignore life-years saved. Med Care. 2020;58(7):579-81.
