Medical Board of Australia 2014, 'Good Medical Practice: A Code of Conduct For Doctors in Australia', Medical Board of Australia, viewed 9 July 2019. - as opposed to making assumptions (Care Search 2018). Cultural Diversity in Australia Statistics from the most recent national census reveal how truly diverse Australia is as a nation. It is also worth remembering, however, that these differences can all-too-often have the potential to complicate the nurse-patient relationship and, henceforth, the provision of health services (Medical Board of Australia 2014). full article: Introduction. However, the reality is often far from this ideal, especially in healthcare, where those who do … Article; Download article; Download Citations ; Hilton Koppe . In 2016, nearly half (49%) of Australians had either been born overseas (first generation Australian) or one or both parents had been born overseas (second generation Australian) (ABS 2016). For example, service providers and practitioners may assume knowledge of English or define culturally acceptable practices as abuse. Keywords: Australia, barriers, telemedicine, telehealth. of Psychology, UCLA. Sensitivity and communication should be the tools you rely on in these situations. The authors also suggested that service providers or practitioners may misinterpret the body language of CALD families, which can interfere with how comfortable the latter feel about expressing their issues or concerns. Only two thirds (67%) of the Australian population were born in Australia. For example, CALD families should be informed that service providers and practitioners are required by law to breach confidentiality and disclose issues in cases involving mandatory reporting of child abuse. However, Weerasinghe and Williams (2003) importantly pointed out that even among CALD families who are proficient in English, the use of professional jargon by service providers and practitioners, without accompanying explanations, can be a deterrent to their uptake of services. Ethnic minority families are less likely to access services if they are concerned they will be typecast and will not receive the same quantity or quality of service they believe others receive. Of the 6,163,667 overseas-born persons, nearly one in five (18%) arrived since the start of 2012 (ABS 2016). At worst, CALD families may perceive that individualistic models of service are an implicit attempt to make ethnic minority families conform to mainstream culture, in which the service provider is imposing a "white is right" model, and which suppresses their right and need to express different parts of their cultural identity at different times. 2008). ... Alexander M. Telemedicine in Australia. Care Search 2018, 'Cultural Considerations', Care Search, viewed 9 July 2019, Engebretson, JC 2016, 'Cultural Diversity and Care', in. In turn, service delivery can be tailored to ensure it is sensitive to cultural factors and more accessible for these harder-to-reach families in the Australian community. Recommending improved patient engagement and health care outcomes. The Australian Institute of Family Studies acknowledges the traditional country throughout Australia on which we gather, live, work and stand. Determine whether there are community resources available to the patient and their family. This relies on healthcare professionals understanding that each patient is an individual with distinct, beliefs, behaviours and requirements. For example, Kokanovic, Petersen, and Klimidis (2006) found that CALD families accessing mental health services indicated considerable concern about the impact on the family's standing in the community of having a relative with a mental illness. Objective: Access barriers to health care for minority populations has been a feature of medical, health and social science literature for over a decade. However, it also presents many challenges. Service providers and practitioners may not have adequate resources to support them in providing a culturally appropriate service. While this barrier can be partly addressed by translating relevant written materials, translation of information in and of itself is not sufficient. This site complies with the HONcode standard for trustworthy health information: Verify here. fear of authorities, such as child protection, police, courts, taxation, immigration and housing departments (although not strictly speaking a cultural barrier, it is a barrier that CALD families may face). © 2021 Ausmed Education Pty Ltd (ABN: 33 107 354 441), https://www.ausmed.com/cpd/articles/transcultural-nursing-australia, https://www.ausmed.com/cpd/articles/cultural-assessment, https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/2071.0...Data%20Summary~30, https://www.caresearch.com.au/caresearch/tabid/2446/Default.aspx, https://nurse.org/articles/how-to-deal-with-patients-with-different-cultures/, https://www.medicalboard.gov.au/Codes-Guidelines-Policies/Code-of-conduct.aspx. Although the intensity of acculturation wanes over time, individuals from ethnic minority groups do have the need to express different parts of their cultural selves at different times (Porter & Washington, 1983). The ways in which services are marketed can have a significant effect on whether families perceive the service to be relevant to them. New migrants arrive in Australia tend to have minimal knowledge about the health-care system in Australia. However, we anticipate that because most ethnic minority families live in urban areas, being a more conspicuous minority in regional Australia can exacerbate the extent to which racism and discrimination are perceived or experienced. For example, they may be concerned that they will be seen as being overly dependent on their family or not sufficiently independent, compared to their age-matched Anglo peers. How they and their family cope with suffering. The National Evaluation of Sure Start in the UK (Lloyd, O'Brien, & Lewis, 2003) indicated that most family counselling services have great difficulty engaging fathers. geographic, socio-economic and cultural barriers to cancer prevention, screening and treatment in the Indigenous population”. Because of differences in cultural characteristics between Anglo-Australian and ethnic minority cultures, a number of barriers to equal access and use of services may be perceived or experienced by service providers and practitioners who deliver services to CALD families. Awareness of aspects of other people’s culture as well as understanding the client’s views and how they articulate their problems. Patients from diverse cultural backgrounds (including First-Nation Peoples) experience almost twice as many adverse effects as English-speaking patients (Multicultural Health Communication 2013). How many separately identified languages are spoken in Australian homes? In a study by Katz (1996), Asian families in the UK (who in the main refer to families from India, Bangladesh and Pakistan), for example, viewed children's mental health issues as being behavioural or spiritual difficulties, and sought advice from Imams, who generally recommended increased religious observance and training (or marriage, in the case of young women) as the solution, rather than psychiatry. “There is a growing body of research to connect racism to poor health outcomes,” says Dr. Neil Maniar, professor of practice and director of the Master of Public Health programat Northeastern University. (2007) pointed out, a service user and service provider "ostensibly belonging to the same ethnic group because of shared country of origin, may actually differ in terms of social class, religious practices, languages, and cultural beliefs about illness and recovery" (p. 8). It is the combination of these as well as ideas, skills, arts, and other capabilities of a people or a group as a whole – and it is more than any of these elements and constantly in flux (Engebretson 2016). Cultural barriers in communication ought to be dealt with efficiently, in order to enable healthy communication. To ensure CALD families have and perceive choice, it is important to ask them if they would prefer a service provider or practitioner who is of the same cultural background as themselves; their choice should not be assumed for them, simply based on their cultural background. Notwithstanding the complexity of issues associated with a culturally diverse workforce, it is still important to be able to provide an opportunity to ethnically match service providers and clients. These can include, for example, local CALD advocacy groups, Migrant Resource Centres (MRCs), Ethnic Communities Councils (ECCs), language centres that provide interpreting and translation services, centres that specialise in meeting the needs of refugees or newly arrived migrants, and multicultural organisations. One way in which institutional racism can manifest is in having practices and procedures that are "colour blind". Thus, the challenge of acculturation spills over into the second and subsequent generations of CALD families, and may underlie intergenerational conflict or tension between family members. If the staff profile of service providers at a family relationship service outlet is not culturally diverse, this can compromise the extent to which they perceive or have a choice in service providers. As the term "culturally diverse" suggests, the nature and magnitude of these barriers vary both within and across cultures. Aboriginal health - barriers to physical activity . More importantly, some CALD families may not necessarily perceive their issues as "problems" that require a "service" to solve them. Reassurance of confidentiality was considered critical for this group. It is important for service providers and practitioners to keep a regularly updated list of the main CALD-focused centres and organisations in their local community who can offer interpreting and translation services as well as support and advice. For example, if there are no staff from a CALD background in the profile of the family relationship service outlet, or accompanying pamphlets do not depict a diverse range of families, some CALD families may then feel the service is not relevant for them. These may be compounded further by the cost of accessing services for those living in poverty or in poor areas. Nurses today are providing care, education, and case management to an increasingly diverse patient population that is challenged with a triad of cultural, linguistic, and health literacy barriers. It is worth keeping in mind that there is a variance in the prevalence of illnesses between cultural groups. Culture is largely tactic, which is to say, it is not generally expressed or discussed at a conscious level – most culturally derived actions are based on implicit cues (Engebretson 2016). People of a non-English speaking background are more likely to experience medication errors, misdiagnosis, incorrect treatment, poorer pain management and poorer outcomes in general (Ferwerda 2016). Further, ethnic minority families in regional Australia may not have the social support of extensive community networks. The ongoing and fluid process in which individuals from CALD groups must balance their conflicting needs for cultural preservation and cultural adaptation is known as acculturation (Berry, 1980). There is always a tension between, on the one hand, a "colour blind" service, which treats everybody in the same way, and a culturally specific service, which assumes that each culture is different. “There are many ways that race and ethnicity are connected to health. Potential clients from ethnic minorities need to believe that the service itself will be delivered in a culturally and linguistically appropriate fashion. For these patients, culture and language set the context for the acquisition and application of health literacy skills. One of the major problems we identified in our previous article was access to health services. This is where culturally-safe practice is crucial. As outlined in section 3.1 (under "Service choice perceived as limited due to lack of cultural diversity in the workforce"), a culturally diverse staff profile is necessary but not sufficient; simply having a culturally diverse workforce does not necessarily imply that the needs and issues of CALD families will be met effectively, and so all staff should receive training in cultural competency. If parent training is viewed by ethnic minority parents only as a way to shape their child's behaviour into conformity with the mainstream, then the intervention will not be successful. 12. © 2021 Australian Institute of Family Studies. lack of awareness or confidence to address the needs of CALD families; practice that is not culturally competent; lack of awareness and partnering with CALD-focused organisations in the local community. Additionally, a national online survey was conducted with 98 service providers working with refugee families. Cultural barriers may include differing languages, differing practices as related to medical procedures, and different conceptions of gender and sexuality. Most conversations are simply monologues delivered in the presence of a witness. Although all Australians have the right to equitable healthcare, patients from culturally and linguistically diverse (CALD) backgrounds (including Aboriginal Peoples) may experience significant barriers to accessing and using healthcare services and suffer adverse events including medication errors, misdiagnosis and healthcare-associated infections (DoH 2019; Brach, Hall & Fitall 2019). In addition to the difficulties inherent in recruiting staff with appropriate skills, experience and knowledge because of standardised professional training practices (Bhui et al., 2007), CALD staff members should not be seen as being "experts" on their own ethnic group, and CALD families should not be allocated only to CALD staff. Also, as Katz (1996) pointed out, in many CALD communities there is likely to be a family or other connection between the client and the service provider. In fact, the whole concept of a family sitting down and discussing their problems together was alien, in that parents very seldom discussed issues with children. The framework includes measures on culturally respectful health care services; Indigenous patient experience of health care; and access to health care services. The simple realities of large distances and low population densities make service provision far more difficult in rural than urban areas of Victoria and Australia. Alternatively, some CALD families may prefer to have a service provider or practitioner who is not of the same cultural background as themselves. For example, many refugee families will have experienced violence or abuse from officials in their own countries, and this may well affect the way they relate to any authority figures (Sipe, 1999). Ethnic minority families who perceive that the skills, support and advice they are receiving from family relationship services reflect individualistic norms may disengage from the service because they do not consider it appropriate for their cultural needs or issues. Neither of these approaches is adequate. Services are more thinly spread, and people have to travel longer distances to reach them. In 2009, 23 per cent of Australians living in outer regional and remote areas felt they wai… Share (show more) Download PDF; Listen (show more) Listen. 1: The health-care system and the development of telemedicine. This is compounded further for ethnic minority women, whose traditional gender role is as carers rather than as those who are cared for (Cortis, Sawrikar, & Muir, 2007; Weerasinghe & Williams, 2003). What illness and care mean to them and their family. Barriers to service accessibility and appropriate service delivery for CALD families in Australia, Enhancing family and relationship service accessibility and delivery to culturally and linguistically diverse families in Australia, Characteristics and experiences of CALD groups in Australia, Recommendations for enhancing service accessibility and delivery for CALD families in Australia, Families and Children Expert Panel Project. While we like to believe in the ideal that all Australians have access to a high standard of healthcare, this is not always the case. Considerations of cultural barriers have featured in this literature, but definitions of what constitutes a cultural barrier have varied. In these cases, CALD families may be concerned about confidentiality issues, in that their community is more likely to find out about their family's concerns and this can compromise the status of their family in the community. There are a number of practical barriers that can affect service accessibility that are not exclusive to ethnic minority families; low-income earners and rural and remote residents may also experience practical barriers in accessing services. Further, Bhui et al. CALD families have all experienced migration from their home countries, with associated issues such as dislocation from close family and community, identity concerns and having to cope with a foreign environment (Berry, 1980; Phinney et al., 2001; Sawrikar & Hunt, 2005). It is vital you adapt your practice to address the wants and reasonable expectations of the patient (Medical Board of Australia 2014). Finally, families from collectivistic cultures, in the main characterised by the central role of the family in the individual's life and traditional gender roles, may be concerned that they will be judged as deficient rather than different (Forehand & Kotchick, 1996; Korbin, forthcoming). Whitten P, Holtz B. Community Profiles for Health Care Providers is a practical tool that assists health care providers to better understand the health beliefs, pre-migration experiences, communication preferences and other aspects of their clients' culture.. Families need to be understood not only in cultural context, but also in the context of their experiences. Background. Ethnic minority families may not take up services if they believe the service provider or practitioner is not aware of or empathetic to their issues as ethnic minorities. 4. Health inequity exists among aboriginal Australians and Torres Strait Islanders, and the cultural barriers are vital factors in addressing aboriginals' health inequity. In addition, families from visible ethnic minorities are very likely to have experienced racism and discrimination of one sort or another, and this will affect their relationships with Anglo-Australians. There is extensive research (e.g., Bell, Bryson, Barnes, & O'Shea, 2005; Box et al., 2001; Page et al., 2007; Williams & Churchill, 2006) pointing to the importance of service providers and practitioners being sensitive to these individual variations within families; ethnic minority families are more likely to engage these services if their concern that family members will be stereotyped or misunderstood is alleviated. You may offend the patient or you might witness something that differs from your beliefs/moral codes. Also, families unsure of their status in Australia may be reluctant to divulge family-related difficulties for fear they will be conveyed to immigration authorities. Ausmed’s Editorial team is committed to providing high-quality and thoroughly researched content to our readers, free of any commercial bias or conflict of interest. These barriers can lead to serious miscommunications between parties with differing cultural backgrounds. However, fathers from ethnic minority families are particularly challenging to engage because of traditional gender roles. Further, these barriers are interrelated, and interact with and reflect barriers that arise from the families' own situation or factors about the specific service. These issues not only point to the importance of a culturally diverse staff to increase the sense of choice for CALD families, but also demonstrate the limitations of assuming that a culturally diverse staff is sufficient for meeting the needs of CALD families. While these studies concentrated on mental health specifically, it appears important for service providers and practitioners in health-related fields to be explicit in the protocol and boundaries of how confidentially the information is held. For example, based on research that investigated parent training issues with Chinese families in the US, Lieh-Mak et al. Use a professional interpreter service. Nevertheless, a staff profile that reflects the ethnic mix of the local population is preferable. This included 50 semi-structured interviews with 25 families from a refugee background who had resided in Australia for between one and ten years, and were living in South Australia or the ACT. When ethnic minority families experience disruption and conflict in their family relationships, government-funded services, such as those provided by FRSP, can provide assistance and support. Forster a therapeutic relationship that portrays genuine respect for the client’s cultural beliefs and values. All articles are developed in consultation with healthcare professionals and peer reviewed where necessary, undergoing a yearly review to ensure all healthcare information is kept up to date. language barriers: English proficiency, professional jargon and misinterpretation of body language; cultural norms that prohibit seeking extra-familial support, especially for women and children; traditional gender roles that prevent men from engaging with services or discussing family difficulties; and. This review focuses on cross-cultural barriers to health care and incongruent aspects from a cultural perspective in the provision of health care. A series of papers for those yearning to propel telehealth to new heights. We acknowledge all traditional custodians, their Elders past, present and emerging, and we pay our respects to their continuing connection to their culture, community, land, sea and rivers. Just as individual service providers and practitioners in Australia differ to a greater or lesser extent from Australian cultural norms, families from CALD groups may deviate from the norms of their culture, both generally and as a result of acculturation. Box 951563, Los Angeles, CA 90095-1563 (310) 825-3634 E-mail: Ltaylor@ucla.edu It is suggested that CALD families who perceive the services as being geared toward Anglo-Saxon families may be less likely to use the services. Australian Bureau of Statistics 2016, ‘2071.0 - Census of Population and Housing: Reflecting Australia - Stories from the Census, 2016,’ ABS, viewed 9 July 2019. Because of the long history of abuse of ethnic minorities in this country, many of these families resist any efforts of the "white establishment" to assist them in raising their children. It is a fact that effective communication is the key to success in both personal and business relationships. A culturally diverse staff profile is necessary but not sufficient; it is still important to have "culturally competent" staff.6 That is, training in cultural competency for all staff, regardless of their ethnic background, will increase effective engagement with all CALD families. Across both urban and regional areas of Australia, the extent of racism and discrimination varies. model of service is culturally inappropriate; service not perceived as relevant due to lack of cultural diversity in the workforce and marketing of services; service choice perceived as limited due to lack of cultural diversity in the workforce; and. Of the 6,163,667 overseas-born persons, nearly one in five (18%) arrived since the start of 2012 (ABS 2016). These include: 1. lack of awareness or confidence to address the needs of CALD families; 2. practice that is not culturally competent; 3. lack of adequate resources; 4. institutional racism; and 5. lack of awareness and partnering with CALD-focuse… Cultural awareness and sensitivity is vital to nursing. Cultural profiles Community profiles for health care providers. See section 4.1. for more information. Commitment on an organisational level that recognises and. It is important to consider the experiences, challenges and issues of ethnic minority families in conjunction with those of service providers and practitioners, to see how best to improve the fit between service providers and service users. Although treating everyone in the same way is superficially equivalent to providing equal opportunities, it can in fact result in discrimination and "institutional racism" (discussed below). Good medical practice guided by genuine efforts to understand and meet the cultural needs and contexts of different patients to obtain good health outcomes, which requires: Having knowledge of, respect for, and sensitivity towards, the cultural needs of the community. Also, lack of training and support in cultural issues can act as a barrier to effective service for CALD families. Start an Ausmed Subscription to unlock this feature! These issues can pertain to a range of factors, such as dislocation, acculturation, identity and racism. Such situations can burden other family members such as children, who at times may be engaged as interpreters for their parents on sensitive issues. Because of differences in cultural characteristics between Anglo-Australian and ethnic minority cultures, a number of barriers to equal access and use of services may be perceived or experienced by service providers and practitioners who deliver services to CALD families. Statistics from the most recent national census reveal how truly diverse Australia is as a nation. The experiences and challenges of ethnic minority families and the challenge of acculturation are also differentially related to area of residence. Patients of a non-Anglo-Saxon background have cited feelings of powerlessness, vulnerability, loneliness and fear (Garrett et al. This may be tied in with language barriers, but could also reflect insufficient dissemination at the local level of information about the range of services available in their community. Johnstone, M & Kanitsaki, O 2006, ‘Culture, language, and patient safety: Making the link’. How they prefer to communicate about death and dying and diagnosis and prognosis. (2007) pointed out that, even among service providers and practitioners from ethnic minority groups, standardised professional training practices reduce the number of culturally tailored options for models of service delivery. Service providers who are unaware of the individualistic norms that underlie models of service delivery in Australia, and who do not acknowledge the resentment some ethnic minority families may experience when receiving a mainstream model that is not tailored to meet their cultural needs, are less likely to engage CALD families in their services (Page et al., 2007). More than one-fifth (21%) of Australians spoke a language other than English at home (ABS 2016). Narayanasamy, A 2002, ‘The ACCESS Model: A Transcultural Nursing Practice Framework’. How you can accommodate their spiritual and religious needs. Medical procedures, and the development of telemedicine Listen ( show more ).... Factors, such as dislocation, acculturation, identity and racism by viewing the barriers outlined above a. Care services ; Indigenous patient experience of health literacy skills, January/February Pages..., fathers from ethnic minority families may prefer to communicate about death dying... 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