Henderson S, Kendall E. (2010) Culturally and linguistically diverse peoples’ knowledge of accessibility and utilisation of health services: exploring the need for improvement in health service delivery. Australian Journal of Primary Health,17(2),195-201.

Interviewer: Michael Bouwman (MB)

Interviewee: Saras Henderson (SH)

MB: Introducing Saras Henderson, Associate Professor, School of Nursing and Midwifery, Griffith University, Australia. I’m speaking with Saras about her study and article, ‘Culturally and Linguistically Diverse Peoples’ Knowledge about Accessibility and Utilisation of Health Services: Exploring the Need for Improvement in Health Service Delivery’, co-written with Professor Elizabeth Kendall and published in Australian Journal of Primary Health. Welcome Saras.

SH: Thank you, Michael.

MB: Firstly if I could ask you to provide a background to the issues for CALD or Culturally and Linguistically Diverse Peoples here in Australia?

SH: Yes for sure. As you know Australia has a large culturally and linguistically diverse population, termed CALD, with 3.5 million people born overseas. In Logan for example in Queensland we have a reasonable number of CALD communities with a sizeable number of refugees. Most of the CALD communities and refugees in particular are non-English speaking at Logan so therefore the Australian health system faces significant challenges in providing accessible and cultural competent service for this growing CALD population. Our aim of our research then is to explore the perspectives of CALD people on health and illness, accessibility and usage and barriers to health services and we explored this research with 4 prominent CALD communities in Logan. We wanted to obtain insights into possible solutions for the low level of health service usage in these communities because we envisaged that gaining such insight and knowledge would translate into a more culturally sensitive model of health service delivery and that would clearly lead to better health outcomes for CALD communities. We selected Sudanese people and Afghani, Burmese and mostly the hill tribe people from Burma; the Karen and the Chin group and the Pacific Islander people

MB: You used qualitative methodology based on focus groups that were recorded, coded and thematically organised. What questions were explored in the focus groups?

SH: We were asking them how did they feel about using health services, what services did they use, if they did use the service what was their experience like for them in terms of the interaction with health professionals, how did they know about health services, where did they get the information and what improvements could be done to those health services for the future? So we explored quite in depth for that and we got really rich data from doing this.

MB: And what were the major themes emerging from the findings?

SH: Things that we found in our study, the research is the 4 themes; the need for doctors to use both traditional healing methods alongside orthodox medicine and more effective use of interpreters face-to-face as opposed to telephone and the most strongest theme was the need for bilingual community-based navigators to address concerns and to help navigate the complex Australian healthcare system so that accessibility and service usage can be improved in these communities that we have sampled anyway.

MB: And were there any unusual findings that you didn’t expect?

SH: Yes, actually we did. The pacific Islander group had been here for a long time, many number of years, we thought the themes would be different for the Pacific Islander group in terms of the familiarity with health services and increase use of services among the Pacific Islander group then the other 3 groups. So it was a bit of a surprise for us because even though they had been here a long time and they also experienced the same themes of unfamiliarity as I was saying of health services, need for doctors to use traditional healing methods alongside orthodox medicine and more effective use of interpreters, the need for bilingual, community-based navigator or natural helper to form a bridge between the community and the health professionals.

MB: And was the use of traditional medicine common?

SH: You know the strong theme that came up was using traditional health methods, all 4 groups that we had in our sample shared with us a different cultural healing method they used. For example the Pacific Islander people would sing and dance if they felt ill and they believed that by doing that they will get better. Only when the illness didn’t go away and it was chest pains or something like that more serious they would seek medical help and similarly some of the Sudanese people were boiling up herbs and things and having that as alternative because they believed that if they did that they would get better. I guess that going to the alternative traditional healing methods was one of the things that people resorted to first with all these 4 groups and fortunately if the illness didn’t go away they sought medical help which we were very pleased about.

MB: And did they feel that the medical profession understood their beliefs?

SH: One of the concerns that came out from our research was that participants felt that traditional healing methods were not taken into consideration alongside the orthodox medicine. They wanted both Michael, they wanted both, you know it’s not that they were not appreciating the Western orthodox medicine but they wanted some kind of credence given to their own traditional ways of healing as well. And the interpreter thing also came in as well where interpretation was done through the telephone where the doctor would have the patient talk on the telephone and then the telephone is given to the doctor, he or she talks to the interpreter on the phone and it was like a 3-way telephone conversation that our participants did not particularly, especially the Burmese, Afghani and Sudanese people, felt it was not optimum and they wanted face to face because you know they could actually describe how they’re feeling, not just the symptoms of it.

MB: And lastly, what are the practical implications of your research and how can the findings be translated into health policy and service delivery?

SH: As researchers at Griffith University I think it was clear to Elizabeth and I that theme number 4, you know the one with the bilingual community-based navigator, had the capacity to address the themes 1 and 3, you know unfamiliarity, the need for doctors to use interpreters and the traditional healing to encourage doctors to consider that alongside that so we figured that theme number 4, the bilingual community-based navigator would be really useful when we put that into place in the community to translate into how it is working in the community implications for improving services and health outcomes for these people. So what we did was, following our research we developed a community navigator model in partnership with the two non-government organisations which is, MultiLink Service Inc and I think Access Inc, the two Logan-based non-government organisations which predominately service CALD communities in that area, so we partnered with them and we also partnered with the Logan-Beaudesert Health Coalition as well which is part of Queensland Health and that was government and they gave us some funding to develop this navigator model to use in the Logan region. We got some funding from Queensland Health to assist to implement the community navigator model and it’s been running for 18 months and as I was saying Michael we have anecdotal evidence from the navigators themselves that the model is working. We did a follow-up in depth interview with them and we found that they are truly making a difference. As researchers we are confident that the principles of this model could be applied to other CALD communities and this model has been nominated for a Queensland Premier’s Award too did you know?

MB: Yes, congratulations and good luck with that.

SH: You know the key thing is I guess that you know we’re hoping that the model will be sustained in terms of funding.

MB: Thank you Saras for talking with us today for Griffith University Research Week on your article on the challenges faced by our culturally diverse health consumer community. Lots of practical insights and practical solutions thrown up there

SH: Thank you for this opportunity, Michael.

This podcast was produced by the International Program of Psycho-Social Health Research (IPP-SHR), Griffith University for the Logan Research Showcase held on 6 September 2011. For further information contact Dr Pam McGrath at [email protected]