A study in PLOS One in February 2024 considers the factors that shaped COVID-19 communication and engagement efforts during the pandemic with a focus on the perspective of “culturally and linguistically diverse” communities. With 29 key informant interviews with community and faith-based leaders in New South Wales, Australia, the researchers identify the importance of “clear, concise, and timely public health messaging”.
CaLD populations and COVID-19
The authors state that the “convention” in Australia is to refer to ethnic minority populations as “culturally and linguistically diverse (CaLD) populations”. Therefore, this term is used throughout the paper. The Australian Institute of Health and Welfare recognises that “some people” from CaLD backgrounds “face greater challenges” when they deal with the health and welfare system, stemming from barriers such as language differences, lower health literacy, or difficulties navigating an “unfamiliar system”.
Not only do studies indicate a “heightened risk” from SARS-CoV-2 in a “diverse group of migrants, refugees, asylum seekers, and other ethnic groups”, but evidence suggests that these at-risk groups have been “excluded from the national response”. This could be due to a “lack of consideration and tailoring” to the needs of CaLD population groups within health strategies and government inaction to ensure that resources are linguistically diverse and “culturally relevant”.
“People from CaLD backgrounds can be left behind in their access to and understanding of recommendations, compounded by cultural discordance and mistrust of health institutions.”
Although English is the “dominant” language in Australia, many people speak a language other than English within families and communities. Among the over 200 languages spoken in Australia, there are 50 “actively spoken Australian Indigenous languages”. This linguistic variety highlights the need for availability of information in other languages, which the authors suggest “often depends on the size of the community, the level of community infrastructure, and the engagement of the community with health services around other health-related issues”.
Linguistic communities with “sizeable numbers of practitioners”, such as Mandarin or Arabic, may “glean information” from national- or community-based radio and newspapers, for example. However, “linguistic minorities” do not have “this level of community infrastructure”. The paper refers to “information intermediaries”, who are “strategic stakeholders” within a community who disseminate information within groups. These people could be community organisation staff, religious leaders, or “natural” leaders.
“Through influencing the flow of communication, information intermediaries shape and inform their community’s reality and knowledge in a culturally appropriate and salient manner.”
Despite an emphasis on the “crucial role” played by these information intermediaries in supporting communities during the COVID-19 pandemic, little is understood about their experiences in terms of “perceptions of the COVID-19 response, the needs of their communities, and their experiences in ‘bridging the gap’ between levels of government and the community”.
Therefore, and considering “concerns” about the government’s ability to consider the needs of CaLD communities in public health strategies and approaches, the researchers sought to understand the “factors that have impacted COVID-19 communication and engagement efforts” from the perspective of “key CaLD community and religious leaders”. They also tried to uncover the processes that could be “adopted to support future communication strategies”, including “promoting pandemic-related vaccines”, as proposed by CaLD information intermediaries.
What does the study find?
29 interviews were conducted with community and religious leaders based in New South Wales, with participants representing CaLD communities “originally from Asian, South Asian, Middle Eastern, and African backgrounds”. Eight themes were identified from an analysis of perspectives on government communication strategies and processes:
- “They know nothing” – understanding the language and generational divide affecting CaLD populations
- “I expected a lot more engagement” – critically assessing the government’s engagement with CaLD communities
- “How much perfection do we need?” – expressing support for the government’s engagement with the CaLD community
- “Bridging the gap” – CaLD communities leaders stepping up
- “With some translation, I would cringe” – quality and scope of translations matter
- “Most of them are tuning into overseas stations” – relying on overseas health messaging among CaLD communities in Australia
- “You can’t reach them by the traditional way” – harnessing social media
- “The people want to know the truth” – challenges of communicating complex medical information to CaLD communities
“The overwhelming message from community leaders was a sense of shared responsibility between their organisations and the government in communicating pertinent and accurate COVID-19 related information to CaLD communities.”
However, while community leaders felt a “sense of duty”, they shouldered “significant costs” related to resources and time, which the authors believe should be “acknowledged by governments in the future”. Further public health information campaigns could follow “several considerations” to improve translation and interpretation capacity.
Improve communication
A “communication gap”, identified in recent research, between CaLD members and the “public health dissemination system” is attributed to a “lack of access to COVID-19 specific information” and “ineffective communication channels for CaLD groups and communities”. This is hardest for people with “low digital or English literacy levels” and “older ethnic minority adults”.
Discussions with community leaders revealed “a similar tension”, which implies that governments demanded “significant responsibility” for delivering public health messaging of community leaders and organisations. To address this, one leader reportedly suggested “more communication” between representatives of governments and community leaders. This would “forge a more collaborative approach”.
“The government expected community leaders to disseminate key public health messages, and the vast majority were willing partners in the efforts to inform their people; however, while there was a shared responsibility, there was not always a shared cost.”
The authors suggest that “additional government support to bridge important gaps in the pandemic response” was raised as a concern for community leaders, who believed that “multicultural organisations had a more significant role to play in educating their communities”.
Respond with agility
“Agility is not a term typically used to describe government action.”
Despite this terminological tension, the authors infer a need for governments to “rapidly shift and pivot based on the current data”. Central to this is “having effective mechanisms to engage and communicate effectively with the community”, particularly for those communities where “English proficiency is limited and trust in governments is strained”. The pandemic highlighted that the public was “not prepared for the evolving nature of public health advice”. Thus, future health communication will require clarification from the outset that “public health advice is not static and will evolve and change”.
“Alerting CaLD communities, especially those with low English language proficiency and less community infrastructure, and the community organisations that serve them about the possibility of evolving public health advice will be an essential feature in future pandemic preparedness.”
Use social media
“One of the strong messages from the community leaders is that a suite of communication strategies is needed to reflect the diversity of CaLD communities, the generational differences in accessing internet-related information, and those with low English proficiency.”
The paper emphasises that CaLD communities have “increasingly engaged with various social media platforms” such as Facebook, YouTube, and WhatsApp. With the use of social media come “several pitfalls”. For example, the source of content is an “important consideration”; community members often voluntarily translated, interpreted, and posted resources on various sites despite limited resources. Another consideration is that everyone had “easy access to a mirage of false and misleading” information about COVID-19. This led to “further strains” and concerns about vaccine hesitancy.
Additionally, a social media challenge is that the “ease of accessibility to overseas pandemic information” did not always apply to the Australian context. Therefore, some CaLD communities’ perception of the pandemic in their locale may have been “coloured” by the “rapid exchange of overseas information in their community language”.
“While it is clear that harnessing social media to disseminate critical public health information will play a significant part in future communication strategies, it will not be the only part of a strategy. A variety of communication platforms with substantial reach and one-to-one contact will still be required in the years to come.”
Know the population
A key lesson from the pandemic in Australia is that “early and sustained investment in local public health units” translated into a “material difference” during the pandemic. The CaLD community leaders “emphasised the need for governments to reinvest in community engagement and in knowing one’s population”. This could be done through increased investment in outreach with CaLD communities, formalising partnerships, fostering regular engagement, and ensuring an understanding of “cultural and linguistic diversity within the community” so that “no one gets left behind”.
“Such investments should not rest solely on the shoulders of public health but have broader appeal to other emergencies, such as fires and floods.”
Health ambassadors
Community leaders suggested that public health information should be disseminated by health practitioners who combine medical and public health knowledge with “high levels of cultural sensitivity” and “the trust and respect of the local community”. Some community leaders, recognising that it is “not financially practical”, stated a need for investment in “one-on-one engagement”. A model that has been used in Victoria, Vaccine Ambassadors, could be applied with variations to “bridge the gap”. Ambassadors were trained to engage with the community and answer vaccine questions.
“The potential to broaden their scope to ‘health ambassadors’ could be a way forward.”
A hybrid model
Many community leaders were “forced” into public health communication roles due to the “volume and urgency” of public health information. During this time, they “leveraged their connections” and language abilities to translate or interpret public health messaging, sometimes without NAATI accreditation. Therefore, there was another “tension” between the need for accurate translations and the urgency of information dissemination.
The engagement of NAATI-certified translators is necessary to “ensure the accuracy” of translations. However, there could be an opportunity for a “hybrid model” where NAATI-accredited translators and interpreters work with informal translator networks to disseminate information. For example, having “someone from the affected community” reviewing official translations would ensure both “accuracy and relevancy to the community”.
“Finding the right balance of accuracy, speed, breadth of dialects, and cultural knowledge appeared to be a priority for the community leaders – and there needed to be a way forward to use both accredited and non-accredited translators during public health emergencies.”
Vaccine information
Another important lesson from the COVID-19 pandemic is the development and implementation of vaccine information campaigns to reach CaLD communities effectively. Community leaders were keen to see “increased outreach to multicultural communities” to support their decision-making about the vaccine.
“While there may not be one approach that will best help CaLD communities, offering them factual, scientifically based information that is understandable to the layperson is an essential component of any strategy.”
Preparing for the future
“Culturally and linguistically diverse communities are an important part of the Australian population, and it is imperative that their needs are met as part of the Australian response to ongoing and future pandemic responses.”
During the COVID-19 pandemic, CaLD communities “bore a significant burden” in the Australian pandemic response. The study highlights that governments can improve communication with and investment in community organisations to support their roles in “facilitating greater cooperation”. While calling for the public health community to “heed the lessons” of the pandemic, the authors highlight the need for communication strategies are “reflective of the CaLD populations” with an awareness of “diversity, language ability, educational background, and internet knowledge”.
How do you interpret the recommendations of this study; does it have implications for communities where you live or work? Effective health communication relies on understanding of its recipients and public health innovation, issues that will be explored in greater detail during the Congress in Washington this April, from the “Beyond Efficacy” workshop to a session with Dr Miller on information and communication. We hope you will join us for these important discussions or subscribe for further insights.
