Some CALD families may prefer to have a service provider or practitioner who is of the same or similar cultural background to themselves because they might feel more comfortable or feel that they will be understood better. Of the 6,163,667 overseas-born persons, nearly one in five (18%) arrived since the start of 2012 (ABS 2016). Only by being culturally sensitive and responsive to ethnic values will parent training be accepted within these populations. Therefore, under-representation of the cultural diversity of the local community in the workforce can compromise effective and culturally appropriate service delivery. Generally, deviations are greater for CALD family members born in Australia compared to immigrants, settled migrants compared to newly arrived migrants, migrants who have chosen to live in Australia compared to those who have not (e.g., spouses who have moved because of their partner or some refugees), and for those who identify with and feel they belong to Australia compared to those who do not (Forehand & Kotchick, 1996; Ward & Kennedy, 1999; Ward & Rana-Deuba, 1999). 1: The health-care system and the development of telemedicine. This is due to genetic differences, dietary, cultural, environmental, socioeconomic or a combination of all of these factors (Collins 2003 quoted by Engebretson 2016). 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. 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. There may be situations in your job when cultural-beliefs and wishes clash with best practice. Statistics from the most recent national census reveal how truly diverse Australia is as a nation. There are also a number of barriers to effective and culturally appropriate service delivery that service providers and practitioners face when interacting with ethnic minority families. 12. For example, being aware of religious diversity within CALD groups makes service providers and practitioners more likely to tailor services to meet the needs of Christian Indians compared to Hindu Indians, Lebanese Muslims compared to Lebanese Christians, and secular Turks compared to Muslim Turks. 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. ... Alexander M. Telemedicine in Australia. 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). Sensitivity and communication should be the tools you rely on in these situations. One way in which institutional racism can manifest is in having practices and procedures that are "colour blind". Most conversations are simply monologues delivered in the presence of a witness. 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. However, it also presents many challenges. Low English proficiency can mean that families are prevented from seeking out or do not have the confidence to seek out information about services in the community from which they could benefit (Box et al., 2001). It is worth keeping in mind that there is a variance in the prevalence of illnesses between cultural groups. Medical Board of Australia 2014, 'Good Medical Practice: A Code of Conduct For Doctors in Australia', Medical Board of Australia, viewed 9 July 2019. 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). 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. Reassurance of confidentiality was considered critical for this group. geographic, socio-economic and cultural barriers to cancer prevention, screening and treatment in the Indigenous population”. 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). 2008). Background. practical barriers accessing services; and. More than one-fifth (21%) of Australians spoke a language other than English at home (ABS 2016). – Margaret Millar. Start an Ausmed Subscription to unlock this feature! 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. Such matches can be useful to families who are concerned they will not be understood or that service providers who are not of the same cultural background will judge them. In Brief In working with diverse populations, health practitioners often view patients’ culture as a barrier to care. Further, ethnic minority families in regional Australia may not have the social support of extensive community networks. This is one reason why healthcare professionals are wise to avoid making assumptions and should work toward understanding a patient’s culture beyond what may seem obvious to them. 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. 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. 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. Barriers to good health care. Alternatively, some CALD families may prefer to have a service provider or practitioner who is not of the same cultural background as themselves. New migrants arrive in Australia tend to have minimal knowledge about the health-care system in Australia. Existing literature regarding breast and cervical cancer screening practices of CALD women in Australia, however, is more limited. How many separately identified languages are spoken in Australian homes? Cultural awareness is interlinked with this – healthcare professionals must be conscious of their own culture and beliefs, and ensure that they are respectful of the beliefs and cultures of others. 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. Officially, Australian society recognizes the diversity of languages and cultures that make up the population, and encourages respect for different traditions and beliefs. © 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. Use a professional interpreter service. How they and their family cope with suffering. 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. Box 951563, Los Angeles, CA 90095-1563 (310) 825-3634 E-mail: Ltaylor@ucla.edu (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. Further, Bhui et al. 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. The Cultural safety in health care for Indigenous Australians: monitoring framework brings together available data to assess progress in achieving cultural safety in the health system for Indigenous Australians. Keywords: Australia, barriers, telemedicine, telehealth. Patients of a non-Anglo-Saxon background have cited feelings of powerlessness, vulnerability, loneliness and fear (Garrett et al. Cultural Diversity in Australia Statistics from the most recent national census reveal how truly diverse Australia is as a nation. 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. Cultural awareness and sensitivity is vital to nursing. As Forehand & Kotchick (1996) pointed out: Ethnic minorities walk a fine line between maintaining their cultural values and customs and adopting the cultural strategies of the European American culture that are typically associated with success. 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). 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. 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). Aboriginal health - barriers to physical activity . The need to provide tailored, culturally appropriate service delivery for ethnic minority families is especially important for preventative or universal services. The experiences and challenges of ethnic minority families and the challenge of acculturation are also differentially related to area of residence. The primary consequences of cultural neglect are poorer outcomes for people of diverse or marginalised backgrounds and, on a more general level, distrust for the healthcare industry (Ferwerda 2016). More broadly, issues of trust and confidentiality may be magnified for some CALD groups. Language presents perhaps the most significant single cultural barrier. The concept of cultural competence has emerged in response to widespread disparities in care by culture, race, ethnicity, religion, gender and sexual orientation, and refers to care that respects patients’ health beliefs about their illness and its causes, interprets health issues from a biopsychosocial rather than biomedical context, involves communication in language accessible to patients, and … This relies on healthcare professionals understanding that each patient is an individual with distinct, beliefs, behaviours and requirements. Lack of information and partnering with CALD-focused services in the local community can compromise the holistic approach that service delivery can offer. In doing so, they hope to better understand and serve their patients, by better understanding differing cultures, values, and perspectives. Notwithstanding, the literature indicates that, broadly, the barriers common to ethnic minority families can be divided into: Ethnic minority families may experience language barriers. Thus, the brochures or other information should indicate that the service is available in minority languages and should point out how it can be accessed. Patients from diverse cultural backgrounds (including First-Nation Peoples) experience almost twice as many adverse effects as English-speaking patients (Multicultural Health Communication 2013). Differences in cultural norms and values between two individuals from the same cultural group may in fact exceed those across two individuals from different cultural groups. For example, if the location of the service outlet is not easily accessible or centrally located, if it is difficult to get to by public transport, if opening hours do not suit the clientele, or if childcare facilities are not provided or nearby, service accessibility is compromised. This process includes consideration of the individual social, cultural, and psychological needs of patients for effective cross-cultural communication with their health care providers. Services are more thinly spread, and people have to travel longer distances to reach them. Culture is influenced by political and economic conditions and varies with factors including age, gender, class, education and personality (Engebretson 2016). 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. (2007) pointed out, based on a review of a number of good practice case studies for promoting and enhancing cultural diversity in children's and parental service provision in the UK, "virtually all of the case studies found engaging with fathers more challenging than engaging with mothers. There is no clear definition of the term "institutional racism", as it is used differently in the medical, health, social work and education literatures. 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). lack of knowledge or understanding of services that are available. Key determinants of health include but are not limited to: education and income, adequate and healthy housing, air quality, and health insurance (Centre for Disease Control of Prevention 2011 quoted by Engebretson 2016). 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. Acknowledging and understanding the social, economic, cultural and behavioural factors that underpin health, both at individual and community levels. Ferwerda, J 2016, ‘How To Care For Patients From Different Cultures’, Nurse.Org, 15 September, viewed 9 July 2019. 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). 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. 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. 4. 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. - as opposed to making assumptions (Care Search 2018). 2015). The ways in which services are marketed can have a significant effect on whether families perceive the service to be relevant to them. These issues can pertain to a range of factors, such as dislocation, acculturation, identity and racism. One leads to ignoring cultural issues that may be very important in understanding the family and identifying the most appropriate intervention, while the other can lead to stereotyping and making assumptions about families that may not be correct. 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. A lack of cultural diversity can also be problematic to family relationship service outlets because "ethnic minority staff are over-relied upon and the racialised experiences of service use are focussed on too heavily" (Page et al., 2007, p. 68). This is where culturally-safe practice is crucial. We take for granted the way in which the following can differ between cultures and regions: eye contact, touch, decision-making, compliments, health-beliefs, healthcare practices, personal space, and modesty (Ferwerda 2016). Volume 39, No.1, January/February 2010 Pages 71-73. Kagawa-Singer, M & Backhall, L 2001, ‘Negotiating Cross-Cultural Issues at End-of-Life’. 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). These include: Service providers and practitioners who are not familiar with ethnic minority families may not feel sufficiently informed or efficacious in addressing the needs of CALD clients generally. (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). Commitment on an organisational level that recognises and. © 2021 Australian Institute of Family Studies. Realizing how culture can influence a person’s perceptions of health and medicine can really make a difference in understanding a person’s medical needs and how to communicate with them. Recommending improved patient engagement and health care outcomes. Whitten P, Holtz B. Such differences can either decrease empathy or understanding for the family's concerns and/or increase (pre-)judgement; CALD families may feel service providers and practitioners who are not as aware of their cultural norms and expectations will judge them less. Thus, culturally competent practitioners feel confident and able to openly discuss culture and religion, as well as issues such as racism and immigration experiences with families, while at the same time exercising their professional judgement about a situation. anything that restricts the use of health services by making it more difficult for some individuals to access Johnstone, M & Kanitsaki, O 2006, ‘Culture, language, and patient safety: Making the link’. (1984) stated that one of their cultural beliefs is that "the private shame of a family should not be made known to outsiders" (cited in Forehand & Kotchick, 1996, p. 199). What illness and care mean to them and their family. 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. For example, service providers and practitioners may assume knowledge of English or define culturally acceptable practices as abuse. Culturally sensitive health care represents a real ethical and practical need in a Western healthcare system increasingly serving a multiethnic society. As the term "culturally diverse" suggests, the nature and magnitude of these barriers vary both within and across cultures. reluctance to engage with services because of concern they will not be understood, or that they will be stereotyped or judged. 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. 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. Neither of these approaches is adequate. If CALD families have had experiences of services that target chronic issues that did not meet their expectations and/or the ideology of the service differs from that of the family's or the community's, they may be reluctant to engage with services when there is a crisis and service provision is necessary. Awareness of aspects of other people’s culture as well as understanding the client’s views and how they articulate their problems. More importantly, some CALD families may not necessarily perceive their issues as "problems" that require a "service" to solve them. 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). 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 another small-scale study of Arabic families, mental illness was considered a negative reflection on the family that may have an impact on events like the marriage of their children (Youssef & Deane, 2006). The potential of error in the absence of culturally-aware nursing is vast. Being a doctor to a colleague is a great honour for any medical practitioner. This site complies with the HONcode standard for trustworthy health information: Verify here. Across both urban and regional areas of Australia, the extent of racism and discrimination varies. 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. Extensive research in this area (e.g. This review focuses on cross-cultural barriers to health care and incongruent aspects from a cultural perspective in the provision of health care. Healthcare professionals could be part of an effective solution for diminishing racial/ethnic disparities in healthcare. On cross-cultural barriers to health care ; and access to health for trustworthy health information: Verify here but of... 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