Action 2.08

Language and cultural factors can create barriers to accessing health care, leading to poorer health outcomes and a lower quality of care for some sections of diverse populations. Diversity comes in many forms – for example:

• Language factors may affect consumers for whom English is not their first language, consumers with a cognitive impairment and consumers with a physical condition such as deafness or blindness
• Cultural factors may affect consumers from culturally and linguistically diverse communities, whose view of health and wellbeing may differ from the Australian experience; the diversity of cultures accessing health care in a multicultural country such as Australia can pose challenges for a health service organisation and its workforce to engage in a culturally responsive way.

There is no ‘one size fits all’ solution to meeting the communication requirements of a diverse consumer population. However, health service organisations can work to develop a framework that integrates cultural competency into its communication mechanisms.¹

Different consumers will engage with different communication mechanisms. Some consumers may prefer casual, verbal conversations, whereas others may prefer written information resources or audiovisual presentations. Communication mechanisms should not be viewed in isolation; instead, the mechanisms chosen should complement each other and aim to appeal to different consumer communication preferences.

Determine the diversity of consumers and the local community

Patient and community data are essential to understanding consumer communication needs, and developing or improving communication mechanisms to meet these needs.¹ Review the diversity of the consumers who use the organisation’s services and make up the local community by²:

• Undertaking a community profiling project, which involves gathering information about the diversity within the community; its history, social and economic characteristics; the groups and networks within the community; and the social and infrastructure services that exist
• Administering surveys to help identify diversity among consumers
• Using demographic data from the Australian Bureau of Statistics, or local, or state and territory government sources to understand the background of the organisation’s consumers
• Networking with other organisations or individuals in the community – such as culturally and linguistically diverse community groups; community participation managers; Primary Health Networks; Local Hospital Networks; local, state and territory government organisations; and professional associations – to share knowledge about communication preferences and needs.

Review current communication mechanisms

Determine whether the organisation’s current communication mechanisms meet the needs of diverse patient populations by reviewing:

• Consumer information developed by the organisation, such as patient brochures, posters and consent forms, to see whether they are
  • culturally appropriate or available in culturally appropriate formats
  • available in a variety of community languages
  • available in a variety of accessible formats, such as audio or braille
• The availability of interpreting services, and methods of access to these services for patients and members of the workforce
• The cultural competency and confidence of the workforce in communicating with diverse patient populations.

One Size Does Not Fit All: Meeting the health care needs of diverse populations can be used to help evaluate the current services provided for diverse patient populations.

If the organisation currently uses communication mechanisms that are tailored to the needs of its diverse consumer and local community populations, review them to determine whether any additions or improvements can be made.

If the organisation does not use communication mechanisms that are tailored to the needs of its consumers, use the strategies outlined below to develop or adapt a framework to help meet these needs.

Set up a supportive foundation for tailoring communication mechanisms

This may involve:

• Engaging the support of the organisation’s management and governing body to help drive change and build workforce support
• Implementing a policy that requires cultural and language considerations to be incorporated into all communication strategies
• Implementing a plain-language policy that makes written information easier to understand³
• Educating the workforce about the diversity of the consumers who use the organisation’s services; consider accessing cultural competency training if people from culturally and linguistically diverse communities, or Aboriginal and Torres Strait Islander communities regularly use the service⁴
• Engaging consumers in developing and reviewing health communications
• Facilitating easy access to interpreting services by
  • identifying and promoting appropriate interpreting services that are competent at working in a health setting (for example, discussing health and medical issues); the Australian Government’s Translating and Interpreting Service can supply phone and on-site services
  • developing policies and procedures, and educating the workforce on when and how to engage an interpreting service
  • educating the workforce on the appropriate use of interpreters – family or friends may not be appropriate interpreters because of health privacy issues.

Resources and tools include:

• The Agency for Healthcare Research and Quality Health Literacy Universal Precautions Toolkit
• Centers for Disease Control and Prevention Simply Put: A guide for creating easy-to-understand materials
• The Plain Language Action and Information Network’s PlainLanguage.gov website.

Implement communication mechanisms that meet the needs of specific populations

This may involve:

• Adapting existing consumer information into culturally appropriate formats by changing the design and messaging used in a resource, or adapting the information for an alternative delivery channel, such as video or audio
• Translating existing consumer information into community languages
• Providing multiple opportunities for consumers to gain access to information in a variety of formats
• Employing or engaging interpreters to be part of the patient care team
• Using techniques to check a consumer’s understanding of information, such as a ‘teach back’ method⁵
• Using symbols or cue cards for communicating with patients during care, such as instructions for the correct use of medicines
• Using technology, mobile apps or social media to help communication, if appropriate.

A number of tools and resources can help guide effective and tailored communication with diverse patient populations, including:

• SA Health Guide for Engaging with Consumers and the Community, Tool 3: Tips for communicating clearly
• Health Translations directory, which provides links to reliable translated health resources produced in Australia
• Eastern Health Cue Cards in community languages
• Centers for Disease Control and Prevention Health literacy website.

Language and cultural factors can create barriers to accessing health care, leading to poorer health outcomes and a lower quality of care for some sections of diverse populations. Diversity comes in many forms; for example:

• Language factors may affect consumers for whom English is not their first language, consumers with a cognitive impairment and consumers with a physical condition such as deafness or blindness
• Cultural factors may affect consumers from culturally and linguistically diverse communities, whose view of health and wellbeing may differ from the Australian experience; the diversity of cultures accessing health care in a multicultural country such as Australia can pose challenges for a health service organisation and its workforce to engage in a culturally responsive way.

There is no ‘one size fits all’ solution to meeting the communication requirements of a diverse consumer population. However, health service organisations can work to develop a framework that integrates cultural competency into its communication mechanisms.¹

Different consumers will engage with different communication mechanisms. Some consumers may prefer casual, verbal conversations, whereas others may prefer written information resources or audiovisual presentations. Communication mechanisms should not be viewed in isolation; instead, the mechanisms chosen should complement each other and aim to appeal to different consumer communication preferences.

Day procedure services may provide care to people from different communities, not just from the local area. Services should identify the diversity of consumers who use their service to develop or improve current communication mechanisms.¹ A first step in this process is to routinely collect patient data through pre-admission screening or by administering surveys to identify diversity among current consumers.

For guidance on undertaking consultations and surveys, see the Victorian Government’s Engagement Toolkit and the Scottish Health Council’s Participation Toolkit.

Review current communication mechanisms

Determine whether the organisation’s current communication mechanisms meet the needs of diverse patient populations by reviewing:

• Consumer information developed by the organisation, such as patient brochures, posters and consent forms, to see whether they are
  • culturally appropriate or available in culturally appropriate formats
  • available in a variety of community languages
  • available in a variety of accessible formats, such as audio or braille
• The availability of interpreting services, and methods of access to these services for patients and members of the workforce
• The cultural competency and confidence of the workforce in communicating with diverse patient populations.

One Size Does Not Fit All: Meeting the healthcare needs of diverse populations can be used to help evaluate the current services provided for diverse patient populations.

If the organisation does not use communication mechanisms that are tailored to the needs of its consumers, use the strategies outlined below to develop or adapt a framework to help meet these needs.

Set up a supportive foundation for tailoring communication mechanisms

This may involve:

• Engaging the support of the organisation’s management and governing body to help drive change and build workforce support
• Implementing a policy that requires cultural and language issues to be incorporated into all communication strategies
• Implementing a plain-language policy that makes written information easier to understand⁴
• Educating the workforce about the diversity of the consumers who use the organisation’s services; consider accessing cultural competency training if people from culturally and linguistically diverse communities, or Aboriginal and Torres Strait Islander communities regularly use the service
• Facilitating easy access to interpreting services by
  • identifying and promoting appropriate interpreting services that are competent at working in a health setting (for example, discussing health and medical issues); the Australian Government’s Translating and Interpreting Service can supply phone and on-site services
  • developing policies and procedures, and educating the workforce on when and how to engage an interpreting service
  • educating the workforce on the appropriate use of interpreters – family or friends may not be appropriate interpreters because of health privacy issues.

Resources and tools include:

• The Agency for Healthcare Research and Quality Health Literacy Universal Precautions Toolkit
• Centers for Disease Control and Prevention Simply Put: A guide for creating easy-to-understand materials
• The Plain Language Action and Information Network’s PlainLanguage.gov website.

Implement communication mechanisms that consider the needs of specific populations

This may involve:

• Adapting existing consumer information into culturally appropriate formats by changing the design and messaging used in a resource, or adapting the information for an alternative delivery channel, such as video or audio
• Sourcing culturally appropriate and accessible consumer information from other organisations that have developed relevant materials
• Translating existing consumer information into community languages
• Providing multiple opportunities for consumers to gain access to information in a variety of formats
• Employing or engaging interpreters as part of the patient care team
• Using techniques to check a consumer’s understanding of information, such as a ‘teach back’ method.⁵

A number of tools and resources can help guide effective and tailored communication with diverse patient populations, including:

• SA Health Guide for Engaging with Consumers and the Community, Tool 3: Tips for communicating clearly
• Health Translations directory, which provides links to reliable translated health resources produced in Australia
• Eastern Health Cue cards in community languages
• Centers for Disease Control and Prevention Health literacy website.

Examples of evidence

Select only examples currently in use:

• Policy documents about communication, including the use of plain language, and addressing the cultural and linguistic diversity of the community that the health service organisation serves
• Demographic profile or demographic survey for the health service organisation that identifies the diversity of the community it serves
• Results of a needs assessment project that identifies local health needs
• Demographic data from external sources that are used for strategic and communication planning to identify the cultural diversity and needs of patients and carers
• Training documents about cultural awareness and diversity
• Consumer and carer information packages or resources that are culturally appropriate, and are available in different languages and accessible formats
• Feedback from consumers from culturally or linguistically diverse backgrounds during the development or review of information packages or resources
• Committee and meeting records that show that the health service organisation is represented at local network meetings that reflect the local diversity of the patient population
• Reports on interpreter use and access
• Feedback from patients and carers about whether communication processes meet their needs
• Observation that clinicians have access to communication resources that provide contact details for support services such as local consumer health advocates, interpreters, or cultural support and liaison services.

Patient and community data are essential to understanding consumer communication needs, and developing or improving communication mechanisms to meet these needs.¹

MPSs or small hospitals that are part of a local health network or private hospital group should adopt or adapt and use the established framework for meeting the communication needs of a diverse consumer and community population.

Small hospitals that are not part of a local health network or private hospital group should develop mechanisms for determining the diversity of the consumers who use the services and the local community by²:

• Administering surveys to help identify diversity among consumers
• Using demographic data from the Australian Bureau of Statistics, or local, or state and territory government sources to understand the background of the organisation’s consumers
• Networking with other organisations or individuals in the community – such as culturally and linguistically diverse community groups; community participation managers; Primary Health Networks; Local Hospital Networks; local, state and territory government organisations; and professional associations – to share knowledge about communication preferences and needs.

Determine whether the organisation’s current communication mechanisms meet the needs of diverse patient populations by reviewing:

• Consumer information developed by the organisation, such as patient brochures, posters and consent forms
• The availability of interpreting services, and methods of access to these services for patients and members of the workforce
• The cultural competence and confidence of the workforce in communicating with diverse patient populations.

One Size Does Not Fit All: Meeting the healthcare needs of diverse populations can be used to help evaluate the current services provided for diverse patient populations.

If the organisation currently uses communication mechanisms that are tailored to the needs of its diverse consumer and local community populations, review them to determine whether any additions or improvements can be made.