'Without support CALD patients will be left behind': A mixed-methods exploration of culturally and linguistically diverse (CALD) client perspectives of telehealth and those of their healthcare providers

Strategies to improve telehealth access for culturally and linguistically diverse communities: a systematic review

AIMS

CaLD populations face considerable digital health inequities; strategies are needed to ensure telehealth models of care are available to all. We aimed to identify and describe interventions that enhance telehealth access for CaLD communities.

METHODS

We systematically searched four databases (PubMed, Scopus, Embase, and CINAHL). Included studies were published between 2011 and 2024 and reported on at least one of the outcomes described in the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework. Two authors independently screened articles, solutions were synthesized qualitatively.

RESULTS

Twenty-seven articles were included in the review and primarily used videoconferencing as the predominant telehealth modality (n = 14, 52%). Five strategies were identified to promote telehealth use across CaLD communities including: (i) Provide bilingual options; (ii) Enhance staff cultural competence; (iii) Provide flexible adaptions to align with consumer needs; (iv) Supply technology and technological support; and (v) Involve digital health navigators and/or health educators.

CONCLUSIONS

Culturally competent professionals supported by language services and technological support are strategies which can help improve equity of access to telehealth services for people from CaLD communities. Such strategies can support the implementation of practical solutions to overcome health inequities and prevent access gaps.

Family member and service provider experiences and perspectives of a digital surveillance and service navigation approach in multicultural context: a qualitative study in identifying the barriers and enablers to Watch Me Grow-Electronic (WMG-E) program with a culturally diverse community

BACKGROUND

Children and families from priority populations experienced significant psychosocial and mental health issues to the COVID-19 pandemic. Yet they also faced significant barriers to service access, particularly families from culturally and linguistically diverse (CALD) backgrounds. With most child and family health nurse clinics ceasing in-person consultations due to the pandemic, many children missed out on health and developmental checks. The aim of this study was to investigate the perspectives and experiences of family members and service providers from an urban, CALD community regarding the implementation of a digital, developmental surveillance, Watch Me Grow-Electronic (WMG-E) program.

METHODS

Semi-structured interviews were conducted with 17 family members, service navigators, and service providers in a multicultural community in South Western Sydney, Australia. This qualitative study is an implementation evaluation which formed as part of a larger, two-site, randomised controlled trial of the WMG-E program. A reflexive thematic analysis approach, using inductive coding, was adopted to analyse the data.

RESULTS

Participants highlighted the comprehensive and personalised support offered by existing child and family health services. The WMG-E was deemed beneficial because the weblink was easy and quick to use and it enabled access to a service navigator who support family access to relevant services. However, the WMG-E was problematic because of technology or language barriers, and it did not facilitate immediate clinician involvement when families completed the weblink.

CONCLUSIONS

Families and service providers in this qualitative study found that using WMG-E empowered parents and caregivers to access developmental screening and learn more about their child's development and engage with relevant services. This beds down a new and innovative solution to the current service delivery gap and create mechanisms that can engage families currently not accessing services, and increases knowledge around navigating the health and social care services. Notwithstanding the issues that were raised by families and service providers, which include accessibility challenges for CALD communities, absence of clinical oversight during screening, and narrow scope of engagement with available services being offered, it is worth noting that improvements regarding these implementation factors must be considered and addressed in order to have longevity and sustainability of the program.

TRIAL REGISTRATION

The study is part of a large randomised controlled trial (Protocol No. 1.0, Version 3.1) was registered with ANZCTR (registration number: ACTRN12621000766819) on July 21st, 2021 and reporting of the trial results will be according to recommendations in the CONSORT Statement.

Access, Readiness and Willingness to Engage in Allied Health Telerehabilitation Services for Adults: Does Cultural and Linguistic Diversity Make a Difference?

Telerehabilitation is an appealing service delivery option for optimising recovery. Internationally, the equity of telerehabilitation services for people from culturally and linguistically diverse (CALD) backgrounds has been questioned. Using a 31-item survey, our study explored the access, readiness and willingness of 260 patients receiving allied health services from a large tertiary health service located in Sydney, Australia, to use telerehabilitation for adults. Overall, 72% patients reported having access to technology, 38% met our readiness criteria and 53% reported willingness to engage in telerehabilitation. There were no differences in access, readiness and willingness to engage in telerehabilitation between patients from CALD and non-CALD backgrounds. Age was the only factor that influenced access (OR = 0.94, 95% CI 0.90 to 0.97), readiness (OR = 0.95, 95% CI 0.92 to 0.98) and willingness (OR = 0.97, 95% CI 0.95 to 1.00) to engage in telerehabilitation. Past experience of telerehabilitation was related to willingness (OR = 2.73, 95% CI 1.55-4.79) but not access (OR = 1.79, 95% CI 0.87 to 3.68) or readiness (OR = 1.90, 95% CI 0.93 to 3.87). Our findings highlight the importance of ensuring positive patient experiences to promote ongoing willingness to use telerehabilitation. Efforts are needed to improve patients' digital health literacy, especially patients from older age groups, to ensure equitable engagement in telerehabilitation services.

Management of pain in cancer patients- lessons from practices during the COVID-19: a qualitative study of cancer care providers' perspectives

BACKGROUND

The ongoing COVID-19 pandemic has impacted health systems globally and affected managing many chronic conditions, including cancer. This study aimed to explore the perceptions of multi-disciplinary cancer care providers on how cancer pain management was affected by the COVID-19 pandemic.

METHODS

Participants were eligible if they were cancer care providers of any specialty and discipline from two tertiary hospitals in Australia. Data were collected using semi-structured interviews to explore cancer care providers' perspectives on cancer pain management within COVID-19. Thematic analysis of interview transcripts used an integrated approach that started with inductive coding before coding deductively against a behaviour framework called the COM-B Model, which proposes that 'capability', 'motivation' and 'opportunity' are requisites for any behaviour.

RESULTS

Twenty-three providers participated. Five themes were developed and interpreted from the analysis of data, namely: "Telehealth enables remote access to cancer pain management but also created a digital divide", "Access to cancer pain management in the community is compromised due to the pandemic", "COVID-19 negatively impacts hospital resource allocation", "Patients were required to trade off cancer pain management against other health priorities" and "Hospital restrictions result in decreased social and psychological support for patients with cancer pain".

CONCLUSIONS

The landscape of cancer pain management in the Australian health system underwent substantial shifts during the COVID-19 pandemic, with lasting impacts. Cancer care providers perceived the pandemic to have significant adverse effects on pain management across multiple levels, with repercussions for patients experiencing cancer-related pain. A more adaptive health system model needs to be established in the future to accommodate vulnerable cancer patients.

A cross-sectional study exploring equity of access to telehealth in culturally and linguistically diverse communities in a major health service

Objectives The utilisation of telehealth among culturally and linguistically diverse communities in Australia remains unexplored. We aimed to describe telehealth (telephone and videoconference) utilisation within a major health service and identify sociodemographic factors that may contribute to limited telehealth access. Methods A cross-sectional study was performed using service activity data from four metropolitan hospitals in Queensland, Australia. Outpatient department data (January to December 2021) were examined. These data included patients (N  = 153 427) of all ages who had an outpatient appointment within 10 speciality services (i.e. Hepatology, Gastroenterology, Immunology and Psychology) that were the most frequent videoconference users. This study measured telehealth utilisation across the four tertiary hospitals and its association with sociodemographic factors. Descriptive statistics and regression analysis were used. Multivariate regression models were adjusted by sex, socioeconomic level and language use. Results Overall, 39% of appointments were delivered through telehealth, with 65% of all reported telehealth services involving a telephone consultation. People who required interpreter services were 66% less likely to use telehealth services (OR adjusted 0.33, 95% CI 0.31-0.36, P  P  Conclusion There is a gap in Australian telehealth service use for people with culturally diverse backgrounds and limited English proficiency. This study highlights a critical need to determine how people from culturally diverse backgrounds would like to engage with digital care options such as telehealth and the necessary support to enable this.

Does the requirement for an interpreter impact experience with telehealth modalities, acceptability and trust in telehealth? Results from a national survey including people requiring interpreter services

We aimed to assess if experience with telehealth modalities, acceptability and levels of trust in telehealth vary with the need for an interpreter using a cross-sectional survey of telehealth consumers in Australia. Non-parametric tests were used to compare the means and percentages between those who required an interpreter and those who did not. A total of N = 1,116 completed the survey; 5% (n = 56) represented people needing an interpreter for telehealth services. Of those needing interpreters, 14.29% had experienced only phone consultations whereas 63.21% of those who did not need interpreters had experienced only phone consultations. Trust in telehealth with allied health professionals was significantly higher among people needing interpreters (mean 4.12 ± 1.02) than those with no interpreter required (mean 3.70 ± 1.30), p = 0.03. People requiring interpreters had non-significantly higher acceptability towards video consultation than those who did not (mean 3.60 ± 0.61 vs mean 3.51 ± 0.80, p = 0.42), similar to telephone consultations (mean 3.71 ± 0.95 vs mean 3.48 ± 0.79, p = 0.38). The need for interpreters does not appear to impact acceptability or trust in telehealth with doctors. However, experience with telehealth modalities and trust in telehealth with allied health varied significantly among groups. Increasing exposure to telehealth modalities, trust and acceptability is crucial to promote equitable access to telehealth.