Fifty-seven people were contacted to participate, of which 46 interviews were undertaken with key stakeholders and informants across Australia. The characteristics of the interviews are described in Appendix 1 using the CORE-Q reporting format (17).
1. The digital divide and how to really connect with people
Prior to COVID-19, outreach activities were largely done face to face via case workers visiting clients, walk-in appointments/consultations, or via group meetings (i.e. with seniors or new mums). Social participation was encouraged: “language-specific social support groups to citizenship classes, sewing classes, just social classes as well, and lot of information sharing, parenting classes. We had that kiddies' playgroups and mothers' groups” (Interview 1). Following the emergence of localised COVID-19 outbreaks in Australia, participants spoke of the “frantic” need to transfer to virtual or telephone mode to continue the delivery of routine services, and the introduction of meetings via teleconferencing platforms, to support engagement opportunities to replace those face-to-face meetings that needed to be suspended. The purpose of the virtual engagement approaches was to ensure that community members received relevant COVID-19 information including social distancing measures, lockdown requirements, testing recommendations and the COVID-19 vaccination program.
Not having access to a computer or the internet, having low digital literacy or English literacy levels and language barriers were all raised as barriers affecting the community. It was not just the community members themselves that lacked the hardware (computers or modems) or internet access to switch online but also staff members from some community organisations. In these situations, many were heavily reliant on their mobile phones. To support those without the hardware, donated laptops and Wi-Fi dongles were used to ensure case workers and community members could continue to connect. Video conferencing sessions were given to help those in the community who were unsure about how to use Zoom, FaceTime, Viber, WhatsApp or other chat and conference platforms (“They had taught them how to use some kind of video conferencing so that then they could actually have their meetings”). Whereas in other settings, telephone contact continued with clients (i.e., those requiring settlement services) and community members: “for a lot of the older community, it's very one-on-one. We implemented the phone checking service where we were identifying the most vulnerable and providing them support and information” (Interview 12). In one situation, a community organisation started up a Saturday night free call teleconference service to connect women “who can't read or write in Somali, but really want to know stuff about COVID.” (Interview 21)
Preference for smartphone-based platforms such as Viber, Facebook Messenger and WhatsApp were reported by participants in comparison to computer-based platforms such as Zoom. Some organisations started to connect with communities via WhatsApp, however they reflected that it took time to set up the connections and the messages were very static.
2. Information voids being filled by international material
It was acknowledged that while Australian mainstream media was a good source of disseminating information at large, participants raised concerns that mainstream media may not reach CaLD communities. Participants spoke about “voids or gaps” occurring during the pandemic in terms of the availability of COVID-19 related news and government information. These gaps were linked to the delays in getting official information translated, or translated materials not being available in all languages. In almost all interviews, participants spoke about the reliance on overseas news programs or the fact that some community’s preference international media that they stream from their country of origin. Concerns were raised that the information coming from overseas did not reflect the situation in Australia nor the rules/recommendations around COVID-19 pandemic control measures. This issue may have led to some communities misunderstanding their risk of COVID-19. For example, early in the pandemic, there were few COVID-19 cases in Africa and so some African people thought they may be protected from the virus just through their ethnicity. Confusion amongst community members regarding the COVID-19 vaccines including about which vaccines are recommended or licensed for use was also linked to CaLD community members watching news channels from abroad.
“I had a conversation with my auntie one day, she watches Greek streaming…, and she was telling me something. I said, "No, that's not exactly the case because here, they're giving us different information." She goes, "Yes, but in essence, it's the same." She was comfortable receiving the information that was coming from Greece without having any clue what Gladys (Premier of NSW at the time) was saying, for example, every morning when she was coming out on TV. (Interview 11)
“The other thing was the absolute confusion, people are really confused about COVID, and that really comes-- It's complicated to understand full stop, but if you consider that most of obviously, everyone in all our communities come from somewhere else, and most of those places in the world have had a very different experience of COVID. I don't think that in New South Wales, we were fast enough to provide the messaging to community, and so we allowed that void to be filled” (Interview 33)
Compounding this issue was that some COVID-19 resources, as they included “technical jargon”, which may have been confusing for people with low literacy or health literacy levels, even if English was their first language. Government materials were not available across all languages nor were they always available in simplified English that was “accessible” to communities.
“There are some communities that are missing the information. If we take example of the South Sudanese community, there's one particularly in Dinka. Dinka is one of the tribes among 64 other tribes. It means you provide information to one tribe, there's 63 missing. That's what I mean by saying, yes, there's some information there, but it doesn't capture everybody. (Interview 1).
In some settings, participants spoke about interpreting the information to “make it real”. For some communities, information was not available in their local language: “we can see the Department of Health Information flashed in Arabic and Chinese, but no African languages were available”. (Interview 21). In these situations, it was stressed that community language radio and online information sessions (“Townhalls”) delivered in-language were critical. Lastly, there were mixed feelings towards the role that Australia’s multicultural and multilingual broadcaster (SBS) played in disseminating information. Some participants described it as being brilliant, others were more reserved in their comments and felt that it failed to capture what was really needed.
“My mother or my auntie, there's no connection to SBS as it used to be years ago. Why would they even go in and watch the Greek news if they can watch the news directly from Greece? Why would I wait for the last night's news if I can watch them live?” (Interview 11)
“Stop wasting money on things like ethnic press and TV. Sure, they do a good job and they're important to a degree, but there is always going to be a gap that you're not going to be able to plug unless you actually get the community to take ownership, and let them do the communication themselves to the people that they're close to”. (Interview 40)
One suggestion that was put forward was to have community leaders talking in-language during the news programs on mainstream media channels or for messages to pop-up. However, others felt this was still missing the mark.
3. Differentiating established, with new and emerging communities needs
There was not a consistent picture when it came to identifying which community groups should have support/resources directed to. Some participants suggested that newly emerging communities (migrant/refugee) would be most at risk from missing out on messages and support services. One key factor contributing to this was the focus on providing translated COVID-19 information to “high volume” community groups versus “high need” groups. Another issue identified was that established communities have ‘infrastructure’ in the form of community organisations, community leaders, in-language newspapers, or radio stations etc. Whereas “it’s the newly arrived communities that have very little infrastructure who are the most vulnerable, I think. Particularly in small communities like the Rohingya, who have only had a written language since the '80s, and hardly anybody can read those”. (Interview 16). However, not all participants agreed with this sentiment.
Participants also highlighted that Governments did not consider those individuals who come from cultural groups with oral traditions or who are illiterate in their own language: “One of the first outbreaks I think in our region was in the meat works, and most of the employees at the meat works work from Karen and Burmese heritage. A lot of people in those communities don't read or write in their own language as well, and so thanks to the local community leaders, we set up a testing site and most people heard of it from word of mouth. That's how, but we do have Karen information that is written, but we also had some videos made”. Having verbal messages was identified as being critical. In some suburbs, organisations resorted to door-knocking to encourage people to go and get tested.
The ability to navigate websites was also emphasised as an issue for some community members. Especially in the beginning of the pandemic, it was not easy to locate relevant information on the government’s websites. While participants acknowledged that there were improvements, challenges remained for those community members who did not read in English. Even if online information was translated, there was often the requirement to browse the website in English to find the relevant language: “The really common accessibility issues were languages were ordered. You had to browse in English alphabetical order. Look, most people do know the name of their language in English, but you also need to know the other language”. Participants noted that not all the COVID-19 resources available online were translated into every language.
4. Speaking COVID-19
Issues around low levels of understanding about COVID-19 (about transmission, testing requirements, vaccination program etc.) and increasing amounts of misinformation triggered some organisations to offer online community forums. These forums were provided for interpreters, case workers, community leaders and often featured bilingual GPs and government officials to provide updated COVID-19 information and to answer any questions. In some settings, these sessions were being held weekly or fortnightly.
“We've had GPs, we even had an orthopaedic surgeon present weekly COVID updates to audiences, getting the accurate advice, wash your hands, keep your distance, do all that, but also talk about the specifics in the community.” (Interview 18)
Other forums were set up to provide updates to local community leaders so they could pass on relevant information to their communities: “We established what we called the Greater Western Sydney Community Leaders Forum. What we did is we invited community leaders from across Western Sydney. We were having Zoom meetings, initially weekly ones, and we started bringing in the police, for example, to talk about the fines and what was legal or not, health practitioners to talk about the virus. Then we brought in some tax agents to talk about work, the job seeker and job keeper sort of stuff.” (Interview 11)
Whilst resource kits were available from the government to support outreach efforts, criticisms were raised that the kits were just information. What was lacking during the early part of the pandemic were training sessions to support the adoption of the resource kit. As one participant indicated there was a need to provide examples of what other organisations or community groups were doing. Lastly, participants also identified that there was a need to provide training forums for case and settlement workers, as well as translators/interpreters to support their understanding about COVID-19: “We ran workshops called Speaking COVID, basically. We've focused on engaging with the interpreters in workshops…. We did those bi-language group and we had some content that we talked about what does airborne transmission mean and what's a droplet, and what does isolation mean, and what does quarantine mean, and all of the terms that became really common in that period and explained those in ways that the interpreters could understand so that they could, in turn, interpret them appropriately for the clients.” (Interview 16)
5. Ineffectiveness of direct translations of English language resources
Understanding and acknowledging the different cultural beliefs about illness and about COVID-19 was critical to the development of resources. However, in many settings participants spoke about the fact that COVID-19 education resources were often developed in English and then translated. Potentially as an outcome, participants spoke about mistrust and misunderstanding amongst community members, linked to the fact that resources were not tailored to their beliefs or practices: One story that someone told me is true stories of elderly woman in a smaller community who contracted the virus. In that culture, when someone's sick…you go and visit them”. (Interview 18). The problem is that the education resources did not account for these practices. Other participants spoke about the words/phrases that were in translated materials which were nonsensical or gave the wrong message: “when we hear the media or the government saying, ‘We've produced the written material, you really have to be careful on what you're saying because no one's vetted the accuracy of that material. That's where I'm suggesting that it seems on the surface that the right thing's been done, but when you have a look at the content, it's highly questionable” (Interview 13). As a solution, it was suggested that education resources needed to be developed from scratch with the targeted communities, which are not only language specific, but which also account for the nuances within the community. The videos should include local faces and phrases that are ‘known in the community”.
“In other words, you end up with 20 slightly different documents. They're not all the same, but that's okay, as long as the fundamental information is the same, the way it's presented is slightly different”. (Interview 17).
Beyond having resources developed in collaboration with the target community, there is still a need to have bicultural workers available to help with supporting community members understanding of the information. For example, it was recommended that people avoid ‘share-plates’. However, for many Arabic-speaking and African communities it is common practice to sit and eat communally, with everyone taking food from a main platter. Therefore, bicultural workers were critically to helping breakdown the messages and to reassure the community that they could still have dinner with their direct family members. These workers do not necessarily have a health background, but they are able to speak the language, read and write in English, and their language. They are seen as having some influence and visibility within their community. In some settings training was provided to the bilingual workers so that they could become the ‘face’ of the COVID-19 communication strategy, working in partnership with the health officials.
“We paid our bilingual educators to make calls to people, the networks they had, we give them targets and we say, "Try and call at least 10 women that you can." (Interview 43)
They also enabled two-way feedback and the capacity to hear from the community members regarding any ongoing issues or factors impacting public health strategies such as testing. While participants spoke of the value of these workers, in reality not all geographic areas had these workers available.
"We hired eight bilingual workers in various language groups so that they can actually speak to callers to a particular language-specific phone number to ask guidance on COVID-related matters. Not to be a substitute for the COVID line, but to be able to actually call a number and speak to someone in your language,”. (Interview 13)
6. Coordination is needed to avoid duplication and address gaps
The issue of duplication was raised in terms of the development of resources and videos for different community groups: “What you ended up having was this website with collections of stuff in different languages often saying the same thing, but slightly different. It was a disaster” (Interview 33). Participants spoke about confusion occurring amongst their community members when there was differing regulations in place across the different states/territories. They also cited confusion when organisations didn’t “sing from the same songbook” or when messages were not consistent: “the service providers might send them something, Department of Health sends them something, and then their workplace sends something else, so it creates a lot of misunderstanding, but it creates a lot of confusion for the young people” (Interview 4).
To reduce these issues, one participant suggested that it would be great to have a “one-stop-shop where GPs and community members also could access accurate health information according to language that they could easily search up and share with other members of the community”. In putting for this suggestion, they acknowledge that a huge amount of work was being done to develop resources but that they were not always being stored in an easily accessible format. Being able to identify the different needs of communities, as well as the funding available/needed promoted one state to introduce a community connector advisor, who was tasked with getting organisations to talk to each other. The need for coordination at a state level was also endorsed by other participants who felt that coordination of efforts could not be done at the district level: “Coordination is really key… It's really important to have functioning networks with good information-sharing and healthy relationships to avoid that”. (Interview 14)
However, duplication was not always framed as having a negative impact on pandemic efforts as in some instances having multiple videos outlining the public health requirements or promoting the COVID-19 vaccine, may be useful as each community organisations will ‘add their own jargon” and will have a close relationship with the community they serve (especially important in places with strong regionalism). As one participant stated: “In Queensland, we have quite strong regionalism and people in the region are sometimes sick of being told what to do by Brisbane all the time. The decisions are from Brisbane in an urban area and they don't always understand what's going on out there”. It was acknowledged that if bottom-up approaches like this are going to be done, it is critical that health experts are involved also to ensure the messages are accurate.
7. Recognising the improvements in governments’ approach
Participants raised concerns that early in the pandemic the Australian and state governments did not seem to have plans for multicultural communities. Issues were raised with governments but that there wasn’t the sense that organisations were ‘heard’. Participants acknowledged that the government was only “15 minutes ahead of us in terms of the decisions and in terms of the roll-out, in terms of policy. A lot was happening, and it was very quick. They just didn't take their time, and maybe they didn't have that time. (Interview 12). At a regional level, local government organisations took it upon themselves to undertake rapid consultations with community members in order to understand their perceptions of the pandemic, as well as their concerns. Using this information, they were able to influence the local district response including the visual and digital resources.
“The advantage of this was because the community came on board in terms of what should go in, how should it be said, we were able to address the immediate fears and concerns of communities. We were able to have their people as the front face, so we could get the messages across. (Interview 43).
Two events were signalled as the triggers for the governments revising their approaches. The first event spoken about was the hard lockdown that occurred in nine public housing towers in inner-Melbourne, where there were significant delays in preparing and distributing materials about the lockdown in community languages and an absence of interpreters. The second event was the issue regarding the translation of COVID-19 materials and the mix up in languages including one document which had Farsi and Arabic mixed together. As one participant indicated, at that point: “the Department of Health said, "Well, okay, let's get this done properly and listen." Following those events, COVID-19 advisory groups were set up focused on multicultural communities which brought together academics, practitioners, GPs, and community members.
This sense of a shift in the government’s approach from mid-2020 was a consistent message across all the interviews. As one participant suggested “they very clearly heard the message from communities, which is stopped doing it to us and start doing it with us”. Representatives from different community organisations spoke about meeting with federal ministers/policy advisors via Zoom meetings. While there appeared to be improvements, issues were still raised regarding the responsiveness of the different government teams including the policy versus communication teams.
My criticism of the Department is that the policy side or the policy team is switched on, and they're with it, they're listening to the advice that we're giving them. We're on the same page. Whereas the communication team, we keep saying the same thing over and over and over again. In the meetings they say, "Yes, that's a good idea and we'll go away", and we just keep seeing the same mistakes come up. We just see things as basic as make sure that English material is in plain simplified English before it goes to the translators. I think I've said that about 12 times.(Interview 40)
In the initial phase, funding was made available however it was directed towards peak bodies as opposed to going directly to the community. It was on the peak bodies to organise the distribution of funds via multicultural COVID-19 community grants, which local organisations could apply for to support local activities. For example: “one community ended up getting some funding,… the women were very keen to watch the news and find out what happened, but the news is all in English. They had someone who was taking the announcements… three or four days' worth and putting it into one chunk of text and having that translated and then shooting that out via WhatsApp or WeChat or something, one of those platforms, to all of the members of the community group. (Interview 16). Lastly, criticisms were made of the funding that was directed towards consultants and creative agencies, as opposed to giving the money to the community to produce local tailored content: “just give the money to the communities. They know the communities best, they know what the issues are. It's targeted, they're very local.” (Interview 40)