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Guidelines for working with Indigenous/CALD populations during the COVID-19 pandemic

People of culturally and linguistically diverse (CALD) and Indigenous backgrounds often experience challenges in healthcare. This article, which is based on the CFI-SPIKES modified protocol 1, aims to provide practical guidelines for health professionals working with Indigenous and CALD people during the COVID-19 pandemic.

1. Setting up the interview

Ensure the room is arranged to provide privacy and prevent interruptions. Telephone interpreters should be used when a person’s language spoken at home is not English and they are not proficient in English. The Translating and Interpreting Service (TIS National: ph 1800 131 450) is an interpreting service provided by the Department of Home Affairs for people who do not speak English and for agencies that need to communicate with their non-English speaking clients.

2. Get to know the consumer

Many Indigenous and CALD populations operate from a high context culture 2 where direct communication of illness is not welcomed and where talking about the context and impact of the illness is more important. It is recommended that the health professional establish a respectful and trusting interpersonal relationship to ensure the person is open to the communication of health information. The health professional can facilitate this by taking some time to get to know a little about the person before communicating information about COVID-19 such as whether or not the person has a diagnosis of COVID-19 and information about quarantine or isolation.

3. Understand what the consumer understands

Build a respectful and trusting relationship by acknowledging the individual as their own cultural expert. The health professional can facilitate this by suspending their own beliefs about illness and by exploring the person’s understanding of COVID-19 and related issues. The DSM-V Cultural Formulation Interview (CFI) 3 provides a helpful framework by asking:

4. Does the person want to know (about whether they have COVID-19)?

Some people may not want to know whether or not they have COVID-19. Hence, it is recommended that health professionals respectfully ask whether the person wants to know if they have the diagnosis of COVID-19? In instances where the person says NO, then information should be provided to the person about the possible risks of COVID-19 to their Indigenous or CALD communities. This can extend to a discussion about techniques such as social distancing, quarantine, and isolation.

5. Providing accessible knowledge

It is important to use non-technical language that is easy to understand when communicating information about COVID-19 and associated quarantine or isolation measures. Medical terms and abbreviations should be avoided. Discussion about the symptoms and quarantine or isolation measures associated with COVID-19 can be supported by interpreters and/or by direction to translated COVID-19 online resources (e.g. from the Department of Health).

6. Addressing emotional reactions and referral to culturally appropriate health services

People from Indigenous or CALD communities may experience shame and guilt in response to a COVID-19 diagnosis. For example, shame may be associated with beliefs that they are being punished by God for wrongdoings, or that their actions or those of another are responsible for the imbalance in the harmony and oneness of the community. Health professionals can support the person by listening to their concerns, normalizing and empathizing, and providing referral to culturally appropriate or Indigenous health services.

7. Provide a summary

Provide a summary of relevant information about symptoms, relevant diagnosis, quarantine or isolation measures and treatment to person. Then check how well they have understood this information. In this step, you could consider the following:

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References

  1. Kayrouz R, Senediak CI, Laube R. Building a bridge: A case report on communicating mental-health diagnoses to patients of a culturally and linguistically diverse background. Australasian Psychiatry. 2017;25(5):478-480.
  2. Hall ET. Beyond Culture. New York: Anchor Books; 1976.
  3. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: Author; 2013.
  4. Hawley ST, Morris AM. Cultural challenges to engaging patients in shared decision making. Patient Educ Couns. 2017;100(1):18-24.
  5. Hibbard JH. Patient activation and the use of information to support informed health decisions. Patient Educ Couns. 2017;100(1):5-7.
  6. Street Jr RL, Volk RJ, Lowenstein L, Michael Fordis Jr C. Engaging patients in the uptake, understanding, and use of evidence: Addressing barriers and facilitators of successful engagement. Patient Educ Couns.100(1):4.
  7. Deen D, Lu W-H, Rothstein D, Santana L, Gold MR. Asking questions: The effect of a brief intervention in community health centers on patient activation. Patient Educ Couns. 2011;84(2):257-60.