Addressing vaccine hesitancy in CALD communities

Anastasia Tsirtsakis

26/02/2021 4:14:27 PM

From cultural and religious beliefs to mistrusting government – how can GPs best address any concerns during the vaccine rollout?

A GP speaking with a patient.
Australians who speak a language other than English at home are among those who have become less willing to receive a COVID vaccination.

Australia’s vaccine roadmap appears to be on track, but a longitudinal survey indicates vaccine hesitancy may be a greater cause for concern than previously thought.
More than one in five (21.7%) Australians say they will ‘probably’ or ‘definitely’ not get a COVID vaccine – up from 12.7% in August. Meanwhile, more than three in 10 (31.9%) have become less willing, with those who speak a language other than English at home among cohorts with the most reluctance.
‘There is a real need to consider a significantly enhanced public health campaign in languages other than English,’ Professor Nicholas Biddle, study co-author, said.
Dr Rebecca Farley, Chair of the RACGP Specific Interests Refugee Health network, knows this firsthand.
Along with safety and efficacy concerns, cultural and religious beliefs have also worked their way into consultations, leading to questions such as ‘is the vaccine halal?’
‘The list of questions [I’ve received] is long and diverse,’ Dr Farley told newsGP.
‘I work with people from such diverse backgrounds and each individual has their own concerns. There’s no one size fits all answer.’
The Queensland GP has worked with culturally and linguistically diverse (CALD) communities for more than a decade and says what is very clear is that GPs are a trusted and reliable source of information.
This was further affirmed during a recent webinar facilitated by the Refugee Health Network Queensland in collaboration with Queensland Health and other partners for more than 130 multicultural community leaders. 
‘The feedback from that forum was that the majority of participants wanted to get their vaccine from their GP and saw their GP as an information source of information about the vaccine,’ Dr Farley said.
‘Many people who aren't yet eligible for the vaccine are already speaking to their GPs to get advice and are beginning to explore their concerns.’
However, what emerged during the pandemic is that many people from CALD backgrounds get much of their information from their own communities.
That has certainly been Dr John Hodgson’s experience.
He runs a respiratory clinic in Melbourne’s northern suburbs and says there can be a lot of mistrust around authority.
‘The methods they use to effect change are different to mine. Their sources of information are generally from people they know personally and trust,’ Dr Hodgson told newsGP.  
‘They frequently do not trust politicians, governments, and people in authority.’
Many of the community members Dr Farley works with also indicated that community leaders were an important source of information about the vaccine. She says this highlights the need for engagement between state governments and CALD communities, as well as Primary Health Networks (PHNs) and GPs, to ensure a ‘culturally responsive’ approach.  
‘It is really important that the insights and understanding gained from consulting and working colllaboratively with different communities filters back to GPs. What are the concerns? What are the myths? What’s going on?’ she said.
‘We’re often very busy with individual patients in general practice and sometimes all of that information from the broader community doesn’t necessarily filter back to us, and it really could inform the work that we do and the conversations that we have.’
So how can GPs approach this?
Dr Farley says empathy, time, and access to an interpreting service, if required, are key.
‘Really being able to take the time to hear your patients’ concerns and making sure that you’ve got an interpreter is important,’ she said.
‘I try to explicitly give patients opportunities to explore their concerns [and] ask them if there are any questions that they’ve heard from family and friends overseas; 'What are some of the issues or worries being discussed in your community? Do you think maybe we could talk about some of those concerns?'.
‘Giving patients that opportunity to raise those questions [is] what we are really so uniquely positioned to do in general practice, and we should be making the most of that opportunity.’
Dr Hodgson says it is important to also remember that not everyone learns through the spoken or written word.
‘My CALD patients may not be educated, may not read or write very well, [but] with support through discussion they are often able to change,’ he said.
‘They learn in alternate ways and solve problems in different ways – a lot are visual learners.
‘As GPs we know this very well and spend a lot of our time discussing issues with patients to help them follow a management plan. We are aware of, and experienced in, the multiple ways to assist patients in problem solving.’
Throughout the pandemic, the RACGP’s 2020 ‘Expert Advice Matters’ campaign encouraged members to share health messaging with their patients and communities in their language.
The RACGP reached out to these GPs on behalf of the Department of Health (DoH) to also give them the opportunity to be involved in filming short social media videos to support the vaccine rollout in aged care.
In a recent COVID-19 vaccine rollout survey, 138 members who speak 30 languages other than English put their hand up to help communicate the importance of vaccination in their local community through opportunities facilitated by the RACGP.
Dr Farley says it is important for GPs to remember that these concerns are not necessarily unique to CALD communities.
‘Empathy is something that all patients need, particularly at this point in time, and … it’s partly why I do the work that I do,’ she said.
‘It is so rewarding working with patients, often with interpreters and across different cultures, to really understand the things they as individuals are worried about, and as you start to really understand those things,  you find that together you really can begin to address those concerns.
‘It makes the difference between someone not having the vaccine, or potentially having the vaccine and still feeling very anxious and not comfortable with that decision, versus really understanding and making an informed decision to have the vaccine.
‘Ensuring people have that genuine understanding of what’s going on is going to be so important as the vaccine continues to be rolled out.’
Resources for addressing vaccine hesitancy in CALD communities:

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