PEOPLE FROM CULTURALLY AND LINGUISTICALLY DIVERSE BACKGROUNDS

Over 50% of people living with chronic hepatitis B in Australia are people from priority CALD communities (see People from priority culturally and linguistically diverse communities).²⁵ Clinicians need to be equipped to provide culturally sensitive and competent services, to improve health outcomes for this priority population.⁴⁸

‘Culturally and linguistically diverse’ is an umbrella term designed to include migrants, temporary residents, international students, refugees, and asylum seekers, as well as their descendants. It draws attention to cultural factors that can influence patterns of health access and outcomes even in people who were born in Australia and speak English proficiently. Understanding a person’s health belief systems and level of health literacy can support the clinician to tailor each episode of care specifically to improve the health outcomes of their patients.

Clinicians should routinely ask patients to identify their country of birth, parents’ countries of birth, languages spoken at home and any family history of liver disease. Answers to these questions can establish the relevance of an offer of testing particularly for patients born in countries of high (≥ 8%) and intermediate (2-7%) prevalence rates for HBV (see Figure 1, Priority populations for HBV testing).¹⁹

Clinicians should stress that many people from priority CALD backgrounds were not vaccinated at birth and therefore perinatal and early childhood exposure are the primary routes of transmission for these people.

Clinicians should advise that interpreters are available and are free of charge.

Clinicians should reassure the person that all people involved, including interpreters and clinicians, will keep confidentiality.

Clinicians should brief any face-to-face or telephone interpreter about maintaining confidentiality regarding everything they learn from the consultation and ensure the interpreters understand the language and concepts to be conveyed. Professional interpreters are bound by a professional code of conduct to respect confidentiality. Where patients are concerned about confidentiality (e.g. in smaller communities), telephone interpreters may be used, and the clinician may refer to the patient using a pseudonym to disguise their identity.

Clinicians should use simple language to explain privacy and when exceptions to privacy may apply.

Clinicians should encourage patients to bring and involve family members in testing, vaccination, monitoring and care as many view health issues as a collective issue. However the use of family members as interpreters is strongly discouraged. Clinicians should also be aware that in certain cultures hepatitis B is highly stigmatised and working with patients in a culturally competent and culturally safe way is crucial for improving the long-term health of individual patients, families and communities.

Opportunistic testing

Opportunistic testing depends on clinicians proactively offering HBV testing to CALD patients. Patients may see clinicians at multiple practices or different clinicians within the same practice. Clinicians should use patient records to document both the offers and the outcomes of HBV testing in order to avoid repeated offers of testing that may result in unnecessary duplication of testing or vaccination. Medical records should include reasons for any refusal of testing. Information about the need for an interpreter, what language is spoken, and the preferred mode of interpreting (face-to-face or telephone) should also be recorded.

Clinicians should be sensitive to any cultural barriers when a person refuses a blood test and should offer the option of involving a multicultural health service which are available in most states.

Family testing

Contact tracing, screening and provision of vaccinationfor household contacts¹¹ should be guided by reference to cultural understandings of the family in the patient’s own community (such as reconfigured refugee families), as these are what determine the level of risk (for example, frequency of occasions where horizontal transmission may occur).

Cultural competence in healthcare describes the ability of systems to provide care to patients with diverse values, beliefs and behaviours, including tailoring delivery to meet the patient’s social, cultural and linguistic needs.⁴⁹

All cultural and ethnic groups have concepts related to health and illness, whether they are cultural or individual beliefs, that influence their health behaviour. These should be considered when communicating with a patient.

Clinicians and practice staff should be equipped with knowledge, skills and tools to work with people from CALD backgrounds to achieve better health outcomes.