issues, barriers and perceptions about the covid-19
TRANSCRIPT
Issues barriers and perceptions about
the COVID-19 vaccine among culturally and linguistically diverse
communities in NSW
Issues barriers and perceptions about
the COVID-19 vaccine among culturally and linguistically diverse
communities in NSW
iii ACKNOWLEDGEMENTS
1 EXECUTIVE SUMMARY
5 RECOMMENDATIONS
6 RESEARCH SUMMARY INFOGRAPHIC
8 INTRODUCTION
9 METHODOLOGY
Recruitment for the focus groups 9
A word about the research design 11
Demographicsofresearchparticipants11
14 FINDINGS
Having the vaccine or not 14
Reasons for having the vaccine 17
Reasons for not having the vaccine 18
Vaccine refusal 20
Other factors considered 21
Knowing someone who has been vaccinated 22
Knowing someone who has had COVID-19 23
Knowing where to get vaccinated 24
SourcesofinformationaboutCOVID-19 and the vaccine 25
29 DISCUSSION
35 ATTACHMENTS
ATTACHMENT 1 ADescriptionoftheFocusGroups35
ATTACHMENT 2 COVID-19VaccineInformationinmultiplelanguages 39
CONTENTS
AUTHORS NOTE
ThisreporthasbeenwrittenbyRobinMiles LindyCassidyandAudreyBennettwithinputtothecontentandrecommendationsfrom Dr Camilla Couch and Patricia McCormick
ACKNOWLEDGEMENTS
ThisresearchconductedbySocialEquityWorkshasbeencommissionedbytheNewSouthWalesCouncilofSocialService(NCOSS)andfundedbyNSWMinistryof Health
The research team would like to thank the following services who helped to set up the focus groups The research team is indebted to these ser-viceswhoopenedtheirdoorstotheresearchteaminashorttimeframebetweenMayandJune2021andinparticularcollaboratedonthefacilitationoffocusgroupswiththeircommunitymembersincludingsup-portingtheteamwithspokenandwrittentranslationandbilingualfacilitation
Rosanna BarberofromAddisonRoadCommunityCentreMarrickville
Romana WaseemfromCanterburyCityCommunityCentre(4Cs)Lakemba
Marg CouchSeniorProjectOfficer Regional Development Australia (RDA)-Riverina
Joanne FitzpatrickfromGriffithWomenonFireGrif-fithCommunityCentreGriffith
Randa GoriyafromtheNSWChaldeanLeagueMtDruittTAFECampusMtDruitt
Khalid ZainulabdeenfromRedCrossNSWACTWol-longong
Sivaharani (Harani) Mayuran from STARTTS deliveredatToongabbieCommunityCentreToongabbie
Sree VithyaHarilingam Wilma Garguath and Zaid NaoumfromSydWestMulticultural CommunityServicesMtDruittandBlacktown
Sofia Lema and John Paul Troiani from Illawarra ShoalhavenLocalHealthDistrictWollongongdeliveredattheWarrawongCommunityCentre
Leissa PittsManagerISLHDMulticulturalHealthandRefugee Health Service
Talei VulathaCommunityResilienceProject OfficerMulticulturalCommunitiesCouncilIllawarra
Wewouldespeciallyliketothankthe167peoplewhoparticipatedinourfocusgroupsallofwhomweregenerouswiththeirtimeandpassionateclearandfearlessinthefeedbacktheyprovidedtotheresearch-ers about the COVID-19 vaccine
RESEARCH TEAMProject Lead Robin Miles
Qualitative Research Team Dr Camilla Couch Patricia McCormick LindyCassidy
Expert Multicultural Advisor Paula Abood
Research Assistant AudreyBennett
REPORT DESIGN Cath Appleton Design
i
1
Australiahasbeenverysuccessfulinstemmingthespreadofthevirusthroughacombinationofborderclosuresquarantineafirst-worldhealthsystemandexpertcontacttracing
ItispossiblethatwerethisresearchconductedtodaythishesitancywouldbereducedduetotheheightenedriskofcontractingCOVID-19throughthe more transmissible Delta variant and its pres-enceinthecommunity
Regardlesstheneedforvaccinetake-upamongCALDcommunitiesremainshighgiventheycanbe at increased risk due to factors such as in-securehigh-riskemploymentandlivinginhighdensityhouseholdsandtoensureequitablepublichealthoutcomesandsocialeconomicandcommunityparticipationforeveryone
Thiswasasmallstudyof199people(oursam-ple)drawnfromculturally-diversecommunitiesinmetropolitanSydneyandtworegionalNSWlo-cationsCommunitymemberswereaskedsurveyquestionseitheronlineorthroughfocusgroupsSeparateinformationwasalsocollectedfromintermediaryorganisationsworkingwithCALDcommunities(viaasecondsurvey)
ThestudyrsquospurposewastounderstandissuesbarriersandperceptionsinrelationtotheCOV-ID-19vaccineamongNSWrsquosmanyculturallyandlinguisticallydiverse(CALD)communitiesAssuchitpresentsagrassrootsperspectiveKeyfindingsarepresentedbelow
CALD communities have mixed responses to the vaccineLikethegeneralpopulationourstudyhighlightsthat NSW residents from CALD backgrounds are mixedintheirresponsestoandconfidenceinhavingtheCOVID-19vaccine
EXECUTIVE SUMMARY
This research was conducted between late April and early June 2021 just prior to the most recent outbreak in Sydney of the Delta variant of COVID-19 Many participants in our study who were unwilling or hesitant to be vaccinated expressed the opinion that COVID-19 was not a lsquoreal and present dangerrsquo in Australia due to the very low case numbers active at the time
FIGURES10 Figure 1
Country of Birth
11 Figure 2 Language spoken at home
12 Figure 3 Length of time living in Australia
12 Figure 4 Age
13 Figure 5 Gender
14 Figure 6 Are you going to get the COVID-19 vaccine
15 Figure 7 COVID-19 Vaccine intention of respondents by age category
16 Figure 8 Respondents COVID-19 Vaccine intention by Country of Origin
17 Figure 9 Reasons for getting vaccinated against COVID-19
18 Figure 10 Reasons for not getting vaccinated against COVID-19
22 Figure 11 Do you know someone who has been vaccinated
23 Figure 12 Knowing someone who has had COVID-19
24 Figure 13 Who do you know who has had COVID-19
25 Figure 14 Where to go to get vaccinated
25 Figure 15 Sources of information about COVID-19 and the COVID-19 vaccine
27 Figure 16 Sources of information for respondents who were planning to have the vaccine
27 Figure 17 Sources of information for respondents who are not planning to have the vaccine
28 Figure 18 Sources of information for respondents who lsquodonrsquot knowrsquo if they will have the vaccine
1StephenDuckettToo many Australians are hesitant to get vaccinated Herersquos how we fix itSydney MorningHeraldMay192021
TABLES10 Table 1
Focus Group Details
15 Table 2 People in the sample already vaccinated
15 Table 3 Vaccine refusal and hesitancy in the sample
20 Table 4 Vaccine refusal by country of birth and language background
21 Table 5 Reasons for not having the vaccine
22 Table 6 Who do you know who has been vaccinated
1
58 of people in our sample reported that they would be having the vaccine
This included 13 people (64) who had already been vaccinated in most cases having had their first vaccination only
42 reported that they were unsure or were not planning to have the vaccine
Of these 29 were unsure or hesitant
13 reported that they would not have the vaccine
ThiscomparescloselytorecentdatapublishedbyTheAgeandSydneyMorningHeraldthatsug-gests lsquoabout a third of Australians are hesitant aboutgettingaCOVID-19vaccinersquo1
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
32
A range of factors appear to influence attitudesOlderpeople(65+)inthesurveysampleweretheagegroupmostlikelytoreporttheyhadhadorwereintendingtohavethevaccinewhileyoung-erpeople(18-24)weremostlikelytoexpressuncertaintyorhesitancy
Countryofbirthalsoshowedupasapossibleindicatorforbeinglsquopositivelypre-disposedrsquoto-wardsvaccinationandwouldbeworthyoffurtherresearch
Knowing someone who had had the virus or been vaccinateddidnrsquotappeartomakerespondentsmorelikelytogetthevaccinethemselves
Themostfrequentlycitedreasonsforgettingthevaccinewereamixofpersonalsafety(lsquokeepingfamilyself-safersquo)altruisticreasons(lsquoforpublichealthrsquoandlsquoitistherightthingtodorsquo)andthemoremotivationalreasonlsquototravelrsquo
AcrossCALDcommunitiesthereisagoodlevelofpracticalknowledgebutstillsomeuncertaintyaboutwheretoaccessvaccinations
Focusgroupparticipantsgenerallyindicatedfamiliaritywiththe2typesofvaccinesavailableandtherisksassociatedwitheachparticularlyre-gardingAstraZenecandashalthoughthiswasnotablynotthecaseforagroupofnewly-arrivedrefugeeswhohadlittleornoknowledgeofvaccinationsforthe virus
Over 80 of respondents knew where to go to getvaccinatedincludingGPsthevaccinationhubforSydneyresidentsandlocalhospitalsHowev-eraconcerning19reportedthattheydidnotknow where to get vaccinated
Fears and concerns about vaccinations remain Despite high rates of knowledge about COVID-19 acrossourstudysamplearangeofconcernsandmisconceptionsndashsharedwiththewiderpopula-tionndashwereevidentTheseincluded
FearaboutbloodclotscausedbytheAstraZeneca vaccine
Fearabouttheperceivedlackoflsquoproperrsquotestingofthevaccinepriortorollout
Lackofcertaintyabouthowthevaccineworks
ConcernsthatthevaccinewillmakeyousickorchangeyourDNA
Concern that the vaccine is a form ofgovernment control
Abeliefthatifyouarehealthyitisbettertofightthevirusandmakeyourselfandyourimmunesystemlsquostrongerrsquoasaresult
Onlyasmallnumberofpeopleinthesurveysample reported that religious or cultural reasons were a barrier to having the vaccine
Public health information can be confusingThefocusgroupshighlightedthatconflictingpub-licmessagingoverly-complexinformation(evenwhentranslated)ornotenoughtargetedinformationwerefactorsinvaccinehesitancywithcomments including
The importance of social and mass mediaAcrossallrespondentsthemostfrequently-citedsourceofinformationregardingCOVID-19nominatedby417wasFacebookAmongthosenotintendingorhesitanttohavethevaccinelsquoFacebookrsquoandlsquoMyfriendsrsquowerenominatedasthemostcommonlyrelieduponsourcesofinformationForthoseintendingtohavethevaccineSBSTVwasthemostfrequently-citedsourceofinformation
The focus group discussions further highlighteddifferentapproacheswithregardstohealth
informationthatneedtobeconsideredinthecontextofpublicmessagingAnumberofgroupsdiscussedusingtheirGPsforhealthinformationandhealthcarebutalsorelyingontheinternet(includingfitnessandwellbeingsites)FacebookandothersocialmediasuchasWhatsAppandWeChatassourcesofhealthinformationYoung-erfocusgroupparticipantsalsospokeaboutobtaininginformationfromadditionalsourcesincluding Tik Tok and Instagram
TelevisionnewslocalnewspapersandcommunitygroupswerealsohighlyregardedassourcesoflsquoaccuratersquoinformationSomefocusgrouppartici-pantsidentifiedusingmainstreammediasourcestolsquofactcheckrsquowhattheywerehearingonsocialmediaLocaltelevisionnewswasparticularlyimportantinregionallocationswherepeoplewantedtoknowwhatwashappeninglocallyandhowitwouldaffectthem
Government websites are not the lsquogo-torsquo source of informationGovernmentwebsiteswerementionedinthelsquootherrsquocategoryofprimarysourcesofinformationnominatedbylessthan10ofresearchrespond-entsThissuggeststhattheyarenotthepreferredlsquosourceoftruthrsquoforCALDcommunitiesAscanof government health websites indicates that a rangeofusefulresourcesconcerningCOVID-19includingforCALDcommunitiesandorganisa-tionssupportingthemhavebeendevelopedHoweverasourexperienceandotherresearchtellsusthesewebsitescanbedifficulttonav-igaterelyonacertainlevelofdigitalinclusionanddigitalliteracyskillstheinformationprovidedcanbecomplextounderstandornotineasy-readformatsndashinvolvingtechnicaltermsandjargonand placing something on a website does not nec-essarilymakeitaccessibletoparticulargroupsinthecommunityevenwhentranslated
Targeted tailored messaging is essentialOtherrecently-publishedresearchconcerningCOVID-19andCALDcommunitiessupportsfindingsfromoursurveyandfocusgroupsandcontainskeyinsightsrelevanttocommunicatingpublichealthinformationThisincludes
ResourcesavailableonwebsitesoftenrelyonahighlevelofEnglishlanguageliteracyorliteracyinapersonrsquosfirstlanguage
The importance of tailoring messaging tothosewithlowerlevelsofhealthliteracywhoaremorelikelytoendorsemisinformedbeliefsaboutCOVID-19andvaccination
Massmediacampaignsshouldbeutilisedbutsupplementedbydecentralisedcommunicationstrategiesthattapintolocalsupport networks
Theneedtoconveyinformationinawaythatismeaningfultopeopleusingtrustedcommunitysourcesandmultiplechannelstoreinforce messages
Drawing on motivational factors is keyOncloserinspectiontheresultsofourstudysuggestthatvaccinehesitancyisperhapsbetterunderstoodaslowmotivationndashoralsquowaitandseersquoapproachManyparticipantssaidthattheywould consider having the vaccine if there was lsquomoreofareasonrsquotodoso
Reasonsgivenbyparticipantsthatwouldmoti-vate them to get vaccinated included
Manyparticipantsevensomewhowerethemostvaccinehesitantsaidthatifbeingfullyvaccinat-edmeantthedifferencebetweenbeingabletotraveloverseastovisitfamilyornottheywoulddefinitelyrolluptheirsleevesandgetlsquothejabrsquo
If I was able to travel to see my
family If there was more risk from COVID-19 ndash another outbreak or
concern about increased
transmission
If I had to in order to keep my job
Nobody knows what to do My GP doesnrsquot even
know what I should do whether I should
have it or not
They say one thing and then they tell you
something elsehellipit (the vaccine rollout) is
so confusing
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2 3
EXECUTIVE SUMMARY
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
54
RECOMMENDATIONS
Againthisalignswithotherresearchwhichemphasisestheimportanceofbuildingmotiva-tionalandlsquopullrsquofactorsintothevaccinerolloutstrategyandaccompanyingmessaginginorderto increase vaccine uptake among CALD com-munitiesInvolvingcommunitiesintheprocessunderstandingconcernsandmotivationalfactorsbuildingtrustandtestingmessaginghavebeenidentifiedaskey
If I could get home to see my mother I would get
vaccinated today
ThisresearchisintendedtoprovideausefulgrassrootsperspectivefromarangeofCALDcommunitiesacrossNSWonissuesbarriersandperceptionsconcerningtheCOVID-19vaccineItishopedthatthesefindingscontributetoagrow-ingbodyofknowledgeregardingCOVID-relatedissuesforNSWrsquosculturally-diversecommunities
The research has highlighted that reinforcing the benefitsofbeingvaccinatedratherthandwellingontherisksismorelikelytogeneratebehaviouralchangeandapositivevaccineresponsefrombothCALDcommunitiesandthegeneralpopulationIt also reminds us of the immense value of the
direct and early engagement with specialist local multicultural and state-wide ethno-specific community organisations in the development and rollout of any public health campaigns
strategies to ensure community involvement in and ownership of any campaigns with trusted sources such as local community leaders and peer champions
tailored targeted messaging across multiple platforms and channels available in easy-to-read format for English and translated versions
supporting health care professionals in their role as educators and leveraging successful local programs that increase COVID-19 vaccine literacy and informed decision making
further research to understand concerns misconceptions and motivations of priority groups
1
2
3
4
5
long-standingtrustandstrongrelationshipsthatexistbetweenlocalplace-basedservicesandthecommunitiestheyworkwithndashcloseconnectionsthatshouldbeutilisedtoadvancepublichealthoutcomes
InthiscontextitisrecommendedthatNSWHealthinpartnershipwithMulticulturalNSWCALDpeakbodiesandcommunityleadersusethisresearchtoinformongoingeffortstoencour-age uptake of the COVID-19 vaccine among CALD communitiesThefindingsindicatethattheseeffortscouldbesupportedby
4 5
Motherrsquos Group at SydWest Multicultural Community Services Blacktown
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
76
HEALTH INFO
Health information from online sources (low use of government websites)
Main stream media
Younger group
Tik Tok
58 said yes to the vaccine with 64 previously vaccinated
= 2 people
29 were unsure or hesitant
13 reported that they would not have the vaccine
Issues barriers and perceptions about the Covid-19 vaccine among culturally and linguistically diverse communities in NSW
if I could get
home to see my
mother I would
get vaccinated
today
Covid is not
real and present
danger but I would
get vaccinated if
there was a
reason too
I would get vaccinated
FEARS amp CONCERNS about the
vaccineFear about blood clots
caused by the Astra Zeneca
vaccineFear about
the perceived lack of lsquoproperrsquo testing of the
vaccineLack of
certainty about how the vaccine
workedConcerns
that the vaccine will make you sick or change
your DNA
Concern that the vaccine
is a form of government
controlA belief that if you were
healthy it was better to fight the virus and
make yourself and your immune system
lsquostrongerrsquo as a result
if there was more risk from Covid ndash another outbreak or concern about increased transmission
199participants
11focus groups
if I had to in order to keep my job
if I was able to travelto see myfamily
More likely to get the vaccine
+65 age groupThis small study of 199 people from a range of cultural backgrounds in
metropolitan Sydney and two regional locations
found that the community is divided in its response to both the safety need
and efficacy of the vaccine
Almost half of the participants knew someone who had contracted COVID-19 over-seas Many people spoke about the impact of COVID-19 on their immediate family including some who had lost loved ones
Influence of friends and family overseas
2 3
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
98
This research project has been commissioned by the New South Wales Council of Social Service (NCOSS) to look at issues concerns attitudes and barriers to receiving the COVID-19 vaccine in culturally and linguistically diverse (CALD) communities in NSW
The research was conducted over two months fromlateApriltolateJune2021withdatacol-lectedjustpriortothelatestCOVID-19outbreakinSydneyItwasundertakenwithsomeurgencygiven the following factors
the lack of data concerning peoplefromculturallyandlinguisticallydiverse backgrounds in larger research studies 2
theheightenedconcerninthecommunity aboutthepotentialsideeffectsofin particulartheAstraZenecavaccinewhich has led to a higher-than-usual rate of vaccine hesitancyinthewidercommunity3
theneedtolifttheoverallvaccinationratein Australia
Emergingresearchindicatesthatmisconceptionsabout COVID-19 in Australia tend to be more common in groups with lower levels of health literacyincludingpeoplewhospeakalanguageotherthanEnglishInadditionthevariedexperi-enceofandinformationaboutCOVID-19trans-missionandvaccinationinoverseascountriesmakesthisaparticularlyinterestingissuegiventhatCALDcommunitymembersmaybehavingregulardiscussionswithrelativesoverseasandgettinginformationaboutCOVID-19fromover-seas sources
2McCafferyKJDoddRHetalHealth literacy and disparities in COVID-19ndashrelated knowledge attitudes beliefs and behaviours in AustraliaPublicHealthResPract202030(4)e30342012 December 2020 First published5 November 2020lsquoThereareseverallimitationstoourstudyAlthoughourrecruitedsamplewaslargeanddiverseitwasnotstatisticallyrepresentativeoftheAustralianpopulationTheproportionofAustraliansfromnon-Englishspeakingbackgroundswassmall(6)sincethesurveywasnottranslatedandrequiredsufficientEnglishskillstocompletethequestionnaireinEnglishrsquo(p7)
3AnonlinesurveyconductedbyEssentialResearch(April2021)completedby1090peoplebetween21ndash26April2021foundjust43ofAustraliansthinktherolloutisbeingdoneefficientlydownfrom68inMarchhellipTheslowrolloutandchanges to the roadmap also appear to have given rise to vaccinehesitancywithoneinsixpeople(16)sayingtheywillnevergetvaccinatedagainstCOVID-19upfrom12lastmonthwhile42saidtheywillgetvaccinatedbutnotrightawayTheproportionofpeoplewhowouldbewillingtogetvaccinatedassoonaspossibleorarealreadyvaccinatedalsodeclineddownfrom47to42rsquoEssentialReport(April 2021)
A mixed-method research methodology was used for this project However it was primarily a qualitative approach that aimed to hear directly from people in the community from culturally and linguistically diverse (CALD) backgrounds The methodology involved
METHODOLOGY
11 focus groups (including one pilot) involving atotalof167participantsfromCALD backgroundsand7locationsGriffith(1) Wollongong(2)Blacktown(2)Lakemba(1) MtDruitt(3)Toongabbie(1)andMarrickville (1)Thesesupportedparticipantstoanswer thesurveyquestionsandenabledmore detailedexplorationofissuesandfurther gatheringofqualitativeinformation(see Table1below)Identifiedmulticulturalandcommunityserviceorganisationswith connectionstoCALDcommunitiesinthe relevantlocationsactedaslsquointermediariesrsquo byassistingwithorganisingthefocusgroups providingbilingualfacilitationofdiscussion andsupportingcommunitymembersto undertakethesurveyMoreinformationonthefocusgroupsandintermediary organisationscanbefoundatAttachmentA
Anonlinesurveywiththesamequestionsas those used in the focus groups was made available This was promoted via NCOSS networksandtheresearchteamrsquosCALD connectionsandcompletedby32peopleThe totalsamplesizeofthisstudywastherefore 199participantsmadeupofmembersof diverseCALDcommunities
Abilingualmulticulturalcommunity engagementexpertwasengagedthroughout theprojecttoadvisetheresearchteam includinginrelationtothedesignofthe surveyBilingualfacilitatorswereusedfor focusgroupswherenecessaryandguidance wasprovidedbyintermediaryorganisation representativesasrequiredandinone instancethesurveywastranslatedintoArabic Focus group members were each provided witha$25giftcardattheendofthesession anda$50giftcardwasdonatedtothe intermediaryorganisationtoprovidesome additionalresourcestoeachgroup
Asecondonlinesurveywasdesignedtoelicit theviewsandexperienceoftheintermediary organisationsintheirworkwithCALD communitiesItgeneratedeightresponses
Two interviews were undertaken with a multiculturalhealthcommunicationexpert from the Illawarra Shoalhaven Local Health DistrictandanEmergencyDepartment medicalpractitioner
Theonlinesurveyresponsesfromthe intermediaryorganisationsandtheinterviews withhealthstaffhaveinformedanalysisof datafromcommunitymembersfindingsand recommendations
Inadditiontheresearchhasbeeninformedbyotherpubliclyavailableresearchincludingfind-ingsconcerningvaccinehesitancyanduptake4andascanofmulticulturalCOVID-19healthresourcesavailableincommunitylanguagesfromtheCommonwealthNSWandVictorianGovern-mentsSBSandEthnolink(seeAttachment2)
Recruitment for the focus groups IntermediaryorganisationsandfocusgroupparticipantswererecruitedusingtheresearchteamrsquosextensiveconnectionswithmulticulturalandcommunityserviceorganisationsacrossNSWanddrawingonkeyNCOSSmemberorganisa-tionsprovidingsupporttoandwithlongstandingrelationshipswithCALDcommunitiesToalargeextenttheselectedlocationsandtheservicesandsupportsprovidedbytheintermediaryorgan-isationsdeterminedtheculturalbackgroundsthatwereincludedinthestudy
4 httpswwwncossorgauCOVID-19-research
INTRODUCTION
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1110
Service Location Group Composition Participant numbers
Addison Road Community Centre Marrickville Community leaders - Vietnamese Chinese Italian Greek Indonesian Latin American and Portuguese speakers
26
Griffith Community Centre Griffith Indonesian and Pakistani women 6 Multicultural Communities Council Illawarra
Wollongong Arabic-speaking group 22
Multicultural Communities Council Illawarra
Wollongong Italian older womenrsquos group 15
Syd West Multicultural Services Mt Druitt Arabic-speaking group 10 Syd West Multicultural Services Blacktown Spanish-speaking seniorsrsquo group 16 Syd West Multicultural Services Blacktown Mothersrsquo support group -
Indian Sri Lankan Pakistani and Ghanaian
14
Canterbury City Community Centre (4Cs)
Lakemba Pakistani Indian and Sri Lankan women
14
Chaldean League and Western Sydney TAFE
Mt Druitt Chaldean group 18
STARTTS - Toongabbie Community Centre
Toongabbie Tamil-speaking group 12
Mt Druitt TAFE ndash TAFE NSW Mt Druitt Work Opportunities for Women group (mixed CALD backgrounds)
14
TOTAL 167
Table 1 Focus Group DetailsExplanatory noteThefocusgroupatMtDruittTAFE-comprisedpredominantlyofCALDwomenenrolledinaCertificateIIentrylevelcourse-wasusedtopilotandrefinethefocusgroupprocesswithsurveyresponsesgeneratedbythegroupincludedinthefinalsurveyresults
A word about the research design Theresearchwascarefullydesigneddrawingonexpertculturaladviceoncommunicationpro-cessesandsurveydesignFocusgroupsincludedparticipantconsentformsincentivevouchersandaone-pageintroductiontotheresearchfortheintermediaryorganisationsIntermediaryorgan-isationsandpreferredlocationswereidentifiedand agreed in advance with NCOSS
Thesurveywasdesignedinaneasy-to-readformatusingsimpleEnglishFeedbackfromthe Spanish-speaking translator was that it was extremelyeasytotranslateandcompleteOthergroupscommentedthattheyfoundthesurveyeasytocompleteandmostgroupsdisplayedasolidlevelofspokenandwrittenEnglishTheresearchdesignandconductalsoleantheavilyontheexpertiseofthefacilitatorsandtheirexten-sivenetworkswhichmadedeliveryinsuchashorttimeframepossibleThepositiveengagementandsupportoftheintermediaryorganisationswasalsoafactorcontributingtothesuccessfulconduct of the research
Withoutfailthemulticulturalandcommunityserviceorganisationsinvolvedintheresearchper-ceived the importance of its purpose and shared a desire to provide NSW Health with feedback directlyfromtheircommunitiesasamatterofurgency
Demographics of research participantsThemakeupofthosewhoparticipatedintheresearch was diverse in age and cultural and languagebackgroundParticipantswerepredom-inantlywomen(84)withmenmakinguponly145OverhalftheparticipantshadlivedinAustraliaformorethan20yearswhichimpactedpositivelyontheirlevelofspokenandwrittenEnglishHowevertherewerequitelowlevelsofEnglishliteracyinanumberofthegroupswhichmadeguidedsurveycompletionamoreneces-sarybutcomplexprocess
1 1 1
6
3
31
16 17
20
12
15
1
8
2
64
1
5
2 13
1 1
7
2 1
5
1 1 1 1 2 10
5
10
15
20
25
30
35
Indo
nesia
Thai
land
Hong
Kon
gAu
stra
lia Iran
Iraq
Viet
nam
Italy
Sri L
anka
Indi
aPa
kist
anGh
ana
Syria
Boliv
iaCh
ilePe
ruEl
Sal
vado
rM
alay
siaUr
ugua
yAr
gent
ina
Cam
bodi
aUk
rain
eRu
ssia
Chin
aSu
dan
Eritr
eaSw
eden
Taiw
anAf
ghan
istan
Pola
ndJa
pan
Egyp
tJo
rdan
13
1 2
10
17
2
21
1
11
1 1
12
2 1
27
10
1 1 1 13 2 1 2 1
6
1 1 1
32
0
5
10
15
20
25
30
35
English Thai
Cant
ones
eVi
etna
mes
eIta
lian
Farsi
Tam
ilTe
lugu
Span
ishSp
anglish
Haus
aUr
duGu
jara
tiPu
njab
iAr
abic
Chalde
anHi
ndi
Khm
erPe
rsian
Russian
Man
darin
Malay
Haza
ragi
Tigr
inya
Kurd
ishCh
ines
ehellipJa
pane
sePo
lish
Swed
ishM
ultip
le
Figure 1 Country of BirthFigure 2 Language spoken at home
METHODOLOGY
Coun
t
Coun
t
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1312
211
1316 14211684
2053
3316
Less that 1year
1 - 2 years 2 - 5 years 5 - 10 years 10 - 20years
More than20 years
000
500
1000
1500
2000
2500
3000
3500
Less than 1-2 years 2-5 years 5-10 years 10-20 More than1 year years 20 years
1453
8430
000 116
Male Female Non-binary Rather not say000
100020003000400050006000700080009000
000
785
1728
2147
1309
1675
2356
Under 18 18-24 25-34 35-44 45-54 55-64 65+000
500
1000
1500
2000
2500
Figure 3 Length of time living in Australia Figure 5 Gender
Figure 4 Age
METHODOLOGY
Chaldean Focus Group Feedback Sheet
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1514
Research participants were asked
If they were intending to get vaccinated
The reasons why they would or would not choose to get vaccinated
If they knew anyone who had already been vaccinated and if so who
If they knew anyone who had contracted COVID-19 and if so who
If they knew where to go to get vaccinated
What sources they used to get information about the COVID-19 vaccination
Basic demographic information age gender country of origin language spoken at home and length of time living in Australia
Having the vaccine or notOfthe199participants117(58)reportedthattheywereplanningtobeorhadalreadybeenvaccinatedwhile78(42)reportedthattheywere not planning to have the vaccine (13) or didnotknowiftheywouldgetvaccinated(29)
1453
8430
000 116
Male Female Non-binary Rather not say000
100020003000400050006000700080009000
05
10152025303540
Under18
18-24 25-34 35-44 45-54 55-64 65+
Coun
t
Yes No Donrsquot Know
Figure 6 Are you going to get the COVID-19 vaccine
Figure 7 COVID-19 Vaccine intention of respondents by age category
13people(65)hadalreadybeenvaccinated(at least 1 dose)6withseveralcommentingthattheyhadchosenorneededtobevaccinatedforwork-relatedreasonsOthersreportedthattheyhadbeenvaccinatedprimarilyforhealthreasonstostaywellandmakesurethattheirfamiliesstayedwellTheywerealsoconcernedaboutpublichealthandsafetyOneofthewomenintheLakemba groups from Sri Lanka was adamant that thebenefitsoutweighedtherisksspokepositive-lyabouthoweasyithadbeentogetthevaccinefrom her local medical centre and that she had experiencednosideeffectsfromthevaccination
Language Count Percent Urdu 1 Italian 3 Arabic 2 Tamil 3 Chaldean 1 Spanish 3 Total 13 65 of sample
Response Count Percent Not planning to have the vaccine 23 13 Unsure about having the vaccine 52 29
75 42
Table 2 Respondents already vaccinated
Table 3 Respondents who indicated vaccine refusal or hesitancy
6 Theresearchersdidnotdistinguishbetweenwhetherpeoplehadreceivedtheirfirstandseconddosesofthevaccineiepartiallyorfullyvaccinated
75(42)indicatedadegreeofvaccinehesitancywith24participants(13)reportingthattheywerenotplanningongettingvaccinatedwhile53(29)reportedtheydidnotknowiftheywouldget vaccinated
Thislevelofvaccinehesitancyreflectslargerstud-iesintheAustraliancommunityAsurveyofover1000participantsfromacrossAustraliaconduct-edinApril2021byEssentialResearchfoundhes-itancyratesof42including16whoindicatedtheywerenevergoingtogetvaccinated7
Foroursurveyresponsesindicatedthatagewasafactorwith85ofrespondentsaged65andoverreportingthattheywouldhaveorhad
7EssentialResearchThe Essential Report21April2021
FINDINGS FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1716
alreadyhadthevaccineThosewhoindicatedthattheywouldnotbehavingthevaccinewerefairlyevenlydistributedacrossagegroupswithyoung-er people aged 18-24 being the age group with thehighestproportionofparticipantsexpressinguncertaintyabouthavingthevaccineTheagegroupwiththesecondhighestlevelofhesitancyproportionatetoothercategorieswerethe35-44yearolds
02468
10121416
Iraq
Vietnam Italy
South Americ
a
Sri La
nkaIndia
Syria
Other South East
AsiaAfric
a
Australia
Sweden
China
Pakistan
Iran
Eastern Europe
Afghanistan
Japan
Coun
t
Yes No Dont know
8095 8190
70486095
4571
6190
095
To stayhealthy and
well
To keep myfamily
healthy andwell
For publichealth
To travel To work It is theright thing
to do
Somethingelse (pleasetell us what)
000100020003000400050006000700080009000
Figure 8 Respondents COVID-19 Vaccine intention by Country of Origin
Figure 9 Reasons for getting vaccinated against COVID-19
Countryoforiginalsoseemedtoplayaroleinpeoplersquosviewsabouthavingthevaccinewithhighvaccinepre-dispositionreportedbyVietnameserespondentstotheonlinesurveyandwomenintheItalian-speakinggroupWhileparticipantsfromIraqrecordedthehighestlsquoyesrsquoresponsethiswasalmostmatchedbyIraqiparticipantswhoreportedthattheywerelsquounsurersquoorlsquodidnotknowrsquowhethertheywouldhavethevaccineTherelevanceofcountryoforigininthisregardwouldbeworthyoffurtherresearch
The Italian focus group held in Wollongong was an olderwomenrsquossocialgroupwithallparticipants(15) agedabove65yearsMostinfactwereaged over75yearswithoneparticipantinher90s 87 of the group had either been vaccinated (3) or were planning to get vaccinated (10)
Of course I will get vaccinated It is important to do this It is a very bad
disease
Thesewomenweremotivatedtostayhealthyandwellkeeptheirfamilyhealthyandwellforpublichealthreasonstobeabletotravelandforgen-eralsafetyMembersofthegroupalsoreportedthattheywantedtogetvaccinatedsothattheywouldbeabletolsquodancersquoandlsquosocialisersquo
Reasons for having the vaccine
Ofthe117participantswhoreportedthattheyhadeitheralreadybeenvaccinatedorwereplan-ningtogetvaccinatedlsquokeepingmyfamilyhealthyandwellrsquo(82)andlsquokeepingmyselfhealthyandwellrsquo(81)werethetwomostpopularreasonsforhavingthevaccineThiswasfollowedbylsquoforpublichealthrsquo(70)lsquoitistherightthingtodorsquo(62)andinorderlsquototravelrsquo(61)(SeeFigure9)
I donrsquot want to
die
Irsquom over 65 I have some health issues I think itrsquos
[having the vaccine] very important to
keep safe
I want to see my family I usually go every year but now I havenrsquot seen them
because of COVID-19 Having it will help
I am well but my parents are older It is important to
keep them well
Otherreasonsthatpeoplegaveforgettingvacci-natedincludedtheneedtocontinueworkinginessentiallsquofrontlinersquoemploymentsuchassecuritycleaningandagedcaresettingsOnewomanintheLakembafocusgroupwhohadalreadyhadherfirstdoseoftheAstraZenecavaccinesaidthatlsquothebenefitsoutweightherisksrsquoandasanolderwomanrsquoIdonotwanttodiersquo
All but one of the focus groups were familiar with thedifferentvaccinescurrentlyavailableinAus-traliaAstraZenecaandPfizerMostparticipantswere also aware of blood clots being associated with the Astra Zeneca vaccine One group of newly-arrivedrefugeesinGriffithhadnotheardofeithertheAstraZenecaorPfizervaccinesandhadamorelimitedunderstandingofthevaccinationprogram in general
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1918
Reasons for not having the vaccine
At the moment the situation is under control and donrsquot feel the need Also I have no plans to
travel in the near future so I donrsquot see the need
3514
21622703
3243
1892
811 541
4865
1081
Thevaccine isnot welltested
Thevaccine is
unsafe
Formedicalreasons
I amscared tohave thevaccine
I dont likevaccines
Forreligiousreasons
Forculturalreasons
I want towait and
see
Somethingelse
(pleasetell uswhat)
000
1000
2000
3000
4000
5000
6000
Figure 10 Reasons for not getting vaccinated against COVID-19
Theperceivedlsquolackofadequatetestingrsquoofthevaccineandlsquofearofbeingvaccinatedrsquoalsore-ceivedhighresponseratesselectedby3514and3243ofparticipantsrespectivelyOnly1355 of respondents cited religious or cultural reasonsasbeingbehindtheirvaccinehesitancy
Open-endedresponsestothisquestionincluded
The vaccine is not 100 working It cannot offer
100 protection
Ofthe42participantswhosaidthattheywouldnothaveorwerehesitanttohavethevaccine4865saidthattheypreferredtolsquowaitandseersquobeforegettingvaccinated
Thediscussioninthefocusgroupsaboutpeoplersquoshesitancytobevaccinatedfocusedonanumberofconcernswhichreflected
poorcommunicationfromanumberof trusted sources including GPs and some media sources
conflictinginformationaboutthevaccinefrom healthauthorities
fearsaboutvaccinesafetythataresharedby thegeneralcommunity
misconceptionsabouttheeffectivenessof andhowthevaccineswork
I will not have it because make me sick
Issuesraisedinfocusgroupsascontributingtoincreasedhesitancyincluded
Some GPs being hesitant to recommendvaccination
Theinformationbeingprovidedisconflicting
Theinformationisoverlycomplexandnotcomprehensibleregardlessofwhetherithasbeen translated
The risk of blood clots
Perceptionsthatthevaccinesaregenerallyunsafe
Concernsthatsomepeoplearedyingafterbeing vaccinated
Not being sure about the risks associated withhaving the vaccine and being pregnant orbreastfeeding
Theperceptionthattherehasbeenalackoftestingofthevaccinespriortorollout
AlackofunderstandingofhowvaccinesworkthecompositionofthevaccinesandwhattheywoulddotothebodyincludingmakingchangestoapersonrsquosDNA
Specificcommentsincluded
I have heard that the vaccine changes
your DNA
I am a mother I am not sure it [the vaccine] is safe for
me when I am breastfeeding
If you are young and healthy your body has the energy to fight the virus
You donrsquot need to have the vaccine You should just let
your body fight it itself
They donrsquot tell you what chemicals are in the
vaccine
Tamil Focus Group Feedback Sheet
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2120
Nobody knows what to do My GP doesnrsquot even know what I should do whether
I should have it or not
I am not sure what to do I have spoken to my
GP but they canrsquot tell me whether I should have the vaccine or not while I am
breastfeeding
They say one thing and then they tell you
something elsehellip it [the vaccine rollout] is so
confusing
Confusionaboutwhattodowheretogoandthe health impacts of the vaccine was a common threadintheconversationsaroundvaccinehesi-tancy
Onewomanwhosehusbandworkedforasecurityfirmsaidthatherhusbandhadhadtobevacci-natedinordertokeephisjob
In several focus groups the issue of government control was also raised A number of people re-portedstronglythattheyfearedthatthevaccinewas lsquoa means that the government was using to controlpeoplersquo
He [husband] had to have it He didnrsquot have a choice He was fine [no side effects] but Irsquom not
thinking I will have it I donrsquot need to Irsquom a mum Irsquom busy I have
to look after my children I donrsquot know how I feel about it whether
Irsquom going to have it
Vaccine refusal
Onlyasmallnumberofparticipants(24or13)saidtheywouldnotgetvacci-natedOfthisgroup21werewomenand 2 were men8 Respondents were bornintendifferentcountrieswithadiverse range of language backgrounds
I never get sick It is the same for all my family We have always been strong and healthy so I will be
saying no to the vaccine
Country of Birth Language Background Count Pakistan Urdu 4 China Taiwan Chinese
(MandarinCantonese) 4
Sri Lanka India Tamil 3 Chile Spanish and English 2 Italy Italian 2 Iraq Syria Arabic 2 Iraq Chaldean 1 Iran Farsi 1 Greece Macedonian 1 Poland Polish 1 Pakistan Punjabi 1 Sweden Swedish 1 Vietnam Vietnamese 1
Table 4 Vaccine refusal by country of birth and language background
8 ThisreflectstheoverallsamplebiastowardswomenThemajorityoffocusgroupparticipantswerewomenXwithYparticipantsbeingmen
Reason for not having the vaccine Percent Count The vaccine is not well tested 5455 12 I want to wait and see 5455 12 The vaccine is unsafe 3636 8 For medical reasons 3182 7 I am scared to have the vaccine 3182 7 I dont like vaccines 1364 3 For religious reasons 1364 3 For cultural reasons 909 2 Something else (please tell us what) 909 2
SomeinthiscategorywereadamantthattheywouldnotbehavingthevaccineandhadverystrongviewsonitlsquoForculturalreasonsIwonrsquotbehavingthevaccinersquoWhenwelookatrespons-esmorecloselyhoweveritwouldappearthatmanyareinfactmorelsquohesitantrsquothanfirmvaccinerefusers
One reluctant middle-aged Tamil-speaking wom-ansaidlsquoIftheysaywehavetogetvaccinatedthenIwillrsquoThissentimentwas stronglysup-portedbythe rest of the Tamil-speaking group
Studyparticipantswhosaidtheywouldnothavethe vaccine were also concerned that lsquothe vaccine wasnotwelltestedrsquo
The vaccine has been rushed out It has not been
properly tested
Table 5 Reasons for not having the vaccine
Peopleinthiscategorysaidthattheywouldlsquowaitandseersquowhathappenswiththewiderrolloutbe-foremakingtheirfinaldecisionThissuggeststhataproportionofthelsquonorsquogroupareinfacthesitantrather than outright refusing to have the vaccine
Therewerealsofearsexpressedbyfocusgroupparticipantsaboutthedangersofbeingvacci-natedParticipantsreportedbeingafraidofthehealthrisksespeciallyfrombloodclotsSomepeopledistinguishedclearlybetweenAstraZene-caandPfizerinthisregardHoweverformanythedistinctionbetweenthedifferentvaccineswaslostandtheyspokeofthevaccinesgenerallybeing unsafe and having a range of unwanted side effects
Other factors consideredInadditiontothebroaderquestionsofwhypeo-plewouldorwouldnotchoosetogetvaccinatedthe research team used the focus group discus-sionstoexplorewhetherthefollowingfactorshadanyimpactonapersonrsquoslikelihoodofbeingvaccine pre-disposed or hesitant
Knowing someone who had been vaccinated
Knowing someone who had contracted COVID-19
Knowing where to go to get vaccinated
Thesourcespeopleturntoforinformation about COVID-19 and COVID-19 vaccines
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2322
Knowing someone who has been vaccinatedOfthosewhorespondedtothisquestion125or70knewsomeonewhohadalreadyhadthevaccine
6983
2570
447
Yes No Dont know000
1000
2000
3000
4000
5000
6000
7000
8000
Figure 11 Do you know someone who has been vaccinated
Amongthe125participantswhoknewsomeonewhohadalreadybeenvaccinated100identifiedlsquoimmediatefamilymembersrsquo(parentschildrensiblingsandpartners)Somefocusgrouppartic-ipantsreportedthatalloftheirfamilymembersoverseas had been vaccinated Others reported thattheirrelativeshadbeenvaccinatedasarequirementoftheiremployment
Who Count Percent Other family member 41 313 Sister 24 1832 Community member 23 1756 Brother 18 1374 Father 17 1298 Mother 16 1221 Work colleague 14 1069 Husband or wife 11 84 Son or daughter 10 763 Partner 4 305 Someone else 45 3435 Total respondents 131
Table 6 Who do you know who has been vaccinated
When this issue was teased out further in focus groupdiscussionsarangeofreasonswere revealed including
My husband works in security and he had
to get it
My friend works as a COVID-19 cleaner and they all had to [get
vaccinated]
My family overseas have already been vaccinated
My son needs to travel for work so he is getting it
My brother in the UK is a doctor and he got it and
his wife
Knowing someone who has had COVID-19Almosthalfoftheparticipantsknewsomeonewho had contracted COVID-19 overseas Some reportedthatallthemembersoftheirfamilyormanymembersoftheirextendedfamilyhadcon-tracted COVID-19 In the older Italian group 10 of the15womenknewsomeoneinItalywhohadcontracted COVID-19
4716 4659
625
Yes No Not sure000
1000
2000
3000
4000
5000
Figure 12 Knowing someone who has had COVID-19
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2524
385 385
1538
2692
641 513000
4359
2051
1026385
1410
Mother
Father
BrotherSis
ter
Son or d
augh
ter
Husban
d or wife
Partner
Other family
mem
berFri
end
Community m
ember
Work co
lleag
ue
Someone else
(please
tell u
s who)
000500
100015002000250030003500400045005000
Figure 13 Who do you know who has had COVID-19
Four people in the focus groups knew someone who had died of COVID-19
All my family back home [Pakistan] got it [COVID-19] but
they are all fine now apart from my father He died But he was really sick before he
got it He had lots of underlying conditions Medical conditions so he was really unwell before he got COVID-19 But everyone else
they are fine now They were sick but they got betterhellip
If you are well and healthy you can fight this off
SurprisinglyknowingpeoplewhohadcontractedCOVID-19didnotseemtoinfluencefocusgroupparticipantsrsquopredispositiontowardseitherhavingthevaccineorbeingvaccinehesitantHowevertheolderItalianwomenrsquosgroupspokeabouttheimpactthatCOVID-19hadhadinItalyintheearlystagesofthepandemicandhowthishadaffectedthemdeeply13ofthe15womeninthisgroupwouldhaveorhadalreadyhadthevaccine
Knowing where to get vaccinated115people(81)whorespondedtothisquestion(n=142) knew where to go to get the vaccine 34 people(19)reportedthattheydidnotknowThisincluded15respondentsfromIraq3re-spondentsfromIndia2respondentsfromChina2 respondents from Pakistan and one respondent fromeachofthefollowingcountriesChinaEri-treaItalySriLankaSwedenSyriaandVietnamThese people were also less sure about whether ornottheywouldhavethevaccineItispossiblethat their lack of knowledge about where to go to get vaccinated was related to their general level ofvaccinehesitancy
7958
29582254
282 563
GPDoctor Vaccinecentre
Hospital Work place Somewhereelse (please
tell us where)
000100020003000400050006000700080009000
Figure 14 Where to go to get vaccinated
From the sample (n=199) GPs were the most commonlyidentifiedplacetogotogetvaccinat-edfollowedbythevaccinecentreatHomebushBayandthenhospitalsOtherplacesidentifiedincluded medical centres and pharmacies
Sources of information about COVID-19 and the vaccineThelargestsinglesourceofinformationaboutCOVID-19 and the vaccine was Facebook (417)
2743
3486
13141086
30862686
3429
2229 2286
41713714
2571
1086 971
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)000500
10001500200025003000350040004500
Figure 15 Sources of information about COVID-19 and the COVID-19 vaccine
Facebook I get my information from
Facebook But if I want to check it I watch the news
on 7 [Channel 7]
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2726
Thesecondlargestsourceofinformationforpeople in the sample was lsquoother forms of social mediarsquo(37)followedbySBStelevision(35)myfriends(34)andothertelevision(31)Oth-ersourcesofinformationpeoplereportedthattheyusedweretheNSWHealthwebsitenightlytelevisionnewsincludingChannel7Channel9andChannel10followedbytheABCtheAustral-iangovernmenthealthwebsitetheirGPlocalMedical Centres and the Red Cross
IntheLakembafocusgrouppredominantlymadeupofwomenfromPakistantherewasanani-mated discussion about Facebook which was the majorsourceofinformationalongwithGooglesearchesandcommunityandfriendship-basedWhatsApp groups There was a general consensus from most in the group that these were their pre-ferredormostcommonsourcesofinformationandnewsHoweveriftheywantedtolsquofactcheckrsquowhattheywerehearingtheywouldwatchthenightlynewsonChannel7orChannel9toverifywhattheyperceivedcouldsometimesbeunrelia-ble sources
IntheMtDruittfocusgroupseveralofthewom-enwithwell-developeddigitalliteracyandgener-alliteracyskillsusedhealthandfitnesswebsitesand social media sites as their source of infor-mationaboutlsquoallthingshealthrelatedrsquoincludingCOVID-19ThesewomenalsospokepositivelyabouttheinformationandsupporttheygotfromthestaffatCanterburyCouncilCommunityCentre(4Cs)whotheycouldrelyontofindoutthingsthattheyidentifiedtheyneededtoknowmoreabout
InthesmallerfocusgroupinGriffithwithrecently-arrived refugee women who had low levels of Englishlanguageliteracytherewaslittleknowledgeaboutthevaccinesnoawarenessofthedifferenttypesofvaccinesandlittleknow-ledgeaboutwheretogotogetvaccinatedorfindoutmoreaboutCOVID-19ingeneralThecommunityservicestaffandvolunteerspresentatthegroupwere working hard to assist these women to improve their English language skills and support themwithtranslatedinformation
In the older Italian women focus group in Wollon-gongparticipantsreportedgettingtheirinfor-mationfromslightlydifferentsourcesndashfamilyinAustralia(10women)Channel9(7women)
Italianradio(3women)andABCTV(3women)Onlytwowomenusedtheinternetandnoneofthe women reported using Facebook or social mediaasasourceoftheirinformationSeveralmentionedthattheygottheirinformationfromtheirGPorspecialistdoctorandonepartici-pantsaidrsquoIdonrsquotlistentoanyonersquoIntheSpan-ish-speaking focus group a comment was made thatseemedtoreflectmanyoftheotherfocusgroup discussions
Whenlsquosourcesofinformationrsquoiscorrelatedwiththegroupwhosaidtheywouldhavethevaccine(n=104)thereisashiftfromFacebookbeingthepreferredsourceofinformationtolsquoSBSTVrsquobeingthepreferredsourceThelsquovaccine-predisposedrsquogroupalsohadthelowestrateofrelyingonFace-bookasasourceofinformationaboutCOVID-19thoughitwasstillhighThegraphbelowhigh-lightshowotherlsquopreferredsourcesrsquoplayoutforthoseintendingtohaveorwhohavealreadyhadthe vaccine
ForthoseparticipantswhoindicatedthattheywouldnotorwerenotplanningtohavethevaccinelsquoFacebookrsquolsquomyfriendsrsquoandlsquomyfamilyrsquowerethesourcesofinformationaboutCOVID-19thatwereequallymostfrequentlycitedfollowedcloselybylsquomyfamilyoverseasrsquolsquoSBSradiorsquoandlsquoSBSTVrsquoassourcesofinformationreceivedthelowestmentionsfromthisgroup(SeeFigure16)
The vaccine-hesitant group were the group who identifiedlsquoFacebookrsquoastheirmostfrequentsourceofinformationaboutCOVID-19lsquoFace-bookrsquowasfollowedbylsquoothersocialmediarsquoandlsquomyfriendsrsquoasthenextmostfrequentsources
lsquoThiscommunityserviceproviderrsquo(theinterme-diaryorganisationwherethefocusgroupwasconducted)wasidentifiedby26ofrespondentsasasourceofinformationregardlessoftheirintentiontogetvaccinatedornotThefactthatboththelsquovaccinehesitantrsquoandthosewhoindi-catedtheywouldnrsquotbegettingthevaccinesoughtinformationfromthissourcesuggeststhatrolling
There is so much confusion about it [the vaccine] that I think my GP is the best
place to go
9 This group of the research sample included a small number ofpeoplewhohadalreadybeenvaccinated
2626
4141
14141111
323228282828
2424
1818
37373737
2828
10101212
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)00050010001500200025003000350040004500
2857
2381
952 952
2857
3333
42864286
3810
4286
23812381
1429
952
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another co
mmunity se
rvice
Somewhere
else (p
lease te
ll us w
here)000
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Figure 16 Sources of information for respondents who were planning to have the vaccine9
Figure 17 Sources of information for respondents who were not planning to have the vaccine
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2928
outpositivemessagingthroughtrusted communityserviceorganisationscouldbeaneffectivewayofshiftingpeoplefromvaccine hesitancytodecidingtohavethevaccine
31372549
980 980
25492157
4314
1176
2353
4902
4118
2157
980392
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)000
1000
2000
3000
4000
5000
6000
Figure 18 Sources of information for respondents who lsquodonrsquot knowrsquo if they will have the vaccine
DISCUSSION
wardstheCOVID-19vaccineareasvariedastheyarewithinthebroadercommunityTherearearangeofinfluencingfactorsincludingagehealthstatushowlongtheyhavebeeninAustraliahowmuchnewstheyreceivefromoverseasandhowbadlyimpactedbythepandemictheirhomecountries have been
The research also highlights that people from culturallyandlinguisticallydiversebackgroundsgettheirinformationaboutCOVID-19andtheCOVID-19vaccinefromawidevarietyofsourcesbothformalandinformalandthatforparticulargroupsinthisstudythereisahighrelianceonFacebookovermoreofficialsourcesofinforma-tion
VulnerabilityTheneedsofhighly-vulnerablegroupswithintheCALDcommunityhavetobetakenintoconsider-ationThisincludesolderpeoplewhohavelivedinAustraliaformanyyearsbuthavelowlevelsofEnglishliteracyndashespeciallywritingandreadingEnglishandsometimesspokenEnglishndashandwhoaremoresusceptibletoseriousillnessandhigherratesofhospitalisationanddeathfromCOVID-19Italsoincludesnewly-arrivedrefugeeswhohavinglowornoEnglishlanguageliteracylacktheconnectionstoandnetworksintothewidercommunityandcommunitysupportsItisalsothecase that some people in these groups are not health literate at all and cannot read and write in their own language
Akeytakeoutfromthehealthandcommunityserviceorganisationsurveyresponsesandinter-viewsundertakenwithmulticulturalhealthandcommunicationexpertsfortheprojectisthatlit-eracylevelsreallydomatterLowlevelsofhealthliteracylowlevelsofEnglishlanguageliteracyandpossiblylowlevelsofliteracyintheirownlan-guage-especiallyforsomenewly-arrivedrefu-gees and those who are part of the humanitarian program such as Dari language speakers from AfghanistanTigrinyalanguagespeakersfromEr-itrea and northern Ethiopia and Oromo language speakers from Ethiopia - need to be factored into anyplanstofurtherpromotethevaccinerolloutanduptaketoculturallyandlinguisticallydiversepeopleinthecommunityThereisaneedfor
The contextThisresearchisimportantgivenhowhighlyculturallydiverseNSWisandtheimpactthiscanhave on the success of public health messaging topeoplewhosefirstlanguageisnotEnglishPeople who were born overseas form almost one-thirdofthe7480228population(276)ofNSWandNSWishometo336ofAustraliarsquosoverseas-bornpopulationPeoplefromaround225 birthplaces have made NSW their home and 21oftheNSWpopulationisfromanon-EnglishspeakingbackgroundMorethan24000humani-tarianentrantshavesettledinNSWoverthepastfiveyearscomprisingalmostathird(32)ofthenationaltotalThe24000humanitarianentrantswhohavesettledinNSWoverthepastfiveyearscame from over 100 countries of origin10Sydneyhasthelargestoverseas-bornpopulationofallthecapitalcities11
Hearingdirectlyfrompeoplefromculturally-diverse backgrounds is important to ensure that policymakersandpublichealthadvocatescandesign responses that are both accessible and un-derstandabletopeopleforwhomEnglishmaybetheirsecondthirdorfourthlanguageApropor-tionofpeopleinthesecommunitieshavelowerlevelsofEnglishlanguageliteracyandinsomecaseslowlevelsofliteracyintheirlanguageoforiginsowillbehardertoreachviatraditionalormainstream methods
Itisalsocriticallyimportantthatduringatimewherethereissomuchlsquonoisersquoacrossmediachannelsrelatingtothevaccinethevaccineroll-outvaccineefficacyandvaccinesafetythatwetakesometimetolistentoandunderstandhowthislsquonoisersquoisbeingheardandmadesenseofbypeoplefromculturally-diversebackgrounds
ThatsaiditisimportanttoreconfirmthattheCALDcommunityisnotahomogenousgroupOurresearchhasfoundthattheviewsandattitudesofparticipantsfromdiverseculturalbackgroundsto-
10RefugeeCouncilofAustraliaHumanitarianEntrantsin New South Wales A resource for New South Wales governmentagencies6-711MulticulturalNSWCommunityRelationsReport2018-20199
29
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3130
groupsFortheparticipantsintheresearchtheirattitudetothevaccineappearedtobeinflu-encedbyanumberoffactorstheirownlevelsofhealthandpre-existinghealthconditionsandthoseoftheirfamilymembersandtheimpactofreceiving COVID-19-related news from overseas particularlyfrompeoplersquoscountryoforiginAnexampleofthiscanbeseenintheItaliangroupin Wollongong where people had received news fromoverseasearlyinthepandemicwhichscaredthemThisexperiencelsquofromhomersquohadinflu-enced most of the women in the Wollongong focus group (n=15) to choose to get vaccinated The interviewee from the Illawarra Shoalhaven Local Health District also spoke about the heightenedconcernthattheywitnessedinthelocalItaliancommunityintheearlystagesofthepandemicOtherpeoplewantedtolsquostayhealthyrsquoandtolsquoprotectthehealthofothersrsquoandformanytherewasasensethattheywantedtolsquogetbacktosomedegreeofnormalcyrsquoandtobeabletolsquotraveloverseastovisitrelativesrsquo
Vaccine hesitancyOfthe42inthisstudywhoappearedundecidedornotplanningtohavethevaccinemanywereinfactadoptingalsquowaitandseersquoapproachbeforemakingtheirfinaldecisionMostparticipantswereinterestedtohearmoreinformationaboutthevaccinesandwereopenedtogettingthevaccinebutdidhaveconcernsaboutthesafetyofthevaccinesespeciallyinregardtoAstraZeneca
The issue of blood clots has led to considerable fearandhesitancyinthecommunityandthisfearandhesitancywasreflectedinourstudyEssentialResearchrsquossurvey(April2021)reportedoneinsixpeople(16)indicatedtheywillnevergetvaccinatedagainstCOVID-19upfrom12thepreviousmonthwhile42saidtheywillgetvaccinatedbutnotrightawayTheproportionofpeople who would be willing to get vaccinated as soonaspossibleorarealreadyvaccinatedalsodeclineddownfrom47to4213Thissurveywas conducted prior to the most recent outbreak inNSWinvolvingthehighlyinfectiousDeltastrain
Therisk-benefitofhavingthevaccineneedstobecarefullyweighedbyeachindividualideallyinconsultationwiththeirdoctoranddependingon
The Hub has lsquobeen working in partnership with keystakeholdergroupstoguidecommunicationstomeetthehealthliteracyandculturallyandlinguisticallydiverse(CALD)needsofitspop-ulationStructuredworkinggroupshavebeencreatedtoprioritisecommunicationstovulner-ableyouthCALDgroupstheelderlyitinerateworkersasylumseekersandrefugeesTheaimsaretotestmessagingandbuildtrustwithprioritypopulationstoensureeffectivecommunicationoftheneedtosustainphysicaldistancingmeas-uresintheabsenceofavaccineSimilareffortsarenowneedednationallyandshouldstartatthetimeofdiseaseoutbreaksinthefuturealongsideplannedmassmediaandhealthcommunicationcampaignsrsquo
InthearticlebyDoddetaltheyreinforcetheimportanceofusingcommunicationformatswhich are lsquosuitable for people with low health literacyandeducationandwhichareappropriateforculturallyandlinguisticallydiversegroupsandIndigenouspopulationsrsquoThearticlearguesthatitisimportanttolookatmotivationsandconcernsabout vaccines when shaping messaging It also pointsoutthatprimarycaredoctorsareatrust-ed source and as such should be supported in deliveringinformationaboutthevaccinesandad-dressingcommunityconcernsThearticlestateslsquoWeneedtounderstandandaddresscitizenrsquosconcernsthatcanpreventoptimaluptakebuildmotivationsintomessagingandprioritisepublictrustbyinformingandinvolvingthecommunityintheprocessSupportinghealth-careprofession-als in their role as educators will ensure people haveadequateandaccessibleinformationfromatrustedsourcetooptimisevaccineuptakeandultimatelyreducecommunitytransmissionofCOVID-19rsquo15
RecentresearchbyAssociateProfessorHollySeale16withUNSWMedicinersquosSchoolofPublicHealthandDeputyChairfortheCollaborationonSocialScienceandImmunisationfoundthereisaneedtolsquodecentralisersquocommunicationsbytapping
translatedmaterialsandinformationaboutthevaccines to be tailored to the needs of people in these newly-emergingcommunitygroups
It was reported that in Wollongong there can sometimesbefourgenerationsoffamilymem-bersfromnewly-arrivedrefugeegroupslivingintheonehouseMostofthesefamilymembersgenerallyhavelimitedEnglishlanguageliteracywhichincreasestheirriskofnotreceivingkeyhealthmessagesandthereforeincreasingthepotentialimpactofCOVID-19-inparticulartheDeltastrainwhichhasprovenhighlyinfectiousamongst household members
Vaccine uptakeNotdissimilartothewidercommunitymorepeopleinourstudywereplanningtohavethevaccinethannotandanumberhadalreadybeenvaccinatedInarecentLancetarticle(February2021)ConcernsandmotivationsaboutCOVID-19vaccinationfindingsfromtwosurveysfromanAustralianlongitudinalstudyconductedinJuneandJuly2020includedthatlsquothetopthreerea-sons for agreeing to vaccinate were lsquoto protect themselvesandothersrsquohelliplsquobeliefinvaccinationandsciencersquohellipandlsquotohelpstopthevirusspreadrsquoEven among those willing to vaccinate there was somehesitancyaboutthesafetyofthevaccineTheLancetarticlenotedthatlsquowillingnesstovaccinatedifferedbybothageandeducationrsquoForthosewhowereindifferentorsaidtheywouldnot get the vaccine the top reasons across the twosurveyswerelsquoconcernaboutthesafetyofthevaccineinitsdevelopmentrsquoandlsquopotentialsideeffectsrsquo12
Olderpeopleinourstudywhocomprised23of the total sample (n=199) were the group most likelytosaythattheywantedtogetthevaccine85ofthoseover65saidtheywouldhaveorhadalreadyhadthevaccineVaccinepredispo-sitionwashoweveralsostrongacrossotherage
12RHDoddKPicklesBNickelECvejicJAyreCBatcupCBonnerTCoppSCornellTDakinJIsautierKJMcCafferyConcerns and motivations about COVID-19 vaccination SydneyHealthLiteracyLabSydneySchoolofPublicHealthFacultyofMedicineandHealthUniversityofSydneypublishedintheLancetFebruary2021p162wwwthelancet cominfectionVol21February2021
theircircumstancesHoweverthesourcesofin-formationthatpeoplemostrelyuponortrustarecriticaltothedisseminationofaccurateandclearmessaging to dispel the fear surrounding events suchasbloodclottingandthemisconceptionsraisedinthefocusgroupsWithsomanypartici-pantsinthisstudygettingtheirinformationfromFacebookandothersocialmediasitesitisvitalthat these channels are used to promote simple positivemessagesandforanyfuturecommunityawareness campaigns
Effective communicationConfusionandmisconceptionsaboutthevac-cinersquosefficacyavailabilityandsafetywereallis-sues that were raised in the focus groups Finding waystoeffectivelycommunicatewithpeoplewithlowerEnglishlanguageliteracyandhealthliteracyisanimportantwaytoaddresstheconfusionandmisconceptionsaboutthevaccineashasbeen discussed in a number of recent Australian studies
Astudy14byMcCafferyetal(2020)concludedthattherearelsquoimportantdisparitiesinCOVID-19-relatedknowledgeattitudesandbehavioursaccordingtopeoplersquoshealthliteracyandlanguagersquoOneofthefindingswasthatlsquopeoplewithlowerhealthliteracywerealsomorelikelyto endorse misinformed beliefs about COVID-19 andvaccinations(ingeneral)thanthosewithadequatehealthliteracyThesamepatternofresults was observed among people who primar-ilyspeakalanguageotherthanEnglishathomersquoTheMcCafferystudyhighlightstheimportanceof tailoring health messages to those with lower healthliteracyandculturallyandlinguisticallydiversecommunitiesItpointsoutthatthereareexamplesofeffectivemanagementofdiversecommunityneedsthatusetailoredhealthmes-sagesandcitestheWesternSydneyLocalHealthDistrictHealthLiteracyHub
13TheEssentialReport-anonlinesurveyconductedbyEssentialResearchcompletedby1090people between 21ndash26 April14McCafferyKJDoddRHCvejicEAyreJBatcupCIsautierJMJCoppTBonnerCPicklesKNickelBDakinTCornellSWolf MS Health literacy and disparities in COVID-19ndashrelated knowledge attitudes beliefs and behaviours in Australia PublicHealthResPract202030(4)e30342012December2020
15 Op cit16 httpssphmedunsweduausitesdefaultfilessphcmNewsEnhancing-supporting-COVID-19-vaccination-programpdf
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
30 31
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3332
intodifferentnetworkingspacessuchaswork-placeslocalgymsmothersrsquogroupsandseniorsrsquoclubswithafocusonallagegroupsregardlessofcurrenteligibilityAccordingtoSealethechal-lengeislsquoensuringemerginginformationisadapt-edfortheintendedaudiencersquoShehasalsosaidlsquoThatrsquoswhatIrsquomalittlebitconcernedaboutatthemomenttherersquosalotofresourcesongov-ernmentwebsitesbutthesetermsaroundbloodclottingareverytechnicalWeactuallyneedtomake sure that we are breaking them down in a waythatwillmakeitmeaningfultopeopleThatrsquosnotjustabouttranslatingitrsquosaboutbeingcon-sciousofpeoplersquoshealthliteracyneedstooSomaybegettingsomemorevisualsintomaterialstotryandsupportthatrsquo17
Thereareanumberofmulticulturalhealthresourcesthatusecommunitylanguagetransla-tionsplainEnglishandvideosfromCALDcommu-nityleaderswhichcanbedownloadedandusedbyservicesandindividualsHowevermanyofthewrittenresourcesstillrelyontechnicalandscien-tifictermsthatrequireareasonablyhighlevelofEnglishlanguageliteracyorhighlevelsofliteracyin the translated language to comprehend Host websites can also be hard to navigate making itdifficulttolocateresourcesfromsimplewebsearchesAsummaryofsomeoftheavailableresourcescanbefoundatAttachment2
MulticulturalHealthUnitsinLocalHealthDis-trictshavestaffwhocanworkwithpeoplefromculturallyandlinguisticallydiversecommunitiesatthelocallevelandtranslateandcontextualisethese materials to the needs of the end user These teams respond to local needs and popu-lationdemographicsandareexpertsineffectivehealthliteracyandhealthcommunicationwiththeirlocalcommunitiesTheyworkcloselywithcommunityandvulnerablegroupstobuildhealthliteracyandimprovedhealthoutcomesintheircommunities
Case Study ndash Be a COVID Warrior ndash Responding to COVID-19 in Multicultural Communities InWollongongtheIllawarraShoalhavenLocalHealthDistrict(ISLHD)MulticulturalHealthSer-viceco-designedacommunityengagementandeducationprogramcalledlsquoBeaCOVIDWarriorrsquowhich commenced in 2020 in response to the pandemic This program was designed to respond tothelowlevelsofhealthliteracyaroundCOVID-19potentialexposuretothevirusandaddressfearandstigmainthelocalCALDcommunitiesThelsquoCOVIDWarriorrsquoprogramreachedaround880peopleranginginagefrom14to85years65ofCOVIDWarriorparticipantswerefemaleand35weremaleCOVIDWarriorparticipantsrepresented 21 language groups The outcomes of the program included increased levels of confidenceinapplyinginfectioncontrolmeasuresincreasedliteracyandhealthliteracyandawarenessofhowCOVID-19istransmittedUltimatelyanimprovedawarenessinapplyingCOVIDsafemeasures was also reported
InApril2020theservicecommencedwelfarechecksviaphoneonafortnightlybasistosup-portsocially-isolatedmulticulturalseniorswhoboretheemotionalstressofsocialisolationFrom these calls the ISLHD heard the needs and concernsofseniorsinthecommunityInadditionourexperiencewithCALDcommunitieshighlightedtheimportanceofyoungpeopleasconduitsofessentialinformationtoadultsincommunityandfamilygroupsduetoEnglishlanguageaccessandeducation
InresponsetheISLHDinitiatedthelsquoCOVIDWarri-orrsquoprogramusingbi-culturalhighschoolstudentsthroughthelocalhighschoolsByincreasingthehealthliteracyofstudentsatschooltheselsquocham-pionsrsquocouldtalktotheirfamiliesincludingolderfamilymembersininformalsettingsandthroughsocialmediawiththeirpeersasastrategytoraisethe level of knowledge of COVID-19 trans-mission preventionandtestingTheprogrambecamesopopularthatitwasextendedintomorelocalhighschools and adults accessing the Adult Migrant EnglishProgramTheprogramwassupportedbylocalsettlementservicesprovidedbybothMaxSolutionsandtheRedCrossItwas
17 httpstheconversationcomhow-can-governments-communicate-with-multicultural-australians-about-COVID-19-vaccines-its-not-as-simple-as-having-a-poster-in-their-language-156097
later extendedtoCALDSeniorsthroughtheMulticulturalCommunitiesCouncilIllawarra(MCCI)supportprograms
AkeycomponentoftheprogramwastoprovideparticipantswithlsquoCOVIDWarriorrsquoKitswhichincludedtworeusablemaskshandsanitiserinfographicsaboutCOVID-19symptomsandinfor-mationaboutwheretestingclinicswereavailablelocallyMCCIandRuralAustraliaforRefugeesdonatedreusablemasksforeveryparticipant
AsthelsquoCOVIDWarriorrsquoprogramwasevolvingsowasthenationalvaccinerolloutplanInforma-tionwasthereforeadaptedtomeetthisinfor-mationgapForexampleadultparticipantsandseniors were supported to understand how to accesstheCOVIDvaccinelsquoeligibilitycheckersrsquoandCALD people were shown how to use the NSW HealthwebsiteCOVID-19informationpages18
Decision makingHowpeoplearecurrentlyconsideringtheriskofCOVID-19isinfluencedbyarangeoffactorsincludingratesoftransmissioninthecommunitynumbersofnewcasesreportsinthemediaofrisksandsideeffectsPeopletendtobasetheirassessmentonwhattheyarecurrentlyexperi-encingandthencheckthisagainstwhattheyarehearinginthemediaincludingandespeciallyonsocialmediaandfromfamilyandfriendsMostoftheparticipantsinourstudyspokeclearlyandarticulatelyabouthowtheyweigheduptherisk-benefitofhavingtheCOVID-19vaccineintheir decision making Low case numbers ndash at the timeofconductingtheresearchndashandasensethat Australia was lsquodoing well in safeguarding the communityagainstCOVID-19rsquoweresignificantfactorsinpeoplersquosdecisionnottobevaccinatedortoadoptalsquowaitandseersquoapproachFamilyfriends and social media were reported as having aconsiderableinfluenceondecisionmakingaswerereportsinthemediaofthebloodclottingsideeffectsofAstraZeneca
ThefactthatFacebookwasreportedlythemostpopularsourceofinformationaboutCOVID-19
18httpswwwhealthnswgovauInfectiouscovid-19Pagesdefaultaspx
andtheCOVID-19vaccineforpeopleinthestudyraisesconcernsaboutthepossibledisseminationofmisconceptionsandlsquofakenewsrsquothatmaybespread or compounded via social media Closed social media groups such as WhatsApp and WeChatwithfamilyandfriendsmayalsoleadtopeoplereinforcingtheirpre-existingbiasesThesefactorscoupledwithasensethatAustraliaisfaringwellcomparedtomanycountriesoverseasappear to have resulted in increased vaccine hesi-tancyamongparticipantsofthestudy
Factorsthatwereidentifiedaschangingvaccine-hesitantparticipantsrsquoperceptionswereanincreased risk from COVID-19 and a correspond-ingincreaseinthenumberofinfectionsandonthebenefitsidetheabilitytotraveloverseastovisitfamilyIntherecentresearchfromtheUniversityofNSWcitedaboveSearlearguesthatlsquotheremaybeotherthingsthatweneedtonowstartfocusingonhellipthatwillstarttopromoteandmotivatepeoplesuchasthechancetotravelmorefreelyforexamplersquoThisappearstobeborneoutbyourfocusgroupfindings19
Untilrecentlytherehavebeenverylowcasenumbers and few lockdowns across most of Aus-tralia and NSW The recent outbreak from mid-JuneinGreaterSydneyandintroductionofthehighlyinfectiousDeltavariantinNSWislikelytoimpactonpeoplersquosassessmentsoftherisk-benefitofhavingthevaccineandonewouldassumereducehesitancyrates
GiventheheightenedcommunityanxietycausedbythisrecentCOVID-19outbreaktheproductionofshortsharpandtargetedmessagingtoCALDgroupsincommunitylanguagesthatisaccessibleandmotivationalfeaturescommunityleadershigh-profilecelebritiesandsportsstarsfromCALDbackgroundsandisdirectedatastate-wideandlocal level would appear to be more urgent than everItisclearthatformessagingtobeeffectiveandreachitsintendedaudiencedistributionchannelsshouldincludeFacebookWhatsAppandothersocialmediaplatformsaswellastrustedsourcessuchasmulticulturalhealthworkersmulticulturalservicesandthroughGPsandMedical Centres If mainstream COVID-19 vaccine
19 Op cit
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
32 33
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3534
awareness campaigns are produced in Australia suchashavebeenproducedinNewZealandtheUnitedKingdomandNorthAmericatheyshouldincludehighprofilewell-knowncommunityfig-uresandsportingstarsfromCALDbackgroundsandincludestrategiesspecificallytargetingCALDcommunitiesincludinggroupsidentifiedaspar-ticularlyhigh-risk
It is also important that informationonvaccinesistranslatedintolanguagesfromnewerandemergingcommunitiesOthersuggestionsaroundreachingthesecommunitiesincludeface-to-facemeetingsorganisedbycrossagencypartnershipsandpeer-ledstrategiessuchas mobilising community champions and influenc-ers Messaging needs to be inclusive and framed around the collective values held by commu-n5
It is clear that reinforcing the benefits of being vaccinated at this time rather than dwelling on the risks is more likely to generate behavioural
changeandapositivevaccineresponsefrombothCALDcommunitiesandthegeneralpopulationAppropriately-designedandtargetedCOVID-19vaccinehealthinformationthatiseasytoreadinanylanguagecanbeconveyedbycommunityleadersandcommunitynetworksandpromotesthepositivebenefitsofgettingvaccinatedwouldbevaluableatthistimeBuildingontheworkofpeerchampionssuchastheCOVIDWarriorprogramisalsoasuccessfulmodeltoincreasingCOVID-19vaccinehealthliteracyandinformed decision making
Mostimportantlypositivelymotivatingculturallyandlinguisticallydiversecommunitymemberstolsquogetthejabrsquoespeciallythosewhoareadoptingalsquowaitandseersquoapproachorarevaccinehesitantwould lead to greater vaccine uptake among culturallyandlinguisticallydiversecommunitiesandthereforethecommunityasawhole
Inner West Multicultural Network Addison Road Community Centre DateWednesday12May
A focus group session of members of the Inner WestMulticulturalNetworkpluscustomersoftheFoodPantryatAddisonRoadwasheldattheAddisonRoadCommunityCentreinMarrickvilleon12Mayat200pmThesessionwaspartoftheregularmeetingoftheInnerWestMulticul-turalNetworkTheconsultationinvolvedabout26peopleandwasconductedbyRosannaBarbero
Thegroupbrainstormedresponsestoquestionsaroundvaccinehesitancyinmulticulturalcom-munitiesandmoreeffectivemessagingTheseresponseshavebeenincorporatedinthefindingsof the report
Griffith Women on Fire Focus Group Griffith Community Centre DateFriday14May
This small focus group of women was held at GriffithCommunityCentreonMay14at11amMargCouchSeniorProjectOfficerRegionalDevelopmentAustralia(RDA)-RiverinaandJoanneFitzpatrickSettlementEngagementandTransitionSupport Worker from Centacare Southwest NSW werethekeylinksandnetworkcontactsfortheGriffithcommunityTheWomenonFire(WOF)group was established as part of the Red Cross RuralFireServiceprogramlsquoManyCulturesOneCommunityrsquoInitiallyitwasestablishedtoeducatewomenonemergencypreparednessandtoen-courage NSW Rural Fire Service (RFS) volunteering andnowhastransformedintoacommunityac-tionsupportgroupTheGriffithSoroptimistInter-nationalnowauspicetheirfinancesandsupporttheWOFgroupactivitiesThefocusgroupwasfacilitatedbyCamillaCouchandlocalcommunityvolunteersledbytheGriffithSoroptimistClub
The women in the group were from Pakistan and IndonesiaThegroupweremainlyyoungmotherswithyoungchildrenandtheprogramhadchild-minding arrangements The language level of the womenwaslowandmostwerestudyingESOLat
ATTACHMENTS
ATTACHMENT 1 A Description of the Focus Groups
TAFEThedeliveryoftheinformationwaslimiteddue to language levels and the lack of bilingual interpretersEachparticipantworkedoneononewithavolunteertoslowlyfillinthesurveyandonewomantookthesurveyhometodiscusswithherhusbandThisgroupexperiencehighlightedthe lack of bilingual workers and services in some rural areas
Arabic speaking group Syd West Multicultural Services Mount Druitt Community worker Zaid Naoum Generalist Caseworker SydWest Multicultural Services DateMonday24May
ThefocusgroupfromSydWestMulticulturalSer-viceswasconductedonMonday24May2021atSydWestMulticulturalServicesMountDruittat300pmItwasfacilitatedbyPatriciaMcCormickandsupportedbyZaidNaoumGeneralistCase-workerSydWestMulticulturalServices
Therewere10womenandmenfromSyriainthegroupThegroupweremostlymaturetoolderparticipantsMostparticipantsrequiredassistancewithEnglishandthecaseworkerZaidNaoumhadtranslatedthesurveyintoArabicpriorto the focus group Zaid also translated during the focus group
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Canterbury City Community Centre (4Cs) group The Cottage Lakemba DateTuesday25May
ThefocusgroupfromCanterburyCityCommunityCentre(4Cs)wasconductedonTuesday25MayattheCottageat28CroydonStreetLakembaat10amItwasfacilitatedbyRobinMilesandsup-portedbyRomanaWaseemCommunityWorkerfrom 4Cs
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
34
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3736
The group was comprised of 14 women from PakistanIndiaandSriLankaThewomenrangedinagefrom23to65MostwerefluentEnglishspeakershoweveronewomanrequiredtransla-tionintoUrdufromoneoftheotherwomeninthegrouptoanswerthequestionsdirectly
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
NSW Chaldean League group Community worker Randa Goriya DateTuesday25May
ThefocusgroupfromNSWChaldeanLeagueMountDruittwasconductedonTuesday25May2021 at 1000am at the NSW Chaldean League premisesItwasfacilitatedbyPatriciaMcCormickandsupportedbyRandaGoriyaacommunityworker for the NSW Chaldean League in Mount DruittRandatranslatedtheintroductionandpromptsforthediscussionandhelpedthepartic-ipantstocompletethesurveyMostofthegrouprequiredhelptodothesurvey
ThegroupoftwelveparticipantswereallChaldeanandwerematuretoolderinageTheywereamixed-gendergroup
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Arabic speaking group Red Cross premises Wollongong DateTuesday25May
ThefocusgrouptookplaceonTuesday25Mayat 3pm at the Red Cross premises at Wollongong Therewere22womenandmenparticipatinginthegroupThefocusgroupwasfacilitatedbyCamilla Couch with support from Khalid Zainu-labdeenBilingualSupportWorkerHumanitarianSettlementProgram(ACTampNSW)
There were diverse ages in the group ranging fromyoungpeopletoolderagedMostofthegroupwereyoungerrecently-arrivedrefugeesfrom diverse backgrounds There was also a small-eroldercohortofparticipantswithhigherliteracylevelsandstrongercommunityengagementwith the local services in the area Camilla Couch facilitated the focus group which was conducted inArabicandEnglishwiththeArabictranslationprovidedbyKhalidZainulabdeen
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Work Opportunities for Women group Mt Druitt TAFE DateWednesday26May
TheWorkOpportunitiesforWomen(WOW)focusgroupwasheldonWednesdayMay261100ndash 100pmatMtDruittTAFEItwasfacilitatedbyCamilla Couch and built on the knowledge gainedintheprevioussessiononcriticalandanalyticalthinkingTheWOWgroupisaTAFECertificatelevel course
There were 14 women from diverse cultural backgroundsinthegroupThegroupweremainlyMuslimwomenwithschoolagechildrenandsome were mature aged Due to the learning fo-custhegroupwasfacilitatedasaclasswithguid-eddiscussionontheissuesandcarefulanalysisofthequestionsNotranslationwasneededduetotheeducationalcontextThestudentswereadeptatusingITandcompletedallthesurveysonline
STARTTS Tamil group Toongabbie Community Centre Community worker Sivaharani (Harani) Mayuran DateThursday27May
Thefocusgroupconsistedof18femalepartic-ipantswhowereyoungertomatureagedThefocus group was held at 1000am at Toongabbie CommunityCentreinTargoRdToongabbie
ThefocusgroupwasfacilitatedbyPatriciaMc-CormickandsupportedbyacommunityworkerSivaharani(Harani)MayuranfromtheSTARTTSTamil Group
ThegrouphadmixedlevelsofspokenandwrittenEnglishTheintroductionanddiscussionpromptsweretranslatedbythecommunityworkerSivaha-rani(Harani)Mayuranandsheandthemorepro-ficientstudentssupportedthosewithlowliteracytoanswerthesurveyquestions
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Spanish Speakers Seniors group SydWest Multicultural Services Blacktown DateTuesday1June
TheFocusGrouptookplaceonTuesday1Juneat1100amattheBlacktownShowgroundsandconsistedof16participants(15womenandoneman)AllparticipantswerebornincountriesinSouthAmericaTheirEnglish-fluencylevelsvariedand one of the members of the group translated thesurveyquestionsanddiscussionintoSpanish
ThegrouphadbeenmeetingforseveralyearsThegroupwasfacilitatedbyLindyCassidyandwassupportedbySreeVithyaHarilingamDayRespiteampSocialSupportTeamLeaderatSydWestMulticulturalServicesBlacktownThegroupwerematureagedtoolderparticipants
Thegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyform There was a more focused discussion on somekeyquestionsaftersurveycompletionThetranslatorassistedconsiderablyinthisprocess
Italian Speakers group Warrawong Community Centre DateMonday7June
The focus group of Italian speakers was held on Monday7Juneat1015amattheWarrawongCommunityCentreItwasfacilitatedbyCamillaCouchandsupportedbyJohnPaulTroianiand
SofiaLemafromIllawarraShoalhavenLHDMulti-cultural Health
There were 15 women in the group The group weremostlymaturetoolderparticipantsandwasconductedinItalianandEnglishwithtranslationprovidedbyJohnPaulThisgroupmeetsregularlyandissupportedbyanumberofservicesintheareaespeciallymulticulturalhealth
The group had a general facilitated discussion aboutthequestionsinthesurveyDuetolittleornoliteracytheindividualsurveyresponseswerethencollectedintooneresponseThesesurveyresponses have been included in the general surveyresponses
Mothers Group SydWest Multicultural Services Blacktown DateThursday10June
ThefocusgrouptookplaceonThursday10Juneat1030amandconsistedof14youngwomen13 of whom had a CALD background The focus groupweremainlymothersfromasupportgroupatSydWestMulticulturalServicesinBlacktown
EightofthewomenwereborninIndiatwofromPakistantwofromSriLankaonefromHausaGhana and one was born in Australia (the Austral-ianbornyoungwomanwasasocialworkstudenthelpingwiththegroup)LindyCassidyfacilitatedthe group with support from Wilma Garguath a projectofficerfromSydWestMulticultural Services
The group varied in age One was between 18-24 yearsoldSevenwereagedbetween25-34yearsSixwereagedbetween35=44yearsGiventheirage and circumstances most of the group did not consider themselves eligible at this stage for vac-cinationThiswasanimportantdifferencefromotherfocusgroupsinthattheemphasiswasmoreonwhattheywoulddooncetheybecameeligible
Participantsdidnotrequireassistancewithspo-kenEnglishThegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyformTherewasamorefocuseddiscussiononsomekeyquestions
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3938
ATTACHMENT 2 COVID-19 Vaccine Information in multiple languagesThefollowingsitesappsprovidetranslatedinformationaboutCOVID-19vaccines
Type of information KeyinformationongettingvaccinatedinNew South Wales and on the vaccines available The websiteusesanautomaticservicetotranslate thecontentintodifferentlanguages
Source of information NSW Government website
Link httpswwwnswgovauCOVID-19health-and-wellbeingCOVID-19-vaccina-tion-nswgetting-vaccinated
Type of information COVID-19ResourcessectionontheServiceNSWapp The app has a link to NSW Government websiteinformationonldquoGettingaCOVID-19vaccinationrdquo(seeabove)ItalsoincludesalinktoCOVID-19vaccinationresourcesinotherlan-guages available from the Department of Health
Source of information Service NSW NSW Government
Link Service NSW App
Type of information ArangeoftranslatedresourcesonCOVID-19bytitleincludingafactsheetonCOVID-19VaccineAstraZeneca(ChAdOx1-S)
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCOV-ID-19Pagestranslatedresources-by-titleaspx
Type of information ADigitalCOVID-19resourcelibrarywithtranslated materials
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiouscov-id-19Pagesdigital-resourcesaspx
Type of information AMultilingualCommunityToolkitontheCOVID-19vaccinationprogramtoassist communityworkersprovideseasytoreadresourcesvideosandlinkstokeyservicesandresources
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCovid-19DocumentsNSW-COVID-19-vaccina-tion-program-presentation-20210527pdf
Type of information TheNSWMulticulturalHealthCommunicationServiceoffershealthresourcesandinformationin a wide range of languages It has translated resources on COVID-19 and links to translated resourcesonCOVID-19vaccination
Source of information MulticulturalHealthCommunicationServiceisa New South Wales-wide health service hosted bySouth-easternSydneyLocalHealthDistrict(SESLHD)
Link httpswwwmhcshealthnswgovau
Type of information COVID-19vaccineinformationaddressingkeyquestionsaboutCOVID-19vaccinationandincludesvideosposterstilesfactsheetsandaudio material Translated into 63 languages
Source of information Department of Health Australian Government website
Link httpswwwhealthgovauinitiatives-and-pro-gramsCOVID-19-vaccinesCOVID-19-vaccine-in-formation-in-your-language
Type of information ThisinformationaddressessomecommonmisinformationaboutCOVID-19Translatedintomultiplelanguages
Source of information DepartmentofHomeAffairs Australian Government website
Link httpscovid19inlanguagehomeaffairsgovaumisinformation-and-truths-about-coronavirus
Type of information Australianandinternationalnewsand informationaboutCOVID-19andCOVID-19 vaccinesisavailableontheSBSCoronavirusPortal in more than 60 languages
Source of information SBSwebsite
Link httpswwwsbscomaulanguagecoronavirus
Type of information InformationprovidedaboutCOVID-19vaccinerolloutandsafetyinlanguagesotherthan English
Source of information Department of Health and Human Services Victorian Government
Link httpswwwcoronavirusvicgovautranslat-ed-information-about-COVID-19-vaccines
Type of information HealthTranslationsprovidestranslatedmateri-alsonhealthandwellbeingInformationaboutCOVID-19isregularlyupdatedincludessomeinformationonvaccinationandisavailableinover60communitylanguages
Source of information Victoriangovernmentinitiative
Link httpswwwhealthtranslationsvicgovaubhcv2bhchtnsfPresentEnglishResource-AllOpenampx=amps=Coronavirus
Type of information A one-stop shop for translated materials in multiplelanguagesonCOVID-19
Source of information Ethnolink Language Services
Link httpswwwethnolinkcomauCOVID-19-coro-navirus-translated-resources
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
40
Issues barriers and perceptions about
the COVID-19 vaccine among culturally and linguistically diverse
communities in NSW
iii ACKNOWLEDGEMENTS
1 EXECUTIVE SUMMARY
5 RECOMMENDATIONS
6 RESEARCH SUMMARY INFOGRAPHIC
8 INTRODUCTION
9 METHODOLOGY
Recruitment for the focus groups 9
A word about the research design 11
Demographicsofresearchparticipants11
14 FINDINGS
Having the vaccine or not 14
Reasons for having the vaccine 17
Reasons for not having the vaccine 18
Vaccine refusal 20
Other factors considered 21
Knowing someone who has been vaccinated 22
Knowing someone who has had COVID-19 23
Knowing where to get vaccinated 24
SourcesofinformationaboutCOVID-19 and the vaccine 25
29 DISCUSSION
35 ATTACHMENTS
ATTACHMENT 1 ADescriptionoftheFocusGroups35
ATTACHMENT 2 COVID-19VaccineInformationinmultiplelanguages 39
CONTENTS
AUTHORS NOTE
ThisreporthasbeenwrittenbyRobinMiles LindyCassidyandAudreyBennettwithinputtothecontentandrecommendationsfrom Dr Camilla Couch and Patricia McCormick
ACKNOWLEDGEMENTS
ThisresearchconductedbySocialEquityWorkshasbeencommissionedbytheNewSouthWalesCouncilofSocialService(NCOSS)andfundedbyNSWMinistryof Health
The research team would like to thank the following services who helped to set up the focus groups The research team is indebted to these ser-viceswhoopenedtheirdoorstotheresearchteaminashorttimeframebetweenMayandJune2021andinparticularcollaboratedonthefacilitationoffocusgroupswiththeircommunitymembersincludingsup-portingtheteamwithspokenandwrittentranslationandbilingualfacilitation
Rosanna BarberofromAddisonRoadCommunityCentreMarrickville
Romana WaseemfromCanterburyCityCommunityCentre(4Cs)Lakemba
Marg CouchSeniorProjectOfficer Regional Development Australia (RDA)-Riverina
Joanne FitzpatrickfromGriffithWomenonFireGrif-fithCommunityCentreGriffith
Randa GoriyafromtheNSWChaldeanLeagueMtDruittTAFECampusMtDruitt
Khalid ZainulabdeenfromRedCrossNSWACTWol-longong
Sivaharani (Harani) Mayuran from STARTTS deliveredatToongabbieCommunityCentreToongabbie
Sree VithyaHarilingam Wilma Garguath and Zaid NaoumfromSydWestMulticultural CommunityServicesMtDruittandBlacktown
Sofia Lema and John Paul Troiani from Illawarra ShoalhavenLocalHealthDistrictWollongongdeliveredattheWarrawongCommunityCentre
Leissa PittsManagerISLHDMulticulturalHealthandRefugee Health Service
Talei VulathaCommunityResilienceProject OfficerMulticulturalCommunitiesCouncilIllawarra
Wewouldespeciallyliketothankthe167peoplewhoparticipatedinourfocusgroupsallofwhomweregenerouswiththeirtimeandpassionateclearandfearlessinthefeedbacktheyprovidedtotheresearch-ers about the COVID-19 vaccine
RESEARCH TEAMProject Lead Robin Miles
Qualitative Research Team Dr Camilla Couch Patricia McCormick LindyCassidy
Expert Multicultural Advisor Paula Abood
Research Assistant AudreyBennett
REPORT DESIGN Cath Appleton Design
i
1
Australiahasbeenverysuccessfulinstemmingthespreadofthevirusthroughacombinationofborderclosuresquarantineafirst-worldhealthsystemandexpertcontacttracing
ItispossiblethatwerethisresearchconductedtodaythishesitancywouldbereducedduetotheheightenedriskofcontractingCOVID-19throughthe more transmissible Delta variant and its pres-enceinthecommunity
Regardlesstheneedforvaccinetake-upamongCALDcommunitiesremainshighgiventheycanbe at increased risk due to factors such as in-securehigh-riskemploymentandlivinginhighdensityhouseholdsandtoensureequitablepublichealthoutcomesandsocialeconomicandcommunityparticipationforeveryone
Thiswasasmallstudyof199people(oursam-ple)drawnfromculturally-diversecommunitiesinmetropolitanSydneyandtworegionalNSWlo-cationsCommunitymemberswereaskedsurveyquestionseitheronlineorthroughfocusgroupsSeparateinformationwasalsocollectedfromintermediaryorganisationsworkingwithCALDcommunities(viaasecondsurvey)
ThestudyrsquospurposewastounderstandissuesbarriersandperceptionsinrelationtotheCOV-ID-19vaccineamongNSWrsquosmanyculturallyandlinguisticallydiverse(CALD)communitiesAssuchitpresentsagrassrootsperspectiveKeyfindingsarepresentedbelow
CALD communities have mixed responses to the vaccineLikethegeneralpopulationourstudyhighlightsthat NSW residents from CALD backgrounds are mixedintheirresponsestoandconfidenceinhavingtheCOVID-19vaccine
EXECUTIVE SUMMARY
This research was conducted between late April and early June 2021 just prior to the most recent outbreak in Sydney of the Delta variant of COVID-19 Many participants in our study who were unwilling or hesitant to be vaccinated expressed the opinion that COVID-19 was not a lsquoreal and present dangerrsquo in Australia due to the very low case numbers active at the time
FIGURES10 Figure 1
Country of Birth
11 Figure 2 Language spoken at home
12 Figure 3 Length of time living in Australia
12 Figure 4 Age
13 Figure 5 Gender
14 Figure 6 Are you going to get the COVID-19 vaccine
15 Figure 7 COVID-19 Vaccine intention of respondents by age category
16 Figure 8 Respondents COVID-19 Vaccine intention by Country of Origin
17 Figure 9 Reasons for getting vaccinated against COVID-19
18 Figure 10 Reasons for not getting vaccinated against COVID-19
22 Figure 11 Do you know someone who has been vaccinated
23 Figure 12 Knowing someone who has had COVID-19
24 Figure 13 Who do you know who has had COVID-19
25 Figure 14 Where to go to get vaccinated
25 Figure 15 Sources of information about COVID-19 and the COVID-19 vaccine
27 Figure 16 Sources of information for respondents who were planning to have the vaccine
27 Figure 17 Sources of information for respondents who are not planning to have the vaccine
28 Figure 18 Sources of information for respondents who lsquodonrsquot knowrsquo if they will have the vaccine
1StephenDuckettToo many Australians are hesitant to get vaccinated Herersquos how we fix itSydney MorningHeraldMay192021
TABLES10 Table 1
Focus Group Details
15 Table 2 People in the sample already vaccinated
15 Table 3 Vaccine refusal and hesitancy in the sample
20 Table 4 Vaccine refusal by country of birth and language background
21 Table 5 Reasons for not having the vaccine
22 Table 6 Who do you know who has been vaccinated
1
58 of people in our sample reported that they would be having the vaccine
This included 13 people (64) who had already been vaccinated in most cases having had their first vaccination only
42 reported that they were unsure or were not planning to have the vaccine
Of these 29 were unsure or hesitant
13 reported that they would not have the vaccine
ThiscomparescloselytorecentdatapublishedbyTheAgeandSydneyMorningHeraldthatsug-gests lsquoabout a third of Australians are hesitant aboutgettingaCOVID-19vaccinersquo1
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
32
A range of factors appear to influence attitudesOlderpeople(65+)inthesurveysampleweretheagegroupmostlikelytoreporttheyhadhadorwereintendingtohavethevaccinewhileyoung-erpeople(18-24)weremostlikelytoexpressuncertaintyorhesitancy
Countryofbirthalsoshowedupasapossibleindicatorforbeinglsquopositivelypre-disposedrsquoto-wardsvaccinationandwouldbeworthyoffurtherresearch
Knowing someone who had had the virus or been vaccinateddidnrsquotappeartomakerespondentsmorelikelytogetthevaccinethemselves
Themostfrequentlycitedreasonsforgettingthevaccinewereamixofpersonalsafety(lsquokeepingfamilyself-safersquo)altruisticreasons(lsquoforpublichealthrsquoandlsquoitistherightthingtodorsquo)andthemoremotivationalreasonlsquototravelrsquo
AcrossCALDcommunitiesthereisagoodlevelofpracticalknowledgebutstillsomeuncertaintyaboutwheretoaccessvaccinations
Focusgroupparticipantsgenerallyindicatedfamiliaritywiththe2typesofvaccinesavailableandtherisksassociatedwitheachparticularlyre-gardingAstraZenecandashalthoughthiswasnotablynotthecaseforagroupofnewly-arrivedrefugeeswhohadlittleornoknowledgeofvaccinationsforthe virus
Over 80 of respondents knew where to go to getvaccinatedincludingGPsthevaccinationhubforSydneyresidentsandlocalhospitalsHowev-eraconcerning19reportedthattheydidnotknow where to get vaccinated
Fears and concerns about vaccinations remain Despite high rates of knowledge about COVID-19 acrossourstudysamplearangeofconcernsandmisconceptionsndashsharedwiththewiderpopula-tionndashwereevidentTheseincluded
FearaboutbloodclotscausedbytheAstraZeneca vaccine
Fearabouttheperceivedlackoflsquoproperrsquotestingofthevaccinepriortorollout
Lackofcertaintyabouthowthevaccineworks
ConcernsthatthevaccinewillmakeyousickorchangeyourDNA
Concern that the vaccine is a form ofgovernment control
Abeliefthatifyouarehealthyitisbettertofightthevirusandmakeyourselfandyourimmunesystemlsquostrongerrsquoasaresult
Onlyasmallnumberofpeopleinthesurveysample reported that religious or cultural reasons were a barrier to having the vaccine
Public health information can be confusingThefocusgroupshighlightedthatconflictingpub-licmessagingoverly-complexinformation(evenwhentranslated)ornotenoughtargetedinformationwerefactorsinvaccinehesitancywithcomments including
The importance of social and mass mediaAcrossallrespondentsthemostfrequently-citedsourceofinformationregardingCOVID-19nominatedby417wasFacebookAmongthosenotintendingorhesitanttohavethevaccinelsquoFacebookrsquoandlsquoMyfriendsrsquowerenominatedasthemostcommonlyrelieduponsourcesofinformationForthoseintendingtohavethevaccineSBSTVwasthemostfrequently-citedsourceofinformation
The focus group discussions further highlighteddifferentapproacheswithregardstohealth
informationthatneedtobeconsideredinthecontextofpublicmessagingAnumberofgroupsdiscussedusingtheirGPsforhealthinformationandhealthcarebutalsorelyingontheinternet(includingfitnessandwellbeingsites)FacebookandothersocialmediasuchasWhatsAppandWeChatassourcesofhealthinformationYoung-erfocusgroupparticipantsalsospokeaboutobtaininginformationfromadditionalsourcesincluding Tik Tok and Instagram
TelevisionnewslocalnewspapersandcommunitygroupswerealsohighlyregardedassourcesoflsquoaccuratersquoinformationSomefocusgrouppartici-pantsidentifiedusingmainstreammediasourcestolsquofactcheckrsquowhattheywerehearingonsocialmediaLocaltelevisionnewswasparticularlyimportantinregionallocationswherepeoplewantedtoknowwhatwashappeninglocallyandhowitwouldaffectthem
Government websites are not the lsquogo-torsquo source of informationGovernmentwebsiteswerementionedinthelsquootherrsquocategoryofprimarysourcesofinformationnominatedbylessthan10ofresearchrespond-entsThissuggeststhattheyarenotthepreferredlsquosourceoftruthrsquoforCALDcommunitiesAscanof government health websites indicates that a rangeofusefulresourcesconcerningCOVID-19includingforCALDcommunitiesandorganisa-tionssupportingthemhavebeendevelopedHoweverasourexperienceandotherresearchtellsusthesewebsitescanbedifficulttonav-igaterelyonacertainlevelofdigitalinclusionanddigitalliteracyskillstheinformationprovidedcanbecomplextounderstandornotineasy-readformatsndashinvolvingtechnicaltermsandjargonand placing something on a website does not nec-essarilymakeitaccessibletoparticulargroupsinthecommunityevenwhentranslated
Targeted tailored messaging is essentialOtherrecently-publishedresearchconcerningCOVID-19andCALDcommunitiessupportsfindingsfromoursurveyandfocusgroupsandcontainskeyinsightsrelevanttocommunicatingpublichealthinformationThisincludes
ResourcesavailableonwebsitesoftenrelyonahighlevelofEnglishlanguageliteracyorliteracyinapersonrsquosfirstlanguage
The importance of tailoring messaging tothosewithlowerlevelsofhealthliteracywhoaremorelikelytoendorsemisinformedbeliefsaboutCOVID-19andvaccination
Massmediacampaignsshouldbeutilisedbutsupplementedbydecentralisedcommunicationstrategiesthattapintolocalsupport networks
Theneedtoconveyinformationinawaythatismeaningfultopeopleusingtrustedcommunitysourcesandmultiplechannelstoreinforce messages
Drawing on motivational factors is keyOncloserinspectiontheresultsofourstudysuggestthatvaccinehesitancyisperhapsbetterunderstoodaslowmotivationndashoralsquowaitandseersquoapproachManyparticipantssaidthattheywould consider having the vaccine if there was lsquomoreofareasonrsquotodoso
Reasonsgivenbyparticipantsthatwouldmoti-vate them to get vaccinated included
Manyparticipantsevensomewhowerethemostvaccinehesitantsaidthatifbeingfullyvaccinat-edmeantthedifferencebetweenbeingabletotraveloverseastovisitfamilyornottheywoulddefinitelyrolluptheirsleevesandgetlsquothejabrsquo
If I was able to travel to see my
family If there was more risk from COVID-19 ndash another outbreak or
concern about increased
transmission
If I had to in order to keep my job
Nobody knows what to do My GP doesnrsquot even
know what I should do whether I should
have it or not
They say one thing and then they tell you
something elsehellipit (the vaccine rollout) is
so confusing
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2 3
EXECUTIVE SUMMARY
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
54
RECOMMENDATIONS
Againthisalignswithotherresearchwhichemphasisestheimportanceofbuildingmotiva-tionalandlsquopullrsquofactorsintothevaccinerolloutstrategyandaccompanyingmessaginginorderto increase vaccine uptake among CALD com-munitiesInvolvingcommunitiesintheprocessunderstandingconcernsandmotivationalfactorsbuildingtrustandtestingmessaginghavebeenidentifiedaskey
If I could get home to see my mother I would get
vaccinated today
ThisresearchisintendedtoprovideausefulgrassrootsperspectivefromarangeofCALDcommunitiesacrossNSWonissuesbarriersandperceptionsconcerningtheCOVID-19vaccineItishopedthatthesefindingscontributetoagrow-ingbodyofknowledgeregardingCOVID-relatedissuesforNSWrsquosculturally-diversecommunities
The research has highlighted that reinforcing the benefitsofbeingvaccinatedratherthandwellingontherisksismorelikelytogeneratebehaviouralchangeandapositivevaccineresponsefrombothCALDcommunitiesandthegeneralpopulationIt also reminds us of the immense value of the
direct and early engagement with specialist local multicultural and state-wide ethno-specific community organisations in the development and rollout of any public health campaigns
strategies to ensure community involvement in and ownership of any campaigns with trusted sources such as local community leaders and peer champions
tailored targeted messaging across multiple platforms and channels available in easy-to-read format for English and translated versions
supporting health care professionals in their role as educators and leveraging successful local programs that increase COVID-19 vaccine literacy and informed decision making
further research to understand concerns misconceptions and motivations of priority groups
1
2
3
4
5
long-standingtrustandstrongrelationshipsthatexistbetweenlocalplace-basedservicesandthecommunitiestheyworkwithndashcloseconnectionsthatshouldbeutilisedtoadvancepublichealthoutcomes
InthiscontextitisrecommendedthatNSWHealthinpartnershipwithMulticulturalNSWCALDpeakbodiesandcommunityleadersusethisresearchtoinformongoingeffortstoencour-age uptake of the COVID-19 vaccine among CALD communitiesThefindingsindicatethattheseeffortscouldbesupportedby
4 5
Motherrsquos Group at SydWest Multicultural Community Services Blacktown
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
76
HEALTH INFO
Health information from online sources (low use of government websites)
Main stream media
Younger group
Tik Tok
58 said yes to the vaccine with 64 previously vaccinated
= 2 people
29 were unsure or hesitant
13 reported that they would not have the vaccine
Issues barriers and perceptions about the Covid-19 vaccine among culturally and linguistically diverse communities in NSW
if I could get
home to see my
mother I would
get vaccinated
today
Covid is not
real and present
danger but I would
get vaccinated if
there was a
reason too
I would get vaccinated
FEARS amp CONCERNS about the
vaccineFear about blood clots
caused by the Astra Zeneca
vaccineFear about
the perceived lack of lsquoproperrsquo testing of the
vaccineLack of
certainty about how the vaccine
workedConcerns
that the vaccine will make you sick or change
your DNA
Concern that the vaccine
is a form of government
controlA belief that if you were
healthy it was better to fight the virus and
make yourself and your immune system
lsquostrongerrsquo as a result
if there was more risk from Covid ndash another outbreak or concern about increased transmission
199participants
11focus groups
if I had to in order to keep my job
if I was able to travelto see myfamily
More likely to get the vaccine
+65 age groupThis small study of 199 people from a range of cultural backgrounds in
metropolitan Sydney and two regional locations
found that the community is divided in its response to both the safety need
and efficacy of the vaccine
Almost half of the participants knew someone who had contracted COVID-19 over-seas Many people spoke about the impact of COVID-19 on their immediate family including some who had lost loved ones
Influence of friends and family overseas
2 3
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
98
This research project has been commissioned by the New South Wales Council of Social Service (NCOSS) to look at issues concerns attitudes and barriers to receiving the COVID-19 vaccine in culturally and linguistically diverse (CALD) communities in NSW
The research was conducted over two months fromlateApriltolateJune2021withdatacol-lectedjustpriortothelatestCOVID-19outbreakinSydneyItwasundertakenwithsomeurgencygiven the following factors
the lack of data concerning peoplefromculturallyandlinguisticallydiverse backgrounds in larger research studies 2
theheightenedconcerninthecommunity aboutthepotentialsideeffectsofin particulartheAstraZenecavaccinewhich has led to a higher-than-usual rate of vaccine hesitancyinthewidercommunity3
theneedtolifttheoverallvaccinationratein Australia
Emergingresearchindicatesthatmisconceptionsabout COVID-19 in Australia tend to be more common in groups with lower levels of health literacyincludingpeoplewhospeakalanguageotherthanEnglishInadditionthevariedexperi-enceofandinformationaboutCOVID-19trans-missionandvaccinationinoverseascountriesmakesthisaparticularlyinterestingissuegiventhatCALDcommunitymembersmaybehavingregulardiscussionswithrelativesoverseasandgettinginformationaboutCOVID-19fromover-seas sources
2McCafferyKJDoddRHetalHealth literacy and disparities in COVID-19ndashrelated knowledge attitudes beliefs and behaviours in AustraliaPublicHealthResPract202030(4)e30342012 December 2020 First published5 November 2020lsquoThereareseverallimitationstoourstudyAlthoughourrecruitedsamplewaslargeanddiverseitwasnotstatisticallyrepresentativeoftheAustralianpopulationTheproportionofAustraliansfromnon-Englishspeakingbackgroundswassmall(6)sincethesurveywasnottranslatedandrequiredsufficientEnglishskillstocompletethequestionnaireinEnglishrsquo(p7)
3AnonlinesurveyconductedbyEssentialResearch(April2021)completedby1090peoplebetween21ndash26April2021foundjust43ofAustraliansthinktherolloutisbeingdoneefficientlydownfrom68inMarchhellipTheslowrolloutandchanges to the roadmap also appear to have given rise to vaccinehesitancywithoneinsixpeople(16)sayingtheywillnevergetvaccinatedagainstCOVID-19upfrom12lastmonthwhile42saidtheywillgetvaccinatedbutnotrightawayTheproportionofpeoplewhowouldbewillingtogetvaccinatedassoonaspossibleorarealreadyvaccinatedalsodeclineddownfrom47to42rsquoEssentialReport(April 2021)
A mixed-method research methodology was used for this project However it was primarily a qualitative approach that aimed to hear directly from people in the community from culturally and linguistically diverse (CALD) backgrounds The methodology involved
METHODOLOGY
11 focus groups (including one pilot) involving atotalof167participantsfromCALD backgroundsand7locationsGriffith(1) Wollongong(2)Blacktown(2)Lakemba(1) MtDruitt(3)Toongabbie(1)andMarrickville (1)Thesesupportedparticipantstoanswer thesurveyquestionsandenabledmore detailedexplorationofissuesandfurther gatheringofqualitativeinformation(see Table1below)Identifiedmulticulturalandcommunityserviceorganisationswith connectionstoCALDcommunitiesinthe relevantlocationsactedaslsquointermediariesrsquo byassistingwithorganisingthefocusgroups providingbilingualfacilitationofdiscussion andsupportingcommunitymembersto undertakethesurveyMoreinformationonthefocusgroupsandintermediary organisationscanbefoundatAttachmentA
Anonlinesurveywiththesamequestionsas those used in the focus groups was made available This was promoted via NCOSS networksandtheresearchteamrsquosCALD connectionsandcompletedby32peopleThe totalsamplesizeofthisstudywastherefore 199participantsmadeupofmembersof diverseCALDcommunities
Abilingualmulticulturalcommunity engagementexpertwasengagedthroughout theprojecttoadvisetheresearchteam includinginrelationtothedesignofthe surveyBilingualfacilitatorswereusedfor focusgroupswherenecessaryandguidance wasprovidedbyintermediaryorganisation representativesasrequiredandinone instancethesurveywastranslatedintoArabic Focus group members were each provided witha$25giftcardattheendofthesession anda$50giftcardwasdonatedtothe intermediaryorganisationtoprovidesome additionalresourcestoeachgroup
Asecondonlinesurveywasdesignedtoelicit theviewsandexperienceoftheintermediary organisationsintheirworkwithCALD communitiesItgeneratedeightresponses
Two interviews were undertaken with a multiculturalhealthcommunicationexpert from the Illawarra Shoalhaven Local Health DistrictandanEmergencyDepartment medicalpractitioner
Theonlinesurveyresponsesfromthe intermediaryorganisationsandtheinterviews withhealthstaffhaveinformedanalysisof datafromcommunitymembersfindingsand recommendations
Inadditiontheresearchhasbeeninformedbyotherpubliclyavailableresearchincludingfind-ingsconcerningvaccinehesitancyanduptake4andascanofmulticulturalCOVID-19healthresourcesavailableincommunitylanguagesfromtheCommonwealthNSWandVictorianGovern-mentsSBSandEthnolink(seeAttachment2)
Recruitment for the focus groups IntermediaryorganisationsandfocusgroupparticipantswererecruitedusingtheresearchteamrsquosextensiveconnectionswithmulticulturalandcommunityserviceorganisationsacrossNSWanddrawingonkeyNCOSSmemberorganisa-tionsprovidingsupporttoandwithlongstandingrelationshipswithCALDcommunitiesToalargeextenttheselectedlocationsandtheservicesandsupportsprovidedbytheintermediaryorgan-isationsdeterminedtheculturalbackgroundsthatwereincludedinthestudy
4 httpswwwncossorgauCOVID-19-research
INTRODUCTION
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1110
Service Location Group Composition Participant numbers
Addison Road Community Centre Marrickville Community leaders - Vietnamese Chinese Italian Greek Indonesian Latin American and Portuguese speakers
26
Griffith Community Centre Griffith Indonesian and Pakistani women 6 Multicultural Communities Council Illawarra
Wollongong Arabic-speaking group 22
Multicultural Communities Council Illawarra
Wollongong Italian older womenrsquos group 15
Syd West Multicultural Services Mt Druitt Arabic-speaking group 10 Syd West Multicultural Services Blacktown Spanish-speaking seniorsrsquo group 16 Syd West Multicultural Services Blacktown Mothersrsquo support group -
Indian Sri Lankan Pakistani and Ghanaian
14
Canterbury City Community Centre (4Cs)
Lakemba Pakistani Indian and Sri Lankan women
14
Chaldean League and Western Sydney TAFE
Mt Druitt Chaldean group 18
STARTTS - Toongabbie Community Centre
Toongabbie Tamil-speaking group 12
Mt Druitt TAFE ndash TAFE NSW Mt Druitt Work Opportunities for Women group (mixed CALD backgrounds)
14
TOTAL 167
Table 1 Focus Group DetailsExplanatory noteThefocusgroupatMtDruittTAFE-comprisedpredominantlyofCALDwomenenrolledinaCertificateIIentrylevelcourse-wasusedtopilotandrefinethefocusgroupprocesswithsurveyresponsesgeneratedbythegroupincludedinthefinalsurveyresults
A word about the research design Theresearchwascarefullydesigneddrawingonexpertculturaladviceoncommunicationpro-cessesandsurveydesignFocusgroupsincludedparticipantconsentformsincentivevouchersandaone-pageintroductiontotheresearchfortheintermediaryorganisationsIntermediaryorgan-isationsandpreferredlocationswereidentifiedand agreed in advance with NCOSS
Thesurveywasdesignedinaneasy-to-readformatusingsimpleEnglishFeedbackfromthe Spanish-speaking translator was that it was extremelyeasytotranslateandcompleteOthergroupscommentedthattheyfoundthesurveyeasytocompleteandmostgroupsdisplayedasolidlevelofspokenandwrittenEnglishTheresearchdesignandconductalsoleantheavilyontheexpertiseofthefacilitatorsandtheirexten-sivenetworkswhichmadedeliveryinsuchashorttimeframepossibleThepositiveengagementandsupportoftheintermediaryorganisationswasalsoafactorcontributingtothesuccessfulconduct of the research
Withoutfailthemulticulturalandcommunityserviceorganisationsinvolvedintheresearchper-ceived the importance of its purpose and shared a desire to provide NSW Health with feedback directlyfromtheircommunitiesasamatterofurgency
Demographics of research participantsThemakeupofthosewhoparticipatedintheresearch was diverse in age and cultural and languagebackgroundParticipantswerepredom-inantlywomen(84)withmenmakinguponly145OverhalftheparticipantshadlivedinAustraliaformorethan20yearswhichimpactedpositivelyontheirlevelofspokenandwrittenEnglishHowevertherewerequitelowlevelsofEnglishliteracyinanumberofthegroupswhichmadeguidedsurveycompletionamoreneces-sarybutcomplexprocess
1 1 1
6
3
31
16 17
20
12
15
1
8
2
64
1
5
2 13
1 1
7
2 1
5
1 1 1 1 2 10
5
10
15
20
25
30
35
Indo
nesia
Thai
land
Hong
Kon
gAu
stra
lia Iran
Iraq
Viet
nam
Italy
Sri L
anka
Indi
aPa
kist
anGh
ana
Syria
Boliv
iaCh
ilePe
ruEl
Sal
vado
rM
alay
siaUr
ugua
yAr
gent
ina
Cam
bodi
aUk
rain
eRu
ssia
Chin
aSu
dan
Eritr
eaSw
eden
Taiw
anAf
ghan
istan
Pola
ndJa
pan
Egyp
tJo
rdan
13
1 2
10
17
2
21
1
11
1 1
12
2 1
27
10
1 1 1 13 2 1 2 1
6
1 1 1
32
0
5
10
15
20
25
30
35
English Thai
Cant
ones
eVi
etna
mes
eIta
lian
Farsi
Tam
ilTe
lugu
Span
ishSp
anglish
Haus
aUr
duGu
jara
tiPu
njab
iAr
abic
Chalde
anHi
ndi
Khm
erPe
rsian
Russian
Man
darin
Malay
Haza
ragi
Tigr
inya
Kurd
ishCh
ines
ehellipJa
pane
sePo
lish
Swed
ishM
ultip
le
Figure 1 Country of BirthFigure 2 Language spoken at home
METHODOLOGY
Coun
t
Coun
t
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1312
211
1316 14211684
2053
3316
Less that 1year
1 - 2 years 2 - 5 years 5 - 10 years 10 - 20years
More than20 years
000
500
1000
1500
2000
2500
3000
3500
Less than 1-2 years 2-5 years 5-10 years 10-20 More than1 year years 20 years
1453
8430
000 116
Male Female Non-binary Rather not say000
100020003000400050006000700080009000
000
785
1728
2147
1309
1675
2356
Under 18 18-24 25-34 35-44 45-54 55-64 65+000
500
1000
1500
2000
2500
Figure 3 Length of time living in Australia Figure 5 Gender
Figure 4 Age
METHODOLOGY
Chaldean Focus Group Feedback Sheet
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1514
Research participants were asked
If they were intending to get vaccinated
The reasons why they would or would not choose to get vaccinated
If they knew anyone who had already been vaccinated and if so who
If they knew anyone who had contracted COVID-19 and if so who
If they knew where to go to get vaccinated
What sources they used to get information about the COVID-19 vaccination
Basic demographic information age gender country of origin language spoken at home and length of time living in Australia
Having the vaccine or notOfthe199participants117(58)reportedthattheywereplanningtobeorhadalreadybeenvaccinatedwhile78(42)reportedthattheywere not planning to have the vaccine (13) or didnotknowiftheywouldgetvaccinated(29)
1453
8430
000 116
Male Female Non-binary Rather not say000
100020003000400050006000700080009000
05
10152025303540
Under18
18-24 25-34 35-44 45-54 55-64 65+
Coun
t
Yes No Donrsquot Know
Figure 6 Are you going to get the COVID-19 vaccine
Figure 7 COVID-19 Vaccine intention of respondents by age category
13people(65)hadalreadybeenvaccinated(at least 1 dose)6withseveralcommentingthattheyhadchosenorneededtobevaccinatedforwork-relatedreasonsOthersreportedthattheyhadbeenvaccinatedprimarilyforhealthreasonstostaywellandmakesurethattheirfamiliesstayedwellTheywerealsoconcernedaboutpublichealthandsafetyOneofthewomenintheLakemba groups from Sri Lanka was adamant that thebenefitsoutweighedtherisksspokepositive-lyabouthoweasyithadbeentogetthevaccinefrom her local medical centre and that she had experiencednosideeffectsfromthevaccination
Language Count Percent Urdu 1 Italian 3 Arabic 2 Tamil 3 Chaldean 1 Spanish 3 Total 13 65 of sample
Response Count Percent Not planning to have the vaccine 23 13 Unsure about having the vaccine 52 29
75 42
Table 2 Respondents already vaccinated
Table 3 Respondents who indicated vaccine refusal or hesitancy
6 Theresearchersdidnotdistinguishbetweenwhetherpeoplehadreceivedtheirfirstandseconddosesofthevaccineiepartiallyorfullyvaccinated
75(42)indicatedadegreeofvaccinehesitancywith24participants(13)reportingthattheywerenotplanningongettingvaccinatedwhile53(29)reportedtheydidnotknowiftheywouldget vaccinated
Thislevelofvaccinehesitancyreflectslargerstud-iesintheAustraliancommunityAsurveyofover1000participantsfromacrossAustraliaconduct-edinApril2021byEssentialResearchfoundhes-itancyratesof42including16whoindicatedtheywerenevergoingtogetvaccinated7
Foroursurveyresponsesindicatedthatagewasafactorwith85ofrespondentsaged65andoverreportingthattheywouldhaveorhad
7EssentialResearchThe Essential Report21April2021
FINDINGS FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1716
alreadyhadthevaccineThosewhoindicatedthattheywouldnotbehavingthevaccinewerefairlyevenlydistributedacrossagegroupswithyoung-er people aged 18-24 being the age group with thehighestproportionofparticipantsexpressinguncertaintyabouthavingthevaccineTheagegroupwiththesecondhighestlevelofhesitancyproportionatetoothercategorieswerethe35-44yearolds
02468
10121416
Iraq
Vietnam Italy
South Americ
a
Sri La
nkaIndia
Syria
Other South East
AsiaAfric
a
Australia
Sweden
China
Pakistan
Iran
Eastern Europe
Afghanistan
Japan
Coun
t
Yes No Dont know
8095 8190
70486095
4571
6190
095
To stayhealthy and
well
To keep myfamily
healthy andwell
For publichealth
To travel To work It is theright thing
to do
Somethingelse (pleasetell us what)
000100020003000400050006000700080009000
Figure 8 Respondents COVID-19 Vaccine intention by Country of Origin
Figure 9 Reasons for getting vaccinated against COVID-19
Countryoforiginalsoseemedtoplayaroleinpeoplersquosviewsabouthavingthevaccinewithhighvaccinepre-dispositionreportedbyVietnameserespondentstotheonlinesurveyandwomenintheItalian-speakinggroupWhileparticipantsfromIraqrecordedthehighestlsquoyesrsquoresponsethiswasalmostmatchedbyIraqiparticipantswhoreportedthattheywerelsquounsurersquoorlsquodidnotknowrsquowhethertheywouldhavethevaccineTherelevanceofcountryoforigininthisregardwouldbeworthyoffurtherresearch
The Italian focus group held in Wollongong was an olderwomenrsquossocialgroupwithallparticipants(15) agedabove65yearsMostinfactwereaged over75yearswithoneparticipantinher90s 87 of the group had either been vaccinated (3) or were planning to get vaccinated (10)
Of course I will get vaccinated It is important to do this It is a very bad
disease
Thesewomenweremotivatedtostayhealthyandwellkeeptheirfamilyhealthyandwellforpublichealthreasonstobeabletotravelandforgen-eralsafetyMembersofthegroupalsoreportedthattheywantedtogetvaccinatedsothattheywouldbeabletolsquodancersquoandlsquosocialisersquo
Reasons for having the vaccine
Ofthe117participantswhoreportedthattheyhadeitheralreadybeenvaccinatedorwereplan-ningtogetvaccinatedlsquokeepingmyfamilyhealthyandwellrsquo(82)andlsquokeepingmyselfhealthyandwellrsquo(81)werethetwomostpopularreasonsforhavingthevaccineThiswasfollowedbylsquoforpublichealthrsquo(70)lsquoitistherightthingtodorsquo(62)andinorderlsquototravelrsquo(61)(SeeFigure9)
I donrsquot want to
die
Irsquom over 65 I have some health issues I think itrsquos
[having the vaccine] very important to
keep safe
I want to see my family I usually go every year but now I havenrsquot seen them
because of COVID-19 Having it will help
I am well but my parents are older It is important to
keep them well
Otherreasonsthatpeoplegaveforgettingvacci-natedincludedtheneedtocontinueworkinginessentiallsquofrontlinersquoemploymentsuchassecuritycleaningandagedcaresettingsOnewomanintheLakembafocusgroupwhohadalreadyhadherfirstdoseoftheAstraZenecavaccinesaidthatlsquothebenefitsoutweightherisksrsquoandasanolderwomanrsquoIdonotwanttodiersquo
All but one of the focus groups were familiar with thedifferentvaccinescurrentlyavailableinAus-traliaAstraZenecaandPfizerMostparticipantswere also aware of blood clots being associated with the Astra Zeneca vaccine One group of newly-arrivedrefugeesinGriffithhadnotheardofeithertheAstraZenecaorPfizervaccinesandhadamorelimitedunderstandingofthevaccinationprogram in general
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1918
Reasons for not having the vaccine
At the moment the situation is under control and donrsquot feel the need Also I have no plans to
travel in the near future so I donrsquot see the need
3514
21622703
3243
1892
811 541
4865
1081
Thevaccine isnot welltested
Thevaccine is
unsafe
Formedicalreasons
I amscared tohave thevaccine
I dont likevaccines
Forreligiousreasons
Forculturalreasons
I want towait and
see
Somethingelse
(pleasetell uswhat)
000
1000
2000
3000
4000
5000
6000
Figure 10 Reasons for not getting vaccinated against COVID-19
Theperceivedlsquolackofadequatetestingrsquoofthevaccineandlsquofearofbeingvaccinatedrsquoalsore-ceivedhighresponseratesselectedby3514and3243ofparticipantsrespectivelyOnly1355 of respondents cited religious or cultural reasonsasbeingbehindtheirvaccinehesitancy
Open-endedresponsestothisquestionincluded
The vaccine is not 100 working It cannot offer
100 protection
Ofthe42participantswhosaidthattheywouldnothaveorwerehesitanttohavethevaccine4865saidthattheypreferredtolsquowaitandseersquobeforegettingvaccinated
Thediscussioninthefocusgroupsaboutpeoplersquoshesitancytobevaccinatedfocusedonanumberofconcernswhichreflected
poorcommunicationfromanumberof trusted sources including GPs and some media sources
conflictinginformationaboutthevaccinefrom healthauthorities
fearsaboutvaccinesafetythataresharedby thegeneralcommunity
misconceptionsabouttheeffectivenessof andhowthevaccineswork
I will not have it because make me sick
Issuesraisedinfocusgroupsascontributingtoincreasedhesitancyincluded
Some GPs being hesitant to recommendvaccination
Theinformationbeingprovidedisconflicting
Theinformationisoverlycomplexandnotcomprehensibleregardlessofwhetherithasbeen translated
The risk of blood clots
Perceptionsthatthevaccinesaregenerallyunsafe
Concernsthatsomepeoplearedyingafterbeing vaccinated
Not being sure about the risks associated withhaving the vaccine and being pregnant orbreastfeeding
Theperceptionthattherehasbeenalackoftestingofthevaccinespriortorollout
AlackofunderstandingofhowvaccinesworkthecompositionofthevaccinesandwhattheywoulddotothebodyincludingmakingchangestoapersonrsquosDNA
Specificcommentsincluded
I have heard that the vaccine changes
your DNA
I am a mother I am not sure it [the vaccine] is safe for
me when I am breastfeeding
If you are young and healthy your body has the energy to fight the virus
You donrsquot need to have the vaccine You should just let
your body fight it itself
They donrsquot tell you what chemicals are in the
vaccine
Tamil Focus Group Feedback Sheet
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2120
Nobody knows what to do My GP doesnrsquot even know what I should do whether
I should have it or not
I am not sure what to do I have spoken to my
GP but they canrsquot tell me whether I should have the vaccine or not while I am
breastfeeding
They say one thing and then they tell you
something elsehellip it [the vaccine rollout] is so
confusing
Confusionaboutwhattodowheretogoandthe health impacts of the vaccine was a common threadintheconversationsaroundvaccinehesi-tancy
Onewomanwhosehusbandworkedforasecurityfirmsaidthatherhusbandhadhadtobevacci-natedinordertokeephisjob
In several focus groups the issue of government control was also raised A number of people re-portedstronglythattheyfearedthatthevaccinewas lsquoa means that the government was using to controlpeoplersquo
He [husband] had to have it He didnrsquot have a choice He was fine [no side effects] but Irsquom not
thinking I will have it I donrsquot need to Irsquom a mum Irsquom busy I have
to look after my children I donrsquot know how I feel about it whether
Irsquom going to have it
Vaccine refusal
Onlyasmallnumberofparticipants(24or13)saidtheywouldnotgetvacci-natedOfthisgroup21werewomenand 2 were men8 Respondents were bornintendifferentcountrieswithadiverse range of language backgrounds
I never get sick It is the same for all my family We have always been strong and healthy so I will be
saying no to the vaccine
Country of Birth Language Background Count Pakistan Urdu 4 China Taiwan Chinese
(MandarinCantonese) 4
Sri Lanka India Tamil 3 Chile Spanish and English 2 Italy Italian 2 Iraq Syria Arabic 2 Iraq Chaldean 1 Iran Farsi 1 Greece Macedonian 1 Poland Polish 1 Pakistan Punjabi 1 Sweden Swedish 1 Vietnam Vietnamese 1
Table 4 Vaccine refusal by country of birth and language background
8 ThisreflectstheoverallsamplebiastowardswomenThemajorityoffocusgroupparticipantswerewomenXwithYparticipantsbeingmen
Reason for not having the vaccine Percent Count The vaccine is not well tested 5455 12 I want to wait and see 5455 12 The vaccine is unsafe 3636 8 For medical reasons 3182 7 I am scared to have the vaccine 3182 7 I dont like vaccines 1364 3 For religious reasons 1364 3 For cultural reasons 909 2 Something else (please tell us what) 909 2
SomeinthiscategorywereadamantthattheywouldnotbehavingthevaccineandhadverystrongviewsonitlsquoForculturalreasonsIwonrsquotbehavingthevaccinersquoWhenwelookatrespons-esmorecloselyhoweveritwouldappearthatmanyareinfactmorelsquohesitantrsquothanfirmvaccinerefusers
One reluctant middle-aged Tamil-speaking wom-ansaidlsquoIftheysaywehavetogetvaccinatedthenIwillrsquoThissentimentwas stronglysup-portedbythe rest of the Tamil-speaking group
Studyparticipantswhosaidtheywouldnothavethe vaccine were also concerned that lsquothe vaccine wasnotwelltestedrsquo
The vaccine has been rushed out It has not been
properly tested
Table 5 Reasons for not having the vaccine
Peopleinthiscategorysaidthattheywouldlsquowaitandseersquowhathappenswiththewiderrolloutbe-foremakingtheirfinaldecisionThissuggeststhataproportionofthelsquonorsquogroupareinfacthesitantrather than outright refusing to have the vaccine
Therewerealsofearsexpressedbyfocusgroupparticipantsaboutthedangersofbeingvacci-natedParticipantsreportedbeingafraidofthehealthrisksespeciallyfrombloodclotsSomepeopledistinguishedclearlybetweenAstraZene-caandPfizerinthisregardHoweverformanythedistinctionbetweenthedifferentvaccineswaslostandtheyspokeofthevaccinesgenerallybeing unsafe and having a range of unwanted side effects
Other factors consideredInadditiontothebroaderquestionsofwhypeo-plewouldorwouldnotchoosetogetvaccinatedthe research team used the focus group discus-sionstoexplorewhetherthefollowingfactorshadanyimpactonapersonrsquoslikelihoodofbeingvaccine pre-disposed or hesitant
Knowing someone who had been vaccinated
Knowing someone who had contracted COVID-19
Knowing where to go to get vaccinated
Thesourcespeopleturntoforinformation about COVID-19 and COVID-19 vaccines
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2322
Knowing someone who has been vaccinatedOfthosewhorespondedtothisquestion125or70knewsomeonewhohadalreadyhadthevaccine
6983
2570
447
Yes No Dont know000
1000
2000
3000
4000
5000
6000
7000
8000
Figure 11 Do you know someone who has been vaccinated
Amongthe125participantswhoknewsomeonewhohadalreadybeenvaccinated100identifiedlsquoimmediatefamilymembersrsquo(parentschildrensiblingsandpartners)Somefocusgrouppartic-ipantsreportedthatalloftheirfamilymembersoverseas had been vaccinated Others reported thattheirrelativeshadbeenvaccinatedasarequirementoftheiremployment
Who Count Percent Other family member 41 313 Sister 24 1832 Community member 23 1756 Brother 18 1374 Father 17 1298 Mother 16 1221 Work colleague 14 1069 Husband or wife 11 84 Son or daughter 10 763 Partner 4 305 Someone else 45 3435 Total respondents 131
Table 6 Who do you know who has been vaccinated
When this issue was teased out further in focus groupdiscussionsarangeofreasonswere revealed including
My husband works in security and he had
to get it
My friend works as a COVID-19 cleaner and they all had to [get
vaccinated]
My family overseas have already been vaccinated
My son needs to travel for work so he is getting it
My brother in the UK is a doctor and he got it and
his wife
Knowing someone who has had COVID-19Almosthalfoftheparticipantsknewsomeonewho had contracted COVID-19 overseas Some reportedthatallthemembersoftheirfamilyormanymembersoftheirextendedfamilyhadcon-tracted COVID-19 In the older Italian group 10 of the15womenknewsomeoneinItalywhohadcontracted COVID-19
4716 4659
625
Yes No Not sure000
1000
2000
3000
4000
5000
Figure 12 Knowing someone who has had COVID-19
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2524
385 385
1538
2692
641 513000
4359
2051
1026385
1410
Mother
Father
BrotherSis
ter
Son or d
augh
ter
Husban
d or wife
Partner
Other family
mem
berFri
end
Community m
ember
Work co
lleag
ue
Someone else
(please
tell u
s who)
000500
100015002000250030003500400045005000
Figure 13 Who do you know who has had COVID-19
Four people in the focus groups knew someone who had died of COVID-19
All my family back home [Pakistan] got it [COVID-19] but
they are all fine now apart from my father He died But he was really sick before he
got it He had lots of underlying conditions Medical conditions so he was really unwell before he got COVID-19 But everyone else
they are fine now They were sick but they got betterhellip
If you are well and healthy you can fight this off
SurprisinglyknowingpeoplewhohadcontractedCOVID-19didnotseemtoinfluencefocusgroupparticipantsrsquopredispositiontowardseitherhavingthevaccineorbeingvaccinehesitantHowevertheolderItalianwomenrsquosgroupspokeabouttheimpactthatCOVID-19hadhadinItalyintheearlystagesofthepandemicandhowthishadaffectedthemdeeply13ofthe15womeninthisgroupwouldhaveorhadalreadyhadthevaccine
Knowing where to get vaccinated115people(81)whorespondedtothisquestion(n=142) knew where to go to get the vaccine 34 people(19)reportedthattheydidnotknowThisincluded15respondentsfromIraq3re-spondentsfromIndia2respondentsfromChina2 respondents from Pakistan and one respondent fromeachofthefollowingcountriesChinaEri-treaItalySriLankaSwedenSyriaandVietnamThese people were also less sure about whether ornottheywouldhavethevaccineItispossiblethat their lack of knowledge about where to go to get vaccinated was related to their general level ofvaccinehesitancy
7958
29582254
282 563
GPDoctor Vaccinecentre
Hospital Work place Somewhereelse (please
tell us where)
000100020003000400050006000700080009000
Figure 14 Where to go to get vaccinated
From the sample (n=199) GPs were the most commonlyidentifiedplacetogotogetvaccinat-edfollowedbythevaccinecentreatHomebushBayandthenhospitalsOtherplacesidentifiedincluded medical centres and pharmacies
Sources of information about COVID-19 and the vaccineThelargestsinglesourceofinformationaboutCOVID-19 and the vaccine was Facebook (417)
2743
3486
13141086
30862686
3429
2229 2286
41713714
2571
1086 971
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)000500
10001500200025003000350040004500
Figure 15 Sources of information about COVID-19 and the COVID-19 vaccine
Facebook I get my information from
Facebook But if I want to check it I watch the news
on 7 [Channel 7]
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2726
Thesecondlargestsourceofinformationforpeople in the sample was lsquoother forms of social mediarsquo(37)followedbySBStelevision(35)myfriends(34)andothertelevision(31)Oth-ersourcesofinformationpeoplereportedthattheyusedweretheNSWHealthwebsitenightlytelevisionnewsincludingChannel7Channel9andChannel10followedbytheABCtheAustral-iangovernmenthealthwebsitetheirGPlocalMedical Centres and the Red Cross
IntheLakembafocusgrouppredominantlymadeupofwomenfromPakistantherewasanani-mated discussion about Facebook which was the majorsourceofinformationalongwithGooglesearchesandcommunityandfriendship-basedWhatsApp groups There was a general consensus from most in the group that these were their pre-ferredormostcommonsourcesofinformationandnewsHoweveriftheywantedtolsquofactcheckrsquowhattheywerehearingtheywouldwatchthenightlynewsonChannel7orChannel9toverifywhattheyperceivedcouldsometimesbeunrelia-ble sources
IntheMtDruittfocusgroupseveralofthewom-enwithwell-developeddigitalliteracyandgener-alliteracyskillsusedhealthandfitnesswebsitesand social media sites as their source of infor-mationaboutlsquoallthingshealthrelatedrsquoincludingCOVID-19ThesewomenalsospokepositivelyabouttheinformationandsupporttheygotfromthestaffatCanterburyCouncilCommunityCentre(4Cs)whotheycouldrelyontofindoutthingsthattheyidentifiedtheyneededtoknowmoreabout
InthesmallerfocusgroupinGriffithwithrecently-arrived refugee women who had low levels of Englishlanguageliteracytherewaslittleknowledgeaboutthevaccinesnoawarenessofthedifferenttypesofvaccinesandlittleknow-ledgeaboutwheretogotogetvaccinatedorfindoutmoreaboutCOVID-19ingeneralThecommunityservicestaffandvolunteerspresentatthegroupwere working hard to assist these women to improve their English language skills and support themwithtranslatedinformation
In the older Italian women focus group in Wollon-gongparticipantsreportedgettingtheirinfor-mationfromslightlydifferentsourcesndashfamilyinAustralia(10women)Channel9(7women)
Italianradio(3women)andABCTV(3women)Onlytwowomenusedtheinternetandnoneofthe women reported using Facebook or social mediaasasourceoftheirinformationSeveralmentionedthattheygottheirinformationfromtheirGPorspecialistdoctorandonepartici-pantsaidrsquoIdonrsquotlistentoanyonersquoIntheSpan-ish-speaking focus group a comment was made thatseemedtoreflectmanyoftheotherfocusgroup discussions
Whenlsquosourcesofinformationrsquoiscorrelatedwiththegroupwhosaidtheywouldhavethevaccine(n=104)thereisashiftfromFacebookbeingthepreferredsourceofinformationtolsquoSBSTVrsquobeingthepreferredsourceThelsquovaccine-predisposedrsquogroupalsohadthelowestrateofrelyingonFace-bookasasourceofinformationaboutCOVID-19thoughitwasstillhighThegraphbelowhigh-lightshowotherlsquopreferredsourcesrsquoplayoutforthoseintendingtohaveorwhohavealreadyhadthe vaccine
ForthoseparticipantswhoindicatedthattheywouldnotorwerenotplanningtohavethevaccinelsquoFacebookrsquolsquomyfriendsrsquoandlsquomyfamilyrsquowerethesourcesofinformationaboutCOVID-19thatwereequallymostfrequentlycitedfollowedcloselybylsquomyfamilyoverseasrsquolsquoSBSradiorsquoandlsquoSBSTVrsquoassourcesofinformationreceivedthelowestmentionsfromthisgroup(SeeFigure16)
The vaccine-hesitant group were the group who identifiedlsquoFacebookrsquoastheirmostfrequentsourceofinformationaboutCOVID-19lsquoFace-bookrsquowasfollowedbylsquoothersocialmediarsquoandlsquomyfriendsrsquoasthenextmostfrequentsources
lsquoThiscommunityserviceproviderrsquo(theinterme-diaryorganisationwherethefocusgroupwasconducted)wasidentifiedby26ofrespondentsasasourceofinformationregardlessoftheirintentiontogetvaccinatedornotThefactthatboththelsquovaccinehesitantrsquoandthosewhoindi-catedtheywouldnrsquotbegettingthevaccinesoughtinformationfromthissourcesuggeststhatrolling
There is so much confusion about it [the vaccine] that I think my GP is the best
place to go
9 This group of the research sample included a small number ofpeoplewhohadalreadybeenvaccinated
2626
4141
14141111
323228282828
2424
1818
37373737
2828
10101212
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)00050010001500200025003000350040004500
2857
2381
952 952
2857
3333
42864286
3810
4286
23812381
1429
952
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another co
mmunity se
rvice
Somewhere
else (p
lease te
ll us w
here)000
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Figure 16 Sources of information for respondents who were planning to have the vaccine9
Figure 17 Sources of information for respondents who were not planning to have the vaccine
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2928
outpositivemessagingthroughtrusted communityserviceorganisationscouldbeaneffectivewayofshiftingpeoplefromvaccine hesitancytodecidingtohavethevaccine
31372549
980 980
25492157
4314
1176
2353
4902
4118
2157
980392
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)000
1000
2000
3000
4000
5000
6000
Figure 18 Sources of information for respondents who lsquodonrsquot knowrsquo if they will have the vaccine
DISCUSSION
wardstheCOVID-19vaccineareasvariedastheyarewithinthebroadercommunityTherearearangeofinfluencingfactorsincludingagehealthstatushowlongtheyhavebeeninAustraliahowmuchnewstheyreceivefromoverseasandhowbadlyimpactedbythepandemictheirhomecountries have been
The research also highlights that people from culturallyandlinguisticallydiversebackgroundsgettheirinformationaboutCOVID-19andtheCOVID-19vaccinefromawidevarietyofsourcesbothformalandinformalandthatforparticulargroupsinthisstudythereisahighrelianceonFacebookovermoreofficialsourcesofinforma-tion
VulnerabilityTheneedsofhighly-vulnerablegroupswithintheCALDcommunityhavetobetakenintoconsider-ationThisincludesolderpeoplewhohavelivedinAustraliaformanyyearsbuthavelowlevelsofEnglishliteracyndashespeciallywritingandreadingEnglishandsometimesspokenEnglishndashandwhoaremoresusceptibletoseriousillnessandhigherratesofhospitalisationanddeathfromCOVID-19Italsoincludesnewly-arrivedrefugeeswhohavinglowornoEnglishlanguageliteracylacktheconnectionstoandnetworksintothewidercommunityandcommunitysupportsItisalsothecase that some people in these groups are not health literate at all and cannot read and write in their own language
Akeytakeoutfromthehealthandcommunityserviceorganisationsurveyresponsesandinter-viewsundertakenwithmulticulturalhealthandcommunicationexpertsfortheprojectisthatlit-eracylevelsreallydomatterLowlevelsofhealthliteracylowlevelsofEnglishlanguageliteracyandpossiblylowlevelsofliteracyintheirownlan-guage-especiallyforsomenewly-arrivedrefu-gees and those who are part of the humanitarian program such as Dari language speakers from AfghanistanTigrinyalanguagespeakersfromEr-itrea and northern Ethiopia and Oromo language speakers from Ethiopia - need to be factored into anyplanstofurtherpromotethevaccinerolloutanduptaketoculturallyandlinguisticallydiversepeopleinthecommunityThereisaneedfor
The contextThisresearchisimportantgivenhowhighlyculturallydiverseNSWisandtheimpactthiscanhave on the success of public health messaging topeoplewhosefirstlanguageisnotEnglishPeople who were born overseas form almost one-thirdofthe7480228population(276)ofNSWandNSWishometo336ofAustraliarsquosoverseas-bornpopulationPeoplefromaround225 birthplaces have made NSW their home and 21oftheNSWpopulationisfromanon-EnglishspeakingbackgroundMorethan24000humani-tarianentrantshavesettledinNSWoverthepastfiveyearscomprisingalmostathird(32)ofthenationaltotalThe24000humanitarianentrantswhohavesettledinNSWoverthepastfiveyearscame from over 100 countries of origin10Sydneyhasthelargestoverseas-bornpopulationofallthecapitalcities11
Hearingdirectlyfrompeoplefromculturally-diverse backgrounds is important to ensure that policymakersandpublichealthadvocatescandesign responses that are both accessible and un-derstandabletopeopleforwhomEnglishmaybetheirsecondthirdorfourthlanguageApropor-tionofpeopleinthesecommunitieshavelowerlevelsofEnglishlanguageliteracyandinsomecaseslowlevelsofliteracyintheirlanguageoforiginsowillbehardertoreachviatraditionalormainstream methods
Itisalsocriticallyimportantthatduringatimewherethereissomuchlsquonoisersquoacrossmediachannelsrelatingtothevaccinethevaccineroll-outvaccineefficacyandvaccinesafetythatwetakesometimetolistentoandunderstandhowthislsquonoisersquoisbeingheardandmadesenseofbypeoplefromculturally-diversebackgrounds
ThatsaiditisimportanttoreconfirmthattheCALDcommunityisnotahomogenousgroupOurresearchhasfoundthattheviewsandattitudesofparticipantsfromdiverseculturalbackgroundsto-
10RefugeeCouncilofAustraliaHumanitarianEntrantsin New South Wales A resource for New South Wales governmentagencies6-711MulticulturalNSWCommunityRelationsReport2018-20199
29
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3130
groupsFortheparticipantsintheresearchtheirattitudetothevaccineappearedtobeinflu-encedbyanumberoffactorstheirownlevelsofhealthandpre-existinghealthconditionsandthoseoftheirfamilymembersandtheimpactofreceiving COVID-19-related news from overseas particularlyfrompeoplersquoscountryoforiginAnexampleofthiscanbeseenintheItaliangroupin Wollongong where people had received news fromoverseasearlyinthepandemicwhichscaredthemThisexperiencelsquofromhomersquohadinflu-enced most of the women in the Wollongong focus group (n=15) to choose to get vaccinated The interviewee from the Illawarra Shoalhaven Local Health District also spoke about the heightenedconcernthattheywitnessedinthelocalItaliancommunityintheearlystagesofthepandemicOtherpeoplewantedtolsquostayhealthyrsquoandtolsquoprotectthehealthofothersrsquoandformanytherewasasensethattheywantedtolsquogetbacktosomedegreeofnormalcyrsquoandtobeabletolsquotraveloverseastovisitrelativesrsquo
Vaccine hesitancyOfthe42inthisstudywhoappearedundecidedornotplanningtohavethevaccinemanywereinfactadoptingalsquowaitandseersquoapproachbeforemakingtheirfinaldecisionMostparticipantswereinterestedtohearmoreinformationaboutthevaccinesandwereopenedtogettingthevaccinebutdidhaveconcernsaboutthesafetyofthevaccinesespeciallyinregardtoAstraZeneca
The issue of blood clots has led to considerable fearandhesitancyinthecommunityandthisfearandhesitancywasreflectedinourstudyEssentialResearchrsquossurvey(April2021)reportedoneinsixpeople(16)indicatedtheywillnevergetvaccinatedagainstCOVID-19upfrom12thepreviousmonthwhile42saidtheywillgetvaccinatedbutnotrightawayTheproportionofpeople who would be willing to get vaccinated as soonaspossibleorarealreadyvaccinatedalsodeclineddownfrom47to4213Thissurveywas conducted prior to the most recent outbreak inNSWinvolvingthehighlyinfectiousDeltastrain
Therisk-benefitofhavingthevaccineneedstobecarefullyweighedbyeachindividualideallyinconsultationwiththeirdoctoranddependingon
The Hub has lsquobeen working in partnership with keystakeholdergroupstoguidecommunicationstomeetthehealthliteracyandculturallyandlinguisticallydiverse(CALD)needsofitspop-ulationStructuredworkinggroupshavebeencreatedtoprioritisecommunicationstovulner-ableyouthCALDgroupstheelderlyitinerateworkersasylumseekersandrefugeesTheaimsaretotestmessagingandbuildtrustwithprioritypopulationstoensureeffectivecommunicationoftheneedtosustainphysicaldistancingmeas-uresintheabsenceofavaccineSimilareffortsarenowneedednationallyandshouldstartatthetimeofdiseaseoutbreaksinthefuturealongsideplannedmassmediaandhealthcommunicationcampaignsrsquo
InthearticlebyDoddetaltheyreinforcetheimportanceofusingcommunicationformatswhich are lsquosuitable for people with low health literacyandeducationandwhichareappropriateforculturallyandlinguisticallydiversegroupsandIndigenouspopulationsrsquoThearticlearguesthatitisimportanttolookatmotivationsandconcernsabout vaccines when shaping messaging It also pointsoutthatprimarycaredoctorsareatrust-ed source and as such should be supported in deliveringinformationaboutthevaccinesandad-dressingcommunityconcernsThearticlestateslsquoWeneedtounderstandandaddresscitizenrsquosconcernsthatcanpreventoptimaluptakebuildmotivationsintomessagingandprioritisepublictrustbyinformingandinvolvingthecommunityintheprocessSupportinghealth-careprofession-als in their role as educators will ensure people haveadequateandaccessibleinformationfromatrustedsourcetooptimisevaccineuptakeandultimatelyreducecommunitytransmissionofCOVID-19rsquo15
RecentresearchbyAssociateProfessorHollySeale16withUNSWMedicinersquosSchoolofPublicHealthandDeputyChairfortheCollaborationonSocialScienceandImmunisationfoundthereisaneedtolsquodecentralisersquocommunicationsbytapping
translatedmaterialsandinformationaboutthevaccines to be tailored to the needs of people in these newly-emergingcommunitygroups
It was reported that in Wollongong there can sometimesbefourgenerationsoffamilymem-bersfromnewly-arrivedrefugeegroupslivingintheonehouseMostofthesefamilymembersgenerallyhavelimitedEnglishlanguageliteracywhichincreasestheirriskofnotreceivingkeyhealthmessagesandthereforeincreasingthepotentialimpactofCOVID-19-inparticulartheDeltastrainwhichhasprovenhighlyinfectiousamongst household members
Vaccine uptakeNotdissimilartothewidercommunitymorepeopleinourstudywereplanningtohavethevaccinethannotandanumberhadalreadybeenvaccinatedInarecentLancetarticle(February2021)ConcernsandmotivationsaboutCOVID-19vaccinationfindingsfromtwosurveysfromanAustralianlongitudinalstudyconductedinJuneandJuly2020includedthatlsquothetopthreerea-sons for agreeing to vaccinate were lsquoto protect themselvesandothersrsquohelliplsquobeliefinvaccinationandsciencersquohellipandlsquotohelpstopthevirusspreadrsquoEven among those willing to vaccinate there was somehesitancyaboutthesafetyofthevaccineTheLancetarticlenotedthatlsquowillingnesstovaccinatedifferedbybothageandeducationrsquoForthosewhowereindifferentorsaidtheywouldnot get the vaccine the top reasons across the twosurveyswerelsquoconcernaboutthesafetyofthevaccineinitsdevelopmentrsquoandlsquopotentialsideeffectsrsquo12
Olderpeopleinourstudywhocomprised23of the total sample (n=199) were the group most likelytosaythattheywantedtogetthevaccine85ofthoseover65saidtheywouldhaveorhadalreadyhadthevaccineVaccinepredispo-sitionwashoweveralsostrongacrossotherage
12RHDoddKPicklesBNickelECvejicJAyreCBatcupCBonnerTCoppSCornellTDakinJIsautierKJMcCafferyConcerns and motivations about COVID-19 vaccination SydneyHealthLiteracyLabSydneySchoolofPublicHealthFacultyofMedicineandHealthUniversityofSydneypublishedintheLancetFebruary2021p162wwwthelancet cominfectionVol21February2021
theircircumstancesHoweverthesourcesofin-formationthatpeoplemostrelyuponortrustarecriticaltothedisseminationofaccurateandclearmessaging to dispel the fear surrounding events suchasbloodclottingandthemisconceptionsraisedinthefocusgroupsWithsomanypartici-pantsinthisstudygettingtheirinformationfromFacebookandothersocialmediasitesitisvitalthat these channels are used to promote simple positivemessagesandforanyfuturecommunityawareness campaigns
Effective communicationConfusionandmisconceptionsaboutthevac-cinersquosefficacyavailabilityandsafetywereallis-sues that were raised in the focus groups Finding waystoeffectivelycommunicatewithpeoplewithlowerEnglishlanguageliteracyandhealthliteracyisanimportantwaytoaddresstheconfusionandmisconceptionsaboutthevaccineashasbeen discussed in a number of recent Australian studies
Astudy14byMcCafferyetal(2020)concludedthattherearelsquoimportantdisparitiesinCOVID-19-relatedknowledgeattitudesandbehavioursaccordingtopeoplersquoshealthliteracyandlanguagersquoOneofthefindingswasthatlsquopeoplewithlowerhealthliteracywerealsomorelikelyto endorse misinformed beliefs about COVID-19 andvaccinations(ingeneral)thanthosewithadequatehealthliteracyThesamepatternofresults was observed among people who primar-ilyspeakalanguageotherthanEnglishathomersquoTheMcCafferystudyhighlightstheimportanceof tailoring health messages to those with lower healthliteracyandculturallyandlinguisticallydiversecommunitiesItpointsoutthatthereareexamplesofeffectivemanagementofdiversecommunityneedsthatusetailoredhealthmes-sagesandcitestheWesternSydneyLocalHealthDistrictHealthLiteracyHub
13TheEssentialReport-anonlinesurveyconductedbyEssentialResearchcompletedby1090people between 21ndash26 April14McCafferyKJDoddRHCvejicEAyreJBatcupCIsautierJMJCoppTBonnerCPicklesKNickelBDakinTCornellSWolf MS Health literacy and disparities in COVID-19ndashrelated knowledge attitudes beliefs and behaviours in Australia PublicHealthResPract202030(4)e30342012December2020
15 Op cit16 httpssphmedunsweduausitesdefaultfilessphcmNewsEnhancing-supporting-COVID-19-vaccination-programpdf
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
30 31
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3332
intodifferentnetworkingspacessuchaswork-placeslocalgymsmothersrsquogroupsandseniorsrsquoclubswithafocusonallagegroupsregardlessofcurrenteligibilityAccordingtoSealethechal-lengeislsquoensuringemerginginformationisadapt-edfortheintendedaudiencersquoShehasalsosaidlsquoThatrsquoswhatIrsquomalittlebitconcernedaboutatthemomenttherersquosalotofresourcesongov-ernmentwebsitesbutthesetermsaroundbloodclottingareverytechnicalWeactuallyneedtomake sure that we are breaking them down in a waythatwillmakeitmeaningfultopeopleThatrsquosnotjustabouttranslatingitrsquosaboutbeingcon-sciousofpeoplersquoshealthliteracyneedstooSomaybegettingsomemorevisualsintomaterialstotryandsupportthatrsquo17
Thereareanumberofmulticulturalhealthresourcesthatusecommunitylanguagetransla-tionsplainEnglishandvideosfromCALDcommu-nityleaderswhichcanbedownloadedandusedbyservicesandindividualsHowevermanyofthewrittenresourcesstillrelyontechnicalandscien-tifictermsthatrequireareasonablyhighlevelofEnglishlanguageliteracyorhighlevelsofliteracyin the translated language to comprehend Host websites can also be hard to navigate making itdifficulttolocateresourcesfromsimplewebsearchesAsummaryofsomeoftheavailableresourcescanbefoundatAttachment2
MulticulturalHealthUnitsinLocalHealthDis-trictshavestaffwhocanworkwithpeoplefromculturallyandlinguisticallydiversecommunitiesatthelocallevelandtranslateandcontextualisethese materials to the needs of the end user These teams respond to local needs and popu-lationdemographicsandareexpertsineffectivehealthliteracyandhealthcommunicationwiththeirlocalcommunitiesTheyworkcloselywithcommunityandvulnerablegroupstobuildhealthliteracyandimprovedhealthoutcomesintheircommunities
Case Study ndash Be a COVID Warrior ndash Responding to COVID-19 in Multicultural Communities InWollongongtheIllawarraShoalhavenLocalHealthDistrict(ISLHD)MulticulturalHealthSer-viceco-designedacommunityengagementandeducationprogramcalledlsquoBeaCOVIDWarriorrsquowhich commenced in 2020 in response to the pandemic This program was designed to respond tothelowlevelsofhealthliteracyaroundCOVID-19potentialexposuretothevirusandaddressfearandstigmainthelocalCALDcommunitiesThelsquoCOVIDWarriorrsquoprogramreachedaround880peopleranginginagefrom14to85years65ofCOVIDWarriorparticipantswerefemaleand35weremaleCOVIDWarriorparticipantsrepresented 21 language groups The outcomes of the program included increased levels of confidenceinapplyinginfectioncontrolmeasuresincreasedliteracyandhealthliteracyandawarenessofhowCOVID-19istransmittedUltimatelyanimprovedawarenessinapplyingCOVIDsafemeasures was also reported
InApril2020theservicecommencedwelfarechecksviaphoneonafortnightlybasistosup-portsocially-isolatedmulticulturalseniorswhoboretheemotionalstressofsocialisolationFrom these calls the ISLHD heard the needs and concernsofseniorsinthecommunityInadditionourexperiencewithCALDcommunitieshighlightedtheimportanceofyoungpeopleasconduitsofessentialinformationtoadultsincommunityandfamilygroupsduetoEnglishlanguageaccessandeducation
InresponsetheISLHDinitiatedthelsquoCOVIDWarri-orrsquoprogramusingbi-culturalhighschoolstudentsthroughthelocalhighschoolsByincreasingthehealthliteracyofstudentsatschooltheselsquocham-pionsrsquocouldtalktotheirfamiliesincludingolderfamilymembersininformalsettingsandthroughsocialmediawiththeirpeersasastrategytoraisethe level of knowledge of COVID-19 trans-mission preventionandtestingTheprogrambecamesopopularthatitwasextendedintomorelocalhighschools and adults accessing the Adult Migrant EnglishProgramTheprogramwassupportedbylocalsettlementservicesprovidedbybothMaxSolutionsandtheRedCrossItwas
17 httpstheconversationcomhow-can-governments-communicate-with-multicultural-australians-about-COVID-19-vaccines-its-not-as-simple-as-having-a-poster-in-their-language-156097
later extendedtoCALDSeniorsthroughtheMulticulturalCommunitiesCouncilIllawarra(MCCI)supportprograms
AkeycomponentoftheprogramwastoprovideparticipantswithlsquoCOVIDWarriorrsquoKitswhichincludedtworeusablemaskshandsanitiserinfographicsaboutCOVID-19symptomsandinfor-mationaboutwheretestingclinicswereavailablelocallyMCCIandRuralAustraliaforRefugeesdonatedreusablemasksforeveryparticipant
AsthelsquoCOVIDWarriorrsquoprogramwasevolvingsowasthenationalvaccinerolloutplanInforma-tionwasthereforeadaptedtomeetthisinfor-mationgapForexampleadultparticipantsandseniors were supported to understand how to accesstheCOVIDvaccinelsquoeligibilitycheckersrsquoandCALD people were shown how to use the NSW HealthwebsiteCOVID-19informationpages18
Decision makingHowpeoplearecurrentlyconsideringtheriskofCOVID-19isinfluencedbyarangeoffactorsincludingratesoftransmissioninthecommunitynumbersofnewcasesreportsinthemediaofrisksandsideeffectsPeopletendtobasetheirassessmentonwhattheyarecurrentlyexperi-encingandthencheckthisagainstwhattheyarehearinginthemediaincludingandespeciallyonsocialmediaandfromfamilyandfriendsMostoftheparticipantsinourstudyspokeclearlyandarticulatelyabouthowtheyweigheduptherisk-benefitofhavingtheCOVID-19vaccineintheir decision making Low case numbers ndash at the timeofconductingtheresearchndashandasensethat Australia was lsquodoing well in safeguarding the communityagainstCOVID-19rsquoweresignificantfactorsinpeoplersquosdecisionnottobevaccinatedortoadoptalsquowaitandseersquoapproachFamilyfriends and social media were reported as having aconsiderableinfluenceondecisionmakingaswerereportsinthemediaofthebloodclottingsideeffectsofAstraZeneca
ThefactthatFacebookwasreportedlythemostpopularsourceofinformationaboutCOVID-19
18httpswwwhealthnswgovauInfectiouscovid-19Pagesdefaultaspx
andtheCOVID-19vaccineforpeopleinthestudyraisesconcernsaboutthepossibledisseminationofmisconceptionsandlsquofakenewsrsquothatmaybespread or compounded via social media Closed social media groups such as WhatsApp and WeChatwithfamilyandfriendsmayalsoleadtopeoplereinforcingtheirpre-existingbiasesThesefactorscoupledwithasensethatAustraliaisfaringwellcomparedtomanycountriesoverseasappear to have resulted in increased vaccine hesi-tancyamongparticipantsofthestudy
Factorsthatwereidentifiedaschangingvaccine-hesitantparticipantsrsquoperceptionswereanincreased risk from COVID-19 and a correspond-ingincreaseinthenumberofinfectionsandonthebenefitsidetheabilitytotraveloverseastovisitfamilyIntherecentresearchfromtheUniversityofNSWcitedaboveSearlearguesthatlsquotheremaybeotherthingsthatweneedtonowstartfocusingonhellipthatwillstarttopromoteandmotivatepeoplesuchasthechancetotravelmorefreelyforexamplersquoThisappearstobeborneoutbyourfocusgroupfindings19
Untilrecentlytherehavebeenverylowcasenumbers and few lockdowns across most of Aus-tralia and NSW The recent outbreak from mid-JuneinGreaterSydneyandintroductionofthehighlyinfectiousDeltavariantinNSWislikelytoimpactonpeoplersquosassessmentsoftherisk-benefitofhavingthevaccineandonewouldassumereducehesitancyrates
GiventheheightenedcommunityanxietycausedbythisrecentCOVID-19outbreaktheproductionofshortsharpandtargetedmessagingtoCALDgroupsincommunitylanguagesthatisaccessibleandmotivationalfeaturescommunityleadershigh-profilecelebritiesandsportsstarsfromCALDbackgroundsandisdirectedatastate-wideandlocal level would appear to be more urgent than everItisclearthatformessagingtobeeffectiveandreachitsintendedaudiencedistributionchannelsshouldincludeFacebookWhatsAppandothersocialmediaplatformsaswellastrustedsourcessuchasmulticulturalhealthworkersmulticulturalservicesandthroughGPsandMedical Centres If mainstream COVID-19 vaccine
19 Op cit
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
32 33
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3534
awareness campaigns are produced in Australia suchashavebeenproducedinNewZealandtheUnitedKingdomandNorthAmericatheyshouldincludehighprofilewell-knowncommunityfig-uresandsportingstarsfromCALDbackgroundsandincludestrategiesspecificallytargetingCALDcommunitiesincludinggroupsidentifiedaspar-ticularlyhigh-risk
It is also important that informationonvaccinesistranslatedintolanguagesfromnewerandemergingcommunitiesOthersuggestionsaroundreachingthesecommunitiesincludeface-to-facemeetingsorganisedbycrossagencypartnershipsandpeer-ledstrategiessuchas mobilising community champions and influenc-ers Messaging needs to be inclusive and framed around the collective values held by commu-n5
It is clear that reinforcing the benefits of being vaccinated at this time rather than dwelling on the risks is more likely to generate behavioural
changeandapositivevaccineresponsefrombothCALDcommunitiesandthegeneralpopulationAppropriately-designedandtargetedCOVID-19vaccinehealthinformationthatiseasytoreadinanylanguagecanbeconveyedbycommunityleadersandcommunitynetworksandpromotesthepositivebenefitsofgettingvaccinatedwouldbevaluableatthistimeBuildingontheworkofpeerchampionssuchastheCOVIDWarriorprogramisalsoasuccessfulmodeltoincreasingCOVID-19vaccinehealthliteracyandinformed decision making
Mostimportantlypositivelymotivatingculturallyandlinguisticallydiversecommunitymemberstolsquogetthejabrsquoespeciallythosewhoareadoptingalsquowaitandseersquoapproachorarevaccinehesitantwould lead to greater vaccine uptake among culturallyandlinguisticallydiversecommunitiesandthereforethecommunityasawhole
Inner West Multicultural Network Addison Road Community Centre DateWednesday12May
A focus group session of members of the Inner WestMulticulturalNetworkpluscustomersoftheFoodPantryatAddisonRoadwasheldattheAddisonRoadCommunityCentreinMarrickvilleon12Mayat200pmThesessionwaspartoftheregularmeetingoftheInnerWestMulticul-turalNetworkTheconsultationinvolvedabout26peopleandwasconductedbyRosannaBarbero
Thegroupbrainstormedresponsestoquestionsaroundvaccinehesitancyinmulticulturalcom-munitiesandmoreeffectivemessagingTheseresponseshavebeenincorporatedinthefindingsof the report
Griffith Women on Fire Focus Group Griffith Community Centre DateFriday14May
This small focus group of women was held at GriffithCommunityCentreonMay14at11amMargCouchSeniorProjectOfficerRegionalDevelopmentAustralia(RDA)-RiverinaandJoanneFitzpatrickSettlementEngagementandTransitionSupport Worker from Centacare Southwest NSW werethekeylinksandnetworkcontactsfortheGriffithcommunityTheWomenonFire(WOF)group was established as part of the Red Cross RuralFireServiceprogramlsquoManyCulturesOneCommunityrsquoInitiallyitwasestablishedtoeducatewomenonemergencypreparednessandtoen-courage NSW Rural Fire Service (RFS) volunteering andnowhastransformedintoacommunityac-tionsupportgroupTheGriffithSoroptimistInter-nationalnowauspicetheirfinancesandsupporttheWOFgroupactivitiesThefocusgroupwasfacilitatedbyCamillaCouchandlocalcommunityvolunteersledbytheGriffithSoroptimistClub
The women in the group were from Pakistan and IndonesiaThegroupweremainlyyoungmotherswithyoungchildrenandtheprogramhadchild-minding arrangements The language level of the womenwaslowandmostwerestudyingESOLat
ATTACHMENTS
ATTACHMENT 1 A Description of the Focus Groups
TAFEThedeliveryoftheinformationwaslimiteddue to language levels and the lack of bilingual interpretersEachparticipantworkedoneononewithavolunteertoslowlyfillinthesurveyandonewomantookthesurveyhometodiscusswithherhusbandThisgroupexperiencehighlightedthe lack of bilingual workers and services in some rural areas
Arabic speaking group Syd West Multicultural Services Mount Druitt Community worker Zaid Naoum Generalist Caseworker SydWest Multicultural Services DateMonday24May
ThefocusgroupfromSydWestMulticulturalSer-viceswasconductedonMonday24May2021atSydWestMulticulturalServicesMountDruittat300pmItwasfacilitatedbyPatriciaMcCormickandsupportedbyZaidNaoumGeneralistCase-workerSydWestMulticulturalServices
Therewere10womenandmenfromSyriainthegroupThegroupweremostlymaturetoolderparticipantsMostparticipantsrequiredassistancewithEnglishandthecaseworkerZaidNaoumhadtranslatedthesurveyintoArabicpriorto the focus group Zaid also translated during the focus group
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Canterbury City Community Centre (4Cs) group The Cottage Lakemba DateTuesday25May
ThefocusgroupfromCanterburyCityCommunityCentre(4Cs)wasconductedonTuesday25MayattheCottageat28CroydonStreetLakembaat10amItwasfacilitatedbyRobinMilesandsup-portedbyRomanaWaseemCommunityWorkerfrom 4Cs
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
34
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3736
The group was comprised of 14 women from PakistanIndiaandSriLankaThewomenrangedinagefrom23to65MostwerefluentEnglishspeakershoweveronewomanrequiredtransla-tionintoUrdufromoneoftheotherwomeninthegrouptoanswerthequestionsdirectly
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
NSW Chaldean League group Community worker Randa Goriya DateTuesday25May
ThefocusgroupfromNSWChaldeanLeagueMountDruittwasconductedonTuesday25May2021 at 1000am at the NSW Chaldean League premisesItwasfacilitatedbyPatriciaMcCormickandsupportedbyRandaGoriyaacommunityworker for the NSW Chaldean League in Mount DruittRandatranslatedtheintroductionandpromptsforthediscussionandhelpedthepartic-ipantstocompletethesurveyMostofthegrouprequiredhelptodothesurvey
ThegroupoftwelveparticipantswereallChaldeanandwerematuretoolderinageTheywereamixed-gendergroup
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Arabic speaking group Red Cross premises Wollongong DateTuesday25May
ThefocusgrouptookplaceonTuesday25Mayat 3pm at the Red Cross premises at Wollongong Therewere22womenandmenparticipatinginthegroupThefocusgroupwasfacilitatedbyCamilla Couch with support from Khalid Zainu-labdeenBilingualSupportWorkerHumanitarianSettlementProgram(ACTampNSW)
There were diverse ages in the group ranging fromyoungpeopletoolderagedMostofthegroupwereyoungerrecently-arrivedrefugeesfrom diverse backgrounds There was also a small-eroldercohortofparticipantswithhigherliteracylevelsandstrongercommunityengagementwith the local services in the area Camilla Couch facilitated the focus group which was conducted inArabicandEnglishwiththeArabictranslationprovidedbyKhalidZainulabdeen
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Work Opportunities for Women group Mt Druitt TAFE DateWednesday26May
TheWorkOpportunitiesforWomen(WOW)focusgroupwasheldonWednesdayMay261100ndash 100pmatMtDruittTAFEItwasfacilitatedbyCamilla Couch and built on the knowledge gainedintheprevioussessiononcriticalandanalyticalthinkingTheWOWgroupisaTAFECertificatelevel course
There were 14 women from diverse cultural backgroundsinthegroupThegroupweremainlyMuslimwomenwithschoolagechildrenandsome were mature aged Due to the learning fo-custhegroupwasfacilitatedasaclasswithguid-eddiscussionontheissuesandcarefulanalysisofthequestionsNotranslationwasneededduetotheeducationalcontextThestudentswereadeptatusingITandcompletedallthesurveysonline
STARTTS Tamil group Toongabbie Community Centre Community worker Sivaharani (Harani) Mayuran DateThursday27May
Thefocusgroupconsistedof18femalepartic-ipantswhowereyoungertomatureagedThefocus group was held at 1000am at Toongabbie CommunityCentreinTargoRdToongabbie
ThefocusgroupwasfacilitatedbyPatriciaMc-CormickandsupportedbyacommunityworkerSivaharani(Harani)MayuranfromtheSTARTTSTamil Group
ThegrouphadmixedlevelsofspokenandwrittenEnglishTheintroductionanddiscussionpromptsweretranslatedbythecommunityworkerSivaha-rani(Harani)Mayuranandsheandthemorepro-ficientstudentssupportedthosewithlowliteracytoanswerthesurveyquestions
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Spanish Speakers Seniors group SydWest Multicultural Services Blacktown DateTuesday1June
TheFocusGrouptookplaceonTuesday1Juneat1100amattheBlacktownShowgroundsandconsistedof16participants(15womenandoneman)AllparticipantswerebornincountriesinSouthAmericaTheirEnglish-fluencylevelsvariedand one of the members of the group translated thesurveyquestionsanddiscussionintoSpanish
ThegrouphadbeenmeetingforseveralyearsThegroupwasfacilitatedbyLindyCassidyandwassupportedbySreeVithyaHarilingamDayRespiteampSocialSupportTeamLeaderatSydWestMulticulturalServicesBlacktownThegroupwerematureagedtoolderparticipants
Thegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyform There was a more focused discussion on somekeyquestionsaftersurveycompletionThetranslatorassistedconsiderablyinthisprocess
Italian Speakers group Warrawong Community Centre DateMonday7June
The focus group of Italian speakers was held on Monday7Juneat1015amattheWarrawongCommunityCentreItwasfacilitatedbyCamillaCouchandsupportedbyJohnPaulTroianiand
SofiaLemafromIllawarraShoalhavenLHDMulti-cultural Health
There were 15 women in the group The group weremostlymaturetoolderparticipantsandwasconductedinItalianandEnglishwithtranslationprovidedbyJohnPaulThisgroupmeetsregularlyandissupportedbyanumberofservicesintheareaespeciallymulticulturalhealth
The group had a general facilitated discussion aboutthequestionsinthesurveyDuetolittleornoliteracytheindividualsurveyresponseswerethencollectedintooneresponseThesesurveyresponses have been included in the general surveyresponses
Mothers Group SydWest Multicultural Services Blacktown DateThursday10June
ThefocusgrouptookplaceonThursday10Juneat1030amandconsistedof14youngwomen13 of whom had a CALD background The focus groupweremainlymothersfromasupportgroupatSydWestMulticulturalServicesinBlacktown
EightofthewomenwereborninIndiatwofromPakistantwofromSriLankaonefromHausaGhana and one was born in Australia (the Austral-ianbornyoungwomanwasasocialworkstudenthelpingwiththegroup)LindyCassidyfacilitatedthe group with support from Wilma Garguath a projectofficerfromSydWestMulticultural Services
The group varied in age One was between 18-24 yearsoldSevenwereagedbetween25-34yearsSixwereagedbetween35=44yearsGiventheirage and circumstances most of the group did not consider themselves eligible at this stage for vac-cinationThiswasanimportantdifferencefromotherfocusgroupsinthattheemphasiswasmoreonwhattheywoulddooncetheybecameeligible
Participantsdidnotrequireassistancewithspo-kenEnglishThegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyformTherewasamorefocuseddiscussiononsomekeyquestions
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3938
ATTACHMENT 2 COVID-19 Vaccine Information in multiple languagesThefollowingsitesappsprovidetranslatedinformationaboutCOVID-19vaccines
Type of information KeyinformationongettingvaccinatedinNew South Wales and on the vaccines available The websiteusesanautomaticservicetotranslate thecontentintodifferentlanguages
Source of information NSW Government website
Link httpswwwnswgovauCOVID-19health-and-wellbeingCOVID-19-vaccina-tion-nswgetting-vaccinated
Type of information COVID-19ResourcessectionontheServiceNSWapp The app has a link to NSW Government websiteinformationonldquoGettingaCOVID-19vaccinationrdquo(seeabove)ItalsoincludesalinktoCOVID-19vaccinationresourcesinotherlan-guages available from the Department of Health
Source of information Service NSW NSW Government
Link Service NSW App
Type of information ArangeoftranslatedresourcesonCOVID-19bytitleincludingafactsheetonCOVID-19VaccineAstraZeneca(ChAdOx1-S)
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCOV-ID-19Pagestranslatedresources-by-titleaspx
Type of information ADigitalCOVID-19resourcelibrarywithtranslated materials
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiouscov-id-19Pagesdigital-resourcesaspx
Type of information AMultilingualCommunityToolkitontheCOVID-19vaccinationprogramtoassist communityworkersprovideseasytoreadresourcesvideosandlinkstokeyservicesandresources
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCovid-19DocumentsNSW-COVID-19-vaccina-tion-program-presentation-20210527pdf
Type of information TheNSWMulticulturalHealthCommunicationServiceoffershealthresourcesandinformationin a wide range of languages It has translated resources on COVID-19 and links to translated resourcesonCOVID-19vaccination
Source of information MulticulturalHealthCommunicationServiceisa New South Wales-wide health service hosted bySouth-easternSydneyLocalHealthDistrict(SESLHD)
Link httpswwwmhcshealthnswgovau
Type of information COVID-19vaccineinformationaddressingkeyquestionsaboutCOVID-19vaccinationandincludesvideosposterstilesfactsheetsandaudio material Translated into 63 languages
Source of information Department of Health Australian Government website
Link httpswwwhealthgovauinitiatives-and-pro-gramsCOVID-19-vaccinesCOVID-19-vaccine-in-formation-in-your-language
Type of information ThisinformationaddressessomecommonmisinformationaboutCOVID-19Translatedintomultiplelanguages
Source of information DepartmentofHomeAffairs Australian Government website
Link httpscovid19inlanguagehomeaffairsgovaumisinformation-and-truths-about-coronavirus
Type of information Australianandinternationalnewsand informationaboutCOVID-19andCOVID-19 vaccinesisavailableontheSBSCoronavirusPortal in more than 60 languages
Source of information SBSwebsite
Link httpswwwsbscomaulanguagecoronavirus
Type of information InformationprovidedaboutCOVID-19vaccinerolloutandsafetyinlanguagesotherthan English
Source of information Department of Health and Human Services Victorian Government
Link httpswwwcoronavirusvicgovautranslat-ed-information-about-COVID-19-vaccines
Type of information HealthTranslationsprovidestranslatedmateri-alsonhealthandwellbeingInformationaboutCOVID-19isregularlyupdatedincludessomeinformationonvaccinationandisavailableinover60communitylanguages
Source of information Victoriangovernmentinitiative
Link httpswwwhealthtranslationsvicgovaubhcv2bhchtnsfPresentEnglishResource-AllOpenampx=amps=Coronavirus
Type of information A one-stop shop for translated materials in multiplelanguagesonCOVID-19
Source of information Ethnolink Language Services
Link httpswwwethnolinkcomauCOVID-19-coro-navirus-translated-resources
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
40
iii ACKNOWLEDGEMENTS
1 EXECUTIVE SUMMARY
5 RECOMMENDATIONS
6 RESEARCH SUMMARY INFOGRAPHIC
8 INTRODUCTION
9 METHODOLOGY
Recruitment for the focus groups 9
A word about the research design 11
Demographicsofresearchparticipants11
14 FINDINGS
Having the vaccine or not 14
Reasons for having the vaccine 17
Reasons for not having the vaccine 18
Vaccine refusal 20
Other factors considered 21
Knowing someone who has been vaccinated 22
Knowing someone who has had COVID-19 23
Knowing where to get vaccinated 24
SourcesofinformationaboutCOVID-19 and the vaccine 25
29 DISCUSSION
35 ATTACHMENTS
ATTACHMENT 1 ADescriptionoftheFocusGroups35
ATTACHMENT 2 COVID-19VaccineInformationinmultiplelanguages 39
CONTENTS
AUTHORS NOTE
ThisreporthasbeenwrittenbyRobinMiles LindyCassidyandAudreyBennettwithinputtothecontentandrecommendationsfrom Dr Camilla Couch and Patricia McCormick
ACKNOWLEDGEMENTS
ThisresearchconductedbySocialEquityWorkshasbeencommissionedbytheNewSouthWalesCouncilofSocialService(NCOSS)andfundedbyNSWMinistryof Health
The research team would like to thank the following services who helped to set up the focus groups The research team is indebted to these ser-viceswhoopenedtheirdoorstotheresearchteaminashorttimeframebetweenMayandJune2021andinparticularcollaboratedonthefacilitationoffocusgroupswiththeircommunitymembersincludingsup-portingtheteamwithspokenandwrittentranslationandbilingualfacilitation
Rosanna BarberofromAddisonRoadCommunityCentreMarrickville
Romana WaseemfromCanterburyCityCommunityCentre(4Cs)Lakemba
Marg CouchSeniorProjectOfficer Regional Development Australia (RDA)-Riverina
Joanne FitzpatrickfromGriffithWomenonFireGrif-fithCommunityCentreGriffith
Randa GoriyafromtheNSWChaldeanLeagueMtDruittTAFECampusMtDruitt
Khalid ZainulabdeenfromRedCrossNSWACTWol-longong
Sivaharani (Harani) Mayuran from STARTTS deliveredatToongabbieCommunityCentreToongabbie
Sree VithyaHarilingam Wilma Garguath and Zaid NaoumfromSydWestMulticultural CommunityServicesMtDruittandBlacktown
Sofia Lema and John Paul Troiani from Illawarra ShoalhavenLocalHealthDistrictWollongongdeliveredattheWarrawongCommunityCentre
Leissa PittsManagerISLHDMulticulturalHealthandRefugee Health Service
Talei VulathaCommunityResilienceProject OfficerMulticulturalCommunitiesCouncilIllawarra
Wewouldespeciallyliketothankthe167peoplewhoparticipatedinourfocusgroupsallofwhomweregenerouswiththeirtimeandpassionateclearandfearlessinthefeedbacktheyprovidedtotheresearch-ers about the COVID-19 vaccine
RESEARCH TEAMProject Lead Robin Miles
Qualitative Research Team Dr Camilla Couch Patricia McCormick LindyCassidy
Expert Multicultural Advisor Paula Abood
Research Assistant AudreyBennett
REPORT DESIGN Cath Appleton Design
i
1
Australiahasbeenverysuccessfulinstemmingthespreadofthevirusthroughacombinationofborderclosuresquarantineafirst-worldhealthsystemandexpertcontacttracing
ItispossiblethatwerethisresearchconductedtodaythishesitancywouldbereducedduetotheheightenedriskofcontractingCOVID-19throughthe more transmissible Delta variant and its pres-enceinthecommunity
Regardlesstheneedforvaccinetake-upamongCALDcommunitiesremainshighgiventheycanbe at increased risk due to factors such as in-securehigh-riskemploymentandlivinginhighdensityhouseholdsandtoensureequitablepublichealthoutcomesandsocialeconomicandcommunityparticipationforeveryone
Thiswasasmallstudyof199people(oursam-ple)drawnfromculturally-diversecommunitiesinmetropolitanSydneyandtworegionalNSWlo-cationsCommunitymemberswereaskedsurveyquestionseitheronlineorthroughfocusgroupsSeparateinformationwasalsocollectedfromintermediaryorganisationsworkingwithCALDcommunities(viaasecondsurvey)
ThestudyrsquospurposewastounderstandissuesbarriersandperceptionsinrelationtotheCOV-ID-19vaccineamongNSWrsquosmanyculturallyandlinguisticallydiverse(CALD)communitiesAssuchitpresentsagrassrootsperspectiveKeyfindingsarepresentedbelow
CALD communities have mixed responses to the vaccineLikethegeneralpopulationourstudyhighlightsthat NSW residents from CALD backgrounds are mixedintheirresponsestoandconfidenceinhavingtheCOVID-19vaccine
EXECUTIVE SUMMARY
This research was conducted between late April and early June 2021 just prior to the most recent outbreak in Sydney of the Delta variant of COVID-19 Many participants in our study who were unwilling or hesitant to be vaccinated expressed the opinion that COVID-19 was not a lsquoreal and present dangerrsquo in Australia due to the very low case numbers active at the time
FIGURES10 Figure 1
Country of Birth
11 Figure 2 Language spoken at home
12 Figure 3 Length of time living in Australia
12 Figure 4 Age
13 Figure 5 Gender
14 Figure 6 Are you going to get the COVID-19 vaccine
15 Figure 7 COVID-19 Vaccine intention of respondents by age category
16 Figure 8 Respondents COVID-19 Vaccine intention by Country of Origin
17 Figure 9 Reasons for getting vaccinated against COVID-19
18 Figure 10 Reasons for not getting vaccinated against COVID-19
22 Figure 11 Do you know someone who has been vaccinated
23 Figure 12 Knowing someone who has had COVID-19
24 Figure 13 Who do you know who has had COVID-19
25 Figure 14 Where to go to get vaccinated
25 Figure 15 Sources of information about COVID-19 and the COVID-19 vaccine
27 Figure 16 Sources of information for respondents who were planning to have the vaccine
27 Figure 17 Sources of information for respondents who are not planning to have the vaccine
28 Figure 18 Sources of information for respondents who lsquodonrsquot knowrsquo if they will have the vaccine
1StephenDuckettToo many Australians are hesitant to get vaccinated Herersquos how we fix itSydney MorningHeraldMay192021
TABLES10 Table 1
Focus Group Details
15 Table 2 People in the sample already vaccinated
15 Table 3 Vaccine refusal and hesitancy in the sample
20 Table 4 Vaccine refusal by country of birth and language background
21 Table 5 Reasons for not having the vaccine
22 Table 6 Who do you know who has been vaccinated
1
58 of people in our sample reported that they would be having the vaccine
This included 13 people (64) who had already been vaccinated in most cases having had their first vaccination only
42 reported that they were unsure or were not planning to have the vaccine
Of these 29 were unsure or hesitant
13 reported that they would not have the vaccine
ThiscomparescloselytorecentdatapublishedbyTheAgeandSydneyMorningHeraldthatsug-gests lsquoabout a third of Australians are hesitant aboutgettingaCOVID-19vaccinersquo1
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
32
A range of factors appear to influence attitudesOlderpeople(65+)inthesurveysampleweretheagegroupmostlikelytoreporttheyhadhadorwereintendingtohavethevaccinewhileyoung-erpeople(18-24)weremostlikelytoexpressuncertaintyorhesitancy
Countryofbirthalsoshowedupasapossibleindicatorforbeinglsquopositivelypre-disposedrsquoto-wardsvaccinationandwouldbeworthyoffurtherresearch
Knowing someone who had had the virus or been vaccinateddidnrsquotappeartomakerespondentsmorelikelytogetthevaccinethemselves
Themostfrequentlycitedreasonsforgettingthevaccinewereamixofpersonalsafety(lsquokeepingfamilyself-safersquo)altruisticreasons(lsquoforpublichealthrsquoandlsquoitistherightthingtodorsquo)andthemoremotivationalreasonlsquototravelrsquo
AcrossCALDcommunitiesthereisagoodlevelofpracticalknowledgebutstillsomeuncertaintyaboutwheretoaccessvaccinations
Focusgroupparticipantsgenerallyindicatedfamiliaritywiththe2typesofvaccinesavailableandtherisksassociatedwitheachparticularlyre-gardingAstraZenecandashalthoughthiswasnotablynotthecaseforagroupofnewly-arrivedrefugeeswhohadlittleornoknowledgeofvaccinationsforthe virus
Over 80 of respondents knew where to go to getvaccinatedincludingGPsthevaccinationhubforSydneyresidentsandlocalhospitalsHowev-eraconcerning19reportedthattheydidnotknow where to get vaccinated
Fears and concerns about vaccinations remain Despite high rates of knowledge about COVID-19 acrossourstudysamplearangeofconcernsandmisconceptionsndashsharedwiththewiderpopula-tionndashwereevidentTheseincluded
FearaboutbloodclotscausedbytheAstraZeneca vaccine
Fearabouttheperceivedlackoflsquoproperrsquotestingofthevaccinepriortorollout
Lackofcertaintyabouthowthevaccineworks
ConcernsthatthevaccinewillmakeyousickorchangeyourDNA
Concern that the vaccine is a form ofgovernment control
Abeliefthatifyouarehealthyitisbettertofightthevirusandmakeyourselfandyourimmunesystemlsquostrongerrsquoasaresult
Onlyasmallnumberofpeopleinthesurveysample reported that religious or cultural reasons were a barrier to having the vaccine
Public health information can be confusingThefocusgroupshighlightedthatconflictingpub-licmessagingoverly-complexinformation(evenwhentranslated)ornotenoughtargetedinformationwerefactorsinvaccinehesitancywithcomments including
The importance of social and mass mediaAcrossallrespondentsthemostfrequently-citedsourceofinformationregardingCOVID-19nominatedby417wasFacebookAmongthosenotintendingorhesitanttohavethevaccinelsquoFacebookrsquoandlsquoMyfriendsrsquowerenominatedasthemostcommonlyrelieduponsourcesofinformationForthoseintendingtohavethevaccineSBSTVwasthemostfrequently-citedsourceofinformation
The focus group discussions further highlighteddifferentapproacheswithregardstohealth
informationthatneedtobeconsideredinthecontextofpublicmessagingAnumberofgroupsdiscussedusingtheirGPsforhealthinformationandhealthcarebutalsorelyingontheinternet(includingfitnessandwellbeingsites)FacebookandothersocialmediasuchasWhatsAppandWeChatassourcesofhealthinformationYoung-erfocusgroupparticipantsalsospokeaboutobtaininginformationfromadditionalsourcesincluding Tik Tok and Instagram
TelevisionnewslocalnewspapersandcommunitygroupswerealsohighlyregardedassourcesoflsquoaccuratersquoinformationSomefocusgrouppartici-pantsidentifiedusingmainstreammediasourcestolsquofactcheckrsquowhattheywerehearingonsocialmediaLocaltelevisionnewswasparticularlyimportantinregionallocationswherepeoplewantedtoknowwhatwashappeninglocallyandhowitwouldaffectthem
Government websites are not the lsquogo-torsquo source of informationGovernmentwebsiteswerementionedinthelsquootherrsquocategoryofprimarysourcesofinformationnominatedbylessthan10ofresearchrespond-entsThissuggeststhattheyarenotthepreferredlsquosourceoftruthrsquoforCALDcommunitiesAscanof government health websites indicates that a rangeofusefulresourcesconcerningCOVID-19includingforCALDcommunitiesandorganisa-tionssupportingthemhavebeendevelopedHoweverasourexperienceandotherresearchtellsusthesewebsitescanbedifficulttonav-igaterelyonacertainlevelofdigitalinclusionanddigitalliteracyskillstheinformationprovidedcanbecomplextounderstandornotineasy-readformatsndashinvolvingtechnicaltermsandjargonand placing something on a website does not nec-essarilymakeitaccessibletoparticulargroupsinthecommunityevenwhentranslated
Targeted tailored messaging is essentialOtherrecently-publishedresearchconcerningCOVID-19andCALDcommunitiessupportsfindingsfromoursurveyandfocusgroupsandcontainskeyinsightsrelevanttocommunicatingpublichealthinformationThisincludes
ResourcesavailableonwebsitesoftenrelyonahighlevelofEnglishlanguageliteracyorliteracyinapersonrsquosfirstlanguage
The importance of tailoring messaging tothosewithlowerlevelsofhealthliteracywhoaremorelikelytoendorsemisinformedbeliefsaboutCOVID-19andvaccination
Massmediacampaignsshouldbeutilisedbutsupplementedbydecentralisedcommunicationstrategiesthattapintolocalsupport networks
Theneedtoconveyinformationinawaythatismeaningfultopeopleusingtrustedcommunitysourcesandmultiplechannelstoreinforce messages
Drawing on motivational factors is keyOncloserinspectiontheresultsofourstudysuggestthatvaccinehesitancyisperhapsbetterunderstoodaslowmotivationndashoralsquowaitandseersquoapproachManyparticipantssaidthattheywould consider having the vaccine if there was lsquomoreofareasonrsquotodoso
Reasonsgivenbyparticipantsthatwouldmoti-vate them to get vaccinated included
Manyparticipantsevensomewhowerethemostvaccinehesitantsaidthatifbeingfullyvaccinat-edmeantthedifferencebetweenbeingabletotraveloverseastovisitfamilyornottheywoulddefinitelyrolluptheirsleevesandgetlsquothejabrsquo
If I was able to travel to see my
family If there was more risk from COVID-19 ndash another outbreak or
concern about increased
transmission
If I had to in order to keep my job
Nobody knows what to do My GP doesnrsquot even
know what I should do whether I should
have it or not
They say one thing and then they tell you
something elsehellipit (the vaccine rollout) is
so confusing
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2 3
EXECUTIVE SUMMARY
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
54
RECOMMENDATIONS
Againthisalignswithotherresearchwhichemphasisestheimportanceofbuildingmotiva-tionalandlsquopullrsquofactorsintothevaccinerolloutstrategyandaccompanyingmessaginginorderto increase vaccine uptake among CALD com-munitiesInvolvingcommunitiesintheprocessunderstandingconcernsandmotivationalfactorsbuildingtrustandtestingmessaginghavebeenidentifiedaskey
If I could get home to see my mother I would get
vaccinated today
ThisresearchisintendedtoprovideausefulgrassrootsperspectivefromarangeofCALDcommunitiesacrossNSWonissuesbarriersandperceptionsconcerningtheCOVID-19vaccineItishopedthatthesefindingscontributetoagrow-ingbodyofknowledgeregardingCOVID-relatedissuesforNSWrsquosculturally-diversecommunities
The research has highlighted that reinforcing the benefitsofbeingvaccinatedratherthandwellingontherisksismorelikelytogeneratebehaviouralchangeandapositivevaccineresponsefrombothCALDcommunitiesandthegeneralpopulationIt also reminds us of the immense value of the
direct and early engagement with specialist local multicultural and state-wide ethno-specific community organisations in the development and rollout of any public health campaigns
strategies to ensure community involvement in and ownership of any campaigns with trusted sources such as local community leaders and peer champions
tailored targeted messaging across multiple platforms and channels available in easy-to-read format for English and translated versions
supporting health care professionals in their role as educators and leveraging successful local programs that increase COVID-19 vaccine literacy and informed decision making
further research to understand concerns misconceptions and motivations of priority groups
1
2
3
4
5
long-standingtrustandstrongrelationshipsthatexistbetweenlocalplace-basedservicesandthecommunitiestheyworkwithndashcloseconnectionsthatshouldbeutilisedtoadvancepublichealthoutcomes
InthiscontextitisrecommendedthatNSWHealthinpartnershipwithMulticulturalNSWCALDpeakbodiesandcommunityleadersusethisresearchtoinformongoingeffortstoencour-age uptake of the COVID-19 vaccine among CALD communitiesThefindingsindicatethattheseeffortscouldbesupportedby
4 5
Motherrsquos Group at SydWest Multicultural Community Services Blacktown
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
76
HEALTH INFO
Health information from online sources (low use of government websites)
Main stream media
Younger group
Tik Tok
58 said yes to the vaccine with 64 previously vaccinated
= 2 people
29 were unsure or hesitant
13 reported that they would not have the vaccine
Issues barriers and perceptions about the Covid-19 vaccine among culturally and linguistically diverse communities in NSW
if I could get
home to see my
mother I would
get vaccinated
today
Covid is not
real and present
danger but I would
get vaccinated if
there was a
reason too
I would get vaccinated
FEARS amp CONCERNS about the
vaccineFear about blood clots
caused by the Astra Zeneca
vaccineFear about
the perceived lack of lsquoproperrsquo testing of the
vaccineLack of
certainty about how the vaccine
workedConcerns
that the vaccine will make you sick or change
your DNA
Concern that the vaccine
is a form of government
controlA belief that if you were
healthy it was better to fight the virus and
make yourself and your immune system
lsquostrongerrsquo as a result
if there was more risk from Covid ndash another outbreak or concern about increased transmission
199participants
11focus groups
if I had to in order to keep my job
if I was able to travelto see myfamily
More likely to get the vaccine
+65 age groupThis small study of 199 people from a range of cultural backgrounds in
metropolitan Sydney and two regional locations
found that the community is divided in its response to both the safety need
and efficacy of the vaccine
Almost half of the participants knew someone who had contracted COVID-19 over-seas Many people spoke about the impact of COVID-19 on their immediate family including some who had lost loved ones
Influence of friends and family overseas
2 3
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
98
This research project has been commissioned by the New South Wales Council of Social Service (NCOSS) to look at issues concerns attitudes and barriers to receiving the COVID-19 vaccine in culturally and linguistically diverse (CALD) communities in NSW
The research was conducted over two months fromlateApriltolateJune2021withdatacol-lectedjustpriortothelatestCOVID-19outbreakinSydneyItwasundertakenwithsomeurgencygiven the following factors
the lack of data concerning peoplefromculturallyandlinguisticallydiverse backgrounds in larger research studies 2
theheightenedconcerninthecommunity aboutthepotentialsideeffectsofin particulartheAstraZenecavaccinewhich has led to a higher-than-usual rate of vaccine hesitancyinthewidercommunity3
theneedtolifttheoverallvaccinationratein Australia
Emergingresearchindicatesthatmisconceptionsabout COVID-19 in Australia tend to be more common in groups with lower levels of health literacyincludingpeoplewhospeakalanguageotherthanEnglishInadditionthevariedexperi-enceofandinformationaboutCOVID-19trans-missionandvaccinationinoverseascountriesmakesthisaparticularlyinterestingissuegiventhatCALDcommunitymembersmaybehavingregulardiscussionswithrelativesoverseasandgettinginformationaboutCOVID-19fromover-seas sources
2McCafferyKJDoddRHetalHealth literacy and disparities in COVID-19ndashrelated knowledge attitudes beliefs and behaviours in AustraliaPublicHealthResPract202030(4)e30342012 December 2020 First published5 November 2020lsquoThereareseverallimitationstoourstudyAlthoughourrecruitedsamplewaslargeanddiverseitwasnotstatisticallyrepresentativeoftheAustralianpopulationTheproportionofAustraliansfromnon-Englishspeakingbackgroundswassmall(6)sincethesurveywasnottranslatedandrequiredsufficientEnglishskillstocompletethequestionnaireinEnglishrsquo(p7)
3AnonlinesurveyconductedbyEssentialResearch(April2021)completedby1090peoplebetween21ndash26April2021foundjust43ofAustraliansthinktherolloutisbeingdoneefficientlydownfrom68inMarchhellipTheslowrolloutandchanges to the roadmap also appear to have given rise to vaccinehesitancywithoneinsixpeople(16)sayingtheywillnevergetvaccinatedagainstCOVID-19upfrom12lastmonthwhile42saidtheywillgetvaccinatedbutnotrightawayTheproportionofpeoplewhowouldbewillingtogetvaccinatedassoonaspossibleorarealreadyvaccinatedalsodeclineddownfrom47to42rsquoEssentialReport(April 2021)
A mixed-method research methodology was used for this project However it was primarily a qualitative approach that aimed to hear directly from people in the community from culturally and linguistically diverse (CALD) backgrounds The methodology involved
METHODOLOGY
11 focus groups (including one pilot) involving atotalof167participantsfromCALD backgroundsand7locationsGriffith(1) Wollongong(2)Blacktown(2)Lakemba(1) MtDruitt(3)Toongabbie(1)andMarrickville (1)Thesesupportedparticipantstoanswer thesurveyquestionsandenabledmore detailedexplorationofissuesandfurther gatheringofqualitativeinformation(see Table1below)Identifiedmulticulturalandcommunityserviceorganisationswith connectionstoCALDcommunitiesinthe relevantlocationsactedaslsquointermediariesrsquo byassistingwithorganisingthefocusgroups providingbilingualfacilitationofdiscussion andsupportingcommunitymembersto undertakethesurveyMoreinformationonthefocusgroupsandintermediary organisationscanbefoundatAttachmentA
Anonlinesurveywiththesamequestionsas those used in the focus groups was made available This was promoted via NCOSS networksandtheresearchteamrsquosCALD connectionsandcompletedby32peopleThe totalsamplesizeofthisstudywastherefore 199participantsmadeupofmembersof diverseCALDcommunities
Abilingualmulticulturalcommunity engagementexpertwasengagedthroughout theprojecttoadvisetheresearchteam includinginrelationtothedesignofthe surveyBilingualfacilitatorswereusedfor focusgroupswherenecessaryandguidance wasprovidedbyintermediaryorganisation representativesasrequiredandinone instancethesurveywastranslatedintoArabic Focus group members were each provided witha$25giftcardattheendofthesession anda$50giftcardwasdonatedtothe intermediaryorganisationtoprovidesome additionalresourcestoeachgroup
Asecondonlinesurveywasdesignedtoelicit theviewsandexperienceoftheintermediary organisationsintheirworkwithCALD communitiesItgeneratedeightresponses
Two interviews were undertaken with a multiculturalhealthcommunicationexpert from the Illawarra Shoalhaven Local Health DistrictandanEmergencyDepartment medicalpractitioner
Theonlinesurveyresponsesfromthe intermediaryorganisationsandtheinterviews withhealthstaffhaveinformedanalysisof datafromcommunitymembersfindingsand recommendations
Inadditiontheresearchhasbeeninformedbyotherpubliclyavailableresearchincludingfind-ingsconcerningvaccinehesitancyanduptake4andascanofmulticulturalCOVID-19healthresourcesavailableincommunitylanguagesfromtheCommonwealthNSWandVictorianGovern-mentsSBSandEthnolink(seeAttachment2)
Recruitment for the focus groups IntermediaryorganisationsandfocusgroupparticipantswererecruitedusingtheresearchteamrsquosextensiveconnectionswithmulticulturalandcommunityserviceorganisationsacrossNSWanddrawingonkeyNCOSSmemberorganisa-tionsprovidingsupporttoandwithlongstandingrelationshipswithCALDcommunitiesToalargeextenttheselectedlocationsandtheservicesandsupportsprovidedbytheintermediaryorgan-isationsdeterminedtheculturalbackgroundsthatwereincludedinthestudy
4 httpswwwncossorgauCOVID-19-research
INTRODUCTION
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1110
Service Location Group Composition Participant numbers
Addison Road Community Centre Marrickville Community leaders - Vietnamese Chinese Italian Greek Indonesian Latin American and Portuguese speakers
26
Griffith Community Centre Griffith Indonesian and Pakistani women 6 Multicultural Communities Council Illawarra
Wollongong Arabic-speaking group 22
Multicultural Communities Council Illawarra
Wollongong Italian older womenrsquos group 15
Syd West Multicultural Services Mt Druitt Arabic-speaking group 10 Syd West Multicultural Services Blacktown Spanish-speaking seniorsrsquo group 16 Syd West Multicultural Services Blacktown Mothersrsquo support group -
Indian Sri Lankan Pakistani and Ghanaian
14
Canterbury City Community Centre (4Cs)
Lakemba Pakistani Indian and Sri Lankan women
14
Chaldean League and Western Sydney TAFE
Mt Druitt Chaldean group 18
STARTTS - Toongabbie Community Centre
Toongabbie Tamil-speaking group 12
Mt Druitt TAFE ndash TAFE NSW Mt Druitt Work Opportunities for Women group (mixed CALD backgrounds)
14
TOTAL 167
Table 1 Focus Group DetailsExplanatory noteThefocusgroupatMtDruittTAFE-comprisedpredominantlyofCALDwomenenrolledinaCertificateIIentrylevelcourse-wasusedtopilotandrefinethefocusgroupprocesswithsurveyresponsesgeneratedbythegroupincludedinthefinalsurveyresults
A word about the research design Theresearchwascarefullydesigneddrawingonexpertculturaladviceoncommunicationpro-cessesandsurveydesignFocusgroupsincludedparticipantconsentformsincentivevouchersandaone-pageintroductiontotheresearchfortheintermediaryorganisationsIntermediaryorgan-isationsandpreferredlocationswereidentifiedand agreed in advance with NCOSS
Thesurveywasdesignedinaneasy-to-readformatusingsimpleEnglishFeedbackfromthe Spanish-speaking translator was that it was extremelyeasytotranslateandcompleteOthergroupscommentedthattheyfoundthesurveyeasytocompleteandmostgroupsdisplayedasolidlevelofspokenandwrittenEnglishTheresearchdesignandconductalsoleantheavilyontheexpertiseofthefacilitatorsandtheirexten-sivenetworkswhichmadedeliveryinsuchashorttimeframepossibleThepositiveengagementandsupportoftheintermediaryorganisationswasalsoafactorcontributingtothesuccessfulconduct of the research
Withoutfailthemulticulturalandcommunityserviceorganisationsinvolvedintheresearchper-ceived the importance of its purpose and shared a desire to provide NSW Health with feedback directlyfromtheircommunitiesasamatterofurgency
Demographics of research participantsThemakeupofthosewhoparticipatedintheresearch was diverse in age and cultural and languagebackgroundParticipantswerepredom-inantlywomen(84)withmenmakinguponly145OverhalftheparticipantshadlivedinAustraliaformorethan20yearswhichimpactedpositivelyontheirlevelofspokenandwrittenEnglishHowevertherewerequitelowlevelsofEnglishliteracyinanumberofthegroupswhichmadeguidedsurveycompletionamoreneces-sarybutcomplexprocess
1 1 1
6
3
31
16 17
20
12
15
1
8
2
64
1
5
2 13
1 1
7
2 1
5
1 1 1 1 2 10
5
10
15
20
25
30
35
Indo
nesia
Thai
land
Hong
Kon
gAu
stra
lia Iran
Iraq
Viet
nam
Italy
Sri L
anka
Indi
aPa
kist
anGh
ana
Syria
Boliv
iaCh
ilePe
ruEl
Sal
vado
rM
alay
siaUr
ugua
yAr
gent
ina
Cam
bodi
aUk
rain
eRu
ssia
Chin
aSu
dan
Eritr
eaSw
eden
Taiw
anAf
ghan
istan
Pola
ndJa
pan
Egyp
tJo
rdan
13
1 2
10
17
2
21
1
11
1 1
12
2 1
27
10
1 1 1 13 2 1 2 1
6
1 1 1
32
0
5
10
15
20
25
30
35
English Thai
Cant
ones
eVi
etna
mes
eIta
lian
Farsi
Tam
ilTe
lugu
Span
ishSp
anglish
Haus
aUr
duGu
jara
tiPu
njab
iAr
abic
Chalde
anHi
ndi
Khm
erPe
rsian
Russian
Man
darin
Malay
Haza
ragi
Tigr
inya
Kurd
ishCh
ines
ehellipJa
pane
sePo
lish
Swed
ishM
ultip
le
Figure 1 Country of BirthFigure 2 Language spoken at home
METHODOLOGY
Coun
t
Coun
t
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1312
211
1316 14211684
2053
3316
Less that 1year
1 - 2 years 2 - 5 years 5 - 10 years 10 - 20years
More than20 years
000
500
1000
1500
2000
2500
3000
3500
Less than 1-2 years 2-5 years 5-10 years 10-20 More than1 year years 20 years
1453
8430
000 116
Male Female Non-binary Rather not say000
100020003000400050006000700080009000
000
785
1728
2147
1309
1675
2356
Under 18 18-24 25-34 35-44 45-54 55-64 65+000
500
1000
1500
2000
2500
Figure 3 Length of time living in Australia Figure 5 Gender
Figure 4 Age
METHODOLOGY
Chaldean Focus Group Feedback Sheet
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1514
Research participants were asked
If they were intending to get vaccinated
The reasons why they would or would not choose to get vaccinated
If they knew anyone who had already been vaccinated and if so who
If they knew anyone who had contracted COVID-19 and if so who
If they knew where to go to get vaccinated
What sources they used to get information about the COVID-19 vaccination
Basic demographic information age gender country of origin language spoken at home and length of time living in Australia
Having the vaccine or notOfthe199participants117(58)reportedthattheywereplanningtobeorhadalreadybeenvaccinatedwhile78(42)reportedthattheywere not planning to have the vaccine (13) or didnotknowiftheywouldgetvaccinated(29)
1453
8430
000 116
Male Female Non-binary Rather not say000
100020003000400050006000700080009000
05
10152025303540
Under18
18-24 25-34 35-44 45-54 55-64 65+
Coun
t
Yes No Donrsquot Know
Figure 6 Are you going to get the COVID-19 vaccine
Figure 7 COVID-19 Vaccine intention of respondents by age category
13people(65)hadalreadybeenvaccinated(at least 1 dose)6withseveralcommentingthattheyhadchosenorneededtobevaccinatedforwork-relatedreasonsOthersreportedthattheyhadbeenvaccinatedprimarilyforhealthreasonstostaywellandmakesurethattheirfamiliesstayedwellTheywerealsoconcernedaboutpublichealthandsafetyOneofthewomenintheLakemba groups from Sri Lanka was adamant that thebenefitsoutweighedtherisksspokepositive-lyabouthoweasyithadbeentogetthevaccinefrom her local medical centre and that she had experiencednosideeffectsfromthevaccination
Language Count Percent Urdu 1 Italian 3 Arabic 2 Tamil 3 Chaldean 1 Spanish 3 Total 13 65 of sample
Response Count Percent Not planning to have the vaccine 23 13 Unsure about having the vaccine 52 29
75 42
Table 2 Respondents already vaccinated
Table 3 Respondents who indicated vaccine refusal or hesitancy
6 Theresearchersdidnotdistinguishbetweenwhetherpeoplehadreceivedtheirfirstandseconddosesofthevaccineiepartiallyorfullyvaccinated
75(42)indicatedadegreeofvaccinehesitancywith24participants(13)reportingthattheywerenotplanningongettingvaccinatedwhile53(29)reportedtheydidnotknowiftheywouldget vaccinated
Thislevelofvaccinehesitancyreflectslargerstud-iesintheAustraliancommunityAsurveyofover1000participantsfromacrossAustraliaconduct-edinApril2021byEssentialResearchfoundhes-itancyratesof42including16whoindicatedtheywerenevergoingtogetvaccinated7
Foroursurveyresponsesindicatedthatagewasafactorwith85ofrespondentsaged65andoverreportingthattheywouldhaveorhad
7EssentialResearchThe Essential Report21April2021
FINDINGS FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1716
alreadyhadthevaccineThosewhoindicatedthattheywouldnotbehavingthevaccinewerefairlyevenlydistributedacrossagegroupswithyoung-er people aged 18-24 being the age group with thehighestproportionofparticipantsexpressinguncertaintyabouthavingthevaccineTheagegroupwiththesecondhighestlevelofhesitancyproportionatetoothercategorieswerethe35-44yearolds
02468
10121416
Iraq
Vietnam Italy
South Americ
a
Sri La
nkaIndia
Syria
Other South East
AsiaAfric
a
Australia
Sweden
China
Pakistan
Iran
Eastern Europe
Afghanistan
Japan
Coun
t
Yes No Dont know
8095 8190
70486095
4571
6190
095
To stayhealthy and
well
To keep myfamily
healthy andwell
For publichealth
To travel To work It is theright thing
to do
Somethingelse (pleasetell us what)
000100020003000400050006000700080009000
Figure 8 Respondents COVID-19 Vaccine intention by Country of Origin
Figure 9 Reasons for getting vaccinated against COVID-19
Countryoforiginalsoseemedtoplayaroleinpeoplersquosviewsabouthavingthevaccinewithhighvaccinepre-dispositionreportedbyVietnameserespondentstotheonlinesurveyandwomenintheItalian-speakinggroupWhileparticipantsfromIraqrecordedthehighestlsquoyesrsquoresponsethiswasalmostmatchedbyIraqiparticipantswhoreportedthattheywerelsquounsurersquoorlsquodidnotknowrsquowhethertheywouldhavethevaccineTherelevanceofcountryoforigininthisregardwouldbeworthyoffurtherresearch
The Italian focus group held in Wollongong was an olderwomenrsquossocialgroupwithallparticipants(15) agedabove65yearsMostinfactwereaged over75yearswithoneparticipantinher90s 87 of the group had either been vaccinated (3) or were planning to get vaccinated (10)
Of course I will get vaccinated It is important to do this It is a very bad
disease
Thesewomenweremotivatedtostayhealthyandwellkeeptheirfamilyhealthyandwellforpublichealthreasonstobeabletotravelandforgen-eralsafetyMembersofthegroupalsoreportedthattheywantedtogetvaccinatedsothattheywouldbeabletolsquodancersquoandlsquosocialisersquo
Reasons for having the vaccine
Ofthe117participantswhoreportedthattheyhadeitheralreadybeenvaccinatedorwereplan-ningtogetvaccinatedlsquokeepingmyfamilyhealthyandwellrsquo(82)andlsquokeepingmyselfhealthyandwellrsquo(81)werethetwomostpopularreasonsforhavingthevaccineThiswasfollowedbylsquoforpublichealthrsquo(70)lsquoitistherightthingtodorsquo(62)andinorderlsquototravelrsquo(61)(SeeFigure9)
I donrsquot want to
die
Irsquom over 65 I have some health issues I think itrsquos
[having the vaccine] very important to
keep safe
I want to see my family I usually go every year but now I havenrsquot seen them
because of COVID-19 Having it will help
I am well but my parents are older It is important to
keep them well
Otherreasonsthatpeoplegaveforgettingvacci-natedincludedtheneedtocontinueworkinginessentiallsquofrontlinersquoemploymentsuchassecuritycleaningandagedcaresettingsOnewomanintheLakembafocusgroupwhohadalreadyhadherfirstdoseoftheAstraZenecavaccinesaidthatlsquothebenefitsoutweightherisksrsquoandasanolderwomanrsquoIdonotwanttodiersquo
All but one of the focus groups were familiar with thedifferentvaccinescurrentlyavailableinAus-traliaAstraZenecaandPfizerMostparticipantswere also aware of blood clots being associated with the Astra Zeneca vaccine One group of newly-arrivedrefugeesinGriffithhadnotheardofeithertheAstraZenecaorPfizervaccinesandhadamorelimitedunderstandingofthevaccinationprogram in general
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1918
Reasons for not having the vaccine
At the moment the situation is under control and donrsquot feel the need Also I have no plans to
travel in the near future so I donrsquot see the need
3514
21622703
3243
1892
811 541
4865
1081
Thevaccine isnot welltested
Thevaccine is
unsafe
Formedicalreasons
I amscared tohave thevaccine
I dont likevaccines
Forreligiousreasons
Forculturalreasons
I want towait and
see
Somethingelse
(pleasetell uswhat)
000
1000
2000
3000
4000
5000
6000
Figure 10 Reasons for not getting vaccinated against COVID-19
Theperceivedlsquolackofadequatetestingrsquoofthevaccineandlsquofearofbeingvaccinatedrsquoalsore-ceivedhighresponseratesselectedby3514and3243ofparticipantsrespectivelyOnly1355 of respondents cited religious or cultural reasonsasbeingbehindtheirvaccinehesitancy
Open-endedresponsestothisquestionincluded
The vaccine is not 100 working It cannot offer
100 protection
Ofthe42participantswhosaidthattheywouldnothaveorwerehesitanttohavethevaccine4865saidthattheypreferredtolsquowaitandseersquobeforegettingvaccinated
Thediscussioninthefocusgroupsaboutpeoplersquoshesitancytobevaccinatedfocusedonanumberofconcernswhichreflected
poorcommunicationfromanumberof trusted sources including GPs and some media sources
conflictinginformationaboutthevaccinefrom healthauthorities
fearsaboutvaccinesafetythataresharedby thegeneralcommunity
misconceptionsabouttheeffectivenessof andhowthevaccineswork
I will not have it because make me sick
Issuesraisedinfocusgroupsascontributingtoincreasedhesitancyincluded
Some GPs being hesitant to recommendvaccination
Theinformationbeingprovidedisconflicting
Theinformationisoverlycomplexandnotcomprehensibleregardlessofwhetherithasbeen translated
The risk of blood clots
Perceptionsthatthevaccinesaregenerallyunsafe
Concernsthatsomepeoplearedyingafterbeing vaccinated
Not being sure about the risks associated withhaving the vaccine and being pregnant orbreastfeeding
Theperceptionthattherehasbeenalackoftestingofthevaccinespriortorollout
AlackofunderstandingofhowvaccinesworkthecompositionofthevaccinesandwhattheywoulddotothebodyincludingmakingchangestoapersonrsquosDNA
Specificcommentsincluded
I have heard that the vaccine changes
your DNA
I am a mother I am not sure it [the vaccine] is safe for
me when I am breastfeeding
If you are young and healthy your body has the energy to fight the virus
You donrsquot need to have the vaccine You should just let
your body fight it itself
They donrsquot tell you what chemicals are in the
vaccine
Tamil Focus Group Feedback Sheet
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2120
Nobody knows what to do My GP doesnrsquot even know what I should do whether
I should have it or not
I am not sure what to do I have spoken to my
GP but they canrsquot tell me whether I should have the vaccine or not while I am
breastfeeding
They say one thing and then they tell you
something elsehellip it [the vaccine rollout] is so
confusing
Confusionaboutwhattodowheretogoandthe health impacts of the vaccine was a common threadintheconversationsaroundvaccinehesi-tancy
Onewomanwhosehusbandworkedforasecurityfirmsaidthatherhusbandhadhadtobevacci-natedinordertokeephisjob
In several focus groups the issue of government control was also raised A number of people re-portedstronglythattheyfearedthatthevaccinewas lsquoa means that the government was using to controlpeoplersquo
He [husband] had to have it He didnrsquot have a choice He was fine [no side effects] but Irsquom not
thinking I will have it I donrsquot need to Irsquom a mum Irsquom busy I have
to look after my children I donrsquot know how I feel about it whether
Irsquom going to have it
Vaccine refusal
Onlyasmallnumberofparticipants(24or13)saidtheywouldnotgetvacci-natedOfthisgroup21werewomenand 2 were men8 Respondents were bornintendifferentcountrieswithadiverse range of language backgrounds
I never get sick It is the same for all my family We have always been strong and healthy so I will be
saying no to the vaccine
Country of Birth Language Background Count Pakistan Urdu 4 China Taiwan Chinese
(MandarinCantonese) 4
Sri Lanka India Tamil 3 Chile Spanish and English 2 Italy Italian 2 Iraq Syria Arabic 2 Iraq Chaldean 1 Iran Farsi 1 Greece Macedonian 1 Poland Polish 1 Pakistan Punjabi 1 Sweden Swedish 1 Vietnam Vietnamese 1
Table 4 Vaccine refusal by country of birth and language background
8 ThisreflectstheoverallsamplebiastowardswomenThemajorityoffocusgroupparticipantswerewomenXwithYparticipantsbeingmen
Reason for not having the vaccine Percent Count The vaccine is not well tested 5455 12 I want to wait and see 5455 12 The vaccine is unsafe 3636 8 For medical reasons 3182 7 I am scared to have the vaccine 3182 7 I dont like vaccines 1364 3 For religious reasons 1364 3 For cultural reasons 909 2 Something else (please tell us what) 909 2
SomeinthiscategorywereadamantthattheywouldnotbehavingthevaccineandhadverystrongviewsonitlsquoForculturalreasonsIwonrsquotbehavingthevaccinersquoWhenwelookatrespons-esmorecloselyhoweveritwouldappearthatmanyareinfactmorelsquohesitantrsquothanfirmvaccinerefusers
One reluctant middle-aged Tamil-speaking wom-ansaidlsquoIftheysaywehavetogetvaccinatedthenIwillrsquoThissentimentwas stronglysup-portedbythe rest of the Tamil-speaking group
Studyparticipantswhosaidtheywouldnothavethe vaccine were also concerned that lsquothe vaccine wasnotwelltestedrsquo
The vaccine has been rushed out It has not been
properly tested
Table 5 Reasons for not having the vaccine
Peopleinthiscategorysaidthattheywouldlsquowaitandseersquowhathappenswiththewiderrolloutbe-foremakingtheirfinaldecisionThissuggeststhataproportionofthelsquonorsquogroupareinfacthesitantrather than outright refusing to have the vaccine
Therewerealsofearsexpressedbyfocusgroupparticipantsaboutthedangersofbeingvacci-natedParticipantsreportedbeingafraidofthehealthrisksespeciallyfrombloodclotsSomepeopledistinguishedclearlybetweenAstraZene-caandPfizerinthisregardHoweverformanythedistinctionbetweenthedifferentvaccineswaslostandtheyspokeofthevaccinesgenerallybeing unsafe and having a range of unwanted side effects
Other factors consideredInadditiontothebroaderquestionsofwhypeo-plewouldorwouldnotchoosetogetvaccinatedthe research team used the focus group discus-sionstoexplorewhetherthefollowingfactorshadanyimpactonapersonrsquoslikelihoodofbeingvaccine pre-disposed or hesitant
Knowing someone who had been vaccinated
Knowing someone who had contracted COVID-19
Knowing where to go to get vaccinated
Thesourcespeopleturntoforinformation about COVID-19 and COVID-19 vaccines
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2322
Knowing someone who has been vaccinatedOfthosewhorespondedtothisquestion125or70knewsomeonewhohadalreadyhadthevaccine
6983
2570
447
Yes No Dont know000
1000
2000
3000
4000
5000
6000
7000
8000
Figure 11 Do you know someone who has been vaccinated
Amongthe125participantswhoknewsomeonewhohadalreadybeenvaccinated100identifiedlsquoimmediatefamilymembersrsquo(parentschildrensiblingsandpartners)Somefocusgrouppartic-ipantsreportedthatalloftheirfamilymembersoverseas had been vaccinated Others reported thattheirrelativeshadbeenvaccinatedasarequirementoftheiremployment
Who Count Percent Other family member 41 313 Sister 24 1832 Community member 23 1756 Brother 18 1374 Father 17 1298 Mother 16 1221 Work colleague 14 1069 Husband or wife 11 84 Son or daughter 10 763 Partner 4 305 Someone else 45 3435 Total respondents 131
Table 6 Who do you know who has been vaccinated
When this issue was teased out further in focus groupdiscussionsarangeofreasonswere revealed including
My husband works in security and he had
to get it
My friend works as a COVID-19 cleaner and they all had to [get
vaccinated]
My family overseas have already been vaccinated
My son needs to travel for work so he is getting it
My brother in the UK is a doctor and he got it and
his wife
Knowing someone who has had COVID-19Almosthalfoftheparticipantsknewsomeonewho had contracted COVID-19 overseas Some reportedthatallthemembersoftheirfamilyormanymembersoftheirextendedfamilyhadcon-tracted COVID-19 In the older Italian group 10 of the15womenknewsomeoneinItalywhohadcontracted COVID-19
4716 4659
625
Yes No Not sure000
1000
2000
3000
4000
5000
Figure 12 Knowing someone who has had COVID-19
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2524
385 385
1538
2692
641 513000
4359
2051
1026385
1410
Mother
Father
BrotherSis
ter
Son or d
augh
ter
Husban
d or wife
Partner
Other family
mem
berFri
end
Community m
ember
Work co
lleag
ue
Someone else
(please
tell u
s who)
000500
100015002000250030003500400045005000
Figure 13 Who do you know who has had COVID-19
Four people in the focus groups knew someone who had died of COVID-19
All my family back home [Pakistan] got it [COVID-19] but
they are all fine now apart from my father He died But he was really sick before he
got it He had lots of underlying conditions Medical conditions so he was really unwell before he got COVID-19 But everyone else
they are fine now They were sick but they got betterhellip
If you are well and healthy you can fight this off
SurprisinglyknowingpeoplewhohadcontractedCOVID-19didnotseemtoinfluencefocusgroupparticipantsrsquopredispositiontowardseitherhavingthevaccineorbeingvaccinehesitantHowevertheolderItalianwomenrsquosgroupspokeabouttheimpactthatCOVID-19hadhadinItalyintheearlystagesofthepandemicandhowthishadaffectedthemdeeply13ofthe15womeninthisgroupwouldhaveorhadalreadyhadthevaccine
Knowing where to get vaccinated115people(81)whorespondedtothisquestion(n=142) knew where to go to get the vaccine 34 people(19)reportedthattheydidnotknowThisincluded15respondentsfromIraq3re-spondentsfromIndia2respondentsfromChina2 respondents from Pakistan and one respondent fromeachofthefollowingcountriesChinaEri-treaItalySriLankaSwedenSyriaandVietnamThese people were also less sure about whether ornottheywouldhavethevaccineItispossiblethat their lack of knowledge about where to go to get vaccinated was related to their general level ofvaccinehesitancy
7958
29582254
282 563
GPDoctor Vaccinecentre
Hospital Work place Somewhereelse (please
tell us where)
000100020003000400050006000700080009000
Figure 14 Where to go to get vaccinated
From the sample (n=199) GPs were the most commonlyidentifiedplacetogotogetvaccinat-edfollowedbythevaccinecentreatHomebushBayandthenhospitalsOtherplacesidentifiedincluded medical centres and pharmacies
Sources of information about COVID-19 and the vaccineThelargestsinglesourceofinformationaboutCOVID-19 and the vaccine was Facebook (417)
2743
3486
13141086
30862686
3429
2229 2286
41713714
2571
1086 971
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)000500
10001500200025003000350040004500
Figure 15 Sources of information about COVID-19 and the COVID-19 vaccine
Facebook I get my information from
Facebook But if I want to check it I watch the news
on 7 [Channel 7]
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2726
Thesecondlargestsourceofinformationforpeople in the sample was lsquoother forms of social mediarsquo(37)followedbySBStelevision(35)myfriends(34)andothertelevision(31)Oth-ersourcesofinformationpeoplereportedthattheyusedweretheNSWHealthwebsitenightlytelevisionnewsincludingChannel7Channel9andChannel10followedbytheABCtheAustral-iangovernmenthealthwebsitetheirGPlocalMedical Centres and the Red Cross
IntheLakembafocusgrouppredominantlymadeupofwomenfromPakistantherewasanani-mated discussion about Facebook which was the majorsourceofinformationalongwithGooglesearchesandcommunityandfriendship-basedWhatsApp groups There was a general consensus from most in the group that these were their pre-ferredormostcommonsourcesofinformationandnewsHoweveriftheywantedtolsquofactcheckrsquowhattheywerehearingtheywouldwatchthenightlynewsonChannel7orChannel9toverifywhattheyperceivedcouldsometimesbeunrelia-ble sources
IntheMtDruittfocusgroupseveralofthewom-enwithwell-developeddigitalliteracyandgener-alliteracyskillsusedhealthandfitnesswebsitesand social media sites as their source of infor-mationaboutlsquoallthingshealthrelatedrsquoincludingCOVID-19ThesewomenalsospokepositivelyabouttheinformationandsupporttheygotfromthestaffatCanterburyCouncilCommunityCentre(4Cs)whotheycouldrelyontofindoutthingsthattheyidentifiedtheyneededtoknowmoreabout
InthesmallerfocusgroupinGriffithwithrecently-arrived refugee women who had low levels of Englishlanguageliteracytherewaslittleknowledgeaboutthevaccinesnoawarenessofthedifferenttypesofvaccinesandlittleknow-ledgeaboutwheretogotogetvaccinatedorfindoutmoreaboutCOVID-19ingeneralThecommunityservicestaffandvolunteerspresentatthegroupwere working hard to assist these women to improve their English language skills and support themwithtranslatedinformation
In the older Italian women focus group in Wollon-gongparticipantsreportedgettingtheirinfor-mationfromslightlydifferentsourcesndashfamilyinAustralia(10women)Channel9(7women)
Italianradio(3women)andABCTV(3women)Onlytwowomenusedtheinternetandnoneofthe women reported using Facebook or social mediaasasourceoftheirinformationSeveralmentionedthattheygottheirinformationfromtheirGPorspecialistdoctorandonepartici-pantsaidrsquoIdonrsquotlistentoanyonersquoIntheSpan-ish-speaking focus group a comment was made thatseemedtoreflectmanyoftheotherfocusgroup discussions
Whenlsquosourcesofinformationrsquoiscorrelatedwiththegroupwhosaidtheywouldhavethevaccine(n=104)thereisashiftfromFacebookbeingthepreferredsourceofinformationtolsquoSBSTVrsquobeingthepreferredsourceThelsquovaccine-predisposedrsquogroupalsohadthelowestrateofrelyingonFace-bookasasourceofinformationaboutCOVID-19thoughitwasstillhighThegraphbelowhigh-lightshowotherlsquopreferredsourcesrsquoplayoutforthoseintendingtohaveorwhohavealreadyhadthe vaccine
ForthoseparticipantswhoindicatedthattheywouldnotorwerenotplanningtohavethevaccinelsquoFacebookrsquolsquomyfriendsrsquoandlsquomyfamilyrsquowerethesourcesofinformationaboutCOVID-19thatwereequallymostfrequentlycitedfollowedcloselybylsquomyfamilyoverseasrsquolsquoSBSradiorsquoandlsquoSBSTVrsquoassourcesofinformationreceivedthelowestmentionsfromthisgroup(SeeFigure16)
The vaccine-hesitant group were the group who identifiedlsquoFacebookrsquoastheirmostfrequentsourceofinformationaboutCOVID-19lsquoFace-bookrsquowasfollowedbylsquoothersocialmediarsquoandlsquomyfriendsrsquoasthenextmostfrequentsources
lsquoThiscommunityserviceproviderrsquo(theinterme-diaryorganisationwherethefocusgroupwasconducted)wasidentifiedby26ofrespondentsasasourceofinformationregardlessoftheirintentiontogetvaccinatedornotThefactthatboththelsquovaccinehesitantrsquoandthosewhoindi-catedtheywouldnrsquotbegettingthevaccinesoughtinformationfromthissourcesuggeststhatrolling
There is so much confusion about it [the vaccine] that I think my GP is the best
place to go
9 This group of the research sample included a small number ofpeoplewhohadalreadybeenvaccinated
2626
4141
14141111
323228282828
2424
1818
37373737
2828
10101212
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)00050010001500200025003000350040004500
2857
2381
952 952
2857
3333
42864286
3810
4286
23812381
1429
952
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another co
mmunity se
rvice
Somewhere
else (p
lease te
ll us w
here)000
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Figure 16 Sources of information for respondents who were planning to have the vaccine9
Figure 17 Sources of information for respondents who were not planning to have the vaccine
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2928
outpositivemessagingthroughtrusted communityserviceorganisationscouldbeaneffectivewayofshiftingpeoplefromvaccine hesitancytodecidingtohavethevaccine
31372549
980 980
25492157
4314
1176
2353
4902
4118
2157
980392
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)000
1000
2000
3000
4000
5000
6000
Figure 18 Sources of information for respondents who lsquodonrsquot knowrsquo if they will have the vaccine
DISCUSSION
wardstheCOVID-19vaccineareasvariedastheyarewithinthebroadercommunityTherearearangeofinfluencingfactorsincludingagehealthstatushowlongtheyhavebeeninAustraliahowmuchnewstheyreceivefromoverseasandhowbadlyimpactedbythepandemictheirhomecountries have been
The research also highlights that people from culturallyandlinguisticallydiversebackgroundsgettheirinformationaboutCOVID-19andtheCOVID-19vaccinefromawidevarietyofsourcesbothformalandinformalandthatforparticulargroupsinthisstudythereisahighrelianceonFacebookovermoreofficialsourcesofinforma-tion
VulnerabilityTheneedsofhighly-vulnerablegroupswithintheCALDcommunityhavetobetakenintoconsider-ationThisincludesolderpeoplewhohavelivedinAustraliaformanyyearsbuthavelowlevelsofEnglishliteracyndashespeciallywritingandreadingEnglishandsometimesspokenEnglishndashandwhoaremoresusceptibletoseriousillnessandhigherratesofhospitalisationanddeathfromCOVID-19Italsoincludesnewly-arrivedrefugeeswhohavinglowornoEnglishlanguageliteracylacktheconnectionstoandnetworksintothewidercommunityandcommunitysupportsItisalsothecase that some people in these groups are not health literate at all and cannot read and write in their own language
Akeytakeoutfromthehealthandcommunityserviceorganisationsurveyresponsesandinter-viewsundertakenwithmulticulturalhealthandcommunicationexpertsfortheprojectisthatlit-eracylevelsreallydomatterLowlevelsofhealthliteracylowlevelsofEnglishlanguageliteracyandpossiblylowlevelsofliteracyintheirownlan-guage-especiallyforsomenewly-arrivedrefu-gees and those who are part of the humanitarian program such as Dari language speakers from AfghanistanTigrinyalanguagespeakersfromEr-itrea and northern Ethiopia and Oromo language speakers from Ethiopia - need to be factored into anyplanstofurtherpromotethevaccinerolloutanduptaketoculturallyandlinguisticallydiversepeopleinthecommunityThereisaneedfor
The contextThisresearchisimportantgivenhowhighlyculturallydiverseNSWisandtheimpactthiscanhave on the success of public health messaging topeoplewhosefirstlanguageisnotEnglishPeople who were born overseas form almost one-thirdofthe7480228population(276)ofNSWandNSWishometo336ofAustraliarsquosoverseas-bornpopulationPeoplefromaround225 birthplaces have made NSW their home and 21oftheNSWpopulationisfromanon-EnglishspeakingbackgroundMorethan24000humani-tarianentrantshavesettledinNSWoverthepastfiveyearscomprisingalmostathird(32)ofthenationaltotalThe24000humanitarianentrantswhohavesettledinNSWoverthepastfiveyearscame from over 100 countries of origin10Sydneyhasthelargestoverseas-bornpopulationofallthecapitalcities11
Hearingdirectlyfrompeoplefromculturally-diverse backgrounds is important to ensure that policymakersandpublichealthadvocatescandesign responses that are both accessible and un-derstandabletopeopleforwhomEnglishmaybetheirsecondthirdorfourthlanguageApropor-tionofpeopleinthesecommunitieshavelowerlevelsofEnglishlanguageliteracyandinsomecaseslowlevelsofliteracyintheirlanguageoforiginsowillbehardertoreachviatraditionalormainstream methods
Itisalsocriticallyimportantthatduringatimewherethereissomuchlsquonoisersquoacrossmediachannelsrelatingtothevaccinethevaccineroll-outvaccineefficacyandvaccinesafetythatwetakesometimetolistentoandunderstandhowthislsquonoisersquoisbeingheardandmadesenseofbypeoplefromculturally-diversebackgrounds
ThatsaiditisimportanttoreconfirmthattheCALDcommunityisnotahomogenousgroupOurresearchhasfoundthattheviewsandattitudesofparticipantsfromdiverseculturalbackgroundsto-
10RefugeeCouncilofAustraliaHumanitarianEntrantsin New South Wales A resource for New South Wales governmentagencies6-711MulticulturalNSWCommunityRelationsReport2018-20199
29
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3130
groupsFortheparticipantsintheresearchtheirattitudetothevaccineappearedtobeinflu-encedbyanumberoffactorstheirownlevelsofhealthandpre-existinghealthconditionsandthoseoftheirfamilymembersandtheimpactofreceiving COVID-19-related news from overseas particularlyfrompeoplersquoscountryoforiginAnexampleofthiscanbeseenintheItaliangroupin Wollongong where people had received news fromoverseasearlyinthepandemicwhichscaredthemThisexperiencelsquofromhomersquohadinflu-enced most of the women in the Wollongong focus group (n=15) to choose to get vaccinated The interviewee from the Illawarra Shoalhaven Local Health District also spoke about the heightenedconcernthattheywitnessedinthelocalItaliancommunityintheearlystagesofthepandemicOtherpeoplewantedtolsquostayhealthyrsquoandtolsquoprotectthehealthofothersrsquoandformanytherewasasensethattheywantedtolsquogetbacktosomedegreeofnormalcyrsquoandtobeabletolsquotraveloverseastovisitrelativesrsquo
Vaccine hesitancyOfthe42inthisstudywhoappearedundecidedornotplanningtohavethevaccinemanywereinfactadoptingalsquowaitandseersquoapproachbeforemakingtheirfinaldecisionMostparticipantswereinterestedtohearmoreinformationaboutthevaccinesandwereopenedtogettingthevaccinebutdidhaveconcernsaboutthesafetyofthevaccinesespeciallyinregardtoAstraZeneca
The issue of blood clots has led to considerable fearandhesitancyinthecommunityandthisfearandhesitancywasreflectedinourstudyEssentialResearchrsquossurvey(April2021)reportedoneinsixpeople(16)indicatedtheywillnevergetvaccinatedagainstCOVID-19upfrom12thepreviousmonthwhile42saidtheywillgetvaccinatedbutnotrightawayTheproportionofpeople who would be willing to get vaccinated as soonaspossibleorarealreadyvaccinatedalsodeclineddownfrom47to4213Thissurveywas conducted prior to the most recent outbreak inNSWinvolvingthehighlyinfectiousDeltastrain
Therisk-benefitofhavingthevaccineneedstobecarefullyweighedbyeachindividualideallyinconsultationwiththeirdoctoranddependingon
The Hub has lsquobeen working in partnership with keystakeholdergroupstoguidecommunicationstomeetthehealthliteracyandculturallyandlinguisticallydiverse(CALD)needsofitspop-ulationStructuredworkinggroupshavebeencreatedtoprioritisecommunicationstovulner-ableyouthCALDgroupstheelderlyitinerateworkersasylumseekersandrefugeesTheaimsaretotestmessagingandbuildtrustwithprioritypopulationstoensureeffectivecommunicationoftheneedtosustainphysicaldistancingmeas-uresintheabsenceofavaccineSimilareffortsarenowneedednationallyandshouldstartatthetimeofdiseaseoutbreaksinthefuturealongsideplannedmassmediaandhealthcommunicationcampaignsrsquo
InthearticlebyDoddetaltheyreinforcetheimportanceofusingcommunicationformatswhich are lsquosuitable for people with low health literacyandeducationandwhichareappropriateforculturallyandlinguisticallydiversegroupsandIndigenouspopulationsrsquoThearticlearguesthatitisimportanttolookatmotivationsandconcernsabout vaccines when shaping messaging It also pointsoutthatprimarycaredoctorsareatrust-ed source and as such should be supported in deliveringinformationaboutthevaccinesandad-dressingcommunityconcernsThearticlestateslsquoWeneedtounderstandandaddresscitizenrsquosconcernsthatcanpreventoptimaluptakebuildmotivationsintomessagingandprioritisepublictrustbyinformingandinvolvingthecommunityintheprocessSupportinghealth-careprofession-als in their role as educators will ensure people haveadequateandaccessibleinformationfromatrustedsourcetooptimisevaccineuptakeandultimatelyreducecommunitytransmissionofCOVID-19rsquo15
RecentresearchbyAssociateProfessorHollySeale16withUNSWMedicinersquosSchoolofPublicHealthandDeputyChairfortheCollaborationonSocialScienceandImmunisationfoundthereisaneedtolsquodecentralisersquocommunicationsbytapping
translatedmaterialsandinformationaboutthevaccines to be tailored to the needs of people in these newly-emergingcommunitygroups
It was reported that in Wollongong there can sometimesbefourgenerationsoffamilymem-bersfromnewly-arrivedrefugeegroupslivingintheonehouseMostofthesefamilymembersgenerallyhavelimitedEnglishlanguageliteracywhichincreasestheirriskofnotreceivingkeyhealthmessagesandthereforeincreasingthepotentialimpactofCOVID-19-inparticulartheDeltastrainwhichhasprovenhighlyinfectiousamongst household members
Vaccine uptakeNotdissimilartothewidercommunitymorepeopleinourstudywereplanningtohavethevaccinethannotandanumberhadalreadybeenvaccinatedInarecentLancetarticle(February2021)ConcernsandmotivationsaboutCOVID-19vaccinationfindingsfromtwosurveysfromanAustralianlongitudinalstudyconductedinJuneandJuly2020includedthatlsquothetopthreerea-sons for agreeing to vaccinate were lsquoto protect themselvesandothersrsquohelliplsquobeliefinvaccinationandsciencersquohellipandlsquotohelpstopthevirusspreadrsquoEven among those willing to vaccinate there was somehesitancyaboutthesafetyofthevaccineTheLancetarticlenotedthatlsquowillingnesstovaccinatedifferedbybothageandeducationrsquoForthosewhowereindifferentorsaidtheywouldnot get the vaccine the top reasons across the twosurveyswerelsquoconcernaboutthesafetyofthevaccineinitsdevelopmentrsquoandlsquopotentialsideeffectsrsquo12
Olderpeopleinourstudywhocomprised23of the total sample (n=199) were the group most likelytosaythattheywantedtogetthevaccine85ofthoseover65saidtheywouldhaveorhadalreadyhadthevaccineVaccinepredispo-sitionwashoweveralsostrongacrossotherage
12RHDoddKPicklesBNickelECvejicJAyreCBatcupCBonnerTCoppSCornellTDakinJIsautierKJMcCafferyConcerns and motivations about COVID-19 vaccination SydneyHealthLiteracyLabSydneySchoolofPublicHealthFacultyofMedicineandHealthUniversityofSydneypublishedintheLancetFebruary2021p162wwwthelancet cominfectionVol21February2021
theircircumstancesHoweverthesourcesofin-formationthatpeoplemostrelyuponortrustarecriticaltothedisseminationofaccurateandclearmessaging to dispel the fear surrounding events suchasbloodclottingandthemisconceptionsraisedinthefocusgroupsWithsomanypartici-pantsinthisstudygettingtheirinformationfromFacebookandothersocialmediasitesitisvitalthat these channels are used to promote simple positivemessagesandforanyfuturecommunityawareness campaigns
Effective communicationConfusionandmisconceptionsaboutthevac-cinersquosefficacyavailabilityandsafetywereallis-sues that were raised in the focus groups Finding waystoeffectivelycommunicatewithpeoplewithlowerEnglishlanguageliteracyandhealthliteracyisanimportantwaytoaddresstheconfusionandmisconceptionsaboutthevaccineashasbeen discussed in a number of recent Australian studies
Astudy14byMcCafferyetal(2020)concludedthattherearelsquoimportantdisparitiesinCOVID-19-relatedknowledgeattitudesandbehavioursaccordingtopeoplersquoshealthliteracyandlanguagersquoOneofthefindingswasthatlsquopeoplewithlowerhealthliteracywerealsomorelikelyto endorse misinformed beliefs about COVID-19 andvaccinations(ingeneral)thanthosewithadequatehealthliteracyThesamepatternofresults was observed among people who primar-ilyspeakalanguageotherthanEnglishathomersquoTheMcCafferystudyhighlightstheimportanceof tailoring health messages to those with lower healthliteracyandculturallyandlinguisticallydiversecommunitiesItpointsoutthatthereareexamplesofeffectivemanagementofdiversecommunityneedsthatusetailoredhealthmes-sagesandcitestheWesternSydneyLocalHealthDistrictHealthLiteracyHub
13TheEssentialReport-anonlinesurveyconductedbyEssentialResearchcompletedby1090people between 21ndash26 April14McCafferyKJDoddRHCvejicEAyreJBatcupCIsautierJMJCoppTBonnerCPicklesKNickelBDakinTCornellSWolf MS Health literacy and disparities in COVID-19ndashrelated knowledge attitudes beliefs and behaviours in Australia PublicHealthResPract202030(4)e30342012December2020
15 Op cit16 httpssphmedunsweduausitesdefaultfilessphcmNewsEnhancing-supporting-COVID-19-vaccination-programpdf
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
30 31
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3332
intodifferentnetworkingspacessuchaswork-placeslocalgymsmothersrsquogroupsandseniorsrsquoclubswithafocusonallagegroupsregardlessofcurrenteligibilityAccordingtoSealethechal-lengeislsquoensuringemerginginformationisadapt-edfortheintendedaudiencersquoShehasalsosaidlsquoThatrsquoswhatIrsquomalittlebitconcernedaboutatthemomenttherersquosalotofresourcesongov-ernmentwebsitesbutthesetermsaroundbloodclottingareverytechnicalWeactuallyneedtomake sure that we are breaking them down in a waythatwillmakeitmeaningfultopeopleThatrsquosnotjustabouttranslatingitrsquosaboutbeingcon-sciousofpeoplersquoshealthliteracyneedstooSomaybegettingsomemorevisualsintomaterialstotryandsupportthatrsquo17
Thereareanumberofmulticulturalhealthresourcesthatusecommunitylanguagetransla-tionsplainEnglishandvideosfromCALDcommu-nityleaderswhichcanbedownloadedandusedbyservicesandindividualsHowevermanyofthewrittenresourcesstillrelyontechnicalandscien-tifictermsthatrequireareasonablyhighlevelofEnglishlanguageliteracyorhighlevelsofliteracyin the translated language to comprehend Host websites can also be hard to navigate making itdifficulttolocateresourcesfromsimplewebsearchesAsummaryofsomeoftheavailableresourcescanbefoundatAttachment2
MulticulturalHealthUnitsinLocalHealthDis-trictshavestaffwhocanworkwithpeoplefromculturallyandlinguisticallydiversecommunitiesatthelocallevelandtranslateandcontextualisethese materials to the needs of the end user These teams respond to local needs and popu-lationdemographicsandareexpertsineffectivehealthliteracyandhealthcommunicationwiththeirlocalcommunitiesTheyworkcloselywithcommunityandvulnerablegroupstobuildhealthliteracyandimprovedhealthoutcomesintheircommunities
Case Study ndash Be a COVID Warrior ndash Responding to COVID-19 in Multicultural Communities InWollongongtheIllawarraShoalhavenLocalHealthDistrict(ISLHD)MulticulturalHealthSer-viceco-designedacommunityengagementandeducationprogramcalledlsquoBeaCOVIDWarriorrsquowhich commenced in 2020 in response to the pandemic This program was designed to respond tothelowlevelsofhealthliteracyaroundCOVID-19potentialexposuretothevirusandaddressfearandstigmainthelocalCALDcommunitiesThelsquoCOVIDWarriorrsquoprogramreachedaround880peopleranginginagefrom14to85years65ofCOVIDWarriorparticipantswerefemaleand35weremaleCOVIDWarriorparticipantsrepresented 21 language groups The outcomes of the program included increased levels of confidenceinapplyinginfectioncontrolmeasuresincreasedliteracyandhealthliteracyandawarenessofhowCOVID-19istransmittedUltimatelyanimprovedawarenessinapplyingCOVIDsafemeasures was also reported
InApril2020theservicecommencedwelfarechecksviaphoneonafortnightlybasistosup-portsocially-isolatedmulticulturalseniorswhoboretheemotionalstressofsocialisolationFrom these calls the ISLHD heard the needs and concernsofseniorsinthecommunityInadditionourexperiencewithCALDcommunitieshighlightedtheimportanceofyoungpeopleasconduitsofessentialinformationtoadultsincommunityandfamilygroupsduetoEnglishlanguageaccessandeducation
InresponsetheISLHDinitiatedthelsquoCOVIDWarri-orrsquoprogramusingbi-culturalhighschoolstudentsthroughthelocalhighschoolsByincreasingthehealthliteracyofstudentsatschooltheselsquocham-pionsrsquocouldtalktotheirfamiliesincludingolderfamilymembersininformalsettingsandthroughsocialmediawiththeirpeersasastrategytoraisethe level of knowledge of COVID-19 trans-mission preventionandtestingTheprogrambecamesopopularthatitwasextendedintomorelocalhighschools and adults accessing the Adult Migrant EnglishProgramTheprogramwassupportedbylocalsettlementservicesprovidedbybothMaxSolutionsandtheRedCrossItwas
17 httpstheconversationcomhow-can-governments-communicate-with-multicultural-australians-about-COVID-19-vaccines-its-not-as-simple-as-having-a-poster-in-their-language-156097
later extendedtoCALDSeniorsthroughtheMulticulturalCommunitiesCouncilIllawarra(MCCI)supportprograms
AkeycomponentoftheprogramwastoprovideparticipantswithlsquoCOVIDWarriorrsquoKitswhichincludedtworeusablemaskshandsanitiserinfographicsaboutCOVID-19symptomsandinfor-mationaboutwheretestingclinicswereavailablelocallyMCCIandRuralAustraliaforRefugeesdonatedreusablemasksforeveryparticipant
AsthelsquoCOVIDWarriorrsquoprogramwasevolvingsowasthenationalvaccinerolloutplanInforma-tionwasthereforeadaptedtomeetthisinfor-mationgapForexampleadultparticipantsandseniors were supported to understand how to accesstheCOVIDvaccinelsquoeligibilitycheckersrsquoandCALD people were shown how to use the NSW HealthwebsiteCOVID-19informationpages18
Decision makingHowpeoplearecurrentlyconsideringtheriskofCOVID-19isinfluencedbyarangeoffactorsincludingratesoftransmissioninthecommunitynumbersofnewcasesreportsinthemediaofrisksandsideeffectsPeopletendtobasetheirassessmentonwhattheyarecurrentlyexperi-encingandthencheckthisagainstwhattheyarehearinginthemediaincludingandespeciallyonsocialmediaandfromfamilyandfriendsMostoftheparticipantsinourstudyspokeclearlyandarticulatelyabouthowtheyweigheduptherisk-benefitofhavingtheCOVID-19vaccineintheir decision making Low case numbers ndash at the timeofconductingtheresearchndashandasensethat Australia was lsquodoing well in safeguarding the communityagainstCOVID-19rsquoweresignificantfactorsinpeoplersquosdecisionnottobevaccinatedortoadoptalsquowaitandseersquoapproachFamilyfriends and social media were reported as having aconsiderableinfluenceondecisionmakingaswerereportsinthemediaofthebloodclottingsideeffectsofAstraZeneca
ThefactthatFacebookwasreportedlythemostpopularsourceofinformationaboutCOVID-19
18httpswwwhealthnswgovauInfectiouscovid-19Pagesdefaultaspx
andtheCOVID-19vaccineforpeopleinthestudyraisesconcernsaboutthepossibledisseminationofmisconceptionsandlsquofakenewsrsquothatmaybespread or compounded via social media Closed social media groups such as WhatsApp and WeChatwithfamilyandfriendsmayalsoleadtopeoplereinforcingtheirpre-existingbiasesThesefactorscoupledwithasensethatAustraliaisfaringwellcomparedtomanycountriesoverseasappear to have resulted in increased vaccine hesi-tancyamongparticipantsofthestudy
Factorsthatwereidentifiedaschangingvaccine-hesitantparticipantsrsquoperceptionswereanincreased risk from COVID-19 and a correspond-ingincreaseinthenumberofinfectionsandonthebenefitsidetheabilitytotraveloverseastovisitfamilyIntherecentresearchfromtheUniversityofNSWcitedaboveSearlearguesthatlsquotheremaybeotherthingsthatweneedtonowstartfocusingonhellipthatwillstarttopromoteandmotivatepeoplesuchasthechancetotravelmorefreelyforexamplersquoThisappearstobeborneoutbyourfocusgroupfindings19
Untilrecentlytherehavebeenverylowcasenumbers and few lockdowns across most of Aus-tralia and NSW The recent outbreak from mid-JuneinGreaterSydneyandintroductionofthehighlyinfectiousDeltavariantinNSWislikelytoimpactonpeoplersquosassessmentsoftherisk-benefitofhavingthevaccineandonewouldassumereducehesitancyrates
GiventheheightenedcommunityanxietycausedbythisrecentCOVID-19outbreaktheproductionofshortsharpandtargetedmessagingtoCALDgroupsincommunitylanguagesthatisaccessibleandmotivationalfeaturescommunityleadershigh-profilecelebritiesandsportsstarsfromCALDbackgroundsandisdirectedatastate-wideandlocal level would appear to be more urgent than everItisclearthatformessagingtobeeffectiveandreachitsintendedaudiencedistributionchannelsshouldincludeFacebookWhatsAppandothersocialmediaplatformsaswellastrustedsourcessuchasmulticulturalhealthworkersmulticulturalservicesandthroughGPsandMedical Centres If mainstream COVID-19 vaccine
19 Op cit
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
32 33
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3534
awareness campaigns are produced in Australia suchashavebeenproducedinNewZealandtheUnitedKingdomandNorthAmericatheyshouldincludehighprofilewell-knowncommunityfig-uresandsportingstarsfromCALDbackgroundsandincludestrategiesspecificallytargetingCALDcommunitiesincludinggroupsidentifiedaspar-ticularlyhigh-risk
It is also important that informationonvaccinesistranslatedintolanguagesfromnewerandemergingcommunitiesOthersuggestionsaroundreachingthesecommunitiesincludeface-to-facemeetingsorganisedbycrossagencypartnershipsandpeer-ledstrategiessuchas mobilising community champions and influenc-ers Messaging needs to be inclusive and framed around the collective values held by commu-n5
It is clear that reinforcing the benefits of being vaccinated at this time rather than dwelling on the risks is more likely to generate behavioural
changeandapositivevaccineresponsefrombothCALDcommunitiesandthegeneralpopulationAppropriately-designedandtargetedCOVID-19vaccinehealthinformationthatiseasytoreadinanylanguagecanbeconveyedbycommunityleadersandcommunitynetworksandpromotesthepositivebenefitsofgettingvaccinatedwouldbevaluableatthistimeBuildingontheworkofpeerchampionssuchastheCOVIDWarriorprogramisalsoasuccessfulmodeltoincreasingCOVID-19vaccinehealthliteracyandinformed decision making
Mostimportantlypositivelymotivatingculturallyandlinguisticallydiversecommunitymemberstolsquogetthejabrsquoespeciallythosewhoareadoptingalsquowaitandseersquoapproachorarevaccinehesitantwould lead to greater vaccine uptake among culturallyandlinguisticallydiversecommunitiesandthereforethecommunityasawhole
Inner West Multicultural Network Addison Road Community Centre DateWednesday12May
A focus group session of members of the Inner WestMulticulturalNetworkpluscustomersoftheFoodPantryatAddisonRoadwasheldattheAddisonRoadCommunityCentreinMarrickvilleon12Mayat200pmThesessionwaspartoftheregularmeetingoftheInnerWestMulticul-turalNetworkTheconsultationinvolvedabout26peopleandwasconductedbyRosannaBarbero
Thegroupbrainstormedresponsestoquestionsaroundvaccinehesitancyinmulticulturalcom-munitiesandmoreeffectivemessagingTheseresponseshavebeenincorporatedinthefindingsof the report
Griffith Women on Fire Focus Group Griffith Community Centre DateFriday14May
This small focus group of women was held at GriffithCommunityCentreonMay14at11amMargCouchSeniorProjectOfficerRegionalDevelopmentAustralia(RDA)-RiverinaandJoanneFitzpatrickSettlementEngagementandTransitionSupport Worker from Centacare Southwest NSW werethekeylinksandnetworkcontactsfortheGriffithcommunityTheWomenonFire(WOF)group was established as part of the Red Cross RuralFireServiceprogramlsquoManyCulturesOneCommunityrsquoInitiallyitwasestablishedtoeducatewomenonemergencypreparednessandtoen-courage NSW Rural Fire Service (RFS) volunteering andnowhastransformedintoacommunityac-tionsupportgroupTheGriffithSoroptimistInter-nationalnowauspicetheirfinancesandsupporttheWOFgroupactivitiesThefocusgroupwasfacilitatedbyCamillaCouchandlocalcommunityvolunteersledbytheGriffithSoroptimistClub
The women in the group were from Pakistan and IndonesiaThegroupweremainlyyoungmotherswithyoungchildrenandtheprogramhadchild-minding arrangements The language level of the womenwaslowandmostwerestudyingESOLat
ATTACHMENTS
ATTACHMENT 1 A Description of the Focus Groups
TAFEThedeliveryoftheinformationwaslimiteddue to language levels and the lack of bilingual interpretersEachparticipantworkedoneononewithavolunteertoslowlyfillinthesurveyandonewomantookthesurveyhometodiscusswithherhusbandThisgroupexperiencehighlightedthe lack of bilingual workers and services in some rural areas
Arabic speaking group Syd West Multicultural Services Mount Druitt Community worker Zaid Naoum Generalist Caseworker SydWest Multicultural Services DateMonday24May
ThefocusgroupfromSydWestMulticulturalSer-viceswasconductedonMonday24May2021atSydWestMulticulturalServicesMountDruittat300pmItwasfacilitatedbyPatriciaMcCormickandsupportedbyZaidNaoumGeneralistCase-workerSydWestMulticulturalServices
Therewere10womenandmenfromSyriainthegroupThegroupweremostlymaturetoolderparticipantsMostparticipantsrequiredassistancewithEnglishandthecaseworkerZaidNaoumhadtranslatedthesurveyintoArabicpriorto the focus group Zaid also translated during the focus group
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Canterbury City Community Centre (4Cs) group The Cottage Lakemba DateTuesday25May
ThefocusgroupfromCanterburyCityCommunityCentre(4Cs)wasconductedonTuesday25MayattheCottageat28CroydonStreetLakembaat10amItwasfacilitatedbyRobinMilesandsup-portedbyRomanaWaseemCommunityWorkerfrom 4Cs
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
34
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3736
The group was comprised of 14 women from PakistanIndiaandSriLankaThewomenrangedinagefrom23to65MostwerefluentEnglishspeakershoweveronewomanrequiredtransla-tionintoUrdufromoneoftheotherwomeninthegrouptoanswerthequestionsdirectly
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
NSW Chaldean League group Community worker Randa Goriya DateTuesday25May
ThefocusgroupfromNSWChaldeanLeagueMountDruittwasconductedonTuesday25May2021 at 1000am at the NSW Chaldean League premisesItwasfacilitatedbyPatriciaMcCormickandsupportedbyRandaGoriyaacommunityworker for the NSW Chaldean League in Mount DruittRandatranslatedtheintroductionandpromptsforthediscussionandhelpedthepartic-ipantstocompletethesurveyMostofthegrouprequiredhelptodothesurvey
ThegroupoftwelveparticipantswereallChaldeanandwerematuretoolderinageTheywereamixed-gendergroup
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Arabic speaking group Red Cross premises Wollongong DateTuesday25May
ThefocusgrouptookplaceonTuesday25Mayat 3pm at the Red Cross premises at Wollongong Therewere22womenandmenparticipatinginthegroupThefocusgroupwasfacilitatedbyCamilla Couch with support from Khalid Zainu-labdeenBilingualSupportWorkerHumanitarianSettlementProgram(ACTampNSW)
There were diverse ages in the group ranging fromyoungpeopletoolderagedMostofthegroupwereyoungerrecently-arrivedrefugeesfrom diverse backgrounds There was also a small-eroldercohortofparticipantswithhigherliteracylevelsandstrongercommunityengagementwith the local services in the area Camilla Couch facilitated the focus group which was conducted inArabicandEnglishwiththeArabictranslationprovidedbyKhalidZainulabdeen
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Work Opportunities for Women group Mt Druitt TAFE DateWednesday26May
TheWorkOpportunitiesforWomen(WOW)focusgroupwasheldonWednesdayMay261100ndash 100pmatMtDruittTAFEItwasfacilitatedbyCamilla Couch and built on the knowledge gainedintheprevioussessiononcriticalandanalyticalthinkingTheWOWgroupisaTAFECertificatelevel course
There were 14 women from diverse cultural backgroundsinthegroupThegroupweremainlyMuslimwomenwithschoolagechildrenandsome were mature aged Due to the learning fo-custhegroupwasfacilitatedasaclasswithguid-eddiscussionontheissuesandcarefulanalysisofthequestionsNotranslationwasneededduetotheeducationalcontextThestudentswereadeptatusingITandcompletedallthesurveysonline
STARTTS Tamil group Toongabbie Community Centre Community worker Sivaharani (Harani) Mayuran DateThursday27May
Thefocusgroupconsistedof18femalepartic-ipantswhowereyoungertomatureagedThefocus group was held at 1000am at Toongabbie CommunityCentreinTargoRdToongabbie
ThefocusgroupwasfacilitatedbyPatriciaMc-CormickandsupportedbyacommunityworkerSivaharani(Harani)MayuranfromtheSTARTTSTamil Group
ThegrouphadmixedlevelsofspokenandwrittenEnglishTheintroductionanddiscussionpromptsweretranslatedbythecommunityworkerSivaha-rani(Harani)Mayuranandsheandthemorepro-ficientstudentssupportedthosewithlowliteracytoanswerthesurveyquestions
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Spanish Speakers Seniors group SydWest Multicultural Services Blacktown DateTuesday1June
TheFocusGrouptookplaceonTuesday1Juneat1100amattheBlacktownShowgroundsandconsistedof16participants(15womenandoneman)AllparticipantswerebornincountriesinSouthAmericaTheirEnglish-fluencylevelsvariedand one of the members of the group translated thesurveyquestionsanddiscussionintoSpanish
ThegrouphadbeenmeetingforseveralyearsThegroupwasfacilitatedbyLindyCassidyandwassupportedbySreeVithyaHarilingamDayRespiteampSocialSupportTeamLeaderatSydWestMulticulturalServicesBlacktownThegroupwerematureagedtoolderparticipants
Thegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyform There was a more focused discussion on somekeyquestionsaftersurveycompletionThetranslatorassistedconsiderablyinthisprocess
Italian Speakers group Warrawong Community Centre DateMonday7June
The focus group of Italian speakers was held on Monday7Juneat1015amattheWarrawongCommunityCentreItwasfacilitatedbyCamillaCouchandsupportedbyJohnPaulTroianiand
SofiaLemafromIllawarraShoalhavenLHDMulti-cultural Health
There were 15 women in the group The group weremostlymaturetoolderparticipantsandwasconductedinItalianandEnglishwithtranslationprovidedbyJohnPaulThisgroupmeetsregularlyandissupportedbyanumberofservicesintheareaespeciallymulticulturalhealth
The group had a general facilitated discussion aboutthequestionsinthesurveyDuetolittleornoliteracytheindividualsurveyresponseswerethencollectedintooneresponseThesesurveyresponses have been included in the general surveyresponses
Mothers Group SydWest Multicultural Services Blacktown DateThursday10June
ThefocusgrouptookplaceonThursday10Juneat1030amandconsistedof14youngwomen13 of whom had a CALD background The focus groupweremainlymothersfromasupportgroupatSydWestMulticulturalServicesinBlacktown
EightofthewomenwereborninIndiatwofromPakistantwofromSriLankaonefromHausaGhana and one was born in Australia (the Austral-ianbornyoungwomanwasasocialworkstudenthelpingwiththegroup)LindyCassidyfacilitatedthe group with support from Wilma Garguath a projectofficerfromSydWestMulticultural Services
The group varied in age One was between 18-24 yearsoldSevenwereagedbetween25-34yearsSixwereagedbetween35=44yearsGiventheirage and circumstances most of the group did not consider themselves eligible at this stage for vac-cinationThiswasanimportantdifferencefromotherfocusgroupsinthattheemphasiswasmoreonwhattheywoulddooncetheybecameeligible
Participantsdidnotrequireassistancewithspo-kenEnglishThegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyformTherewasamorefocuseddiscussiononsomekeyquestions
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3938
ATTACHMENT 2 COVID-19 Vaccine Information in multiple languagesThefollowingsitesappsprovidetranslatedinformationaboutCOVID-19vaccines
Type of information KeyinformationongettingvaccinatedinNew South Wales and on the vaccines available The websiteusesanautomaticservicetotranslate thecontentintodifferentlanguages
Source of information NSW Government website
Link httpswwwnswgovauCOVID-19health-and-wellbeingCOVID-19-vaccina-tion-nswgetting-vaccinated
Type of information COVID-19ResourcessectionontheServiceNSWapp The app has a link to NSW Government websiteinformationonldquoGettingaCOVID-19vaccinationrdquo(seeabove)ItalsoincludesalinktoCOVID-19vaccinationresourcesinotherlan-guages available from the Department of Health
Source of information Service NSW NSW Government
Link Service NSW App
Type of information ArangeoftranslatedresourcesonCOVID-19bytitleincludingafactsheetonCOVID-19VaccineAstraZeneca(ChAdOx1-S)
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCOV-ID-19Pagestranslatedresources-by-titleaspx
Type of information ADigitalCOVID-19resourcelibrarywithtranslated materials
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiouscov-id-19Pagesdigital-resourcesaspx
Type of information AMultilingualCommunityToolkitontheCOVID-19vaccinationprogramtoassist communityworkersprovideseasytoreadresourcesvideosandlinkstokeyservicesandresources
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCovid-19DocumentsNSW-COVID-19-vaccina-tion-program-presentation-20210527pdf
Type of information TheNSWMulticulturalHealthCommunicationServiceoffershealthresourcesandinformationin a wide range of languages It has translated resources on COVID-19 and links to translated resourcesonCOVID-19vaccination
Source of information MulticulturalHealthCommunicationServiceisa New South Wales-wide health service hosted bySouth-easternSydneyLocalHealthDistrict(SESLHD)
Link httpswwwmhcshealthnswgovau
Type of information COVID-19vaccineinformationaddressingkeyquestionsaboutCOVID-19vaccinationandincludesvideosposterstilesfactsheetsandaudio material Translated into 63 languages
Source of information Department of Health Australian Government website
Link httpswwwhealthgovauinitiatives-and-pro-gramsCOVID-19-vaccinesCOVID-19-vaccine-in-formation-in-your-language
Type of information ThisinformationaddressessomecommonmisinformationaboutCOVID-19Translatedintomultiplelanguages
Source of information DepartmentofHomeAffairs Australian Government website
Link httpscovid19inlanguagehomeaffairsgovaumisinformation-and-truths-about-coronavirus
Type of information Australianandinternationalnewsand informationaboutCOVID-19andCOVID-19 vaccinesisavailableontheSBSCoronavirusPortal in more than 60 languages
Source of information SBSwebsite
Link httpswwwsbscomaulanguagecoronavirus
Type of information InformationprovidedaboutCOVID-19vaccinerolloutandsafetyinlanguagesotherthan English
Source of information Department of Health and Human Services Victorian Government
Link httpswwwcoronavirusvicgovautranslat-ed-information-about-COVID-19-vaccines
Type of information HealthTranslationsprovidestranslatedmateri-alsonhealthandwellbeingInformationaboutCOVID-19isregularlyupdatedincludessomeinformationonvaccinationandisavailableinover60communitylanguages
Source of information Victoriangovernmentinitiative
Link httpswwwhealthtranslationsvicgovaubhcv2bhchtnsfPresentEnglishResource-AllOpenampx=amps=Coronavirus
Type of information A one-stop shop for translated materials in multiplelanguagesonCOVID-19
Source of information Ethnolink Language Services
Link httpswwwethnolinkcomauCOVID-19-coro-navirus-translated-resources
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
40
1
Australiahasbeenverysuccessfulinstemmingthespreadofthevirusthroughacombinationofborderclosuresquarantineafirst-worldhealthsystemandexpertcontacttracing
ItispossiblethatwerethisresearchconductedtodaythishesitancywouldbereducedduetotheheightenedriskofcontractingCOVID-19throughthe more transmissible Delta variant and its pres-enceinthecommunity
Regardlesstheneedforvaccinetake-upamongCALDcommunitiesremainshighgiventheycanbe at increased risk due to factors such as in-securehigh-riskemploymentandlivinginhighdensityhouseholdsandtoensureequitablepublichealthoutcomesandsocialeconomicandcommunityparticipationforeveryone
Thiswasasmallstudyof199people(oursam-ple)drawnfromculturally-diversecommunitiesinmetropolitanSydneyandtworegionalNSWlo-cationsCommunitymemberswereaskedsurveyquestionseitheronlineorthroughfocusgroupsSeparateinformationwasalsocollectedfromintermediaryorganisationsworkingwithCALDcommunities(viaasecondsurvey)
ThestudyrsquospurposewastounderstandissuesbarriersandperceptionsinrelationtotheCOV-ID-19vaccineamongNSWrsquosmanyculturallyandlinguisticallydiverse(CALD)communitiesAssuchitpresentsagrassrootsperspectiveKeyfindingsarepresentedbelow
CALD communities have mixed responses to the vaccineLikethegeneralpopulationourstudyhighlightsthat NSW residents from CALD backgrounds are mixedintheirresponsestoandconfidenceinhavingtheCOVID-19vaccine
EXECUTIVE SUMMARY
This research was conducted between late April and early June 2021 just prior to the most recent outbreak in Sydney of the Delta variant of COVID-19 Many participants in our study who were unwilling or hesitant to be vaccinated expressed the opinion that COVID-19 was not a lsquoreal and present dangerrsquo in Australia due to the very low case numbers active at the time
FIGURES10 Figure 1
Country of Birth
11 Figure 2 Language spoken at home
12 Figure 3 Length of time living in Australia
12 Figure 4 Age
13 Figure 5 Gender
14 Figure 6 Are you going to get the COVID-19 vaccine
15 Figure 7 COVID-19 Vaccine intention of respondents by age category
16 Figure 8 Respondents COVID-19 Vaccine intention by Country of Origin
17 Figure 9 Reasons for getting vaccinated against COVID-19
18 Figure 10 Reasons for not getting vaccinated against COVID-19
22 Figure 11 Do you know someone who has been vaccinated
23 Figure 12 Knowing someone who has had COVID-19
24 Figure 13 Who do you know who has had COVID-19
25 Figure 14 Where to go to get vaccinated
25 Figure 15 Sources of information about COVID-19 and the COVID-19 vaccine
27 Figure 16 Sources of information for respondents who were planning to have the vaccine
27 Figure 17 Sources of information for respondents who are not planning to have the vaccine
28 Figure 18 Sources of information for respondents who lsquodonrsquot knowrsquo if they will have the vaccine
1StephenDuckettToo many Australians are hesitant to get vaccinated Herersquos how we fix itSydney MorningHeraldMay192021
TABLES10 Table 1
Focus Group Details
15 Table 2 People in the sample already vaccinated
15 Table 3 Vaccine refusal and hesitancy in the sample
20 Table 4 Vaccine refusal by country of birth and language background
21 Table 5 Reasons for not having the vaccine
22 Table 6 Who do you know who has been vaccinated
1
58 of people in our sample reported that they would be having the vaccine
This included 13 people (64) who had already been vaccinated in most cases having had their first vaccination only
42 reported that they were unsure or were not planning to have the vaccine
Of these 29 were unsure or hesitant
13 reported that they would not have the vaccine
ThiscomparescloselytorecentdatapublishedbyTheAgeandSydneyMorningHeraldthatsug-gests lsquoabout a third of Australians are hesitant aboutgettingaCOVID-19vaccinersquo1
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
32
A range of factors appear to influence attitudesOlderpeople(65+)inthesurveysampleweretheagegroupmostlikelytoreporttheyhadhadorwereintendingtohavethevaccinewhileyoung-erpeople(18-24)weremostlikelytoexpressuncertaintyorhesitancy
Countryofbirthalsoshowedupasapossibleindicatorforbeinglsquopositivelypre-disposedrsquoto-wardsvaccinationandwouldbeworthyoffurtherresearch
Knowing someone who had had the virus or been vaccinateddidnrsquotappeartomakerespondentsmorelikelytogetthevaccinethemselves
Themostfrequentlycitedreasonsforgettingthevaccinewereamixofpersonalsafety(lsquokeepingfamilyself-safersquo)altruisticreasons(lsquoforpublichealthrsquoandlsquoitistherightthingtodorsquo)andthemoremotivationalreasonlsquototravelrsquo
AcrossCALDcommunitiesthereisagoodlevelofpracticalknowledgebutstillsomeuncertaintyaboutwheretoaccessvaccinations
Focusgroupparticipantsgenerallyindicatedfamiliaritywiththe2typesofvaccinesavailableandtherisksassociatedwitheachparticularlyre-gardingAstraZenecandashalthoughthiswasnotablynotthecaseforagroupofnewly-arrivedrefugeeswhohadlittleornoknowledgeofvaccinationsforthe virus
Over 80 of respondents knew where to go to getvaccinatedincludingGPsthevaccinationhubforSydneyresidentsandlocalhospitalsHowev-eraconcerning19reportedthattheydidnotknow where to get vaccinated
Fears and concerns about vaccinations remain Despite high rates of knowledge about COVID-19 acrossourstudysamplearangeofconcernsandmisconceptionsndashsharedwiththewiderpopula-tionndashwereevidentTheseincluded
FearaboutbloodclotscausedbytheAstraZeneca vaccine
Fearabouttheperceivedlackoflsquoproperrsquotestingofthevaccinepriortorollout
Lackofcertaintyabouthowthevaccineworks
ConcernsthatthevaccinewillmakeyousickorchangeyourDNA
Concern that the vaccine is a form ofgovernment control
Abeliefthatifyouarehealthyitisbettertofightthevirusandmakeyourselfandyourimmunesystemlsquostrongerrsquoasaresult
Onlyasmallnumberofpeopleinthesurveysample reported that religious or cultural reasons were a barrier to having the vaccine
Public health information can be confusingThefocusgroupshighlightedthatconflictingpub-licmessagingoverly-complexinformation(evenwhentranslated)ornotenoughtargetedinformationwerefactorsinvaccinehesitancywithcomments including
The importance of social and mass mediaAcrossallrespondentsthemostfrequently-citedsourceofinformationregardingCOVID-19nominatedby417wasFacebookAmongthosenotintendingorhesitanttohavethevaccinelsquoFacebookrsquoandlsquoMyfriendsrsquowerenominatedasthemostcommonlyrelieduponsourcesofinformationForthoseintendingtohavethevaccineSBSTVwasthemostfrequently-citedsourceofinformation
The focus group discussions further highlighteddifferentapproacheswithregardstohealth
informationthatneedtobeconsideredinthecontextofpublicmessagingAnumberofgroupsdiscussedusingtheirGPsforhealthinformationandhealthcarebutalsorelyingontheinternet(includingfitnessandwellbeingsites)FacebookandothersocialmediasuchasWhatsAppandWeChatassourcesofhealthinformationYoung-erfocusgroupparticipantsalsospokeaboutobtaininginformationfromadditionalsourcesincluding Tik Tok and Instagram
TelevisionnewslocalnewspapersandcommunitygroupswerealsohighlyregardedassourcesoflsquoaccuratersquoinformationSomefocusgrouppartici-pantsidentifiedusingmainstreammediasourcestolsquofactcheckrsquowhattheywerehearingonsocialmediaLocaltelevisionnewswasparticularlyimportantinregionallocationswherepeoplewantedtoknowwhatwashappeninglocallyandhowitwouldaffectthem
Government websites are not the lsquogo-torsquo source of informationGovernmentwebsiteswerementionedinthelsquootherrsquocategoryofprimarysourcesofinformationnominatedbylessthan10ofresearchrespond-entsThissuggeststhattheyarenotthepreferredlsquosourceoftruthrsquoforCALDcommunitiesAscanof government health websites indicates that a rangeofusefulresourcesconcerningCOVID-19includingforCALDcommunitiesandorganisa-tionssupportingthemhavebeendevelopedHoweverasourexperienceandotherresearchtellsusthesewebsitescanbedifficulttonav-igaterelyonacertainlevelofdigitalinclusionanddigitalliteracyskillstheinformationprovidedcanbecomplextounderstandornotineasy-readformatsndashinvolvingtechnicaltermsandjargonand placing something on a website does not nec-essarilymakeitaccessibletoparticulargroupsinthecommunityevenwhentranslated
Targeted tailored messaging is essentialOtherrecently-publishedresearchconcerningCOVID-19andCALDcommunitiessupportsfindingsfromoursurveyandfocusgroupsandcontainskeyinsightsrelevanttocommunicatingpublichealthinformationThisincludes
ResourcesavailableonwebsitesoftenrelyonahighlevelofEnglishlanguageliteracyorliteracyinapersonrsquosfirstlanguage
The importance of tailoring messaging tothosewithlowerlevelsofhealthliteracywhoaremorelikelytoendorsemisinformedbeliefsaboutCOVID-19andvaccination
Massmediacampaignsshouldbeutilisedbutsupplementedbydecentralisedcommunicationstrategiesthattapintolocalsupport networks
Theneedtoconveyinformationinawaythatismeaningfultopeopleusingtrustedcommunitysourcesandmultiplechannelstoreinforce messages
Drawing on motivational factors is keyOncloserinspectiontheresultsofourstudysuggestthatvaccinehesitancyisperhapsbetterunderstoodaslowmotivationndashoralsquowaitandseersquoapproachManyparticipantssaidthattheywould consider having the vaccine if there was lsquomoreofareasonrsquotodoso
Reasonsgivenbyparticipantsthatwouldmoti-vate them to get vaccinated included
Manyparticipantsevensomewhowerethemostvaccinehesitantsaidthatifbeingfullyvaccinat-edmeantthedifferencebetweenbeingabletotraveloverseastovisitfamilyornottheywoulddefinitelyrolluptheirsleevesandgetlsquothejabrsquo
If I was able to travel to see my
family If there was more risk from COVID-19 ndash another outbreak or
concern about increased
transmission
If I had to in order to keep my job
Nobody knows what to do My GP doesnrsquot even
know what I should do whether I should
have it or not
They say one thing and then they tell you
something elsehellipit (the vaccine rollout) is
so confusing
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2 3
EXECUTIVE SUMMARY
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
54
RECOMMENDATIONS
Againthisalignswithotherresearchwhichemphasisestheimportanceofbuildingmotiva-tionalandlsquopullrsquofactorsintothevaccinerolloutstrategyandaccompanyingmessaginginorderto increase vaccine uptake among CALD com-munitiesInvolvingcommunitiesintheprocessunderstandingconcernsandmotivationalfactorsbuildingtrustandtestingmessaginghavebeenidentifiedaskey
If I could get home to see my mother I would get
vaccinated today
ThisresearchisintendedtoprovideausefulgrassrootsperspectivefromarangeofCALDcommunitiesacrossNSWonissuesbarriersandperceptionsconcerningtheCOVID-19vaccineItishopedthatthesefindingscontributetoagrow-ingbodyofknowledgeregardingCOVID-relatedissuesforNSWrsquosculturally-diversecommunities
The research has highlighted that reinforcing the benefitsofbeingvaccinatedratherthandwellingontherisksismorelikelytogeneratebehaviouralchangeandapositivevaccineresponsefrombothCALDcommunitiesandthegeneralpopulationIt also reminds us of the immense value of the
direct and early engagement with specialist local multicultural and state-wide ethno-specific community organisations in the development and rollout of any public health campaigns
strategies to ensure community involvement in and ownership of any campaigns with trusted sources such as local community leaders and peer champions
tailored targeted messaging across multiple platforms and channels available in easy-to-read format for English and translated versions
supporting health care professionals in their role as educators and leveraging successful local programs that increase COVID-19 vaccine literacy and informed decision making
further research to understand concerns misconceptions and motivations of priority groups
1
2
3
4
5
long-standingtrustandstrongrelationshipsthatexistbetweenlocalplace-basedservicesandthecommunitiestheyworkwithndashcloseconnectionsthatshouldbeutilisedtoadvancepublichealthoutcomes
InthiscontextitisrecommendedthatNSWHealthinpartnershipwithMulticulturalNSWCALDpeakbodiesandcommunityleadersusethisresearchtoinformongoingeffortstoencour-age uptake of the COVID-19 vaccine among CALD communitiesThefindingsindicatethattheseeffortscouldbesupportedby
4 5
Motherrsquos Group at SydWest Multicultural Community Services Blacktown
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
76
HEALTH INFO
Health information from online sources (low use of government websites)
Main stream media
Younger group
Tik Tok
58 said yes to the vaccine with 64 previously vaccinated
= 2 people
29 were unsure or hesitant
13 reported that they would not have the vaccine
Issues barriers and perceptions about the Covid-19 vaccine among culturally and linguistically diverse communities in NSW
if I could get
home to see my
mother I would
get vaccinated
today
Covid is not
real and present
danger but I would
get vaccinated if
there was a
reason too
I would get vaccinated
FEARS amp CONCERNS about the
vaccineFear about blood clots
caused by the Astra Zeneca
vaccineFear about
the perceived lack of lsquoproperrsquo testing of the
vaccineLack of
certainty about how the vaccine
workedConcerns
that the vaccine will make you sick or change
your DNA
Concern that the vaccine
is a form of government
controlA belief that if you were
healthy it was better to fight the virus and
make yourself and your immune system
lsquostrongerrsquo as a result
if there was more risk from Covid ndash another outbreak or concern about increased transmission
199participants
11focus groups
if I had to in order to keep my job
if I was able to travelto see myfamily
More likely to get the vaccine
+65 age groupThis small study of 199 people from a range of cultural backgrounds in
metropolitan Sydney and two regional locations
found that the community is divided in its response to both the safety need
and efficacy of the vaccine
Almost half of the participants knew someone who had contracted COVID-19 over-seas Many people spoke about the impact of COVID-19 on their immediate family including some who had lost loved ones
Influence of friends and family overseas
2 3
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
98
This research project has been commissioned by the New South Wales Council of Social Service (NCOSS) to look at issues concerns attitudes and barriers to receiving the COVID-19 vaccine in culturally and linguistically diverse (CALD) communities in NSW
The research was conducted over two months fromlateApriltolateJune2021withdatacol-lectedjustpriortothelatestCOVID-19outbreakinSydneyItwasundertakenwithsomeurgencygiven the following factors
the lack of data concerning peoplefromculturallyandlinguisticallydiverse backgrounds in larger research studies 2
theheightenedconcerninthecommunity aboutthepotentialsideeffectsofin particulartheAstraZenecavaccinewhich has led to a higher-than-usual rate of vaccine hesitancyinthewidercommunity3
theneedtolifttheoverallvaccinationratein Australia
Emergingresearchindicatesthatmisconceptionsabout COVID-19 in Australia tend to be more common in groups with lower levels of health literacyincludingpeoplewhospeakalanguageotherthanEnglishInadditionthevariedexperi-enceofandinformationaboutCOVID-19trans-missionandvaccinationinoverseascountriesmakesthisaparticularlyinterestingissuegiventhatCALDcommunitymembersmaybehavingregulardiscussionswithrelativesoverseasandgettinginformationaboutCOVID-19fromover-seas sources
2McCafferyKJDoddRHetalHealth literacy and disparities in COVID-19ndashrelated knowledge attitudes beliefs and behaviours in AustraliaPublicHealthResPract202030(4)e30342012 December 2020 First published5 November 2020lsquoThereareseverallimitationstoourstudyAlthoughourrecruitedsamplewaslargeanddiverseitwasnotstatisticallyrepresentativeoftheAustralianpopulationTheproportionofAustraliansfromnon-Englishspeakingbackgroundswassmall(6)sincethesurveywasnottranslatedandrequiredsufficientEnglishskillstocompletethequestionnaireinEnglishrsquo(p7)
3AnonlinesurveyconductedbyEssentialResearch(April2021)completedby1090peoplebetween21ndash26April2021foundjust43ofAustraliansthinktherolloutisbeingdoneefficientlydownfrom68inMarchhellipTheslowrolloutandchanges to the roadmap also appear to have given rise to vaccinehesitancywithoneinsixpeople(16)sayingtheywillnevergetvaccinatedagainstCOVID-19upfrom12lastmonthwhile42saidtheywillgetvaccinatedbutnotrightawayTheproportionofpeoplewhowouldbewillingtogetvaccinatedassoonaspossibleorarealreadyvaccinatedalsodeclineddownfrom47to42rsquoEssentialReport(April 2021)
A mixed-method research methodology was used for this project However it was primarily a qualitative approach that aimed to hear directly from people in the community from culturally and linguistically diverse (CALD) backgrounds The methodology involved
METHODOLOGY
11 focus groups (including one pilot) involving atotalof167participantsfromCALD backgroundsand7locationsGriffith(1) Wollongong(2)Blacktown(2)Lakemba(1) MtDruitt(3)Toongabbie(1)andMarrickville (1)Thesesupportedparticipantstoanswer thesurveyquestionsandenabledmore detailedexplorationofissuesandfurther gatheringofqualitativeinformation(see Table1below)Identifiedmulticulturalandcommunityserviceorganisationswith connectionstoCALDcommunitiesinthe relevantlocationsactedaslsquointermediariesrsquo byassistingwithorganisingthefocusgroups providingbilingualfacilitationofdiscussion andsupportingcommunitymembersto undertakethesurveyMoreinformationonthefocusgroupsandintermediary organisationscanbefoundatAttachmentA
Anonlinesurveywiththesamequestionsas those used in the focus groups was made available This was promoted via NCOSS networksandtheresearchteamrsquosCALD connectionsandcompletedby32peopleThe totalsamplesizeofthisstudywastherefore 199participantsmadeupofmembersof diverseCALDcommunities
Abilingualmulticulturalcommunity engagementexpertwasengagedthroughout theprojecttoadvisetheresearchteam includinginrelationtothedesignofthe surveyBilingualfacilitatorswereusedfor focusgroupswherenecessaryandguidance wasprovidedbyintermediaryorganisation representativesasrequiredandinone instancethesurveywastranslatedintoArabic Focus group members were each provided witha$25giftcardattheendofthesession anda$50giftcardwasdonatedtothe intermediaryorganisationtoprovidesome additionalresourcestoeachgroup
Asecondonlinesurveywasdesignedtoelicit theviewsandexperienceoftheintermediary organisationsintheirworkwithCALD communitiesItgeneratedeightresponses
Two interviews were undertaken with a multiculturalhealthcommunicationexpert from the Illawarra Shoalhaven Local Health DistrictandanEmergencyDepartment medicalpractitioner
Theonlinesurveyresponsesfromthe intermediaryorganisationsandtheinterviews withhealthstaffhaveinformedanalysisof datafromcommunitymembersfindingsand recommendations
Inadditiontheresearchhasbeeninformedbyotherpubliclyavailableresearchincludingfind-ingsconcerningvaccinehesitancyanduptake4andascanofmulticulturalCOVID-19healthresourcesavailableincommunitylanguagesfromtheCommonwealthNSWandVictorianGovern-mentsSBSandEthnolink(seeAttachment2)
Recruitment for the focus groups IntermediaryorganisationsandfocusgroupparticipantswererecruitedusingtheresearchteamrsquosextensiveconnectionswithmulticulturalandcommunityserviceorganisationsacrossNSWanddrawingonkeyNCOSSmemberorganisa-tionsprovidingsupporttoandwithlongstandingrelationshipswithCALDcommunitiesToalargeextenttheselectedlocationsandtheservicesandsupportsprovidedbytheintermediaryorgan-isationsdeterminedtheculturalbackgroundsthatwereincludedinthestudy
4 httpswwwncossorgauCOVID-19-research
INTRODUCTION
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1110
Service Location Group Composition Participant numbers
Addison Road Community Centre Marrickville Community leaders - Vietnamese Chinese Italian Greek Indonesian Latin American and Portuguese speakers
26
Griffith Community Centre Griffith Indonesian and Pakistani women 6 Multicultural Communities Council Illawarra
Wollongong Arabic-speaking group 22
Multicultural Communities Council Illawarra
Wollongong Italian older womenrsquos group 15
Syd West Multicultural Services Mt Druitt Arabic-speaking group 10 Syd West Multicultural Services Blacktown Spanish-speaking seniorsrsquo group 16 Syd West Multicultural Services Blacktown Mothersrsquo support group -
Indian Sri Lankan Pakistani and Ghanaian
14
Canterbury City Community Centre (4Cs)
Lakemba Pakistani Indian and Sri Lankan women
14
Chaldean League and Western Sydney TAFE
Mt Druitt Chaldean group 18
STARTTS - Toongabbie Community Centre
Toongabbie Tamil-speaking group 12
Mt Druitt TAFE ndash TAFE NSW Mt Druitt Work Opportunities for Women group (mixed CALD backgrounds)
14
TOTAL 167
Table 1 Focus Group DetailsExplanatory noteThefocusgroupatMtDruittTAFE-comprisedpredominantlyofCALDwomenenrolledinaCertificateIIentrylevelcourse-wasusedtopilotandrefinethefocusgroupprocesswithsurveyresponsesgeneratedbythegroupincludedinthefinalsurveyresults
A word about the research design Theresearchwascarefullydesigneddrawingonexpertculturaladviceoncommunicationpro-cessesandsurveydesignFocusgroupsincludedparticipantconsentformsincentivevouchersandaone-pageintroductiontotheresearchfortheintermediaryorganisationsIntermediaryorgan-isationsandpreferredlocationswereidentifiedand agreed in advance with NCOSS
Thesurveywasdesignedinaneasy-to-readformatusingsimpleEnglishFeedbackfromthe Spanish-speaking translator was that it was extremelyeasytotranslateandcompleteOthergroupscommentedthattheyfoundthesurveyeasytocompleteandmostgroupsdisplayedasolidlevelofspokenandwrittenEnglishTheresearchdesignandconductalsoleantheavilyontheexpertiseofthefacilitatorsandtheirexten-sivenetworkswhichmadedeliveryinsuchashorttimeframepossibleThepositiveengagementandsupportoftheintermediaryorganisationswasalsoafactorcontributingtothesuccessfulconduct of the research
Withoutfailthemulticulturalandcommunityserviceorganisationsinvolvedintheresearchper-ceived the importance of its purpose and shared a desire to provide NSW Health with feedback directlyfromtheircommunitiesasamatterofurgency
Demographics of research participantsThemakeupofthosewhoparticipatedintheresearch was diverse in age and cultural and languagebackgroundParticipantswerepredom-inantlywomen(84)withmenmakinguponly145OverhalftheparticipantshadlivedinAustraliaformorethan20yearswhichimpactedpositivelyontheirlevelofspokenandwrittenEnglishHowevertherewerequitelowlevelsofEnglishliteracyinanumberofthegroupswhichmadeguidedsurveycompletionamoreneces-sarybutcomplexprocess
1 1 1
6
3
31
16 17
20
12
15
1
8
2
64
1
5
2 13
1 1
7
2 1
5
1 1 1 1 2 10
5
10
15
20
25
30
35
Indo
nesia
Thai
land
Hong
Kon
gAu
stra
lia Iran
Iraq
Viet
nam
Italy
Sri L
anka
Indi
aPa
kist
anGh
ana
Syria
Boliv
iaCh
ilePe
ruEl
Sal
vado
rM
alay
siaUr
ugua
yAr
gent
ina
Cam
bodi
aUk
rain
eRu
ssia
Chin
aSu
dan
Eritr
eaSw
eden
Taiw
anAf
ghan
istan
Pola
ndJa
pan
Egyp
tJo
rdan
13
1 2
10
17
2
21
1
11
1 1
12
2 1
27
10
1 1 1 13 2 1 2 1
6
1 1 1
32
0
5
10
15
20
25
30
35
English Thai
Cant
ones
eVi
etna
mes
eIta
lian
Farsi
Tam
ilTe
lugu
Span
ishSp
anglish
Haus
aUr
duGu
jara
tiPu
njab
iAr
abic
Chalde
anHi
ndi
Khm
erPe
rsian
Russian
Man
darin
Malay
Haza
ragi
Tigr
inya
Kurd
ishCh
ines
ehellipJa
pane
sePo
lish
Swed
ishM
ultip
le
Figure 1 Country of BirthFigure 2 Language spoken at home
METHODOLOGY
Coun
t
Coun
t
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1312
211
1316 14211684
2053
3316
Less that 1year
1 - 2 years 2 - 5 years 5 - 10 years 10 - 20years
More than20 years
000
500
1000
1500
2000
2500
3000
3500
Less than 1-2 years 2-5 years 5-10 years 10-20 More than1 year years 20 years
1453
8430
000 116
Male Female Non-binary Rather not say000
100020003000400050006000700080009000
000
785
1728
2147
1309
1675
2356
Under 18 18-24 25-34 35-44 45-54 55-64 65+000
500
1000
1500
2000
2500
Figure 3 Length of time living in Australia Figure 5 Gender
Figure 4 Age
METHODOLOGY
Chaldean Focus Group Feedback Sheet
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1514
Research participants were asked
If they were intending to get vaccinated
The reasons why they would or would not choose to get vaccinated
If they knew anyone who had already been vaccinated and if so who
If they knew anyone who had contracted COVID-19 and if so who
If they knew where to go to get vaccinated
What sources they used to get information about the COVID-19 vaccination
Basic demographic information age gender country of origin language spoken at home and length of time living in Australia
Having the vaccine or notOfthe199participants117(58)reportedthattheywereplanningtobeorhadalreadybeenvaccinatedwhile78(42)reportedthattheywere not planning to have the vaccine (13) or didnotknowiftheywouldgetvaccinated(29)
1453
8430
000 116
Male Female Non-binary Rather not say000
100020003000400050006000700080009000
05
10152025303540
Under18
18-24 25-34 35-44 45-54 55-64 65+
Coun
t
Yes No Donrsquot Know
Figure 6 Are you going to get the COVID-19 vaccine
Figure 7 COVID-19 Vaccine intention of respondents by age category
13people(65)hadalreadybeenvaccinated(at least 1 dose)6withseveralcommentingthattheyhadchosenorneededtobevaccinatedforwork-relatedreasonsOthersreportedthattheyhadbeenvaccinatedprimarilyforhealthreasonstostaywellandmakesurethattheirfamiliesstayedwellTheywerealsoconcernedaboutpublichealthandsafetyOneofthewomenintheLakemba groups from Sri Lanka was adamant that thebenefitsoutweighedtherisksspokepositive-lyabouthoweasyithadbeentogetthevaccinefrom her local medical centre and that she had experiencednosideeffectsfromthevaccination
Language Count Percent Urdu 1 Italian 3 Arabic 2 Tamil 3 Chaldean 1 Spanish 3 Total 13 65 of sample
Response Count Percent Not planning to have the vaccine 23 13 Unsure about having the vaccine 52 29
75 42
Table 2 Respondents already vaccinated
Table 3 Respondents who indicated vaccine refusal or hesitancy
6 Theresearchersdidnotdistinguishbetweenwhetherpeoplehadreceivedtheirfirstandseconddosesofthevaccineiepartiallyorfullyvaccinated
75(42)indicatedadegreeofvaccinehesitancywith24participants(13)reportingthattheywerenotplanningongettingvaccinatedwhile53(29)reportedtheydidnotknowiftheywouldget vaccinated
Thislevelofvaccinehesitancyreflectslargerstud-iesintheAustraliancommunityAsurveyofover1000participantsfromacrossAustraliaconduct-edinApril2021byEssentialResearchfoundhes-itancyratesof42including16whoindicatedtheywerenevergoingtogetvaccinated7
Foroursurveyresponsesindicatedthatagewasafactorwith85ofrespondentsaged65andoverreportingthattheywouldhaveorhad
7EssentialResearchThe Essential Report21April2021
FINDINGS FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1716
alreadyhadthevaccineThosewhoindicatedthattheywouldnotbehavingthevaccinewerefairlyevenlydistributedacrossagegroupswithyoung-er people aged 18-24 being the age group with thehighestproportionofparticipantsexpressinguncertaintyabouthavingthevaccineTheagegroupwiththesecondhighestlevelofhesitancyproportionatetoothercategorieswerethe35-44yearolds
02468
10121416
Iraq
Vietnam Italy
South Americ
a
Sri La
nkaIndia
Syria
Other South East
AsiaAfric
a
Australia
Sweden
China
Pakistan
Iran
Eastern Europe
Afghanistan
Japan
Coun
t
Yes No Dont know
8095 8190
70486095
4571
6190
095
To stayhealthy and
well
To keep myfamily
healthy andwell
For publichealth
To travel To work It is theright thing
to do
Somethingelse (pleasetell us what)
000100020003000400050006000700080009000
Figure 8 Respondents COVID-19 Vaccine intention by Country of Origin
Figure 9 Reasons for getting vaccinated against COVID-19
Countryoforiginalsoseemedtoplayaroleinpeoplersquosviewsabouthavingthevaccinewithhighvaccinepre-dispositionreportedbyVietnameserespondentstotheonlinesurveyandwomenintheItalian-speakinggroupWhileparticipantsfromIraqrecordedthehighestlsquoyesrsquoresponsethiswasalmostmatchedbyIraqiparticipantswhoreportedthattheywerelsquounsurersquoorlsquodidnotknowrsquowhethertheywouldhavethevaccineTherelevanceofcountryoforigininthisregardwouldbeworthyoffurtherresearch
The Italian focus group held in Wollongong was an olderwomenrsquossocialgroupwithallparticipants(15) agedabove65yearsMostinfactwereaged over75yearswithoneparticipantinher90s 87 of the group had either been vaccinated (3) or were planning to get vaccinated (10)
Of course I will get vaccinated It is important to do this It is a very bad
disease
Thesewomenweremotivatedtostayhealthyandwellkeeptheirfamilyhealthyandwellforpublichealthreasonstobeabletotravelandforgen-eralsafetyMembersofthegroupalsoreportedthattheywantedtogetvaccinatedsothattheywouldbeabletolsquodancersquoandlsquosocialisersquo
Reasons for having the vaccine
Ofthe117participantswhoreportedthattheyhadeitheralreadybeenvaccinatedorwereplan-ningtogetvaccinatedlsquokeepingmyfamilyhealthyandwellrsquo(82)andlsquokeepingmyselfhealthyandwellrsquo(81)werethetwomostpopularreasonsforhavingthevaccineThiswasfollowedbylsquoforpublichealthrsquo(70)lsquoitistherightthingtodorsquo(62)andinorderlsquototravelrsquo(61)(SeeFigure9)
I donrsquot want to
die
Irsquom over 65 I have some health issues I think itrsquos
[having the vaccine] very important to
keep safe
I want to see my family I usually go every year but now I havenrsquot seen them
because of COVID-19 Having it will help
I am well but my parents are older It is important to
keep them well
Otherreasonsthatpeoplegaveforgettingvacci-natedincludedtheneedtocontinueworkinginessentiallsquofrontlinersquoemploymentsuchassecuritycleaningandagedcaresettingsOnewomanintheLakembafocusgroupwhohadalreadyhadherfirstdoseoftheAstraZenecavaccinesaidthatlsquothebenefitsoutweightherisksrsquoandasanolderwomanrsquoIdonotwanttodiersquo
All but one of the focus groups were familiar with thedifferentvaccinescurrentlyavailableinAus-traliaAstraZenecaandPfizerMostparticipantswere also aware of blood clots being associated with the Astra Zeneca vaccine One group of newly-arrivedrefugeesinGriffithhadnotheardofeithertheAstraZenecaorPfizervaccinesandhadamorelimitedunderstandingofthevaccinationprogram in general
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1918
Reasons for not having the vaccine
At the moment the situation is under control and donrsquot feel the need Also I have no plans to
travel in the near future so I donrsquot see the need
3514
21622703
3243
1892
811 541
4865
1081
Thevaccine isnot welltested
Thevaccine is
unsafe
Formedicalreasons
I amscared tohave thevaccine
I dont likevaccines
Forreligiousreasons
Forculturalreasons
I want towait and
see
Somethingelse
(pleasetell uswhat)
000
1000
2000
3000
4000
5000
6000
Figure 10 Reasons for not getting vaccinated against COVID-19
Theperceivedlsquolackofadequatetestingrsquoofthevaccineandlsquofearofbeingvaccinatedrsquoalsore-ceivedhighresponseratesselectedby3514and3243ofparticipantsrespectivelyOnly1355 of respondents cited religious or cultural reasonsasbeingbehindtheirvaccinehesitancy
Open-endedresponsestothisquestionincluded
The vaccine is not 100 working It cannot offer
100 protection
Ofthe42participantswhosaidthattheywouldnothaveorwerehesitanttohavethevaccine4865saidthattheypreferredtolsquowaitandseersquobeforegettingvaccinated
Thediscussioninthefocusgroupsaboutpeoplersquoshesitancytobevaccinatedfocusedonanumberofconcernswhichreflected
poorcommunicationfromanumberof trusted sources including GPs and some media sources
conflictinginformationaboutthevaccinefrom healthauthorities
fearsaboutvaccinesafetythataresharedby thegeneralcommunity
misconceptionsabouttheeffectivenessof andhowthevaccineswork
I will not have it because make me sick
Issuesraisedinfocusgroupsascontributingtoincreasedhesitancyincluded
Some GPs being hesitant to recommendvaccination
Theinformationbeingprovidedisconflicting
Theinformationisoverlycomplexandnotcomprehensibleregardlessofwhetherithasbeen translated
The risk of blood clots
Perceptionsthatthevaccinesaregenerallyunsafe
Concernsthatsomepeoplearedyingafterbeing vaccinated
Not being sure about the risks associated withhaving the vaccine and being pregnant orbreastfeeding
Theperceptionthattherehasbeenalackoftestingofthevaccinespriortorollout
AlackofunderstandingofhowvaccinesworkthecompositionofthevaccinesandwhattheywoulddotothebodyincludingmakingchangestoapersonrsquosDNA
Specificcommentsincluded
I have heard that the vaccine changes
your DNA
I am a mother I am not sure it [the vaccine] is safe for
me when I am breastfeeding
If you are young and healthy your body has the energy to fight the virus
You donrsquot need to have the vaccine You should just let
your body fight it itself
They donrsquot tell you what chemicals are in the
vaccine
Tamil Focus Group Feedback Sheet
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2120
Nobody knows what to do My GP doesnrsquot even know what I should do whether
I should have it or not
I am not sure what to do I have spoken to my
GP but they canrsquot tell me whether I should have the vaccine or not while I am
breastfeeding
They say one thing and then they tell you
something elsehellip it [the vaccine rollout] is so
confusing
Confusionaboutwhattodowheretogoandthe health impacts of the vaccine was a common threadintheconversationsaroundvaccinehesi-tancy
Onewomanwhosehusbandworkedforasecurityfirmsaidthatherhusbandhadhadtobevacci-natedinordertokeephisjob
In several focus groups the issue of government control was also raised A number of people re-portedstronglythattheyfearedthatthevaccinewas lsquoa means that the government was using to controlpeoplersquo
He [husband] had to have it He didnrsquot have a choice He was fine [no side effects] but Irsquom not
thinking I will have it I donrsquot need to Irsquom a mum Irsquom busy I have
to look after my children I donrsquot know how I feel about it whether
Irsquom going to have it
Vaccine refusal
Onlyasmallnumberofparticipants(24or13)saidtheywouldnotgetvacci-natedOfthisgroup21werewomenand 2 were men8 Respondents were bornintendifferentcountrieswithadiverse range of language backgrounds
I never get sick It is the same for all my family We have always been strong and healthy so I will be
saying no to the vaccine
Country of Birth Language Background Count Pakistan Urdu 4 China Taiwan Chinese
(MandarinCantonese) 4
Sri Lanka India Tamil 3 Chile Spanish and English 2 Italy Italian 2 Iraq Syria Arabic 2 Iraq Chaldean 1 Iran Farsi 1 Greece Macedonian 1 Poland Polish 1 Pakistan Punjabi 1 Sweden Swedish 1 Vietnam Vietnamese 1
Table 4 Vaccine refusal by country of birth and language background
8 ThisreflectstheoverallsamplebiastowardswomenThemajorityoffocusgroupparticipantswerewomenXwithYparticipantsbeingmen
Reason for not having the vaccine Percent Count The vaccine is not well tested 5455 12 I want to wait and see 5455 12 The vaccine is unsafe 3636 8 For medical reasons 3182 7 I am scared to have the vaccine 3182 7 I dont like vaccines 1364 3 For religious reasons 1364 3 For cultural reasons 909 2 Something else (please tell us what) 909 2
SomeinthiscategorywereadamantthattheywouldnotbehavingthevaccineandhadverystrongviewsonitlsquoForculturalreasonsIwonrsquotbehavingthevaccinersquoWhenwelookatrespons-esmorecloselyhoweveritwouldappearthatmanyareinfactmorelsquohesitantrsquothanfirmvaccinerefusers
One reluctant middle-aged Tamil-speaking wom-ansaidlsquoIftheysaywehavetogetvaccinatedthenIwillrsquoThissentimentwas stronglysup-portedbythe rest of the Tamil-speaking group
Studyparticipantswhosaidtheywouldnothavethe vaccine were also concerned that lsquothe vaccine wasnotwelltestedrsquo
The vaccine has been rushed out It has not been
properly tested
Table 5 Reasons for not having the vaccine
Peopleinthiscategorysaidthattheywouldlsquowaitandseersquowhathappenswiththewiderrolloutbe-foremakingtheirfinaldecisionThissuggeststhataproportionofthelsquonorsquogroupareinfacthesitantrather than outright refusing to have the vaccine
Therewerealsofearsexpressedbyfocusgroupparticipantsaboutthedangersofbeingvacci-natedParticipantsreportedbeingafraidofthehealthrisksespeciallyfrombloodclotsSomepeopledistinguishedclearlybetweenAstraZene-caandPfizerinthisregardHoweverformanythedistinctionbetweenthedifferentvaccineswaslostandtheyspokeofthevaccinesgenerallybeing unsafe and having a range of unwanted side effects
Other factors consideredInadditiontothebroaderquestionsofwhypeo-plewouldorwouldnotchoosetogetvaccinatedthe research team used the focus group discus-sionstoexplorewhetherthefollowingfactorshadanyimpactonapersonrsquoslikelihoodofbeingvaccine pre-disposed or hesitant
Knowing someone who had been vaccinated
Knowing someone who had contracted COVID-19
Knowing where to go to get vaccinated
Thesourcespeopleturntoforinformation about COVID-19 and COVID-19 vaccines
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2322
Knowing someone who has been vaccinatedOfthosewhorespondedtothisquestion125or70knewsomeonewhohadalreadyhadthevaccine
6983
2570
447
Yes No Dont know000
1000
2000
3000
4000
5000
6000
7000
8000
Figure 11 Do you know someone who has been vaccinated
Amongthe125participantswhoknewsomeonewhohadalreadybeenvaccinated100identifiedlsquoimmediatefamilymembersrsquo(parentschildrensiblingsandpartners)Somefocusgrouppartic-ipantsreportedthatalloftheirfamilymembersoverseas had been vaccinated Others reported thattheirrelativeshadbeenvaccinatedasarequirementoftheiremployment
Who Count Percent Other family member 41 313 Sister 24 1832 Community member 23 1756 Brother 18 1374 Father 17 1298 Mother 16 1221 Work colleague 14 1069 Husband or wife 11 84 Son or daughter 10 763 Partner 4 305 Someone else 45 3435 Total respondents 131
Table 6 Who do you know who has been vaccinated
When this issue was teased out further in focus groupdiscussionsarangeofreasonswere revealed including
My husband works in security and he had
to get it
My friend works as a COVID-19 cleaner and they all had to [get
vaccinated]
My family overseas have already been vaccinated
My son needs to travel for work so he is getting it
My brother in the UK is a doctor and he got it and
his wife
Knowing someone who has had COVID-19Almosthalfoftheparticipantsknewsomeonewho had contracted COVID-19 overseas Some reportedthatallthemembersoftheirfamilyormanymembersoftheirextendedfamilyhadcon-tracted COVID-19 In the older Italian group 10 of the15womenknewsomeoneinItalywhohadcontracted COVID-19
4716 4659
625
Yes No Not sure000
1000
2000
3000
4000
5000
Figure 12 Knowing someone who has had COVID-19
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2524
385 385
1538
2692
641 513000
4359
2051
1026385
1410
Mother
Father
BrotherSis
ter
Son or d
augh
ter
Husban
d or wife
Partner
Other family
mem
berFri
end
Community m
ember
Work co
lleag
ue
Someone else
(please
tell u
s who)
000500
100015002000250030003500400045005000
Figure 13 Who do you know who has had COVID-19
Four people in the focus groups knew someone who had died of COVID-19
All my family back home [Pakistan] got it [COVID-19] but
they are all fine now apart from my father He died But he was really sick before he
got it He had lots of underlying conditions Medical conditions so he was really unwell before he got COVID-19 But everyone else
they are fine now They were sick but they got betterhellip
If you are well and healthy you can fight this off
SurprisinglyknowingpeoplewhohadcontractedCOVID-19didnotseemtoinfluencefocusgroupparticipantsrsquopredispositiontowardseitherhavingthevaccineorbeingvaccinehesitantHowevertheolderItalianwomenrsquosgroupspokeabouttheimpactthatCOVID-19hadhadinItalyintheearlystagesofthepandemicandhowthishadaffectedthemdeeply13ofthe15womeninthisgroupwouldhaveorhadalreadyhadthevaccine
Knowing where to get vaccinated115people(81)whorespondedtothisquestion(n=142) knew where to go to get the vaccine 34 people(19)reportedthattheydidnotknowThisincluded15respondentsfromIraq3re-spondentsfromIndia2respondentsfromChina2 respondents from Pakistan and one respondent fromeachofthefollowingcountriesChinaEri-treaItalySriLankaSwedenSyriaandVietnamThese people were also less sure about whether ornottheywouldhavethevaccineItispossiblethat their lack of knowledge about where to go to get vaccinated was related to their general level ofvaccinehesitancy
7958
29582254
282 563
GPDoctor Vaccinecentre
Hospital Work place Somewhereelse (please
tell us where)
000100020003000400050006000700080009000
Figure 14 Where to go to get vaccinated
From the sample (n=199) GPs were the most commonlyidentifiedplacetogotogetvaccinat-edfollowedbythevaccinecentreatHomebushBayandthenhospitalsOtherplacesidentifiedincluded medical centres and pharmacies
Sources of information about COVID-19 and the vaccineThelargestsinglesourceofinformationaboutCOVID-19 and the vaccine was Facebook (417)
2743
3486
13141086
30862686
3429
2229 2286
41713714
2571
1086 971
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)000500
10001500200025003000350040004500
Figure 15 Sources of information about COVID-19 and the COVID-19 vaccine
Facebook I get my information from
Facebook But if I want to check it I watch the news
on 7 [Channel 7]
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2726
Thesecondlargestsourceofinformationforpeople in the sample was lsquoother forms of social mediarsquo(37)followedbySBStelevision(35)myfriends(34)andothertelevision(31)Oth-ersourcesofinformationpeoplereportedthattheyusedweretheNSWHealthwebsitenightlytelevisionnewsincludingChannel7Channel9andChannel10followedbytheABCtheAustral-iangovernmenthealthwebsitetheirGPlocalMedical Centres and the Red Cross
IntheLakembafocusgrouppredominantlymadeupofwomenfromPakistantherewasanani-mated discussion about Facebook which was the majorsourceofinformationalongwithGooglesearchesandcommunityandfriendship-basedWhatsApp groups There was a general consensus from most in the group that these were their pre-ferredormostcommonsourcesofinformationandnewsHoweveriftheywantedtolsquofactcheckrsquowhattheywerehearingtheywouldwatchthenightlynewsonChannel7orChannel9toverifywhattheyperceivedcouldsometimesbeunrelia-ble sources
IntheMtDruittfocusgroupseveralofthewom-enwithwell-developeddigitalliteracyandgener-alliteracyskillsusedhealthandfitnesswebsitesand social media sites as their source of infor-mationaboutlsquoallthingshealthrelatedrsquoincludingCOVID-19ThesewomenalsospokepositivelyabouttheinformationandsupporttheygotfromthestaffatCanterburyCouncilCommunityCentre(4Cs)whotheycouldrelyontofindoutthingsthattheyidentifiedtheyneededtoknowmoreabout
InthesmallerfocusgroupinGriffithwithrecently-arrived refugee women who had low levels of Englishlanguageliteracytherewaslittleknowledgeaboutthevaccinesnoawarenessofthedifferenttypesofvaccinesandlittleknow-ledgeaboutwheretogotogetvaccinatedorfindoutmoreaboutCOVID-19ingeneralThecommunityservicestaffandvolunteerspresentatthegroupwere working hard to assist these women to improve their English language skills and support themwithtranslatedinformation
In the older Italian women focus group in Wollon-gongparticipantsreportedgettingtheirinfor-mationfromslightlydifferentsourcesndashfamilyinAustralia(10women)Channel9(7women)
Italianradio(3women)andABCTV(3women)Onlytwowomenusedtheinternetandnoneofthe women reported using Facebook or social mediaasasourceoftheirinformationSeveralmentionedthattheygottheirinformationfromtheirGPorspecialistdoctorandonepartici-pantsaidrsquoIdonrsquotlistentoanyonersquoIntheSpan-ish-speaking focus group a comment was made thatseemedtoreflectmanyoftheotherfocusgroup discussions
Whenlsquosourcesofinformationrsquoiscorrelatedwiththegroupwhosaidtheywouldhavethevaccine(n=104)thereisashiftfromFacebookbeingthepreferredsourceofinformationtolsquoSBSTVrsquobeingthepreferredsourceThelsquovaccine-predisposedrsquogroupalsohadthelowestrateofrelyingonFace-bookasasourceofinformationaboutCOVID-19thoughitwasstillhighThegraphbelowhigh-lightshowotherlsquopreferredsourcesrsquoplayoutforthoseintendingtohaveorwhohavealreadyhadthe vaccine
ForthoseparticipantswhoindicatedthattheywouldnotorwerenotplanningtohavethevaccinelsquoFacebookrsquolsquomyfriendsrsquoandlsquomyfamilyrsquowerethesourcesofinformationaboutCOVID-19thatwereequallymostfrequentlycitedfollowedcloselybylsquomyfamilyoverseasrsquolsquoSBSradiorsquoandlsquoSBSTVrsquoassourcesofinformationreceivedthelowestmentionsfromthisgroup(SeeFigure16)
The vaccine-hesitant group were the group who identifiedlsquoFacebookrsquoastheirmostfrequentsourceofinformationaboutCOVID-19lsquoFace-bookrsquowasfollowedbylsquoothersocialmediarsquoandlsquomyfriendsrsquoasthenextmostfrequentsources
lsquoThiscommunityserviceproviderrsquo(theinterme-diaryorganisationwherethefocusgroupwasconducted)wasidentifiedby26ofrespondentsasasourceofinformationregardlessoftheirintentiontogetvaccinatedornotThefactthatboththelsquovaccinehesitantrsquoandthosewhoindi-catedtheywouldnrsquotbegettingthevaccinesoughtinformationfromthissourcesuggeststhatrolling
There is so much confusion about it [the vaccine] that I think my GP is the best
place to go
9 This group of the research sample included a small number ofpeoplewhohadalreadybeenvaccinated
2626
4141
14141111
323228282828
2424
1818
37373737
2828
10101212
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)00050010001500200025003000350040004500
2857
2381
952 952
2857
3333
42864286
3810
4286
23812381
1429
952
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another co
mmunity se
rvice
Somewhere
else (p
lease te
ll us w
here)000
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Figure 16 Sources of information for respondents who were planning to have the vaccine9
Figure 17 Sources of information for respondents who were not planning to have the vaccine
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2928
outpositivemessagingthroughtrusted communityserviceorganisationscouldbeaneffectivewayofshiftingpeoplefromvaccine hesitancytodecidingtohavethevaccine
31372549
980 980
25492157
4314
1176
2353
4902
4118
2157
980392
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)000
1000
2000
3000
4000
5000
6000
Figure 18 Sources of information for respondents who lsquodonrsquot knowrsquo if they will have the vaccine
DISCUSSION
wardstheCOVID-19vaccineareasvariedastheyarewithinthebroadercommunityTherearearangeofinfluencingfactorsincludingagehealthstatushowlongtheyhavebeeninAustraliahowmuchnewstheyreceivefromoverseasandhowbadlyimpactedbythepandemictheirhomecountries have been
The research also highlights that people from culturallyandlinguisticallydiversebackgroundsgettheirinformationaboutCOVID-19andtheCOVID-19vaccinefromawidevarietyofsourcesbothformalandinformalandthatforparticulargroupsinthisstudythereisahighrelianceonFacebookovermoreofficialsourcesofinforma-tion
VulnerabilityTheneedsofhighly-vulnerablegroupswithintheCALDcommunityhavetobetakenintoconsider-ationThisincludesolderpeoplewhohavelivedinAustraliaformanyyearsbuthavelowlevelsofEnglishliteracyndashespeciallywritingandreadingEnglishandsometimesspokenEnglishndashandwhoaremoresusceptibletoseriousillnessandhigherratesofhospitalisationanddeathfromCOVID-19Italsoincludesnewly-arrivedrefugeeswhohavinglowornoEnglishlanguageliteracylacktheconnectionstoandnetworksintothewidercommunityandcommunitysupportsItisalsothecase that some people in these groups are not health literate at all and cannot read and write in their own language
Akeytakeoutfromthehealthandcommunityserviceorganisationsurveyresponsesandinter-viewsundertakenwithmulticulturalhealthandcommunicationexpertsfortheprojectisthatlit-eracylevelsreallydomatterLowlevelsofhealthliteracylowlevelsofEnglishlanguageliteracyandpossiblylowlevelsofliteracyintheirownlan-guage-especiallyforsomenewly-arrivedrefu-gees and those who are part of the humanitarian program such as Dari language speakers from AfghanistanTigrinyalanguagespeakersfromEr-itrea and northern Ethiopia and Oromo language speakers from Ethiopia - need to be factored into anyplanstofurtherpromotethevaccinerolloutanduptaketoculturallyandlinguisticallydiversepeopleinthecommunityThereisaneedfor
The contextThisresearchisimportantgivenhowhighlyculturallydiverseNSWisandtheimpactthiscanhave on the success of public health messaging topeoplewhosefirstlanguageisnotEnglishPeople who were born overseas form almost one-thirdofthe7480228population(276)ofNSWandNSWishometo336ofAustraliarsquosoverseas-bornpopulationPeoplefromaround225 birthplaces have made NSW their home and 21oftheNSWpopulationisfromanon-EnglishspeakingbackgroundMorethan24000humani-tarianentrantshavesettledinNSWoverthepastfiveyearscomprisingalmostathird(32)ofthenationaltotalThe24000humanitarianentrantswhohavesettledinNSWoverthepastfiveyearscame from over 100 countries of origin10Sydneyhasthelargestoverseas-bornpopulationofallthecapitalcities11
Hearingdirectlyfrompeoplefromculturally-diverse backgrounds is important to ensure that policymakersandpublichealthadvocatescandesign responses that are both accessible and un-derstandabletopeopleforwhomEnglishmaybetheirsecondthirdorfourthlanguageApropor-tionofpeopleinthesecommunitieshavelowerlevelsofEnglishlanguageliteracyandinsomecaseslowlevelsofliteracyintheirlanguageoforiginsowillbehardertoreachviatraditionalormainstream methods
Itisalsocriticallyimportantthatduringatimewherethereissomuchlsquonoisersquoacrossmediachannelsrelatingtothevaccinethevaccineroll-outvaccineefficacyandvaccinesafetythatwetakesometimetolistentoandunderstandhowthislsquonoisersquoisbeingheardandmadesenseofbypeoplefromculturally-diversebackgrounds
ThatsaiditisimportanttoreconfirmthattheCALDcommunityisnotahomogenousgroupOurresearchhasfoundthattheviewsandattitudesofparticipantsfromdiverseculturalbackgroundsto-
10RefugeeCouncilofAustraliaHumanitarianEntrantsin New South Wales A resource for New South Wales governmentagencies6-711MulticulturalNSWCommunityRelationsReport2018-20199
29
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3130
groupsFortheparticipantsintheresearchtheirattitudetothevaccineappearedtobeinflu-encedbyanumberoffactorstheirownlevelsofhealthandpre-existinghealthconditionsandthoseoftheirfamilymembersandtheimpactofreceiving COVID-19-related news from overseas particularlyfrompeoplersquoscountryoforiginAnexampleofthiscanbeseenintheItaliangroupin Wollongong where people had received news fromoverseasearlyinthepandemicwhichscaredthemThisexperiencelsquofromhomersquohadinflu-enced most of the women in the Wollongong focus group (n=15) to choose to get vaccinated The interviewee from the Illawarra Shoalhaven Local Health District also spoke about the heightenedconcernthattheywitnessedinthelocalItaliancommunityintheearlystagesofthepandemicOtherpeoplewantedtolsquostayhealthyrsquoandtolsquoprotectthehealthofothersrsquoandformanytherewasasensethattheywantedtolsquogetbacktosomedegreeofnormalcyrsquoandtobeabletolsquotraveloverseastovisitrelativesrsquo
Vaccine hesitancyOfthe42inthisstudywhoappearedundecidedornotplanningtohavethevaccinemanywereinfactadoptingalsquowaitandseersquoapproachbeforemakingtheirfinaldecisionMostparticipantswereinterestedtohearmoreinformationaboutthevaccinesandwereopenedtogettingthevaccinebutdidhaveconcernsaboutthesafetyofthevaccinesespeciallyinregardtoAstraZeneca
The issue of blood clots has led to considerable fearandhesitancyinthecommunityandthisfearandhesitancywasreflectedinourstudyEssentialResearchrsquossurvey(April2021)reportedoneinsixpeople(16)indicatedtheywillnevergetvaccinatedagainstCOVID-19upfrom12thepreviousmonthwhile42saidtheywillgetvaccinatedbutnotrightawayTheproportionofpeople who would be willing to get vaccinated as soonaspossibleorarealreadyvaccinatedalsodeclineddownfrom47to4213Thissurveywas conducted prior to the most recent outbreak inNSWinvolvingthehighlyinfectiousDeltastrain
Therisk-benefitofhavingthevaccineneedstobecarefullyweighedbyeachindividualideallyinconsultationwiththeirdoctoranddependingon
The Hub has lsquobeen working in partnership with keystakeholdergroupstoguidecommunicationstomeetthehealthliteracyandculturallyandlinguisticallydiverse(CALD)needsofitspop-ulationStructuredworkinggroupshavebeencreatedtoprioritisecommunicationstovulner-ableyouthCALDgroupstheelderlyitinerateworkersasylumseekersandrefugeesTheaimsaretotestmessagingandbuildtrustwithprioritypopulationstoensureeffectivecommunicationoftheneedtosustainphysicaldistancingmeas-uresintheabsenceofavaccineSimilareffortsarenowneedednationallyandshouldstartatthetimeofdiseaseoutbreaksinthefuturealongsideplannedmassmediaandhealthcommunicationcampaignsrsquo
InthearticlebyDoddetaltheyreinforcetheimportanceofusingcommunicationformatswhich are lsquosuitable for people with low health literacyandeducationandwhichareappropriateforculturallyandlinguisticallydiversegroupsandIndigenouspopulationsrsquoThearticlearguesthatitisimportanttolookatmotivationsandconcernsabout vaccines when shaping messaging It also pointsoutthatprimarycaredoctorsareatrust-ed source and as such should be supported in deliveringinformationaboutthevaccinesandad-dressingcommunityconcernsThearticlestateslsquoWeneedtounderstandandaddresscitizenrsquosconcernsthatcanpreventoptimaluptakebuildmotivationsintomessagingandprioritisepublictrustbyinformingandinvolvingthecommunityintheprocessSupportinghealth-careprofession-als in their role as educators will ensure people haveadequateandaccessibleinformationfromatrustedsourcetooptimisevaccineuptakeandultimatelyreducecommunitytransmissionofCOVID-19rsquo15
RecentresearchbyAssociateProfessorHollySeale16withUNSWMedicinersquosSchoolofPublicHealthandDeputyChairfortheCollaborationonSocialScienceandImmunisationfoundthereisaneedtolsquodecentralisersquocommunicationsbytapping
translatedmaterialsandinformationaboutthevaccines to be tailored to the needs of people in these newly-emergingcommunitygroups
It was reported that in Wollongong there can sometimesbefourgenerationsoffamilymem-bersfromnewly-arrivedrefugeegroupslivingintheonehouseMostofthesefamilymembersgenerallyhavelimitedEnglishlanguageliteracywhichincreasestheirriskofnotreceivingkeyhealthmessagesandthereforeincreasingthepotentialimpactofCOVID-19-inparticulartheDeltastrainwhichhasprovenhighlyinfectiousamongst household members
Vaccine uptakeNotdissimilartothewidercommunitymorepeopleinourstudywereplanningtohavethevaccinethannotandanumberhadalreadybeenvaccinatedInarecentLancetarticle(February2021)ConcernsandmotivationsaboutCOVID-19vaccinationfindingsfromtwosurveysfromanAustralianlongitudinalstudyconductedinJuneandJuly2020includedthatlsquothetopthreerea-sons for agreeing to vaccinate were lsquoto protect themselvesandothersrsquohelliplsquobeliefinvaccinationandsciencersquohellipandlsquotohelpstopthevirusspreadrsquoEven among those willing to vaccinate there was somehesitancyaboutthesafetyofthevaccineTheLancetarticlenotedthatlsquowillingnesstovaccinatedifferedbybothageandeducationrsquoForthosewhowereindifferentorsaidtheywouldnot get the vaccine the top reasons across the twosurveyswerelsquoconcernaboutthesafetyofthevaccineinitsdevelopmentrsquoandlsquopotentialsideeffectsrsquo12
Olderpeopleinourstudywhocomprised23of the total sample (n=199) were the group most likelytosaythattheywantedtogetthevaccine85ofthoseover65saidtheywouldhaveorhadalreadyhadthevaccineVaccinepredispo-sitionwashoweveralsostrongacrossotherage
12RHDoddKPicklesBNickelECvejicJAyreCBatcupCBonnerTCoppSCornellTDakinJIsautierKJMcCafferyConcerns and motivations about COVID-19 vaccination SydneyHealthLiteracyLabSydneySchoolofPublicHealthFacultyofMedicineandHealthUniversityofSydneypublishedintheLancetFebruary2021p162wwwthelancet cominfectionVol21February2021
theircircumstancesHoweverthesourcesofin-formationthatpeoplemostrelyuponortrustarecriticaltothedisseminationofaccurateandclearmessaging to dispel the fear surrounding events suchasbloodclottingandthemisconceptionsraisedinthefocusgroupsWithsomanypartici-pantsinthisstudygettingtheirinformationfromFacebookandothersocialmediasitesitisvitalthat these channels are used to promote simple positivemessagesandforanyfuturecommunityawareness campaigns
Effective communicationConfusionandmisconceptionsaboutthevac-cinersquosefficacyavailabilityandsafetywereallis-sues that were raised in the focus groups Finding waystoeffectivelycommunicatewithpeoplewithlowerEnglishlanguageliteracyandhealthliteracyisanimportantwaytoaddresstheconfusionandmisconceptionsaboutthevaccineashasbeen discussed in a number of recent Australian studies
Astudy14byMcCafferyetal(2020)concludedthattherearelsquoimportantdisparitiesinCOVID-19-relatedknowledgeattitudesandbehavioursaccordingtopeoplersquoshealthliteracyandlanguagersquoOneofthefindingswasthatlsquopeoplewithlowerhealthliteracywerealsomorelikelyto endorse misinformed beliefs about COVID-19 andvaccinations(ingeneral)thanthosewithadequatehealthliteracyThesamepatternofresults was observed among people who primar-ilyspeakalanguageotherthanEnglishathomersquoTheMcCafferystudyhighlightstheimportanceof tailoring health messages to those with lower healthliteracyandculturallyandlinguisticallydiversecommunitiesItpointsoutthatthereareexamplesofeffectivemanagementofdiversecommunityneedsthatusetailoredhealthmes-sagesandcitestheWesternSydneyLocalHealthDistrictHealthLiteracyHub
13TheEssentialReport-anonlinesurveyconductedbyEssentialResearchcompletedby1090people between 21ndash26 April14McCafferyKJDoddRHCvejicEAyreJBatcupCIsautierJMJCoppTBonnerCPicklesKNickelBDakinTCornellSWolf MS Health literacy and disparities in COVID-19ndashrelated knowledge attitudes beliefs and behaviours in Australia PublicHealthResPract202030(4)e30342012December2020
15 Op cit16 httpssphmedunsweduausitesdefaultfilessphcmNewsEnhancing-supporting-COVID-19-vaccination-programpdf
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
30 31
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3332
intodifferentnetworkingspacessuchaswork-placeslocalgymsmothersrsquogroupsandseniorsrsquoclubswithafocusonallagegroupsregardlessofcurrenteligibilityAccordingtoSealethechal-lengeislsquoensuringemerginginformationisadapt-edfortheintendedaudiencersquoShehasalsosaidlsquoThatrsquoswhatIrsquomalittlebitconcernedaboutatthemomenttherersquosalotofresourcesongov-ernmentwebsitesbutthesetermsaroundbloodclottingareverytechnicalWeactuallyneedtomake sure that we are breaking them down in a waythatwillmakeitmeaningfultopeopleThatrsquosnotjustabouttranslatingitrsquosaboutbeingcon-sciousofpeoplersquoshealthliteracyneedstooSomaybegettingsomemorevisualsintomaterialstotryandsupportthatrsquo17
Thereareanumberofmulticulturalhealthresourcesthatusecommunitylanguagetransla-tionsplainEnglishandvideosfromCALDcommu-nityleaderswhichcanbedownloadedandusedbyservicesandindividualsHowevermanyofthewrittenresourcesstillrelyontechnicalandscien-tifictermsthatrequireareasonablyhighlevelofEnglishlanguageliteracyorhighlevelsofliteracyin the translated language to comprehend Host websites can also be hard to navigate making itdifficulttolocateresourcesfromsimplewebsearchesAsummaryofsomeoftheavailableresourcescanbefoundatAttachment2
MulticulturalHealthUnitsinLocalHealthDis-trictshavestaffwhocanworkwithpeoplefromculturallyandlinguisticallydiversecommunitiesatthelocallevelandtranslateandcontextualisethese materials to the needs of the end user These teams respond to local needs and popu-lationdemographicsandareexpertsineffectivehealthliteracyandhealthcommunicationwiththeirlocalcommunitiesTheyworkcloselywithcommunityandvulnerablegroupstobuildhealthliteracyandimprovedhealthoutcomesintheircommunities
Case Study ndash Be a COVID Warrior ndash Responding to COVID-19 in Multicultural Communities InWollongongtheIllawarraShoalhavenLocalHealthDistrict(ISLHD)MulticulturalHealthSer-viceco-designedacommunityengagementandeducationprogramcalledlsquoBeaCOVIDWarriorrsquowhich commenced in 2020 in response to the pandemic This program was designed to respond tothelowlevelsofhealthliteracyaroundCOVID-19potentialexposuretothevirusandaddressfearandstigmainthelocalCALDcommunitiesThelsquoCOVIDWarriorrsquoprogramreachedaround880peopleranginginagefrom14to85years65ofCOVIDWarriorparticipantswerefemaleand35weremaleCOVIDWarriorparticipantsrepresented 21 language groups The outcomes of the program included increased levels of confidenceinapplyinginfectioncontrolmeasuresincreasedliteracyandhealthliteracyandawarenessofhowCOVID-19istransmittedUltimatelyanimprovedawarenessinapplyingCOVIDsafemeasures was also reported
InApril2020theservicecommencedwelfarechecksviaphoneonafortnightlybasistosup-portsocially-isolatedmulticulturalseniorswhoboretheemotionalstressofsocialisolationFrom these calls the ISLHD heard the needs and concernsofseniorsinthecommunityInadditionourexperiencewithCALDcommunitieshighlightedtheimportanceofyoungpeopleasconduitsofessentialinformationtoadultsincommunityandfamilygroupsduetoEnglishlanguageaccessandeducation
InresponsetheISLHDinitiatedthelsquoCOVIDWarri-orrsquoprogramusingbi-culturalhighschoolstudentsthroughthelocalhighschoolsByincreasingthehealthliteracyofstudentsatschooltheselsquocham-pionsrsquocouldtalktotheirfamiliesincludingolderfamilymembersininformalsettingsandthroughsocialmediawiththeirpeersasastrategytoraisethe level of knowledge of COVID-19 trans-mission preventionandtestingTheprogrambecamesopopularthatitwasextendedintomorelocalhighschools and adults accessing the Adult Migrant EnglishProgramTheprogramwassupportedbylocalsettlementservicesprovidedbybothMaxSolutionsandtheRedCrossItwas
17 httpstheconversationcomhow-can-governments-communicate-with-multicultural-australians-about-COVID-19-vaccines-its-not-as-simple-as-having-a-poster-in-their-language-156097
later extendedtoCALDSeniorsthroughtheMulticulturalCommunitiesCouncilIllawarra(MCCI)supportprograms
AkeycomponentoftheprogramwastoprovideparticipantswithlsquoCOVIDWarriorrsquoKitswhichincludedtworeusablemaskshandsanitiserinfographicsaboutCOVID-19symptomsandinfor-mationaboutwheretestingclinicswereavailablelocallyMCCIandRuralAustraliaforRefugeesdonatedreusablemasksforeveryparticipant
AsthelsquoCOVIDWarriorrsquoprogramwasevolvingsowasthenationalvaccinerolloutplanInforma-tionwasthereforeadaptedtomeetthisinfor-mationgapForexampleadultparticipantsandseniors were supported to understand how to accesstheCOVIDvaccinelsquoeligibilitycheckersrsquoandCALD people were shown how to use the NSW HealthwebsiteCOVID-19informationpages18
Decision makingHowpeoplearecurrentlyconsideringtheriskofCOVID-19isinfluencedbyarangeoffactorsincludingratesoftransmissioninthecommunitynumbersofnewcasesreportsinthemediaofrisksandsideeffectsPeopletendtobasetheirassessmentonwhattheyarecurrentlyexperi-encingandthencheckthisagainstwhattheyarehearinginthemediaincludingandespeciallyonsocialmediaandfromfamilyandfriendsMostoftheparticipantsinourstudyspokeclearlyandarticulatelyabouthowtheyweigheduptherisk-benefitofhavingtheCOVID-19vaccineintheir decision making Low case numbers ndash at the timeofconductingtheresearchndashandasensethat Australia was lsquodoing well in safeguarding the communityagainstCOVID-19rsquoweresignificantfactorsinpeoplersquosdecisionnottobevaccinatedortoadoptalsquowaitandseersquoapproachFamilyfriends and social media were reported as having aconsiderableinfluenceondecisionmakingaswerereportsinthemediaofthebloodclottingsideeffectsofAstraZeneca
ThefactthatFacebookwasreportedlythemostpopularsourceofinformationaboutCOVID-19
18httpswwwhealthnswgovauInfectiouscovid-19Pagesdefaultaspx
andtheCOVID-19vaccineforpeopleinthestudyraisesconcernsaboutthepossibledisseminationofmisconceptionsandlsquofakenewsrsquothatmaybespread or compounded via social media Closed social media groups such as WhatsApp and WeChatwithfamilyandfriendsmayalsoleadtopeoplereinforcingtheirpre-existingbiasesThesefactorscoupledwithasensethatAustraliaisfaringwellcomparedtomanycountriesoverseasappear to have resulted in increased vaccine hesi-tancyamongparticipantsofthestudy
Factorsthatwereidentifiedaschangingvaccine-hesitantparticipantsrsquoperceptionswereanincreased risk from COVID-19 and a correspond-ingincreaseinthenumberofinfectionsandonthebenefitsidetheabilitytotraveloverseastovisitfamilyIntherecentresearchfromtheUniversityofNSWcitedaboveSearlearguesthatlsquotheremaybeotherthingsthatweneedtonowstartfocusingonhellipthatwillstarttopromoteandmotivatepeoplesuchasthechancetotravelmorefreelyforexamplersquoThisappearstobeborneoutbyourfocusgroupfindings19
Untilrecentlytherehavebeenverylowcasenumbers and few lockdowns across most of Aus-tralia and NSW The recent outbreak from mid-JuneinGreaterSydneyandintroductionofthehighlyinfectiousDeltavariantinNSWislikelytoimpactonpeoplersquosassessmentsoftherisk-benefitofhavingthevaccineandonewouldassumereducehesitancyrates
GiventheheightenedcommunityanxietycausedbythisrecentCOVID-19outbreaktheproductionofshortsharpandtargetedmessagingtoCALDgroupsincommunitylanguagesthatisaccessibleandmotivationalfeaturescommunityleadershigh-profilecelebritiesandsportsstarsfromCALDbackgroundsandisdirectedatastate-wideandlocal level would appear to be more urgent than everItisclearthatformessagingtobeeffectiveandreachitsintendedaudiencedistributionchannelsshouldincludeFacebookWhatsAppandothersocialmediaplatformsaswellastrustedsourcessuchasmulticulturalhealthworkersmulticulturalservicesandthroughGPsandMedical Centres If mainstream COVID-19 vaccine
19 Op cit
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
32 33
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3534
awareness campaigns are produced in Australia suchashavebeenproducedinNewZealandtheUnitedKingdomandNorthAmericatheyshouldincludehighprofilewell-knowncommunityfig-uresandsportingstarsfromCALDbackgroundsandincludestrategiesspecificallytargetingCALDcommunitiesincludinggroupsidentifiedaspar-ticularlyhigh-risk
It is also important that informationonvaccinesistranslatedintolanguagesfromnewerandemergingcommunitiesOthersuggestionsaroundreachingthesecommunitiesincludeface-to-facemeetingsorganisedbycrossagencypartnershipsandpeer-ledstrategiessuchas mobilising community champions and influenc-ers Messaging needs to be inclusive and framed around the collective values held by commu-n5
It is clear that reinforcing the benefits of being vaccinated at this time rather than dwelling on the risks is more likely to generate behavioural
changeandapositivevaccineresponsefrombothCALDcommunitiesandthegeneralpopulationAppropriately-designedandtargetedCOVID-19vaccinehealthinformationthatiseasytoreadinanylanguagecanbeconveyedbycommunityleadersandcommunitynetworksandpromotesthepositivebenefitsofgettingvaccinatedwouldbevaluableatthistimeBuildingontheworkofpeerchampionssuchastheCOVIDWarriorprogramisalsoasuccessfulmodeltoincreasingCOVID-19vaccinehealthliteracyandinformed decision making
Mostimportantlypositivelymotivatingculturallyandlinguisticallydiversecommunitymemberstolsquogetthejabrsquoespeciallythosewhoareadoptingalsquowaitandseersquoapproachorarevaccinehesitantwould lead to greater vaccine uptake among culturallyandlinguisticallydiversecommunitiesandthereforethecommunityasawhole
Inner West Multicultural Network Addison Road Community Centre DateWednesday12May
A focus group session of members of the Inner WestMulticulturalNetworkpluscustomersoftheFoodPantryatAddisonRoadwasheldattheAddisonRoadCommunityCentreinMarrickvilleon12Mayat200pmThesessionwaspartoftheregularmeetingoftheInnerWestMulticul-turalNetworkTheconsultationinvolvedabout26peopleandwasconductedbyRosannaBarbero
Thegroupbrainstormedresponsestoquestionsaroundvaccinehesitancyinmulticulturalcom-munitiesandmoreeffectivemessagingTheseresponseshavebeenincorporatedinthefindingsof the report
Griffith Women on Fire Focus Group Griffith Community Centre DateFriday14May
This small focus group of women was held at GriffithCommunityCentreonMay14at11amMargCouchSeniorProjectOfficerRegionalDevelopmentAustralia(RDA)-RiverinaandJoanneFitzpatrickSettlementEngagementandTransitionSupport Worker from Centacare Southwest NSW werethekeylinksandnetworkcontactsfortheGriffithcommunityTheWomenonFire(WOF)group was established as part of the Red Cross RuralFireServiceprogramlsquoManyCulturesOneCommunityrsquoInitiallyitwasestablishedtoeducatewomenonemergencypreparednessandtoen-courage NSW Rural Fire Service (RFS) volunteering andnowhastransformedintoacommunityac-tionsupportgroupTheGriffithSoroptimistInter-nationalnowauspicetheirfinancesandsupporttheWOFgroupactivitiesThefocusgroupwasfacilitatedbyCamillaCouchandlocalcommunityvolunteersledbytheGriffithSoroptimistClub
The women in the group were from Pakistan and IndonesiaThegroupweremainlyyoungmotherswithyoungchildrenandtheprogramhadchild-minding arrangements The language level of the womenwaslowandmostwerestudyingESOLat
ATTACHMENTS
ATTACHMENT 1 A Description of the Focus Groups
TAFEThedeliveryoftheinformationwaslimiteddue to language levels and the lack of bilingual interpretersEachparticipantworkedoneononewithavolunteertoslowlyfillinthesurveyandonewomantookthesurveyhometodiscusswithherhusbandThisgroupexperiencehighlightedthe lack of bilingual workers and services in some rural areas
Arabic speaking group Syd West Multicultural Services Mount Druitt Community worker Zaid Naoum Generalist Caseworker SydWest Multicultural Services DateMonday24May
ThefocusgroupfromSydWestMulticulturalSer-viceswasconductedonMonday24May2021atSydWestMulticulturalServicesMountDruittat300pmItwasfacilitatedbyPatriciaMcCormickandsupportedbyZaidNaoumGeneralistCase-workerSydWestMulticulturalServices
Therewere10womenandmenfromSyriainthegroupThegroupweremostlymaturetoolderparticipantsMostparticipantsrequiredassistancewithEnglishandthecaseworkerZaidNaoumhadtranslatedthesurveyintoArabicpriorto the focus group Zaid also translated during the focus group
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Canterbury City Community Centre (4Cs) group The Cottage Lakemba DateTuesday25May
ThefocusgroupfromCanterburyCityCommunityCentre(4Cs)wasconductedonTuesday25MayattheCottageat28CroydonStreetLakembaat10amItwasfacilitatedbyRobinMilesandsup-portedbyRomanaWaseemCommunityWorkerfrom 4Cs
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
34
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3736
The group was comprised of 14 women from PakistanIndiaandSriLankaThewomenrangedinagefrom23to65MostwerefluentEnglishspeakershoweveronewomanrequiredtransla-tionintoUrdufromoneoftheotherwomeninthegrouptoanswerthequestionsdirectly
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
NSW Chaldean League group Community worker Randa Goriya DateTuesday25May
ThefocusgroupfromNSWChaldeanLeagueMountDruittwasconductedonTuesday25May2021 at 1000am at the NSW Chaldean League premisesItwasfacilitatedbyPatriciaMcCormickandsupportedbyRandaGoriyaacommunityworker for the NSW Chaldean League in Mount DruittRandatranslatedtheintroductionandpromptsforthediscussionandhelpedthepartic-ipantstocompletethesurveyMostofthegrouprequiredhelptodothesurvey
ThegroupoftwelveparticipantswereallChaldeanandwerematuretoolderinageTheywereamixed-gendergroup
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Arabic speaking group Red Cross premises Wollongong DateTuesday25May
ThefocusgrouptookplaceonTuesday25Mayat 3pm at the Red Cross premises at Wollongong Therewere22womenandmenparticipatinginthegroupThefocusgroupwasfacilitatedbyCamilla Couch with support from Khalid Zainu-labdeenBilingualSupportWorkerHumanitarianSettlementProgram(ACTampNSW)
There were diverse ages in the group ranging fromyoungpeopletoolderagedMostofthegroupwereyoungerrecently-arrivedrefugeesfrom diverse backgrounds There was also a small-eroldercohortofparticipantswithhigherliteracylevelsandstrongercommunityengagementwith the local services in the area Camilla Couch facilitated the focus group which was conducted inArabicandEnglishwiththeArabictranslationprovidedbyKhalidZainulabdeen
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Work Opportunities for Women group Mt Druitt TAFE DateWednesday26May
TheWorkOpportunitiesforWomen(WOW)focusgroupwasheldonWednesdayMay261100ndash 100pmatMtDruittTAFEItwasfacilitatedbyCamilla Couch and built on the knowledge gainedintheprevioussessiononcriticalandanalyticalthinkingTheWOWgroupisaTAFECertificatelevel course
There were 14 women from diverse cultural backgroundsinthegroupThegroupweremainlyMuslimwomenwithschoolagechildrenandsome were mature aged Due to the learning fo-custhegroupwasfacilitatedasaclasswithguid-eddiscussionontheissuesandcarefulanalysisofthequestionsNotranslationwasneededduetotheeducationalcontextThestudentswereadeptatusingITandcompletedallthesurveysonline
STARTTS Tamil group Toongabbie Community Centre Community worker Sivaharani (Harani) Mayuran DateThursday27May
Thefocusgroupconsistedof18femalepartic-ipantswhowereyoungertomatureagedThefocus group was held at 1000am at Toongabbie CommunityCentreinTargoRdToongabbie
ThefocusgroupwasfacilitatedbyPatriciaMc-CormickandsupportedbyacommunityworkerSivaharani(Harani)MayuranfromtheSTARTTSTamil Group
ThegrouphadmixedlevelsofspokenandwrittenEnglishTheintroductionanddiscussionpromptsweretranslatedbythecommunityworkerSivaha-rani(Harani)Mayuranandsheandthemorepro-ficientstudentssupportedthosewithlowliteracytoanswerthesurveyquestions
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Spanish Speakers Seniors group SydWest Multicultural Services Blacktown DateTuesday1June
TheFocusGrouptookplaceonTuesday1Juneat1100amattheBlacktownShowgroundsandconsistedof16participants(15womenandoneman)AllparticipantswerebornincountriesinSouthAmericaTheirEnglish-fluencylevelsvariedand one of the members of the group translated thesurveyquestionsanddiscussionintoSpanish
ThegrouphadbeenmeetingforseveralyearsThegroupwasfacilitatedbyLindyCassidyandwassupportedbySreeVithyaHarilingamDayRespiteampSocialSupportTeamLeaderatSydWestMulticulturalServicesBlacktownThegroupwerematureagedtoolderparticipants
Thegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyform There was a more focused discussion on somekeyquestionsaftersurveycompletionThetranslatorassistedconsiderablyinthisprocess
Italian Speakers group Warrawong Community Centre DateMonday7June
The focus group of Italian speakers was held on Monday7Juneat1015amattheWarrawongCommunityCentreItwasfacilitatedbyCamillaCouchandsupportedbyJohnPaulTroianiand
SofiaLemafromIllawarraShoalhavenLHDMulti-cultural Health
There were 15 women in the group The group weremostlymaturetoolderparticipantsandwasconductedinItalianandEnglishwithtranslationprovidedbyJohnPaulThisgroupmeetsregularlyandissupportedbyanumberofservicesintheareaespeciallymulticulturalhealth
The group had a general facilitated discussion aboutthequestionsinthesurveyDuetolittleornoliteracytheindividualsurveyresponseswerethencollectedintooneresponseThesesurveyresponses have been included in the general surveyresponses
Mothers Group SydWest Multicultural Services Blacktown DateThursday10June
ThefocusgrouptookplaceonThursday10Juneat1030amandconsistedof14youngwomen13 of whom had a CALD background The focus groupweremainlymothersfromasupportgroupatSydWestMulticulturalServicesinBlacktown
EightofthewomenwereborninIndiatwofromPakistantwofromSriLankaonefromHausaGhana and one was born in Australia (the Austral-ianbornyoungwomanwasasocialworkstudenthelpingwiththegroup)LindyCassidyfacilitatedthe group with support from Wilma Garguath a projectofficerfromSydWestMulticultural Services
The group varied in age One was between 18-24 yearsoldSevenwereagedbetween25-34yearsSixwereagedbetween35=44yearsGiventheirage and circumstances most of the group did not consider themselves eligible at this stage for vac-cinationThiswasanimportantdifferencefromotherfocusgroupsinthattheemphasiswasmoreonwhattheywoulddooncetheybecameeligible
Participantsdidnotrequireassistancewithspo-kenEnglishThegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyformTherewasamorefocuseddiscussiononsomekeyquestions
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3938
ATTACHMENT 2 COVID-19 Vaccine Information in multiple languagesThefollowingsitesappsprovidetranslatedinformationaboutCOVID-19vaccines
Type of information KeyinformationongettingvaccinatedinNew South Wales and on the vaccines available The websiteusesanautomaticservicetotranslate thecontentintodifferentlanguages
Source of information NSW Government website
Link httpswwwnswgovauCOVID-19health-and-wellbeingCOVID-19-vaccina-tion-nswgetting-vaccinated
Type of information COVID-19ResourcessectionontheServiceNSWapp The app has a link to NSW Government websiteinformationonldquoGettingaCOVID-19vaccinationrdquo(seeabove)ItalsoincludesalinktoCOVID-19vaccinationresourcesinotherlan-guages available from the Department of Health
Source of information Service NSW NSW Government
Link Service NSW App
Type of information ArangeoftranslatedresourcesonCOVID-19bytitleincludingafactsheetonCOVID-19VaccineAstraZeneca(ChAdOx1-S)
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCOV-ID-19Pagestranslatedresources-by-titleaspx
Type of information ADigitalCOVID-19resourcelibrarywithtranslated materials
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiouscov-id-19Pagesdigital-resourcesaspx
Type of information AMultilingualCommunityToolkitontheCOVID-19vaccinationprogramtoassist communityworkersprovideseasytoreadresourcesvideosandlinkstokeyservicesandresources
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCovid-19DocumentsNSW-COVID-19-vaccina-tion-program-presentation-20210527pdf
Type of information TheNSWMulticulturalHealthCommunicationServiceoffershealthresourcesandinformationin a wide range of languages It has translated resources on COVID-19 and links to translated resourcesonCOVID-19vaccination
Source of information MulticulturalHealthCommunicationServiceisa New South Wales-wide health service hosted bySouth-easternSydneyLocalHealthDistrict(SESLHD)
Link httpswwwmhcshealthnswgovau
Type of information COVID-19vaccineinformationaddressingkeyquestionsaboutCOVID-19vaccinationandincludesvideosposterstilesfactsheetsandaudio material Translated into 63 languages
Source of information Department of Health Australian Government website
Link httpswwwhealthgovauinitiatives-and-pro-gramsCOVID-19-vaccinesCOVID-19-vaccine-in-formation-in-your-language
Type of information ThisinformationaddressessomecommonmisinformationaboutCOVID-19Translatedintomultiplelanguages
Source of information DepartmentofHomeAffairs Australian Government website
Link httpscovid19inlanguagehomeaffairsgovaumisinformation-and-truths-about-coronavirus
Type of information Australianandinternationalnewsand informationaboutCOVID-19andCOVID-19 vaccinesisavailableontheSBSCoronavirusPortal in more than 60 languages
Source of information SBSwebsite
Link httpswwwsbscomaulanguagecoronavirus
Type of information InformationprovidedaboutCOVID-19vaccinerolloutandsafetyinlanguagesotherthan English
Source of information Department of Health and Human Services Victorian Government
Link httpswwwcoronavirusvicgovautranslat-ed-information-about-COVID-19-vaccines
Type of information HealthTranslationsprovidestranslatedmateri-alsonhealthandwellbeingInformationaboutCOVID-19isregularlyupdatedincludessomeinformationonvaccinationandisavailableinover60communitylanguages
Source of information Victoriangovernmentinitiative
Link httpswwwhealthtranslationsvicgovaubhcv2bhchtnsfPresentEnglishResource-AllOpenampx=amps=Coronavirus
Type of information A one-stop shop for translated materials in multiplelanguagesonCOVID-19
Source of information Ethnolink Language Services
Link httpswwwethnolinkcomauCOVID-19-coro-navirus-translated-resources
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
40
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
32
A range of factors appear to influence attitudesOlderpeople(65+)inthesurveysampleweretheagegroupmostlikelytoreporttheyhadhadorwereintendingtohavethevaccinewhileyoung-erpeople(18-24)weremostlikelytoexpressuncertaintyorhesitancy
Countryofbirthalsoshowedupasapossibleindicatorforbeinglsquopositivelypre-disposedrsquoto-wardsvaccinationandwouldbeworthyoffurtherresearch
Knowing someone who had had the virus or been vaccinateddidnrsquotappeartomakerespondentsmorelikelytogetthevaccinethemselves
Themostfrequentlycitedreasonsforgettingthevaccinewereamixofpersonalsafety(lsquokeepingfamilyself-safersquo)altruisticreasons(lsquoforpublichealthrsquoandlsquoitistherightthingtodorsquo)andthemoremotivationalreasonlsquototravelrsquo
AcrossCALDcommunitiesthereisagoodlevelofpracticalknowledgebutstillsomeuncertaintyaboutwheretoaccessvaccinations
Focusgroupparticipantsgenerallyindicatedfamiliaritywiththe2typesofvaccinesavailableandtherisksassociatedwitheachparticularlyre-gardingAstraZenecandashalthoughthiswasnotablynotthecaseforagroupofnewly-arrivedrefugeeswhohadlittleornoknowledgeofvaccinationsforthe virus
Over 80 of respondents knew where to go to getvaccinatedincludingGPsthevaccinationhubforSydneyresidentsandlocalhospitalsHowev-eraconcerning19reportedthattheydidnotknow where to get vaccinated
Fears and concerns about vaccinations remain Despite high rates of knowledge about COVID-19 acrossourstudysamplearangeofconcernsandmisconceptionsndashsharedwiththewiderpopula-tionndashwereevidentTheseincluded
FearaboutbloodclotscausedbytheAstraZeneca vaccine
Fearabouttheperceivedlackoflsquoproperrsquotestingofthevaccinepriortorollout
Lackofcertaintyabouthowthevaccineworks
ConcernsthatthevaccinewillmakeyousickorchangeyourDNA
Concern that the vaccine is a form ofgovernment control
Abeliefthatifyouarehealthyitisbettertofightthevirusandmakeyourselfandyourimmunesystemlsquostrongerrsquoasaresult
Onlyasmallnumberofpeopleinthesurveysample reported that religious or cultural reasons were a barrier to having the vaccine
Public health information can be confusingThefocusgroupshighlightedthatconflictingpub-licmessagingoverly-complexinformation(evenwhentranslated)ornotenoughtargetedinformationwerefactorsinvaccinehesitancywithcomments including
The importance of social and mass mediaAcrossallrespondentsthemostfrequently-citedsourceofinformationregardingCOVID-19nominatedby417wasFacebookAmongthosenotintendingorhesitanttohavethevaccinelsquoFacebookrsquoandlsquoMyfriendsrsquowerenominatedasthemostcommonlyrelieduponsourcesofinformationForthoseintendingtohavethevaccineSBSTVwasthemostfrequently-citedsourceofinformation
The focus group discussions further highlighteddifferentapproacheswithregardstohealth
informationthatneedtobeconsideredinthecontextofpublicmessagingAnumberofgroupsdiscussedusingtheirGPsforhealthinformationandhealthcarebutalsorelyingontheinternet(includingfitnessandwellbeingsites)FacebookandothersocialmediasuchasWhatsAppandWeChatassourcesofhealthinformationYoung-erfocusgroupparticipantsalsospokeaboutobtaininginformationfromadditionalsourcesincluding Tik Tok and Instagram
TelevisionnewslocalnewspapersandcommunitygroupswerealsohighlyregardedassourcesoflsquoaccuratersquoinformationSomefocusgrouppartici-pantsidentifiedusingmainstreammediasourcestolsquofactcheckrsquowhattheywerehearingonsocialmediaLocaltelevisionnewswasparticularlyimportantinregionallocationswherepeoplewantedtoknowwhatwashappeninglocallyandhowitwouldaffectthem
Government websites are not the lsquogo-torsquo source of informationGovernmentwebsiteswerementionedinthelsquootherrsquocategoryofprimarysourcesofinformationnominatedbylessthan10ofresearchrespond-entsThissuggeststhattheyarenotthepreferredlsquosourceoftruthrsquoforCALDcommunitiesAscanof government health websites indicates that a rangeofusefulresourcesconcerningCOVID-19includingforCALDcommunitiesandorganisa-tionssupportingthemhavebeendevelopedHoweverasourexperienceandotherresearchtellsusthesewebsitescanbedifficulttonav-igaterelyonacertainlevelofdigitalinclusionanddigitalliteracyskillstheinformationprovidedcanbecomplextounderstandornotineasy-readformatsndashinvolvingtechnicaltermsandjargonand placing something on a website does not nec-essarilymakeitaccessibletoparticulargroupsinthecommunityevenwhentranslated
Targeted tailored messaging is essentialOtherrecently-publishedresearchconcerningCOVID-19andCALDcommunitiessupportsfindingsfromoursurveyandfocusgroupsandcontainskeyinsightsrelevanttocommunicatingpublichealthinformationThisincludes
ResourcesavailableonwebsitesoftenrelyonahighlevelofEnglishlanguageliteracyorliteracyinapersonrsquosfirstlanguage
The importance of tailoring messaging tothosewithlowerlevelsofhealthliteracywhoaremorelikelytoendorsemisinformedbeliefsaboutCOVID-19andvaccination
Massmediacampaignsshouldbeutilisedbutsupplementedbydecentralisedcommunicationstrategiesthattapintolocalsupport networks
Theneedtoconveyinformationinawaythatismeaningfultopeopleusingtrustedcommunitysourcesandmultiplechannelstoreinforce messages
Drawing on motivational factors is keyOncloserinspectiontheresultsofourstudysuggestthatvaccinehesitancyisperhapsbetterunderstoodaslowmotivationndashoralsquowaitandseersquoapproachManyparticipantssaidthattheywould consider having the vaccine if there was lsquomoreofareasonrsquotodoso
Reasonsgivenbyparticipantsthatwouldmoti-vate them to get vaccinated included
Manyparticipantsevensomewhowerethemostvaccinehesitantsaidthatifbeingfullyvaccinat-edmeantthedifferencebetweenbeingabletotraveloverseastovisitfamilyornottheywoulddefinitelyrolluptheirsleevesandgetlsquothejabrsquo
If I was able to travel to see my
family If there was more risk from COVID-19 ndash another outbreak or
concern about increased
transmission
If I had to in order to keep my job
Nobody knows what to do My GP doesnrsquot even
know what I should do whether I should
have it or not
They say one thing and then they tell you
something elsehellipit (the vaccine rollout) is
so confusing
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2 3
EXECUTIVE SUMMARY
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
54
RECOMMENDATIONS
Againthisalignswithotherresearchwhichemphasisestheimportanceofbuildingmotiva-tionalandlsquopullrsquofactorsintothevaccinerolloutstrategyandaccompanyingmessaginginorderto increase vaccine uptake among CALD com-munitiesInvolvingcommunitiesintheprocessunderstandingconcernsandmotivationalfactorsbuildingtrustandtestingmessaginghavebeenidentifiedaskey
If I could get home to see my mother I would get
vaccinated today
ThisresearchisintendedtoprovideausefulgrassrootsperspectivefromarangeofCALDcommunitiesacrossNSWonissuesbarriersandperceptionsconcerningtheCOVID-19vaccineItishopedthatthesefindingscontributetoagrow-ingbodyofknowledgeregardingCOVID-relatedissuesforNSWrsquosculturally-diversecommunities
The research has highlighted that reinforcing the benefitsofbeingvaccinatedratherthandwellingontherisksismorelikelytogeneratebehaviouralchangeandapositivevaccineresponsefrombothCALDcommunitiesandthegeneralpopulationIt also reminds us of the immense value of the
direct and early engagement with specialist local multicultural and state-wide ethno-specific community organisations in the development and rollout of any public health campaigns
strategies to ensure community involvement in and ownership of any campaigns with trusted sources such as local community leaders and peer champions
tailored targeted messaging across multiple platforms and channels available in easy-to-read format for English and translated versions
supporting health care professionals in their role as educators and leveraging successful local programs that increase COVID-19 vaccine literacy and informed decision making
further research to understand concerns misconceptions and motivations of priority groups
1
2
3
4
5
long-standingtrustandstrongrelationshipsthatexistbetweenlocalplace-basedservicesandthecommunitiestheyworkwithndashcloseconnectionsthatshouldbeutilisedtoadvancepublichealthoutcomes
InthiscontextitisrecommendedthatNSWHealthinpartnershipwithMulticulturalNSWCALDpeakbodiesandcommunityleadersusethisresearchtoinformongoingeffortstoencour-age uptake of the COVID-19 vaccine among CALD communitiesThefindingsindicatethattheseeffortscouldbesupportedby
4 5
Motherrsquos Group at SydWest Multicultural Community Services Blacktown
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
76
HEALTH INFO
Health information from online sources (low use of government websites)
Main stream media
Younger group
Tik Tok
58 said yes to the vaccine with 64 previously vaccinated
= 2 people
29 were unsure or hesitant
13 reported that they would not have the vaccine
Issues barriers and perceptions about the Covid-19 vaccine among culturally and linguistically diverse communities in NSW
if I could get
home to see my
mother I would
get vaccinated
today
Covid is not
real and present
danger but I would
get vaccinated if
there was a
reason too
I would get vaccinated
FEARS amp CONCERNS about the
vaccineFear about blood clots
caused by the Astra Zeneca
vaccineFear about
the perceived lack of lsquoproperrsquo testing of the
vaccineLack of
certainty about how the vaccine
workedConcerns
that the vaccine will make you sick or change
your DNA
Concern that the vaccine
is a form of government
controlA belief that if you were
healthy it was better to fight the virus and
make yourself and your immune system
lsquostrongerrsquo as a result
if there was more risk from Covid ndash another outbreak or concern about increased transmission
199participants
11focus groups
if I had to in order to keep my job
if I was able to travelto see myfamily
More likely to get the vaccine
+65 age groupThis small study of 199 people from a range of cultural backgrounds in
metropolitan Sydney and two regional locations
found that the community is divided in its response to both the safety need
and efficacy of the vaccine
Almost half of the participants knew someone who had contracted COVID-19 over-seas Many people spoke about the impact of COVID-19 on their immediate family including some who had lost loved ones
Influence of friends and family overseas
2 3
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
98
This research project has been commissioned by the New South Wales Council of Social Service (NCOSS) to look at issues concerns attitudes and barriers to receiving the COVID-19 vaccine in culturally and linguistically diverse (CALD) communities in NSW
The research was conducted over two months fromlateApriltolateJune2021withdatacol-lectedjustpriortothelatestCOVID-19outbreakinSydneyItwasundertakenwithsomeurgencygiven the following factors
the lack of data concerning peoplefromculturallyandlinguisticallydiverse backgrounds in larger research studies 2
theheightenedconcerninthecommunity aboutthepotentialsideeffectsofin particulartheAstraZenecavaccinewhich has led to a higher-than-usual rate of vaccine hesitancyinthewidercommunity3
theneedtolifttheoverallvaccinationratein Australia
Emergingresearchindicatesthatmisconceptionsabout COVID-19 in Australia tend to be more common in groups with lower levels of health literacyincludingpeoplewhospeakalanguageotherthanEnglishInadditionthevariedexperi-enceofandinformationaboutCOVID-19trans-missionandvaccinationinoverseascountriesmakesthisaparticularlyinterestingissuegiventhatCALDcommunitymembersmaybehavingregulardiscussionswithrelativesoverseasandgettinginformationaboutCOVID-19fromover-seas sources
2McCafferyKJDoddRHetalHealth literacy and disparities in COVID-19ndashrelated knowledge attitudes beliefs and behaviours in AustraliaPublicHealthResPract202030(4)e30342012 December 2020 First published5 November 2020lsquoThereareseverallimitationstoourstudyAlthoughourrecruitedsamplewaslargeanddiverseitwasnotstatisticallyrepresentativeoftheAustralianpopulationTheproportionofAustraliansfromnon-Englishspeakingbackgroundswassmall(6)sincethesurveywasnottranslatedandrequiredsufficientEnglishskillstocompletethequestionnaireinEnglishrsquo(p7)
3AnonlinesurveyconductedbyEssentialResearch(April2021)completedby1090peoplebetween21ndash26April2021foundjust43ofAustraliansthinktherolloutisbeingdoneefficientlydownfrom68inMarchhellipTheslowrolloutandchanges to the roadmap also appear to have given rise to vaccinehesitancywithoneinsixpeople(16)sayingtheywillnevergetvaccinatedagainstCOVID-19upfrom12lastmonthwhile42saidtheywillgetvaccinatedbutnotrightawayTheproportionofpeoplewhowouldbewillingtogetvaccinatedassoonaspossibleorarealreadyvaccinatedalsodeclineddownfrom47to42rsquoEssentialReport(April 2021)
A mixed-method research methodology was used for this project However it was primarily a qualitative approach that aimed to hear directly from people in the community from culturally and linguistically diverse (CALD) backgrounds The methodology involved
METHODOLOGY
11 focus groups (including one pilot) involving atotalof167participantsfromCALD backgroundsand7locationsGriffith(1) Wollongong(2)Blacktown(2)Lakemba(1) MtDruitt(3)Toongabbie(1)andMarrickville (1)Thesesupportedparticipantstoanswer thesurveyquestionsandenabledmore detailedexplorationofissuesandfurther gatheringofqualitativeinformation(see Table1below)Identifiedmulticulturalandcommunityserviceorganisationswith connectionstoCALDcommunitiesinthe relevantlocationsactedaslsquointermediariesrsquo byassistingwithorganisingthefocusgroups providingbilingualfacilitationofdiscussion andsupportingcommunitymembersto undertakethesurveyMoreinformationonthefocusgroupsandintermediary organisationscanbefoundatAttachmentA
Anonlinesurveywiththesamequestionsas those used in the focus groups was made available This was promoted via NCOSS networksandtheresearchteamrsquosCALD connectionsandcompletedby32peopleThe totalsamplesizeofthisstudywastherefore 199participantsmadeupofmembersof diverseCALDcommunities
Abilingualmulticulturalcommunity engagementexpertwasengagedthroughout theprojecttoadvisetheresearchteam includinginrelationtothedesignofthe surveyBilingualfacilitatorswereusedfor focusgroupswherenecessaryandguidance wasprovidedbyintermediaryorganisation representativesasrequiredandinone instancethesurveywastranslatedintoArabic Focus group members were each provided witha$25giftcardattheendofthesession anda$50giftcardwasdonatedtothe intermediaryorganisationtoprovidesome additionalresourcestoeachgroup
Asecondonlinesurveywasdesignedtoelicit theviewsandexperienceoftheintermediary organisationsintheirworkwithCALD communitiesItgeneratedeightresponses
Two interviews were undertaken with a multiculturalhealthcommunicationexpert from the Illawarra Shoalhaven Local Health DistrictandanEmergencyDepartment medicalpractitioner
Theonlinesurveyresponsesfromthe intermediaryorganisationsandtheinterviews withhealthstaffhaveinformedanalysisof datafromcommunitymembersfindingsand recommendations
Inadditiontheresearchhasbeeninformedbyotherpubliclyavailableresearchincludingfind-ingsconcerningvaccinehesitancyanduptake4andascanofmulticulturalCOVID-19healthresourcesavailableincommunitylanguagesfromtheCommonwealthNSWandVictorianGovern-mentsSBSandEthnolink(seeAttachment2)
Recruitment for the focus groups IntermediaryorganisationsandfocusgroupparticipantswererecruitedusingtheresearchteamrsquosextensiveconnectionswithmulticulturalandcommunityserviceorganisationsacrossNSWanddrawingonkeyNCOSSmemberorganisa-tionsprovidingsupporttoandwithlongstandingrelationshipswithCALDcommunitiesToalargeextenttheselectedlocationsandtheservicesandsupportsprovidedbytheintermediaryorgan-isationsdeterminedtheculturalbackgroundsthatwereincludedinthestudy
4 httpswwwncossorgauCOVID-19-research
INTRODUCTION
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1110
Service Location Group Composition Participant numbers
Addison Road Community Centre Marrickville Community leaders - Vietnamese Chinese Italian Greek Indonesian Latin American and Portuguese speakers
26
Griffith Community Centre Griffith Indonesian and Pakistani women 6 Multicultural Communities Council Illawarra
Wollongong Arabic-speaking group 22
Multicultural Communities Council Illawarra
Wollongong Italian older womenrsquos group 15
Syd West Multicultural Services Mt Druitt Arabic-speaking group 10 Syd West Multicultural Services Blacktown Spanish-speaking seniorsrsquo group 16 Syd West Multicultural Services Blacktown Mothersrsquo support group -
Indian Sri Lankan Pakistani and Ghanaian
14
Canterbury City Community Centre (4Cs)
Lakemba Pakistani Indian and Sri Lankan women
14
Chaldean League and Western Sydney TAFE
Mt Druitt Chaldean group 18
STARTTS - Toongabbie Community Centre
Toongabbie Tamil-speaking group 12
Mt Druitt TAFE ndash TAFE NSW Mt Druitt Work Opportunities for Women group (mixed CALD backgrounds)
14
TOTAL 167
Table 1 Focus Group DetailsExplanatory noteThefocusgroupatMtDruittTAFE-comprisedpredominantlyofCALDwomenenrolledinaCertificateIIentrylevelcourse-wasusedtopilotandrefinethefocusgroupprocesswithsurveyresponsesgeneratedbythegroupincludedinthefinalsurveyresults
A word about the research design Theresearchwascarefullydesigneddrawingonexpertculturaladviceoncommunicationpro-cessesandsurveydesignFocusgroupsincludedparticipantconsentformsincentivevouchersandaone-pageintroductiontotheresearchfortheintermediaryorganisationsIntermediaryorgan-isationsandpreferredlocationswereidentifiedand agreed in advance with NCOSS
Thesurveywasdesignedinaneasy-to-readformatusingsimpleEnglishFeedbackfromthe Spanish-speaking translator was that it was extremelyeasytotranslateandcompleteOthergroupscommentedthattheyfoundthesurveyeasytocompleteandmostgroupsdisplayedasolidlevelofspokenandwrittenEnglishTheresearchdesignandconductalsoleantheavilyontheexpertiseofthefacilitatorsandtheirexten-sivenetworkswhichmadedeliveryinsuchashorttimeframepossibleThepositiveengagementandsupportoftheintermediaryorganisationswasalsoafactorcontributingtothesuccessfulconduct of the research
Withoutfailthemulticulturalandcommunityserviceorganisationsinvolvedintheresearchper-ceived the importance of its purpose and shared a desire to provide NSW Health with feedback directlyfromtheircommunitiesasamatterofurgency
Demographics of research participantsThemakeupofthosewhoparticipatedintheresearch was diverse in age and cultural and languagebackgroundParticipantswerepredom-inantlywomen(84)withmenmakinguponly145OverhalftheparticipantshadlivedinAustraliaformorethan20yearswhichimpactedpositivelyontheirlevelofspokenandwrittenEnglishHowevertherewerequitelowlevelsofEnglishliteracyinanumberofthegroupswhichmadeguidedsurveycompletionamoreneces-sarybutcomplexprocess
1 1 1
6
3
31
16 17
20
12
15
1
8
2
64
1
5
2 13
1 1
7
2 1
5
1 1 1 1 2 10
5
10
15
20
25
30
35
Indo
nesia
Thai
land
Hong
Kon
gAu
stra
lia Iran
Iraq
Viet
nam
Italy
Sri L
anka
Indi
aPa
kist
anGh
ana
Syria
Boliv
iaCh
ilePe
ruEl
Sal
vado
rM
alay
siaUr
ugua
yAr
gent
ina
Cam
bodi
aUk
rain
eRu
ssia
Chin
aSu
dan
Eritr
eaSw
eden
Taiw
anAf
ghan
istan
Pola
ndJa
pan
Egyp
tJo
rdan
13
1 2
10
17
2
21
1
11
1 1
12
2 1
27
10
1 1 1 13 2 1 2 1
6
1 1 1
32
0
5
10
15
20
25
30
35
English Thai
Cant
ones
eVi
etna
mes
eIta
lian
Farsi
Tam
ilTe
lugu
Span
ishSp
anglish
Haus
aUr
duGu
jara
tiPu
njab
iAr
abic
Chalde
anHi
ndi
Khm
erPe
rsian
Russian
Man
darin
Malay
Haza
ragi
Tigr
inya
Kurd
ishCh
ines
ehellipJa
pane
sePo
lish
Swed
ishM
ultip
le
Figure 1 Country of BirthFigure 2 Language spoken at home
METHODOLOGY
Coun
t
Coun
t
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1312
211
1316 14211684
2053
3316
Less that 1year
1 - 2 years 2 - 5 years 5 - 10 years 10 - 20years
More than20 years
000
500
1000
1500
2000
2500
3000
3500
Less than 1-2 years 2-5 years 5-10 years 10-20 More than1 year years 20 years
1453
8430
000 116
Male Female Non-binary Rather not say000
100020003000400050006000700080009000
000
785
1728
2147
1309
1675
2356
Under 18 18-24 25-34 35-44 45-54 55-64 65+000
500
1000
1500
2000
2500
Figure 3 Length of time living in Australia Figure 5 Gender
Figure 4 Age
METHODOLOGY
Chaldean Focus Group Feedback Sheet
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1514
Research participants were asked
If they were intending to get vaccinated
The reasons why they would or would not choose to get vaccinated
If they knew anyone who had already been vaccinated and if so who
If they knew anyone who had contracted COVID-19 and if so who
If they knew where to go to get vaccinated
What sources they used to get information about the COVID-19 vaccination
Basic demographic information age gender country of origin language spoken at home and length of time living in Australia
Having the vaccine or notOfthe199participants117(58)reportedthattheywereplanningtobeorhadalreadybeenvaccinatedwhile78(42)reportedthattheywere not planning to have the vaccine (13) or didnotknowiftheywouldgetvaccinated(29)
1453
8430
000 116
Male Female Non-binary Rather not say000
100020003000400050006000700080009000
05
10152025303540
Under18
18-24 25-34 35-44 45-54 55-64 65+
Coun
t
Yes No Donrsquot Know
Figure 6 Are you going to get the COVID-19 vaccine
Figure 7 COVID-19 Vaccine intention of respondents by age category
13people(65)hadalreadybeenvaccinated(at least 1 dose)6withseveralcommentingthattheyhadchosenorneededtobevaccinatedforwork-relatedreasonsOthersreportedthattheyhadbeenvaccinatedprimarilyforhealthreasonstostaywellandmakesurethattheirfamiliesstayedwellTheywerealsoconcernedaboutpublichealthandsafetyOneofthewomenintheLakemba groups from Sri Lanka was adamant that thebenefitsoutweighedtherisksspokepositive-lyabouthoweasyithadbeentogetthevaccinefrom her local medical centre and that she had experiencednosideeffectsfromthevaccination
Language Count Percent Urdu 1 Italian 3 Arabic 2 Tamil 3 Chaldean 1 Spanish 3 Total 13 65 of sample
Response Count Percent Not planning to have the vaccine 23 13 Unsure about having the vaccine 52 29
75 42
Table 2 Respondents already vaccinated
Table 3 Respondents who indicated vaccine refusal or hesitancy
6 Theresearchersdidnotdistinguishbetweenwhetherpeoplehadreceivedtheirfirstandseconddosesofthevaccineiepartiallyorfullyvaccinated
75(42)indicatedadegreeofvaccinehesitancywith24participants(13)reportingthattheywerenotplanningongettingvaccinatedwhile53(29)reportedtheydidnotknowiftheywouldget vaccinated
Thislevelofvaccinehesitancyreflectslargerstud-iesintheAustraliancommunityAsurveyofover1000participantsfromacrossAustraliaconduct-edinApril2021byEssentialResearchfoundhes-itancyratesof42including16whoindicatedtheywerenevergoingtogetvaccinated7
Foroursurveyresponsesindicatedthatagewasafactorwith85ofrespondentsaged65andoverreportingthattheywouldhaveorhad
7EssentialResearchThe Essential Report21April2021
FINDINGS FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1716
alreadyhadthevaccineThosewhoindicatedthattheywouldnotbehavingthevaccinewerefairlyevenlydistributedacrossagegroupswithyoung-er people aged 18-24 being the age group with thehighestproportionofparticipantsexpressinguncertaintyabouthavingthevaccineTheagegroupwiththesecondhighestlevelofhesitancyproportionatetoothercategorieswerethe35-44yearolds
02468
10121416
Iraq
Vietnam Italy
South Americ
a
Sri La
nkaIndia
Syria
Other South East
AsiaAfric
a
Australia
Sweden
China
Pakistan
Iran
Eastern Europe
Afghanistan
Japan
Coun
t
Yes No Dont know
8095 8190
70486095
4571
6190
095
To stayhealthy and
well
To keep myfamily
healthy andwell
For publichealth
To travel To work It is theright thing
to do
Somethingelse (pleasetell us what)
000100020003000400050006000700080009000
Figure 8 Respondents COVID-19 Vaccine intention by Country of Origin
Figure 9 Reasons for getting vaccinated against COVID-19
Countryoforiginalsoseemedtoplayaroleinpeoplersquosviewsabouthavingthevaccinewithhighvaccinepre-dispositionreportedbyVietnameserespondentstotheonlinesurveyandwomenintheItalian-speakinggroupWhileparticipantsfromIraqrecordedthehighestlsquoyesrsquoresponsethiswasalmostmatchedbyIraqiparticipantswhoreportedthattheywerelsquounsurersquoorlsquodidnotknowrsquowhethertheywouldhavethevaccineTherelevanceofcountryoforigininthisregardwouldbeworthyoffurtherresearch
The Italian focus group held in Wollongong was an olderwomenrsquossocialgroupwithallparticipants(15) agedabove65yearsMostinfactwereaged over75yearswithoneparticipantinher90s 87 of the group had either been vaccinated (3) or were planning to get vaccinated (10)
Of course I will get vaccinated It is important to do this It is a very bad
disease
Thesewomenweremotivatedtostayhealthyandwellkeeptheirfamilyhealthyandwellforpublichealthreasonstobeabletotravelandforgen-eralsafetyMembersofthegroupalsoreportedthattheywantedtogetvaccinatedsothattheywouldbeabletolsquodancersquoandlsquosocialisersquo
Reasons for having the vaccine
Ofthe117participantswhoreportedthattheyhadeitheralreadybeenvaccinatedorwereplan-ningtogetvaccinatedlsquokeepingmyfamilyhealthyandwellrsquo(82)andlsquokeepingmyselfhealthyandwellrsquo(81)werethetwomostpopularreasonsforhavingthevaccineThiswasfollowedbylsquoforpublichealthrsquo(70)lsquoitistherightthingtodorsquo(62)andinorderlsquototravelrsquo(61)(SeeFigure9)
I donrsquot want to
die
Irsquom over 65 I have some health issues I think itrsquos
[having the vaccine] very important to
keep safe
I want to see my family I usually go every year but now I havenrsquot seen them
because of COVID-19 Having it will help
I am well but my parents are older It is important to
keep them well
Otherreasonsthatpeoplegaveforgettingvacci-natedincludedtheneedtocontinueworkinginessentiallsquofrontlinersquoemploymentsuchassecuritycleaningandagedcaresettingsOnewomanintheLakembafocusgroupwhohadalreadyhadherfirstdoseoftheAstraZenecavaccinesaidthatlsquothebenefitsoutweightherisksrsquoandasanolderwomanrsquoIdonotwanttodiersquo
All but one of the focus groups were familiar with thedifferentvaccinescurrentlyavailableinAus-traliaAstraZenecaandPfizerMostparticipantswere also aware of blood clots being associated with the Astra Zeneca vaccine One group of newly-arrivedrefugeesinGriffithhadnotheardofeithertheAstraZenecaorPfizervaccinesandhadamorelimitedunderstandingofthevaccinationprogram in general
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1918
Reasons for not having the vaccine
At the moment the situation is under control and donrsquot feel the need Also I have no plans to
travel in the near future so I donrsquot see the need
3514
21622703
3243
1892
811 541
4865
1081
Thevaccine isnot welltested
Thevaccine is
unsafe
Formedicalreasons
I amscared tohave thevaccine
I dont likevaccines
Forreligiousreasons
Forculturalreasons
I want towait and
see
Somethingelse
(pleasetell uswhat)
000
1000
2000
3000
4000
5000
6000
Figure 10 Reasons for not getting vaccinated against COVID-19
Theperceivedlsquolackofadequatetestingrsquoofthevaccineandlsquofearofbeingvaccinatedrsquoalsore-ceivedhighresponseratesselectedby3514and3243ofparticipantsrespectivelyOnly1355 of respondents cited religious or cultural reasonsasbeingbehindtheirvaccinehesitancy
Open-endedresponsestothisquestionincluded
The vaccine is not 100 working It cannot offer
100 protection
Ofthe42participantswhosaidthattheywouldnothaveorwerehesitanttohavethevaccine4865saidthattheypreferredtolsquowaitandseersquobeforegettingvaccinated
Thediscussioninthefocusgroupsaboutpeoplersquoshesitancytobevaccinatedfocusedonanumberofconcernswhichreflected
poorcommunicationfromanumberof trusted sources including GPs and some media sources
conflictinginformationaboutthevaccinefrom healthauthorities
fearsaboutvaccinesafetythataresharedby thegeneralcommunity
misconceptionsabouttheeffectivenessof andhowthevaccineswork
I will not have it because make me sick
Issuesraisedinfocusgroupsascontributingtoincreasedhesitancyincluded
Some GPs being hesitant to recommendvaccination
Theinformationbeingprovidedisconflicting
Theinformationisoverlycomplexandnotcomprehensibleregardlessofwhetherithasbeen translated
The risk of blood clots
Perceptionsthatthevaccinesaregenerallyunsafe
Concernsthatsomepeoplearedyingafterbeing vaccinated
Not being sure about the risks associated withhaving the vaccine and being pregnant orbreastfeeding
Theperceptionthattherehasbeenalackoftestingofthevaccinespriortorollout
AlackofunderstandingofhowvaccinesworkthecompositionofthevaccinesandwhattheywoulddotothebodyincludingmakingchangestoapersonrsquosDNA
Specificcommentsincluded
I have heard that the vaccine changes
your DNA
I am a mother I am not sure it [the vaccine] is safe for
me when I am breastfeeding
If you are young and healthy your body has the energy to fight the virus
You donrsquot need to have the vaccine You should just let
your body fight it itself
They donrsquot tell you what chemicals are in the
vaccine
Tamil Focus Group Feedback Sheet
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2120
Nobody knows what to do My GP doesnrsquot even know what I should do whether
I should have it or not
I am not sure what to do I have spoken to my
GP but they canrsquot tell me whether I should have the vaccine or not while I am
breastfeeding
They say one thing and then they tell you
something elsehellip it [the vaccine rollout] is so
confusing
Confusionaboutwhattodowheretogoandthe health impacts of the vaccine was a common threadintheconversationsaroundvaccinehesi-tancy
Onewomanwhosehusbandworkedforasecurityfirmsaidthatherhusbandhadhadtobevacci-natedinordertokeephisjob
In several focus groups the issue of government control was also raised A number of people re-portedstronglythattheyfearedthatthevaccinewas lsquoa means that the government was using to controlpeoplersquo
He [husband] had to have it He didnrsquot have a choice He was fine [no side effects] but Irsquom not
thinking I will have it I donrsquot need to Irsquom a mum Irsquom busy I have
to look after my children I donrsquot know how I feel about it whether
Irsquom going to have it
Vaccine refusal
Onlyasmallnumberofparticipants(24or13)saidtheywouldnotgetvacci-natedOfthisgroup21werewomenand 2 were men8 Respondents were bornintendifferentcountrieswithadiverse range of language backgrounds
I never get sick It is the same for all my family We have always been strong and healthy so I will be
saying no to the vaccine
Country of Birth Language Background Count Pakistan Urdu 4 China Taiwan Chinese
(MandarinCantonese) 4
Sri Lanka India Tamil 3 Chile Spanish and English 2 Italy Italian 2 Iraq Syria Arabic 2 Iraq Chaldean 1 Iran Farsi 1 Greece Macedonian 1 Poland Polish 1 Pakistan Punjabi 1 Sweden Swedish 1 Vietnam Vietnamese 1
Table 4 Vaccine refusal by country of birth and language background
8 ThisreflectstheoverallsamplebiastowardswomenThemajorityoffocusgroupparticipantswerewomenXwithYparticipantsbeingmen
Reason for not having the vaccine Percent Count The vaccine is not well tested 5455 12 I want to wait and see 5455 12 The vaccine is unsafe 3636 8 For medical reasons 3182 7 I am scared to have the vaccine 3182 7 I dont like vaccines 1364 3 For religious reasons 1364 3 For cultural reasons 909 2 Something else (please tell us what) 909 2
SomeinthiscategorywereadamantthattheywouldnotbehavingthevaccineandhadverystrongviewsonitlsquoForculturalreasonsIwonrsquotbehavingthevaccinersquoWhenwelookatrespons-esmorecloselyhoweveritwouldappearthatmanyareinfactmorelsquohesitantrsquothanfirmvaccinerefusers
One reluctant middle-aged Tamil-speaking wom-ansaidlsquoIftheysaywehavetogetvaccinatedthenIwillrsquoThissentimentwas stronglysup-portedbythe rest of the Tamil-speaking group
Studyparticipantswhosaidtheywouldnothavethe vaccine were also concerned that lsquothe vaccine wasnotwelltestedrsquo
The vaccine has been rushed out It has not been
properly tested
Table 5 Reasons for not having the vaccine
Peopleinthiscategorysaidthattheywouldlsquowaitandseersquowhathappenswiththewiderrolloutbe-foremakingtheirfinaldecisionThissuggeststhataproportionofthelsquonorsquogroupareinfacthesitantrather than outright refusing to have the vaccine
Therewerealsofearsexpressedbyfocusgroupparticipantsaboutthedangersofbeingvacci-natedParticipantsreportedbeingafraidofthehealthrisksespeciallyfrombloodclotsSomepeopledistinguishedclearlybetweenAstraZene-caandPfizerinthisregardHoweverformanythedistinctionbetweenthedifferentvaccineswaslostandtheyspokeofthevaccinesgenerallybeing unsafe and having a range of unwanted side effects
Other factors consideredInadditiontothebroaderquestionsofwhypeo-plewouldorwouldnotchoosetogetvaccinatedthe research team used the focus group discus-sionstoexplorewhetherthefollowingfactorshadanyimpactonapersonrsquoslikelihoodofbeingvaccine pre-disposed or hesitant
Knowing someone who had been vaccinated
Knowing someone who had contracted COVID-19
Knowing where to go to get vaccinated
Thesourcespeopleturntoforinformation about COVID-19 and COVID-19 vaccines
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2322
Knowing someone who has been vaccinatedOfthosewhorespondedtothisquestion125or70knewsomeonewhohadalreadyhadthevaccine
6983
2570
447
Yes No Dont know000
1000
2000
3000
4000
5000
6000
7000
8000
Figure 11 Do you know someone who has been vaccinated
Amongthe125participantswhoknewsomeonewhohadalreadybeenvaccinated100identifiedlsquoimmediatefamilymembersrsquo(parentschildrensiblingsandpartners)Somefocusgrouppartic-ipantsreportedthatalloftheirfamilymembersoverseas had been vaccinated Others reported thattheirrelativeshadbeenvaccinatedasarequirementoftheiremployment
Who Count Percent Other family member 41 313 Sister 24 1832 Community member 23 1756 Brother 18 1374 Father 17 1298 Mother 16 1221 Work colleague 14 1069 Husband or wife 11 84 Son or daughter 10 763 Partner 4 305 Someone else 45 3435 Total respondents 131
Table 6 Who do you know who has been vaccinated
When this issue was teased out further in focus groupdiscussionsarangeofreasonswere revealed including
My husband works in security and he had
to get it
My friend works as a COVID-19 cleaner and they all had to [get
vaccinated]
My family overseas have already been vaccinated
My son needs to travel for work so he is getting it
My brother in the UK is a doctor and he got it and
his wife
Knowing someone who has had COVID-19Almosthalfoftheparticipantsknewsomeonewho had contracted COVID-19 overseas Some reportedthatallthemembersoftheirfamilyormanymembersoftheirextendedfamilyhadcon-tracted COVID-19 In the older Italian group 10 of the15womenknewsomeoneinItalywhohadcontracted COVID-19
4716 4659
625
Yes No Not sure000
1000
2000
3000
4000
5000
Figure 12 Knowing someone who has had COVID-19
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2524
385 385
1538
2692
641 513000
4359
2051
1026385
1410
Mother
Father
BrotherSis
ter
Son or d
augh
ter
Husban
d or wife
Partner
Other family
mem
berFri
end
Community m
ember
Work co
lleag
ue
Someone else
(please
tell u
s who)
000500
100015002000250030003500400045005000
Figure 13 Who do you know who has had COVID-19
Four people in the focus groups knew someone who had died of COVID-19
All my family back home [Pakistan] got it [COVID-19] but
they are all fine now apart from my father He died But he was really sick before he
got it He had lots of underlying conditions Medical conditions so he was really unwell before he got COVID-19 But everyone else
they are fine now They were sick but they got betterhellip
If you are well and healthy you can fight this off
SurprisinglyknowingpeoplewhohadcontractedCOVID-19didnotseemtoinfluencefocusgroupparticipantsrsquopredispositiontowardseitherhavingthevaccineorbeingvaccinehesitantHowevertheolderItalianwomenrsquosgroupspokeabouttheimpactthatCOVID-19hadhadinItalyintheearlystagesofthepandemicandhowthishadaffectedthemdeeply13ofthe15womeninthisgroupwouldhaveorhadalreadyhadthevaccine
Knowing where to get vaccinated115people(81)whorespondedtothisquestion(n=142) knew where to go to get the vaccine 34 people(19)reportedthattheydidnotknowThisincluded15respondentsfromIraq3re-spondentsfromIndia2respondentsfromChina2 respondents from Pakistan and one respondent fromeachofthefollowingcountriesChinaEri-treaItalySriLankaSwedenSyriaandVietnamThese people were also less sure about whether ornottheywouldhavethevaccineItispossiblethat their lack of knowledge about where to go to get vaccinated was related to their general level ofvaccinehesitancy
7958
29582254
282 563
GPDoctor Vaccinecentre
Hospital Work place Somewhereelse (please
tell us where)
000100020003000400050006000700080009000
Figure 14 Where to go to get vaccinated
From the sample (n=199) GPs were the most commonlyidentifiedplacetogotogetvaccinat-edfollowedbythevaccinecentreatHomebushBayandthenhospitalsOtherplacesidentifiedincluded medical centres and pharmacies
Sources of information about COVID-19 and the vaccineThelargestsinglesourceofinformationaboutCOVID-19 and the vaccine was Facebook (417)
2743
3486
13141086
30862686
3429
2229 2286
41713714
2571
1086 971
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)000500
10001500200025003000350040004500
Figure 15 Sources of information about COVID-19 and the COVID-19 vaccine
Facebook I get my information from
Facebook But if I want to check it I watch the news
on 7 [Channel 7]
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2726
Thesecondlargestsourceofinformationforpeople in the sample was lsquoother forms of social mediarsquo(37)followedbySBStelevision(35)myfriends(34)andothertelevision(31)Oth-ersourcesofinformationpeoplereportedthattheyusedweretheNSWHealthwebsitenightlytelevisionnewsincludingChannel7Channel9andChannel10followedbytheABCtheAustral-iangovernmenthealthwebsitetheirGPlocalMedical Centres and the Red Cross
IntheLakembafocusgrouppredominantlymadeupofwomenfromPakistantherewasanani-mated discussion about Facebook which was the majorsourceofinformationalongwithGooglesearchesandcommunityandfriendship-basedWhatsApp groups There was a general consensus from most in the group that these were their pre-ferredormostcommonsourcesofinformationandnewsHoweveriftheywantedtolsquofactcheckrsquowhattheywerehearingtheywouldwatchthenightlynewsonChannel7orChannel9toverifywhattheyperceivedcouldsometimesbeunrelia-ble sources
IntheMtDruittfocusgroupseveralofthewom-enwithwell-developeddigitalliteracyandgener-alliteracyskillsusedhealthandfitnesswebsitesand social media sites as their source of infor-mationaboutlsquoallthingshealthrelatedrsquoincludingCOVID-19ThesewomenalsospokepositivelyabouttheinformationandsupporttheygotfromthestaffatCanterburyCouncilCommunityCentre(4Cs)whotheycouldrelyontofindoutthingsthattheyidentifiedtheyneededtoknowmoreabout
InthesmallerfocusgroupinGriffithwithrecently-arrived refugee women who had low levels of Englishlanguageliteracytherewaslittleknowledgeaboutthevaccinesnoawarenessofthedifferenttypesofvaccinesandlittleknow-ledgeaboutwheretogotogetvaccinatedorfindoutmoreaboutCOVID-19ingeneralThecommunityservicestaffandvolunteerspresentatthegroupwere working hard to assist these women to improve their English language skills and support themwithtranslatedinformation
In the older Italian women focus group in Wollon-gongparticipantsreportedgettingtheirinfor-mationfromslightlydifferentsourcesndashfamilyinAustralia(10women)Channel9(7women)
Italianradio(3women)andABCTV(3women)Onlytwowomenusedtheinternetandnoneofthe women reported using Facebook or social mediaasasourceoftheirinformationSeveralmentionedthattheygottheirinformationfromtheirGPorspecialistdoctorandonepartici-pantsaidrsquoIdonrsquotlistentoanyonersquoIntheSpan-ish-speaking focus group a comment was made thatseemedtoreflectmanyoftheotherfocusgroup discussions
Whenlsquosourcesofinformationrsquoiscorrelatedwiththegroupwhosaidtheywouldhavethevaccine(n=104)thereisashiftfromFacebookbeingthepreferredsourceofinformationtolsquoSBSTVrsquobeingthepreferredsourceThelsquovaccine-predisposedrsquogroupalsohadthelowestrateofrelyingonFace-bookasasourceofinformationaboutCOVID-19thoughitwasstillhighThegraphbelowhigh-lightshowotherlsquopreferredsourcesrsquoplayoutforthoseintendingtohaveorwhohavealreadyhadthe vaccine
ForthoseparticipantswhoindicatedthattheywouldnotorwerenotplanningtohavethevaccinelsquoFacebookrsquolsquomyfriendsrsquoandlsquomyfamilyrsquowerethesourcesofinformationaboutCOVID-19thatwereequallymostfrequentlycitedfollowedcloselybylsquomyfamilyoverseasrsquolsquoSBSradiorsquoandlsquoSBSTVrsquoassourcesofinformationreceivedthelowestmentionsfromthisgroup(SeeFigure16)
The vaccine-hesitant group were the group who identifiedlsquoFacebookrsquoastheirmostfrequentsourceofinformationaboutCOVID-19lsquoFace-bookrsquowasfollowedbylsquoothersocialmediarsquoandlsquomyfriendsrsquoasthenextmostfrequentsources
lsquoThiscommunityserviceproviderrsquo(theinterme-diaryorganisationwherethefocusgroupwasconducted)wasidentifiedby26ofrespondentsasasourceofinformationregardlessoftheirintentiontogetvaccinatedornotThefactthatboththelsquovaccinehesitantrsquoandthosewhoindi-catedtheywouldnrsquotbegettingthevaccinesoughtinformationfromthissourcesuggeststhatrolling
There is so much confusion about it [the vaccine] that I think my GP is the best
place to go
9 This group of the research sample included a small number ofpeoplewhohadalreadybeenvaccinated
2626
4141
14141111
323228282828
2424
1818
37373737
2828
10101212
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)00050010001500200025003000350040004500
2857
2381
952 952
2857
3333
42864286
3810
4286
23812381
1429
952
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another co
mmunity se
rvice
Somewhere
else (p
lease te
ll us w
here)000
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Figure 16 Sources of information for respondents who were planning to have the vaccine9
Figure 17 Sources of information for respondents who were not planning to have the vaccine
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2928
outpositivemessagingthroughtrusted communityserviceorganisationscouldbeaneffectivewayofshiftingpeoplefromvaccine hesitancytodecidingtohavethevaccine
31372549
980 980
25492157
4314
1176
2353
4902
4118
2157
980392
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)000
1000
2000
3000
4000
5000
6000
Figure 18 Sources of information for respondents who lsquodonrsquot knowrsquo if they will have the vaccine
DISCUSSION
wardstheCOVID-19vaccineareasvariedastheyarewithinthebroadercommunityTherearearangeofinfluencingfactorsincludingagehealthstatushowlongtheyhavebeeninAustraliahowmuchnewstheyreceivefromoverseasandhowbadlyimpactedbythepandemictheirhomecountries have been
The research also highlights that people from culturallyandlinguisticallydiversebackgroundsgettheirinformationaboutCOVID-19andtheCOVID-19vaccinefromawidevarietyofsourcesbothformalandinformalandthatforparticulargroupsinthisstudythereisahighrelianceonFacebookovermoreofficialsourcesofinforma-tion
VulnerabilityTheneedsofhighly-vulnerablegroupswithintheCALDcommunityhavetobetakenintoconsider-ationThisincludesolderpeoplewhohavelivedinAustraliaformanyyearsbuthavelowlevelsofEnglishliteracyndashespeciallywritingandreadingEnglishandsometimesspokenEnglishndashandwhoaremoresusceptibletoseriousillnessandhigherratesofhospitalisationanddeathfromCOVID-19Italsoincludesnewly-arrivedrefugeeswhohavinglowornoEnglishlanguageliteracylacktheconnectionstoandnetworksintothewidercommunityandcommunitysupportsItisalsothecase that some people in these groups are not health literate at all and cannot read and write in their own language
Akeytakeoutfromthehealthandcommunityserviceorganisationsurveyresponsesandinter-viewsundertakenwithmulticulturalhealthandcommunicationexpertsfortheprojectisthatlit-eracylevelsreallydomatterLowlevelsofhealthliteracylowlevelsofEnglishlanguageliteracyandpossiblylowlevelsofliteracyintheirownlan-guage-especiallyforsomenewly-arrivedrefu-gees and those who are part of the humanitarian program such as Dari language speakers from AfghanistanTigrinyalanguagespeakersfromEr-itrea and northern Ethiopia and Oromo language speakers from Ethiopia - need to be factored into anyplanstofurtherpromotethevaccinerolloutanduptaketoculturallyandlinguisticallydiversepeopleinthecommunityThereisaneedfor
The contextThisresearchisimportantgivenhowhighlyculturallydiverseNSWisandtheimpactthiscanhave on the success of public health messaging topeoplewhosefirstlanguageisnotEnglishPeople who were born overseas form almost one-thirdofthe7480228population(276)ofNSWandNSWishometo336ofAustraliarsquosoverseas-bornpopulationPeoplefromaround225 birthplaces have made NSW their home and 21oftheNSWpopulationisfromanon-EnglishspeakingbackgroundMorethan24000humani-tarianentrantshavesettledinNSWoverthepastfiveyearscomprisingalmostathird(32)ofthenationaltotalThe24000humanitarianentrantswhohavesettledinNSWoverthepastfiveyearscame from over 100 countries of origin10Sydneyhasthelargestoverseas-bornpopulationofallthecapitalcities11
Hearingdirectlyfrompeoplefromculturally-diverse backgrounds is important to ensure that policymakersandpublichealthadvocatescandesign responses that are both accessible and un-derstandabletopeopleforwhomEnglishmaybetheirsecondthirdorfourthlanguageApropor-tionofpeopleinthesecommunitieshavelowerlevelsofEnglishlanguageliteracyandinsomecaseslowlevelsofliteracyintheirlanguageoforiginsowillbehardertoreachviatraditionalormainstream methods
Itisalsocriticallyimportantthatduringatimewherethereissomuchlsquonoisersquoacrossmediachannelsrelatingtothevaccinethevaccineroll-outvaccineefficacyandvaccinesafetythatwetakesometimetolistentoandunderstandhowthislsquonoisersquoisbeingheardandmadesenseofbypeoplefromculturally-diversebackgrounds
ThatsaiditisimportanttoreconfirmthattheCALDcommunityisnotahomogenousgroupOurresearchhasfoundthattheviewsandattitudesofparticipantsfromdiverseculturalbackgroundsto-
10RefugeeCouncilofAustraliaHumanitarianEntrantsin New South Wales A resource for New South Wales governmentagencies6-711MulticulturalNSWCommunityRelationsReport2018-20199
29
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3130
groupsFortheparticipantsintheresearchtheirattitudetothevaccineappearedtobeinflu-encedbyanumberoffactorstheirownlevelsofhealthandpre-existinghealthconditionsandthoseoftheirfamilymembersandtheimpactofreceiving COVID-19-related news from overseas particularlyfrompeoplersquoscountryoforiginAnexampleofthiscanbeseenintheItaliangroupin Wollongong where people had received news fromoverseasearlyinthepandemicwhichscaredthemThisexperiencelsquofromhomersquohadinflu-enced most of the women in the Wollongong focus group (n=15) to choose to get vaccinated The interviewee from the Illawarra Shoalhaven Local Health District also spoke about the heightenedconcernthattheywitnessedinthelocalItaliancommunityintheearlystagesofthepandemicOtherpeoplewantedtolsquostayhealthyrsquoandtolsquoprotectthehealthofothersrsquoandformanytherewasasensethattheywantedtolsquogetbacktosomedegreeofnormalcyrsquoandtobeabletolsquotraveloverseastovisitrelativesrsquo
Vaccine hesitancyOfthe42inthisstudywhoappearedundecidedornotplanningtohavethevaccinemanywereinfactadoptingalsquowaitandseersquoapproachbeforemakingtheirfinaldecisionMostparticipantswereinterestedtohearmoreinformationaboutthevaccinesandwereopenedtogettingthevaccinebutdidhaveconcernsaboutthesafetyofthevaccinesespeciallyinregardtoAstraZeneca
The issue of blood clots has led to considerable fearandhesitancyinthecommunityandthisfearandhesitancywasreflectedinourstudyEssentialResearchrsquossurvey(April2021)reportedoneinsixpeople(16)indicatedtheywillnevergetvaccinatedagainstCOVID-19upfrom12thepreviousmonthwhile42saidtheywillgetvaccinatedbutnotrightawayTheproportionofpeople who would be willing to get vaccinated as soonaspossibleorarealreadyvaccinatedalsodeclineddownfrom47to4213Thissurveywas conducted prior to the most recent outbreak inNSWinvolvingthehighlyinfectiousDeltastrain
Therisk-benefitofhavingthevaccineneedstobecarefullyweighedbyeachindividualideallyinconsultationwiththeirdoctoranddependingon
The Hub has lsquobeen working in partnership with keystakeholdergroupstoguidecommunicationstomeetthehealthliteracyandculturallyandlinguisticallydiverse(CALD)needsofitspop-ulationStructuredworkinggroupshavebeencreatedtoprioritisecommunicationstovulner-ableyouthCALDgroupstheelderlyitinerateworkersasylumseekersandrefugeesTheaimsaretotestmessagingandbuildtrustwithprioritypopulationstoensureeffectivecommunicationoftheneedtosustainphysicaldistancingmeas-uresintheabsenceofavaccineSimilareffortsarenowneedednationallyandshouldstartatthetimeofdiseaseoutbreaksinthefuturealongsideplannedmassmediaandhealthcommunicationcampaignsrsquo
InthearticlebyDoddetaltheyreinforcetheimportanceofusingcommunicationformatswhich are lsquosuitable for people with low health literacyandeducationandwhichareappropriateforculturallyandlinguisticallydiversegroupsandIndigenouspopulationsrsquoThearticlearguesthatitisimportanttolookatmotivationsandconcernsabout vaccines when shaping messaging It also pointsoutthatprimarycaredoctorsareatrust-ed source and as such should be supported in deliveringinformationaboutthevaccinesandad-dressingcommunityconcernsThearticlestateslsquoWeneedtounderstandandaddresscitizenrsquosconcernsthatcanpreventoptimaluptakebuildmotivationsintomessagingandprioritisepublictrustbyinformingandinvolvingthecommunityintheprocessSupportinghealth-careprofession-als in their role as educators will ensure people haveadequateandaccessibleinformationfromatrustedsourcetooptimisevaccineuptakeandultimatelyreducecommunitytransmissionofCOVID-19rsquo15
RecentresearchbyAssociateProfessorHollySeale16withUNSWMedicinersquosSchoolofPublicHealthandDeputyChairfortheCollaborationonSocialScienceandImmunisationfoundthereisaneedtolsquodecentralisersquocommunicationsbytapping
translatedmaterialsandinformationaboutthevaccines to be tailored to the needs of people in these newly-emergingcommunitygroups
It was reported that in Wollongong there can sometimesbefourgenerationsoffamilymem-bersfromnewly-arrivedrefugeegroupslivingintheonehouseMostofthesefamilymembersgenerallyhavelimitedEnglishlanguageliteracywhichincreasestheirriskofnotreceivingkeyhealthmessagesandthereforeincreasingthepotentialimpactofCOVID-19-inparticulartheDeltastrainwhichhasprovenhighlyinfectiousamongst household members
Vaccine uptakeNotdissimilartothewidercommunitymorepeopleinourstudywereplanningtohavethevaccinethannotandanumberhadalreadybeenvaccinatedInarecentLancetarticle(February2021)ConcernsandmotivationsaboutCOVID-19vaccinationfindingsfromtwosurveysfromanAustralianlongitudinalstudyconductedinJuneandJuly2020includedthatlsquothetopthreerea-sons for agreeing to vaccinate were lsquoto protect themselvesandothersrsquohelliplsquobeliefinvaccinationandsciencersquohellipandlsquotohelpstopthevirusspreadrsquoEven among those willing to vaccinate there was somehesitancyaboutthesafetyofthevaccineTheLancetarticlenotedthatlsquowillingnesstovaccinatedifferedbybothageandeducationrsquoForthosewhowereindifferentorsaidtheywouldnot get the vaccine the top reasons across the twosurveyswerelsquoconcernaboutthesafetyofthevaccineinitsdevelopmentrsquoandlsquopotentialsideeffectsrsquo12
Olderpeopleinourstudywhocomprised23of the total sample (n=199) were the group most likelytosaythattheywantedtogetthevaccine85ofthoseover65saidtheywouldhaveorhadalreadyhadthevaccineVaccinepredispo-sitionwashoweveralsostrongacrossotherage
12RHDoddKPicklesBNickelECvejicJAyreCBatcupCBonnerTCoppSCornellTDakinJIsautierKJMcCafferyConcerns and motivations about COVID-19 vaccination SydneyHealthLiteracyLabSydneySchoolofPublicHealthFacultyofMedicineandHealthUniversityofSydneypublishedintheLancetFebruary2021p162wwwthelancet cominfectionVol21February2021
theircircumstancesHoweverthesourcesofin-formationthatpeoplemostrelyuponortrustarecriticaltothedisseminationofaccurateandclearmessaging to dispel the fear surrounding events suchasbloodclottingandthemisconceptionsraisedinthefocusgroupsWithsomanypartici-pantsinthisstudygettingtheirinformationfromFacebookandothersocialmediasitesitisvitalthat these channels are used to promote simple positivemessagesandforanyfuturecommunityawareness campaigns
Effective communicationConfusionandmisconceptionsaboutthevac-cinersquosefficacyavailabilityandsafetywereallis-sues that were raised in the focus groups Finding waystoeffectivelycommunicatewithpeoplewithlowerEnglishlanguageliteracyandhealthliteracyisanimportantwaytoaddresstheconfusionandmisconceptionsaboutthevaccineashasbeen discussed in a number of recent Australian studies
Astudy14byMcCafferyetal(2020)concludedthattherearelsquoimportantdisparitiesinCOVID-19-relatedknowledgeattitudesandbehavioursaccordingtopeoplersquoshealthliteracyandlanguagersquoOneofthefindingswasthatlsquopeoplewithlowerhealthliteracywerealsomorelikelyto endorse misinformed beliefs about COVID-19 andvaccinations(ingeneral)thanthosewithadequatehealthliteracyThesamepatternofresults was observed among people who primar-ilyspeakalanguageotherthanEnglishathomersquoTheMcCafferystudyhighlightstheimportanceof tailoring health messages to those with lower healthliteracyandculturallyandlinguisticallydiversecommunitiesItpointsoutthatthereareexamplesofeffectivemanagementofdiversecommunityneedsthatusetailoredhealthmes-sagesandcitestheWesternSydneyLocalHealthDistrictHealthLiteracyHub
13TheEssentialReport-anonlinesurveyconductedbyEssentialResearchcompletedby1090people between 21ndash26 April14McCafferyKJDoddRHCvejicEAyreJBatcupCIsautierJMJCoppTBonnerCPicklesKNickelBDakinTCornellSWolf MS Health literacy and disparities in COVID-19ndashrelated knowledge attitudes beliefs and behaviours in Australia PublicHealthResPract202030(4)e30342012December2020
15 Op cit16 httpssphmedunsweduausitesdefaultfilessphcmNewsEnhancing-supporting-COVID-19-vaccination-programpdf
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
30 31
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3332
intodifferentnetworkingspacessuchaswork-placeslocalgymsmothersrsquogroupsandseniorsrsquoclubswithafocusonallagegroupsregardlessofcurrenteligibilityAccordingtoSealethechal-lengeislsquoensuringemerginginformationisadapt-edfortheintendedaudiencersquoShehasalsosaidlsquoThatrsquoswhatIrsquomalittlebitconcernedaboutatthemomenttherersquosalotofresourcesongov-ernmentwebsitesbutthesetermsaroundbloodclottingareverytechnicalWeactuallyneedtomake sure that we are breaking them down in a waythatwillmakeitmeaningfultopeopleThatrsquosnotjustabouttranslatingitrsquosaboutbeingcon-sciousofpeoplersquoshealthliteracyneedstooSomaybegettingsomemorevisualsintomaterialstotryandsupportthatrsquo17
Thereareanumberofmulticulturalhealthresourcesthatusecommunitylanguagetransla-tionsplainEnglishandvideosfromCALDcommu-nityleaderswhichcanbedownloadedandusedbyservicesandindividualsHowevermanyofthewrittenresourcesstillrelyontechnicalandscien-tifictermsthatrequireareasonablyhighlevelofEnglishlanguageliteracyorhighlevelsofliteracyin the translated language to comprehend Host websites can also be hard to navigate making itdifficulttolocateresourcesfromsimplewebsearchesAsummaryofsomeoftheavailableresourcescanbefoundatAttachment2
MulticulturalHealthUnitsinLocalHealthDis-trictshavestaffwhocanworkwithpeoplefromculturallyandlinguisticallydiversecommunitiesatthelocallevelandtranslateandcontextualisethese materials to the needs of the end user These teams respond to local needs and popu-lationdemographicsandareexpertsineffectivehealthliteracyandhealthcommunicationwiththeirlocalcommunitiesTheyworkcloselywithcommunityandvulnerablegroupstobuildhealthliteracyandimprovedhealthoutcomesintheircommunities
Case Study ndash Be a COVID Warrior ndash Responding to COVID-19 in Multicultural Communities InWollongongtheIllawarraShoalhavenLocalHealthDistrict(ISLHD)MulticulturalHealthSer-viceco-designedacommunityengagementandeducationprogramcalledlsquoBeaCOVIDWarriorrsquowhich commenced in 2020 in response to the pandemic This program was designed to respond tothelowlevelsofhealthliteracyaroundCOVID-19potentialexposuretothevirusandaddressfearandstigmainthelocalCALDcommunitiesThelsquoCOVIDWarriorrsquoprogramreachedaround880peopleranginginagefrom14to85years65ofCOVIDWarriorparticipantswerefemaleand35weremaleCOVIDWarriorparticipantsrepresented 21 language groups The outcomes of the program included increased levels of confidenceinapplyinginfectioncontrolmeasuresincreasedliteracyandhealthliteracyandawarenessofhowCOVID-19istransmittedUltimatelyanimprovedawarenessinapplyingCOVIDsafemeasures was also reported
InApril2020theservicecommencedwelfarechecksviaphoneonafortnightlybasistosup-portsocially-isolatedmulticulturalseniorswhoboretheemotionalstressofsocialisolationFrom these calls the ISLHD heard the needs and concernsofseniorsinthecommunityInadditionourexperiencewithCALDcommunitieshighlightedtheimportanceofyoungpeopleasconduitsofessentialinformationtoadultsincommunityandfamilygroupsduetoEnglishlanguageaccessandeducation
InresponsetheISLHDinitiatedthelsquoCOVIDWarri-orrsquoprogramusingbi-culturalhighschoolstudentsthroughthelocalhighschoolsByincreasingthehealthliteracyofstudentsatschooltheselsquocham-pionsrsquocouldtalktotheirfamiliesincludingolderfamilymembersininformalsettingsandthroughsocialmediawiththeirpeersasastrategytoraisethe level of knowledge of COVID-19 trans-mission preventionandtestingTheprogrambecamesopopularthatitwasextendedintomorelocalhighschools and adults accessing the Adult Migrant EnglishProgramTheprogramwassupportedbylocalsettlementservicesprovidedbybothMaxSolutionsandtheRedCrossItwas
17 httpstheconversationcomhow-can-governments-communicate-with-multicultural-australians-about-COVID-19-vaccines-its-not-as-simple-as-having-a-poster-in-their-language-156097
later extendedtoCALDSeniorsthroughtheMulticulturalCommunitiesCouncilIllawarra(MCCI)supportprograms
AkeycomponentoftheprogramwastoprovideparticipantswithlsquoCOVIDWarriorrsquoKitswhichincludedtworeusablemaskshandsanitiserinfographicsaboutCOVID-19symptomsandinfor-mationaboutwheretestingclinicswereavailablelocallyMCCIandRuralAustraliaforRefugeesdonatedreusablemasksforeveryparticipant
AsthelsquoCOVIDWarriorrsquoprogramwasevolvingsowasthenationalvaccinerolloutplanInforma-tionwasthereforeadaptedtomeetthisinfor-mationgapForexampleadultparticipantsandseniors were supported to understand how to accesstheCOVIDvaccinelsquoeligibilitycheckersrsquoandCALD people were shown how to use the NSW HealthwebsiteCOVID-19informationpages18
Decision makingHowpeoplearecurrentlyconsideringtheriskofCOVID-19isinfluencedbyarangeoffactorsincludingratesoftransmissioninthecommunitynumbersofnewcasesreportsinthemediaofrisksandsideeffectsPeopletendtobasetheirassessmentonwhattheyarecurrentlyexperi-encingandthencheckthisagainstwhattheyarehearinginthemediaincludingandespeciallyonsocialmediaandfromfamilyandfriendsMostoftheparticipantsinourstudyspokeclearlyandarticulatelyabouthowtheyweigheduptherisk-benefitofhavingtheCOVID-19vaccineintheir decision making Low case numbers ndash at the timeofconductingtheresearchndashandasensethat Australia was lsquodoing well in safeguarding the communityagainstCOVID-19rsquoweresignificantfactorsinpeoplersquosdecisionnottobevaccinatedortoadoptalsquowaitandseersquoapproachFamilyfriends and social media were reported as having aconsiderableinfluenceondecisionmakingaswerereportsinthemediaofthebloodclottingsideeffectsofAstraZeneca
ThefactthatFacebookwasreportedlythemostpopularsourceofinformationaboutCOVID-19
18httpswwwhealthnswgovauInfectiouscovid-19Pagesdefaultaspx
andtheCOVID-19vaccineforpeopleinthestudyraisesconcernsaboutthepossibledisseminationofmisconceptionsandlsquofakenewsrsquothatmaybespread or compounded via social media Closed social media groups such as WhatsApp and WeChatwithfamilyandfriendsmayalsoleadtopeoplereinforcingtheirpre-existingbiasesThesefactorscoupledwithasensethatAustraliaisfaringwellcomparedtomanycountriesoverseasappear to have resulted in increased vaccine hesi-tancyamongparticipantsofthestudy
Factorsthatwereidentifiedaschangingvaccine-hesitantparticipantsrsquoperceptionswereanincreased risk from COVID-19 and a correspond-ingincreaseinthenumberofinfectionsandonthebenefitsidetheabilitytotraveloverseastovisitfamilyIntherecentresearchfromtheUniversityofNSWcitedaboveSearlearguesthatlsquotheremaybeotherthingsthatweneedtonowstartfocusingonhellipthatwillstarttopromoteandmotivatepeoplesuchasthechancetotravelmorefreelyforexamplersquoThisappearstobeborneoutbyourfocusgroupfindings19
Untilrecentlytherehavebeenverylowcasenumbers and few lockdowns across most of Aus-tralia and NSW The recent outbreak from mid-JuneinGreaterSydneyandintroductionofthehighlyinfectiousDeltavariantinNSWislikelytoimpactonpeoplersquosassessmentsoftherisk-benefitofhavingthevaccineandonewouldassumereducehesitancyrates
GiventheheightenedcommunityanxietycausedbythisrecentCOVID-19outbreaktheproductionofshortsharpandtargetedmessagingtoCALDgroupsincommunitylanguagesthatisaccessibleandmotivationalfeaturescommunityleadershigh-profilecelebritiesandsportsstarsfromCALDbackgroundsandisdirectedatastate-wideandlocal level would appear to be more urgent than everItisclearthatformessagingtobeeffectiveandreachitsintendedaudiencedistributionchannelsshouldincludeFacebookWhatsAppandothersocialmediaplatformsaswellastrustedsourcessuchasmulticulturalhealthworkersmulticulturalservicesandthroughGPsandMedical Centres If mainstream COVID-19 vaccine
19 Op cit
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
32 33
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3534
awareness campaigns are produced in Australia suchashavebeenproducedinNewZealandtheUnitedKingdomandNorthAmericatheyshouldincludehighprofilewell-knowncommunityfig-uresandsportingstarsfromCALDbackgroundsandincludestrategiesspecificallytargetingCALDcommunitiesincludinggroupsidentifiedaspar-ticularlyhigh-risk
It is also important that informationonvaccinesistranslatedintolanguagesfromnewerandemergingcommunitiesOthersuggestionsaroundreachingthesecommunitiesincludeface-to-facemeetingsorganisedbycrossagencypartnershipsandpeer-ledstrategiessuchas mobilising community champions and influenc-ers Messaging needs to be inclusive and framed around the collective values held by commu-n5
It is clear that reinforcing the benefits of being vaccinated at this time rather than dwelling on the risks is more likely to generate behavioural
changeandapositivevaccineresponsefrombothCALDcommunitiesandthegeneralpopulationAppropriately-designedandtargetedCOVID-19vaccinehealthinformationthatiseasytoreadinanylanguagecanbeconveyedbycommunityleadersandcommunitynetworksandpromotesthepositivebenefitsofgettingvaccinatedwouldbevaluableatthistimeBuildingontheworkofpeerchampionssuchastheCOVIDWarriorprogramisalsoasuccessfulmodeltoincreasingCOVID-19vaccinehealthliteracyandinformed decision making
Mostimportantlypositivelymotivatingculturallyandlinguisticallydiversecommunitymemberstolsquogetthejabrsquoespeciallythosewhoareadoptingalsquowaitandseersquoapproachorarevaccinehesitantwould lead to greater vaccine uptake among culturallyandlinguisticallydiversecommunitiesandthereforethecommunityasawhole
Inner West Multicultural Network Addison Road Community Centre DateWednesday12May
A focus group session of members of the Inner WestMulticulturalNetworkpluscustomersoftheFoodPantryatAddisonRoadwasheldattheAddisonRoadCommunityCentreinMarrickvilleon12Mayat200pmThesessionwaspartoftheregularmeetingoftheInnerWestMulticul-turalNetworkTheconsultationinvolvedabout26peopleandwasconductedbyRosannaBarbero
Thegroupbrainstormedresponsestoquestionsaroundvaccinehesitancyinmulticulturalcom-munitiesandmoreeffectivemessagingTheseresponseshavebeenincorporatedinthefindingsof the report
Griffith Women on Fire Focus Group Griffith Community Centre DateFriday14May
This small focus group of women was held at GriffithCommunityCentreonMay14at11amMargCouchSeniorProjectOfficerRegionalDevelopmentAustralia(RDA)-RiverinaandJoanneFitzpatrickSettlementEngagementandTransitionSupport Worker from Centacare Southwest NSW werethekeylinksandnetworkcontactsfortheGriffithcommunityTheWomenonFire(WOF)group was established as part of the Red Cross RuralFireServiceprogramlsquoManyCulturesOneCommunityrsquoInitiallyitwasestablishedtoeducatewomenonemergencypreparednessandtoen-courage NSW Rural Fire Service (RFS) volunteering andnowhastransformedintoacommunityac-tionsupportgroupTheGriffithSoroptimistInter-nationalnowauspicetheirfinancesandsupporttheWOFgroupactivitiesThefocusgroupwasfacilitatedbyCamillaCouchandlocalcommunityvolunteersledbytheGriffithSoroptimistClub
The women in the group were from Pakistan and IndonesiaThegroupweremainlyyoungmotherswithyoungchildrenandtheprogramhadchild-minding arrangements The language level of the womenwaslowandmostwerestudyingESOLat
ATTACHMENTS
ATTACHMENT 1 A Description of the Focus Groups
TAFEThedeliveryoftheinformationwaslimiteddue to language levels and the lack of bilingual interpretersEachparticipantworkedoneononewithavolunteertoslowlyfillinthesurveyandonewomantookthesurveyhometodiscusswithherhusbandThisgroupexperiencehighlightedthe lack of bilingual workers and services in some rural areas
Arabic speaking group Syd West Multicultural Services Mount Druitt Community worker Zaid Naoum Generalist Caseworker SydWest Multicultural Services DateMonday24May
ThefocusgroupfromSydWestMulticulturalSer-viceswasconductedonMonday24May2021atSydWestMulticulturalServicesMountDruittat300pmItwasfacilitatedbyPatriciaMcCormickandsupportedbyZaidNaoumGeneralistCase-workerSydWestMulticulturalServices
Therewere10womenandmenfromSyriainthegroupThegroupweremostlymaturetoolderparticipantsMostparticipantsrequiredassistancewithEnglishandthecaseworkerZaidNaoumhadtranslatedthesurveyintoArabicpriorto the focus group Zaid also translated during the focus group
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Canterbury City Community Centre (4Cs) group The Cottage Lakemba DateTuesday25May
ThefocusgroupfromCanterburyCityCommunityCentre(4Cs)wasconductedonTuesday25MayattheCottageat28CroydonStreetLakembaat10amItwasfacilitatedbyRobinMilesandsup-portedbyRomanaWaseemCommunityWorkerfrom 4Cs
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
34
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3736
The group was comprised of 14 women from PakistanIndiaandSriLankaThewomenrangedinagefrom23to65MostwerefluentEnglishspeakershoweveronewomanrequiredtransla-tionintoUrdufromoneoftheotherwomeninthegrouptoanswerthequestionsdirectly
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
NSW Chaldean League group Community worker Randa Goriya DateTuesday25May
ThefocusgroupfromNSWChaldeanLeagueMountDruittwasconductedonTuesday25May2021 at 1000am at the NSW Chaldean League premisesItwasfacilitatedbyPatriciaMcCormickandsupportedbyRandaGoriyaacommunityworker for the NSW Chaldean League in Mount DruittRandatranslatedtheintroductionandpromptsforthediscussionandhelpedthepartic-ipantstocompletethesurveyMostofthegrouprequiredhelptodothesurvey
ThegroupoftwelveparticipantswereallChaldeanandwerematuretoolderinageTheywereamixed-gendergroup
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Arabic speaking group Red Cross premises Wollongong DateTuesday25May
ThefocusgrouptookplaceonTuesday25Mayat 3pm at the Red Cross premises at Wollongong Therewere22womenandmenparticipatinginthegroupThefocusgroupwasfacilitatedbyCamilla Couch with support from Khalid Zainu-labdeenBilingualSupportWorkerHumanitarianSettlementProgram(ACTampNSW)
There were diverse ages in the group ranging fromyoungpeopletoolderagedMostofthegroupwereyoungerrecently-arrivedrefugeesfrom diverse backgrounds There was also a small-eroldercohortofparticipantswithhigherliteracylevelsandstrongercommunityengagementwith the local services in the area Camilla Couch facilitated the focus group which was conducted inArabicandEnglishwiththeArabictranslationprovidedbyKhalidZainulabdeen
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Work Opportunities for Women group Mt Druitt TAFE DateWednesday26May
TheWorkOpportunitiesforWomen(WOW)focusgroupwasheldonWednesdayMay261100ndash 100pmatMtDruittTAFEItwasfacilitatedbyCamilla Couch and built on the knowledge gainedintheprevioussessiononcriticalandanalyticalthinkingTheWOWgroupisaTAFECertificatelevel course
There were 14 women from diverse cultural backgroundsinthegroupThegroupweremainlyMuslimwomenwithschoolagechildrenandsome were mature aged Due to the learning fo-custhegroupwasfacilitatedasaclasswithguid-eddiscussionontheissuesandcarefulanalysisofthequestionsNotranslationwasneededduetotheeducationalcontextThestudentswereadeptatusingITandcompletedallthesurveysonline
STARTTS Tamil group Toongabbie Community Centre Community worker Sivaharani (Harani) Mayuran DateThursday27May
Thefocusgroupconsistedof18femalepartic-ipantswhowereyoungertomatureagedThefocus group was held at 1000am at Toongabbie CommunityCentreinTargoRdToongabbie
ThefocusgroupwasfacilitatedbyPatriciaMc-CormickandsupportedbyacommunityworkerSivaharani(Harani)MayuranfromtheSTARTTSTamil Group
ThegrouphadmixedlevelsofspokenandwrittenEnglishTheintroductionanddiscussionpromptsweretranslatedbythecommunityworkerSivaha-rani(Harani)Mayuranandsheandthemorepro-ficientstudentssupportedthosewithlowliteracytoanswerthesurveyquestions
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Spanish Speakers Seniors group SydWest Multicultural Services Blacktown DateTuesday1June
TheFocusGrouptookplaceonTuesday1Juneat1100amattheBlacktownShowgroundsandconsistedof16participants(15womenandoneman)AllparticipantswerebornincountriesinSouthAmericaTheirEnglish-fluencylevelsvariedand one of the members of the group translated thesurveyquestionsanddiscussionintoSpanish
ThegrouphadbeenmeetingforseveralyearsThegroupwasfacilitatedbyLindyCassidyandwassupportedbySreeVithyaHarilingamDayRespiteampSocialSupportTeamLeaderatSydWestMulticulturalServicesBlacktownThegroupwerematureagedtoolderparticipants
Thegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyform There was a more focused discussion on somekeyquestionsaftersurveycompletionThetranslatorassistedconsiderablyinthisprocess
Italian Speakers group Warrawong Community Centre DateMonday7June
The focus group of Italian speakers was held on Monday7Juneat1015amattheWarrawongCommunityCentreItwasfacilitatedbyCamillaCouchandsupportedbyJohnPaulTroianiand
SofiaLemafromIllawarraShoalhavenLHDMulti-cultural Health
There were 15 women in the group The group weremostlymaturetoolderparticipantsandwasconductedinItalianandEnglishwithtranslationprovidedbyJohnPaulThisgroupmeetsregularlyandissupportedbyanumberofservicesintheareaespeciallymulticulturalhealth
The group had a general facilitated discussion aboutthequestionsinthesurveyDuetolittleornoliteracytheindividualsurveyresponseswerethencollectedintooneresponseThesesurveyresponses have been included in the general surveyresponses
Mothers Group SydWest Multicultural Services Blacktown DateThursday10June
ThefocusgrouptookplaceonThursday10Juneat1030amandconsistedof14youngwomen13 of whom had a CALD background The focus groupweremainlymothersfromasupportgroupatSydWestMulticulturalServicesinBlacktown
EightofthewomenwereborninIndiatwofromPakistantwofromSriLankaonefromHausaGhana and one was born in Australia (the Austral-ianbornyoungwomanwasasocialworkstudenthelpingwiththegroup)LindyCassidyfacilitatedthe group with support from Wilma Garguath a projectofficerfromSydWestMulticultural Services
The group varied in age One was between 18-24 yearsoldSevenwereagedbetween25-34yearsSixwereagedbetween35=44yearsGiventheirage and circumstances most of the group did not consider themselves eligible at this stage for vac-cinationThiswasanimportantdifferencefromotherfocusgroupsinthattheemphasiswasmoreonwhattheywoulddooncetheybecameeligible
Participantsdidnotrequireassistancewithspo-kenEnglishThegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyformTherewasamorefocuseddiscussiononsomekeyquestions
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3938
ATTACHMENT 2 COVID-19 Vaccine Information in multiple languagesThefollowingsitesappsprovidetranslatedinformationaboutCOVID-19vaccines
Type of information KeyinformationongettingvaccinatedinNew South Wales and on the vaccines available The websiteusesanautomaticservicetotranslate thecontentintodifferentlanguages
Source of information NSW Government website
Link httpswwwnswgovauCOVID-19health-and-wellbeingCOVID-19-vaccina-tion-nswgetting-vaccinated
Type of information COVID-19ResourcessectionontheServiceNSWapp The app has a link to NSW Government websiteinformationonldquoGettingaCOVID-19vaccinationrdquo(seeabove)ItalsoincludesalinktoCOVID-19vaccinationresourcesinotherlan-guages available from the Department of Health
Source of information Service NSW NSW Government
Link Service NSW App
Type of information ArangeoftranslatedresourcesonCOVID-19bytitleincludingafactsheetonCOVID-19VaccineAstraZeneca(ChAdOx1-S)
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCOV-ID-19Pagestranslatedresources-by-titleaspx
Type of information ADigitalCOVID-19resourcelibrarywithtranslated materials
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiouscov-id-19Pagesdigital-resourcesaspx
Type of information AMultilingualCommunityToolkitontheCOVID-19vaccinationprogramtoassist communityworkersprovideseasytoreadresourcesvideosandlinkstokeyservicesandresources
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCovid-19DocumentsNSW-COVID-19-vaccina-tion-program-presentation-20210527pdf
Type of information TheNSWMulticulturalHealthCommunicationServiceoffershealthresourcesandinformationin a wide range of languages It has translated resources on COVID-19 and links to translated resourcesonCOVID-19vaccination
Source of information MulticulturalHealthCommunicationServiceisa New South Wales-wide health service hosted bySouth-easternSydneyLocalHealthDistrict(SESLHD)
Link httpswwwmhcshealthnswgovau
Type of information COVID-19vaccineinformationaddressingkeyquestionsaboutCOVID-19vaccinationandincludesvideosposterstilesfactsheetsandaudio material Translated into 63 languages
Source of information Department of Health Australian Government website
Link httpswwwhealthgovauinitiatives-and-pro-gramsCOVID-19-vaccinesCOVID-19-vaccine-in-formation-in-your-language
Type of information ThisinformationaddressessomecommonmisinformationaboutCOVID-19Translatedintomultiplelanguages
Source of information DepartmentofHomeAffairs Australian Government website
Link httpscovid19inlanguagehomeaffairsgovaumisinformation-and-truths-about-coronavirus
Type of information Australianandinternationalnewsand informationaboutCOVID-19andCOVID-19 vaccinesisavailableontheSBSCoronavirusPortal in more than 60 languages
Source of information SBSwebsite
Link httpswwwsbscomaulanguagecoronavirus
Type of information InformationprovidedaboutCOVID-19vaccinerolloutandsafetyinlanguagesotherthan English
Source of information Department of Health and Human Services Victorian Government
Link httpswwwcoronavirusvicgovautranslat-ed-information-about-COVID-19-vaccines
Type of information HealthTranslationsprovidestranslatedmateri-alsonhealthandwellbeingInformationaboutCOVID-19isregularlyupdatedincludessomeinformationonvaccinationandisavailableinover60communitylanguages
Source of information Victoriangovernmentinitiative
Link httpswwwhealthtranslationsvicgovaubhcv2bhchtnsfPresentEnglishResource-AllOpenampx=amps=Coronavirus
Type of information A one-stop shop for translated materials in multiplelanguagesonCOVID-19
Source of information Ethnolink Language Services
Link httpswwwethnolinkcomauCOVID-19-coro-navirus-translated-resources
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
40
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
54
RECOMMENDATIONS
Againthisalignswithotherresearchwhichemphasisestheimportanceofbuildingmotiva-tionalandlsquopullrsquofactorsintothevaccinerolloutstrategyandaccompanyingmessaginginorderto increase vaccine uptake among CALD com-munitiesInvolvingcommunitiesintheprocessunderstandingconcernsandmotivationalfactorsbuildingtrustandtestingmessaginghavebeenidentifiedaskey
If I could get home to see my mother I would get
vaccinated today
ThisresearchisintendedtoprovideausefulgrassrootsperspectivefromarangeofCALDcommunitiesacrossNSWonissuesbarriersandperceptionsconcerningtheCOVID-19vaccineItishopedthatthesefindingscontributetoagrow-ingbodyofknowledgeregardingCOVID-relatedissuesforNSWrsquosculturally-diversecommunities
The research has highlighted that reinforcing the benefitsofbeingvaccinatedratherthandwellingontherisksismorelikelytogeneratebehaviouralchangeandapositivevaccineresponsefrombothCALDcommunitiesandthegeneralpopulationIt also reminds us of the immense value of the
direct and early engagement with specialist local multicultural and state-wide ethno-specific community organisations in the development and rollout of any public health campaigns
strategies to ensure community involvement in and ownership of any campaigns with trusted sources such as local community leaders and peer champions
tailored targeted messaging across multiple platforms and channels available in easy-to-read format for English and translated versions
supporting health care professionals in their role as educators and leveraging successful local programs that increase COVID-19 vaccine literacy and informed decision making
further research to understand concerns misconceptions and motivations of priority groups
1
2
3
4
5
long-standingtrustandstrongrelationshipsthatexistbetweenlocalplace-basedservicesandthecommunitiestheyworkwithndashcloseconnectionsthatshouldbeutilisedtoadvancepublichealthoutcomes
InthiscontextitisrecommendedthatNSWHealthinpartnershipwithMulticulturalNSWCALDpeakbodiesandcommunityleadersusethisresearchtoinformongoingeffortstoencour-age uptake of the COVID-19 vaccine among CALD communitiesThefindingsindicatethattheseeffortscouldbesupportedby
4 5
Motherrsquos Group at SydWest Multicultural Community Services Blacktown
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
76
HEALTH INFO
Health information from online sources (low use of government websites)
Main stream media
Younger group
Tik Tok
58 said yes to the vaccine with 64 previously vaccinated
= 2 people
29 were unsure or hesitant
13 reported that they would not have the vaccine
Issues barriers and perceptions about the Covid-19 vaccine among culturally and linguistically diverse communities in NSW
if I could get
home to see my
mother I would
get vaccinated
today
Covid is not
real and present
danger but I would
get vaccinated if
there was a
reason too
I would get vaccinated
FEARS amp CONCERNS about the
vaccineFear about blood clots
caused by the Astra Zeneca
vaccineFear about
the perceived lack of lsquoproperrsquo testing of the
vaccineLack of
certainty about how the vaccine
workedConcerns
that the vaccine will make you sick or change
your DNA
Concern that the vaccine
is a form of government
controlA belief that if you were
healthy it was better to fight the virus and
make yourself and your immune system
lsquostrongerrsquo as a result
if there was more risk from Covid ndash another outbreak or concern about increased transmission
199participants
11focus groups
if I had to in order to keep my job
if I was able to travelto see myfamily
More likely to get the vaccine
+65 age groupThis small study of 199 people from a range of cultural backgrounds in
metropolitan Sydney and two regional locations
found that the community is divided in its response to both the safety need
and efficacy of the vaccine
Almost half of the participants knew someone who had contracted COVID-19 over-seas Many people spoke about the impact of COVID-19 on their immediate family including some who had lost loved ones
Influence of friends and family overseas
2 3
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
98
This research project has been commissioned by the New South Wales Council of Social Service (NCOSS) to look at issues concerns attitudes and barriers to receiving the COVID-19 vaccine in culturally and linguistically diverse (CALD) communities in NSW
The research was conducted over two months fromlateApriltolateJune2021withdatacol-lectedjustpriortothelatestCOVID-19outbreakinSydneyItwasundertakenwithsomeurgencygiven the following factors
the lack of data concerning peoplefromculturallyandlinguisticallydiverse backgrounds in larger research studies 2
theheightenedconcerninthecommunity aboutthepotentialsideeffectsofin particulartheAstraZenecavaccinewhich has led to a higher-than-usual rate of vaccine hesitancyinthewidercommunity3
theneedtolifttheoverallvaccinationratein Australia
Emergingresearchindicatesthatmisconceptionsabout COVID-19 in Australia tend to be more common in groups with lower levels of health literacyincludingpeoplewhospeakalanguageotherthanEnglishInadditionthevariedexperi-enceofandinformationaboutCOVID-19trans-missionandvaccinationinoverseascountriesmakesthisaparticularlyinterestingissuegiventhatCALDcommunitymembersmaybehavingregulardiscussionswithrelativesoverseasandgettinginformationaboutCOVID-19fromover-seas sources
2McCafferyKJDoddRHetalHealth literacy and disparities in COVID-19ndashrelated knowledge attitudes beliefs and behaviours in AustraliaPublicHealthResPract202030(4)e30342012 December 2020 First published5 November 2020lsquoThereareseverallimitationstoourstudyAlthoughourrecruitedsamplewaslargeanddiverseitwasnotstatisticallyrepresentativeoftheAustralianpopulationTheproportionofAustraliansfromnon-Englishspeakingbackgroundswassmall(6)sincethesurveywasnottranslatedandrequiredsufficientEnglishskillstocompletethequestionnaireinEnglishrsquo(p7)
3AnonlinesurveyconductedbyEssentialResearch(April2021)completedby1090peoplebetween21ndash26April2021foundjust43ofAustraliansthinktherolloutisbeingdoneefficientlydownfrom68inMarchhellipTheslowrolloutandchanges to the roadmap also appear to have given rise to vaccinehesitancywithoneinsixpeople(16)sayingtheywillnevergetvaccinatedagainstCOVID-19upfrom12lastmonthwhile42saidtheywillgetvaccinatedbutnotrightawayTheproportionofpeoplewhowouldbewillingtogetvaccinatedassoonaspossibleorarealreadyvaccinatedalsodeclineddownfrom47to42rsquoEssentialReport(April 2021)
A mixed-method research methodology was used for this project However it was primarily a qualitative approach that aimed to hear directly from people in the community from culturally and linguistically diverse (CALD) backgrounds The methodology involved
METHODOLOGY
11 focus groups (including one pilot) involving atotalof167participantsfromCALD backgroundsand7locationsGriffith(1) Wollongong(2)Blacktown(2)Lakemba(1) MtDruitt(3)Toongabbie(1)andMarrickville (1)Thesesupportedparticipantstoanswer thesurveyquestionsandenabledmore detailedexplorationofissuesandfurther gatheringofqualitativeinformation(see Table1below)Identifiedmulticulturalandcommunityserviceorganisationswith connectionstoCALDcommunitiesinthe relevantlocationsactedaslsquointermediariesrsquo byassistingwithorganisingthefocusgroups providingbilingualfacilitationofdiscussion andsupportingcommunitymembersto undertakethesurveyMoreinformationonthefocusgroupsandintermediary organisationscanbefoundatAttachmentA
Anonlinesurveywiththesamequestionsas those used in the focus groups was made available This was promoted via NCOSS networksandtheresearchteamrsquosCALD connectionsandcompletedby32peopleThe totalsamplesizeofthisstudywastherefore 199participantsmadeupofmembersof diverseCALDcommunities
Abilingualmulticulturalcommunity engagementexpertwasengagedthroughout theprojecttoadvisetheresearchteam includinginrelationtothedesignofthe surveyBilingualfacilitatorswereusedfor focusgroupswherenecessaryandguidance wasprovidedbyintermediaryorganisation representativesasrequiredandinone instancethesurveywastranslatedintoArabic Focus group members were each provided witha$25giftcardattheendofthesession anda$50giftcardwasdonatedtothe intermediaryorganisationtoprovidesome additionalresourcestoeachgroup
Asecondonlinesurveywasdesignedtoelicit theviewsandexperienceoftheintermediary organisationsintheirworkwithCALD communitiesItgeneratedeightresponses
Two interviews were undertaken with a multiculturalhealthcommunicationexpert from the Illawarra Shoalhaven Local Health DistrictandanEmergencyDepartment medicalpractitioner
Theonlinesurveyresponsesfromthe intermediaryorganisationsandtheinterviews withhealthstaffhaveinformedanalysisof datafromcommunitymembersfindingsand recommendations
Inadditiontheresearchhasbeeninformedbyotherpubliclyavailableresearchincludingfind-ingsconcerningvaccinehesitancyanduptake4andascanofmulticulturalCOVID-19healthresourcesavailableincommunitylanguagesfromtheCommonwealthNSWandVictorianGovern-mentsSBSandEthnolink(seeAttachment2)
Recruitment for the focus groups IntermediaryorganisationsandfocusgroupparticipantswererecruitedusingtheresearchteamrsquosextensiveconnectionswithmulticulturalandcommunityserviceorganisationsacrossNSWanddrawingonkeyNCOSSmemberorganisa-tionsprovidingsupporttoandwithlongstandingrelationshipswithCALDcommunitiesToalargeextenttheselectedlocationsandtheservicesandsupportsprovidedbytheintermediaryorgan-isationsdeterminedtheculturalbackgroundsthatwereincludedinthestudy
4 httpswwwncossorgauCOVID-19-research
INTRODUCTION
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1110
Service Location Group Composition Participant numbers
Addison Road Community Centre Marrickville Community leaders - Vietnamese Chinese Italian Greek Indonesian Latin American and Portuguese speakers
26
Griffith Community Centre Griffith Indonesian and Pakistani women 6 Multicultural Communities Council Illawarra
Wollongong Arabic-speaking group 22
Multicultural Communities Council Illawarra
Wollongong Italian older womenrsquos group 15
Syd West Multicultural Services Mt Druitt Arabic-speaking group 10 Syd West Multicultural Services Blacktown Spanish-speaking seniorsrsquo group 16 Syd West Multicultural Services Blacktown Mothersrsquo support group -
Indian Sri Lankan Pakistani and Ghanaian
14
Canterbury City Community Centre (4Cs)
Lakemba Pakistani Indian and Sri Lankan women
14
Chaldean League and Western Sydney TAFE
Mt Druitt Chaldean group 18
STARTTS - Toongabbie Community Centre
Toongabbie Tamil-speaking group 12
Mt Druitt TAFE ndash TAFE NSW Mt Druitt Work Opportunities for Women group (mixed CALD backgrounds)
14
TOTAL 167
Table 1 Focus Group DetailsExplanatory noteThefocusgroupatMtDruittTAFE-comprisedpredominantlyofCALDwomenenrolledinaCertificateIIentrylevelcourse-wasusedtopilotandrefinethefocusgroupprocesswithsurveyresponsesgeneratedbythegroupincludedinthefinalsurveyresults
A word about the research design Theresearchwascarefullydesigneddrawingonexpertculturaladviceoncommunicationpro-cessesandsurveydesignFocusgroupsincludedparticipantconsentformsincentivevouchersandaone-pageintroductiontotheresearchfortheintermediaryorganisationsIntermediaryorgan-isationsandpreferredlocationswereidentifiedand agreed in advance with NCOSS
Thesurveywasdesignedinaneasy-to-readformatusingsimpleEnglishFeedbackfromthe Spanish-speaking translator was that it was extremelyeasytotranslateandcompleteOthergroupscommentedthattheyfoundthesurveyeasytocompleteandmostgroupsdisplayedasolidlevelofspokenandwrittenEnglishTheresearchdesignandconductalsoleantheavilyontheexpertiseofthefacilitatorsandtheirexten-sivenetworkswhichmadedeliveryinsuchashorttimeframepossibleThepositiveengagementandsupportoftheintermediaryorganisationswasalsoafactorcontributingtothesuccessfulconduct of the research
Withoutfailthemulticulturalandcommunityserviceorganisationsinvolvedintheresearchper-ceived the importance of its purpose and shared a desire to provide NSW Health with feedback directlyfromtheircommunitiesasamatterofurgency
Demographics of research participantsThemakeupofthosewhoparticipatedintheresearch was diverse in age and cultural and languagebackgroundParticipantswerepredom-inantlywomen(84)withmenmakinguponly145OverhalftheparticipantshadlivedinAustraliaformorethan20yearswhichimpactedpositivelyontheirlevelofspokenandwrittenEnglishHowevertherewerequitelowlevelsofEnglishliteracyinanumberofthegroupswhichmadeguidedsurveycompletionamoreneces-sarybutcomplexprocess
1 1 1
6
3
31
16 17
20
12
15
1
8
2
64
1
5
2 13
1 1
7
2 1
5
1 1 1 1 2 10
5
10
15
20
25
30
35
Indo
nesia
Thai
land
Hong
Kon
gAu
stra
lia Iran
Iraq
Viet
nam
Italy
Sri L
anka
Indi
aPa
kist
anGh
ana
Syria
Boliv
iaCh
ilePe
ruEl
Sal
vado
rM
alay
siaUr
ugua
yAr
gent
ina
Cam
bodi
aUk
rain
eRu
ssia
Chin
aSu
dan
Eritr
eaSw
eden
Taiw
anAf
ghan
istan
Pola
ndJa
pan
Egyp
tJo
rdan
13
1 2
10
17
2
21
1
11
1 1
12
2 1
27
10
1 1 1 13 2 1 2 1
6
1 1 1
32
0
5
10
15
20
25
30
35
English Thai
Cant
ones
eVi
etna
mes
eIta
lian
Farsi
Tam
ilTe
lugu
Span
ishSp
anglish
Haus
aUr
duGu
jara
tiPu
njab
iAr
abic
Chalde
anHi
ndi
Khm
erPe
rsian
Russian
Man
darin
Malay
Haza
ragi
Tigr
inya
Kurd
ishCh
ines
ehellipJa
pane
sePo
lish
Swed
ishM
ultip
le
Figure 1 Country of BirthFigure 2 Language spoken at home
METHODOLOGY
Coun
t
Coun
t
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1312
211
1316 14211684
2053
3316
Less that 1year
1 - 2 years 2 - 5 years 5 - 10 years 10 - 20years
More than20 years
000
500
1000
1500
2000
2500
3000
3500
Less than 1-2 years 2-5 years 5-10 years 10-20 More than1 year years 20 years
1453
8430
000 116
Male Female Non-binary Rather not say000
100020003000400050006000700080009000
000
785
1728
2147
1309
1675
2356
Under 18 18-24 25-34 35-44 45-54 55-64 65+000
500
1000
1500
2000
2500
Figure 3 Length of time living in Australia Figure 5 Gender
Figure 4 Age
METHODOLOGY
Chaldean Focus Group Feedback Sheet
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1514
Research participants were asked
If they were intending to get vaccinated
The reasons why they would or would not choose to get vaccinated
If they knew anyone who had already been vaccinated and if so who
If they knew anyone who had contracted COVID-19 and if so who
If they knew where to go to get vaccinated
What sources they used to get information about the COVID-19 vaccination
Basic demographic information age gender country of origin language spoken at home and length of time living in Australia
Having the vaccine or notOfthe199participants117(58)reportedthattheywereplanningtobeorhadalreadybeenvaccinatedwhile78(42)reportedthattheywere not planning to have the vaccine (13) or didnotknowiftheywouldgetvaccinated(29)
1453
8430
000 116
Male Female Non-binary Rather not say000
100020003000400050006000700080009000
05
10152025303540
Under18
18-24 25-34 35-44 45-54 55-64 65+
Coun
t
Yes No Donrsquot Know
Figure 6 Are you going to get the COVID-19 vaccine
Figure 7 COVID-19 Vaccine intention of respondents by age category
13people(65)hadalreadybeenvaccinated(at least 1 dose)6withseveralcommentingthattheyhadchosenorneededtobevaccinatedforwork-relatedreasonsOthersreportedthattheyhadbeenvaccinatedprimarilyforhealthreasonstostaywellandmakesurethattheirfamiliesstayedwellTheywerealsoconcernedaboutpublichealthandsafetyOneofthewomenintheLakemba groups from Sri Lanka was adamant that thebenefitsoutweighedtherisksspokepositive-lyabouthoweasyithadbeentogetthevaccinefrom her local medical centre and that she had experiencednosideeffectsfromthevaccination
Language Count Percent Urdu 1 Italian 3 Arabic 2 Tamil 3 Chaldean 1 Spanish 3 Total 13 65 of sample
Response Count Percent Not planning to have the vaccine 23 13 Unsure about having the vaccine 52 29
75 42
Table 2 Respondents already vaccinated
Table 3 Respondents who indicated vaccine refusal or hesitancy
6 Theresearchersdidnotdistinguishbetweenwhetherpeoplehadreceivedtheirfirstandseconddosesofthevaccineiepartiallyorfullyvaccinated
75(42)indicatedadegreeofvaccinehesitancywith24participants(13)reportingthattheywerenotplanningongettingvaccinatedwhile53(29)reportedtheydidnotknowiftheywouldget vaccinated
Thislevelofvaccinehesitancyreflectslargerstud-iesintheAustraliancommunityAsurveyofover1000participantsfromacrossAustraliaconduct-edinApril2021byEssentialResearchfoundhes-itancyratesof42including16whoindicatedtheywerenevergoingtogetvaccinated7
Foroursurveyresponsesindicatedthatagewasafactorwith85ofrespondentsaged65andoverreportingthattheywouldhaveorhad
7EssentialResearchThe Essential Report21April2021
FINDINGS FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1716
alreadyhadthevaccineThosewhoindicatedthattheywouldnotbehavingthevaccinewerefairlyevenlydistributedacrossagegroupswithyoung-er people aged 18-24 being the age group with thehighestproportionofparticipantsexpressinguncertaintyabouthavingthevaccineTheagegroupwiththesecondhighestlevelofhesitancyproportionatetoothercategorieswerethe35-44yearolds
02468
10121416
Iraq
Vietnam Italy
South Americ
a
Sri La
nkaIndia
Syria
Other South East
AsiaAfric
a
Australia
Sweden
China
Pakistan
Iran
Eastern Europe
Afghanistan
Japan
Coun
t
Yes No Dont know
8095 8190
70486095
4571
6190
095
To stayhealthy and
well
To keep myfamily
healthy andwell
For publichealth
To travel To work It is theright thing
to do
Somethingelse (pleasetell us what)
000100020003000400050006000700080009000
Figure 8 Respondents COVID-19 Vaccine intention by Country of Origin
Figure 9 Reasons for getting vaccinated against COVID-19
Countryoforiginalsoseemedtoplayaroleinpeoplersquosviewsabouthavingthevaccinewithhighvaccinepre-dispositionreportedbyVietnameserespondentstotheonlinesurveyandwomenintheItalian-speakinggroupWhileparticipantsfromIraqrecordedthehighestlsquoyesrsquoresponsethiswasalmostmatchedbyIraqiparticipantswhoreportedthattheywerelsquounsurersquoorlsquodidnotknowrsquowhethertheywouldhavethevaccineTherelevanceofcountryoforigininthisregardwouldbeworthyoffurtherresearch
The Italian focus group held in Wollongong was an olderwomenrsquossocialgroupwithallparticipants(15) agedabove65yearsMostinfactwereaged over75yearswithoneparticipantinher90s 87 of the group had either been vaccinated (3) or were planning to get vaccinated (10)
Of course I will get vaccinated It is important to do this It is a very bad
disease
Thesewomenweremotivatedtostayhealthyandwellkeeptheirfamilyhealthyandwellforpublichealthreasonstobeabletotravelandforgen-eralsafetyMembersofthegroupalsoreportedthattheywantedtogetvaccinatedsothattheywouldbeabletolsquodancersquoandlsquosocialisersquo
Reasons for having the vaccine
Ofthe117participantswhoreportedthattheyhadeitheralreadybeenvaccinatedorwereplan-ningtogetvaccinatedlsquokeepingmyfamilyhealthyandwellrsquo(82)andlsquokeepingmyselfhealthyandwellrsquo(81)werethetwomostpopularreasonsforhavingthevaccineThiswasfollowedbylsquoforpublichealthrsquo(70)lsquoitistherightthingtodorsquo(62)andinorderlsquototravelrsquo(61)(SeeFigure9)
I donrsquot want to
die
Irsquom over 65 I have some health issues I think itrsquos
[having the vaccine] very important to
keep safe
I want to see my family I usually go every year but now I havenrsquot seen them
because of COVID-19 Having it will help
I am well but my parents are older It is important to
keep them well
Otherreasonsthatpeoplegaveforgettingvacci-natedincludedtheneedtocontinueworkinginessentiallsquofrontlinersquoemploymentsuchassecuritycleaningandagedcaresettingsOnewomanintheLakembafocusgroupwhohadalreadyhadherfirstdoseoftheAstraZenecavaccinesaidthatlsquothebenefitsoutweightherisksrsquoandasanolderwomanrsquoIdonotwanttodiersquo
All but one of the focus groups were familiar with thedifferentvaccinescurrentlyavailableinAus-traliaAstraZenecaandPfizerMostparticipantswere also aware of blood clots being associated with the Astra Zeneca vaccine One group of newly-arrivedrefugeesinGriffithhadnotheardofeithertheAstraZenecaorPfizervaccinesandhadamorelimitedunderstandingofthevaccinationprogram in general
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1918
Reasons for not having the vaccine
At the moment the situation is under control and donrsquot feel the need Also I have no plans to
travel in the near future so I donrsquot see the need
3514
21622703
3243
1892
811 541
4865
1081
Thevaccine isnot welltested
Thevaccine is
unsafe
Formedicalreasons
I amscared tohave thevaccine
I dont likevaccines
Forreligiousreasons
Forculturalreasons
I want towait and
see
Somethingelse
(pleasetell uswhat)
000
1000
2000
3000
4000
5000
6000
Figure 10 Reasons for not getting vaccinated against COVID-19
Theperceivedlsquolackofadequatetestingrsquoofthevaccineandlsquofearofbeingvaccinatedrsquoalsore-ceivedhighresponseratesselectedby3514and3243ofparticipantsrespectivelyOnly1355 of respondents cited religious or cultural reasonsasbeingbehindtheirvaccinehesitancy
Open-endedresponsestothisquestionincluded
The vaccine is not 100 working It cannot offer
100 protection
Ofthe42participantswhosaidthattheywouldnothaveorwerehesitanttohavethevaccine4865saidthattheypreferredtolsquowaitandseersquobeforegettingvaccinated
Thediscussioninthefocusgroupsaboutpeoplersquoshesitancytobevaccinatedfocusedonanumberofconcernswhichreflected
poorcommunicationfromanumberof trusted sources including GPs and some media sources
conflictinginformationaboutthevaccinefrom healthauthorities
fearsaboutvaccinesafetythataresharedby thegeneralcommunity
misconceptionsabouttheeffectivenessof andhowthevaccineswork
I will not have it because make me sick
Issuesraisedinfocusgroupsascontributingtoincreasedhesitancyincluded
Some GPs being hesitant to recommendvaccination
Theinformationbeingprovidedisconflicting
Theinformationisoverlycomplexandnotcomprehensibleregardlessofwhetherithasbeen translated
The risk of blood clots
Perceptionsthatthevaccinesaregenerallyunsafe
Concernsthatsomepeoplearedyingafterbeing vaccinated
Not being sure about the risks associated withhaving the vaccine and being pregnant orbreastfeeding
Theperceptionthattherehasbeenalackoftestingofthevaccinespriortorollout
AlackofunderstandingofhowvaccinesworkthecompositionofthevaccinesandwhattheywoulddotothebodyincludingmakingchangestoapersonrsquosDNA
Specificcommentsincluded
I have heard that the vaccine changes
your DNA
I am a mother I am not sure it [the vaccine] is safe for
me when I am breastfeeding
If you are young and healthy your body has the energy to fight the virus
You donrsquot need to have the vaccine You should just let
your body fight it itself
They donrsquot tell you what chemicals are in the
vaccine
Tamil Focus Group Feedback Sheet
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2120
Nobody knows what to do My GP doesnrsquot even know what I should do whether
I should have it or not
I am not sure what to do I have spoken to my
GP but they canrsquot tell me whether I should have the vaccine or not while I am
breastfeeding
They say one thing and then they tell you
something elsehellip it [the vaccine rollout] is so
confusing
Confusionaboutwhattodowheretogoandthe health impacts of the vaccine was a common threadintheconversationsaroundvaccinehesi-tancy
Onewomanwhosehusbandworkedforasecurityfirmsaidthatherhusbandhadhadtobevacci-natedinordertokeephisjob
In several focus groups the issue of government control was also raised A number of people re-portedstronglythattheyfearedthatthevaccinewas lsquoa means that the government was using to controlpeoplersquo
He [husband] had to have it He didnrsquot have a choice He was fine [no side effects] but Irsquom not
thinking I will have it I donrsquot need to Irsquom a mum Irsquom busy I have
to look after my children I donrsquot know how I feel about it whether
Irsquom going to have it
Vaccine refusal
Onlyasmallnumberofparticipants(24or13)saidtheywouldnotgetvacci-natedOfthisgroup21werewomenand 2 were men8 Respondents were bornintendifferentcountrieswithadiverse range of language backgrounds
I never get sick It is the same for all my family We have always been strong and healthy so I will be
saying no to the vaccine
Country of Birth Language Background Count Pakistan Urdu 4 China Taiwan Chinese
(MandarinCantonese) 4
Sri Lanka India Tamil 3 Chile Spanish and English 2 Italy Italian 2 Iraq Syria Arabic 2 Iraq Chaldean 1 Iran Farsi 1 Greece Macedonian 1 Poland Polish 1 Pakistan Punjabi 1 Sweden Swedish 1 Vietnam Vietnamese 1
Table 4 Vaccine refusal by country of birth and language background
8 ThisreflectstheoverallsamplebiastowardswomenThemajorityoffocusgroupparticipantswerewomenXwithYparticipantsbeingmen
Reason for not having the vaccine Percent Count The vaccine is not well tested 5455 12 I want to wait and see 5455 12 The vaccine is unsafe 3636 8 For medical reasons 3182 7 I am scared to have the vaccine 3182 7 I dont like vaccines 1364 3 For religious reasons 1364 3 For cultural reasons 909 2 Something else (please tell us what) 909 2
SomeinthiscategorywereadamantthattheywouldnotbehavingthevaccineandhadverystrongviewsonitlsquoForculturalreasonsIwonrsquotbehavingthevaccinersquoWhenwelookatrespons-esmorecloselyhoweveritwouldappearthatmanyareinfactmorelsquohesitantrsquothanfirmvaccinerefusers
One reluctant middle-aged Tamil-speaking wom-ansaidlsquoIftheysaywehavetogetvaccinatedthenIwillrsquoThissentimentwas stronglysup-portedbythe rest of the Tamil-speaking group
Studyparticipantswhosaidtheywouldnothavethe vaccine were also concerned that lsquothe vaccine wasnotwelltestedrsquo
The vaccine has been rushed out It has not been
properly tested
Table 5 Reasons for not having the vaccine
Peopleinthiscategorysaidthattheywouldlsquowaitandseersquowhathappenswiththewiderrolloutbe-foremakingtheirfinaldecisionThissuggeststhataproportionofthelsquonorsquogroupareinfacthesitantrather than outright refusing to have the vaccine
Therewerealsofearsexpressedbyfocusgroupparticipantsaboutthedangersofbeingvacci-natedParticipantsreportedbeingafraidofthehealthrisksespeciallyfrombloodclotsSomepeopledistinguishedclearlybetweenAstraZene-caandPfizerinthisregardHoweverformanythedistinctionbetweenthedifferentvaccineswaslostandtheyspokeofthevaccinesgenerallybeing unsafe and having a range of unwanted side effects
Other factors consideredInadditiontothebroaderquestionsofwhypeo-plewouldorwouldnotchoosetogetvaccinatedthe research team used the focus group discus-sionstoexplorewhetherthefollowingfactorshadanyimpactonapersonrsquoslikelihoodofbeingvaccine pre-disposed or hesitant
Knowing someone who had been vaccinated
Knowing someone who had contracted COVID-19
Knowing where to go to get vaccinated
Thesourcespeopleturntoforinformation about COVID-19 and COVID-19 vaccines
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2322
Knowing someone who has been vaccinatedOfthosewhorespondedtothisquestion125or70knewsomeonewhohadalreadyhadthevaccine
6983
2570
447
Yes No Dont know000
1000
2000
3000
4000
5000
6000
7000
8000
Figure 11 Do you know someone who has been vaccinated
Amongthe125participantswhoknewsomeonewhohadalreadybeenvaccinated100identifiedlsquoimmediatefamilymembersrsquo(parentschildrensiblingsandpartners)Somefocusgrouppartic-ipantsreportedthatalloftheirfamilymembersoverseas had been vaccinated Others reported thattheirrelativeshadbeenvaccinatedasarequirementoftheiremployment
Who Count Percent Other family member 41 313 Sister 24 1832 Community member 23 1756 Brother 18 1374 Father 17 1298 Mother 16 1221 Work colleague 14 1069 Husband or wife 11 84 Son or daughter 10 763 Partner 4 305 Someone else 45 3435 Total respondents 131
Table 6 Who do you know who has been vaccinated
When this issue was teased out further in focus groupdiscussionsarangeofreasonswere revealed including
My husband works in security and he had
to get it
My friend works as a COVID-19 cleaner and they all had to [get
vaccinated]
My family overseas have already been vaccinated
My son needs to travel for work so he is getting it
My brother in the UK is a doctor and he got it and
his wife
Knowing someone who has had COVID-19Almosthalfoftheparticipantsknewsomeonewho had contracted COVID-19 overseas Some reportedthatallthemembersoftheirfamilyormanymembersoftheirextendedfamilyhadcon-tracted COVID-19 In the older Italian group 10 of the15womenknewsomeoneinItalywhohadcontracted COVID-19
4716 4659
625
Yes No Not sure000
1000
2000
3000
4000
5000
Figure 12 Knowing someone who has had COVID-19
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2524
385 385
1538
2692
641 513000
4359
2051
1026385
1410
Mother
Father
BrotherSis
ter
Son or d
augh
ter
Husban
d or wife
Partner
Other family
mem
berFri
end
Community m
ember
Work co
lleag
ue
Someone else
(please
tell u
s who)
000500
100015002000250030003500400045005000
Figure 13 Who do you know who has had COVID-19
Four people in the focus groups knew someone who had died of COVID-19
All my family back home [Pakistan] got it [COVID-19] but
they are all fine now apart from my father He died But he was really sick before he
got it He had lots of underlying conditions Medical conditions so he was really unwell before he got COVID-19 But everyone else
they are fine now They were sick but they got betterhellip
If you are well and healthy you can fight this off
SurprisinglyknowingpeoplewhohadcontractedCOVID-19didnotseemtoinfluencefocusgroupparticipantsrsquopredispositiontowardseitherhavingthevaccineorbeingvaccinehesitantHowevertheolderItalianwomenrsquosgroupspokeabouttheimpactthatCOVID-19hadhadinItalyintheearlystagesofthepandemicandhowthishadaffectedthemdeeply13ofthe15womeninthisgroupwouldhaveorhadalreadyhadthevaccine
Knowing where to get vaccinated115people(81)whorespondedtothisquestion(n=142) knew where to go to get the vaccine 34 people(19)reportedthattheydidnotknowThisincluded15respondentsfromIraq3re-spondentsfromIndia2respondentsfromChina2 respondents from Pakistan and one respondent fromeachofthefollowingcountriesChinaEri-treaItalySriLankaSwedenSyriaandVietnamThese people were also less sure about whether ornottheywouldhavethevaccineItispossiblethat their lack of knowledge about where to go to get vaccinated was related to their general level ofvaccinehesitancy
7958
29582254
282 563
GPDoctor Vaccinecentre
Hospital Work place Somewhereelse (please
tell us where)
000100020003000400050006000700080009000
Figure 14 Where to go to get vaccinated
From the sample (n=199) GPs were the most commonlyidentifiedplacetogotogetvaccinat-edfollowedbythevaccinecentreatHomebushBayandthenhospitalsOtherplacesidentifiedincluded medical centres and pharmacies
Sources of information about COVID-19 and the vaccineThelargestsinglesourceofinformationaboutCOVID-19 and the vaccine was Facebook (417)
2743
3486
13141086
30862686
3429
2229 2286
41713714
2571
1086 971
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)000500
10001500200025003000350040004500
Figure 15 Sources of information about COVID-19 and the COVID-19 vaccine
Facebook I get my information from
Facebook But if I want to check it I watch the news
on 7 [Channel 7]
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2726
Thesecondlargestsourceofinformationforpeople in the sample was lsquoother forms of social mediarsquo(37)followedbySBStelevision(35)myfriends(34)andothertelevision(31)Oth-ersourcesofinformationpeoplereportedthattheyusedweretheNSWHealthwebsitenightlytelevisionnewsincludingChannel7Channel9andChannel10followedbytheABCtheAustral-iangovernmenthealthwebsitetheirGPlocalMedical Centres and the Red Cross
IntheLakembafocusgrouppredominantlymadeupofwomenfromPakistantherewasanani-mated discussion about Facebook which was the majorsourceofinformationalongwithGooglesearchesandcommunityandfriendship-basedWhatsApp groups There was a general consensus from most in the group that these were their pre-ferredormostcommonsourcesofinformationandnewsHoweveriftheywantedtolsquofactcheckrsquowhattheywerehearingtheywouldwatchthenightlynewsonChannel7orChannel9toverifywhattheyperceivedcouldsometimesbeunrelia-ble sources
IntheMtDruittfocusgroupseveralofthewom-enwithwell-developeddigitalliteracyandgener-alliteracyskillsusedhealthandfitnesswebsitesand social media sites as their source of infor-mationaboutlsquoallthingshealthrelatedrsquoincludingCOVID-19ThesewomenalsospokepositivelyabouttheinformationandsupporttheygotfromthestaffatCanterburyCouncilCommunityCentre(4Cs)whotheycouldrelyontofindoutthingsthattheyidentifiedtheyneededtoknowmoreabout
InthesmallerfocusgroupinGriffithwithrecently-arrived refugee women who had low levels of Englishlanguageliteracytherewaslittleknowledgeaboutthevaccinesnoawarenessofthedifferenttypesofvaccinesandlittleknow-ledgeaboutwheretogotogetvaccinatedorfindoutmoreaboutCOVID-19ingeneralThecommunityservicestaffandvolunteerspresentatthegroupwere working hard to assist these women to improve their English language skills and support themwithtranslatedinformation
In the older Italian women focus group in Wollon-gongparticipantsreportedgettingtheirinfor-mationfromslightlydifferentsourcesndashfamilyinAustralia(10women)Channel9(7women)
Italianradio(3women)andABCTV(3women)Onlytwowomenusedtheinternetandnoneofthe women reported using Facebook or social mediaasasourceoftheirinformationSeveralmentionedthattheygottheirinformationfromtheirGPorspecialistdoctorandonepartici-pantsaidrsquoIdonrsquotlistentoanyonersquoIntheSpan-ish-speaking focus group a comment was made thatseemedtoreflectmanyoftheotherfocusgroup discussions
Whenlsquosourcesofinformationrsquoiscorrelatedwiththegroupwhosaidtheywouldhavethevaccine(n=104)thereisashiftfromFacebookbeingthepreferredsourceofinformationtolsquoSBSTVrsquobeingthepreferredsourceThelsquovaccine-predisposedrsquogroupalsohadthelowestrateofrelyingonFace-bookasasourceofinformationaboutCOVID-19thoughitwasstillhighThegraphbelowhigh-lightshowotherlsquopreferredsourcesrsquoplayoutforthoseintendingtohaveorwhohavealreadyhadthe vaccine
ForthoseparticipantswhoindicatedthattheywouldnotorwerenotplanningtohavethevaccinelsquoFacebookrsquolsquomyfriendsrsquoandlsquomyfamilyrsquowerethesourcesofinformationaboutCOVID-19thatwereequallymostfrequentlycitedfollowedcloselybylsquomyfamilyoverseasrsquolsquoSBSradiorsquoandlsquoSBSTVrsquoassourcesofinformationreceivedthelowestmentionsfromthisgroup(SeeFigure16)
The vaccine-hesitant group were the group who identifiedlsquoFacebookrsquoastheirmostfrequentsourceofinformationaboutCOVID-19lsquoFace-bookrsquowasfollowedbylsquoothersocialmediarsquoandlsquomyfriendsrsquoasthenextmostfrequentsources
lsquoThiscommunityserviceproviderrsquo(theinterme-diaryorganisationwherethefocusgroupwasconducted)wasidentifiedby26ofrespondentsasasourceofinformationregardlessoftheirintentiontogetvaccinatedornotThefactthatboththelsquovaccinehesitantrsquoandthosewhoindi-catedtheywouldnrsquotbegettingthevaccinesoughtinformationfromthissourcesuggeststhatrolling
There is so much confusion about it [the vaccine] that I think my GP is the best
place to go
9 This group of the research sample included a small number ofpeoplewhohadalreadybeenvaccinated
2626
4141
14141111
323228282828
2424
1818
37373737
2828
10101212
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)00050010001500200025003000350040004500
2857
2381
952 952
2857
3333
42864286
3810
4286
23812381
1429
952
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another co
mmunity se
rvice
Somewhere
else (p
lease te
ll us w
here)000
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Figure 16 Sources of information for respondents who were planning to have the vaccine9
Figure 17 Sources of information for respondents who were not planning to have the vaccine
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2928
outpositivemessagingthroughtrusted communityserviceorganisationscouldbeaneffectivewayofshiftingpeoplefromvaccine hesitancytodecidingtohavethevaccine
31372549
980 980
25492157
4314
1176
2353
4902
4118
2157
980392
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)000
1000
2000
3000
4000
5000
6000
Figure 18 Sources of information for respondents who lsquodonrsquot knowrsquo if they will have the vaccine
DISCUSSION
wardstheCOVID-19vaccineareasvariedastheyarewithinthebroadercommunityTherearearangeofinfluencingfactorsincludingagehealthstatushowlongtheyhavebeeninAustraliahowmuchnewstheyreceivefromoverseasandhowbadlyimpactedbythepandemictheirhomecountries have been
The research also highlights that people from culturallyandlinguisticallydiversebackgroundsgettheirinformationaboutCOVID-19andtheCOVID-19vaccinefromawidevarietyofsourcesbothformalandinformalandthatforparticulargroupsinthisstudythereisahighrelianceonFacebookovermoreofficialsourcesofinforma-tion
VulnerabilityTheneedsofhighly-vulnerablegroupswithintheCALDcommunityhavetobetakenintoconsider-ationThisincludesolderpeoplewhohavelivedinAustraliaformanyyearsbuthavelowlevelsofEnglishliteracyndashespeciallywritingandreadingEnglishandsometimesspokenEnglishndashandwhoaremoresusceptibletoseriousillnessandhigherratesofhospitalisationanddeathfromCOVID-19Italsoincludesnewly-arrivedrefugeeswhohavinglowornoEnglishlanguageliteracylacktheconnectionstoandnetworksintothewidercommunityandcommunitysupportsItisalsothecase that some people in these groups are not health literate at all and cannot read and write in their own language
Akeytakeoutfromthehealthandcommunityserviceorganisationsurveyresponsesandinter-viewsundertakenwithmulticulturalhealthandcommunicationexpertsfortheprojectisthatlit-eracylevelsreallydomatterLowlevelsofhealthliteracylowlevelsofEnglishlanguageliteracyandpossiblylowlevelsofliteracyintheirownlan-guage-especiallyforsomenewly-arrivedrefu-gees and those who are part of the humanitarian program such as Dari language speakers from AfghanistanTigrinyalanguagespeakersfromEr-itrea and northern Ethiopia and Oromo language speakers from Ethiopia - need to be factored into anyplanstofurtherpromotethevaccinerolloutanduptaketoculturallyandlinguisticallydiversepeopleinthecommunityThereisaneedfor
The contextThisresearchisimportantgivenhowhighlyculturallydiverseNSWisandtheimpactthiscanhave on the success of public health messaging topeoplewhosefirstlanguageisnotEnglishPeople who were born overseas form almost one-thirdofthe7480228population(276)ofNSWandNSWishometo336ofAustraliarsquosoverseas-bornpopulationPeoplefromaround225 birthplaces have made NSW their home and 21oftheNSWpopulationisfromanon-EnglishspeakingbackgroundMorethan24000humani-tarianentrantshavesettledinNSWoverthepastfiveyearscomprisingalmostathird(32)ofthenationaltotalThe24000humanitarianentrantswhohavesettledinNSWoverthepastfiveyearscame from over 100 countries of origin10Sydneyhasthelargestoverseas-bornpopulationofallthecapitalcities11
Hearingdirectlyfrompeoplefromculturally-diverse backgrounds is important to ensure that policymakersandpublichealthadvocatescandesign responses that are both accessible and un-derstandabletopeopleforwhomEnglishmaybetheirsecondthirdorfourthlanguageApropor-tionofpeopleinthesecommunitieshavelowerlevelsofEnglishlanguageliteracyandinsomecaseslowlevelsofliteracyintheirlanguageoforiginsowillbehardertoreachviatraditionalormainstream methods
Itisalsocriticallyimportantthatduringatimewherethereissomuchlsquonoisersquoacrossmediachannelsrelatingtothevaccinethevaccineroll-outvaccineefficacyandvaccinesafetythatwetakesometimetolistentoandunderstandhowthislsquonoisersquoisbeingheardandmadesenseofbypeoplefromculturally-diversebackgrounds
ThatsaiditisimportanttoreconfirmthattheCALDcommunityisnotahomogenousgroupOurresearchhasfoundthattheviewsandattitudesofparticipantsfromdiverseculturalbackgroundsto-
10RefugeeCouncilofAustraliaHumanitarianEntrantsin New South Wales A resource for New South Wales governmentagencies6-711MulticulturalNSWCommunityRelationsReport2018-20199
29
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3130
groupsFortheparticipantsintheresearchtheirattitudetothevaccineappearedtobeinflu-encedbyanumberoffactorstheirownlevelsofhealthandpre-existinghealthconditionsandthoseoftheirfamilymembersandtheimpactofreceiving COVID-19-related news from overseas particularlyfrompeoplersquoscountryoforiginAnexampleofthiscanbeseenintheItaliangroupin Wollongong where people had received news fromoverseasearlyinthepandemicwhichscaredthemThisexperiencelsquofromhomersquohadinflu-enced most of the women in the Wollongong focus group (n=15) to choose to get vaccinated The interviewee from the Illawarra Shoalhaven Local Health District also spoke about the heightenedconcernthattheywitnessedinthelocalItaliancommunityintheearlystagesofthepandemicOtherpeoplewantedtolsquostayhealthyrsquoandtolsquoprotectthehealthofothersrsquoandformanytherewasasensethattheywantedtolsquogetbacktosomedegreeofnormalcyrsquoandtobeabletolsquotraveloverseastovisitrelativesrsquo
Vaccine hesitancyOfthe42inthisstudywhoappearedundecidedornotplanningtohavethevaccinemanywereinfactadoptingalsquowaitandseersquoapproachbeforemakingtheirfinaldecisionMostparticipantswereinterestedtohearmoreinformationaboutthevaccinesandwereopenedtogettingthevaccinebutdidhaveconcernsaboutthesafetyofthevaccinesespeciallyinregardtoAstraZeneca
The issue of blood clots has led to considerable fearandhesitancyinthecommunityandthisfearandhesitancywasreflectedinourstudyEssentialResearchrsquossurvey(April2021)reportedoneinsixpeople(16)indicatedtheywillnevergetvaccinatedagainstCOVID-19upfrom12thepreviousmonthwhile42saidtheywillgetvaccinatedbutnotrightawayTheproportionofpeople who would be willing to get vaccinated as soonaspossibleorarealreadyvaccinatedalsodeclineddownfrom47to4213Thissurveywas conducted prior to the most recent outbreak inNSWinvolvingthehighlyinfectiousDeltastrain
Therisk-benefitofhavingthevaccineneedstobecarefullyweighedbyeachindividualideallyinconsultationwiththeirdoctoranddependingon
The Hub has lsquobeen working in partnership with keystakeholdergroupstoguidecommunicationstomeetthehealthliteracyandculturallyandlinguisticallydiverse(CALD)needsofitspop-ulationStructuredworkinggroupshavebeencreatedtoprioritisecommunicationstovulner-ableyouthCALDgroupstheelderlyitinerateworkersasylumseekersandrefugeesTheaimsaretotestmessagingandbuildtrustwithprioritypopulationstoensureeffectivecommunicationoftheneedtosustainphysicaldistancingmeas-uresintheabsenceofavaccineSimilareffortsarenowneedednationallyandshouldstartatthetimeofdiseaseoutbreaksinthefuturealongsideplannedmassmediaandhealthcommunicationcampaignsrsquo
InthearticlebyDoddetaltheyreinforcetheimportanceofusingcommunicationformatswhich are lsquosuitable for people with low health literacyandeducationandwhichareappropriateforculturallyandlinguisticallydiversegroupsandIndigenouspopulationsrsquoThearticlearguesthatitisimportanttolookatmotivationsandconcernsabout vaccines when shaping messaging It also pointsoutthatprimarycaredoctorsareatrust-ed source and as such should be supported in deliveringinformationaboutthevaccinesandad-dressingcommunityconcernsThearticlestateslsquoWeneedtounderstandandaddresscitizenrsquosconcernsthatcanpreventoptimaluptakebuildmotivationsintomessagingandprioritisepublictrustbyinformingandinvolvingthecommunityintheprocessSupportinghealth-careprofession-als in their role as educators will ensure people haveadequateandaccessibleinformationfromatrustedsourcetooptimisevaccineuptakeandultimatelyreducecommunitytransmissionofCOVID-19rsquo15
RecentresearchbyAssociateProfessorHollySeale16withUNSWMedicinersquosSchoolofPublicHealthandDeputyChairfortheCollaborationonSocialScienceandImmunisationfoundthereisaneedtolsquodecentralisersquocommunicationsbytapping
translatedmaterialsandinformationaboutthevaccines to be tailored to the needs of people in these newly-emergingcommunitygroups
It was reported that in Wollongong there can sometimesbefourgenerationsoffamilymem-bersfromnewly-arrivedrefugeegroupslivingintheonehouseMostofthesefamilymembersgenerallyhavelimitedEnglishlanguageliteracywhichincreasestheirriskofnotreceivingkeyhealthmessagesandthereforeincreasingthepotentialimpactofCOVID-19-inparticulartheDeltastrainwhichhasprovenhighlyinfectiousamongst household members
Vaccine uptakeNotdissimilartothewidercommunitymorepeopleinourstudywereplanningtohavethevaccinethannotandanumberhadalreadybeenvaccinatedInarecentLancetarticle(February2021)ConcernsandmotivationsaboutCOVID-19vaccinationfindingsfromtwosurveysfromanAustralianlongitudinalstudyconductedinJuneandJuly2020includedthatlsquothetopthreerea-sons for agreeing to vaccinate were lsquoto protect themselvesandothersrsquohelliplsquobeliefinvaccinationandsciencersquohellipandlsquotohelpstopthevirusspreadrsquoEven among those willing to vaccinate there was somehesitancyaboutthesafetyofthevaccineTheLancetarticlenotedthatlsquowillingnesstovaccinatedifferedbybothageandeducationrsquoForthosewhowereindifferentorsaidtheywouldnot get the vaccine the top reasons across the twosurveyswerelsquoconcernaboutthesafetyofthevaccineinitsdevelopmentrsquoandlsquopotentialsideeffectsrsquo12
Olderpeopleinourstudywhocomprised23of the total sample (n=199) were the group most likelytosaythattheywantedtogetthevaccine85ofthoseover65saidtheywouldhaveorhadalreadyhadthevaccineVaccinepredispo-sitionwashoweveralsostrongacrossotherage
12RHDoddKPicklesBNickelECvejicJAyreCBatcupCBonnerTCoppSCornellTDakinJIsautierKJMcCafferyConcerns and motivations about COVID-19 vaccination SydneyHealthLiteracyLabSydneySchoolofPublicHealthFacultyofMedicineandHealthUniversityofSydneypublishedintheLancetFebruary2021p162wwwthelancet cominfectionVol21February2021
theircircumstancesHoweverthesourcesofin-formationthatpeoplemostrelyuponortrustarecriticaltothedisseminationofaccurateandclearmessaging to dispel the fear surrounding events suchasbloodclottingandthemisconceptionsraisedinthefocusgroupsWithsomanypartici-pantsinthisstudygettingtheirinformationfromFacebookandothersocialmediasitesitisvitalthat these channels are used to promote simple positivemessagesandforanyfuturecommunityawareness campaigns
Effective communicationConfusionandmisconceptionsaboutthevac-cinersquosefficacyavailabilityandsafetywereallis-sues that were raised in the focus groups Finding waystoeffectivelycommunicatewithpeoplewithlowerEnglishlanguageliteracyandhealthliteracyisanimportantwaytoaddresstheconfusionandmisconceptionsaboutthevaccineashasbeen discussed in a number of recent Australian studies
Astudy14byMcCafferyetal(2020)concludedthattherearelsquoimportantdisparitiesinCOVID-19-relatedknowledgeattitudesandbehavioursaccordingtopeoplersquoshealthliteracyandlanguagersquoOneofthefindingswasthatlsquopeoplewithlowerhealthliteracywerealsomorelikelyto endorse misinformed beliefs about COVID-19 andvaccinations(ingeneral)thanthosewithadequatehealthliteracyThesamepatternofresults was observed among people who primar-ilyspeakalanguageotherthanEnglishathomersquoTheMcCafferystudyhighlightstheimportanceof tailoring health messages to those with lower healthliteracyandculturallyandlinguisticallydiversecommunitiesItpointsoutthatthereareexamplesofeffectivemanagementofdiversecommunityneedsthatusetailoredhealthmes-sagesandcitestheWesternSydneyLocalHealthDistrictHealthLiteracyHub
13TheEssentialReport-anonlinesurveyconductedbyEssentialResearchcompletedby1090people between 21ndash26 April14McCafferyKJDoddRHCvejicEAyreJBatcupCIsautierJMJCoppTBonnerCPicklesKNickelBDakinTCornellSWolf MS Health literacy and disparities in COVID-19ndashrelated knowledge attitudes beliefs and behaviours in Australia PublicHealthResPract202030(4)e30342012December2020
15 Op cit16 httpssphmedunsweduausitesdefaultfilessphcmNewsEnhancing-supporting-COVID-19-vaccination-programpdf
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
30 31
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3332
intodifferentnetworkingspacessuchaswork-placeslocalgymsmothersrsquogroupsandseniorsrsquoclubswithafocusonallagegroupsregardlessofcurrenteligibilityAccordingtoSealethechal-lengeislsquoensuringemerginginformationisadapt-edfortheintendedaudiencersquoShehasalsosaidlsquoThatrsquoswhatIrsquomalittlebitconcernedaboutatthemomenttherersquosalotofresourcesongov-ernmentwebsitesbutthesetermsaroundbloodclottingareverytechnicalWeactuallyneedtomake sure that we are breaking them down in a waythatwillmakeitmeaningfultopeopleThatrsquosnotjustabouttranslatingitrsquosaboutbeingcon-sciousofpeoplersquoshealthliteracyneedstooSomaybegettingsomemorevisualsintomaterialstotryandsupportthatrsquo17
Thereareanumberofmulticulturalhealthresourcesthatusecommunitylanguagetransla-tionsplainEnglishandvideosfromCALDcommu-nityleaderswhichcanbedownloadedandusedbyservicesandindividualsHowevermanyofthewrittenresourcesstillrelyontechnicalandscien-tifictermsthatrequireareasonablyhighlevelofEnglishlanguageliteracyorhighlevelsofliteracyin the translated language to comprehend Host websites can also be hard to navigate making itdifficulttolocateresourcesfromsimplewebsearchesAsummaryofsomeoftheavailableresourcescanbefoundatAttachment2
MulticulturalHealthUnitsinLocalHealthDis-trictshavestaffwhocanworkwithpeoplefromculturallyandlinguisticallydiversecommunitiesatthelocallevelandtranslateandcontextualisethese materials to the needs of the end user These teams respond to local needs and popu-lationdemographicsandareexpertsineffectivehealthliteracyandhealthcommunicationwiththeirlocalcommunitiesTheyworkcloselywithcommunityandvulnerablegroupstobuildhealthliteracyandimprovedhealthoutcomesintheircommunities
Case Study ndash Be a COVID Warrior ndash Responding to COVID-19 in Multicultural Communities InWollongongtheIllawarraShoalhavenLocalHealthDistrict(ISLHD)MulticulturalHealthSer-viceco-designedacommunityengagementandeducationprogramcalledlsquoBeaCOVIDWarriorrsquowhich commenced in 2020 in response to the pandemic This program was designed to respond tothelowlevelsofhealthliteracyaroundCOVID-19potentialexposuretothevirusandaddressfearandstigmainthelocalCALDcommunitiesThelsquoCOVIDWarriorrsquoprogramreachedaround880peopleranginginagefrom14to85years65ofCOVIDWarriorparticipantswerefemaleand35weremaleCOVIDWarriorparticipantsrepresented 21 language groups The outcomes of the program included increased levels of confidenceinapplyinginfectioncontrolmeasuresincreasedliteracyandhealthliteracyandawarenessofhowCOVID-19istransmittedUltimatelyanimprovedawarenessinapplyingCOVIDsafemeasures was also reported
InApril2020theservicecommencedwelfarechecksviaphoneonafortnightlybasistosup-portsocially-isolatedmulticulturalseniorswhoboretheemotionalstressofsocialisolationFrom these calls the ISLHD heard the needs and concernsofseniorsinthecommunityInadditionourexperiencewithCALDcommunitieshighlightedtheimportanceofyoungpeopleasconduitsofessentialinformationtoadultsincommunityandfamilygroupsduetoEnglishlanguageaccessandeducation
InresponsetheISLHDinitiatedthelsquoCOVIDWarri-orrsquoprogramusingbi-culturalhighschoolstudentsthroughthelocalhighschoolsByincreasingthehealthliteracyofstudentsatschooltheselsquocham-pionsrsquocouldtalktotheirfamiliesincludingolderfamilymembersininformalsettingsandthroughsocialmediawiththeirpeersasastrategytoraisethe level of knowledge of COVID-19 trans-mission preventionandtestingTheprogrambecamesopopularthatitwasextendedintomorelocalhighschools and adults accessing the Adult Migrant EnglishProgramTheprogramwassupportedbylocalsettlementservicesprovidedbybothMaxSolutionsandtheRedCrossItwas
17 httpstheconversationcomhow-can-governments-communicate-with-multicultural-australians-about-COVID-19-vaccines-its-not-as-simple-as-having-a-poster-in-their-language-156097
later extendedtoCALDSeniorsthroughtheMulticulturalCommunitiesCouncilIllawarra(MCCI)supportprograms
AkeycomponentoftheprogramwastoprovideparticipantswithlsquoCOVIDWarriorrsquoKitswhichincludedtworeusablemaskshandsanitiserinfographicsaboutCOVID-19symptomsandinfor-mationaboutwheretestingclinicswereavailablelocallyMCCIandRuralAustraliaforRefugeesdonatedreusablemasksforeveryparticipant
AsthelsquoCOVIDWarriorrsquoprogramwasevolvingsowasthenationalvaccinerolloutplanInforma-tionwasthereforeadaptedtomeetthisinfor-mationgapForexampleadultparticipantsandseniors were supported to understand how to accesstheCOVIDvaccinelsquoeligibilitycheckersrsquoandCALD people were shown how to use the NSW HealthwebsiteCOVID-19informationpages18
Decision makingHowpeoplearecurrentlyconsideringtheriskofCOVID-19isinfluencedbyarangeoffactorsincludingratesoftransmissioninthecommunitynumbersofnewcasesreportsinthemediaofrisksandsideeffectsPeopletendtobasetheirassessmentonwhattheyarecurrentlyexperi-encingandthencheckthisagainstwhattheyarehearinginthemediaincludingandespeciallyonsocialmediaandfromfamilyandfriendsMostoftheparticipantsinourstudyspokeclearlyandarticulatelyabouthowtheyweigheduptherisk-benefitofhavingtheCOVID-19vaccineintheir decision making Low case numbers ndash at the timeofconductingtheresearchndashandasensethat Australia was lsquodoing well in safeguarding the communityagainstCOVID-19rsquoweresignificantfactorsinpeoplersquosdecisionnottobevaccinatedortoadoptalsquowaitandseersquoapproachFamilyfriends and social media were reported as having aconsiderableinfluenceondecisionmakingaswerereportsinthemediaofthebloodclottingsideeffectsofAstraZeneca
ThefactthatFacebookwasreportedlythemostpopularsourceofinformationaboutCOVID-19
18httpswwwhealthnswgovauInfectiouscovid-19Pagesdefaultaspx
andtheCOVID-19vaccineforpeopleinthestudyraisesconcernsaboutthepossibledisseminationofmisconceptionsandlsquofakenewsrsquothatmaybespread or compounded via social media Closed social media groups such as WhatsApp and WeChatwithfamilyandfriendsmayalsoleadtopeoplereinforcingtheirpre-existingbiasesThesefactorscoupledwithasensethatAustraliaisfaringwellcomparedtomanycountriesoverseasappear to have resulted in increased vaccine hesi-tancyamongparticipantsofthestudy
Factorsthatwereidentifiedaschangingvaccine-hesitantparticipantsrsquoperceptionswereanincreased risk from COVID-19 and a correspond-ingincreaseinthenumberofinfectionsandonthebenefitsidetheabilitytotraveloverseastovisitfamilyIntherecentresearchfromtheUniversityofNSWcitedaboveSearlearguesthatlsquotheremaybeotherthingsthatweneedtonowstartfocusingonhellipthatwillstarttopromoteandmotivatepeoplesuchasthechancetotravelmorefreelyforexamplersquoThisappearstobeborneoutbyourfocusgroupfindings19
Untilrecentlytherehavebeenverylowcasenumbers and few lockdowns across most of Aus-tralia and NSW The recent outbreak from mid-JuneinGreaterSydneyandintroductionofthehighlyinfectiousDeltavariantinNSWislikelytoimpactonpeoplersquosassessmentsoftherisk-benefitofhavingthevaccineandonewouldassumereducehesitancyrates
GiventheheightenedcommunityanxietycausedbythisrecentCOVID-19outbreaktheproductionofshortsharpandtargetedmessagingtoCALDgroupsincommunitylanguagesthatisaccessibleandmotivationalfeaturescommunityleadershigh-profilecelebritiesandsportsstarsfromCALDbackgroundsandisdirectedatastate-wideandlocal level would appear to be more urgent than everItisclearthatformessagingtobeeffectiveandreachitsintendedaudiencedistributionchannelsshouldincludeFacebookWhatsAppandothersocialmediaplatformsaswellastrustedsourcessuchasmulticulturalhealthworkersmulticulturalservicesandthroughGPsandMedical Centres If mainstream COVID-19 vaccine
19 Op cit
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
32 33
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3534
awareness campaigns are produced in Australia suchashavebeenproducedinNewZealandtheUnitedKingdomandNorthAmericatheyshouldincludehighprofilewell-knowncommunityfig-uresandsportingstarsfromCALDbackgroundsandincludestrategiesspecificallytargetingCALDcommunitiesincludinggroupsidentifiedaspar-ticularlyhigh-risk
It is also important that informationonvaccinesistranslatedintolanguagesfromnewerandemergingcommunitiesOthersuggestionsaroundreachingthesecommunitiesincludeface-to-facemeetingsorganisedbycrossagencypartnershipsandpeer-ledstrategiessuchas mobilising community champions and influenc-ers Messaging needs to be inclusive and framed around the collective values held by commu-n5
It is clear that reinforcing the benefits of being vaccinated at this time rather than dwelling on the risks is more likely to generate behavioural
changeandapositivevaccineresponsefrombothCALDcommunitiesandthegeneralpopulationAppropriately-designedandtargetedCOVID-19vaccinehealthinformationthatiseasytoreadinanylanguagecanbeconveyedbycommunityleadersandcommunitynetworksandpromotesthepositivebenefitsofgettingvaccinatedwouldbevaluableatthistimeBuildingontheworkofpeerchampionssuchastheCOVIDWarriorprogramisalsoasuccessfulmodeltoincreasingCOVID-19vaccinehealthliteracyandinformed decision making
Mostimportantlypositivelymotivatingculturallyandlinguisticallydiversecommunitymemberstolsquogetthejabrsquoespeciallythosewhoareadoptingalsquowaitandseersquoapproachorarevaccinehesitantwould lead to greater vaccine uptake among culturallyandlinguisticallydiversecommunitiesandthereforethecommunityasawhole
Inner West Multicultural Network Addison Road Community Centre DateWednesday12May
A focus group session of members of the Inner WestMulticulturalNetworkpluscustomersoftheFoodPantryatAddisonRoadwasheldattheAddisonRoadCommunityCentreinMarrickvilleon12Mayat200pmThesessionwaspartoftheregularmeetingoftheInnerWestMulticul-turalNetworkTheconsultationinvolvedabout26peopleandwasconductedbyRosannaBarbero
Thegroupbrainstormedresponsestoquestionsaroundvaccinehesitancyinmulticulturalcom-munitiesandmoreeffectivemessagingTheseresponseshavebeenincorporatedinthefindingsof the report
Griffith Women on Fire Focus Group Griffith Community Centre DateFriday14May
This small focus group of women was held at GriffithCommunityCentreonMay14at11amMargCouchSeniorProjectOfficerRegionalDevelopmentAustralia(RDA)-RiverinaandJoanneFitzpatrickSettlementEngagementandTransitionSupport Worker from Centacare Southwest NSW werethekeylinksandnetworkcontactsfortheGriffithcommunityTheWomenonFire(WOF)group was established as part of the Red Cross RuralFireServiceprogramlsquoManyCulturesOneCommunityrsquoInitiallyitwasestablishedtoeducatewomenonemergencypreparednessandtoen-courage NSW Rural Fire Service (RFS) volunteering andnowhastransformedintoacommunityac-tionsupportgroupTheGriffithSoroptimistInter-nationalnowauspicetheirfinancesandsupporttheWOFgroupactivitiesThefocusgroupwasfacilitatedbyCamillaCouchandlocalcommunityvolunteersledbytheGriffithSoroptimistClub
The women in the group were from Pakistan and IndonesiaThegroupweremainlyyoungmotherswithyoungchildrenandtheprogramhadchild-minding arrangements The language level of the womenwaslowandmostwerestudyingESOLat
ATTACHMENTS
ATTACHMENT 1 A Description of the Focus Groups
TAFEThedeliveryoftheinformationwaslimiteddue to language levels and the lack of bilingual interpretersEachparticipantworkedoneononewithavolunteertoslowlyfillinthesurveyandonewomantookthesurveyhometodiscusswithherhusbandThisgroupexperiencehighlightedthe lack of bilingual workers and services in some rural areas
Arabic speaking group Syd West Multicultural Services Mount Druitt Community worker Zaid Naoum Generalist Caseworker SydWest Multicultural Services DateMonday24May
ThefocusgroupfromSydWestMulticulturalSer-viceswasconductedonMonday24May2021atSydWestMulticulturalServicesMountDruittat300pmItwasfacilitatedbyPatriciaMcCormickandsupportedbyZaidNaoumGeneralistCase-workerSydWestMulticulturalServices
Therewere10womenandmenfromSyriainthegroupThegroupweremostlymaturetoolderparticipantsMostparticipantsrequiredassistancewithEnglishandthecaseworkerZaidNaoumhadtranslatedthesurveyintoArabicpriorto the focus group Zaid also translated during the focus group
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Canterbury City Community Centre (4Cs) group The Cottage Lakemba DateTuesday25May
ThefocusgroupfromCanterburyCityCommunityCentre(4Cs)wasconductedonTuesday25MayattheCottageat28CroydonStreetLakembaat10amItwasfacilitatedbyRobinMilesandsup-portedbyRomanaWaseemCommunityWorkerfrom 4Cs
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
34
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3736
The group was comprised of 14 women from PakistanIndiaandSriLankaThewomenrangedinagefrom23to65MostwerefluentEnglishspeakershoweveronewomanrequiredtransla-tionintoUrdufromoneoftheotherwomeninthegrouptoanswerthequestionsdirectly
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
NSW Chaldean League group Community worker Randa Goriya DateTuesday25May
ThefocusgroupfromNSWChaldeanLeagueMountDruittwasconductedonTuesday25May2021 at 1000am at the NSW Chaldean League premisesItwasfacilitatedbyPatriciaMcCormickandsupportedbyRandaGoriyaacommunityworker for the NSW Chaldean League in Mount DruittRandatranslatedtheintroductionandpromptsforthediscussionandhelpedthepartic-ipantstocompletethesurveyMostofthegrouprequiredhelptodothesurvey
ThegroupoftwelveparticipantswereallChaldeanandwerematuretoolderinageTheywereamixed-gendergroup
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Arabic speaking group Red Cross premises Wollongong DateTuesday25May
ThefocusgrouptookplaceonTuesday25Mayat 3pm at the Red Cross premises at Wollongong Therewere22womenandmenparticipatinginthegroupThefocusgroupwasfacilitatedbyCamilla Couch with support from Khalid Zainu-labdeenBilingualSupportWorkerHumanitarianSettlementProgram(ACTampNSW)
There were diverse ages in the group ranging fromyoungpeopletoolderagedMostofthegroupwereyoungerrecently-arrivedrefugeesfrom diverse backgrounds There was also a small-eroldercohortofparticipantswithhigherliteracylevelsandstrongercommunityengagementwith the local services in the area Camilla Couch facilitated the focus group which was conducted inArabicandEnglishwiththeArabictranslationprovidedbyKhalidZainulabdeen
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Work Opportunities for Women group Mt Druitt TAFE DateWednesday26May
TheWorkOpportunitiesforWomen(WOW)focusgroupwasheldonWednesdayMay261100ndash 100pmatMtDruittTAFEItwasfacilitatedbyCamilla Couch and built on the knowledge gainedintheprevioussessiononcriticalandanalyticalthinkingTheWOWgroupisaTAFECertificatelevel course
There were 14 women from diverse cultural backgroundsinthegroupThegroupweremainlyMuslimwomenwithschoolagechildrenandsome were mature aged Due to the learning fo-custhegroupwasfacilitatedasaclasswithguid-eddiscussionontheissuesandcarefulanalysisofthequestionsNotranslationwasneededduetotheeducationalcontextThestudentswereadeptatusingITandcompletedallthesurveysonline
STARTTS Tamil group Toongabbie Community Centre Community worker Sivaharani (Harani) Mayuran DateThursday27May
Thefocusgroupconsistedof18femalepartic-ipantswhowereyoungertomatureagedThefocus group was held at 1000am at Toongabbie CommunityCentreinTargoRdToongabbie
ThefocusgroupwasfacilitatedbyPatriciaMc-CormickandsupportedbyacommunityworkerSivaharani(Harani)MayuranfromtheSTARTTSTamil Group
ThegrouphadmixedlevelsofspokenandwrittenEnglishTheintroductionanddiscussionpromptsweretranslatedbythecommunityworkerSivaha-rani(Harani)Mayuranandsheandthemorepro-ficientstudentssupportedthosewithlowliteracytoanswerthesurveyquestions
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Spanish Speakers Seniors group SydWest Multicultural Services Blacktown DateTuesday1June
TheFocusGrouptookplaceonTuesday1Juneat1100amattheBlacktownShowgroundsandconsistedof16participants(15womenandoneman)AllparticipantswerebornincountriesinSouthAmericaTheirEnglish-fluencylevelsvariedand one of the members of the group translated thesurveyquestionsanddiscussionintoSpanish
ThegrouphadbeenmeetingforseveralyearsThegroupwasfacilitatedbyLindyCassidyandwassupportedbySreeVithyaHarilingamDayRespiteampSocialSupportTeamLeaderatSydWestMulticulturalServicesBlacktownThegroupwerematureagedtoolderparticipants
Thegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyform There was a more focused discussion on somekeyquestionsaftersurveycompletionThetranslatorassistedconsiderablyinthisprocess
Italian Speakers group Warrawong Community Centre DateMonday7June
The focus group of Italian speakers was held on Monday7Juneat1015amattheWarrawongCommunityCentreItwasfacilitatedbyCamillaCouchandsupportedbyJohnPaulTroianiand
SofiaLemafromIllawarraShoalhavenLHDMulti-cultural Health
There were 15 women in the group The group weremostlymaturetoolderparticipantsandwasconductedinItalianandEnglishwithtranslationprovidedbyJohnPaulThisgroupmeetsregularlyandissupportedbyanumberofservicesintheareaespeciallymulticulturalhealth
The group had a general facilitated discussion aboutthequestionsinthesurveyDuetolittleornoliteracytheindividualsurveyresponseswerethencollectedintooneresponseThesesurveyresponses have been included in the general surveyresponses
Mothers Group SydWest Multicultural Services Blacktown DateThursday10June
ThefocusgrouptookplaceonThursday10Juneat1030amandconsistedof14youngwomen13 of whom had a CALD background The focus groupweremainlymothersfromasupportgroupatSydWestMulticulturalServicesinBlacktown
EightofthewomenwereborninIndiatwofromPakistantwofromSriLankaonefromHausaGhana and one was born in Australia (the Austral-ianbornyoungwomanwasasocialworkstudenthelpingwiththegroup)LindyCassidyfacilitatedthe group with support from Wilma Garguath a projectofficerfromSydWestMulticultural Services
The group varied in age One was between 18-24 yearsoldSevenwereagedbetween25-34yearsSixwereagedbetween35=44yearsGiventheirage and circumstances most of the group did not consider themselves eligible at this stage for vac-cinationThiswasanimportantdifferencefromotherfocusgroupsinthattheemphasiswasmoreonwhattheywoulddooncetheybecameeligible
Participantsdidnotrequireassistancewithspo-kenEnglishThegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyformTherewasamorefocuseddiscussiononsomekeyquestions
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3938
ATTACHMENT 2 COVID-19 Vaccine Information in multiple languagesThefollowingsitesappsprovidetranslatedinformationaboutCOVID-19vaccines
Type of information KeyinformationongettingvaccinatedinNew South Wales and on the vaccines available The websiteusesanautomaticservicetotranslate thecontentintodifferentlanguages
Source of information NSW Government website
Link httpswwwnswgovauCOVID-19health-and-wellbeingCOVID-19-vaccina-tion-nswgetting-vaccinated
Type of information COVID-19ResourcessectionontheServiceNSWapp The app has a link to NSW Government websiteinformationonldquoGettingaCOVID-19vaccinationrdquo(seeabove)ItalsoincludesalinktoCOVID-19vaccinationresourcesinotherlan-guages available from the Department of Health
Source of information Service NSW NSW Government
Link Service NSW App
Type of information ArangeoftranslatedresourcesonCOVID-19bytitleincludingafactsheetonCOVID-19VaccineAstraZeneca(ChAdOx1-S)
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCOV-ID-19Pagestranslatedresources-by-titleaspx
Type of information ADigitalCOVID-19resourcelibrarywithtranslated materials
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiouscov-id-19Pagesdigital-resourcesaspx
Type of information AMultilingualCommunityToolkitontheCOVID-19vaccinationprogramtoassist communityworkersprovideseasytoreadresourcesvideosandlinkstokeyservicesandresources
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCovid-19DocumentsNSW-COVID-19-vaccina-tion-program-presentation-20210527pdf
Type of information TheNSWMulticulturalHealthCommunicationServiceoffershealthresourcesandinformationin a wide range of languages It has translated resources on COVID-19 and links to translated resourcesonCOVID-19vaccination
Source of information MulticulturalHealthCommunicationServiceisa New South Wales-wide health service hosted bySouth-easternSydneyLocalHealthDistrict(SESLHD)
Link httpswwwmhcshealthnswgovau
Type of information COVID-19vaccineinformationaddressingkeyquestionsaboutCOVID-19vaccinationandincludesvideosposterstilesfactsheetsandaudio material Translated into 63 languages
Source of information Department of Health Australian Government website
Link httpswwwhealthgovauinitiatives-and-pro-gramsCOVID-19-vaccinesCOVID-19-vaccine-in-formation-in-your-language
Type of information ThisinformationaddressessomecommonmisinformationaboutCOVID-19Translatedintomultiplelanguages
Source of information DepartmentofHomeAffairs Australian Government website
Link httpscovid19inlanguagehomeaffairsgovaumisinformation-and-truths-about-coronavirus
Type of information Australianandinternationalnewsand informationaboutCOVID-19andCOVID-19 vaccinesisavailableontheSBSCoronavirusPortal in more than 60 languages
Source of information SBSwebsite
Link httpswwwsbscomaulanguagecoronavirus
Type of information InformationprovidedaboutCOVID-19vaccinerolloutandsafetyinlanguagesotherthan English
Source of information Department of Health and Human Services Victorian Government
Link httpswwwcoronavirusvicgovautranslat-ed-information-about-COVID-19-vaccines
Type of information HealthTranslationsprovidestranslatedmateri-alsonhealthandwellbeingInformationaboutCOVID-19isregularlyupdatedincludessomeinformationonvaccinationandisavailableinover60communitylanguages
Source of information Victoriangovernmentinitiative
Link httpswwwhealthtranslationsvicgovaubhcv2bhchtnsfPresentEnglishResource-AllOpenampx=amps=Coronavirus
Type of information A one-stop shop for translated materials in multiplelanguagesonCOVID-19
Source of information Ethnolink Language Services
Link httpswwwethnolinkcomauCOVID-19-coro-navirus-translated-resources
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
40
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
76
HEALTH INFO
Health information from online sources (low use of government websites)
Main stream media
Younger group
Tik Tok
58 said yes to the vaccine with 64 previously vaccinated
= 2 people
29 were unsure or hesitant
13 reported that they would not have the vaccine
Issues barriers and perceptions about the Covid-19 vaccine among culturally and linguistically diverse communities in NSW
if I could get
home to see my
mother I would
get vaccinated
today
Covid is not
real and present
danger but I would
get vaccinated if
there was a
reason too
I would get vaccinated
FEARS amp CONCERNS about the
vaccineFear about blood clots
caused by the Astra Zeneca
vaccineFear about
the perceived lack of lsquoproperrsquo testing of the
vaccineLack of
certainty about how the vaccine
workedConcerns
that the vaccine will make you sick or change
your DNA
Concern that the vaccine
is a form of government
controlA belief that if you were
healthy it was better to fight the virus and
make yourself and your immune system
lsquostrongerrsquo as a result
if there was more risk from Covid ndash another outbreak or concern about increased transmission
199participants
11focus groups
if I had to in order to keep my job
if I was able to travelto see myfamily
More likely to get the vaccine
+65 age groupThis small study of 199 people from a range of cultural backgrounds in
metropolitan Sydney and two regional locations
found that the community is divided in its response to both the safety need
and efficacy of the vaccine
Almost half of the participants knew someone who had contracted COVID-19 over-seas Many people spoke about the impact of COVID-19 on their immediate family including some who had lost loved ones
Influence of friends and family overseas
2 3
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
98
This research project has been commissioned by the New South Wales Council of Social Service (NCOSS) to look at issues concerns attitudes and barriers to receiving the COVID-19 vaccine in culturally and linguistically diverse (CALD) communities in NSW
The research was conducted over two months fromlateApriltolateJune2021withdatacol-lectedjustpriortothelatestCOVID-19outbreakinSydneyItwasundertakenwithsomeurgencygiven the following factors
the lack of data concerning peoplefromculturallyandlinguisticallydiverse backgrounds in larger research studies 2
theheightenedconcerninthecommunity aboutthepotentialsideeffectsofin particulartheAstraZenecavaccinewhich has led to a higher-than-usual rate of vaccine hesitancyinthewidercommunity3
theneedtolifttheoverallvaccinationratein Australia
Emergingresearchindicatesthatmisconceptionsabout COVID-19 in Australia tend to be more common in groups with lower levels of health literacyincludingpeoplewhospeakalanguageotherthanEnglishInadditionthevariedexperi-enceofandinformationaboutCOVID-19trans-missionandvaccinationinoverseascountriesmakesthisaparticularlyinterestingissuegiventhatCALDcommunitymembersmaybehavingregulardiscussionswithrelativesoverseasandgettinginformationaboutCOVID-19fromover-seas sources
2McCafferyKJDoddRHetalHealth literacy and disparities in COVID-19ndashrelated knowledge attitudes beliefs and behaviours in AustraliaPublicHealthResPract202030(4)e30342012 December 2020 First published5 November 2020lsquoThereareseverallimitationstoourstudyAlthoughourrecruitedsamplewaslargeanddiverseitwasnotstatisticallyrepresentativeoftheAustralianpopulationTheproportionofAustraliansfromnon-Englishspeakingbackgroundswassmall(6)sincethesurveywasnottranslatedandrequiredsufficientEnglishskillstocompletethequestionnaireinEnglishrsquo(p7)
3AnonlinesurveyconductedbyEssentialResearch(April2021)completedby1090peoplebetween21ndash26April2021foundjust43ofAustraliansthinktherolloutisbeingdoneefficientlydownfrom68inMarchhellipTheslowrolloutandchanges to the roadmap also appear to have given rise to vaccinehesitancywithoneinsixpeople(16)sayingtheywillnevergetvaccinatedagainstCOVID-19upfrom12lastmonthwhile42saidtheywillgetvaccinatedbutnotrightawayTheproportionofpeoplewhowouldbewillingtogetvaccinatedassoonaspossibleorarealreadyvaccinatedalsodeclineddownfrom47to42rsquoEssentialReport(April 2021)
A mixed-method research methodology was used for this project However it was primarily a qualitative approach that aimed to hear directly from people in the community from culturally and linguistically diverse (CALD) backgrounds The methodology involved
METHODOLOGY
11 focus groups (including one pilot) involving atotalof167participantsfromCALD backgroundsand7locationsGriffith(1) Wollongong(2)Blacktown(2)Lakemba(1) MtDruitt(3)Toongabbie(1)andMarrickville (1)Thesesupportedparticipantstoanswer thesurveyquestionsandenabledmore detailedexplorationofissuesandfurther gatheringofqualitativeinformation(see Table1below)Identifiedmulticulturalandcommunityserviceorganisationswith connectionstoCALDcommunitiesinthe relevantlocationsactedaslsquointermediariesrsquo byassistingwithorganisingthefocusgroups providingbilingualfacilitationofdiscussion andsupportingcommunitymembersto undertakethesurveyMoreinformationonthefocusgroupsandintermediary organisationscanbefoundatAttachmentA
Anonlinesurveywiththesamequestionsas those used in the focus groups was made available This was promoted via NCOSS networksandtheresearchteamrsquosCALD connectionsandcompletedby32peopleThe totalsamplesizeofthisstudywastherefore 199participantsmadeupofmembersof diverseCALDcommunities
Abilingualmulticulturalcommunity engagementexpertwasengagedthroughout theprojecttoadvisetheresearchteam includinginrelationtothedesignofthe surveyBilingualfacilitatorswereusedfor focusgroupswherenecessaryandguidance wasprovidedbyintermediaryorganisation representativesasrequiredandinone instancethesurveywastranslatedintoArabic Focus group members were each provided witha$25giftcardattheendofthesession anda$50giftcardwasdonatedtothe intermediaryorganisationtoprovidesome additionalresourcestoeachgroup
Asecondonlinesurveywasdesignedtoelicit theviewsandexperienceoftheintermediary organisationsintheirworkwithCALD communitiesItgeneratedeightresponses
Two interviews were undertaken with a multiculturalhealthcommunicationexpert from the Illawarra Shoalhaven Local Health DistrictandanEmergencyDepartment medicalpractitioner
Theonlinesurveyresponsesfromthe intermediaryorganisationsandtheinterviews withhealthstaffhaveinformedanalysisof datafromcommunitymembersfindingsand recommendations
Inadditiontheresearchhasbeeninformedbyotherpubliclyavailableresearchincludingfind-ingsconcerningvaccinehesitancyanduptake4andascanofmulticulturalCOVID-19healthresourcesavailableincommunitylanguagesfromtheCommonwealthNSWandVictorianGovern-mentsSBSandEthnolink(seeAttachment2)
Recruitment for the focus groups IntermediaryorganisationsandfocusgroupparticipantswererecruitedusingtheresearchteamrsquosextensiveconnectionswithmulticulturalandcommunityserviceorganisationsacrossNSWanddrawingonkeyNCOSSmemberorganisa-tionsprovidingsupporttoandwithlongstandingrelationshipswithCALDcommunitiesToalargeextenttheselectedlocationsandtheservicesandsupportsprovidedbytheintermediaryorgan-isationsdeterminedtheculturalbackgroundsthatwereincludedinthestudy
4 httpswwwncossorgauCOVID-19-research
INTRODUCTION
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1110
Service Location Group Composition Participant numbers
Addison Road Community Centre Marrickville Community leaders - Vietnamese Chinese Italian Greek Indonesian Latin American and Portuguese speakers
26
Griffith Community Centre Griffith Indonesian and Pakistani women 6 Multicultural Communities Council Illawarra
Wollongong Arabic-speaking group 22
Multicultural Communities Council Illawarra
Wollongong Italian older womenrsquos group 15
Syd West Multicultural Services Mt Druitt Arabic-speaking group 10 Syd West Multicultural Services Blacktown Spanish-speaking seniorsrsquo group 16 Syd West Multicultural Services Blacktown Mothersrsquo support group -
Indian Sri Lankan Pakistani and Ghanaian
14
Canterbury City Community Centre (4Cs)
Lakemba Pakistani Indian and Sri Lankan women
14
Chaldean League and Western Sydney TAFE
Mt Druitt Chaldean group 18
STARTTS - Toongabbie Community Centre
Toongabbie Tamil-speaking group 12
Mt Druitt TAFE ndash TAFE NSW Mt Druitt Work Opportunities for Women group (mixed CALD backgrounds)
14
TOTAL 167
Table 1 Focus Group DetailsExplanatory noteThefocusgroupatMtDruittTAFE-comprisedpredominantlyofCALDwomenenrolledinaCertificateIIentrylevelcourse-wasusedtopilotandrefinethefocusgroupprocesswithsurveyresponsesgeneratedbythegroupincludedinthefinalsurveyresults
A word about the research design Theresearchwascarefullydesigneddrawingonexpertculturaladviceoncommunicationpro-cessesandsurveydesignFocusgroupsincludedparticipantconsentformsincentivevouchersandaone-pageintroductiontotheresearchfortheintermediaryorganisationsIntermediaryorgan-isationsandpreferredlocationswereidentifiedand agreed in advance with NCOSS
Thesurveywasdesignedinaneasy-to-readformatusingsimpleEnglishFeedbackfromthe Spanish-speaking translator was that it was extremelyeasytotranslateandcompleteOthergroupscommentedthattheyfoundthesurveyeasytocompleteandmostgroupsdisplayedasolidlevelofspokenandwrittenEnglishTheresearchdesignandconductalsoleantheavilyontheexpertiseofthefacilitatorsandtheirexten-sivenetworkswhichmadedeliveryinsuchashorttimeframepossibleThepositiveengagementandsupportoftheintermediaryorganisationswasalsoafactorcontributingtothesuccessfulconduct of the research
Withoutfailthemulticulturalandcommunityserviceorganisationsinvolvedintheresearchper-ceived the importance of its purpose and shared a desire to provide NSW Health with feedback directlyfromtheircommunitiesasamatterofurgency
Demographics of research participantsThemakeupofthosewhoparticipatedintheresearch was diverse in age and cultural and languagebackgroundParticipantswerepredom-inantlywomen(84)withmenmakinguponly145OverhalftheparticipantshadlivedinAustraliaformorethan20yearswhichimpactedpositivelyontheirlevelofspokenandwrittenEnglishHowevertherewerequitelowlevelsofEnglishliteracyinanumberofthegroupswhichmadeguidedsurveycompletionamoreneces-sarybutcomplexprocess
1 1 1
6
3
31
16 17
20
12
15
1
8
2
64
1
5
2 13
1 1
7
2 1
5
1 1 1 1 2 10
5
10
15
20
25
30
35
Indo
nesia
Thai
land
Hong
Kon
gAu
stra
lia Iran
Iraq
Viet
nam
Italy
Sri L
anka
Indi
aPa
kist
anGh
ana
Syria
Boliv
iaCh
ilePe
ruEl
Sal
vado
rM
alay
siaUr
ugua
yAr
gent
ina
Cam
bodi
aUk
rain
eRu
ssia
Chin
aSu
dan
Eritr
eaSw
eden
Taiw
anAf
ghan
istan
Pola
ndJa
pan
Egyp
tJo
rdan
13
1 2
10
17
2
21
1
11
1 1
12
2 1
27
10
1 1 1 13 2 1 2 1
6
1 1 1
32
0
5
10
15
20
25
30
35
English Thai
Cant
ones
eVi
etna
mes
eIta
lian
Farsi
Tam
ilTe
lugu
Span
ishSp
anglish
Haus
aUr
duGu
jara
tiPu
njab
iAr
abic
Chalde
anHi
ndi
Khm
erPe
rsian
Russian
Man
darin
Malay
Haza
ragi
Tigr
inya
Kurd
ishCh
ines
ehellipJa
pane
sePo
lish
Swed
ishM
ultip
le
Figure 1 Country of BirthFigure 2 Language spoken at home
METHODOLOGY
Coun
t
Coun
t
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1312
211
1316 14211684
2053
3316
Less that 1year
1 - 2 years 2 - 5 years 5 - 10 years 10 - 20years
More than20 years
000
500
1000
1500
2000
2500
3000
3500
Less than 1-2 years 2-5 years 5-10 years 10-20 More than1 year years 20 years
1453
8430
000 116
Male Female Non-binary Rather not say000
100020003000400050006000700080009000
000
785
1728
2147
1309
1675
2356
Under 18 18-24 25-34 35-44 45-54 55-64 65+000
500
1000
1500
2000
2500
Figure 3 Length of time living in Australia Figure 5 Gender
Figure 4 Age
METHODOLOGY
Chaldean Focus Group Feedback Sheet
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1514
Research participants were asked
If they were intending to get vaccinated
The reasons why they would or would not choose to get vaccinated
If they knew anyone who had already been vaccinated and if so who
If they knew anyone who had contracted COVID-19 and if so who
If they knew where to go to get vaccinated
What sources they used to get information about the COVID-19 vaccination
Basic demographic information age gender country of origin language spoken at home and length of time living in Australia
Having the vaccine or notOfthe199participants117(58)reportedthattheywereplanningtobeorhadalreadybeenvaccinatedwhile78(42)reportedthattheywere not planning to have the vaccine (13) or didnotknowiftheywouldgetvaccinated(29)
1453
8430
000 116
Male Female Non-binary Rather not say000
100020003000400050006000700080009000
05
10152025303540
Under18
18-24 25-34 35-44 45-54 55-64 65+
Coun
t
Yes No Donrsquot Know
Figure 6 Are you going to get the COVID-19 vaccine
Figure 7 COVID-19 Vaccine intention of respondents by age category
13people(65)hadalreadybeenvaccinated(at least 1 dose)6withseveralcommentingthattheyhadchosenorneededtobevaccinatedforwork-relatedreasonsOthersreportedthattheyhadbeenvaccinatedprimarilyforhealthreasonstostaywellandmakesurethattheirfamiliesstayedwellTheywerealsoconcernedaboutpublichealthandsafetyOneofthewomenintheLakemba groups from Sri Lanka was adamant that thebenefitsoutweighedtherisksspokepositive-lyabouthoweasyithadbeentogetthevaccinefrom her local medical centre and that she had experiencednosideeffectsfromthevaccination
Language Count Percent Urdu 1 Italian 3 Arabic 2 Tamil 3 Chaldean 1 Spanish 3 Total 13 65 of sample
Response Count Percent Not planning to have the vaccine 23 13 Unsure about having the vaccine 52 29
75 42
Table 2 Respondents already vaccinated
Table 3 Respondents who indicated vaccine refusal or hesitancy
6 Theresearchersdidnotdistinguishbetweenwhetherpeoplehadreceivedtheirfirstandseconddosesofthevaccineiepartiallyorfullyvaccinated
75(42)indicatedadegreeofvaccinehesitancywith24participants(13)reportingthattheywerenotplanningongettingvaccinatedwhile53(29)reportedtheydidnotknowiftheywouldget vaccinated
Thislevelofvaccinehesitancyreflectslargerstud-iesintheAustraliancommunityAsurveyofover1000participantsfromacrossAustraliaconduct-edinApril2021byEssentialResearchfoundhes-itancyratesof42including16whoindicatedtheywerenevergoingtogetvaccinated7
Foroursurveyresponsesindicatedthatagewasafactorwith85ofrespondentsaged65andoverreportingthattheywouldhaveorhad
7EssentialResearchThe Essential Report21April2021
FINDINGS FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1716
alreadyhadthevaccineThosewhoindicatedthattheywouldnotbehavingthevaccinewerefairlyevenlydistributedacrossagegroupswithyoung-er people aged 18-24 being the age group with thehighestproportionofparticipantsexpressinguncertaintyabouthavingthevaccineTheagegroupwiththesecondhighestlevelofhesitancyproportionatetoothercategorieswerethe35-44yearolds
02468
10121416
Iraq
Vietnam Italy
South Americ
a
Sri La
nkaIndia
Syria
Other South East
AsiaAfric
a
Australia
Sweden
China
Pakistan
Iran
Eastern Europe
Afghanistan
Japan
Coun
t
Yes No Dont know
8095 8190
70486095
4571
6190
095
To stayhealthy and
well
To keep myfamily
healthy andwell
For publichealth
To travel To work It is theright thing
to do
Somethingelse (pleasetell us what)
000100020003000400050006000700080009000
Figure 8 Respondents COVID-19 Vaccine intention by Country of Origin
Figure 9 Reasons for getting vaccinated against COVID-19
Countryoforiginalsoseemedtoplayaroleinpeoplersquosviewsabouthavingthevaccinewithhighvaccinepre-dispositionreportedbyVietnameserespondentstotheonlinesurveyandwomenintheItalian-speakinggroupWhileparticipantsfromIraqrecordedthehighestlsquoyesrsquoresponsethiswasalmostmatchedbyIraqiparticipantswhoreportedthattheywerelsquounsurersquoorlsquodidnotknowrsquowhethertheywouldhavethevaccineTherelevanceofcountryoforigininthisregardwouldbeworthyoffurtherresearch
The Italian focus group held in Wollongong was an olderwomenrsquossocialgroupwithallparticipants(15) agedabove65yearsMostinfactwereaged over75yearswithoneparticipantinher90s 87 of the group had either been vaccinated (3) or were planning to get vaccinated (10)
Of course I will get vaccinated It is important to do this It is a very bad
disease
Thesewomenweremotivatedtostayhealthyandwellkeeptheirfamilyhealthyandwellforpublichealthreasonstobeabletotravelandforgen-eralsafetyMembersofthegroupalsoreportedthattheywantedtogetvaccinatedsothattheywouldbeabletolsquodancersquoandlsquosocialisersquo
Reasons for having the vaccine
Ofthe117participantswhoreportedthattheyhadeitheralreadybeenvaccinatedorwereplan-ningtogetvaccinatedlsquokeepingmyfamilyhealthyandwellrsquo(82)andlsquokeepingmyselfhealthyandwellrsquo(81)werethetwomostpopularreasonsforhavingthevaccineThiswasfollowedbylsquoforpublichealthrsquo(70)lsquoitistherightthingtodorsquo(62)andinorderlsquototravelrsquo(61)(SeeFigure9)
I donrsquot want to
die
Irsquom over 65 I have some health issues I think itrsquos
[having the vaccine] very important to
keep safe
I want to see my family I usually go every year but now I havenrsquot seen them
because of COVID-19 Having it will help
I am well but my parents are older It is important to
keep them well
Otherreasonsthatpeoplegaveforgettingvacci-natedincludedtheneedtocontinueworkinginessentiallsquofrontlinersquoemploymentsuchassecuritycleaningandagedcaresettingsOnewomanintheLakembafocusgroupwhohadalreadyhadherfirstdoseoftheAstraZenecavaccinesaidthatlsquothebenefitsoutweightherisksrsquoandasanolderwomanrsquoIdonotwanttodiersquo
All but one of the focus groups were familiar with thedifferentvaccinescurrentlyavailableinAus-traliaAstraZenecaandPfizerMostparticipantswere also aware of blood clots being associated with the Astra Zeneca vaccine One group of newly-arrivedrefugeesinGriffithhadnotheardofeithertheAstraZenecaorPfizervaccinesandhadamorelimitedunderstandingofthevaccinationprogram in general
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1918
Reasons for not having the vaccine
At the moment the situation is under control and donrsquot feel the need Also I have no plans to
travel in the near future so I donrsquot see the need
3514
21622703
3243
1892
811 541
4865
1081
Thevaccine isnot welltested
Thevaccine is
unsafe
Formedicalreasons
I amscared tohave thevaccine
I dont likevaccines
Forreligiousreasons
Forculturalreasons
I want towait and
see
Somethingelse
(pleasetell uswhat)
000
1000
2000
3000
4000
5000
6000
Figure 10 Reasons for not getting vaccinated against COVID-19
Theperceivedlsquolackofadequatetestingrsquoofthevaccineandlsquofearofbeingvaccinatedrsquoalsore-ceivedhighresponseratesselectedby3514and3243ofparticipantsrespectivelyOnly1355 of respondents cited religious or cultural reasonsasbeingbehindtheirvaccinehesitancy
Open-endedresponsestothisquestionincluded
The vaccine is not 100 working It cannot offer
100 protection
Ofthe42participantswhosaidthattheywouldnothaveorwerehesitanttohavethevaccine4865saidthattheypreferredtolsquowaitandseersquobeforegettingvaccinated
Thediscussioninthefocusgroupsaboutpeoplersquoshesitancytobevaccinatedfocusedonanumberofconcernswhichreflected
poorcommunicationfromanumberof trusted sources including GPs and some media sources
conflictinginformationaboutthevaccinefrom healthauthorities
fearsaboutvaccinesafetythataresharedby thegeneralcommunity
misconceptionsabouttheeffectivenessof andhowthevaccineswork
I will not have it because make me sick
Issuesraisedinfocusgroupsascontributingtoincreasedhesitancyincluded
Some GPs being hesitant to recommendvaccination
Theinformationbeingprovidedisconflicting
Theinformationisoverlycomplexandnotcomprehensibleregardlessofwhetherithasbeen translated
The risk of blood clots
Perceptionsthatthevaccinesaregenerallyunsafe
Concernsthatsomepeoplearedyingafterbeing vaccinated
Not being sure about the risks associated withhaving the vaccine and being pregnant orbreastfeeding
Theperceptionthattherehasbeenalackoftestingofthevaccinespriortorollout
AlackofunderstandingofhowvaccinesworkthecompositionofthevaccinesandwhattheywoulddotothebodyincludingmakingchangestoapersonrsquosDNA
Specificcommentsincluded
I have heard that the vaccine changes
your DNA
I am a mother I am not sure it [the vaccine] is safe for
me when I am breastfeeding
If you are young and healthy your body has the energy to fight the virus
You donrsquot need to have the vaccine You should just let
your body fight it itself
They donrsquot tell you what chemicals are in the
vaccine
Tamil Focus Group Feedback Sheet
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2120
Nobody knows what to do My GP doesnrsquot even know what I should do whether
I should have it or not
I am not sure what to do I have spoken to my
GP but they canrsquot tell me whether I should have the vaccine or not while I am
breastfeeding
They say one thing and then they tell you
something elsehellip it [the vaccine rollout] is so
confusing
Confusionaboutwhattodowheretogoandthe health impacts of the vaccine was a common threadintheconversationsaroundvaccinehesi-tancy
Onewomanwhosehusbandworkedforasecurityfirmsaidthatherhusbandhadhadtobevacci-natedinordertokeephisjob
In several focus groups the issue of government control was also raised A number of people re-portedstronglythattheyfearedthatthevaccinewas lsquoa means that the government was using to controlpeoplersquo
He [husband] had to have it He didnrsquot have a choice He was fine [no side effects] but Irsquom not
thinking I will have it I donrsquot need to Irsquom a mum Irsquom busy I have
to look after my children I donrsquot know how I feel about it whether
Irsquom going to have it
Vaccine refusal
Onlyasmallnumberofparticipants(24or13)saidtheywouldnotgetvacci-natedOfthisgroup21werewomenand 2 were men8 Respondents were bornintendifferentcountrieswithadiverse range of language backgrounds
I never get sick It is the same for all my family We have always been strong and healthy so I will be
saying no to the vaccine
Country of Birth Language Background Count Pakistan Urdu 4 China Taiwan Chinese
(MandarinCantonese) 4
Sri Lanka India Tamil 3 Chile Spanish and English 2 Italy Italian 2 Iraq Syria Arabic 2 Iraq Chaldean 1 Iran Farsi 1 Greece Macedonian 1 Poland Polish 1 Pakistan Punjabi 1 Sweden Swedish 1 Vietnam Vietnamese 1
Table 4 Vaccine refusal by country of birth and language background
8 ThisreflectstheoverallsamplebiastowardswomenThemajorityoffocusgroupparticipantswerewomenXwithYparticipantsbeingmen
Reason for not having the vaccine Percent Count The vaccine is not well tested 5455 12 I want to wait and see 5455 12 The vaccine is unsafe 3636 8 For medical reasons 3182 7 I am scared to have the vaccine 3182 7 I dont like vaccines 1364 3 For religious reasons 1364 3 For cultural reasons 909 2 Something else (please tell us what) 909 2
SomeinthiscategorywereadamantthattheywouldnotbehavingthevaccineandhadverystrongviewsonitlsquoForculturalreasonsIwonrsquotbehavingthevaccinersquoWhenwelookatrespons-esmorecloselyhoweveritwouldappearthatmanyareinfactmorelsquohesitantrsquothanfirmvaccinerefusers
One reluctant middle-aged Tamil-speaking wom-ansaidlsquoIftheysaywehavetogetvaccinatedthenIwillrsquoThissentimentwas stronglysup-portedbythe rest of the Tamil-speaking group
Studyparticipantswhosaidtheywouldnothavethe vaccine were also concerned that lsquothe vaccine wasnotwelltestedrsquo
The vaccine has been rushed out It has not been
properly tested
Table 5 Reasons for not having the vaccine
Peopleinthiscategorysaidthattheywouldlsquowaitandseersquowhathappenswiththewiderrolloutbe-foremakingtheirfinaldecisionThissuggeststhataproportionofthelsquonorsquogroupareinfacthesitantrather than outright refusing to have the vaccine
Therewerealsofearsexpressedbyfocusgroupparticipantsaboutthedangersofbeingvacci-natedParticipantsreportedbeingafraidofthehealthrisksespeciallyfrombloodclotsSomepeopledistinguishedclearlybetweenAstraZene-caandPfizerinthisregardHoweverformanythedistinctionbetweenthedifferentvaccineswaslostandtheyspokeofthevaccinesgenerallybeing unsafe and having a range of unwanted side effects
Other factors consideredInadditiontothebroaderquestionsofwhypeo-plewouldorwouldnotchoosetogetvaccinatedthe research team used the focus group discus-sionstoexplorewhetherthefollowingfactorshadanyimpactonapersonrsquoslikelihoodofbeingvaccine pre-disposed or hesitant
Knowing someone who had been vaccinated
Knowing someone who had contracted COVID-19
Knowing where to go to get vaccinated
Thesourcespeopleturntoforinformation about COVID-19 and COVID-19 vaccines
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2322
Knowing someone who has been vaccinatedOfthosewhorespondedtothisquestion125or70knewsomeonewhohadalreadyhadthevaccine
6983
2570
447
Yes No Dont know000
1000
2000
3000
4000
5000
6000
7000
8000
Figure 11 Do you know someone who has been vaccinated
Amongthe125participantswhoknewsomeonewhohadalreadybeenvaccinated100identifiedlsquoimmediatefamilymembersrsquo(parentschildrensiblingsandpartners)Somefocusgrouppartic-ipantsreportedthatalloftheirfamilymembersoverseas had been vaccinated Others reported thattheirrelativeshadbeenvaccinatedasarequirementoftheiremployment
Who Count Percent Other family member 41 313 Sister 24 1832 Community member 23 1756 Brother 18 1374 Father 17 1298 Mother 16 1221 Work colleague 14 1069 Husband or wife 11 84 Son or daughter 10 763 Partner 4 305 Someone else 45 3435 Total respondents 131
Table 6 Who do you know who has been vaccinated
When this issue was teased out further in focus groupdiscussionsarangeofreasonswere revealed including
My husband works in security and he had
to get it
My friend works as a COVID-19 cleaner and they all had to [get
vaccinated]
My family overseas have already been vaccinated
My son needs to travel for work so he is getting it
My brother in the UK is a doctor and he got it and
his wife
Knowing someone who has had COVID-19Almosthalfoftheparticipantsknewsomeonewho had contracted COVID-19 overseas Some reportedthatallthemembersoftheirfamilyormanymembersoftheirextendedfamilyhadcon-tracted COVID-19 In the older Italian group 10 of the15womenknewsomeoneinItalywhohadcontracted COVID-19
4716 4659
625
Yes No Not sure000
1000
2000
3000
4000
5000
Figure 12 Knowing someone who has had COVID-19
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2524
385 385
1538
2692
641 513000
4359
2051
1026385
1410
Mother
Father
BrotherSis
ter
Son or d
augh
ter
Husban
d or wife
Partner
Other family
mem
berFri
end
Community m
ember
Work co
lleag
ue
Someone else
(please
tell u
s who)
000500
100015002000250030003500400045005000
Figure 13 Who do you know who has had COVID-19
Four people in the focus groups knew someone who had died of COVID-19
All my family back home [Pakistan] got it [COVID-19] but
they are all fine now apart from my father He died But he was really sick before he
got it He had lots of underlying conditions Medical conditions so he was really unwell before he got COVID-19 But everyone else
they are fine now They were sick but they got betterhellip
If you are well and healthy you can fight this off
SurprisinglyknowingpeoplewhohadcontractedCOVID-19didnotseemtoinfluencefocusgroupparticipantsrsquopredispositiontowardseitherhavingthevaccineorbeingvaccinehesitantHowevertheolderItalianwomenrsquosgroupspokeabouttheimpactthatCOVID-19hadhadinItalyintheearlystagesofthepandemicandhowthishadaffectedthemdeeply13ofthe15womeninthisgroupwouldhaveorhadalreadyhadthevaccine
Knowing where to get vaccinated115people(81)whorespondedtothisquestion(n=142) knew where to go to get the vaccine 34 people(19)reportedthattheydidnotknowThisincluded15respondentsfromIraq3re-spondentsfromIndia2respondentsfromChina2 respondents from Pakistan and one respondent fromeachofthefollowingcountriesChinaEri-treaItalySriLankaSwedenSyriaandVietnamThese people were also less sure about whether ornottheywouldhavethevaccineItispossiblethat their lack of knowledge about where to go to get vaccinated was related to their general level ofvaccinehesitancy
7958
29582254
282 563
GPDoctor Vaccinecentre
Hospital Work place Somewhereelse (please
tell us where)
000100020003000400050006000700080009000
Figure 14 Where to go to get vaccinated
From the sample (n=199) GPs were the most commonlyidentifiedplacetogotogetvaccinat-edfollowedbythevaccinecentreatHomebushBayandthenhospitalsOtherplacesidentifiedincluded medical centres and pharmacies
Sources of information about COVID-19 and the vaccineThelargestsinglesourceofinformationaboutCOVID-19 and the vaccine was Facebook (417)
2743
3486
13141086
30862686
3429
2229 2286
41713714
2571
1086 971
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)000500
10001500200025003000350040004500
Figure 15 Sources of information about COVID-19 and the COVID-19 vaccine
Facebook I get my information from
Facebook But if I want to check it I watch the news
on 7 [Channel 7]
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2726
Thesecondlargestsourceofinformationforpeople in the sample was lsquoother forms of social mediarsquo(37)followedbySBStelevision(35)myfriends(34)andothertelevision(31)Oth-ersourcesofinformationpeoplereportedthattheyusedweretheNSWHealthwebsitenightlytelevisionnewsincludingChannel7Channel9andChannel10followedbytheABCtheAustral-iangovernmenthealthwebsitetheirGPlocalMedical Centres and the Red Cross
IntheLakembafocusgrouppredominantlymadeupofwomenfromPakistantherewasanani-mated discussion about Facebook which was the majorsourceofinformationalongwithGooglesearchesandcommunityandfriendship-basedWhatsApp groups There was a general consensus from most in the group that these were their pre-ferredormostcommonsourcesofinformationandnewsHoweveriftheywantedtolsquofactcheckrsquowhattheywerehearingtheywouldwatchthenightlynewsonChannel7orChannel9toverifywhattheyperceivedcouldsometimesbeunrelia-ble sources
IntheMtDruittfocusgroupseveralofthewom-enwithwell-developeddigitalliteracyandgener-alliteracyskillsusedhealthandfitnesswebsitesand social media sites as their source of infor-mationaboutlsquoallthingshealthrelatedrsquoincludingCOVID-19ThesewomenalsospokepositivelyabouttheinformationandsupporttheygotfromthestaffatCanterburyCouncilCommunityCentre(4Cs)whotheycouldrelyontofindoutthingsthattheyidentifiedtheyneededtoknowmoreabout
InthesmallerfocusgroupinGriffithwithrecently-arrived refugee women who had low levels of Englishlanguageliteracytherewaslittleknowledgeaboutthevaccinesnoawarenessofthedifferenttypesofvaccinesandlittleknow-ledgeaboutwheretogotogetvaccinatedorfindoutmoreaboutCOVID-19ingeneralThecommunityservicestaffandvolunteerspresentatthegroupwere working hard to assist these women to improve their English language skills and support themwithtranslatedinformation
In the older Italian women focus group in Wollon-gongparticipantsreportedgettingtheirinfor-mationfromslightlydifferentsourcesndashfamilyinAustralia(10women)Channel9(7women)
Italianradio(3women)andABCTV(3women)Onlytwowomenusedtheinternetandnoneofthe women reported using Facebook or social mediaasasourceoftheirinformationSeveralmentionedthattheygottheirinformationfromtheirGPorspecialistdoctorandonepartici-pantsaidrsquoIdonrsquotlistentoanyonersquoIntheSpan-ish-speaking focus group a comment was made thatseemedtoreflectmanyoftheotherfocusgroup discussions
Whenlsquosourcesofinformationrsquoiscorrelatedwiththegroupwhosaidtheywouldhavethevaccine(n=104)thereisashiftfromFacebookbeingthepreferredsourceofinformationtolsquoSBSTVrsquobeingthepreferredsourceThelsquovaccine-predisposedrsquogroupalsohadthelowestrateofrelyingonFace-bookasasourceofinformationaboutCOVID-19thoughitwasstillhighThegraphbelowhigh-lightshowotherlsquopreferredsourcesrsquoplayoutforthoseintendingtohaveorwhohavealreadyhadthe vaccine
ForthoseparticipantswhoindicatedthattheywouldnotorwerenotplanningtohavethevaccinelsquoFacebookrsquolsquomyfriendsrsquoandlsquomyfamilyrsquowerethesourcesofinformationaboutCOVID-19thatwereequallymostfrequentlycitedfollowedcloselybylsquomyfamilyoverseasrsquolsquoSBSradiorsquoandlsquoSBSTVrsquoassourcesofinformationreceivedthelowestmentionsfromthisgroup(SeeFigure16)
The vaccine-hesitant group were the group who identifiedlsquoFacebookrsquoastheirmostfrequentsourceofinformationaboutCOVID-19lsquoFace-bookrsquowasfollowedbylsquoothersocialmediarsquoandlsquomyfriendsrsquoasthenextmostfrequentsources
lsquoThiscommunityserviceproviderrsquo(theinterme-diaryorganisationwherethefocusgroupwasconducted)wasidentifiedby26ofrespondentsasasourceofinformationregardlessoftheirintentiontogetvaccinatedornotThefactthatboththelsquovaccinehesitantrsquoandthosewhoindi-catedtheywouldnrsquotbegettingthevaccinesoughtinformationfromthissourcesuggeststhatrolling
There is so much confusion about it [the vaccine] that I think my GP is the best
place to go
9 This group of the research sample included a small number ofpeoplewhohadalreadybeenvaccinated
2626
4141
14141111
323228282828
2424
1818
37373737
2828
10101212
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)00050010001500200025003000350040004500
2857
2381
952 952
2857
3333
42864286
3810
4286
23812381
1429
952
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another co
mmunity se
rvice
Somewhere
else (p
lease te
ll us w
here)000
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Figure 16 Sources of information for respondents who were planning to have the vaccine9
Figure 17 Sources of information for respondents who were not planning to have the vaccine
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2928
outpositivemessagingthroughtrusted communityserviceorganisationscouldbeaneffectivewayofshiftingpeoplefromvaccine hesitancytodecidingtohavethevaccine
31372549
980 980
25492157
4314
1176
2353
4902
4118
2157
980392
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)000
1000
2000
3000
4000
5000
6000
Figure 18 Sources of information for respondents who lsquodonrsquot knowrsquo if they will have the vaccine
DISCUSSION
wardstheCOVID-19vaccineareasvariedastheyarewithinthebroadercommunityTherearearangeofinfluencingfactorsincludingagehealthstatushowlongtheyhavebeeninAustraliahowmuchnewstheyreceivefromoverseasandhowbadlyimpactedbythepandemictheirhomecountries have been
The research also highlights that people from culturallyandlinguisticallydiversebackgroundsgettheirinformationaboutCOVID-19andtheCOVID-19vaccinefromawidevarietyofsourcesbothformalandinformalandthatforparticulargroupsinthisstudythereisahighrelianceonFacebookovermoreofficialsourcesofinforma-tion
VulnerabilityTheneedsofhighly-vulnerablegroupswithintheCALDcommunityhavetobetakenintoconsider-ationThisincludesolderpeoplewhohavelivedinAustraliaformanyyearsbuthavelowlevelsofEnglishliteracyndashespeciallywritingandreadingEnglishandsometimesspokenEnglishndashandwhoaremoresusceptibletoseriousillnessandhigherratesofhospitalisationanddeathfromCOVID-19Italsoincludesnewly-arrivedrefugeeswhohavinglowornoEnglishlanguageliteracylacktheconnectionstoandnetworksintothewidercommunityandcommunitysupportsItisalsothecase that some people in these groups are not health literate at all and cannot read and write in their own language
Akeytakeoutfromthehealthandcommunityserviceorganisationsurveyresponsesandinter-viewsundertakenwithmulticulturalhealthandcommunicationexpertsfortheprojectisthatlit-eracylevelsreallydomatterLowlevelsofhealthliteracylowlevelsofEnglishlanguageliteracyandpossiblylowlevelsofliteracyintheirownlan-guage-especiallyforsomenewly-arrivedrefu-gees and those who are part of the humanitarian program such as Dari language speakers from AfghanistanTigrinyalanguagespeakersfromEr-itrea and northern Ethiopia and Oromo language speakers from Ethiopia - need to be factored into anyplanstofurtherpromotethevaccinerolloutanduptaketoculturallyandlinguisticallydiversepeopleinthecommunityThereisaneedfor
The contextThisresearchisimportantgivenhowhighlyculturallydiverseNSWisandtheimpactthiscanhave on the success of public health messaging topeoplewhosefirstlanguageisnotEnglishPeople who were born overseas form almost one-thirdofthe7480228population(276)ofNSWandNSWishometo336ofAustraliarsquosoverseas-bornpopulationPeoplefromaround225 birthplaces have made NSW their home and 21oftheNSWpopulationisfromanon-EnglishspeakingbackgroundMorethan24000humani-tarianentrantshavesettledinNSWoverthepastfiveyearscomprisingalmostathird(32)ofthenationaltotalThe24000humanitarianentrantswhohavesettledinNSWoverthepastfiveyearscame from over 100 countries of origin10Sydneyhasthelargestoverseas-bornpopulationofallthecapitalcities11
Hearingdirectlyfrompeoplefromculturally-diverse backgrounds is important to ensure that policymakersandpublichealthadvocatescandesign responses that are both accessible and un-derstandabletopeopleforwhomEnglishmaybetheirsecondthirdorfourthlanguageApropor-tionofpeopleinthesecommunitieshavelowerlevelsofEnglishlanguageliteracyandinsomecaseslowlevelsofliteracyintheirlanguageoforiginsowillbehardertoreachviatraditionalormainstream methods
Itisalsocriticallyimportantthatduringatimewherethereissomuchlsquonoisersquoacrossmediachannelsrelatingtothevaccinethevaccineroll-outvaccineefficacyandvaccinesafetythatwetakesometimetolistentoandunderstandhowthislsquonoisersquoisbeingheardandmadesenseofbypeoplefromculturally-diversebackgrounds
ThatsaiditisimportanttoreconfirmthattheCALDcommunityisnotahomogenousgroupOurresearchhasfoundthattheviewsandattitudesofparticipantsfromdiverseculturalbackgroundsto-
10RefugeeCouncilofAustraliaHumanitarianEntrantsin New South Wales A resource for New South Wales governmentagencies6-711MulticulturalNSWCommunityRelationsReport2018-20199
29
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3130
groupsFortheparticipantsintheresearchtheirattitudetothevaccineappearedtobeinflu-encedbyanumberoffactorstheirownlevelsofhealthandpre-existinghealthconditionsandthoseoftheirfamilymembersandtheimpactofreceiving COVID-19-related news from overseas particularlyfrompeoplersquoscountryoforiginAnexampleofthiscanbeseenintheItaliangroupin Wollongong where people had received news fromoverseasearlyinthepandemicwhichscaredthemThisexperiencelsquofromhomersquohadinflu-enced most of the women in the Wollongong focus group (n=15) to choose to get vaccinated The interviewee from the Illawarra Shoalhaven Local Health District also spoke about the heightenedconcernthattheywitnessedinthelocalItaliancommunityintheearlystagesofthepandemicOtherpeoplewantedtolsquostayhealthyrsquoandtolsquoprotectthehealthofothersrsquoandformanytherewasasensethattheywantedtolsquogetbacktosomedegreeofnormalcyrsquoandtobeabletolsquotraveloverseastovisitrelativesrsquo
Vaccine hesitancyOfthe42inthisstudywhoappearedundecidedornotplanningtohavethevaccinemanywereinfactadoptingalsquowaitandseersquoapproachbeforemakingtheirfinaldecisionMostparticipantswereinterestedtohearmoreinformationaboutthevaccinesandwereopenedtogettingthevaccinebutdidhaveconcernsaboutthesafetyofthevaccinesespeciallyinregardtoAstraZeneca
The issue of blood clots has led to considerable fearandhesitancyinthecommunityandthisfearandhesitancywasreflectedinourstudyEssentialResearchrsquossurvey(April2021)reportedoneinsixpeople(16)indicatedtheywillnevergetvaccinatedagainstCOVID-19upfrom12thepreviousmonthwhile42saidtheywillgetvaccinatedbutnotrightawayTheproportionofpeople who would be willing to get vaccinated as soonaspossibleorarealreadyvaccinatedalsodeclineddownfrom47to4213Thissurveywas conducted prior to the most recent outbreak inNSWinvolvingthehighlyinfectiousDeltastrain
Therisk-benefitofhavingthevaccineneedstobecarefullyweighedbyeachindividualideallyinconsultationwiththeirdoctoranddependingon
The Hub has lsquobeen working in partnership with keystakeholdergroupstoguidecommunicationstomeetthehealthliteracyandculturallyandlinguisticallydiverse(CALD)needsofitspop-ulationStructuredworkinggroupshavebeencreatedtoprioritisecommunicationstovulner-ableyouthCALDgroupstheelderlyitinerateworkersasylumseekersandrefugeesTheaimsaretotestmessagingandbuildtrustwithprioritypopulationstoensureeffectivecommunicationoftheneedtosustainphysicaldistancingmeas-uresintheabsenceofavaccineSimilareffortsarenowneedednationallyandshouldstartatthetimeofdiseaseoutbreaksinthefuturealongsideplannedmassmediaandhealthcommunicationcampaignsrsquo
InthearticlebyDoddetaltheyreinforcetheimportanceofusingcommunicationformatswhich are lsquosuitable for people with low health literacyandeducationandwhichareappropriateforculturallyandlinguisticallydiversegroupsandIndigenouspopulationsrsquoThearticlearguesthatitisimportanttolookatmotivationsandconcernsabout vaccines when shaping messaging It also pointsoutthatprimarycaredoctorsareatrust-ed source and as such should be supported in deliveringinformationaboutthevaccinesandad-dressingcommunityconcernsThearticlestateslsquoWeneedtounderstandandaddresscitizenrsquosconcernsthatcanpreventoptimaluptakebuildmotivationsintomessagingandprioritisepublictrustbyinformingandinvolvingthecommunityintheprocessSupportinghealth-careprofession-als in their role as educators will ensure people haveadequateandaccessibleinformationfromatrustedsourcetooptimisevaccineuptakeandultimatelyreducecommunitytransmissionofCOVID-19rsquo15
RecentresearchbyAssociateProfessorHollySeale16withUNSWMedicinersquosSchoolofPublicHealthandDeputyChairfortheCollaborationonSocialScienceandImmunisationfoundthereisaneedtolsquodecentralisersquocommunicationsbytapping
translatedmaterialsandinformationaboutthevaccines to be tailored to the needs of people in these newly-emergingcommunitygroups
It was reported that in Wollongong there can sometimesbefourgenerationsoffamilymem-bersfromnewly-arrivedrefugeegroupslivingintheonehouseMostofthesefamilymembersgenerallyhavelimitedEnglishlanguageliteracywhichincreasestheirriskofnotreceivingkeyhealthmessagesandthereforeincreasingthepotentialimpactofCOVID-19-inparticulartheDeltastrainwhichhasprovenhighlyinfectiousamongst household members
Vaccine uptakeNotdissimilartothewidercommunitymorepeopleinourstudywereplanningtohavethevaccinethannotandanumberhadalreadybeenvaccinatedInarecentLancetarticle(February2021)ConcernsandmotivationsaboutCOVID-19vaccinationfindingsfromtwosurveysfromanAustralianlongitudinalstudyconductedinJuneandJuly2020includedthatlsquothetopthreerea-sons for agreeing to vaccinate were lsquoto protect themselvesandothersrsquohelliplsquobeliefinvaccinationandsciencersquohellipandlsquotohelpstopthevirusspreadrsquoEven among those willing to vaccinate there was somehesitancyaboutthesafetyofthevaccineTheLancetarticlenotedthatlsquowillingnesstovaccinatedifferedbybothageandeducationrsquoForthosewhowereindifferentorsaidtheywouldnot get the vaccine the top reasons across the twosurveyswerelsquoconcernaboutthesafetyofthevaccineinitsdevelopmentrsquoandlsquopotentialsideeffectsrsquo12
Olderpeopleinourstudywhocomprised23of the total sample (n=199) were the group most likelytosaythattheywantedtogetthevaccine85ofthoseover65saidtheywouldhaveorhadalreadyhadthevaccineVaccinepredispo-sitionwashoweveralsostrongacrossotherage
12RHDoddKPicklesBNickelECvejicJAyreCBatcupCBonnerTCoppSCornellTDakinJIsautierKJMcCafferyConcerns and motivations about COVID-19 vaccination SydneyHealthLiteracyLabSydneySchoolofPublicHealthFacultyofMedicineandHealthUniversityofSydneypublishedintheLancetFebruary2021p162wwwthelancet cominfectionVol21February2021
theircircumstancesHoweverthesourcesofin-formationthatpeoplemostrelyuponortrustarecriticaltothedisseminationofaccurateandclearmessaging to dispel the fear surrounding events suchasbloodclottingandthemisconceptionsraisedinthefocusgroupsWithsomanypartici-pantsinthisstudygettingtheirinformationfromFacebookandothersocialmediasitesitisvitalthat these channels are used to promote simple positivemessagesandforanyfuturecommunityawareness campaigns
Effective communicationConfusionandmisconceptionsaboutthevac-cinersquosefficacyavailabilityandsafetywereallis-sues that were raised in the focus groups Finding waystoeffectivelycommunicatewithpeoplewithlowerEnglishlanguageliteracyandhealthliteracyisanimportantwaytoaddresstheconfusionandmisconceptionsaboutthevaccineashasbeen discussed in a number of recent Australian studies
Astudy14byMcCafferyetal(2020)concludedthattherearelsquoimportantdisparitiesinCOVID-19-relatedknowledgeattitudesandbehavioursaccordingtopeoplersquoshealthliteracyandlanguagersquoOneofthefindingswasthatlsquopeoplewithlowerhealthliteracywerealsomorelikelyto endorse misinformed beliefs about COVID-19 andvaccinations(ingeneral)thanthosewithadequatehealthliteracyThesamepatternofresults was observed among people who primar-ilyspeakalanguageotherthanEnglishathomersquoTheMcCafferystudyhighlightstheimportanceof tailoring health messages to those with lower healthliteracyandculturallyandlinguisticallydiversecommunitiesItpointsoutthatthereareexamplesofeffectivemanagementofdiversecommunityneedsthatusetailoredhealthmes-sagesandcitestheWesternSydneyLocalHealthDistrictHealthLiteracyHub
13TheEssentialReport-anonlinesurveyconductedbyEssentialResearchcompletedby1090people between 21ndash26 April14McCafferyKJDoddRHCvejicEAyreJBatcupCIsautierJMJCoppTBonnerCPicklesKNickelBDakinTCornellSWolf MS Health literacy and disparities in COVID-19ndashrelated knowledge attitudes beliefs and behaviours in Australia PublicHealthResPract202030(4)e30342012December2020
15 Op cit16 httpssphmedunsweduausitesdefaultfilessphcmNewsEnhancing-supporting-COVID-19-vaccination-programpdf
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
30 31
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3332
intodifferentnetworkingspacessuchaswork-placeslocalgymsmothersrsquogroupsandseniorsrsquoclubswithafocusonallagegroupsregardlessofcurrenteligibilityAccordingtoSealethechal-lengeislsquoensuringemerginginformationisadapt-edfortheintendedaudiencersquoShehasalsosaidlsquoThatrsquoswhatIrsquomalittlebitconcernedaboutatthemomenttherersquosalotofresourcesongov-ernmentwebsitesbutthesetermsaroundbloodclottingareverytechnicalWeactuallyneedtomake sure that we are breaking them down in a waythatwillmakeitmeaningfultopeopleThatrsquosnotjustabouttranslatingitrsquosaboutbeingcon-sciousofpeoplersquoshealthliteracyneedstooSomaybegettingsomemorevisualsintomaterialstotryandsupportthatrsquo17
Thereareanumberofmulticulturalhealthresourcesthatusecommunitylanguagetransla-tionsplainEnglishandvideosfromCALDcommu-nityleaderswhichcanbedownloadedandusedbyservicesandindividualsHowevermanyofthewrittenresourcesstillrelyontechnicalandscien-tifictermsthatrequireareasonablyhighlevelofEnglishlanguageliteracyorhighlevelsofliteracyin the translated language to comprehend Host websites can also be hard to navigate making itdifficulttolocateresourcesfromsimplewebsearchesAsummaryofsomeoftheavailableresourcescanbefoundatAttachment2
MulticulturalHealthUnitsinLocalHealthDis-trictshavestaffwhocanworkwithpeoplefromculturallyandlinguisticallydiversecommunitiesatthelocallevelandtranslateandcontextualisethese materials to the needs of the end user These teams respond to local needs and popu-lationdemographicsandareexpertsineffectivehealthliteracyandhealthcommunicationwiththeirlocalcommunitiesTheyworkcloselywithcommunityandvulnerablegroupstobuildhealthliteracyandimprovedhealthoutcomesintheircommunities
Case Study ndash Be a COVID Warrior ndash Responding to COVID-19 in Multicultural Communities InWollongongtheIllawarraShoalhavenLocalHealthDistrict(ISLHD)MulticulturalHealthSer-viceco-designedacommunityengagementandeducationprogramcalledlsquoBeaCOVIDWarriorrsquowhich commenced in 2020 in response to the pandemic This program was designed to respond tothelowlevelsofhealthliteracyaroundCOVID-19potentialexposuretothevirusandaddressfearandstigmainthelocalCALDcommunitiesThelsquoCOVIDWarriorrsquoprogramreachedaround880peopleranginginagefrom14to85years65ofCOVIDWarriorparticipantswerefemaleand35weremaleCOVIDWarriorparticipantsrepresented 21 language groups The outcomes of the program included increased levels of confidenceinapplyinginfectioncontrolmeasuresincreasedliteracyandhealthliteracyandawarenessofhowCOVID-19istransmittedUltimatelyanimprovedawarenessinapplyingCOVIDsafemeasures was also reported
InApril2020theservicecommencedwelfarechecksviaphoneonafortnightlybasistosup-portsocially-isolatedmulticulturalseniorswhoboretheemotionalstressofsocialisolationFrom these calls the ISLHD heard the needs and concernsofseniorsinthecommunityInadditionourexperiencewithCALDcommunitieshighlightedtheimportanceofyoungpeopleasconduitsofessentialinformationtoadultsincommunityandfamilygroupsduetoEnglishlanguageaccessandeducation
InresponsetheISLHDinitiatedthelsquoCOVIDWarri-orrsquoprogramusingbi-culturalhighschoolstudentsthroughthelocalhighschoolsByincreasingthehealthliteracyofstudentsatschooltheselsquocham-pionsrsquocouldtalktotheirfamiliesincludingolderfamilymembersininformalsettingsandthroughsocialmediawiththeirpeersasastrategytoraisethe level of knowledge of COVID-19 trans-mission preventionandtestingTheprogrambecamesopopularthatitwasextendedintomorelocalhighschools and adults accessing the Adult Migrant EnglishProgramTheprogramwassupportedbylocalsettlementservicesprovidedbybothMaxSolutionsandtheRedCrossItwas
17 httpstheconversationcomhow-can-governments-communicate-with-multicultural-australians-about-COVID-19-vaccines-its-not-as-simple-as-having-a-poster-in-their-language-156097
later extendedtoCALDSeniorsthroughtheMulticulturalCommunitiesCouncilIllawarra(MCCI)supportprograms
AkeycomponentoftheprogramwastoprovideparticipantswithlsquoCOVIDWarriorrsquoKitswhichincludedtworeusablemaskshandsanitiserinfographicsaboutCOVID-19symptomsandinfor-mationaboutwheretestingclinicswereavailablelocallyMCCIandRuralAustraliaforRefugeesdonatedreusablemasksforeveryparticipant
AsthelsquoCOVIDWarriorrsquoprogramwasevolvingsowasthenationalvaccinerolloutplanInforma-tionwasthereforeadaptedtomeetthisinfor-mationgapForexampleadultparticipantsandseniors were supported to understand how to accesstheCOVIDvaccinelsquoeligibilitycheckersrsquoandCALD people were shown how to use the NSW HealthwebsiteCOVID-19informationpages18
Decision makingHowpeoplearecurrentlyconsideringtheriskofCOVID-19isinfluencedbyarangeoffactorsincludingratesoftransmissioninthecommunitynumbersofnewcasesreportsinthemediaofrisksandsideeffectsPeopletendtobasetheirassessmentonwhattheyarecurrentlyexperi-encingandthencheckthisagainstwhattheyarehearinginthemediaincludingandespeciallyonsocialmediaandfromfamilyandfriendsMostoftheparticipantsinourstudyspokeclearlyandarticulatelyabouthowtheyweigheduptherisk-benefitofhavingtheCOVID-19vaccineintheir decision making Low case numbers ndash at the timeofconductingtheresearchndashandasensethat Australia was lsquodoing well in safeguarding the communityagainstCOVID-19rsquoweresignificantfactorsinpeoplersquosdecisionnottobevaccinatedortoadoptalsquowaitandseersquoapproachFamilyfriends and social media were reported as having aconsiderableinfluenceondecisionmakingaswerereportsinthemediaofthebloodclottingsideeffectsofAstraZeneca
ThefactthatFacebookwasreportedlythemostpopularsourceofinformationaboutCOVID-19
18httpswwwhealthnswgovauInfectiouscovid-19Pagesdefaultaspx
andtheCOVID-19vaccineforpeopleinthestudyraisesconcernsaboutthepossibledisseminationofmisconceptionsandlsquofakenewsrsquothatmaybespread or compounded via social media Closed social media groups such as WhatsApp and WeChatwithfamilyandfriendsmayalsoleadtopeoplereinforcingtheirpre-existingbiasesThesefactorscoupledwithasensethatAustraliaisfaringwellcomparedtomanycountriesoverseasappear to have resulted in increased vaccine hesi-tancyamongparticipantsofthestudy
Factorsthatwereidentifiedaschangingvaccine-hesitantparticipantsrsquoperceptionswereanincreased risk from COVID-19 and a correspond-ingincreaseinthenumberofinfectionsandonthebenefitsidetheabilitytotraveloverseastovisitfamilyIntherecentresearchfromtheUniversityofNSWcitedaboveSearlearguesthatlsquotheremaybeotherthingsthatweneedtonowstartfocusingonhellipthatwillstarttopromoteandmotivatepeoplesuchasthechancetotravelmorefreelyforexamplersquoThisappearstobeborneoutbyourfocusgroupfindings19
Untilrecentlytherehavebeenverylowcasenumbers and few lockdowns across most of Aus-tralia and NSW The recent outbreak from mid-JuneinGreaterSydneyandintroductionofthehighlyinfectiousDeltavariantinNSWislikelytoimpactonpeoplersquosassessmentsoftherisk-benefitofhavingthevaccineandonewouldassumereducehesitancyrates
GiventheheightenedcommunityanxietycausedbythisrecentCOVID-19outbreaktheproductionofshortsharpandtargetedmessagingtoCALDgroupsincommunitylanguagesthatisaccessibleandmotivationalfeaturescommunityleadershigh-profilecelebritiesandsportsstarsfromCALDbackgroundsandisdirectedatastate-wideandlocal level would appear to be more urgent than everItisclearthatformessagingtobeeffectiveandreachitsintendedaudiencedistributionchannelsshouldincludeFacebookWhatsAppandothersocialmediaplatformsaswellastrustedsourcessuchasmulticulturalhealthworkersmulticulturalservicesandthroughGPsandMedical Centres If mainstream COVID-19 vaccine
19 Op cit
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
32 33
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3534
awareness campaigns are produced in Australia suchashavebeenproducedinNewZealandtheUnitedKingdomandNorthAmericatheyshouldincludehighprofilewell-knowncommunityfig-uresandsportingstarsfromCALDbackgroundsandincludestrategiesspecificallytargetingCALDcommunitiesincludinggroupsidentifiedaspar-ticularlyhigh-risk
It is also important that informationonvaccinesistranslatedintolanguagesfromnewerandemergingcommunitiesOthersuggestionsaroundreachingthesecommunitiesincludeface-to-facemeetingsorganisedbycrossagencypartnershipsandpeer-ledstrategiessuchas mobilising community champions and influenc-ers Messaging needs to be inclusive and framed around the collective values held by commu-n5
It is clear that reinforcing the benefits of being vaccinated at this time rather than dwelling on the risks is more likely to generate behavioural
changeandapositivevaccineresponsefrombothCALDcommunitiesandthegeneralpopulationAppropriately-designedandtargetedCOVID-19vaccinehealthinformationthatiseasytoreadinanylanguagecanbeconveyedbycommunityleadersandcommunitynetworksandpromotesthepositivebenefitsofgettingvaccinatedwouldbevaluableatthistimeBuildingontheworkofpeerchampionssuchastheCOVIDWarriorprogramisalsoasuccessfulmodeltoincreasingCOVID-19vaccinehealthliteracyandinformed decision making
Mostimportantlypositivelymotivatingculturallyandlinguisticallydiversecommunitymemberstolsquogetthejabrsquoespeciallythosewhoareadoptingalsquowaitandseersquoapproachorarevaccinehesitantwould lead to greater vaccine uptake among culturallyandlinguisticallydiversecommunitiesandthereforethecommunityasawhole
Inner West Multicultural Network Addison Road Community Centre DateWednesday12May
A focus group session of members of the Inner WestMulticulturalNetworkpluscustomersoftheFoodPantryatAddisonRoadwasheldattheAddisonRoadCommunityCentreinMarrickvilleon12Mayat200pmThesessionwaspartoftheregularmeetingoftheInnerWestMulticul-turalNetworkTheconsultationinvolvedabout26peopleandwasconductedbyRosannaBarbero
Thegroupbrainstormedresponsestoquestionsaroundvaccinehesitancyinmulticulturalcom-munitiesandmoreeffectivemessagingTheseresponseshavebeenincorporatedinthefindingsof the report
Griffith Women on Fire Focus Group Griffith Community Centre DateFriday14May
This small focus group of women was held at GriffithCommunityCentreonMay14at11amMargCouchSeniorProjectOfficerRegionalDevelopmentAustralia(RDA)-RiverinaandJoanneFitzpatrickSettlementEngagementandTransitionSupport Worker from Centacare Southwest NSW werethekeylinksandnetworkcontactsfortheGriffithcommunityTheWomenonFire(WOF)group was established as part of the Red Cross RuralFireServiceprogramlsquoManyCulturesOneCommunityrsquoInitiallyitwasestablishedtoeducatewomenonemergencypreparednessandtoen-courage NSW Rural Fire Service (RFS) volunteering andnowhastransformedintoacommunityac-tionsupportgroupTheGriffithSoroptimistInter-nationalnowauspicetheirfinancesandsupporttheWOFgroupactivitiesThefocusgroupwasfacilitatedbyCamillaCouchandlocalcommunityvolunteersledbytheGriffithSoroptimistClub
The women in the group were from Pakistan and IndonesiaThegroupweremainlyyoungmotherswithyoungchildrenandtheprogramhadchild-minding arrangements The language level of the womenwaslowandmostwerestudyingESOLat
ATTACHMENTS
ATTACHMENT 1 A Description of the Focus Groups
TAFEThedeliveryoftheinformationwaslimiteddue to language levels and the lack of bilingual interpretersEachparticipantworkedoneononewithavolunteertoslowlyfillinthesurveyandonewomantookthesurveyhometodiscusswithherhusbandThisgroupexperiencehighlightedthe lack of bilingual workers and services in some rural areas
Arabic speaking group Syd West Multicultural Services Mount Druitt Community worker Zaid Naoum Generalist Caseworker SydWest Multicultural Services DateMonday24May
ThefocusgroupfromSydWestMulticulturalSer-viceswasconductedonMonday24May2021atSydWestMulticulturalServicesMountDruittat300pmItwasfacilitatedbyPatriciaMcCormickandsupportedbyZaidNaoumGeneralistCase-workerSydWestMulticulturalServices
Therewere10womenandmenfromSyriainthegroupThegroupweremostlymaturetoolderparticipantsMostparticipantsrequiredassistancewithEnglishandthecaseworkerZaidNaoumhadtranslatedthesurveyintoArabicpriorto the focus group Zaid also translated during the focus group
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Canterbury City Community Centre (4Cs) group The Cottage Lakemba DateTuesday25May
ThefocusgroupfromCanterburyCityCommunityCentre(4Cs)wasconductedonTuesday25MayattheCottageat28CroydonStreetLakembaat10amItwasfacilitatedbyRobinMilesandsup-portedbyRomanaWaseemCommunityWorkerfrom 4Cs
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
34
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3736
The group was comprised of 14 women from PakistanIndiaandSriLankaThewomenrangedinagefrom23to65MostwerefluentEnglishspeakershoweveronewomanrequiredtransla-tionintoUrdufromoneoftheotherwomeninthegrouptoanswerthequestionsdirectly
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
NSW Chaldean League group Community worker Randa Goriya DateTuesday25May
ThefocusgroupfromNSWChaldeanLeagueMountDruittwasconductedonTuesday25May2021 at 1000am at the NSW Chaldean League premisesItwasfacilitatedbyPatriciaMcCormickandsupportedbyRandaGoriyaacommunityworker for the NSW Chaldean League in Mount DruittRandatranslatedtheintroductionandpromptsforthediscussionandhelpedthepartic-ipantstocompletethesurveyMostofthegrouprequiredhelptodothesurvey
ThegroupoftwelveparticipantswereallChaldeanandwerematuretoolderinageTheywereamixed-gendergroup
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Arabic speaking group Red Cross premises Wollongong DateTuesday25May
ThefocusgrouptookplaceonTuesday25Mayat 3pm at the Red Cross premises at Wollongong Therewere22womenandmenparticipatinginthegroupThefocusgroupwasfacilitatedbyCamilla Couch with support from Khalid Zainu-labdeenBilingualSupportWorkerHumanitarianSettlementProgram(ACTampNSW)
There were diverse ages in the group ranging fromyoungpeopletoolderagedMostofthegroupwereyoungerrecently-arrivedrefugeesfrom diverse backgrounds There was also a small-eroldercohortofparticipantswithhigherliteracylevelsandstrongercommunityengagementwith the local services in the area Camilla Couch facilitated the focus group which was conducted inArabicandEnglishwiththeArabictranslationprovidedbyKhalidZainulabdeen
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Work Opportunities for Women group Mt Druitt TAFE DateWednesday26May
TheWorkOpportunitiesforWomen(WOW)focusgroupwasheldonWednesdayMay261100ndash 100pmatMtDruittTAFEItwasfacilitatedbyCamilla Couch and built on the knowledge gainedintheprevioussessiononcriticalandanalyticalthinkingTheWOWgroupisaTAFECertificatelevel course
There were 14 women from diverse cultural backgroundsinthegroupThegroupweremainlyMuslimwomenwithschoolagechildrenandsome were mature aged Due to the learning fo-custhegroupwasfacilitatedasaclasswithguid-eddiscussionontheissuesandcarefulanalysisofthequestionsNotranslationwasneededduetotheeducationalcontextThestudentswereadeptatusingITandcompletedallthesurveysonline
STARTTS Tamil group Toongabbie Community Centre Community worker Sivaharani (Harani) Mayuran DateThursday27May
Thefocusgroupconsistedof18femalepartic-ipantswhowereyoungertomatureagedThefocus group was held at 1000am at Toongabbie CommunityCentreinTargoRdToongabbie
ThefocusgroupwasfacilitatedbyPatriciaMc-CormickandsupportedbyacommunityworkerSivaharani(Harani)MayuranfromtheSTARTTSTamil Group
ThegrouphadmixedlevelsofspokenandwrittenEnglishTheintroductionanddiscussionpromptsweretranslatedbythecommunityworkerSivaha-rani(Harani)Mayuranandsheandthemorepro-ficientstudentssupportedthosewithlowliteracytoanswerthesurveyquestions
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Spanish Speakers Seniors group SydWest Multicultural Services Blacktown DateTuesday1June
TheFocusGrouptookplaceonTuesday1Juneat1100amattheBlacktownShowgroundsandconsistedof16participants(15womenandoneman)AllparticipantswerebornincountriesinSouthAmericaTheirEnglish-fluencylevelsvariedand one of the members of the group translated thesurveyquestionsanddiscussionintoSpanish
ThegrouphadbeenmeetingforseveralyearsThegroupwasfacilitatedbyLindyCassidyandwassupportedbySreeVithyaHarilingamDayRespiteampSocialSupportTeamLeaderatSydWestMulticulturalServicesBlacktownThegroupwerematureagedtoolderparticipants
Thegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyform There was a more focused discussion on somekeyquestionsaftersurveycompletionThetranslatorassistedconsiderablyinthisprocess
Italian Speakers group Warrawong Community Centre DateMonday7June
The focus group of Italian speakers was held on Monday7Juneat1015amattheWarrawongCommunityCentreItwasfacilitatedbyCamillaCouchandsupportedbyJohnPaulTroianiand
SofiaLemafromIllawarraShoalhavenLHDMulti-cultural Health
There were 15 women in the group The group weremostlymaturetoolderparticipantsandwasconductedinItalianandEnglishwithtranslationprovidedbyJohnPaulThisgroupmeetsregularlyandissupportedbyanumberofservicesintheareaespeciallymulticulturalhealth
The group had a general facilitated discussion aboutthequestionsinthesurveyDuetolittleornoliteracytheindividualsurveyresponseswerethencollectedintooneresponseThesesurveyresponses have been included in the general surveyresponses
Mothers Group SydWest Multicultural Services Blacktown DateThursday10June
ThefocusgrouptookplaceonThursday10Juneat1030amandconsistedof14youngwomen13 of whom had a CALD background The focus groupweremainlymothersfromasupportgroupatSydWestMulticulturalServicesinBlacktown
EightofthewomenwereborninIndiatwofromPakistantwofromSriLankaonefromHausaGhana and one was born in Australia (the Austral-ianbornyoungwomanwasasocialworkstudenthelpingwiththegroup)LindyCassidyfacilitatedthe group with support from Wilma Garguath a projectofficerfromSydWestMulticultural Services
The group varied in age One was between 18-24 yearsoldSevenwereagedbetween25-34yearsSixwereagedbetween35=44yearsGiventheirage and circumstances most of the group did not consider themselves eligible at this stage for vac-cinationThiswasanimportantdifferencefromotherfocusgroupsinthattheemphasiswasmoreonwhattheywoulddooncetheybecameeligible
Participantsdidnotrequireassistancewithspo-kenEnglishThegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyformTherewasamorefocuseddiscussiononsomekeyquestions
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3938
ATTACHMENT 2 COVID-19 Vaccine Information in multiple languagesThefollowingsitesappsprovidetranslatedinformationaboutCOVID-19vaccines
Type of information KeyinformationongettingvaccinatedinNew South Wales and on the vaccines available The websiteusesanautomaticservicetotranslate thecontentintodifferentlanguages
Source of information NSW Government website
Link httpswwwnswgovauCOVID-19health-and-wellbeingCOVID-19-vaccina-tion-nswgetting-vaccinated
Type of information COVID-19ResourcessectionontheServiceNSWapp The app has a link to NSW Government websiteinformationonldquoGettingaCOVID-19vaccinationrdquo(seeabove)ItalsoincludesalinktoCOVID-19vaccinationresourcesinotherlan-guages available from the Department of Health
Source of information Service NSW NSW Government
Link Service NSW App
Type of information ArangeoftranslatedresourcesonCOVID-19bytitleincludingafactsheetonCOVID-19VaccineAstraZeneca(ChAdOx1-S)
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCOV-ID-19Pagestranslatedresources-by-titleaspx
Type of information ADigitalCOVID-19resourcelibrarywithtranslated materials
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiouscov-id-19Pagesdigital-resourcesaspx
Type of information AMultilingualCommunityToolkitontheCOVID-19vaccinationprogramtoassist communityworkersprovideseasytoreadresourcesvideosandlinkstokeyservicesandresources
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCovid-19DocumentsNSW-COVID-19-vaccina-tion-program-presentation-20210527pdf
Type of information TheNSWMulticulturalHealthCommunicationServiceoffershealthresourcesandinformationin a wide range of languages It has translated resources on COVID-19 and links to translated resourcesonCOVID-19vaccination
Source of information MulticulturalHealthCommunicationServiceisa New South Wales-wide health service hosted bySouth-easternSydneyLocalHealthDistrict(SESLHD)
Link httpswwwmhcshealthnswgovau
Type of information COVID-19vaccineinformationaddressingkeyquestionsaboutCOVID-19vaccinationandincludesvideosposterstilesfactsheetsandaudio material Translated into 63 languages
Source of information Department of Health Australian Government website
Link httpswwwhealthgovauinitiatives-and-pro-gramsCOVID-19-vaccinesCOVID-19-vaccine-in-formation-in-your-language
Type of information ThisinformationaddressessomecommonmisinformationaboutCOVID-19Translatedintomultiplelanguages
Source of information DepartmentofHomeAffairs Australian Government website
Link httpscovid19inlanguagehomeaffairsgovaumisinformation-and-truths-about-coronavirus
Type of information Australianandinternationalnewsand informationaboutCOVID-19andCOVID-19 vaccinesisavailableontheSBSCoronavirusPortal in more than 60 languages
Source of information SBSwebsite
Link httpswwwsbscomaulanguagecoronavirus
Type of information InformationprovidedaboutCOVID-19vaccinerolloutandsafetyinlanguagesotherthan English
Source of information Department of Health and Human Services Victorian Government
Link httpswwwcoronavirusvicgovautranslat-ed-information-about-COVID-19-vaccines
Type of information HealthTranslationsprovidestranslatedmateri-alsonhealthandwellbeingInformationaboutCOVID-19isregularlyupdatedincludessomeinformationonvaccinationandisavailableinover60communitylanguages
Source of information Victoriangovernmentinitiative
Link httpswwwhealthtranslationsvicgovaubhcv2bhchtnsfPresentEnglishResource-AllOpenampx=amps=Coronavirus
Type of information A one-stop shop for translated materials in multiplelanguagesonCOVID-19
Source of information Ethnolink Language Services
Link httpswwwethnolinkcomauCOVID-19-coro-navirus-translated-resources
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
40
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
98
This research project has been commissioned by the New South Wales Council of Social Service (NCOSS) to look at issues concerns attitudes and barriers to receiving the COVID-19 vaccine in culturally and linguistically diverse (CALD) communities in NSW
The research was conducted over two months fromlateApriltolateJune2021withdatacol-lectedjustpriortothelatestCOVID-19outbreakinSydneyItwasundertakenwithsomeurgencygiven the following factors
the lack of data concerning peoplefromculturallyandlinguisticallydiverse backgrounds in larger research studies 2
theheightenedconcerninthecommunity aboutthepotentialsideeffectsofin particulartheAstraZenecavaccinewhich has led to a higher-than-usual rate of vaccine hesitancyinthewidercommunity3
theneedtolifttheoverallvaccinationratein Australia
Emergingresearchindicatesthatmisconceptionsabout COVID-19 in Australia tend to be more common in groups with lower levels of health literacyincludingpeoplewhospeakalanguageotherthanEnglishInadditionthevariedexperi-enceofandinformationaboutCOVID-19trans-missionandvaccinationinoverseascountriesmakesthisaparticularlyinterestingissuegiventhatCALDcommunitymembersmaybehavingregulardiscussionswithrelativesoverseasandgettinginformationaboutCOVID-19fromover-seas sources
2McCafferyKJDoddRHetalHealth literacy and disparities in COVID-19ndashrelated knowledge attitudes beliefs and behaviours in AustraliaPublicHealthResPract202030(4)e30342012 December 2020 First published5 November 2020lsquoThereareseverallimitationstoourstudyAlthoughourrecruitedsamplewaslargeanddiverseitwasnotstatisticallyrepresentativeoftheAustralianpopulationTheproportionofAustraliansfromnon-Englishspeakingbackgroundswassmall(6)sincethesurveywasnottranslatedandrequiredsufficientEnglishskillstocompletethequestionnaireinEnglishrsquo(p7)
3AnonlinesurveyconductedbyEssentialResearch(April2021)completedby1090peoplebetween21ndash26April2021foundjust43ofAustraliansthinktherolloutisbeingdoneefficientlydownfrom68inMarchhellipTheslowrolloutandchanges to the roadmap also appear to have given rise to vaccinehesitancywithoneinsixpeople(16)sayingtheywillnevergetvaccinatedagainstCOVID-19upfrom12lastmonthwhile42saidtheywillgetvaccinatedbutnotrightawayTheproportionofpeoplewhowouldbewillingtogetvaccinatedassoonaspossibleorarealreadyvaccinatedalsodeclineddownfrom47to42rsquoEssentialReport(April 2021)
A mixed-method research methodology was used for this project However it was primarily a qualitative approach that aimed to hear directly from people in the community from culturally and linguistically diverse (CALD) backgrounds The methodology involved
METHODOLOGY
11 focus groups (including one pilot) involving atotalof167participantsfromCALD backgroundsand7locationsGriffith(1) Wollongong(2)Blacktown(2)Lakemba(1) MtDruitt(3)Toongabbie(1)andMarrickville (1)Thesesupportedparticipantstoanswer thesurveyquestionsandenabledmore detailedexplorationofissuesandfurther gatheringofqualitativeinformation(see Table1below)Identifiedmulticulturalandcommunityserviceorganisationswith connectionstoCALDcommunitiesinthe relevantlocationsactedaslsquointermediariesrsquo byassistingwithorganisingthefocusgroups providingbilingualfacilitationofdiscussion andsupportingcommunitymembersto undertakethesurveyMoreinformationonthefocusgroupsandintermediary organisationscanbefoundatAttachmentA
Anonlinesurveywiththesamequestionsas those used in the focus groups was made available This was promoted via NCOSS networksandtheresearchteamrsquosCALD connectionsandcompletedby32peopleThe totalsamplesizeofthisstudywastherefore 199participantsmadeupofmembersof diverseCALDcommunities
Abilingualmulticulturalcommunity engagementexpertwasengagedthroughout theprojecttoadvisetheresearchteam includinginrelationtothedesignofthe surveyBilingualfacilitatorswereusedfor focusgroupswherenecessaryandguidance wasprovidedbyintermediaryorganisation representativesasrequiredandinone instancethesurveywastranslatedintoArabic Focus group members were each provided witha$25giftcardattheendofthesession anda$50giftcardwasdonatedtothe intermediaryorganisationtoprovidesome additionalresourcestoeachgroup
Asecondonlinesurveywasdesignedtoelicit theviewsandexperienceoftheintermediary organisationsintheirworkwithCALD communitiesItgeneratedeightresponses
Two interviews were undertaken with a multiculturalhealthcommunicationexpert from the Illawarra Shoalhaven Local Health DistrictandanEmergencyDepartment medicalpractitioner
Theonlinesurveyresponsesfromthe intermediaryorganisationsandtheinterviews withhealthstaffhaveinformedanalysisof datafromcommunitymembersfindingsand recommendations
Inadditiontheresearchhasbeeninformedbyotherpubliclyavailableresearchincludingfind-ingsconcerningvaccinehesitancyanduptake4andascanofmulticulturalCOVID-19healthresourcesavailableincommunitylanguagesfromtheCommonwealthNSWandVictorianGovern-mentsSBSandEthnolink(seeAttachment2)
Recruitment for the focus groups IntermediaryorganisationsandfocusgroupparticipantswererecruitedusingtheresearchteamrsquosextensiveconnectionswithmulticulturalandcommunityserviceorganisationsacrossNSWanddrawingonkeyNCOSSmemberorganisa-tionsprovidingsupporttoandwithlongstandingrelationshipswithCALDcommunitiesToalargeextenttheselectedlocationsandtheservicesandsupportsprovidedbytheintermediaryorgan-isationsdeterminedtheculturalbackgroundsthatwereincludedinthestudy
4 httpswwwncossorgauCOVID-19-research
INTRODUCTION
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1110
Service Location Group Composition Participant numbers
Addison Road Community Centre Marrickville Community leaders - Vietnamese Chinese Italian Greek Indonesian Latin American and Portuguese speakers
26
Griffith Community Centre Griffith Indonesian and Pakistani women 6 Multicultural Communities Council Illawarra
Wollongong Arabic-speaking group 22
Multicultural Communities Council Illawarra
Wollongong Italian older womenrsquos group 15
Syd West Multicultural Services Mt Druitt Arabic-speaking group 10 Syd West Multicultural Services Blacktown Spanish-speaking seniorsrsquo group 16 Syd West Multicultural Services Blacktown Mothersrsquo support group -
Indian Sri Lankan Pakistani and Ghanaian
14
Canterbury City Community Centre (4Cs)
Lakemba Pakistani Indian and Sri Lankan women
14
Chaldean League and Western Sydney TAFE
Mt Druitt Chaldean group 18
STARTTS - Toongabbie Community Centre
Toongabbie Tamil-speaking group 12
Mt Druitt TAFE ndash TAFE NSW Mt Druitt Work Opportunities for Women group (mixed CALD backgrounds)
14
TOTAL 167
Table 1 Focus Group DetailsExplanatory noteThefocusgroupatMtDruittTAFE-comprisedpredominantlyofCALDwomenenrolledinaCertificateIIentrylevelcourse-wasusedtopilotandrefinethefocusgroupprocesswithsurveyresponsesgeneratedbythegroupincludedinthefinalsurveyresults
A word about the research design Theresearchwascarefullydesigneddrawingonexpertculturaladviceoncommunicationpro-cessesandsurveydesignFocusgroupsincludedparticipantconsentformsincentivevouchersandaone-pageintroductiontotheresearchfortheintermediaryorganisationsIntermediaryorgan-isationsandpreferredlocationswereidentifiedand agreed in advance with NCOSS
Thesurveywasdesignedinaneasy-to-readformatusingsimpleEnglishFeedbackfromthe Spanish-speaking translator was that it was extremelyeasytotranslateandcompleteOthergroupscommentedthattheyfoundthesurveyeasytocompleteandmostgroupsdisplayedasolidlevelofspokenandwrittenEnglishTheresearchdesignandconductalsoleantheavilyontheexpertiseofthefacilitatorsandtheirexten-sivenetworkswhichmadedeliveryinsuchashorttimeframepossibleThepositiveengagementandsupportoftheintermediaryorganisationswasalsoafactorcontributingtothesuccessfulconduct of the research
Withoutfailthemulticulturalandcommunityserviceorganisationsinvolvedintheresearchper-ceived the importance of its purpose and shared a desire to provide NSW Health with feedback directlyfromtheircommunitiesasamatterofurgency
Demographics of research participantsThemakeupofthosewhoparticipatedintheresearch was diverse in age and cultural and languagebackgroundParticipantswerepredom-inantlywomen(84)withmenmakinguponly145OverhalftheparticipantshadlivedinAustraliaformorethan20yearswhichimpactedpositivelyontheirlevelofspokenandwrittenEnglishHowevertherewerequitelowlevelsofEnglishliteracyinanumberofthegroupswhichmadeguidedsurveycompletionamoreneces-sarybutcomplexprocess
1 1 1
6
3
31
16 17
20
12
15
1
8
2
64
1
5
2 13
1 1
7
2 1
5
1 1 1 1 2 10
5
10
15
20
25
30
35
Indo
nesia
Thai
land
Hong
Kon
gAu
stra
lia Iran
Iraq
Viet
nam
Italy
Sri L
anka
Indi
aPa
kist
anGh
ana
Syria
Boliv
iaCh
ilePe
ruEl
Sal
vado
rM
alay
siaUr
ugua
yAr
gent
ina
Cam
bodi
aUk
rain
eRu
ssia
Chin
aSu
dan
Eritr
eaSw
eden
Taiw
anAf
ghan
istan
Pola
ndJa
pan
Egyp
tJo
rdan
13
1 2
10
17
2
21
1
11
1 1
12
2 1
27
10
1 1 1 13 2 1 2 1
6
1 1 1
32
0
5
10
15
20
25
30
35
English Thai
Cant
ones
eVi
etna
mes
eIta
lian
Farsi
Tam
ilTe
lugu
Span
ishSp
anglish
Haus
aUr
duGu
jara
tiPu
njab
iAr
abic
Chalde
anHi
ndi
Khm
erPe
rsian
Russian
Man
darin
Malay
Haza
ragi
Tigr
inya
Kurd
ishCh
ines
ehellipJa
pane
sePo
lish
Swed
ishM
ultip
le
Figure 1 Country of BirthFigure 2 Language spoken at home
METHODOLOGY
Coun
t
Coun
t
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1312
211
1316 14211684
2053
3316
Less that 1year
1 - 2 years 2 - 5 years 5 - 10 years 10 - 20years
More than20 years
000
500
1000
1500
2000
2500
3000
3500
Less than 1-2 years 2-5 years 5-10 years 10-20 More than1 year years 20 years
1453
8430
000 116
Male Female Non-binary Rather not say000
100020003000400050006000700080009000
000
785
1728
2147
1309
1675
2356
Under 18 18-24 25-34 35-44 45-54 55-64 65+000
500
1000
1500
2000
2500
Figure 3 Length of time living in Australia Figure 5 Gender
Figure 4 Age
METHODOLOGY
Chaldean Focus Group Feedback Sheet
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1514
Research participants were asked
If they were intending to get vaccinated
The reasons why they would or would not choose to get vaccinated
If they knew anyone who had already been vaccinated and if so who
If they knew anyone who had contracted COVID-19 and if so who
If they knew where to go to get vaccinated
What sources they used to get information about the COVID-19 vaccination
Basic demographic information age gender country of origin language spoken at home and length of time living in Australia
Having the vaccine or notOfthe199participants117(58)reportedthattheywereplanningtobeorhadalreadybeenvaccinatedwhile78(42)reportedthattheywere not planning to have the vaccine (13) or didnotknowiftheywouldgetvaccinated(29)
1453
8430
000 116
Male Female Non-binary Rather not say000
100020003000400050006000700080009000
05
10152025303540
Under18
18-24 25-34 35-44 45-54 55-64 65+
Coun
t
Yes No Donrsquot Know
Figure 6 Are you going to get the COVID-19 vaccine
Figure 7 COVID-19 Vaccine intention of respondents by age category
13people(65)hadalreadybeenvaccinated(at least 1 dose)6withseveralcommentingthattheyhadchosenorneededtobevaccinatedforwork-relatedreasonsOthersreportedthattheyhadbeenvaccinatedprimarilyforhealthreasonstostaywellandmakesurethattheirfamiliesstayedwellTheywerealsoconcernedaboutpublichealthandsafetyOneofthewomenintheLakemba groups from Sri Lanka was adamant that thebenefitsoutweighedtherisksspokepositive-lyabouthoweasyithadbeentogetthevaccinefrom her local medical centre and that she had experiencednosideeffectsfromthevaccination
Language Count Percent Urdu 1 Italian 3 Arabic 2 Tamil 3 Chaldean 1 Spanish 3 Total 13 65 of sample
Response Count Percent Not planning to have the vaccine 23 13 Unsure about having the vaccine 52 29
75 42
Table 2 Respondents already vaccinated
Table 3 Respondents who indicated vaccine refusal or hesitancy
6 Theresearchersdidnotdistinguishbetweenwhetherpeoplehadreceivedtheirfirstandseconddosesofthevaccineiepartiallyorfullyvaccinated
75(42)indicatedadegreeofvaccinehesitancywith24participants(13)reportingthattheywerenotplanningongettingvaccinatedwhile53(29)reportedtheydidnotknowiftheywouldget vaccinated
Thislevelofvaccinehesitancyreflectslargerstud-iesintheAustraliancommunityAsurveyofover1000participantsfromacrossAustraliaconduct-edinApril2021byEssentialResearchfoundhes-itancyratesof42including16whoindicatedtheywerenevergoingtogetvaccinated7
Foroursurveyresponsesindicatedthatagewasafactorwith85ofrespondentsaged65andoverreportingthattheywouldhaveorhad
7EssentialResearchThe Essential Report21April2021
FINDINGS FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1716
alreadyhadthevaccineThosewhoindicatedthattheywouldnotbehavingthevaccinewerefairlyevenlydistributedacrossagegroupswithyoung-er people aged 18-24 being the age group with thehighestproportionofparticipantsexpressinguncertaintyabouthavingthevaccineTheagegroupwiththesecondhighestlevelofhesitancyproportionatetoothercategorieswerethe35-44yearolds
02468
10121416
Iraq
Vietnam Italy
South Americ
a
Sri La
nkaIndia
Syria
Other South East
AsiaAfric
a
Australia
Sweden
China
Pakistan
Iran
Eastern Europe
Afghanistan
Japan
Coun
t
Yes No Dont know
8095 8190
70486095
4571
6190
095
To stayhealthy and
well
To keep myfamily
healthy andwell
For publichealth
To travel To work It is theright thing
to do
Somethingelse (pleasetell us what)
000100020003000400050006000700080009000
Figure 8 Respondents COVID-19 Vaccine intention by Country of Origin
Figure 9 Reasons for getting vaccinated against COVID-19
Countryoforiginalsoseemedtoplayaroleinpeoplersquosviewsabouthavingthevaccinewithhighvaccinepre-dispositionreportedbyVietnameserespondentstotheonlinesurveyandwomenintheItalian-speakinggroupWhileparticipantsfromIraqrecordedthehighestlsquoyesrsquoresponsethiswasalmostmatchedbyIraqiparticipantswhoreportedthattheywerelsquounsurersquoorlsquodidnotknowrsquowhethertheywouldhavethevaccineTherelevanceofcountryoforigininthisregardwouldbeworthyoffurtherresearch
The Italian focus group held in Wollongong was an olderwomenrsquossocialgroupwithallparticipants(15) agedabove65yearsMostinfactwereaged over75yearswithoneparticipantinher90s 87 of the group had either been vaccinated (3) or were planning to get vaccinated (10)
Of course I will get vaccinated It is important to do this It is a very bad
disease
Thesewomenweremotivatedtostayhealthyandwellkeeptheirfamilyhealthyandwellforpublichealthreasonstobeabletotravelandforgen-eralsafetyMembersofthegroupalsoreportedthattheywantedtogetvaccinatedsothattheywouldbeabletolsquodancersquoandlsquosocialisersquo
Reasons for having the vaccine
Ofthe117participantswhoreportedthattheyhadeitheralreadybeenvaccinatedorwereplan-ningtogetvaccinatedlsquokeepingmyfamilyhealthyandwellrsquo(82)andlsquokeepingmyselfhealthyandwellrsquo(81)werethetwomostpopularreasonsforhavingthevaccineThiswasfollowedbylsquoforpublichealthrsquo(70)lsquoitistherightthingtodorsquo(62)andinorderlsquototravelrsquo(61)(SeeFigure9)
I donrsquot want to
die
Irsquom over 65 I have some health issues I think itrsquos
[having the vaccine] very important to
keep safe
I want to see my family I usually go every year but now I havenrsquot seen them
because of COVID-19 Having it will help
I am well but my parents are older It is important to
keep them well
Otherreasonsthatpeoplegaveforgettingvacci-natedincludedtheneedtocontinueworkinginessentiallsquofrontlinersquoemploymentsuchassecuritycleaningandagedcaresettingsOnewomanintheLakembafocusgroupwhohadalreadyhadherfirstdoseoftheAstraZenecavaccinesaidthatlsquothebenefitsoutweightherisksrsquoandasanolderwomanrsquoIdonotwanttodiersquo
All but one of the focus groups were familiar with thedifferentvaccinescurrentlyavailableinAus-traliaAstraZenecaandPfizerMostparticipantswere also aware of blood clots being associated with the Astra Zeneca vaccine One group of newly-arrivedrefugeesinGriffithhadnotheardofeithertheAstraZenecaorPfizervaccinesandhadamorelimitedunderstandingofthevaccinationprogram in general
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1918
Reasons for not having the vaccine
At the moment the situation is under control and donrsquot feel the need Also I have no plans to
travel in the near future so I donrsquot see the need
3514
21622703
3243
1892
811 541
4865
1081
Thevaccine isnot welltested
Thevaccine is
unsafe
Formedicalreasons
I amscared tohave thevaccine
I dont likevaccines
Forreligiousreasons
Forculturalreasons
I want towait and
see
Somethingelse
(pleasetell uswhat)
000
1000
2000
3000
4000
5000
6000
Figure 10 Reasons for not getting vaccinated against COVID-19
Theperceivedlsquolackofadequatetestingrsquoofthevaccineandlsquofearofbeingvaccinatedrsquoalsore-ceivedhighresponseratesselectedby3514and3243ofparticipantsrespectivelyOnly1355 of respondents cited religious or cultural reasonsasbeingbehindtheirvaccinehesitancy
Open-endedresponsestothisquestionincluded
The vaccine is not 100 working It cannot offer
100 protection
Ofthe42participantswhosaidthattheywouldnothaveorwerehesitanttohavethevaccine4865saidthattheypreferredtolsquowaitandseersquobeforegettingvaccinated
Thediscussioninthefocusgroupsaboutpeoplersquoshesitancytobevaccinatedfocusedonanumberofconcernswhichreflected
poorcommunicationfromanumberof trusted sources including GPs and some media sources
conflictinginformationaboutthevaccinefrom healthauthorities
fearsaboutvaccinesafetythataresharedby thegeneralcommunity
misconceptionsabouttheeffectivenessof andhowthevaccineswork
I will not have it because make me sick
Issuesraisedinfocusgroupsascontributingtoincreasedhesitancyincluded
Some GPs being hesitant to recommendvaccination
Theinformationbeingprovidedisconflicting
Theinformationisoverlycomplexandnotcomprehensibleregardlessofwhetherithasbeen translated
The risk of blood clots
Perceptionsthatthevaccinesaregenerallyunsafe
Concernsthatsomepeoplearedyingafterbeing vaccinated
Not being sure about the risks associated withhaving the vaccine and being pregnant orbreastfeeding
Theperceptionthattherehasbeenalackoftestingofthevaccinespriortorollout
AlackofunderstandingofhowvaccinesworkthecompositionofthevaccinesandwhattheywoulddotothebodyincludingmakingchangestoapersonrsquosDNA
Specificcommentsincluded
I have heard that the vaccine changes
your DNA
I am a mother I am not sure it [the vaccine] is safe for
me when I am breastfeeding
If you are young and healthy your body has the energy to fight the virus
You donrsquot need to have the vaccine You should just let
your body fight it itself
They donrsquot tell you what chemicals are in the
vaccine
Tamil Focus Group Feedback Sheet
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2120
Nobody knows what to do My GP doesnrsquot even know what I should do whether
I should have it or not
I am not sure what to do I have spoken to my
GP but they canrsquot tell me whether I should have the vaccine or not while I am
breastfeeding
They say one thing and then they tell you
something elsehellip it [the vaccine rollout] is so
confusing
Confusionaboutwhattodowheretogoandthe health impacts of the vaccine was a common threadintheconversationsaroundvaccinehesi-tancy
Onewomanwhosehusbandworkedforasecurityfirmsaidthatherhusbandhadhadtobevacci-natedinordertokeephisjob
In several focus groups the issue of government control was also raised A number of people re-portedstronglythattheyfearedthatthevaccinewas lsquoa means that the government was using to controlpeoplersquo
He [husband] had to have it He didnrsquot have a choice He was fine [no side effects] but Irsquom not
thinking I will have it I donrsquot need to Irsquom a mum Irsquom busy I have
to look after my children I donrsquot know how I feel about it whether
Irsquom going to have it
Vaccine refusal
Onlyasmallnumberofparticipants(24or13)saidtheywouldnotgetvacci-natedOfthisgroup21werewomenand 2 were men8 Respondents were bornintendifferentcountrieswithadiverse range of language backgrounds
I never get sick It is the same for all my family We have always been strong and healthy so I will be
saying no to the vaccine
Country of Birth Language Background Count Pakistan Urdu 4 China Taiwan Chinese
(MandarinCantonese) 4
Sri Lanka India Tamil 3 Chile Spanish and English 2 Italy Italian 2 Iraq Syria Arabic 2 Iraq Chaldean 1 Iran Farsi 1 Greece Macedonian 1 Poland Polish 1 Pakistan Punjabi 1 Sweden Swedish 1 Vietnam Vietnamese 1
Table 4 Vaccine refusal by country of birth and language background
8 ThisreflectstheoverallsamplebiastowardswomenThemajorityoffocusgroupparticipantswerewomenXwithYparticipantsbeingmen
Reason for not having the vaccine Percent Count The vaccine is not well tested 5455 12 I want to wait and see 5455 12 The vaccine is unsafe 3636 8 For medical reasons 3182 7 I am scared to have the vaccine 3182 7 I dont like vaccines 1364 3 For religious reasons 1364 3 For cultural reasons 909 2 Something else (please tell us what) 909 2
SomeinthiscategorywereadamantthattheywouldnotbehavingthevaccineandhadverystrongviewsonitlsquoForculturalreasonsIwonrsquotbehavingthevaccinersquoWhenwelookatrespons-esmorecloselyhoweveritwouldappearthatmanyareinfactmorelsquohesitantrsquothanfirmvaccinerefusers
One reluctant middle-aged Tamil-speaking wom-ansaidlsquoIftheysaywehavetogetvaccinatedthenIwillrsquoThissentimentwas stronglysup-portedbythe rest of the Tamil-speaking group
Studyparticipantswhosaidtheywouldnothavethe vaccine were also concerned that lsquothe vaccine wasnotwelltestedrsquo
The vaccine has been rushed out It has not been
properly tested
Table 5 Reasons for not having the vaccine
Peopleinthiscategorysaidthattheywouldlsquowaitandseersquowhathappenswiththewiderrolloutbe-foremakingtheirfinaldecisionThissuggeststhataproportionofthelsquonorsquogroupareinfacthesitantrather than outright refusing to have the vaccine
Therewerealsofearsexpressedbyfocusgroupparticipantsaboutthedangersofbeingvacci-natedParticipantsreportedbeingafraidofthehealthrisksespeciallyfrombloodclotsSomepeopledistinguishedclearlybetweenAstraZene-caandPfizerinthisregardHoweverformanythedistinctionbetweenthedifferentvaccineswaslostandtheyspokeofthevaccinesgenerallybeing unsafe and having a range of unwanted side effects
Other factors consideredInadditiontothebroaderquestionsofwhypeo-plewouldorwouldnotchoosetogetvaccinatedthe research team used the focus group discus-sionstoexplorewhetherthefollowingfactorshadanyimpactonapersonrsquoslikelihoodofbeingvaccine pre-disposed or hesitant
Knowing someone who had been vaccinated
Knowing someone who had contracted COVID-19
Knowing where to go to get vaccinated
Thesourcespeopleturntoforinformation about COVID-19 and COVID-19 vaccines
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2322
Knowing someone who has been vaccinatedOfthosewhorespondedtothisquestion125or70knewsomeonewhohadalreadyhadthevaccine
6983
2570
447
Yes No Dont know000
1000
2000
3000
4000
5000
6000
7000
8000
Figure 11 Do you know someone who has been vaccinated
Amongthe125participantswhoknewsomeonewhohadalreadybeenvaccinated100identifiedlsquoimmediatefamilymembersrsquo(parentschildrensiblingsandpartners)Somefocusgrouppartic-ipantsreportedthatalloftheirfamilymembersoverseas had been vaccinated Others reported thattheirrelativeshadbeenvaccinatedasarequirementoftheiremployment
Who Count Percent Other family member 41 313 Sister 24 1832 Community member 23 1756 Brother 18 1374 Father 17 1298 Mother 16 1221 Work colleague 14 1069 Husband or wife 11 84 Son or daughter 10 763 Partner 4 305 Someone else 45 3435 Total respondents 131
Table 6 Who do you know who has been vaccinated
When this issue was teased out further in focus groupdiscussionsarangeofreasonswere revealed including
My husband works in security and he had
to get it
My friend works as a COVID-19 cleaner and they all had to [get
vaccinated]
My family overseas have already been vaccinated
My son needs to travel for work so he is getting it
My brother in the UK is a doctor and he got it and
his wife
Knowing someone who has had COVID-19Almosthalfoftheparticipantsknewsomeonewho had contracted COVID-19 overseas Some reportedthatallthemembersoftheirfamilyormanymembersoftheirextendedfamilyhadcon-tracted COVID-19 In the older Italian group 10 of the15womenknewsomeoneinItalywhohadcontracted COVID-19
4716 4659
625
Yes No Not sure000
1000
2000
3000
4000
5000
Figure 12 Knowing someone who has had COVID-19
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2524
385 385
1538
2692
641 513000
4359
2051
1026385
1410
Mother
Father
BrotherSis
ter
Son or d
augh
ter
Husban
d or wife
Partner
Other family
mem
berFri
end
Community m
ember
Work co
lleag
ue
Someone else
(please
tell u
s who)
000500
100015002000250030003500400045005000
Figure 13 Who do you know who has had COVID-19
Four people in the focus groups knew someone who had died of COVID-19
All my family back home [Pakistan] got it [COVID-19] but
they are all fine now apart from my father He died But he was really sick before he
got it He had lots of underlying conditions Medical conditions so he was really unwell before he got COVID-19 But everyone else
they are fine now They were sick but they got betterhellip
If you are well and healthy you can fight this off
SurprisinglyknowingpeoplewhohadcontractedCOVID-19didnotseemtoinfluencefocusgroupparticipantsrsquopredispositiontowardseitherhavingthevaccineorbeingvaccinehesitantHowevertheolderItalianwomenrsquosgroupspokeabouttheimpactthatCOVID-19hadhadinItalyintheearlystagesofthepandemicandhowthishadaffectedthemdeeply13ofthe15womeninthisgroupwouldhaveorhadalreadyhadthevaccine
Knowing where to get vaccinated115people(81)whorespondedtothisquestion(n=142) knew where to go to get the vaccine 34 people(19)reportedthattheydidnotknowThisincluded15respondentsfromIraq3re-spondentsfromIndia2respondentsfromChina2 respondents from Pakistan and one respondent fromeachofthefollowingcountriesChinaEri-treaItalySriLankaSwedenSyriaandVietnamThese people were also less sure about whether ornottheywouldhavethevaccineItispossiblethat their lack of knowledge about where to go to get vaccinated was related to their general level ofvaccinehesitancy
7958
29582254
282 563
GPDoctor Vaccinecentre
Hospital Work place Somewhereelse (please
tell us where)
000100020003000400050006000700080009000
Figure 14 Where to go to get vaccinated
From the sample (n=199) GPs were the most commonlyidentifiedplacetogotogetvaccinat-edfollowedbythevaccinecentreatHomebushBayandthenhospitalsOtherplacesidentifiedincluded medical centres and pharmacies
Sources of information about COVID-19 and the vaccineThelargestsinglesourceofinformationaboutCOVID-19 and the vaccine was Facebook (417)
2743
3486
13141086
30862686
3429
2229 2286
41713714
2571
1086 971
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)000500
10001500200025003000350040004500
Figure 15 Sources of information about COVID-19 and the COVID-19 vaccine
Facebook I get my information from
Facebook But if I want to check it I watch the news
on 7 [Channel 7]
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2726
Thesecondlargestsourceofinformationforpeople in the sample was lsquoother forms of social mediarsquo(37)followedbySBStelevision(35)myfriends(34)andothertelevision(31)Oth-ersourcesofinformationpeoplereportedthattheyusedweretheNSWHealthwebsitenightlytelevisionnewsincludingChannel7Channel9andChannel10followedbytheABCtheAustral-iangovernmenthealthwebsitetheirGPlocalMedical Centres and the Red Cross
IntheLakembafocusgrouppredominantlymadeupofwomenfromPakistantherewasanani-mated discussion about Facebook which was the majorsourceofinformationalongwithGooglesearchesandcommunityandfriendship-basedWhatsApp groups There was a general consensus from most in the group that these were their pre-ferredormostcommonsourcesofinformationandnewsHoweveriftheywantedtolsquofactcheckrsquowhattheywerehearingtheywouldwatchthenightlynewsonChannel7orChannel9toverifywhattheyperceivedcouldsometimesbeunrelia-ble sources
IntheMtDruittfocusgroupseveralofthewom-enwithwell-developeddigitalliteracyandgener-alliteracyskillsusedhealthandfitnesswebsitesand social media sites as their source of infor-mationaboutlsquoallthingshealthrelatedrsquoincludingCOVID-19ThesewomenalsospokepositivelyabouttheinformationandsupporttheygotfromthestaffatCanterburyCouncilCommunityCentre(4Cs)whotheycouldrelyontofindoutthingsthattheyidentifiedtheyneededtoknowmoreabout
InthesmallerfocusgroupinGriffithwithrecently-arrived refugee women who had low levels of Englishlanguageliteracytherewaslittleknowledgeaboutthevaccinesnoawarenessofthedifferenttypesofvaccinesandlittleknow-ledgeaboutwheretogotogetvaccinatedorfindoutmoreaboutCOVID-19ingeneralThecommunityservicestaffandvolunteerspresentatthegroupwere working hard to assist these women to improve their English language skills and support themwithtranslatedinformation
In the older Italian women focus group in Wollon-gongparticipantsreportedgettingtheirinfor-mationfromslightlydifferentsourcesndashfamilyinAustralia(10women)Channel9(7women)
Italianradio(3women)andABCTV(3women)Onlytwowomenusedtheinternetandnoneofthe women reported using Facebook or social mediaasasourceoftheirinformationSeveralmentionedthattheygottheirinformationfromtheirGPorspecialistdoctorandonepartici-pantsaidrsquoIdonrsquotlistentoanyonersquoIntheSpan-ish-speaking focus group a comment was made thatseemedtoreflectmanyoftheotherfocusgroup discussions
Whenlsquosourcesofinformationrsquoiscorrelatedwiththegroupwhosaidtheywouldhavethevaccine(n=104)thereisashiftfromFacebookbeingthepreferredsourceofinformationtolsquoSBSTVrsquobeingthepreferredsourceThelsquovaccine-predisposedrsquogroupalsohadthelowestrateofrelyingonFace-bookasasourceofinformationaboutCOVID-19thoughitwasstillhighThegraphbelowhigh-lightshowotherlsquopreferredsourcesrsquoplayoutforthoseintendingtohaveorwhohavealreadyhadthe vaccine
ForthoseparticipantswhoindicatedthattheywouldnotorwerenotplanningtohavethevaccinelsquoFacebookrsquolsquomyfriendsrsquoandlsquomyfamilyrsquowerethesourcesofinformationaboutCOVID-19thatwereequallymostfrequentlycitedfollowedcloselybylsquomyfamilyoverseasrsquolsquoSBSradiorsquoandlsquoSBSTVrsquoassourcesofinformationreceivedthelowestmentionsfromthisgroup(SeeFigure16)
The vaccine-hesitant group were the group who identifiedlsquoFacebookrsquoastheirmostfrequentsourceofinformationaboutCOVID-19lsquoFace-bookrsquowasfollowedbylsquoothersocialmediarsquoandlsquomyfriendsrsquoasthenextmostfrequentsources
lsquoThiscommunityserviceproviderrsquo(theinterme-diaryorganisationwherethefocusgroupwasconducted)wasidentifiedby26ofrespondentsasasourceofinformationregardlessoftheirintentiontogetvaccinatedornotThefactthatboththelsquovaccinehesitantrsquoandthosewhoindi-catedtheywouldnrsquotbegettingthevaccinesoughtinformationfromthissourcesuggeststhatrolling
There is so much confusion about it [the vaccine] that I think my GP is the best
place to go
9 This group of the research sample included a small number ofpeoplewhohadalreadybeenvaccinated
2626
4141
14141111
323228282828
2424
1818
37373737
2828
10101212
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)00050010001500200025003000350040004500
2857
2381
952 952
2857
3333
42864286
3810
4286
23812381
1429
952
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another co
mmunity se
rvice
Somewhere
else (p
lease te
ll us w
here)000
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Figure 16 Sources of information for respondents who were planning to have the vaccine9
Figure 17 Sources of information for respondents who were not planning to have the vaccine
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2928
outpositivemessagingthroughtrusted communityserviceorganisationscouldbeaneffectivewayofshiftingpeoplefromvaccine hesitancytodecidingtohavethevaccine
31372549
980 980
25492157
4314
1176
2353
4902
4118
2157
980392
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)000
1000
2000
3000
4000
5000
6000
Figure 18 Sources of information for respondents who lsquodonrsquot knowrsquo if they will have the vaccine
DISCUSSION
wardstheCOVID-19vaccineareasvariedastheyarewithinthebroadercommunityTherearearangeofinfluencingfactorsincludingagehealthstatushowlongtheyhavebeeninAustraliahowmuchnewstheyreceivefromoverseasandhowbadlyimpactedbythepandemictheirhomecountries have been
The research also highlights that people from culturallyandlinguisticallydiversebackgroundsgettheirinformationaboutCOVID-19andtheCOVID-19vaccinefromawidevarietyofsourcesbothformalandinformalandthatforparticulargroupsinthisstudythereisahighrelianceonFacebookovermoreofficialsourcesofinforma-tion
VulnerabilityTheneedsofhighly-vulnerablegroupswithintheCALDcommunityhavetobetakenintoconsider-ationThisincludesolderpeoplewhohavelivedinAustraliaformanyyearsbuthavelowlevelsofEnglishliteracyndashespeciallywritingandreadingEnglishandsometimesspokenEnglishndashandwhoaremoresusceptibletoseriousillnessandhigherratesofhospitalisationanddeathfromCOVID-19Italsoincludesnewly-arrivedrefugeeswhohavinglowornoEnglishlanguageliteracylacktheconnectionstoandnetworksintothewidercommunityandcommunitysupportsItisalsothecase that some people in these groups are not health literate at all and cannot read and write in their own language
Akeytakeoutfromthehealthandcommunityserviceorganisationsurveyresponsesandinter-viewsundertakenwithmulticulturalhealthandcommunicationexpertsfortheprojectisthatlit-eracylevelsreallydomatterLowlevelsofhealthliteracylowlevelsofEnglishlanguageliteracyandpossiblylowlevelsofliteracyintheirownlan-guage-especiallyforsomenewly-arrivedrefu-gees and those who are part of the humanitarian program such as Dari language speakers from AfghanistanTigrinyalanguagespeakersfromEr-itrea and northern Ethiopia and Oromo language speakers from Ethiopia - need to be factored into anyplanstofurtherpromotethevaccinerolloutanduptaketoculturallyandlinguisticallydiversepeopleinthecommunityThereisaneedfor
The contextThisresearchisimportantgivenhowhighlyculturallydiverseNSWisandtheimpactthiscanhave on the success of public health messaging topeoplewhosefirstlanguageisnotEnglishPeople who were born overseas form almost one-thirdofthe7480228population(276)ofNSWandNSWishometo336ofAustraliarsquosoverseas-bornpopulationPeoplefromaround225 birthplaces have made NSW their home and 21oftheNSWpopulationisfromanon-EnglishspeakingbackgroundMorethan24000humani-tarianentrantshavesettledinNSWoverthepastfiveyearscomprisingalmostathird(32)ofthenationaltotalThe24000humanitarianentrantswhohavesettledinNSWoverthepastfiveyearscame from over 100 countries of origin10Sydneyhasthelargestoverseas-bornpopulationofallthecapitalcities11
Hearingdirectlyfrompeoplefromculturally-diverse backgrounds is important to ensure that policymakersandpublichealthadvocatescandesign responses that are both accessible and un-derstandabletopeopleforwhomEnglishmaybetheirsecondthirdorfourthlanguageApropor-tionofpeopleinthesecommunitieshavelowerlevelsofEnglishlanguageliteracyandinsomecaseslowlevelsofliteracyintheirlanguageoforiginsowillbehardertoreachviatraditionalormainstream methods
Itisalsocriticallyimportantthatduringatimewherethereissomuchlsquonoisersquoacrossmediachannelsrelatingtothevaccinethevaccineroll-outvaccineefficacyandvaccinesafetythatwetakesometimetolistentoandunderstandhowthislsquonoisersquoisbeingheardandmadesenseofbypeoplefromculturally-diversebackgrounds
ThatsaiditisimportanttoreconfirmthattheCALDcommunityisnotahomogenousgroupOurresearchhasfoundthattheviewsandattitudesofparticipantsfromdiverseculturalbackgroundsto-
10RefugeeCouncilofAustraliaHumanitarianEntrantsin New South Wales A resource for New South Wales governmentagencies6-711MulticulturalNSWCommunityRelationsReport2018-20199
29
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3130
groupsFortheparticipantsintheresearchtheirattitudetothevaccineappearedtobeinflu-encedbyanumberoffactorstheirownlevelsofhealthandpre-existinghealthconditionsandthoseoftheirfamilymembersandtheimpactofreceiving COVID-19-related news from overseas particularlyfrompeoplersquoscountryoforiginAnexampleofthiscanbeseenintheItaliangroupin Wollongong where people had received news fromoverseasearlyinthepandemicwhichscaredthemThisexperiencelsquofromhomersquohadinflu-enced most of the women in the Wollongong focus group (n=15) to choose to get vaccinated The interviewee from the Illawarra Shoalhaven Local Health District also spoke about the heightenedconcernthattheywitnessedinthelocalItaliancommunityintheearlystagesofthepandemicOtherpeoplewantedtolsquostayhealthyrsquoandtolsquoprotectthehealthofothersrsquoandformanytherewasasensethattheywantedtolsquogetbacktosomedegreeofnormalcyrsquoandtobeabletolsquotraveloverseastovisitrelativesrsquo
Vaccine hesitancyOfthe42inthisstudywhoappearedundecidedornotplanningtohavethevaccinemanywereinfactadoptingalsquowaitandseersquoapproachbeforemakingtheirfinaldecisionMostparticipantswereinterestedtohearmoreinformationaboutthevaccinesandwereopenedtogettingthevaccinebutdidhaveconcernsaboutthesafetyofthevaccinesespeciallyinregardtoAstraZeneca
The issue of blood clots has led to considerable fearandhesitancyinthecommunityandthisfearandhesitancywasreflectedinourstudyEssentialResearchrsquossurvey(April2021)reportedoneinsixpeople(16)indicatedtheywillnevergetvaccinatedagainstCOVID-19upfrom12thepreviousmonthwhile42saidtheywillgetvaccinatedbutnotrightawayTheproportionofpeople who would be willing to get vaccinated as soonaspossibleorarealreadyvaccinatedalsodeclineddownfrom47to4213Thissurveywas conducted prior to the most recent outbreak inNSWinvolvingthehighlyinfectiousDeltastrain
Therisk-benefitofhavingthevaccineneedstobecarefullyweighedbyeachindividualideallyinconsultationwiththeirdoctoranddependingon
The Hub has lsquobeen working in partnership with keystakeholdergroupstoguidecommunicationstomeetthehealthliteracyandculturallyandlinguisticallydiverse(CALD)needsofitspop-ulationStructuredworkinggroupshavebeencreatedtoprioritisecommunicationstovulner-ableyouthCALDgroupstheelderlyitinerateworkersasylumseekersandrefugeesTheaimsaretotestmessagingandbuildtrustwithprioritypopulationstoensureeffectivecommunicationoftheneedtosustainphysicaldistancingmeas-uresintheabsenceofavaccineSimilareffortsarenowneedednationallyandshouldstartatthetimeofdiseaseoutbreaksinthefuturealongsideplannedmassmediaandhealthcommunicationcampaignsrsquo
InthearticlebyDoddetaltheyreinforcetheimportanceofusingcommunicationformatswhich are lsquosuitable for people with low health literacyandeducationandwhichareappropriateforculturallyandlinguisticallydiversegroupsandIndigenouspopulationsrsquoThearticlearguesthatitisimportanttolookatmotivationsandconcernsabout vaccines when shaping messaging It also pointsoutthatprimarycaredoctorsareatrust-ed source and as such should be supported in deliveringinformationaboutthevaccinesandad-dressingcommunityconcernsThearticlestateslsquoWeneedtounderstandandaddresscitizenrsquosconcernsthatcanpreventoptimaluptakebuildmotivationsintomessagingandprioritisepublictrustbyinformingandinvolvingthecommunityintheprocessSupportinghealth-careprofession-als in their role as educators will ensure people haveadequateandaccessibleinformationfromatrustedsourcetooptimisevaccineuptakeandultimatelyreducecommunitytransmissionofCOVID-19rsquo15
RecentresearchbyAssociateProfessorHollySeale16withUNSWMedicinersquosSchoolofPublicHealthandDeputyChairfortheCollaborationonSocialScienceandImmunisationfoundthereisaneedtolsquodecentralisersquocommunicationsbytapping
translatedmaterialsandinformationaboutthevaccines to be tailored to the needs of people in these newly-emergingcommunitygroups
It was reported that in Wollongong there can sometimesbefourgenerationsoffamilymem-bersfromnewly-arrivedrefugeegroupslivingintheonehouseMostofthesefamilymembersgenerallyhavelimitedEnglishlanguageliteracywhichincreasestheirriskofnotreceivingkeyhealthmessagesandthereforeincreasingthepotentialimpactofCOVID-19-inparticulartheDeltastrainwhichhasprovenhighlyinfectiousamongst household members
Vaccine uptakeNotdissimilartothewidercommunitymorepeopleinourstudywereplanningtohavethevaccinethannotandanumberhadalreadybeenvaccinatedInarecentLancetarticle(February2021)ConcernsandmotivationsaboutCOVID-19vaccinationfindingsfromtwosurveysfromanAustralianlongitudinalstudyconductedinJuneandJuly2020includedthatlsquothetopthreerea-sons for agreeing to vaccinate were lsquoto protect themselvesandothersrsquohelliplsquobeliefinvaccinationandsciencersquohellipandlsquotohelpstopthevirusspreadrsquoEven among those willing to vaccinate there was somehesitancyaboutthesafetyofthevaccineTheLancetarticlenotedthatlsquowillingnesstovaccinatedifferedbybothageandeducationrsquoForthosewhowereindifferentorsaidtheywouldnot get the vaccine the top reasons across the twosurveyswerelsquoconcernaboutthesafetyofthevaccineinitsdevelopmentrsquoandlsquopotentialsideeffectsrsquo12
Olderpeopleinourstudywhocomprised23of the total sample (n=199) were the group most likelytosaythattheywantedtogetthevaccine85ofthoseover65saidtheywouldhaveorhadalreadyhadthevaccineVaccinepredispo-sitionwashoweveralsostrongacrossotherage
12RHDoddKPicklesBNickelECvejicJAyreCBatcupCBonnerTCoppSCornellTDakinJIsautierKJMcCafferyConcerns and motivations about COVID-19 vaccination SydneyHealthLiteracyLabSydneySchoolofPublicHealthFacultyofMedicineandHealthUniversityofSydneypublishedintheLancetFebruary2021p162wwwthelancet cominfectionVol21February2021
theircircumstancesHoweverthesourcesofin-formationthatpeoplemostrelyuponortrustarecriticaltothedisseminationofaccurateandclearmessaging to dispel the fear surrounding events suchasbloodclottingandthemisconceptionsraisedinthefocusgroupsWithsomanypartici-pantsinthisstudygettingtheirinformationfromFacebookandothersocialmediasitesitisvitalthat these channels are used to promote simple positivemessagesandforanyfuturecommunityawareness campaigns
Effective communicationConfusionandmisconceptionsaboutthevac-cinersquosefficacyavailabilityandsafetywereallis-sues that were raised in the focus groups Finding waystoeffectivelycommunicatewithpeoplewithlowerEnglishlanguageliteracyandhealthliteracyisanimportantwaytoaddresstheconfusionandmisconceptionsaboutthevaccineashasbeen discussed in a number of recent Australian studies
Astudy14byMcCafferyetal(2020)concludedthattherearelsquoimportantdisparitiesinCOVID-19-relatedknowledgeattitudesandbehavioursaccordingtopeoplersquoshealthliteracyandlanguagersquoOneofthefindingswasthatlsquopeoplewithlowerhealthliteracywerealsomorelikelyto endorse misinformed beliefs about COVID-19 andvaccinations(ingeneral)thanthosewithadequatehealthliteracyThesamepatternofresults was observed among people who primar-ilyspeakalanguageotherthanEnglishathomersquoTheMcCafferystudyhighlightstheimportanceof tailoring health messages to those with lower healthliteracyandculturallyandlinguisticallydiversecommunitiesItpointsoutthatthereareexamplesofeffectivemanagementofdiversecommunityneedsthatusetailoredhealthmes-sagesandcitestheWesternSydneyLocalHealthDistrictHealthLiteracyHub
13TheEssentialReport-anonlinesurveyconductedbyEssentialResearchcompletedby1090people between 21ndash26 April14McCafferyKJDoddRHCvejicEAyreJBatcupCIsautierJMJCoppTBonnerCPicklesKNickelBDakinTCornellSWolf MS Health literacy and disparities in COVID-19ndashrelated knowledge attitudes beliefs and behaviours in Australia PublicHealthResPract202030(4)e30342012December2020
15 Op cit16 httpssphmedunsweduausitesdefaultfilessphcmNewsEnhancing-supporting-COVID-19-vaccination-programpdf
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
30 31
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3332
intodifferentnetworkingspacessuchaswork-placeslocalgymsmothersrsquogroupsandseniorsrsquoclubswithafocusonallagegroupsregardlessofcurrenteligibilityAccordingtoSealethechal-lengeislsquoensuringemerginginformationisadapt-edfortheintendedaudiencersquoShehasalsosaidlsquoThatrsquoswhatIrsquomalittlebitconcernedaboutatthemomenttherersquosalotofresourcesongov-ernmentwebsitesbutthesetermsaroundbloodclottingareverytechnicalWeactuallyneedtomake sure that we are breaking them down in a waythatwillmakeitmeaningfultopeopleThatrsquosnotjustabouttranslatingitrsquosaboutbeingcon-sciousofpeoplersquoshealthliteracyneedstooSomaybegettingsomemorevisualsintomaterialstotryandsupportthatrsquo17
Thereareanumberofmulticulturalhealthresourcesthatusecommunitylanguagetransla-tionsplainEnglishandvideosfromCALDcommu-nityleaderswhichcanbedownloadedandusedbyservicesandindividualsHowevermanyofthewrittenresourcesstillrelyontechnicalandscien-tifictermsthatrequireareasonablyhighlevelofEnglishlanguageliteracyorhighlevelsofliteracyin the translated language to comprehend Host websites can also be hard to navigate making itdifficulttolocateresourcesfromsimplewebsearchesAsummaryofsomeoftheavailableresourcescanbefoundatAttachment2
MulticulturalHealthUnitsinLocalHealthDis-trictshavestaffwhocanworkwithpeoplefromculturallyandlinguisticallydiversecommunitiesatthelocallevelandtranslateandcontextualisethese materials to the needs of the end user These teams respond to local needs and popu-lationdemographicsandareexpertsineffectivehealthliteracyandhealthcommunicationwiththeirlocalcommunitiesTheyworkcloselywithcommunityandvulnerablegroupstobuildhealthliteracyandimprovedhealthoutcomesintheircommunities
Case Study ndash Be a COVID Warrior ndash Responding to COVID-19 in Multicultural Communities InWollongongtheIllawarraShoalhavenLocalHealthDistrict(ISLHD)MulticulturalHealthSer-viceco-designedacommunityengagementandeducationprogramcalledlsquoBeaCOVIDWarriorrsquowhich commenced in 2020 in response to the pandemic This program was designed to respond tothelowlevelsofhealthliteracyaroundCOVID-19potentialexposuretothevirusandaddressfearandstigmainthelocalCALDcommunitiesThelsquoCOVIDWarriorrsquoprogramreachedaround880peopleranginginagefrom14to85years65ofCOVIDWarriorparticipantswerefemaleand35weremaleCOVIDWarriorparticipantsrepresented 21 language groups The outcomes of the program included increased levels of confidenceinapplyinginfectioncontrolmeasuresincreasedliteracyandhealthliteracyandawarenessofhowCOVID-19istransmittedUltimatelyanimprovedawarenessinapplyingCOVIDsafemeasures was also reported
InApril2020theservicecommencedwelfarechecksviaphoneonafortnightlybasistosup-portsocially-isolatedmulticulturalseniorswhoboretheemotionalstressofsocialisolationFrom these calls the ISLHD heard the needs and concernsofseniorsinthecommunityInadditionourexperiencewithCALDcommunitieshighlightedtheimportanceofyoungpeopleasconduitsofessentialinformationtoadultsincommunityandfamilygroupsduetoEnglishlanguageaccessandeducation
InresponsetheISLHDinitiatedthelsquoCOVIDWarri-orrsquoprogramusingbi-culturalhighschoolstudentsthroughthelocalhighschoolsByincreasingthehealthliteracyofstudentsatschooltheselsquocham-pionsrsquocouldtalktotheirfamiliesincludingolderfamilymembersininformalsettingsandthroughsocialmediawiththeirpeersasastrategytoraisethe level of knowledge of COVID-19 trans-mission preventionandtestingTheprogrambecamesopopularthatitwasextendedintomorelocalhighschools and adults accessing the Adult Migrant EnglishProgramTheprogramwassupportedbylocalsettlementservicesprovidedbybothMaxSolutionsandtheRedCrossItwas
17 httpstheconversationcomhow-can-governments-communicate-with-multicultural-australians-about-COVID-19-vaccines-its-not-as-simple-as-having-a-poster-in-their-language-156097
later extendedtoCALDSeniorsthroughtheMulticulturalCommunitiesCouncilIllawarra(MCCI)supportprograms
AkeycomponentoftheprogramwastoprovideparticipantswithlsquoCOVIDWarriorrsquoKitswhichincludedtworeusablemaskshandsanitiserinfographicsaboutCOVID-19symptomsandinfor-mationaboutwheretestingclinicswereavailablelocallyMCCIandRuralAustraliaforRefugeesdonatedreusablemasksforeveryparticipant
AsthelsquoCOVIDWarriorrsquoprogramwasevolvingsowasthenationalvaccinerolloutplanInforma-tionwasthereforeadaptedtomeetthisinfor-mationgapForexampleadultparticipantsandseniors were supported to understand how to accesstheCOVIDvaccinelsquoeligibilitycheckersrsquoandCALD people were shown how to use the NSW HealthwebsiteCOVID-19informationpages18
Decision makingHowpeoplearecurrentlyconsideringtheriskofCOVID-19isinfluencedbyarangeoffactorsincludingratesoftransmissioninthecommunitynumbersofnewcasesreportsinthemediaofrisksandsideeffectsPeopletendtobasetheirassessmentonwhattheyarecurrentlyexperi-encingandthencheckthisagainstwhattheyarehearinginthemediaincludingandespeciallyonsocialmediaandfromfamilyandfriendsMostoftheparticipantsinourstudyspokeclearlyandarticulatelyabouthowtheyweigheduptherisk-benefitofhavingtheCOVID-19vaccineintheir decision making Low case numbers ndash at the timeofconductingtheresearchndashandasensethat Australia was lsquodoing well in safeguarding the communityagainstCOVID-19rsquoweresignificantfactorsinpeoplersquosdecisionnottobevaccinatedortoadoptalsquowaitandseersquoapproachFamilyfriends and social media were reported as having aconsiderableinfluenceondecisionmakingaswerereportsinthemediaofthebloodclottingsideeffectsofAstraZeneca
ThefactthatFacebookwasreportedlythemostpopularsourceofinformationaboutCOVID-19
18httpswwwhealthnswgovauInfectiouscovid-19Pagesdefaultaspx
andtheCOVID-19vaccineforpeopleinthestudyraisesconcernsaboutthepossibledisseminationofmisconceptionsandlsquofakenewsrsquothatmaybespread or compounded via social media Closed social media groups such as WhatsApp and WeChatwithfamilyandfriendsmayalsoleadtopeoplereinforcingtheirpre-existingbiasesThesefactorscoupledwithasensethatAustraliaisfaringwellcomparedtomanycountriesoverseasappear to have resulted in increased vaccine hesi-tancyamongparticipantsofthestudy
Factorsthatwereidentifiedaschangingvaccine-hesitantparticipantsrsquoperceptionswereanincreased risk from COVID-19 and a correspond-ingincreaseinthenumberofinfectionsandonthebenefitsidetheabilitytotraveloverseastovisitfamilyIntherecentresearchfromtheUniversityofNSWcitedaboveSearlearguesthatlsquotheremaybeotherthingsthatweneedtonowstartfocusingonhellipthatwillstarttopromoteandmotivatepeoplesuchasthechancetotravelmorefreelyforexamplersquoThisappearstobeborneoutbyourfocusgroupfindings19
Untilrecentlytherehavebeenverylowcasenumbers and few lockdowns across most of Aus-tralia and NSW The recent outbreak from mid-JuneinGreaterSydneyandintroductionofthehighlyinfectiousDeltavariantinNSWislikelytoimpactonpeoplersquosassessmentsoftherisk-benefitofhavingthevaccineandonewouldassumereducehesitancyrates
GiventheheightenedcommunityanxietycausedbythisrecentCOVID-19outbreaktheproductionofshortsharpandtargetedmessagingtoCALDgroupsincommunitylanguagesthatisaccessibleandmotivationalfeaturescommunityleadershigh-profilecelebritiesandsportsstarsfromCALDbackgroundsandisdirectedatastate-wideandlocal level would appear to be more urgent than everItisclearthatformessagingtobeeffectiveandreachitsintendedaudiencedistributionchannelsshouldincludeFacebookWhatsAppandothersocialmediaplatformsaswellastrustedsourcessuchasmulticulturalhealthworkersmulticulturalservicesandthroughGPsandMedical Centres If mainstream COVID-19 vaccine
19 Op cit
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
32 33
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3534
awareness campaigns are produced in Australia suchashavebeenproducedinNewZealandtheUnitedKingdomandNorthAmericatheyshouldincludehighprofilewell-knowncommunityfig-uresandsportingstarsfromCALDbackgroundsandincludestrategiesspecificallytargetingCALDcommunitiesincludinggroupsidentifiedaspar-ticularlyhigh-risk
It is also important that informationonvaccinesistranslatedintolanguagesfromnewerandemergingcommunitiesOthersuggestionsaroundreachingthesecommunitiesincludeface-to-facemeetingsorganisedbycrossagencypartnershipsandpeer-ledstrategiessuchas mobilising community champions and influenc-ers Messaging needs to be inclusive and framed around the collective values held by commu-n5
It is clear that reinforcing the benefits of being vaccinated at this time rather than dwelling on the risks is more likely to generate behavioural
changeandapositivevaccineresponsefrombothCALDcommunitiesandthegeneralpopulationAppropriately-designedandtargetedCOVID-19vaccinehealthinformationthatiseasytoreadinanylanguagecanbeconveyedbycommunityleadersandcommunitynetworksandpromotesthepositivebenefitsofgettingvaccinatedwouldbevaluableatthistimeBuildingontheworkofpeerchampionssuchastheCOVIDWarriorprogramisalsoasuccessfulmodeltoincreasingCOVID-19vaccinehealthliteracyandinformed decision making
Mostimportantlypositivelymotivatingculturallyandlinguisticallydiversecommunitymemberstolsquogetthejabrsquoespeciallythosewhoareadoptingalsquowaitandseersquoapproachorarevaccinehesitantwould lead to greater vaccine uptake among culturallyandlinguisticallydiversecommunitiesandthereforethecommunityasawhole
Inner West Multicultural Network Addison Road Community Centre DateWednesday12May
A focus group session of members of the Inner WestMulticulturalNetworkpluscustomersoftheFoodPantryatAddisonRoadwasheldattheAddisonRoadCommunityCentreinMarrickvilleon12Mayat200pmThesessionwaspartoftheregularmeetingoftheInnerWestMulticul-turalNetworkTheconsultationinvolvedabout26peopleandwasconductedbyRosannaBarbero
Thegroupbrainstormedresponsestoquestionsaroundvaccinehesitancyinmulticulturalcom-munitiesandmoreeffectivemessagingTheseresponseshavebeenincorporatedinthefindingsof the report
Griffith Women on Fire Focus Group Griffith Community Centre DateFriday14May
This small focus group of women was held at GriffithCommunityCentreonMay14at11amMargCouchSeniorProjectOfficerRegionalDevelopmentAustralia(RDA)-RiverinaandJoanneFitzpatrickSettlementEngagementandTransitionSupport Worker from Centacare Southwest NSW werethekeylinksandnetworkcontactsfortheGriffithcommunityTheWomenonFire(WOF)group was established as part of the Red Cross RuralFireServiceprogramlsquoManyCulturesOneCommunityrsquoInitiallyitwasestablishedtoeducatewomenonemergencypreparednessandtoen-courage NSW Rural Fire Service (RFS) volunteering andnowhastransformedintoacommunityac-tionsupportgroupTheGriffithSoroptimistInter-nationalnowauspicetheirfinancesandsupporttheWOFgroupactivitiesThefocusgroupwasfacilitatedbyCamillaCouchandlocalcommunityvolunteersledbytheGriffithSoroptimistClub
The women in the group were from Pakistan and IndonesiaThegroupweremainlyyoungmotherswithyoungchildrenandtheprogramhadchild-minding arrangements The language level of the womenwaslowandmostwerestudyingESOLat
ATTACHMENTS
ATTACHMENT 1 A Description of the Focus Groups
TAFEThedeliveryoftheinformationwaslimiteddue to language levels and the lack of bilingual interpretersEachparticipantworkedoneononewithavolunteertoslowlyfillinthesurveyandonewomantookthesurveyhometodiscusswithherhusbandThisgroupexperiencehighlightedthe lack of bilingual workers and services in some rural areas
Arabic speaking group Syd West Multicultural Services Mount Druitt Community worker Zaid Naoum Generalist Caseworker SydWest Multicultural Services DateMonday24May
ThefocusgroupfromSydWestMulticulturalSer-viceswasconductedonMonday24May2021atSydWestMulticulturalServicesMountDruittat300pmItwasfacilitatedbyPatriciaMcCormickandsupportedbyZaidNaoumGeneralistCase-workerSydWestMulticulturalServices
Therewere10womenandmenfromSyriainthegroupThegroupweremostlymaturetoolderparticipantsMostparticipantsrequiredassistancewithEnglishandthecaseworkerZaidNaoumhadtranslatedthesurveyintoArabicpriorto the focus group Zaid also translated during the focus group
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Canterbury City Community Centre (4Cs) group The Cottage Lakemba DateTuesday25May
ThefocusgroupfromCanterburyCityCommunityCentre(4Cs)wasconductedonTuesday25MayattheCottageat28CroydonStreetLakembaat10amItwasfacilitatedbyRobinMilesandsup-portedbyRomanaWaseemCommunityWorkerfrom 4Cs
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
34
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3736
The group was comprised of 14 women from PakistanIndiaandSriLankaThewomenrangedinagefrom23to65MostwerefluentEnglishspeakershoweveronewomanrequiredtransla-tionintoUrdufromoneoftheotherwomeninthegrouptoanswerthequestionsdirectly
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
NSW Chaldean League group Community worker Randa Goriya DateTuesday25May
ThefocusgroupfromNSWChaldeanLeagueMountDruittwasconductedonTuesday25May2021 at 1000am at the NSW Chaldean League premisesItwasfacilitatedbyPatriciaMcCormickandsupportedbyRandaGoriyaacommunityworker for the NSW Chaldean League in Mount DruittRandatranslatedtheintroductionandpromptsforthediscussionandhelpedthepartic-ipantstocompletethesurveyMostofthegrouprequiredhelptodothesurvey
ThegroupoftwelveparticipantswereallChaldeanandwerematuretoolderinageTheywereamixed-gendergroup
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Arabic speaking group Red Cross premises Wollongong DateTuesday25May
ThefocusgrouptookplaceonTuesday25Mayat 3pm at the Red Cross premises at Wollongong Therewere22womenandmenparticipatinginthegroupThefocusgroupwasfacilitatedbyCamilla Couch with support from Khalid Zainu-labdeenBilingualSupportWorkerHumanitarianSettlementProgram(ACTampNSW)
There were diverse ages in the group ranging fromyoungpeopletoolderagedMostofthegroupwereyoungerrecently-arrivedrefugeesfrom diverse backgrounds There was also a small-eroldercohortofparticipantswithhigherliteracylevelsandstrongercommunityengagementwith the local services in the area Camilla Couch facilitated the focus group which was conducted inArabicandEnglishwiththeArabictranslationprovidedbyKhalidZainulabdeen
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Work Opportunities for Women group Mt Druitt TAFE DateWednesday26May
TheWorkOpportunitiesforWomen(WOW)focusgroupwasheldonWednesdayMay261100ndash 100pmatMtDruittTAFEItwasfacilitatedbyCamilla Couch and built on the knowledge gainedintheprevioussessiononcriticalandanalyticalthinkingTheWOWgroupisaTAFECertificatelevel course
There were 14 women from diverse cultural backgroundsinthegroupThegroupweremainlyMuslimwomenwithschoolagechildrenandsome were mature aged Due to the learning fo-custhegroupwasfacilitatedasaclasswithguid-eddiscussionontheissuesandcarefulanalysisofthequestionsNotranslationwasneededduetotheeducationalcontextThestudentswereadeptatusingITandcompletedallthesurveysonline
STARTTS Tamil group Toongabbie Community Centre Community worker Sivaharani (Harani) Mayuran DateThursday27May
Thefocusgroupconsistedof18femalepartic-ipantswhowereyoungertomatureagedThefocus group was held at 1000am at Toongabbie CommunityCentreinTargoRdToongabbie
ThefocusgroupwasfacilitatedbyPatriciaMc-CormickandsupportedbyacommunityworkerSivaharani(Harani)MayuranfromtheSTARTTSTamil Group
ThegrouphadmixedlevelsofspokenandwrittenEnglishTheintroductionanddiscussionpromptsweretranslatedbythecommunityworkerSivaha-rani(Harani)Mayuranandsheandthemorepro-ficientstudentssupportedthosewithlowliteracytoanswerthesurveyquestions
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Spanish Speakers Seniors group SydWest Multicultural Services Blacktown DateTuesday1June
TheFocusGrouptookplaceonTuesday1Juneat1100amattheBlacktownShowgroundsandconsistedof16participants(15womenandoneman)AllparticipantswerebornincountriesinSouthAmericaTheirEnglish-fluencylevelsvariedand one of the members of the group translated thesurveyquestionsanddiscussionintoSpanish
ThegrouphadbeenmeetingforseveralyearsThegroupwasfacilitatedbyLindyCassidyandwassupportedbySreeVithyaHarilingamDayRespiteampSocialSupportTeamLeaderatSydWestMulticulturalServicesBlacktownThegroupwerematureagedtoolderparticipants
Thegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyform There was a more focused discussion on somekeyquestionsaftersurveycompletionThetranslatorassistedconsiderablyinthisprocess
Italian Speakers group Warrawong Community Centre DateMonday7June
The focus group of Italian speakers was held on Monday7Juneat1015amattheWarrawongCommunityCentreItwasfacilitatedbyCamillaCouchandsupportedbyJohnPaulTroianiand
SofiaLemafromIllawarraShoalhavenLHDMulti-cultural Health
There were 15 women in the group The group weremostlymaturetoolderparticipantsandwasconductedinItalianandEnglishwithtranslationprovidedbyJohnPaulThisgroupmeetsregularlyandissupportedbyanumberofservicesintheareaespeciallymulticulturalhealth
The group had a general facilitated discussion aboutthequestionsinthesurveyDuetolittleornoliteracytheindividualsurveyresponseswerethencollectedintooneresponseThesesurveyresponses have been included in the general surveyresponses
Mothers Group SydWest Multicultural Services Blacktown DateThursday10June
ThefocusgrouptookplaceonThursday10Juneat1030amandconsistedof14youngwomen13 of whom had a CALD background The focus groupweremainlymothersfromasupportgroupatSydWestMulticulturalServicesinBlacktown
EightofthewomenwereborninIndiatwofromPakistantwofromSriLankaonefromHausaGhana and one was born in Australia (the Austral-ianbornyoungwomanwasasocialworkstudenthelpingwiththegroup)LindyCassidyfacilitatedthe group with support from Wilma Garguath a projectofficerfromSydWestMulticultural Services
The group varied in age One was between 18-24 yearsoldSevenwereagedbetween25-34yearsSixwereagedbetween35=44yearsGiventheirage and circumstances most of the group did not consider themselves eligible at this stage for vac-cinationThiswasanimportantdifferencefromotherfocusgroupsinthattheemphasiswasmoreonwhattheywoulddooncetheybecameeligible
Participantsdidnotrequireassistancewithspo-kenEnglishThegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyformTherewasamorefocuseddiscussiononsomekeyquestions
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3938
ATTACHMENT 2 COVID-19 Vaccine Information in multiple languagesThefollowingsitesappsprovidetranslatedinformationaboutCOVID-19vaccines
Type of information KeyinformationongettingvaccinatedinNew South Wales and on the vaccines available The websiteusesanautomaticservicetotranslate thecontentintodifferentlanguages
Source of information NSW Government website
Link httpswwwnswgovauCOVID-19health-and-wellbeingCOVID-19-vaccina-tion-nswgetting-vaccinated
Type of information COVID-19ResourcessectionontheServiceNSWapp The app has a link to NSW Government websiteinformationonldquoGettingaCOVID-19vaccinationrdquo(seeabove)ItalsoincludesalinktoCOVID-19vaccinationresourcesinotherlan-guages available from the Department of Health
Source of information Service NSW NSW Government
Link Service NSW App
Type of information ArangeoftranslatedresourcesonCOVID-19bytitleincludingafactsheetonCOVID-19VaccineAstraZeneca(ChAdOx1-S)
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCOV-ID-19Pagestranslatedresources-by-titleaspx
Type of information ADigitalCOVID-19resourcelibrarywithtranslated materials
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiouscov-id-19Pagesdigital-resourcesaspx
Type of information AMultilingualCommunityToolkitontheCOVID-19vaccinationprogramtoassist communityworkersprovideseasytoreadresourcesvideosandlinkstokeyservicesandresources
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCovid-19DocumentsNSW-COVID-19-vaccina-tion-program-presentation-20210527pdf
Type of information TheNSWMulticulturalHealthCommunicationServiceoffershealthresourcesandinformationin a wide range of languages It has translated resources on COVID-19 and links to translated resourcesonCOVID-19vaccination
Source of information MulticulturalHealthCommunicationServiceisa New South Wales-wide health service hosted bySouth-easternSydneyLocalHealthDistrict(SESLHD)
Link httpswwwmhcshealthnswgovau
Type of information COVID-19vaccineinformationaddressingkeyquestionsaboutCOVID-19vaccinationandincludesvideosposterstilesfactsheetsandaudio material Translated into 63 languages
Source of information Department of Health Australian Government website
Link httpswwwhealthgovauinitiatives-and-pro-gramsCOVID-19-vaccinesCOVID-19-vaccine-in-formation-in-your-language
Type of information ThisinformationaddressessomecommonmisinformationaboutCOVID-19Translatedintomultiplelanguages
Source of information DepartmentofHomeAffairs Australian Government website
Link httpscovid19inlanguagehomeaffairsgovaumisinformation-and-truths-about-coronavirus
Type of information Australianandinternationalnewsand informationaboutCOVID-19andCOVID-19 vaccinesisavailableontheSBSCoronavirusPortal in more than 60 languages
Source of information SBSwebsite
Link httpswwwsbscomaulanguagecoronavirus
Type of information InformationprovidedaboutCOVID-19vaccinerolloutandsafetyinlanguagesotherthan English
Source of information Department of Health and Human Services Victorian Government
Link httpswwwcoronavirusvicgovautranslat-ed-information-about-COVID-19-vaccines
Type of information HealthTranslationsprovidestranslatedmateri-alsonhealthandwellbeingInformationaboutCOVID-19isregularlyupdatedincludessomeinformationonvaccinationandisavailableinover60communitylanguages
Source of information Victoriangovernmentinitiative
Link httpswwwhealthtranslationsvicgovaubhcv2bhchtnsfPresentEnglishResource-AllOpenampx=amps=Coronavirus
Type of information A one-stop shop for translated materials in multiplelanguagesonCOVID-19
Source of information Ethnolink Language Services
Link httpswwwethnolinkcomauCOVID-19-coro-navirus-translated-resources
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
40
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1110
Service Location Group Composition Participant numbers
Addison Road Community Centre Marrickville Community leaders - Vietnamese Chinese Italian Greek Indonesian Latin American and Portuguese speakers
26
Griffith Community Centre Griffith Indonesian and Pakistani women 6 Multicultural Communities Council Illawarra
Wollongong Arabic-speaking group 22
Multicultural Communities Council Illawarra
Wollongong Italian older womenrsquos group 15
Syd West Multicultural Services Mt Druitt Arabic-speaking group 10 Syd West Multicultural Services Blacktown Spanish-speaking seniorsrsquo group 16 Syd West Multicultural Services Blacktown Mothersrsquo support group -
Indian Sri Lankan Pakistani and Ghanaian
14
Canterbury City Community Centre (4Cs)
Lakemba Pakistani Indian and Sri Lankan women
14
Chaldean League and Western Sydney TAFE
Mt Druitt Chaldean group 18
STARTTS - Toongabbie Community Centre
Toongabbie Tamil-speaking group 12
Mt Druitt TAFE ndash TAFE NSW Mt Druitt Work Opportunities for Women group (mixed CALD backgrounds)
14
TOTAL 167
Table 1 Focus Group DetailsExplanatory noteThefocusgroupatMtDruittTAFE-comprisedpredominantlyofCALDwomenenrolledinaCertificateIIentrylevelcourse-wasusedtopilotandrefinethefocusgroupprocesswithsurveyresponsesgeneratedbythegroupincludedinthefinalsurveyresults
A word about the research design Theresearchwascarefullydesigneddrawingonexpertculturaladviceoncommunicationpro-cessesandsurveydesignFocusgroupsincludedparticipantconsentformsincentivevouchersandaone-pageintroductiontotheresearchfortheintermediaryorganisationsIntermediaryorgan-isationsandpreferredlocationswereidentifiedand agreed in advance with NCOSS
Thesurveywasdesignedinaneasy-to-readformatusingsimpleEnglishFeedbackfromthe Spanish-speaking translator was that it was extremelyeasytotranslateandcompleteOthergroupscommentedthattheyfoundthesurveyeasytocompleteandmostgroupsdisplayedasolidlevelofspokenandwrittenEnglishTheresearchdesignandconductalsoleantheavilyontheexpertiseofthefacilitatorsandtheirexten-sivenetworkswhichmadedeliveryinsuchashorttimeframepossibleThepositiveengagementandsupportoftheintermediaryorganisationswasalsoafactorcontributingtothesuccessfulconduct of the research
Withoutfailthemulticulturalandcommunityserviceorganisationsinvolvedintheresearchper-ceived the importance of its purpose and shared a desire to provide NSW Health with feedback directlyfromtheircommunitiesasamatterofurgency
Demographics of research participantsThemakeupofthosewhoparticipatedintheresearch was diverse in age and cultural and languagebackgroundParticipantswerepredom-inantlywomen(84)withmenmakinguponly145OverhalftheparticipantshadlivedinAustraliaformorethan20yearswhichimpactedpositivelyontheirlevelofspokenandwrittenEnglishHowevertherewerequitelowlevelsofEnglishliteracyinanumberofthegroupswhichmadeguidedsurveycompletionamoreneces-sarybutcomplexprocess
1 1 1
6
3
31
16 17
20
12
15
1
8
2
64
1
5
2 13
1 1
7
2 1
5
1 1 1 1 2 10
5
10
15
20
25
30
35
Indo
nesia
Thai
land
Hong
Kon
gAu
stra
lia Iran
Iraq
Viet
nam
Italy
Sri L
anka
Indi
aPa
kist
anGh
ana
Syria
Boliv
iaCh
ilePe
ruEl
Sal
vado
rM
alay
siaUr
ugua
yAr
gent
ina
Cam
bodi
aUk
rain
eRu
ssia
Chin
aSu
dan
Eritr
eaSw
eden
Taiw
anAf
ghan
istan
Pola
ndJa
pan
Egyp
tJo
rdan
13
1 2
10
17
2
21
1
11
1 1
12
2 1
27
10
1 1 1 13 2 1 2 1
6
1 1 1
32
0
5
10
15
20
25
30
35
English Thai
Cant
ones
eVi
etna
mes
eIta
lian
Farsi
Tam
ilTe
lugu
Span
ishSp
anglish
Haus
aUr
duGu
jara
tiPu
njab
iAr
abic
Chalde
anHi
ndi
Khm
erPe
rsian
Russian
Man
darin
Malay
Haza
ragi
Tigr
inya
Kurd
ishCh
ines
ehellipJa
pane
sePo
lish
Swed
ishM
ultip
le
Figure 1 Country of BirthFigure 2 Language spoken at home
METHODOLOGY
Coun
t
Coun
t
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1312
211
1316 14211684
2053
3316
Less that 1year
1 - 2 years 2 - 5 years 5 - 10 years 10 - 20years
More than20 years
000
500
1000
1500
2000
2500
3000
3500
Less than 1-2 years 2-5 years 5-10 years 10-20 More than1 year years 20 years
1453
8430
000 116
Male Female Non-binary Rather not say000
100020003000400050006000700080009000
000
785
1728
2147
1309
1675
2356
Under 18 18-24 25-34 35-44 45-54 55-64 65+000
500
1000
1500
2000
2500
Figure 3 Length of time living in Australia Figure 5 Gender
Figure 4 Age
METHODOLOGY
Chaldean Focus Group Feedback Sheet
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1514
Research participants were asked
If they were intending to get vaccinated
The reasons why they would or would not choose to get vaccinated
If they knew anyone who had already been vaccinated and if so who
If they knew anyone who had contracted COVID-19 and if so who
If they knew where to go to get vaccinated
What sources they used to get information about the COVID-19 vaccination
Basic demographic information age gender country of origin language spoken at home and length of time living in Australia
Having the vaccine or notOfthe199participants117(58)reportedthattheywereplanningtobeorhadalreadybeenvaccinatedwhile78(42)reportedthattheywere not planning to have the vaccine (13) or didnotknowiftheywouldgetvaccinated(29)
1453
8430
000 116
Male Female Non-binary Rather not say000
100020003000400050006000700080009000
05
10152025303540
Under18
18-24 25-34 35-44 45-54 55-64 65+
Coun
t
Yes No Donrsquot Know
Figure 6 Are you going to get the COVID-19 vaccine
Figure 7 COVID-19 Vaccine intention of respondents by age category
13people(65)hadalreadybeenvaccinated(at least 1 dose)6withseveralcommentingthattheyhadchosenorneededtobevaccinatedforwork-relatedreasonsOthersreportedthattheyhadbeenvaccinatedprimarilyforhealthreasonstostaywellandmakesurethattheirfamiliesstayedwellTheywerealsoconcernedaboutpublichealthandsafetyOneofthewomenintheLakemba groups from Sri Lanka was adamant that thebenefitsoutweighedtherisksspokepositive-lyabouthoweasyithadbeentogetthevaccinefrom her local medical centre and that she had experiencednosideeffectsfromthevaccination
Language Count Percent Urdu 1 Italian 3 Arabic 2 Tamil 3 Chaldean 1 Spanish 3 Total 13 65 of sample
Response Count Percent Not planning to have the vaccine 23 13 Unsure about having the vaccine 52 29
75 42
Table 2 Respondents already vaccinated
Table 3 Respondents who indicated vaccine refusal or hesitancy
6 Theresearchersdidnotdistinguishbetweenwhetherpeoplehadreceivedtheirfirstandseconddosesofthevaccineiepartiallyorfullyvaccinated
75(42)indicatedadegreeofvaccinehesitancywith24participants(13)reportingthattheywerenotplanningongettingvaccinatedwhile53(29)reportedtheydidnotknowiftheywouldget vaccinated
Thislevelofvaccinehesitancyreflectslargerstud-iesintheAustraliancommunityAsurveyofover1000participantsfromacrossAustraliaconduct-edinApril2021byEssentialResearchfoundhes-itancyratesof42including16whoindicatedtheywerenevergoingtogetvaccinated7
Foroursurveyresponsesindicatedthatagewasafactorwith85ofrespondentsaged65andoverreportingthattheywouldhaveorhad
7EssentialResearchThe Essential Report21April2021
FINDINGS FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1716
alreadyhadthevaccineThosewhoindicatedthattheywouldnotbehavingthevaccinewerefairlyevenlydistributedacrossagegroupswithyoung-er people aged 18-24 being the age group with thehighestproportionofparticipantsexpressinguncertaintyabouthavingthevaccineTheagegroupwiththesecondhighestlevelofhesitancyproportionatetoothercategorieswerethe35-44yearolds
02468
10121416
Iraq
Vietnam Italy
South Americ
a
Sri La
nkaIndia
Syria
Other South East
AsiaAfric
a
Australia
Sweden
China
Pakistan
Iran
Eastern Europe
Afghanistan
Japan
Coun
t
Yes No Dont know
8095 8190
70486095
4571
6190
095
To stayhealthy and
well
To keep myfamily
healthy andwell
For publichealth
To travel To work It is theright thing
to do
Somethingelse (pleasetell us what)
000100020003000400050006000700080009000
Figure 8 Respondents COVID-19 Vaccine intention by Country of Origin
Figure 9 Reasons for getting vaccinated against COVID-19
Countryoforiginalsoseemedtoplayaroleinpeoplersquosviewsabouthavingthevaccinewithhighvaccinepre-dispositionreportedbyVietnameserespondentstotheonlinesurveyandwomenintheItalian-speakinggroupWhileparticipantsfromIraqrecordedthehighestlsquoyesrsquoresponsethiswasalmostmatchedbyIraqiparticipantswhoreportedthattheywerelsquounsurersquoorlsquodidnotknowrsquowhethertheywouldhavethevaccineTherelevanceofcountryoforigininthisregardwouldbeworthyoffurtherresearch
The Italian focus group held in Wollongong was an olderwomenrsquossocialgroupwithallparticipants(15) agedabove65yearsMostinfactwereaged over75yearswithoneparticipantinher90s 87 of the group had either been vaccinated (3) or were planning to get vaccinated (10)
Of course I will get vaccinated It is important to do this It is a very bad
disease
Thesewomenweremotivatedtostayhealthyandwellkeeptheirfamilyhealthyandwellforpublichealthreasonstobeabletotravelandforgen-eralsafetyMembersofthegroupalsoreportedthattheywantedtogetvaccinatedsothattheywouldbeabletolsquodancersquoandlsquosocialisersquo
Reasons for having the vaccine
Ofthe117participantswhoreportedthattheyhadeitheralreadybeenvaccinatedorwereplan-ningtogetvaccinatedlsquokeepingmyfamilyhealthyandwellrsquo(82)andlsquokeepingmyselfhealthyandwellrsquo(81)werethetwomostpopularreasonsforhavingthevaccineThiswasfollowedbylsquoforpublichealthrsquo(70)lsquoitistherightthingtodorsquo(62)andinorderlsquototravelrsquo(61)(SeeFigure9)
I donrsquot want to
die
Irsquom over 65 I have some health issues I think itrsquos
[having the vaccine] very important to
keep safe
I want to see my family I usually go every year but now I havenrsquot seen them
because of COVID-19 Having it will help
I am well but my parents are older It is important to
keep them well
Otherreasonsthatpeoplegaveforgettingvacci-natedincludedtheneedtocontinueworkinginessentiallsquofrontlinersquoemploymentsuchassecuritycleaningandagedcaresettingsOnewomanintheLakembafocusgroupwhohadalreadyhadherfirstdoseoftheAstraZenecavaccinesaidthatlsquothebenefitsoutweightherisksrsquoandasanolderwomanrsquoIdonotwanttodiersquo
All but one of the focus groups were familiar with thedifferentvaccinescurrentlyavailableinAus-traliaAstraZenecaandPfizerMostparticipantswere also aware of blood clots being associated with the Astra Zeneca vaccine One group of newly-arrivedrefugeesinGriffithhadnotheardofeithertheAstraZenecaorPfizervaccinesandhadamorelimitedunderstandingofthevaccinationprogram in general
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1918
Reasons for not having the vaccine
At the moment the situation is under control and donrsquot feel the need Also I have no plans to
travel in the near future so I donrsquot see the need
3514
21622703
3243
1892
811 541
4865
1081
Thevaccine isnot welltested
Thevaccine is
unsafe
Formedicalreasons
I amscared tohave thevaccine
I dont likevaccines
Forreligiousreasons
Forculturalreasons
I want towait and
see
Somethingelse
(pleasetell uswhat)
000
1000
2000
3000
4000
5000
6000
Figure 10 Reasons for not getting vaccinated against COVID-19
Theperceivedlsquolackofadequatetestingrsquoofthevaccineandlsquofearofbeingvaccinatedrsquoalsore-ceivedhighresponseratesselectedby3514and3243ofparticipantsrespectivelyOnly1355 of respondents cited religious or cultural reasonsasbeingbehindtheirvaccinehesitancy
Open-endedresponsestothisquestionincluded
The vaccine is not 100 working It cannot offer
100 protection
Ofthe42participantswhosaidthattheywouldnothaveorwerehesitanttohavethevaccine4865saidthattheypreferredtolsquowaitandseersquobeforegettingvaccinated
Thediscussioninthefocusgroupsaboutpeoplersquoshesitancytobevaccinatedfocusedonanumberofconcernswhichreflected
poorcommunicationfromanumberof trusted sources including GPs and some media sources
conflictinginformationaboutthevaccinefrom healthauthorities
fearsaboutvaccinesafetythataresharedby thegeneralcommunity
misconceptionsabouttheeffectivenessof andhowthevaccineswork
I will not have it because make me sick
Issuesraisedinfocusgroupsascontributingtoincreasedhesitancyincluded
Some GPs being hesitant to recommendvaccination
Theinformationbeingprovidedisconflicting
Theinformationisoverlycomplexandnotcomprehensibleregardlessofwhetherithasbeen translated
The risk of blood clots
Perceptionsthatthevaccinesaregenerallyunsafe
Concernsthatsomepeoplearedyingafterbeing vaccinated
Not being sure about the risks associated withhaving the vaccine and being pregnant orbreastfeeding
Theperceptionthattherehasbeenalackoftestingofthevaccinespriortorollout
AlackofunderstandingofhowvaccinesworkthecompositionofthevaccinesandwhattheywoulddotothebodyincludingmakingchangestoapersonrsquosDNA
Specificcommentsincluded
I have heard that the vaccine changes
your DNA
I am a mother I am not sure it [the vaccine] is safe for
me when I am breastfeeding
If you are young and healthy your body has the energy to fight the virus
You donrsquot need to have the vaccine You should just let
your body fight it itself
They donrsquot tell you what chemicals are in the
vaccine
Tamil Focus Group Feedback Sheet
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2120
Nobody knows what to do My GP doesnrsquot even know what I should do whether
I should have it or not
I am not sure what to do I have spoken to my
GP but they canrsquot tell me whether I should have the vaccine or not while I am
breastfeeding
They say one thing and then they tell you
something elsehellip it [the vaccine rollout] is so
confusing
Confusionaboutwhattodowheretogoandthe health impacts of the vaccine was a common threadintheconversationsaroundvaccinehesi-tancy
Onewomanwhosehusbandworkedforasecurityfirmsaidthatherhusbandhadhadtobevacci-natedinordertokeephisjob
In several focus groups the issue of government control was also raised A number of people re-portedstronglythattheyfearedthatthevaccinewas lsquoa means that the government was using to controlpeoplersquo
He [husband] had to have it He didnrsquot have a choice He was fine [no side effects] but Irsquom not
thinking I will have it I donrsquot need to Irsquom a mum Irsquom busy I have
to look after my children I donrsquot know how I feel about it whether
Irsquom going to have it
Vaccine refusal
Onlyasmallnumberofparticipants(24or13)saidtheywouldnotgetvacci-natedOfthisgroup21werewomenand 2 were men8 Respondents were bornintendifferentcountrieswithadiverse range of language backgrounds
I never get sick It is the same for all my family We have always been strong and healthy so I will be
saying no to the vaccine
Country of Birth Language Background Count Pakistan Urdu 4 China Taiwan Chinese
(MandarinCantonese) 4
Sri Lanka India Tamil 3 Chile Spanish and English 2 Italy Italian 2 Iraq Syria Arabic 2 Iraq Chaldean 1 Iran Farsi 1 Greece Macedonian 1 Poland Polish 1 Pakistan Punjabi 1 Sweden Swedish 1 Vietnam Vietnamese 1
Table 4 Vaccine refusal by country of birth and language background
8 ThisreflectstheoverallsamplebiastowardswomenThemajorityoffocusgroupparticipantswerewomenXwithYparticipantsbeingmen
Reason for not having the vaccine Percent Count The vaccine is not well tested 5455 12 I want to wait and see 5455 12 The vaccine is unsafe 3636 8 For medical reasons 3182 7 I am scared to have the vaccine 3182 7 I dont like vaccines 1364 3 For religious reasons 1364 3 For cultural reasons 909 2 Something else (please tell us what) 909 2
SomeinthiscategorywereadamantthattheywouldnotbehavingthevaccineandhadverystrongviewsonitlsquoForculturalreasonsIwonrsquotbehavingthevaccinersquoWhenwelookatrespons-esmorecloselyhoweveritwouldappearthatmanyareinfactmorelsquohesitantrsquothanfirmvaccinerefusers
One reluctant middle-aged Tamil-speaking wom-ansaidlsquoIftheysaywehavetogetvaccinatedthenIwillrsquoThissentimentwas stronglysup-portedbythe rest of the Tamil-speaking group
Studyparticipantswhosaidtheywouldnothavethe vaccine were also concerned that lsquothe vaccine wasnotwelltestedrsquo
The vaccine has been rushed out It has not been
properly tested
Table 5 Reasons for not having the vaccine
Peopleinthiscategorysaidthattheywouldlsquowaitandseersquowhathappenswiththewiderrolloutbe-foremakingtheirfinaldecisionThissuggeststhataproportionofthelsquonorsquogroupareinfacthesitantrather than outright refusing to have the vaccine
Therewerealsofearsexpressedbyfocusgroupparticipantsaboutthedangersofbeingvacci-natedParticipantsreportedbeingafraidofthehealthrisksespeciallyfrombloodclotsSomepeopledistinguishedclearlybetweenAstraZene-caandPfizerinthisregardHoweverformanythedistinctionbetweenthedifferentvaccineswaslostandtheyspokeofthevaccinesgenerallybeing unsafe and having a range of unwanted side effects
Other factors consideredInadditiontothebroaderquestionsofwhypeo-plewouldorwouldnotchoosetogetvaccinatedthe research team used the focus group discus-sionstoexplorewhetherthefollowingfactorshadanyimpactonapersonrsquoslikelihoodofbeingvaccine pre-disposed or hesitant
Knowing someone who had been vaccinated
Knowing someone who had contracted COVID-19
Knowing where to go to get vaccinated
Thesourcespeopleturntoforinformation about COVID-19 and COVID-19 vaccines
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2322
Knowing someone who has been vaccinatedOfthosewhorespondedtothisquestion125or70knewsomeonewhohadalreadyhadthevaccine
6983
2570
447
Yes No Dont know000
1000
2000
3000
4000
5000
6000
7000
8000
Figure 11 Do you know someone who has been vaccinated
Amongthe125participantswhoknewsomeonewhohadalreadybeenvaccinated100identifiedlsquoimmediatefamilymembersrsquo(parentschildrensiblingsandpartners)Somefocusgrouppartic-ipantsreportedthatalloftheirfamilymembersoverseas had been vaccinated Others reported thattheirrelativeshadbeenvaccinatedasarequirementoftheiremployment
Who Count Percent Other family member 41 313 Sister 24 1832 Community member 23 1756 Brother 18 1374 Father 17 1298 Mother 16 1221 Work colleague 14 1069 Husband or wife 11 84 Son or daughter 10 763 Partner 4 305 Someone else 45 3435 Total respondents 131
Table 6 Who do you know who has been vaccinated
When this issue was teased out further in focus groupdiscussionsarangeofreasonswere revealed including
My husband works in security and he had
to get it
My friend works as a COVID-19 cleaner and they all had to [get
vaccinated]
My family overseas have already been vaccinated
My son needs to travel for work so he is getting it
My brother in the UK is a doctor and he got it and
his wife
Knowing someone who has had COVID-19Almosthalfoftheparticipantsknewsomeonewho had contracted COVID-19 overseas Some reportedthatallthemembersoftheirfamilyormanymembersoftheirextendedfamilyhadcon-tracted COVID-19 In the older Italian group 10 of the15womenknewsomeoneinItalywhohadcontracted COVID-19
4716 4659
625
Yes No Not sure000
1000
2000
3000
4000
5000
Figure 12 Knowing someone who has had COVID-19
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2524
385 385
1538
2692
641 513000
4359
2051
1026385
1410
Mother
Father
BrotherSis
ter
Son or d
augh
ter
Husban
d or wife
Partner
Other family
mem
berFri
end
Community m
ember
Work co
lleag
ue
Someone else
(please
tell u
s who)
000500
100015002000250030003500400045005000
Figure 13 Who do you know who has had COVID-19
Four people in the focus groups knew someone who had died of COVID-19
All my family back home [Pakistan] got it [COVID-19] but
they are all fine now apart from my father He died But he was really sick before he
got it He had lots of underlying conditions Medical conditions so he was really unwell before he got COVID-19 But everyone else
they are fine now They were sick but they got betterhellip
If you are well and healthy you can fight this off
SurprisinglyknowingpeoplewhohadcontractedCOVID-19didnotseemtoinfluencefocusgroupparticipantsrsquopredispositiontowardseitherhavingthevaccineorbeingvaccinehesitantHowevertheolderItalianwomenrsquosgroupspokeabouttheimpactthatCOVID-19hadhadinItalyintheearlystagesofthepandemicandhowthishadaffectedthemdeeply13ofthe15womeninthisgroupwouldhaveorhadalreadyhadthevaccine
Knowing where to get vaccinated115people(81)whorespondedtothisquestion(n=142) knew where to go to get the vaccine 34 people(19)reportedthattheydidnotknowThisincluded15respondentsfromIraq3re-spondentsfromIndia2respondentsfromChina2 respondents from Pakistan and one respondent fromeachofthefollowingcountriesChinaEri-treaItalySriLankaSwedenSyriaandVietnamThese people were also less sure about whether ornottheywouldhavethevaccineItispossiblethat their lack of knowledge about where to go to get vaccinated was related to their general level ofvaccinehesitancy
7958
29582254
282 563
GPDoctor Vaccinecentre
Hospital Work place Somewhereelse (please
tell us where)
000100020003000400050006000700080009000
Figure 14 Where to go to get vaccinated
From the sample (n=199) GPs were the most commonlyidentifiedplacetogotogetvaccinat-edfollowedbythevaccinecentreatHomebushBayandthenhospitalsOtherplacesidentifiedincluded medical centres and pharmacies
Sources of information about COVID-19 and the vaccineThelargestsinglesourceofinformationaboutCOVID-19 and the vaccine was Facebook (417)
2743
3486
13141086
30862686
3429
2229 2286
41713714
2571
1086 971
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)000500
10001500200025003000350040004500
Figure 15 Sources of information about COVID-19 and the COVID-19 vaccine
Facebook I get my information from
Facebook But if I want to check it I watch the news
on 7 [Channel 7]
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2726
Thesecondlargestsourceofinformationforpeople in the sample was lsquoother forms of social mediarsquo(37)followedbySBStelevision(35)myfriends(34)andothertelevision(31)Oth-ersourcesofinformationpeoplereportedthattheyusedweretheNSWHealthwebsitenightlytelevisionnewsincludingChannel7Channel9andChannel10followedbytheABCtheAustral-iangovernmenthealthwebsitetheirGPlocalMedical Centres and the Red Cross
IntheLakembafocusgrouppredominantlymadeupofwomenfromPakistantherewasanani-mated discussion about Facebook which was the majorsourceofinformationalongwithGooglesearchesandcommunityandfriendship-basedWhatsApp groups There was a general consensus from most in the group that these were their pre-ferredormostcommonsourcesofinformationandnewsHoweveriftheywantedtolsquofactcheckrsquowhattheywerehearingtheywouldwatchthenightlynewsonChannel7orChannel9toverifywhattheyperceivedcouldsometimesbeunrelia-ble sources
IntheMtDruittfocusgroupseveralofthewom-enwithwell-developeddigitalliteracyandgener-alliteracyskillsusedhealthandfitnesswebsitesand social media sites as their source of infor-mationaboutlsquoallthingshealthrelatedrsquoincludingCOVID-19ThesewomenalsospokepositivelyabouttheinformationandsupporttheygotfromthestaffatCanterburyCouncilCommunityCentre(4Cs)whotheycouldrelyontofindoutthingsthattheyidentifiedtheyneededtoknowmoreabout
InthesmallerfocusgroupinGriffithwithrecently-arrived refugee women who had low levels of Englishlanguageliteracytherewaslittleknowledgeaboutthevaccinesnoawarenessofthedifferenttypesofvaccinesandlittleknow-ledgeaboutwheretogotogetvaccinatedorfindoutmoreaboutCOVID-19ingeneralThecommunityservicestaffandvolunteerspresentatthegroupwere working hard to assist these women to improve their English language skills and support themwithtranslatedinformation
In the older Italian women focus group in Wollon-gongparticipantsreportedgettingtheirinfor-mationfromslightlydifferentsourcesndashfamilyinAustralia(10women)Channel9(7women)
Italianradio(3women)andABCTV(3women)Onlytwowomenusedtheinternetandnoneofthe women reported using Facebook or social mediaasasourceoftheirinformationSeveralmentionedthattheygottheirinformationfromtheirGPorspecialistdoctorandonepartici-pantsaidrsquoIdonrsquotlistentoanyonersquoIntheSpan-ish-speaking focus group a comment was made thatseemedtoreflectmanyoftheotherfocusgroup discussions
Whenlsquosourcesofinformationrsquoiscorrelatedwiththegroupwhosaidtheywouldhavethevaccine(n=104)thereisashiftfromFacebookbeingthepreferredsourceofinformationtolsquoSBSTVrsquobeingthepreferredsourceThelsquovaccine-predisposedrsquogroupalsohadthelowestrateofrelyingonFace-bookasasourceofinformationaboutCOVID-19thoughitwasstillhighThegraphbelowhigh-lightshowotherlsquopreferredsourcesrsquoplayoutforthoseintendingtohaveorwhohavealreadyhadthe vaccine
ForthoseparticipantswhoindicatedthattheywouldnotorwerenotplanningtohavethevaccinelsquoFacebookrsquolsquomyfriendsrsquoandlsquomyfamilyrsquowerethesourcesofinformationaboutCOVID-19thatwereequallymostfrequentlycitedfollowedcloselybylsquomyfamilyoverseasrsquolsquoSBSradiorsquoandlsquoSBSTVrsquoassourcesofinformationreceivedthelowestmentionsfromthisgroup(SeeFigure16)
The vaccine-hesitant group were the group who identifiedlsquoFacebookrsquoastheirmostfrequentsourceofinformationaboutCOVID-19lsquoFace-bookrsquowasfollowedbylsquoothersocialmediarsquoandlsquomyfriendsrsquoasthenextmostfrequentsources
lsquoThiscommunityserviceproviderrsquo(theinterme-diaryorganisationwherethefocusgroupwasconducted)wasidentifiedby26ofrespondentsasasourceofinformationregardlessoftheirintentiontogetvaccinatedornotThefactthatboththelsquovaccinehesitantrsquoandthosewhoindi-catedtheywouldnrsquotbegettingthevaccinesoughtinformationfromthissourcesuggeststhatrolling
There is so much confusion about it [the vaccine] that I think my GP is the best
place to go
9 This group of the research sample included a small number ofpeoplewhohadalreadybeenvaccinated
2626
4141
14141111
323228282828
2424
1818
37373737
2828
10101212
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)00050010001500200025003000350040004500
2857
2381
952 952
2857
3333
42864286
3810
4286
23812381
1429
952
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another co
mmunity se
rvice
Somewhere
else (p
lease te
ll us w
here)000
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Figure 16 Sources of information for respondents who were planning to have the vaccine9
Figure 17 Sources of information for respondents who were not planning to have the vaccine
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2928
outpositivemessagingthroughtrusted communityserviceorganisationscouldbeaneffectivewayofshiftingpeoplefromvaccine hesitancytodecidingtohavethevaccine
31372549
980 980
25492157
4314
1176
2353
4902
4118
2157
980392
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)000
1000
2000
3000
4000
5000
6000
Figure 18 Sources of information for respondents who lsquodonrsquot knowrsquo if they will have the vaccine
DISCUSSION
wardstheCOVID-19vaccineareasvariedastheyarewithinthebroadercommunityTherearearangeofinfluencingfactorsincludingagehealthstatushowlongtheyhavebeeninAustraliahowmuchnewstheyreceivefromoverseasandhowbadlyimpactedbythepandemictheirhomecountries have been
The research also highlights that people from culturallyandlinguisticallydiversebackgroundsgettheirinformationaboutCOVID-19andtheCOVID-19vaccinefromawidevarietyofsourcesbothformalandinformalandthatforparticulargroupsinthisstudythereisahighrelianceonFacebookovermoreofficialsourcesofinforma-tion
VulnerabilityTheneedsofhighly-vulnerablegroupswithintheCALDcommunityhavetobetakenintoconsider-ationThisincludesolderpeoplewhohavelivedinAustraliaformanyyearsbuthavelowlevelsofEnglishliteracyndashespeciallywritingandreadingEnglishandsometimesspokenEnglishndashandwhoaremoresusceptibletoseriousillnessandhigherratesofhospitalisationanddeathfromCOVID-19Italsoincludesnewly-arrivedrefugeeswhohavinglowornoEnglishlanguageliteracylacktheconnectionstoandnetworksintothewidercommunityandcommunitysupportsItisalsothecase that some people in these groups are not health literate at all and cannot read and write in their own language
Akeytakeoutfromthehealthandcommunityserviceorganisationsurveyresponsesandinter-viewsundertakenwithmulticulturalhealthandcommunicationexpertsfortheprojectisthatlit-eracylevelsreallydomatterLowlevelsofhealthliteracylowlevelsofEnglishlanguageliteracyandpossiblylowlevelsofliteracyintheirownlan-guage-especiallyforsomenewly-arrivedrefu-gees and those who are part of the humanitarian program such as Dari language speakers from AfghanistanTigrinyalanguagespeakersfromEr-itrea and northern Ethiopia and Oromo language speakers from Ethiopia - need to be factored into anyplanstofurtherpromotethevaccinerolloutanduptaketoculturallyandlinguisticallydiversepeopleinthecommunityThereisaneedfor
The contextThisresearchisimportantgivenhowhighlyculturallydiverseNSWisandtheimpactthiscanhave on the success of public health messaging topeoplewhosefirstlanguageisnotEnglishPeople who were born overseas form almost one-thirdofthe7480228population(276)ofNSWandNSWishometo336ofAustraliarsquosoverseas-bornpopulationPeoplefromaround225 birthplaces have made NSW their home and 21oftheNSWpopulationisfromanon-EnglishspeakingbackgroundMorethan24000humani-tarianentrantshavesettledinNSWoverthepastfiveyearscomprisingalmostathird(32)ofthenationaltotalThe24000humanitarianentrantswhohavesettledinNSWoverthepastfiveyearscame from over 100 countries of origin10Sydneyhasthelargestoverseas-bornpopulationofallthecapitalcities11
Hearingdirectlyfrompeoplefromculturally-diverse backgrounds is important to ensure that policymakersandpublichealthadvocatescandesign responses that are both accessible and un-derstandabletopeopleforwhomEnglishmaybetheirsecondthirdorfourthlanguageApropor-tionofpeopleinthesecommunitieshavelowerlevelsofEnglishlanguageliteracyandinsomecaseslowlevelsofliteracyintheirlanguageoforiginsowillbehardertoreachviatraditionalormainstream methods
Itisalsocriticallyimportantthatduringatimewherethereissomuchlsquonoisersquoacrossmediachannelsrelatingtothevaccinethevaccineroll-outvaccineefficacyandvaccinesafetythatwetakesometimetolistentoandunderstandhowthislsquonoisersquoisbeingheardandmadesenseofbypeoplefromculturally-diversebackgrounds
ThatsaiditisimportanttoreconfirmthattheCALDcommunityisnotahomogenousgroupOurresearchhasfoundthattheviewsandattitudesofparticipantsfromdiverseculturalbackgroundsto-
10RefugeeCouncilofAustraliaHumanitarianEntrantsin New South Wales A resource for New South Wales governmentagencies6-711MulticulturalNSWCommunityRelationsReport2018-20199
29
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3130
groupsFortheparticipantsintheresearchtheirattitudetothevaccineappearedtobeinflu-encedbyanumberoffactorstheirownlevelsofhealthandpre-existinghealthconditionsandthoseoftheirfamilymembersandtheimpactofreceiving COVID-19-related news from overseas particularlyfrompeoplersquoscountryoforiginAnexampleofthiscanbeseenintheItaliangroupin Wollongong where people had received news fromoverseasearlyinthepandemicwhichscaredthemThisexperiencelsquofromhomersquohadinflu-enced most of the women in the Wollongong focus group (n=15) to choose to get vaccinated The interviewee from the Illawarra Shoalhaven Local Health District also spoke about the heightenedconcernthattheywitnessedinthelocalItaliancommunityintheearlystagesofthepandemicOtherpeoplewantedtolsquostayhealthyrsquoandtolsquoprotectthehealthofothersrsquoandformanytherewasasensethattheywantedtolsquogetbacktosomedegreeofnormalcyrsquoandtobeabletolsquotraveloverseastovisitrelativesrsquo
Vaccine hesitancyOfthe42inthisstudywhoappearedundecidedornotplanningtohavethevaccinemanywereinfactadoptingalsquowaitandseersquoapproachbeforemakingtheirfinaldecisionMostparticipantswereinterestedtohearmoreinformationaboutthevaccinesandwereopenedtogettingthevaccinebutdidhaveconcernsaboutthesafetyofthevaccinesespeciallyinregardtoAstraZeneca
The issue of blood clots has led to considerable fearandhesitancyinthecommunityandthisfearandhesitancywasreflectedinourstudyEssentialResearchrsquossurvey(April2021)reportedoneinsixpeople(16)indicatedtheywillnevergetvaccinatedagainstCOVID-19upfrom12thepreviousmonthwhile42saidtheywillgetvaccinatedbutnotrightawayTheproportionofpeople who would be willing to get vaccinated as soonaspossibleorarealreadyvaccinatedalsodeclineddownfrom47to4213Thissurveywas conducted prior to the most recent outbreak inNSWinvolvingthehighlyinfectiousDeltastrain
Therisk-benefitofhavingthevaccineneedstobecarefullyweighedbyeachindividualideallyinconsultationwiththeirdoctoranddependingon
The Hub has lsquobeen working in partnership with keystakeholdergroupstoguidecommunicationstomeetthehealthliteracyandculturallyandlinguisticallydiverse(CALD)needsofitspop-ulationStructuredworkinggroupshavebeencreatedtoprioritisecommunicationstovulner-ableyouthCALDgroupstheelderlyitinerateworkersasylumseekersandrefugeesTheaimsaretotestmessagingandbuildtrustwithprioritypopulationstoensureeffectivecommunicationoftheneedtosustainphysicaldistancingmeas-uresintheabsenceofavaccineSimilareffortsarenowneedednationallyandshouldstartatthetimeofdiseaseoutbreaksinthefuturealongsideplannedmassmediaandhealthcommunicationcampaignsrsquo
InthearticlebyDoddetaltheyreinforcetheimportanceofusingcommunicationformatswhich are lsquosuitable for people with low health literacyandeducationandwhichareappropriateforculturallyandlinguisticallydiversegroupsandIndigenouspopulationsrsquoThearticlearguesthatitisimportanttolookatmotivationsandconcernsabout vaccines when shaping messaging It also pointsoutthatprimarycaredoctorsareatrust-ed source and as such should be supported in deliveringinformationaboutthevaccinesandad-dressingcommunityconcernsThearticlestateslsquoWeneedtounderstandandaddresscitizenrsquosconcernsthatcanpreventoptimaluptakebuildmotivationsintomessagingandprioritisepublictrustbyinformingandinvolvingthecommunityintheprocessSupportinghealth-careprofession-als in their role as educators will ensure people haveadequateandaccessibleinformationfromatrustedsourcetooptimisevaccineuptakeandultimatelyreducecommunitytransmissionofCOVID-19rsquo15
RecentresearchbyAssociateProfessorHollySeale16withUNSWMedicinersquosSchoolofPublicHealthandDeputyChairfortheCollaborationonSocialScienceandImmunisationfoundthereisaneedtolsquodecentralisersquocommunicationsbytapping
translatedmaterialsandinformationaboutthevaccines to be tailored to the needs of people in these newly-emergingcommunitygroups
It was reported that in Wollongong there can sometimesbefourgenerationsoffamilymem-bersfromnewly-arrivedrefugeegroupslivingintheonehouseMostofthesefamilymembersgenerallyhavelimitedEnglishlanguageliteracywhichincreasestheirriskofnotreceivingkeyhealthmessagesandthereforeincreasingthepotentialimpactofCOVID-19-inparticulartheDeltastrainwhichhasprovenhighlyinfectiousamongst household members
Vaccine uptakeNotdissimilartothewidercommunitymorepeopleinourstudywereplanningtohavethevaccinethannotandanumberhadalreadybeenvaccinatedInarecentLancetarticle(February2021)ConcernsandmotivationsaboutCOVID-19vaccinationfindingsfromtwosurveysfromanAustralianlongitudinalstudyconductedinJuneandJuly2020includedthatlsquothetopthreerea-sons for agreeing to vaccinate were lsquoto protect themselvesandothersrsquohelliplsquobeliefinvaccinationandsciencersquohellipandlsquotohelpstopthevirusspreadrsquoEven among those willing to vaccinate there was somehesitancyaboutthesafetyofthevaccineTheLancetarticlenotedthatlsquowillingnesstovaccinatedifferedbybothageandeducationrsquoForthosewhowereindifferentorsaidtheywouldnot get the vaccine the top reasons across the twosurveyswerelsquoconcernaboutthesafetyofthevaccineinitsdevelopmentrsquoandlsquopotentialsideeffectsrsquo12
Olderpeopleinourstudywhocomprised23of the total sample (n=199) were the group most likelytosaythattheywantedtogetthevaccine85ofthoseover65saidtheywouldhaveorhadalreadyhadthevaccineVaccinepredispo-sitionwashoweveralsostrongacrossotherage
12RHDoddKPicklesBNickelECvejicJAyreCBatcupCBonnerTCoppSCornellTDakinJIsautierKJMcCafferyConcerns and motivations about COVID-19 vaccination SydneyHealthLiteracyLabSydneySchoolofPublicHealthFacultyofMedicineandHealthUniversityofSydneypublishedintheLancetFebruary2021p162wwwthelancet cominfectionVol21February2021
theircircumstancesHoweverthesourcesofin-formationthatpeoplemostrelyuponortrustarecriticaltothedisseminationofaccurateandclearmessaging to dispel the fear surrounding events suchasbloodclottingandthemisconceptionsraisedinthefocusgroupsWithsomanypartici-pantsinthisstudygettingtheirinformationfromFacebookandothersocialmediasitesitisvitalthat these channels are used to promote simple positivemessagesandforanyfuturecommunityawareness campaigns
Effective communicationConfusionandmisconceptionsaboutthevac-cinersquosefficacyavailabilityandsafetywereallis-sues that were raised in the focus groups Finding waystoeffectivelycommunicatewithpeoplewithlowerEnglishlanguageliteracyandhealthliteracyisanimportantwaytoaddresstheconfusionandmisconceptionsaboutthevaccineashasbeen discussed in a number of recent Australian studies
Astudy14byMcCafferyetal(2020)concludedthattherearelsquoimportantdisparitiesinCOVID-19-relatedknowledgeattitudesandbehavioursaccordingtopeoplersquoshealthliteracyandlanguagersquoOneofthefindingswasthatlsquopeoplewithlowerhealthliteracywerealsomorelikelyto endorse misinformed beliefs about COVID-19 andvaccinations(ingeneral)thanthosewithadequatehealthliteracyThesamepatternofresults was observed among people who primar-ilyspeakalanguageotherthanEnglishathomersquoTheMcCafferystudyhighlightstheimportanceof tailoring health messages to those with lower healthliteracyandculturallyandlinguisticallydiversecommunitiesItpointsoutthatthereareexamplesofeffectivemanagementofdiversecommunityneedsthatusetailoredhealthmes-sagesandcitestheWesternSydneyLocalHealthDistrictHealthLiteracyHub
13TheEssentialReport-anonlinesurveyconductedbyEssentialResearchcompletedby1090people between 21ndash26 April14McCafferyKJDoddRHCvejicEAyreJBatcupCIsautierJMJCoppTBonnerCPicklesKNickelBDakinTCornellSWolf MS Health literacy and disparities in COVID-19ndashrelated knowledge attitudes beliefs and behaviours in Australia PublicHealthResPract202030(4)e30342012December2020
15 Op cit16 httpssphmedunsweduausitesdefaultfilessphcmNewsEnhancing-supporting-COVID-19-vaccination-programpdf
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
30 31
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3332
intodifferentnetworkingspacessuchaswork-placeslocalgymsmothersrsquogroupsandseniorsrsquoclubswithafocusonallagegroupsregardlessofcurrenteligibilityAccordingtoSealethechal-lengeislsquoensuringemerginginformationisadapt-edfortheintendedaudiencersquoShehasalsosaidlsquoThatrsquoswhatIrsquomalittlebitconcernedaboutatthemomenttherersquosalotofresourcesongov-ernmentwebsitesbutthesetermsaroundbloodclottingareverytechnicalWeactuallyneedtomake sure that we are breaking them down in a waythatwillmakeitmeaningfultopeopleThatrsquosnotjustabouttranslatingitrsquosaboutbeingcon-sciousofpeoplersquoshealthliteracyneedstooSomaybegettingsomemorevisualsintomaterialstotryandsupportthatrsquo17
Thereareanumberofmulticulturalhealthresourcesthatusecommunitylanguagetransla-tionsplainEnglishandvideosfromCALDcommu-nityleaderswhichcanbedownloadedandusedbyservicesandindividualsHowevermanyofthewrittenresourcesstillrelyontechnicalandscien-tifictermsthatrequireareasonablyhighlevelofEnglishlanguageliteracyorhighlevelsofliteracyin the translated language to comprehend Host websites can also be hard to navigate making itdifficulttolocateresourcesfromsimplewebsearchesAsummaryofsomeoftheavailableresourcescanbefoundatAttachment2
MulticulturalHealthUnitsinLocalHealthDis-trictshavestaffwhocanworkwithpeoplefromculturallyandlinguisticallydiversecommunitiesatthelocallevelandtranslateandcontextualisethese materials to the needs of the end user These teams respond to local needs and popu-lationdemographicsandareexpertsineffectivehealthliteracyandhealthcommunicationwiththeirlocalcommunitiesTheyworkcloselywithcommunityandvulnerablegroupstobuildhealthliteracyandimprovedhealthoutcomesintheircommunities
Case Study ndash Be a COVID Warrior ndash Responding to COVID-19 in Multicultural Communities InWollongongtheIllawarraShoalhavenLocalHealthDistrict(ISLHD)MulticulturalHealthSer-viceco-designedacommunityengagementandeducationprogramcalledlsquoBeaCOVIDWarriorrsquowhich commenced in 2020 in response to the pandemic This program was designed to respond tothelowlevelsofhealthliteracyaroundCOVID-19potentialexposuretothevirusandaddressfearandstigmainthelocalCALDcommunitiesThelsquoCOVIDWarriorrsquoprogramreachedaround880peopleranginginagefrom14to85years65ofCOVIDWarriorparticipantswerefemaleand35weremaleCOVIDWarriorparticipantsrepresented 21 language groups The outcomes of the program included increased levels of confidenceinapplyinginfectioncontrolmeasuresincreasedliteracyandhealthliteracyandawarenessofhowCOVID-19istransmittedUltimatelyanimprovedawarenessinapplyingCOVIDsafemeasures was also reported
InApril2020theservicecommencedwelfarechecksviaphoneonafortnightlybasistosup-portsocially-isolatedmulticulturalseniorswhoboretheemotionalstressofsocialisolationFrom these calls the ISLHD heard the needs and concernsofseniorsinthecommunityInadditionourexperiencewithCALDcommunitieshighlightedtheimportanceofyoungpeopleasconduitsofessentialinformationtoadultsincommunityandfamilygroupsduetoEnglishlanguageaccessandeducation
InresponsetheISLHDinitiatedthelsquoCOVIDWarri-orrsquoprogramusingbi-culturalhighschoolstudentsthroughthelocalhighschoolsByincreasingthehealthliteracyofstudentsatschooltheselsquocham-pionsrsquocouldtalktotheirfamiliesincludingolderfamilymembersininformalsettingsandthroughsocialmediawiththeirpeersasastrategytoraisethe level of knowledge of COVID-19 trans-mission preventionandtestingTheprogrambecamesopopularthatitwasextendedintomorelocalhighschools and adults accessing the Adult Migrant EnglishProgramTheprogramwassupportedbylocalsettlementservicesprovidedbybothMaxSolutionsandtheRedCrossItwas
17 httpstheconversationcomhow-can-governments-communicate-with-multicultural-australians-about-COVID-19-vaccines-its-not-as-simple-as-having-a-poster-in-their-language-156097
later extendedtoCALDSeniorsthroughtheMulticulturalCommunitiesCouncilIllawarra(MCCI)supportprograms
AkeycomponentoftheprogramwastoprovideparticipantswithlsquoCOVIDWarriorrsquoKitswhichincludedtworeusablemaskshandsanitiserinfographicsaboutCOVID-19symptomsandinfor-mationaboutwheretestingclinicswereavailablelocallyMCCIandRuralAustraliaforRefugeesdonatedreusablemasksforeveryparticipant
AsthelsquoCOVIDWarriorrsquoprogramwasevolvingsowasthenationalvaccinerolloutplanInforma-tionwasthereforeadaptedtomeetthisinfor-mationgapForexampleadultparticipantsandseniors were supported to understand how to accesstheCOVIDvaccinelsquoeligibilitycheckersrsquoandCALD people were shown how to use the NSW HealthwebsiteCOVID-19informationpages18
Decision makingHowpeoplearecurrentlyconsideringtheriskofCOVID-19isinfluencedbyarangeoffactorsincludingratesoftransmissioninthecommunitynumbersofnewcasesreportsinthemediaofrisksandsideeffectsPeopletendtobasetheirassessmentonwhattheyarecurrentlyexperi-encingandthencheckthisagainstwhattheyarehearinginthemediaincludingandespeciallyonsocialmediaandfromfamilyandfriendsMostoftheparticipantsinourstudyspokeclearlyandarticulatelyabouthowtheyweigheduptherisk-benefitofhavingtheCOVID-19vaccineintheir decision making Low case numbers ndash at the timeofconductingtheresearchndashandasensethat Australia was lsquodoing well in safeguarding the communityagainstCOVID-19rsquoweresignificantfactorsinpeoplersquosdecisionnottobevaccinatedortoadoptalsquowaitandseersquoapproachFamilyfriends and social media were reported as having aconsiderableinfluenceondecisionmakingaswerereportsinthemediaofthebloodclottingsideeffectsofAstraZeneca
ThefactthatFacebookwasreportedlythemostpopularsourceofinformationaboutCOVID-19
18httpswwwhealthnswgovauInfectiouscovid-19Pagesdefaultaspx
andtheCOVID-19vaccineforpeopleinthestudyraisesconcernsaboutthepossibledisseminationofmisconceptionsandlsquofakenewsrsquothatmaybespread or compounded via social media Closed social media groups such as WhatsApp and WeChatwithfamilyandfriendsmayalsoleadtopeoplereinforcingtheirpre-existingbiasesThesefactorscoupledwithasensethatAustraliaisfaringwellcomparedtomanycountriesoverseasappear to have resulted in increased vaccine hesi-tancyamongparticipantsofthestudy
Factorsthatwereidentifiedaschangingvaccine-hesitantparticipantsrsquoperceptionswereanincreased risk from COVID-19 and a correspond-ingincreaseinthenumberofinfectionsandonthebenefitsidetheabilitytotraveloverseastovisitfamilyIntherecentresearchfromtheUniversityofNSWcitedaboveSearlearguesthatlsquotheremaybeotherthingsthatweneedtonowstartfocusingonhellipthatwillstarttopromoteandmotivatepeoplesuchasthechancetotravelmorefreelyforexamplersquoThisappearstobeborneoutbyourfocusgroupfindings19
Untilrecentlytherehavebeenverylowcasenumbers and few lockdowns across most of Aus-tralia and NSW The recent outbreak from mid-JuneinGreaterSydneyandintroductionofthehighlyinfectiousDeltavariantinNSWislikelytoimpactonpeoplersquosassessmentsoftherisk-benefitofhavingthevaccineandonewouldassumereducehesitancyrates
GiventheheightenedcommunityanxietycausedbythisrecentCOVID-19outbreaktheproductionofshortsharpandtargetedmessagingtoCALDgroupsincommunitylanguagesthatisaccessibleandmotivationalfeaturescommunityleadershigh-profilecelebritiesandsportsstarsfromCALDbackgroundsandisdirectedatastate-wideandlocal level would appear to be more urgent than everItisclearthatformessagingtobeeffectiveandreachitsintendedaudiencedistributionchannelsshouldincludeFacebookWhatsAppandothersocialmediaplatformsaswellastrustedsourcessuchasmulticulturalhealthworkersmulticulturalservicesandthroughGPsandMedical Centres If mainstream COVID-19 vaccine
19 Op cit
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
32 33
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3534
awareness campaigns are produced in Australia suchashavebeenproducedinNewZealandtheUnitedKingdomandNorthAmericatheyshouldincludehighprofilewell-knowncommunityfig-uresandsportingstarsfromCALDbackgroundsandincludestrategiesspecificallytargetingCALDcommunitiesincludinggroupsidentifiedaspar-ticularlyhigh-risk
It is also important that informationonvaccinesistranslatedintolanguagesfromnewerandemergingcommunitiesOthersuggestionsaroundreachingthesecommunitiesincludeface-to-facemeetingsorganisedbycrossagencypartnershipsandpeer-ledstrategiessuchas mobilising community champions and influenc-ers Messaging needs to be inclusive and framed around the collective values held by commu-n5
It is clear that reinforcing the benefits of being vaccinated at this time rather than dwelling on the risks is more likely to generate behavioural
changeandapositivevaccineresponsefrombothCALDcommunitiesandthegeneralpopulationAppropriately-designedandtargetedCOVID-19vaccinehealthinformationthatiseasytoreadinanylanguagecanbeconveyedbycommunityleadersandcommunitynetworksandpromotesthepositivebenefitsofgettingvaccinatedwouldbevaluableatthistimeBuildingontheworkofpeerchampionssuchastheCOVIDWarriorprogramisalsoasuccessfulmodeltoincreasingCOVID-19vaccinehealthliteracyandinformed decision making
Mostimportantlypositivelymotivatingculturallyandlinguisticallydiversecommunitymemberstolsquogetthejabrsquoespeciallythosewhoareadoptingalsquowaitandseersquoapproachorarevaccinehesitantwould lead to greater vaccine uptake among culturallyandlinguisticallydiversecommunitiesandthereforethecommunityasawhole
Inner West Multicultural Network Addison Road Community Centre DateWednesday12May
A focus group session of members of the Inner WestMulticulturalNetworkpluscustomersoftheFoodPantryatAddisonRoadwasheldattheAddisonRoadCommunityCentreinMarrickvilleon12Mayat200pmThesessionwaspartoftheregularmeetingoftheInnerWestMulticul-turalNetworkTheconsultationinvolvedabout26peopleandwasconductedbyRosannaBarbero
Thegroupbrainstormedresponsestoquestionsaroundvaccinehesitancyinmulticulturalcom-munitiesandmoreeffectivemessagingTheseresponseshavebeenincorporatedinthefindingsof the report
Griffith Women on Fire Focus Group Griffith Community Centre DateFriday14May
This small focus group of women was held at GriffithCommunityCentreonMay14at11amMargCouchSeniorProjectOfficerRegionalDevelopmentAustralia(RDA)-RiverinaandJoanneFitzpatrickSettlementEngagementandTransitionSupport Worker from Centacare Southwest NSW werethekeylinksandnetworkcontactsfortheGriffithcommunityTheWomenonFire(WOF)group was established as part of the Red Cross RuralFireServiceprogramlsquoManyCulturesOneCommunityrsquoInitiallyitwasestablishedtoeducatewomenonemergencypreparednessandtoen-courage NSW Rural Fire Service (RFS) volunteering andnowhastransformedintoacommunityac-tionsupportgroupTheGriffithSoroptimistInter-nationalnowauspicetheirfinancesandsupporttheWOFgroupactivitiesThefocusgroupwasfacilitatedbyCamillaCouchandlocalcommunityvolunteersledbytheGriffithSoroptimistClub
The women in the group were from Pakistan and IndonesiaThegroupweremainlyyoungmotherswithyoungchildrenandtheprogramhadchild-minding arrangements The language level of the womenwaslowandmostwerestudyingESOLat
ATTACHMENTS
ATTACHMENT 1 A Description of the Focus Groups
TAFEThedeliveryoftheinformationwaslimiteddue to language levels and the lack of bilingual interpretersEachparticipantworkedoneononewithavolunteertoslowlyfillinthesurveyandonewomantookthesurveyhometodiscusswithherhusbandThisgroupexperiencehighlightedthe lack of bilingual workers and services in some rural areas
Arabic speaking group Syd West Multicultural Services Mount Druitt Community worker Zaid Naoum Generalist Caseworker SydWest Multicultural Services DateMonday24May
ThefocusgroupfromSydWestMulticulturalSer-viceswasconductedonMonday24May2021atSydWestMulticulturalServicesMountDruittat300pmItwasfacilitatedbyPatriciaMcCormickandsupportedbyZaidNaoumGeneralistCase-workerSydWestMulticulturalServices
Therewere10womenandmenfromSyriainthegroupThegroupweremostlymaturetoolderparticipantsMostparticipantsrequiredassistancewithEnglishandthecaseworkerZaidNaoumhadtranslatedthesurveyintoArabicpriorto the focus group Zaid also translated during the focus group
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Canterbury City Community Centre (4Cs) group The Cottage Lakemba DateTuesday25May
ThefocusgroupfromCanterburyCityCommunityCentre(4Cs)wasconductedonTuesday25MayattheCottageat28CroydonStreetLakembaat10amItwasfacilitatedbyRobinMilesandsup-portedbyRomanaWaseemCommunityWorkerfrom 4Cs
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
34
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3736
The group was comprised of 14 women from PakistanIndiaandSriLankaThewomenrangedinagefrom23to65MostwerefluentEnglishspeakershoweveronewomanrequiredtransla-tionintoUrdufromoneoftheotherwomeninthegrouptoanswerthequestionsdirectly
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
NSW Chaldean League group Community worker Randa Goriya DateTuesday25May
ThefocusgroupfromNSWChaldeanLeagueMountDruittwasconductedonTuesday25May2021 at 1000am at the NSW Chaldean League premisesItwasfacilitatedbyPatriciaMcCormickandsupportedbyRandaGoriyaacommunityworker for the NSW Chaldean League in Mount DruittRandatranslatedtheintroductionandpromptsforthediscussionandhelpedthepartic-ipantstocompletethesurveyMostofthegrouprequiredhelptodothesurvey
ThegroupoftwelveparticipantswereallChaldeanandwerematuretoolderinageTheywereamixed-gendergroup
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Arabic speaking group Red Cross premises Wollongong DateTuesday25May
ThefocusgrouptookplaceonTuesday25Mayat 3pm at the Red Cross premises at Wollongong Therewere22womenandmenparticipatinginthegroupThefocusgroupwasfacilitatedbyCamilla Couch with support from Khalid Zainu-labdeenBilingualSupportWorkerHumanitarianSettlementProgram(ACTampNSW)
There were diverse ages in the group ranging fromyoungpeopletoolderagedMostofthegroupwereyoungerrecently-arrivedrefugeesfrom diverse backgrounds There was also a small-eroldercohortofparticipantswithhigherliteracylevelsandstrongercommunityengagementwith the local services in the area Camilla Couch facilitated the focus group which was conducted inArabicandEnglishwiththeArabictranslationprovidedbyKhalidZainulabdeen
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Work Opportunities for Women group Mt Druitt TAFE DateWednesday26May
TheWorkOpportunitiesforWomen(WOW)focusgroupwasheldonWednesdayMay261100ndash 100pmatMtDruittTAFEItwasfacilitatedbyCamilla Couch and built on the knowledge gainedintheprevioussessiononcriticalandanalyticalthinkingTheWOWgroupisaTAFECertificatelevel course
There were 14 women from diverse cultural backgroundsinthegroupThegroupweremainlyMuslimwomenwithschoolagechildrenandsome were mature aged Due to the learning fo-custhegroupwasfacilitatedasaclasswithguid-eddiscussionontheissuesandcarefulanalysisofthequestionsNotranslationwasneededduetotheeducationalcontextThestudentswereadeptatusingITandcompletedallthesurveysonline
STARTTS Tamil group Toongabbie Community Centre Community worker Sivaharani (Harani) Mayuran DateThursday27May
Thefocusgroupconsistedof18femalepartic-ipantswhowereyoungertomatureagedThefocus group was held at 1000am at Toongabbie CommunityCentreinTargoRdToongabbie
ThefocusgroupwasfacilitatedbyPatriciaMc-CormickandsupportedbyacommunityworkerSivaharani(Harani)MayuranfromtheSTARTTSTamil Group
ThegrouphadmixedlevelsofspokenandwrittenEnglishTheintroductionanddiscussionpromptsweretranslatedbythecommunityworkerSivaha-rani(Harani)Mayuranandsheandthemorepro-ficientstudentssupportedthosewithlowliteracytoanswerthesurveyquestions
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Spanish Speakers Seniors group SydWest Multicultural Services Blacktown DateTuesday1June
TheFocusGrouptookplaceonTuesday1Juneat1100amattheBlacktownShowgroundsandconsistedof16participants(15womenandoneman)AllparticipantswerebornincountriesinSouthAmericaTheirEnglish-fluencylevelsvariedand one of the members of the group translated thesurveyquestionsanddiscussionintoSpanish
ThegrouphadbeenmeetingforseveralyearsThegroupwasfacilitatedbyLindyCassidyandwassupportedbySreeVithyaHarilingamDayRespiteampSocialSupportTeamLeaderatSydWestMulticulturalServicesBlacktownThegroupwerematureagedtoolderparticipants
Thegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyform There was a more focused discussion on somekeyquestionsaftersurveycompletionThetranslatorassistedconsiderablyinthisprocess
Italian Speakers group Warrawong Community Centre DateMonday7June
The focus group of Italian speakers was held on Monday7Juneat1015amattheWarrawongCommunityCentreItwasfacilitatedbyCamillaCouchandsupportedbyJohnPaulTroianiand
SofiaLemafromIllawarraShoalhavenLHDMulti-cultural Health
There were 15 women in the group The group weremostlymaturetoolderparticipantsandwasconductedinItalianandEnglishwithtranslationprovidedbyJohnPaulThisgroupmeetsregularlyandissupportedbyanumberofservicesintheareaespeciallymulticulturalhealth
The group had a general facilitated discussion aboutthequestionsinthesurveyDuetolittleornoliteracytheindividualsurveyresponseswerethencollectedintooneresponseThesesurveyresponses have been included in the general surveyresponses
Mothers Group SydWest Multicultural Services Blacktown DateThursday10June
ThefocusgrouptookplaceonThursday10Juneat1030amandconsistedof14youngwomen13 of whom had a CALD background The focus groupweremainlymothersfromasupportgroupatSydWestMulticulturalServicesinBlacktown
EightofthewomenwereborninIndiatwofromPakistantwofromSriLankaonefromHausaGhana and one was born in Australia (the Austral-ianbornyoungwomanwasasocialworkstudenthelpingwiththegroup)LindyCassidyfacilitatedthe group with support from Wilma Garguath a projectofficerfromSydWestMulticultural Services
The group varied in age One was between 18-24 yearsoldSevenwereagedbetween25-34yearsSixwereagedbetween35=44yearsGiventheirage and circumstances most of the group did not consider themselves eligible at this stage for vac-cinationThiswasanimportantdifferencefromotherfocusgroupsinthattheemphasiswasmoreonwhattheywoulddooncetheybecameeligible
Participantsdidnotrequireassistancewithspo-kenEnglishThegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyformTherewasamorefocuseddiscussiononsomekeyquestions
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3938
ATTACHMENT 2 COVID-19 Vaccine Information in multiple languagesThefollowingsitesappsprovidetranslatedinformationaboutCOVID-19vaccines
Type of information KeyinformationongettingvaccinatedinNew South Wales and on the vaccines available The websiteusesanautomaticservicetotranslate thecontentintodifferentlanguages
Source of information NSW Government website
Link httpswwwnswgovauCOVID-19health-and-wellbeingCOVID-19-vaccina-tion-nswgetting-vaccinated
Type of information COVID-19ResourcessectionontheServiceNSWapp The app has a link to NSW Government websiteinformationonldquoGettingaCOVID-19vaccinationrdquo(seeabove)ItalsoincludesalinktoCOVID-19vaccinationresourcesinotherlan-guages available from the Department of Health
Source of information Service NSW NSW Government
Link Service NSW App
Type of information ArangeoftranslatedresourcesonCOVID-19bytitleincludingafactsheetonCOVID-19VaccineAstraZeneca(ChAdOx1-S)
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCOV-ID-19Pagestranslatedresources-by-titleaspx
Type of information ADigitalCOVID-19resourcelibrarywithtranslated materials
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiouscov-id-19Pagesdigital-resourcesaspx
Type of information AMultilingualCommunityToolkitontheCOVID-19vaccinationprogramtoassist communityworkersprovideseasytoreadresourcesvideosandlinkstokeyservicesandresources
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCovid-19DocumentsNSW-COVID-19-vaccina-tion-program-presentation-20210527pdf
Type of information TheNSWMulticulturalHealthCommunicationServiceoffershealthresourcesandinformationin a wide range of languages It has translated resources on COVID-19 and links to translated resourcesonCOVID-19vaccination
Source of information MulticulturalHealthCommunicationServiceisa New South Wales-wide health service hosted bySouth-easternSydneyLocalHealthDistrict(SESLHD)
Link httpswwwmhcshealthnswgovau
Type of information COVID-19vaccineinformationaddressingkeyquestionsaboutCOVID-19vaccinationandincludesvideosposterstilesfactsheetsandaudio material Translated into 63 languages
Source of information Department of Health Australian Government website
Link httpswwwhealthgovauinitiatives-and-pro-gramsCOVID-19-vaccinesCOVID-19-vaccine-in-formation-in-your-language
Type of information ThisinformationaddressessomecommonmisinformationaboutCOVID-19Translatedintomultiplelanguages
Source of information DepartmentofHomeAffairs Australian Government website
Link httpscovid19inlanguagehomeaffairsgovaumisinformation-and-truths-about-coronavirus
Type of information Australianandinternationalnewsand informationaboutCOVID-19andCOVID-19 vaccinesisavailableontheSBSCoronavirusPortal in more than 60 languages
Source of information SBSwebsite
Link httpswwwsbscomaulanguagecoronavirus
Type of information InformationprovidedaboutCOVID-19vaccinerolloutandsafetyinlanguagesotherthan English
Source of information Department of Health and Human Services Victorian Government
Link httpswwwcoronavirusvicgovautranslat-ed-information-about-COVID-19-vaccines
Type of information HealthTranslationsprovidestranslatedmateri-alsonhealthandwellbeingInformationaboutCOVID-19isregularlyupdatedincludessomeinformationonvaccinationandisavailableinover60communitylanguages
Source of information Victoriangovernmentinitiative
Link httpswwwhealthtranslationsvicgovaubhcv2bhchtnsfPresentEnglishResource-AllOpenampx=amps=Coronavirus
Type of information A one-stop shop for translated materials in multiplelanguagesonCOVID-19
Source of information Ethnolink Language Services
Link httpswwwethnolinkcomauCOVID-19-coro-navirus-translated-resources
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
40
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1312
211
1316 14211684
2053
3316
Less that 1year
1 - 2 years 2 - 5 years 5 - 10 years 10 - 20years
More than20 years
000
500
1000
1500
2000
2500
3000
3500
Less than 1-2 years 2-5 years 5-10 years 10-20 More than1 year years 20 years
1453
8430
000 116
Male Female Non-binary Rather not say000
100020003000400050006000700080009000
000
785
1728
2147
1309
1675
2356
Under 18 18-24 25-34 35-44 45-54 55-64 65+000
500
1000
1500
2000
2500
Figure 3 Length of time living in Australia Figure 5 Gender
Figure 4 Age
METHODOLOGY
Chaldean Focus Group Feedback Sheet
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1514
Research participants were asked
If they were intending to get vaccinated
The reasons why they would or would not choose to get vaccinated
If they knew anyone who had already been vaccinated and if so who
If they knew anyone who had contracted COVID-19 and if so who
If they knew where to go to get vaccinated
What sources they used to get information about the COVID-19 vaccination
Basic demographic information age gender country of origin language spoken at home and length of time living in Australia
Having the vaccine or notOfthe199participants117(58)reportedthattheywereplanningtobeorhadalreadybeenvaccinatedwhile78(42)reportedthattheywere not planning to have the vaccine (13) or didnotknowiftheywouldgetvaccinated(29)
1453
8430
000 116
Male Female Non-binary Rather not say000
100020003000400050006000700080009000
05
10152025303540
Under18
18-24 25-34 35-44 45-54 55-64 65+
Coun
t
Yes No Donrsquot Know
Figure 6 Are you going to get the COVID-19 vaccine
Figure 7 COVID-19 Vaccine intention of respondents by age category
13people(65)hadalreadybeenvaccinated(at least 1 dose)6withseveralcommentingthattheyhadchosenorneededtobevaccinatedforwork-relatedreasonsOthersreportedthattheyhadbeenvaccinatedprimarilyforhealthreasonstostaywellandmakesurethattheirfamiliesstayedwellTheywerealsoconcernedaboutpublichealthandsafetyOneofthewomenintheLakemba groups from Sri Lanka was adamant that thebenefitsoutweighedtherisksspokepositive-lyabouthoweasyithadbeentogetthevaccinefrom her local medical centre and that she had experiencednosideeffectsfromthevaccination
Language Count Percent Urdu 1 Italian 3 Arabic 2 Tamil 3 Chaldean 1 Spanish 3 Total 13 65 of sample
Response Count Percent Not planning to have the vaccine 23 13 Unsure about having the vaccine 52 29
75 42
Table 2 Respondents already vaccinated
Table 3 Respondents who indicated vaccine refusal or hesitancy
6 Theresearchersdidnotdistinguishbetweenwhetherpeoplehadreceivedtheirfirstandseconddosesofthevaccineiepartiallyorfullyvaccinated
75(42)indicatedadegreeofvaccinehesitancywith24participants(13)reportingthattheywerenotplanningongettingvaccinatedwhile53(29)reportedtheydidnotknowiftheywouldget vaccinated
Thislevelofvaccinehesitancyreflectslargerstud-iesintheAustraliancommunityAsurveyofover1000participantsfromacrossAustraliaconduct-edinApril2021byEssentialResearchfoundhes-itancyratesof42including16whoindicatedtheywerenevergoingtogetvaccinated7
Foroursurveyresponsesindicatedthatagewasafactorwith85ofrespondentsaged65andoverreportingthattheywouldhaveorhad
7EssentialResearchThe Essential Report21April2021
FINDINGS FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1716
alreadyhadthevaccineThosewhoindicatedthattheywouldnotbehavingthevaccinewerefairlyevenlydistributedacrossagegroupswithyoung-er people aged 18-24 being the age group with thehighestproportionofparticipantsexpressinguncertaintyabouthavingthevaccineTheagegroupwiththesecondhighestlevelofhesitancyproportionatetoothercategorieswerethe35-44yearolds
02468
10121416
Iraq
Vietnam Italy
South Americ
a
Sri La
nkaIndia
Syria
Other South East
AsiaAfric
a
Australia
Sweden
China
Pakistan
Iran
Eastern Europe
Afghanistan
Japan
Coun
t
Yes No Dont know
8095 8190
70486095
4571
6190
095
To stayhealthy and
well
To keep myfamily
healthy andwell
For publichealth
To travel To work It is theright thing
to do
Somethingelse (pleasetell us what)
000100020003000400050006000700080009000
Figure 8 Respondents COVID-19 Vaccine intention by Country of Origin
Figure 9 Reasons for getting vaccinated against COVID-19
Countryoforiginalsoseemedtoplayaroleinpeoplersquosviewsabouthavingthevaccinewithhighvaccinepre-dispositionreportedbyVietnameserespondentstotheonlinesurveyandwomenintheItalian-speakinggroupWhileparticipantsfromIraqrecordedthehighestlsquoyesrsquoresponsethiswasalmostmatchedbyIraqiparticipantswhoreportedthattheywerelsquounsurersquoorlsquodidnotknowrsquowhethertheywouldhavethevaccineTherelevanceofcountryoforigininthisregardwouldbeworthyoffurtherresearch
The Italian focus group held in Wollongong was an olderwomenrsquossocialgroupwithallparticipants(15) agedabove65yearsMostinfactwereaged over75yearswithoneparticipantinher90s 87 of the group had either been vaccinated (3) or were planning to get vaccinated (10)
Of course I will get vaccinated It is important to do this It is a very bad
disease
Thesewomenweremotivatedtostayhealthyandwellkeeptheirfamilyhealthyandwellforpublichealthreasonstobeabletotravelandforgen-eralsafetyMembersofthegroupalsoreportedthattheywantedtogetvaccinatedsothattheywouldbeabletolsquodancersquoandlsquosocialisersquo
Reasons for having the vaccine
Ofthe117participantswhoreportedthattheyhadeitheralreadybeenvaccinatedorwereplan-ningtogetvaccinatedlsquokeepingmyfamilyhealthyandwellrsquo(82)andlsquokeepingmyselfhealthyandwellrsquo(81)werethetwomostpopularreasonsforhavingthevaccineThiswasfollowedbylsquoforpublichealthrsquo(70)lsquoitistherightthingtodorsquo(62)andinorderlsquototravelrsquo(61)(SeeFigure9)
I donrsquot want to
die
Irsquom over 65 I have some health issues I think itrsquos
[having the vaccine] very important to
keep safe
I want to see my family I usually go every year but now I havenrsquot seen them
because of COVID-19 Having it will help
I am well but my parents are older It is important to
keep them well
Otherreasonsthatpeoplegaveforgettingvacci-natedincludedtheneedtocontinueworkinginessentiallsquofrontlinersquoemploymentsuchassecuritycleaningandagedcaresettingsOnewomanintheLakembafocusgroupwhohadalreadyhadherfirstdoseoftheAstraZenecavaccinesaidthatlsquothebenefitsoutweightherisksrsquoandasanolderwomanrsquoIdonotwanttodiersquo
All but one of the focus groups were familiar with thedifferentvaccinescurrentlyavailableinAus-traliaAstraZenecaandPfizerMostparticipantswere also aware of blood clots being associated with the Astra Zeneca vaccine One group of newly-arrivedrefugeesinGriffithhadnotheardofeithertheAstraZenecaorPfizervaccinesandhadamorelimitedunderstandingofthevaccinationprogram in general
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1918
Reasons for not having the vaccine
At the moment the situation is under control and donrsquot feel the need Also I have no plans to
travel in the near future so I donrsquot see the need
3514
21622703
3243
1892
811 541
4865
1081
Thevaccine isnot welltested
Thevaccine is
unsafe
Formedicalreasons
I amscared tohave thevaccine
I dont likevaccines
Forreligiousreasons
Forculturalreasons
I want towait and
see
Somethingelse
(pleasetell uswhat)
000
1000
2000
3000
4000
5000
6000
Figure 10 Reasons for not getting vaccinated against COVID-19
Theperceivedlsquolackofadequatetestingrsquoofthevaccineandlsquofearofbeingvaccinatedrsquoalsore-ceivedhighresponseratesselectedby3514and3243ofparticipantsrespectivelyOnly1355 of respondents cited religious or cultural reasonsasbeingbehindtheirvaccinehesitancy
Open-endedresponsestothisquestionincluded
The vaccine is not 100 working It cannot offer
100 protection
Ofthe42participantswhosaidthattheywouldnothaveorwerehesitanttohavethevaccine4865saidthattheypreferredtolsquowaitandseersquobeforegettingvaccinated
Thediscussioninthefocusgroupsaboutpeoplersquoshesitancytobevaccinatedfocusedonanumberofconcernswhichreflected
poorcommunicationfromanumberof trusted sources including GPs and some media sources
conflictinginformationaboutthevaccinefrom healthauthorities
fearsaboutvaccinesafetythataresharedby thegeneralcommunity
misconceptionsabouttheeffectivenessof andhowthevaccineswork
I will not have it because make me sick
Issuesraisedinfocusgroupsascontributingtoincreasedhesitancyincluded
Some GPs being hesitant to recommendvaccination
Theinformationbeingprovidedisconflicting
Theinformationisoverlycomplexandnotcomprehensibleregardlessofwhetherithasbeen translated
The risk of blood clots
Perceptionsthatthevaccinesaregenerallyunsafe
Concernsthatsomepeoplearedyingafterbeing vaccinated
Not being sure about the risks associated withhaving the vaccine and being pregnant orbreastfeeding
Theperceptionthattherehasbeenalackoftestingofthevaccinespriortorollout
AlackofunderstandingofhowvaccinesworkthecompositionofthevaccinesandwhattheywoulddotothebodyincludingmakingchangestoapersonrsquosDNA
Specificcommentsincluded
I have heard that the vaccine changes
your DNA
I am a mother I am not sure it [the vaccine] is safe for
me when I am breastfeeding
If you are young and healthy your body has the energy to fight the virus
You donrsquot need to have the vaccine You should just let
your body fight it itself
They donrsquot tell you what chemicals are in the
vaccine
Tamil Focus Group Feedback Sheet
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2120
Nobody knows what to do My GP doesnrsquot even know what I should do whether
I should have it or not
I am not sure what to do I have spoken to my
GP but they canrsquot tell me whether I should have the vaccine or not while I am
breastfeeding
They say one thing and then they tell you
something elsehellip it [the vaccine rollout] is so
confusing
Confusionaboutwhattodowheretogoandthe health impacts of the vaccine was a common threadintheconversationsaroundvaccinehesi-tancy
Onewomanwhosehusbandworkedforasecurityfirmsaidthatherhusbandhadhadtobevacci-natedinordertokeephisjob
In several focus groups the issue of government control was also raised A number of people re-portedstronglythattheyfearedthatthevaccinewas lsquoa means that the government was using to controlpeoplersquo
He [husband] had to have it He didnrsquot have a choice He was fine [no side effects] but Irsquom not
thinking I will have it I donrsquot need to Irsquom a mum Irsquom busy I have
to look after my children I donrsquot know how I feel about it whether
Irsquom going to have it
Vaccine refusal
Onlyasmallnumberofparticipants(24or13)saidtheywouldnotgetvacci-natedOfthisgroup21werewomenand 2 were men8 Respondents were bornintendifferentcountrieswithadiverse range of language backgrounds
I never get sick It is the same for all my family We have always been strong and healthy so I will be
saying no to the vaccine
Country of Birth Language Background Count Pakistan Urdu 4 China Taiwan Chinese
(MandarinCantonese) 4
Sri Lanka India Tamil 3 Chile Spanish and English 2 Italy Italian 2 Iraq Syria Arabic 2 Iraq Chaldean 1 Iran Farsi 1 Greece Macedonian 1 Poland Polish 1 Pakistan Punjabi 1 Sweden Swedish 1 Vietnam Vietnamese 1
Table 4 Vaccine refusal by country of birth and language background
8 ThisreflectstheoverallsamplebiastowardswomenThemajorityoffocusgroupparticipantswerewomenXwithYparticipantsbeingmen
Reason for not having the vaccine Percent Count The vaccine is not well tested 5455 12 I want to wait and see 5455 12 The vaccine is unsafe 3636 8 For medical reasons 3182 7 I am scared to have the vaccine 3182 7 I dont like vaccines 1364 3 For religious reasons 1364 3 For cultural reasons 909 2 Something else (please tell us what) 909 2
SomeinthiscategorywereadamantthattheywouldnotbehavingthevaccineandhadverystrongviewsonitlsquoForculturalreasonsIwonrsquotbehavingthevaccinersquoWhenwelookatrespons-esmorecloselyhoweveritwouldappearthatmanyareinfactmorelsquohesitantrsquothanfirmvaccinerefusers
One reluctant middle-aged Tamil-speaking wom-ansaidlsquoIftheysaywehavetogetvaccinatedthenIwillrsquoThissentimentwas stronglysup-portedbythe rest of the Tamil-speaking group
Studyparticipantswhosaidtheywouldnothavethe vaccine were also concerned that lsquothe vaccine wasnotwelltestedrsquo
The vaccine has been rushed out It has not been
properly tested
Table 5 Reasons for not having the vaccine
Peopleinthiscategorysaidthattheywouldlsquowaitandseersquowhathappenswiththewiderrolloutbe-foremakingtheirfinaldecisionThissuggeststhataproportionofthelsquonorsquogroupareinfacthesitantrather than outright refusing to have the vaccine
Therewerealsofearsexpressedbyfocusgroupparticipantsaboutthedangersofbeingvacci-natedParticipantsreportedbeingafraidofthehealthrisksespeciallyfrombloodclotsSomepeopledistinguishedclearlybetweenAstraZene-caandPfizerinthisregardHoweverformanythedistinctionbetweenthedifferentvaccineswaslostandtheyspokeofthevaccinesgenerallybeing unsafe and having a range of unwanted side effects
Other factors consideredInadditiontothebroaderquestionsofwhypeo-plewouldorwouldnotchoosetogetvaccinatedthe research team used the focus group discus-sionstoexplorewhetherthefollowingfactorshadanyimpactonapersonrsquoslikelihoodofbeingvaccine pre-disposed or hesitant
Knowing someone who had been vaccinated
Knowing someone who had contracted COVID-19
Knowing where to go to get vaccinated
Thesourcespeopleturntoforinformation about COVID-19 and COVID-19 vaccines
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2322
Knowing someone who has been vaccinatedOfthosewhorespondedtothisquestion125or70knewsomeonewhohadalreadyhadthevaccine
6983
2570
447
Yes No Dont know000
1000
2000
3000
4000
5000
6000
7000
8000
Figure 11 Do you know someone who has been vaccinated
Amongthe125participantswhoknewsomeonewhohadalreadybeenvaccinated100identifiedlsquoimmediatefamilymembersrsquo(parentschildrensiblingsandpartners)Somefocusgrouppartic-ipantsreportedthatalloftheirfamilymembersoverseas had been vaccinated Others reported thattheirrelativeshadbeenvaccinatedasarequirementoftheiremployment
Who Count Percent Other family member 41 313 Sister 24 1832 Community member 23 1756 Brother 18 1374 Father 17 1298 Mother 16 1221 Work colleague 14 1069 Husband or wife 11 84 Son or daughter 10 763 Partner 4 305 Someone else 45 3435 Total respondents 131
Table 6 Who do you know who has been vaccinated
When this issue was teased out further in focus groupdiscussionsarangeofreasonswere revealed including
My husband works in security and he had
to get it
My friend works as a COVID-19 cleaner and they all had to [get
vaccinated]
My family overseas have already been vaccinated
My son needs to travel for work so he is getting it
My brother in the UK is a doctor and he got it and
his wife
Knowing someone who has had COVID-19Almosthalfoftheparticipantsknewsomeonewho had contracted COVID-19 overseas Some reportedthatallthemembersoftheirfamilyormanymembersoftheirextendedfamilyhadcon-tracted COVID-19 In the older Italian group 10 of the15womenknewsomeoneinItalywhohadcontracted COVID-19
4716 4659
625
Yes No Not sure000
1000
2000
3000
4000
5000
Figure 12 Knowing someone who has had COVID-19
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2524
385 385
1538
2692
641 513000
4359
2051
1026385
1410
Mother
Father
BrotherSis
ter
Son or d
augh
ter
Husban
d or wife
Partner
Other family
mem
berFri
end
Community m
ember
Work co
lleag
ue
Someone else
(please
tell u
s who)
000500
100015002000250030003500400045005000
Figure 13 Who do you know who has had COVID-19
Four people in the focus groups knew someone who had died of COVID-19
All my family back home [Pakistan] got it [COVID-19] but
they are all fine now apart from my father He died But he was really sick before he
got it He had lots of underlying conditions Medical conditions so he was really unwell before he got COVID-19 But everyone else
they are fine now They were sick but they got betterhellip
If you are well and healthy you can fight this off
SurprisinglyknowingpeoplewhohadcontractedCOVID-19didnotseemtoinfluencefocusgroupparticipantsrsquopredispositiontowardseitherhavingthevaccineorbeingvaccinehesitantHowevertheolderItalianwomenrsquosgroupspokeabouttheimpactthatCOVID-19hadhadinItalyintheearlystagesofthepandemicandhowthishadaffectedthemdeeply13ofthe15womeninthisgroupwouldhaveorhadalreadyhadthevaccine
Knowing where to get vaccinated115people(81)whorespondedtothisquestion(n=142) knew where to go to get the vaccine 34 people(19)reportedthattheydidnotknowThisincluded15respondentsfromIraq3re-spondentsfromIndia2respondentsfromChina2 respondents from Pakistan and one respondent fromeachofthefollowingcountriesChinaEri-treaItalySriLankaSwedenSyriaandVietnamThese people were also less sure about whether ornottheywouldhavethevaccineItispossiblethat their lack of knowledge about where to go to get vaccinated was related to their general level ofvaccinehesitancy
7958
29582254
282 563
GPDoctor Vaccinecentre
Hospital Work place Somewhereelse (please
tell us where)
000100020003000400050006000700080009000
Figure 14 Where to go to get vaccinated
From the sample (n=199) GPs were the most commonlyidentifiedplacetogotogetvaccinat-edfollowedbythevaccinecentreatHomebushBayandthenhospitalsOtherplacesidentifiedincluded medical centres and pharmacies
Sources of information about COVID-19 and the vaccineThelargestsinglesourceofinformationaboutCOVID-19 and the vaccine was Facebook (417)
2743
3486
13141086
30862686
3429
2229 2286
41713714
2571
1086 971
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)000500
10001500200025003000350040004500
Figure 15 Sources of information about COVID-19 and the COVID-19 vaccine
Facebook I get my information from
Facebook But if I want to check it I watch the news
on 7 [Channel 7]
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2726
Thesecondlargestsourceofinformationforpeople in the sample was lsquoother forms of social mediarsquo(37)followedbySBStelevision(35)myfriends(34)andothertelevision(31)Oth-ersourcesofinformationpeoplereportedthattheyusedweretheNSWHealthwebsitenightlytelevisionnewsincludingChannel7Channel9andChannel10followedbytheABCtheAustral-iangovernmenthealthwebsitetheirGPlocalMedical Centres and the Red Cross
IntheLakembafocusgrouppredominantlymadeupofwomenfromPakistantherewasanani-mated discussion about Facebook which was the majorsourceofinformationalongwithGooglesearchesandcommunityandfriendship-basedWhatsApp groups There was a general consensus from most in the group that these were their pre-ferredormostcommonsourcesofinformationandnewsHoweveriftheywantedtolsquofactcheckrsquowhattheywerehearingtheywouldwatchthenightlynewsonChannel7orChannel9toverifywhattheyperceivedcouldsometimesbeunrelia-ble sources
IntheMtDruittfocusgroupseveralofthewom-enwithwell-developeddigitalliteracyandgener-alliteracyskillsusedhealthandfitnesswebsitesand social media sites as their source of infor-mationaboutlsquoallthingshealthrelatedrsquoincludingCOVID-19ThesewomenalsospokepositivelyabouttheinformationandsupporttheygotfromthestaffatCanterburyCouncilCommunityCentre(4Cs)whotheycouldrelyontofindoutthingsthattheyidentifiedtheyneededtoknowmoreabout
InthesmallerfocusgroupinGriffithwithrecently-arrived refugee women who had low levels of Englishlanguageliteracytherewaslittleknowledgeaboutthevaccinesnoawarenessofthedifferenttypesofvaccinesandlittleknow-ledgeaboutwheretogotogetvaccinatedorfindoutmoreaboutCOVID-19ingeneralThecommunityservicestaffandvolunteerspresentatthegroupwere working hard to assist these women to improve their English language skills and support themwithtranslatedinformation
In the older Italian women focus group in Wollon-gongparticipantsreportedgettingtheirinfor-mationfromslightlydifferentsourcesndashfamilyinAustralia(10women)Channel9(7women)
Italianradio(3women)andABCTV(3women)Onlytwowomenusedtheinternetandnoneofthe women reported using Facebook or social mediaasasourceoftheirinformationSeveralmentionedthattheygottheirinformationfromtheirGPorspecialistdoctorandonepartici-pantsaidrsquoIdonrsquotlistentoanyonersquoIntheSpan-ish-speaking focus group a comment was made thatseemedtoreflectmanyoftheotherfocusgroup discussions
Whenlsquosourcesofinformationrsquoiscorrelatedwiththegroupwhosaidtheywouldhavethevaccine(n=104)thereisashiftfromFacebookbeingthepreferredsourceofinformationtolsquoSBSTVrsquobeingthepreferredsourceThelsquovaccine-predisposedrsquogroupalsohadthelowestrateofrelyingonFace-bookasasourceofinformationaboutCOVID-19thoughitwasstillhighThegraphbelowhigh-lightshowotherlsquopreferredsourcesrsquoplayoutforthoseintendingtohaveorwhohavealreadyhadthe vaccine
ForthoseparticipantswhoindicatedthattheywouldnotorwerenotplanningtohavethevaccinelsquoFacebookrsquolsquomyfriendsrsquoandlsquomyfamilyrsquowerethesourcesofinformationaboutCOVID-19thatwereequallymostfrequentlycitedfollowedcloselybylsquomyfamilyoverseasrsquolsquoSBSradiorsquoandlsquoSBSTVrsquoassourcesofinformationreceivedthelowestmentionsfromthisgroup(SeeFigure16)
The vaccine-hesitant group were the group who identifiedlsquoFacebookrsquoastheirmostfrequentsourceofinformationaboutCOVID-19lsquoFace-bookrsquowasfollowedbylsquoothersocialmediarsquoandlsquomyfriendsrsquoasthenextmostfrequentsources
lsquoThiscommunityserviceproviderrsquo(theinterme-diaryorganisationwherethefocusgroupwasconducted)wasidentifiedby26ofrespondentsasasourceofinformationregardlessoftheirintentiontogetvaccinatedornotThefactthatboththelsquovaccinehesitantrsquoandthosewhoindi-catedtheywouldnrsquotbegettingthevaccinesoughtinformationfromthissourcesuggeststhatrolling
There is so much confusion about it [the vaccine] that I think my GP is the best
place to go
9 This group of the research sample included a small number ofpeoplewhohadalreadybeenvaccinated
2626
4141
14141111
323228282828
2424
1818
37373737
2828
10101212
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)00050010001500200025003000350040004500
2857
2381
952 952
2857
3333
42864286
3810
4286
23812381
1429
952
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another co
mmunity se
rvice
Somewhere
else (p
lease te
ll us w
here)000
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Figure 16 Sources of information for respondents who were planning to have the vaccine9
Figure 17 Sources of information for respondents who were not planning to have the vaccine
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2928
outpositivemessagingthroughtrusted communityserviceorganisationscouldbeaneffectivewayofshiftingpeoplefromvaccine hesitancytodecidingtohavethevaccine
31372549
980 980
25492157
4314
1176
2353
4902
4118
2157
980392
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)000
1000
2000
3000
4000
5000
6000
Figure 18 Sources of information for respondents who lsquodonrsquot knowrsquo if they will have the vaccine
DISCUSSION
wardstheCOVID-19vaccineareasvariedastheyarewithinthebroadercommunityTherearearangeofinfluencingfactorsincludingagehealthstatushowlongtheyhavebeeninAustraliahowmuchnewstheyreceivefromoverseasandhowbadlyimpactedbythepandemictheirhomecountries have been
The research also highlights that people from culturallyandlinguisticallydiversebackgroundsgettheirinformationaboutCOVID-19andtheCOVID-19vaccinefromawidevarietyofsourcesbothformalandinformalandthatforparticulargroupsinthisstudythereisahighrelianceonFacebookovermoreofficialsourcesofinforma-tion
VulnerabilityTheneedsofhighly-vulnerablegroupswithintheCALDcommunityhavetobetakenintoconsider-ationThisincludesolderpeoplewhohavelivedinAustraliaformanyyearsbuthavelowlevelsofEnglishliteracyndashespeciallywritingandreadingEnglishandsometimesspokenEnglishndashandwhoaremoresusceptibletoseriousillnessandhigherratesofhospitalisationanddeathfromCOVID-19Italsoincludesnewly-arrivedrefugeeswhohavinglowornoEnglishlanguageliteracylacktheconnectionstoandnetworksintothewidercommunityandcommunitysupportsItisalsothecase that some people in these groups are not health literate at all and cannot read and write in their own language
Akeytakeoutfromthehealthandcommunityserviceorganisationsurveyresponsesandinter-viewsundertakenwithmulticulturalhealthandcommunicationexpertsfortheprojectisthatlit-eracylevelsreallydomatterLowlevelsofhealthliteracylowlevelsofEnglishlanguageliteracyandpossiblylowlevelsofliteracyintheirownlan-guage-especiallyforsomenewly-arrivedrefu-gees and those who are part of the humanitarian program such as Dari language speakers from AfghanistanTigrinyalanguagespeakersfromEr-itrea and northern Ethiopia and Oromo language speakers from Ethiopia - need to be factored into anyplanstofurtherpromotethevaccinerolloutanduptaketoculturallyandlinguisticallydiversepeopleinthecommunityThereisaneedfor
The contextThisresearchisimportantgivenhowhighlyculturallydiverseNSWisandtheimpactthiscanhave on the success of public health messaging topeoplewhosefirstlanguageisnotEnglishPeople who were born overseas form almost one-thirdofthe7480228population(276)ofNSWandNSWishometo336ofAustraliarsquosoverseas-bornpopulationPeoplefromaround225 birthplaces have made NSW their home and 21oftheNSWpopulationisfromanon-EnglishspeakingbackgroundMorethan24000humani-tarianentrantshavesettledinNSWoverthepastfiveyearscomprisingalmostathird(32)ofthenationaltotalThe24000humanitarianentrantswhohavesettledinNSWoverthepastfiveyearscame from over 100 countries of origin10Sydneyhasthelargestoverseas-bornpopulationofallthecapitalcities11
Hearingdirectlyfrompeoplefromculturally-diverse backgrounds is important to ensure that policymakersandpublichealthadvocatescandesign responses that are both accessible and un-derstandabletopeopleforwhomEnglishmaybetheirsecondthirdorfourthlanguageApropor-tionofpeopleinthesecommunitieshavelowerlevelsofEnglishlanguageliteracyandinsomecaseslowlevelsofliteracyintheirlanguageoforiginsowillbehardertoreachviatraditionalormainstream methods
Itisalsocriticallyimportantthatduringatimewherethereissomuchlsquonoisersquoacrossmediachannelsrelatingtothevaccinethevaccineroll-outvaccineefficacyandvaccinesafetythatwetakesometimetolistentoandunderstandhowthislsquonoisersquoisbeingheardandmadesenseofbypeoplefromculturally-diversebackgrounds
ThatsaiditisimportanttoreconfirmthattheCALDcommunityisnotahomogenousgroupOurresearchhasfoundthattheviewsandattitudesofparticipantsfromdiverseculturalbackgroundsto-
10RefugeeCouncilofAustraliaHumanitarianEntrantsin New South Wales A resource for New South Wales governmentagencies6-711MulticulturalNSWCommunityRelationsReport2018-20199
29
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3130
groupsFortheparticipantsintheresearchtheirattitudetothevaccineappearedtobeinflu-encedbyanumberoffactorstheirownlevelsofhealthandpre-existinghealthconditionsandthoseoftheirfamilymembersandtheimpactofreceiving COVID-19-related news from overseas particularlyfrompeoplersquoscountryoforiginAnexampleofthiscanbeseenintheItaliangroupin Wollongong where people had received news fromoverseasearlyinthepandemicwhichscaredthemThisexperiencelsquofromhomersquohadinflu-enced most of the women in the Wollongong focus group (n=15) to choose to get vaccinated The interviewee from the Illawarra Shoalhaven Local Health District also spoke about the heightenedconcernthattheywitnessedinthelocalItaliancommunityintheearlystagesofthepandemicOtherpeoplewantedtolsquostayhealthyrsquoandtolsquoprotectthehealthofothersrsquoandformanytherewasasensethattheywantedtolsquogetbacktosomedegreeofnormalcyrsquoandtobeabletolsquotraveloverseastovisitrelativesrsquo
Vaccine hesitancyOfthe42inthisstudywhoappearedundecidedornotplanningtohavethevaccinemanywereinfactadoptingalsquowaitandseersquoapproachbeforemakingtheirfinaldecisionMostparticipantswereinterestedtohearmoreinformationaboutthevaccinesandwereopenedtogettingthevaccinebutdidhaveconcernsaboutthesafetyofthevaccinesespeciallyinregardtoAstraZeneca
The issue of blood clots has led to considerable fearandhesitancyinthecommunityandthisfearandhesitancywasreflectedinourstudyEssentialResearchrsquossurvey(April2021)reportedoneinsixpeople(16)indicatedtheywillnevergetvaccinatedagainstCOVID-19upfrom12thepreviousmonthwhile42saidtheywillgetvaccinatedbutnotrightawayTheproportionofpeople who would be willing to get vaccinated as soonaspossibleorarealreadyvaccinatedalsodeclineddownfrom47to4213Thissurveywas conducted prior to the most recent outbreak inNSWinvolvingthehighlyinfectiousDeltastrain
Therisk-benefitofhavingthevaccineneedstobecarefullyweighedbyeachindividualideallyinconsultationwiththeirdoctoranddependingon
The Hub has lsquobeen working in partnership with keystakeholdergroupstoguidecommunicationstomeetthehealthliteracyandculturallyandlinguisticallydiverse(CALD)needsofitspop-ulationStructuredworkinggroupshavebeencreatedtoprioritisecommunicationstovulner-ableyouthCALDgroupstheelderlyitinerateworkersasylumseekersandrefugeesTheaimsaretotestmessagingandbuildtrustwithprioritypopulationstoensureeffectivecommunicationoftheneedtosustainphysicaldistancingmeas-uresintheabsenceofavaccineSimilareffortsarenowneedednationallyandshouldstartatthetimeofdiseaseoutbreaksinthefuturealongsideplannedmassmediaandhealthcommunicationcampaignsrsquo
InthearticlebyDoddetaltheyreinforcetheimportanceofusingcommunicationformatswhich are lsquosuitable for people with low health literacyandeducationandwhichareappropriateforculturallyandlinguisticallydiversegroupsandIndigenouspopulationsrsquoThearticlearguesthatitisimportanttolookatmotivationsandconcernsabout vaccines when shaping messaging It also pointsoutthatprimarycaredoctorsareatrust-ed source and as such should be supported in deliveringinformationaboutthevaccinesandad-dressingcommunityconcernsThearticlestateslsquoWeneedtounderstandandaddresscitizenrsquosconcernsthatcanpreventoptimaluptakebuildmotivationsintomessagingandprioritisepublictrustbyinformingandinvolvingthecommunityintheprocessSupportinghealth-careprofession-als in their role as educators will ensure people haveadequateandaccessibleinformationfromatrustedsourcetooptimisevaccineuptakeandultimatelyreducecommunitytransmissionofCOVID-19rsquo15
RecentresearchbyAssociateProfessorHollySeale16withUNSWMedicinersquosSchoolofPublicHealthandDeputyChairfortheCollaborationonSocialScienceandImmunisationfoundthereisaneedtolsquodecentralisersquocommunicationsbytapping
translatedmaterialsandinformationaboutthevaccines to be tailored to the needs of people in these newly-emergingcommunitygroups
It was reported that in Wollongong there can sometimesbefourgenerationsoffamilymem-bersfromnewly-arrivedrefugeegroupslivingintheonehouseMostofthesefamilymembersgenerallyhavelimitedEnglishlanguageliteracywhichincreasestheirriskofnotreceivingkeyhealthmessagesandthereforeincreasingthepotentialimpactofCOVID-19-inparticulartheDeltastrainwhichhasprovenhighlyinfectiousamongst household members
Vaccine uptakeNotdissimilartothewidercommunitymorepeopleinourstudywereplanningtohavethevaccinethannotandanumberhadalreadybeenvaccinatedInarecentLancetarticle(February2021)ConcernsandmotivationsaboutCOVID-19vaccinationfindingsfromtwosurveysfromanAustralianlongitudinalstudyconductedinJuneandJuly2020includedthatlsquothetopthreerea-sons for agreeing to vaccinate were lsquoto protect themselvesandothersrsquohelliplsquobeliefinvaccinationandsciencersquohellipandlsquotohelpstopthevirusspreadrsquoEven among those willing to vaccinate there was somehesitancyaboutthesafetyofthevaccineTheLancetarticlenotedthatlsquowillingnesstovaccinatedifferedbybothageandeducationrsquoForthosewhowereindifferentorsaidtheywouldnot get the vaccine the top reasons across the twosurveyswerelsquoconcernaboutthesafetyofthevaccineinitsdevelopmentrsquoandlsquopotentialsideeffectsrsquo12
Olderpeopleinourstudywhocomprised23of the total sample (n=199) were the group most likelytosaythattheywantedtogetthevaccine85ofthoseover65saidtheywouldhaveorhadalreadyhadthevaccineVaccinepredispo-sitionwashoweveralsostrongacrossotherage
12RHDoddKPicklesBNickelECvejicJAyreCBatcupCBonnerTCoppSCornellTDakinJIsautierKJMcCafferyConcerns and motivations about COVID-19 vaccination SydneyHealthLiteracyLabSydneySchoolofPublicHealthFacultyofMedicineandHealthUniversityofSydneypublishedintheLancetFebruary2021p162wwwthelancet cominfectionVol21February2021
theircircumstancesHoweverthesourcesofin-formationthatpeoplemostrelyuponortrustarecriticaltothedisseminationofaccurateandclearmessaging to dispel the fear surrounding events suchasbloodclottingandthemisconceptionsraisedinthefocusgroupsWithsomanypartici-pantsinthisstudygettingtheirinformationfromFacebookandothersocialmediasitesitisvitalthat these channels are used to promote simple positivemessagesandforanyfuturecommunityawareness campaigns
Effective communicationConfusionandmisconceptionsaboutthevac-cinersquosefficacyavailabilityandsafetywereallis-sues that were raised in the focus groups Finding waystoeffectivelycommunicatewithpeoplewithlowerEnglishlanguageliteracyandhealthliteracyisanimportantwaytoaddresstheconfusionandmisconceptionsaboutthevaccineashasbeen discussed in a number of recent Australian studies
Astudy14byMcCafferyetal(2020)concludedthattherearelsquoimportantdisparitiesinCOVID-19-relatedknowledgeattitudesandbehavioursaccordingtopeoplersquoshealthliteracyandlanguagersquoOneofthefindingswasthatlsquopeoplewithlowerhealthliteracywerealsomorelikelyto endorse misinformed beliefs about COVID-19 andvaccinations(ingeneral)thanthosewithadequatehealthliteracyThesamepatternofresults was observed among people who primar-ilyspeakalanguageotherthanEnglishathomersquoTheMcCafferystudyhighlightstheimportanceof tailoring health messages to those with lower healthliteracyandculturallyandlinguisticallydiversecommunitiesItpointsoutthatthereareexamplesofeffectivemanagementofdiversecommunityneedsthatusetailoredhealthmes-sagesandcitestheWesternSydneyLocalHealthDistrictHealthLiteracyHub
13TheEssentialReport-anonlinesurveyconductedbyEssentialResearchcompletedby1090people between 21ndash26 April14McCafferyKJDoddRHCvejicEAyreJBatcupCIsautierJMJCoppTBonnerCPicklesKNickelBDakinTCornellSWolf MS Health literacy and disparities in COVID-19ndashrelated knowledge attitudes beliefs and behaviours in Australia PublicHealthResPract202030(4)e30342012December2020
15 Op cit16 httpssphmedunsweduausitesdefaultfilessphcmNewsEnhancing-supporting-COVID-19-vaccination-programpdf
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
30 31
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3332
intodifferentnetworkingspacessuchaswork-placeslocalgymsmothersrsquogroupsandseniorsrsquoclubswithafocusonallagegroupsregardlessofcurrenteligibilityAccordingtoSealethechal-lengeislsquoensuringemerginginformationisadapt-edfortheintendedaudiencersquoShehasalsosaidlsquoThatrsquoswhatIrsquomalittlebitconcernedaboutatthemomenttherersquosalotofresourcesongov-ernmentwebsitesbutthesetermsaroundbloodclottingareverytechnicalWeactuallyneedtomake sure that we are breaking them down in a waythatwillmakeitmeaningfultopeopleThatrsquosnotjustabouttranslatingitrsquosaboutbeingcon-sciousofpeoplersquoshealthliteracyneedstooSomaybegettingsomemorevisualsintomaterialstotryandsupportthatrsquo17
Thereareanumberofmulticulturalhealthresourcesthatusecommunitylanguagetransla-tionsplainEnglishandvideosfromCALDcommu-nityleaderswhichcanbedownloadedandusedbyservicesandindividualsHowevermanyofthewrittenresourcesstillrelyontechnicalandscien-tifictermsthatrequireareasonablyhighlevelofEnglishlanguageliteracyorhighlevelsofliteracyin the translated language to comprehend Host websites can also be hard to navigate making itdifficulttolocateresourcesfromsimplewebsearchesAsummaryofsomeoftheavailableresourcescanbefoundatAttachment2
MulticulturalHealthUnitsinLocalHealthDis-trictshavestaffwhocanworkwithpeoplefromculturallyandlinguisticallydiversecommunitiesatthelocallevelandtranslateandcontextualisethese materials to the needs of the end user These teams respond to local needs and popu-lationdemographicsandareexpertsineffectivehealthliteracyandhealthcommunicationwiththeirlocalcommunitiesTheyworkcloselywithcommunityandvulnerablegroupstobuildhealthliteracyandimprovedhealthoutcomesintheircommunities
Case Study ndash Be a COVID Warrior ndash Responding to COVID-19 in Multicultural Communities InWollongongtheIllawarraShoalhavenLocalHealthDistrict(ISLHD)MulticulturalHealthSer-viceco-designedacommunityengagementandeducationprogramcalledlsquoBeaCOVIDWarriorrsquowhich commenced in 2020 in response to the pandemic This program was designed to respond tothelowlevelsofhealthliteracyaroundCOVID-19potentialexposuretothevirusandaddressfearandstigmainthelocalCALDcommunitiesThelsquoCOVIDWarriorrsquoprogramreachedaround880peopleranginginagefrom14to85years65ofCOVIDWarriorparticipantswerefemaleand35weremaleCOVIDWarriorparticipantsrepresented 21 language groups The outcomes of the program included increased levels of confidenceinapplyinginfectioncontrolmeasuresincreasedliteracyandhealthliteracyandawarenessofhowCOVID-19istransmittedUltimatelyanimprovedawarenessinapplyingCOVIDsafemeasures was also reported
InApril2020theservicecommencedwelfarechecksviaphoneonafortnightlybasistosup-portsocially-isolatedmulticulturalseniorswhoboretheemotionalstressofsocialisolationFrom these calls the ISLHD heard the needs and concernsofseniorsinthecommunityInadditionourexperiencewithCALDcommunitieshighlightedtheimportanceofyoungpeopleasconduitsofessentialinformationtoadultsincommunityandfamilygroupsduetoEnglishlanguageaccessandeducation
InresponsetheISLHDinitiatedthelsquoCOVIDWarri-orrsquoprogramusingbi-culturalhighschoolstudentsthroughthelocalhighschoolsByincreasingthehealthliteracyofstudentsatschooltheselsquocham-pionsrsquocouldtalktotheirfamiliesincludingolderfamilymembersininformalsettingsandthroughsocialmediawiththeirpeersasastrategytoraisethe level of knowledge of COVID-19 trans-mission preventionandtestingTheprogrambecamesopopularthatitwasextendedintomorelocalhighschools and adults accessing the Adult Migrant EnglishProgramTheprogramwassupportedbylocalsettlementservicesprovidedbybothMaxSolutionsandtheRedCrossItwas
17 httpstheconversationcomhow-can-governments-communicate-with-multicultural-australians-about-COVID-19-vaccines-its-not-as-simple-as-having-a-poster-in-their-language-156097
later extendedtoCALDSeniorsthroughtheMulticulturalCommunitiesCouncilIllawarra(MCCI)supportprograms
AkeycomponentoftheprogramwastoprovideparticipantswithlsquoCOVIDWarriorrsquoKitswhichincludedtworeusablemaskshandsanitiserinfographicsaboutCOVID-19symptomsandinfor-mationaboutwheretestingclinicswereavailablelocallyMCCIandRuralAustraliaforRefugeesdonatedreusablemasksforeveryparticipant
AsthelsquoCOVIDWarriorrsquoprogramwasevolvingsowasthenationalvaccinerolloutplanInforma-tionwasthereforeadaptedtomeetthisinfor-mationgapForexampleadultparticipantsandseniors were supported to understand how to accesstheCOVIDvaccinelsquoeligibilitycheckersrsquoandCALD people were shown how to use the NSW HealthwebsiteCOVID-19informationpages18
Decision makingHowpeoplearecurrentlyconsideringtheriskofCOVID-19isinfluencedbyarangeoffactorsincludingratesoftransmissioninthecommunitynumbersofnewcasesreportsinthemediaofrisksandsideeffectsPeopletendtobasetheirassessmentonwhattheyarecurrentlyexperi-encingandthencheckthisagainstwhattheyarehearinginthemediaincludingandespeciallyonsocialmediaandfromfamilyandfriendsMostoftheparticipantsinourstudyspokeclearlyandarticulatelyabouthowtheyweigheduptherisk-benefitofhavingtheCOVID-19vaccineintheir decision making Low case numbers ndash at the timeofconductingtheresearchndashandasensethat Australia was lsquodoing well in safeguarding the communityagainstCOVID-19rsquoweresignificantfactorsinpeoplersquosdecisionnottobevaccinatedortoadoptalsquowaitandseersquoapproachFamilyfriends and social media were reported as having aconsiderableinfluenceondecisionmakingaswerereportsinthemediaofthebloodclottingsideeffectsofAstraZeneca
ThefactthatFacebookwasreportedlythemostpopularsourceofinformationaboutCOVID-19
18httpswwwhealthnswgovauInfectiouscovid-19Pagesdefaultaspx
andtheCOVID-19vaccineforpeopleinthestudyraisesconcernsaboutthepossibledisseminationofmisconceptionsandlsquofakenewsrsquothatmaybespread or compounded via social media Closed social media groups such as WhatsApp and WeChatwithfamilyandfriendsmayalsoleadtopeoplereinforcingtheirpre-existingbiasesThesefactorscoupledwithasensethatAustraliaisfaringwellcomparedtomanycountriesoverseasappear to have resulted in increased vaccine hesi-tancyamongparticipantsofthestudy
Factorsthatwereidentifiedaschangingvaccine-hesitantparticipantsrsquoperceptionswereanincreased risk from COVID-19 and a correspond-ingincreaseinthenumberofinfectionsandonthebenefitsidetheabilitytotraveloverseastovisitfamilyIntherecentresearchfromtheUniversityofNSWcitedaboveSearlearguesthatlsquotheremaybeotherthingsthatweneedtonowstartfocusingonhellipthatwillstarttopromoteandmotivatepeoplesuchasthechancetotravelmorefreelyforexamplersquoThisappearstobeborneoutbyourfocusgroupfindings19
Untilrecentlytherehavebeenverylowcasenumbers and few lockdowns across most of Aus-tralia and NSW The recent outbreak from mid-JuneinGreaterSydneyandintroductionofthehighlyinfectiousDeltavariantinNSWislikelytoimpactonpeoplersquosassessmentsoftherisk-benefitofhavingthevaccineandonewouldassumereducehesitancyrates
GiventheheightenedcommunityanxietycausedbythisrecentCOVID-19outbreaktheproductionofshortsharpandtargetedmessagingtoCALDgroupsincommunitylanguagesthatisaccessibleandmotivationalfeaturescommunityleadershigh-profilecelebritiesandsportsstarsfromCALDbackgroundsandisdirectedatastate-wideandlocal level would appear to be more urgent than everItisclearthatformessagingtobeeffectiveandreachitsintendedaudiencedistributionchannelsshouldincludeFacebookWhatsAppandothersocialmediaplatformsaswellastrustedsourcessuchasmulticulturalhealthworkersmulticulturalservicesandthroughGPsandMedical Centres If mainstream COVID-19 vaccine
19 Op cit
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
32 33
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3534
awareness campaigns are produced in Australia suchashavebeenproducedinNewZealandtheUnitedKingdomandNorthAmericatheyshouldincludehighprofilewell-knowncommunityfig-uresandsportingstarsfromCALDbackgroundsandincludestrategiesspecificallytargetingCALDcommunitiesincludinggroupsidentifiedaspar-ticularlyhigh-risk
It is also important that informationonvaccinesistranslatedintolanguagesfromnewerandemergingcommunitiesOthersuggestionsaroundreachingthesecommunitiesincludeface-to-facemeetingsorganisedbycrossagencypartnershipsandpeer-ledstrategiessuchas mobilising community champions and influenc-ers Messaging needs to be inclusive and framed around the collective values held by commu-n5
It is clear that reinforcing the benefits of being vaccinated at this time rather than dwelling on the risks is more likely to generate behavioural
changeandapositivevaccineresponsefrombothCALDcommunitiesandthegeneralpopulationAppropriately-designedandtargetedCOVID-19vaccinehealthinformationthatiseasytoreadinanylanguagecanbeconveyedbycommunityleadersandcommunitynetworksandpromotesthepositivebenefitsofgettingvaccinatedwouldbevaluableatthistimeBuildingontheworkofpeerchampionssuchastheCOVIDWarriorprogramisalsoasuccessfulmodeltoincreasingCOVID-19vaccinehealthliteracyandinformed decision making
Mostimportantlypositivelymotivatingculturallyandlinguisticallydiversecommunitymemberstolsquogetthejabrsquoespeciallythosewhoareadoptingalsquowaitandseersquoapproachorarevaccinehesitantwould lead to greater vaccine uptake among culturallyandlinguisticallydiversecommunitiesandthereforethecommunityasawhole
Inner West Multicultural Network Addison Road Community Centre DateWednesday12May
A focus group session of members of the Inner WestMulticulturalNetworkpluscustomersoftheFoodPantryatAddisonRoadwasheldattheAddisonRoadCommunityCentreinMarrickvilleon12Mayat200pmThesessionwaspartoftheregularmeetingoftheInnerWestMulticul-turalNetworkTheconsultationinvolvedabout26peopleandwasconductedbyRosannaBarbero
Thegroupbrainstormedresponsestoquestionsaroundvaccinehesitancyinmulticulturalcom-munitiesandmoreeffectivemessagingTheseresponseshavebeenincorporatedinthefindingsof the report
Griffith Women on Fire Focus Group Griffith Community Centre DateFriday14May
This small focus group of women was held at GriffithCommunityCentreonMay14at11amMargCouchSeniorProjectOfficerRegionalDevelopmentAustralia(RDA)-RiverinaandJoanneFitzpatrickSettlementEngagementandTransitionSupport Worker from Centacare Southwest NSW werethekeylinksandnetworkcontactsfortheGriffithcommunityTheWomenonFire(WOF)group was established as part of the Red Cross RuralFireServiceprogramlsquoManyCulturesOneCommunityrsquoInitiallyitwasestablishedtoeducatewomenonemergencypreparednessandtoen-courage NSW Rural Fire Service (RFS) volunteering andnowhastransformedintoacommunityac-tionsupportgroupTheGriffithSoroptimistInter-nationalnowauspicetheirfinancesandsupporttheWOFgroupactivitiesThefocusgroupwasfacilitatedbyCamillaCouchandlocalcommunityvolunteersledbytheGriffithSoroptimistClub
The women in the group were from Pakistan and IndonesiaThegroupweremainlyyoungmotherswithyoungchildrenandtheprogramhadchild-minding arrangements The language level of the womenwaslowandmostwerestudyingESOLat
ATTACHMENTS
ATTACHMENT 1 A Description of the Focus Groups
TAFEThedeliveryoftheinformationwaslimiteddue to language levels and the lack of bilingual interpretersEachparticipantworkedoneononewithavolunteertoslowlyfillinthesurveyandonewomantookthesurveyhometodiscusswithherhusbandThisgroupexperiencehighlightedthe lack of bilingual workers and services in some rural areas
Arabic speaking group Syd West Multicultural Services Mount Druitt Community worker Zaid Naoum Generalist Caseworker SydWest Multicultural Services DateMonday24May
ThefocusgroupfromSydWestMulticulturalSer-viceswasconductedonMonday24May2021atSydWestMulticulturalServicesMountDruittat300pmItwasfacilitatedbyPatriciaMcCormickandsupportedbyZaidNaoumGeneralistCase-workerSydWestMulticulturalServices
Therewere10womenandmenfromSyriainthegroupThegroupweremostlymaturetoolderparticipantsMostparticipantsrequiredassistancewithEnglishandthecaseworkerZaidNaoumhadtranslatedthesurveyintoArabicpriorto the focus group Zaid also translated during the focus group
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Canterbury City Community Centre (4Cs) group The Cottage Lakemba DateTuesday25May
ThefocusgroupfromCanterburyCityCommunityCentre(4Cs)wasconductedonTuesday25MayattheCottageat28CroydonStreetLakembaat10amItwasfacilitatedbyRobinMilesandsup-portedbyRomanaWaseemCommunityWorkerfrom 4Cs
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
34
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3736
The group was comprised of 14 women from PakistanIndiaandSriLankaThewomenrangedinagefrom23to65MostwerefluentEnglishspeakershoweveronewomanrequiredtransla-tionintoUrdufromoneoftheotherwomeninthegrouptoanswerthequestionsdirectly
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
NSW Chaldean League group Community worker Randa Goriya DateTuesday25May
ThefocusgroupfromNSWChaldeanLeagueMountDruittwasconductedonTuesday25May2021 at 1000am at the NSW Chaldean League premisesItwasfacilitatedbyPatriciaMcCormickandsupportedbyRandaGoriyaacommunityworker for the NSW Chaldean League in Mount DruittRandatranslatedtheintroductionandpromptsforthediscussionandhelpedthepartic-ipantstocompletethesurveyMostofthegrouprequiredhelptodothesurvey
ThegroupoftwelveparticipantswereallChaldeanandwerematuretoolderinageTheywereamixed-gendergroup
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Arabic speaking group Red Cross premises Wollongong DateTuesday25May
ThefocusgrouptookplaceonTuesday25Mayat 3pm at the Red Cross premises at Wollongong Therewere22womenandmenparticipatinginthegroupThefocusgroupwasfacilitatedbyCamilla Couch with support from Khalid Zainu-labdeenBilingualSupportWorkerHumanitarianSettlementProgram(ACTampNSW)
There were diverse ages in the group ranging fromyoungpeopletoolderagedMostofthegroupwereyoungerrecently-arrivedrefugeesfrom diverse backgrounds There was also a small-eroldercohortofparticipantswithhigherliteracylevelsandstrongercommunityengagementwith the local services in the area Camilla Couch facilitated the focus group which was conducted inArabicandEnglishwiththeArabictranslationprovidedbyKhalidZainulabdeen
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Work Opportunities for Women group Mt Druitt TAFE DateWednesday26May
TheWorkOpportunitiesforWomen(WOW)focusgroupwasheldonWednesdayMay261100ndash 100pmatMtDruittTAFEItwasfacilitatedbyCamilla Couch and built on the knowledge gainedintheprevioussessiononcriticalandanalyticalthinkingTheWOWgroupisaTAFECertificatelevel course
There were 14 women from diverse cultural backgroundsinthegroupThegroupweremainlyMuslimwomenwithschoolagechildrenandsome were mature aged Due to the learning fo-custhegroupwasfacilitatedasaclasswithguid-eddiscussionontheissuesandcarefulanalysisofthequestionsNotranslationwasneededduetotheeducationalcontextThestudentswereadeptatusingITandcompletedallthesurveysonline
STARTTS Tamil group Toongabbie Community Centre Community worker Sivaharani (Harani) Mayuran DateThursday27May
Thefocusgroupconsistedof18femalepartic-ipantswhowereyoungertomatureagedThefocus group was held at 1000am at Toongabbie CommunityCentreinTargoRdToongabbie
ThefocusgroupwasfacilitatedbyPatriciaMc-CormickandsupportedbyacommunityworkerSivaharani(Harani)MayuranfromtheSTARTTSTamil Group
ThegrouphadmixedlevelsofspokenandwrittenEnglishTheintroductionanddiscussionpromptsweretranslatedbythecommunityworkerSivaha-rani(Harani)Mayuranandsheandthemorepro-ficientstudentssupportedthosewithlowliteracytoanswerthesurveyquestions
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Spanish Speakers Seniors group SydWest Multicultural Services Blacktown DateTuesday1June
TheFocusGrouptookplaceonTuesday1Juneat1100amattheBlacktownShowgroundsandconsistedof16participants(15womenandoneman)AllparticipantswerebornincountriesinSouthAmericaTheirEnglish-fluencylevelsvariedand one of the members of the group translated thesurveyquestionsanddiscussionintoSpanish
ThegrouphadbeenmeetingforseveralyearsThegroupwasfacilitatedbyLindyCassidyandwassupportedbySreeVithyaHarilingamDayRespiteampSocialSupportTeamLeaderatSydWestMulticulturalServicesBlacktownThegroupwerematureagedtoolderparticipants
Thegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyform There was a more focused discussion on somekeyquestionsaftersurveycompletionThetranslatorassistedconsiderablyinthisprocess
Italian Speakers group Warrawong Community Centre DateMonday7June
The focus group of Italian speakers was held on Monday7Juneat1015amattheWarrawongCommunityCentreItwasfacilitatedbyCamillaCouchandsupportedbyJohnPaulTroianiand
SofiaLemafromIllawarraShoalhavenLHDMulti-cultural Health
There were 15 women in the group The group weremostlymaturetoolderparticipantsandwasconductedinItalianandEnglishwithtranslationprovidedbyJohnPaulThisgroupmeetsregularlyandissupportedbyanumberofservicesintheareaespeciallymulticulturalhealth
The group had a general facilitated discussion aboutthequestionsinthesurveyDuetolittleornoliteracytheindividualsurveyresponseswerethencollectedintooneresponseThesesurveyresponses have been included in the general surveyresponses
Mothers Group SydWest Multicultural Services Blacktown DateThursday10June
ThefocusgrouptookplaceonThursday10Juneat1030amandconsistedof14youngwomen13 of whom had a CALD background The focus groupweremainlymothersfromasupportgroupatSydWestMulticulturalServicesinBlacktown
EightofthewomenwereborninIndiatwofromPakistantwofromSriLankaonefromHausaGhana and one was born in Australia (the Austral-ianbornyoungwomanwasasocialworkstudenthelpingwiththegroup)LindyCassidyfacilitatedthe group with support from Wilma Garguath a projectofficerfromSydWestMulticultural Services
The group varied in age One was between 18-24 yearsoldSevenwereagedbetween25-34yearsSixwereagedbetween35=44yearsGiventheirage and circumstances most of the group did not consider themselves eligible at this stage for vac-cinationThiswasanimportantdifferencefromotherfocusgroupsinthattheemphasiswasmoreonwhattheywoulddooncetheybecameeligible
Participantsdidnotrequireassistancewithspo-kenEnglishThegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyformTherewasamorefocuseddiscussiononsomekeyquestions
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3938
ATTACHMENT 2 COVID-19 Vaccine Information in multiple languagesThefollowingsitesappsprovidetranslatedinformationaboutCOVID-19vaccines
Type of information KeyinformationongettingvaccinatedinNew South Wales and on the vaccines available The websiteusesanautomaticservicetotranslate thecontentintodifferentlanguages
Source of information NSW Government website
Link httpswwwnswgovauCOVID-19health-and-wellbeingCOVID-19-vaccina-tion-nswgetting-vaccinated
Type of information COVID-19ResourcessectionontheServiceNSWapp The app has a link to NSW Government websiteinformationonldquoGettingaCOVID-19vaccinationrdquo(seeabove)ItalsoincludesalinktoCOVID-19vaccinationresourcesinotherlan-guages available from the Department of Health
Source of information Service NSW NSW Government
Link Service NSW App
Type of information ArangeoftranslatedresourcesonCOVID-19bytitleincludingafactsheetonCOVID-19VaccineAstraZeneca(ChAdOx1-S)
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCOV-ID-19Pagestranslatedresources-by-titleaspx
Type of information ADigitalCOVID-19resourcelibrarywithtranslated materials
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiouscov-id-19Pagesdigital-resourcesaspx
Type of information AMultilingualCommunityToolkitontheCOVID-19vaccinationprogramtoassist communityworkersprovideseasytoreadresourcesvideosandlinkstokeyservicesandresources
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCovid-19DocumentsNSW-COVID-19-vaccina-tion-program-presentation-20210527pdf
Type of information TheNSWMulticulturalHealthCommunicationServiceoffershealthresourcesandinformationin a wide range of languages It has translated resources on COVID-19 and links to translated resourcesonCOVID-19vaccination
Source of information MulticulturalHealthCommunicationServiceisa New South Wales-wide health service hosted bySouth-easternSydneyLocalHealthDistrict(SESLHD)
Link httpswwwmhcshealthnswgovau
Type of information COVID-19vaccineinformationaddressingkeyquestionsaboutCOVID-19vaccinationandincludesvideosposterstilesfactsheetsandaudio material Translated into 63 languages
Source of information Department of Health Australian Government website
Link httpswwwhealthgovauinitiatives-and-pro-gramsCOVID-19-vaccinesCOVID-19-vaccine-in-formation-in-your-language
Type of information ThisinformationaddressessomecommonmisinformationaboutCOVID-19Translatedintomultiplelanguages
Source of information DepartmentofHomeAffairs Australian Government website
Link httpscovid19inlanguagehomeaffairsgovaumisinformation-and-truths-about-coronavirus
Type of information Australianandinternationalnewsand informationaboutCOVID-19andCOVID-19 vaccinesisavailableontheSBSCoronavirusPortal in more than 60 languages
Source of information SBSwebsite
Link httpswwwsbscomaulanguagecoronavirus
Type of information InformationprovidedaboutCOVID-19vaccinerolloutandsafetyinlanguagesotherthan English
Source of information Department of Health and Human Services Victorian Government
Link httpswwwcoronavirusvicgovautranslat-ed-information-about-COVID-19-vaccines
Type of information HealthTranslationsprovidestranslatedmateri-alsonhealthandwellbeingInformationaboutCOVID-19isregularlyupdatedincludessomeinformationonvaccinationandisavailableinover60communitylanguages
Source of information Victoriangovernmentinitiative
Link httpswwwhealthtranslationsvicgovaubhcv2bhchtnsfPresentEnglishResource-AllOpenampx=amps=Coronavirus
Type of information A one-stop shop for translated materials in multiplelanguagesonCOVID-19
Source of information Ethnolink Language Services
Link httpswwwethnolinkcomauCOVID-19-coro-navirus-translated-resources
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
40
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1514
Research participants were asked
If they were intending to get vaccinated
The reasons why they would or would not choose to get vaccinated
If they knew anyone who had already been vaccinated and if so who
If they knew anyone who had contracted COVID-19 and if so who
If they knew where to go to get vaccinated
What sources they used to get information about the COVID-19 vaccination
Basic demographic information age gender country of origin language spoken at home and length of time living in Australia
Having the vaccine or notOfthe199participants117(58)reportedthattheywereplanningtobeorhadalreadybeenvaccinatedwhile78(42)reportedthattheywere not planning to have the vaccine (13) or didnotknowiftheywouldgetvaccinated(29)
1453
8430
000 116
Male Female Non-binary Rather not say000
100020003000400050006000700080009000
05
10152025303540
Under18
18-24 25-34 35-44 45-54 55-64 65+
Coun
t
Yes No Donrsquot Know
Figure 6 Are you going to get the COVID-19 vaccine
Figure 7 COVID-19 Vaccine intention of respondents by age category
13people(65)hadalreadybeenvaccinated(at least 1 dose)6withseveralcommentingthattheyhadchosenorneededtobevaccinatedforwork-relatedreasonsOthersreportedthattheyhadbeenvaccinatedprimarilyforhealthreasonstostaywellandmakesurethattheirfamiliesstayedwellTheywerealsoconcernedaboutpublichealthandsafetyOneofthewomenintheLakemba groups from Sri Lanka was adamant that thebenefitsoutweighedtherisksspokepositive-lyabouthoweasyithadbeentogetthevaccinefrom her local medical centre and that she had experiencednosideeffectsfromthevaccination
Language Count Percent Urdu 1 Italian 3 Arabic 2 Tamil 3 Chaldean 1 Spanish 3 Total 13 65 of sample
Response Count Percent Not planning to have the vaccine 23 13 Unsure about having the vaccine 52 29
75 42
Table 2 Respondents already vaccinated
Table 3 Respondents who indicated vaccine refusal or hesitancy
6 Theresearchersdidnotdistinguishbetweenwhetherpeoplehadreceivedtheirfirstandseconddosesofthevaccineiepartiallyorfullyvaccinated
75(42)indicatedadegreeofvaccinehesitancywith24participants(13)reportingthattheywerenotplanningongettingvaccinatedwhile53(29)reportedtheydidnotknowiftheywouldget vaccinated
Thislevelofvaccinehesitancyreflectslargerstud-iesintheAustraliancommunityAsurveyofover1000participantsfromacrossAustraliaconduct-edinApril2021byEssentialResearchfoundhes-itancyratesof42including16whoindicatedtheywerenevergoingtogetvaccinated7
Foroursurveyresponsesindicatedthatagewasafactorwith85ofrespondentsaged65andoverreportingthattheywouldhaveorhad
7EssentialResearchThe Essential Report21April2021
FINDINGS FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1716
alreadyhadthevaccineThosewhoindicatedthattheywouldnotbehavingthevaccinewerefairlyevenlydistributedacrossagegroupswithyoung-er people aged 18-24 being the age group with thehighestproportionofparticipantsexpressinguncertaintyabouthavingthevaccineTheagegroupwiththesecondhighestlevelofhesitancyproportionatetoothercategorieswerethe35-44yearolds
02468
10121416
Iraq
Vietnam Italy
South Americ
a
Sri La
nkaIndia
Syria
Other South East
AsiaAfric
a
Australia
Sweden
China
Pakistan
Iran
Eastern Europe
Afghanistan
Japan
Coun
t
Yes No Dont know
8095 8190
70486095
4571
6190
095
To stayhealthy and
well
To keep myfamily
healthy andwell
For publichealth
To travel To work It is theright thing
to do
Somethingelse (pleasetell us what)
000100020003000400050006000700080009000
Figure 8 Respondents COVID-19 Vaccine intention by Country of Origin
Figure 9 Reasons for getting vaccinated against COVID-19
Countryoforiginalsoseemedtoplayaroleinpeoplersquosviewsabouthavingthevaccinewithhighvaccinepre-dispositionreportedbyVietnameserespondentstotheonlinesurveyandwomenintheItalian-speakinggroupWhileparticipantsfromIraqrecordedthehighestlsquoyesrsquoresponsethiswasalmostmatchedbyIraqiparticipantswhoreportedthattheywerelsquounsurersquoorlsquodidnotknowrsquowhethertheywouldhavethevaccineTherelevanceofcountryoforigininthisregardwouldbeworthyoffurtherresearch
The Italian focus group held in Wollongong was an olderwomenrsquossocialgroupwithallparticipants(15) agedabove65yearsMostinfactwereaged over75yearswithoneparticipantinher90s 87 of the group had either been vaccinated (3) or were planning to get vaccinated (10)
Of course I will get vaccinated It is important to do this It is a very bad
disease
Thesewomenweremotivatedtostayhealthyandwellkeeptheirfamilyhealthyandwellforpublichealthreasonstobeabletotravelandforgen-eralsafetyMembersofthegroupalsoreportedthattheywantedtogetvaccinatedsothattheywouldbeabletolsquodancersquoandlsquosocialisersquo
Reasons for having the vaccine
Ofthe117participantswhoreportedthattheyhadeitheralreadybeenvaccinatedorwereplan-ningtogetvaccinatedlsquokeepingmyfamilyhealthyandwellrsquo(82)andlsquokeepingmyselfhealthyandwellrsquo(81)werethetwomostpopularreasonsforhavingthevaccineThiswasfollowedbylsquoforpublichealthrsquo(70)lsquoitistherightthingtodorsquo(62)andinorderlsquototravelrsquo(61)(SeeFigure9)
I donrsquot want to
die
Irsquom over 65 I have some health issues I think itrsquos
[having the vaccine] very important to
keep safe
I want to see my family I usually go every year but now I havenrsquot seen them
because of COVID-19 Having it will help
I am well but my parents are older It is important to
keep them well
Otherreasonsthatpeoplegaveforgettingvacci-natedincludedtheneedtocontinueworkinginessentiallsquofrontlinersquoemploymentsuchassecuritycleaningandagedcaresettingsOnewomanintheLakembafocusgroupwhohadalreadyhadherfirstdoseoftheAstraZenecavaccinesaidthatlsquothebenefitsoutweightherisksrsquoandasanolderwomanrsquoIdonotwanttodiersquo
All but one of the focus groups were familiar with thedifferentvaccinescurrentlyavailableinAus-traliaAstraZenecaandPfizerMostparticipantswere also aware of blood clots being associated with the Astra Zeneca vaccine One group of newly-arrivedrefugeesinGriffithhadnotheardofeithertheAstraZenecaorPfizervaccinesandhadamorelimitedunderstandingofthevaccinationprogram in general
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1918
Reasons for not having the vaccine
At the moment the situation is under control and donrsquot feel the need Also I have no plans to
travel in the near future so I donrsquot see the need
3514
21622703
3243
1892
811 541
4865
1081
Thevaccine isnot welltested
Thevaccine is
unsafe
Formedicalreasons
I amscared tohave thevaccine
I dont likevaccines
Forreligiousreasons
Forculturalreasons
I want towait and
see
Somethingelse
(pleasetell uswhat)
000
1000
2000
3000
4000
5000
6000
Figure 10 Reasons for not getting vaccinated against COVID-19
Theperceivedlsquolackofadequatetestingrsquoofthevaccineandlsquofearofbeingvaccinatedrsquoalsore-ceivedhighresponseratesselectedby3514and3243ofparticipantsrespectivelyOnly1355 of respondents cited religious or cultural reasonsasbeingbehindtheirvaccinehesitancy
Open-endedresponsestothisquestionincluded
The vaccine is not 100 working It cannot offer
100 protection
Ofthe42participantswhosaidthattheywouldnothaveorwerehesitanttohavethevaccine4865saidthattheypreferredtolsquowaitandseersquobeforegettingvaccinated
Thediscussioninthefocusgroupsaboutpeoplersquoshesitancytobevaccinatedfocusedonanumberofconcernswhichreflected
poorcommunicationfromanumberof trusted sources including GPs and some media sources
conflictinginformationaboutthevaccinefrom healthauthorities
fearsaboutvaccinesafetythataresharedby thegeneralcommunity
misconceptionsabouttheeffectivenessof andhowthevaccineswork
I will not have it because make me sick
Issuesraisedinfocusgroupsascontributingtoincreasedhesitancyincluded
Some GPs being hesitant to recommendvaccination
Theinformationbeingprovidedisconflicting
Theinformationisoverlycomplexandnotcomprehensibleregardlessofwhetherithasbeen translated
The risk of blood clots
Perceptionsthatthevaccinesaregenerallyunsafe
Concernsthatsomepeoplearedyingafterbeing vaccinated
Not being sure about the risks associated withhaving the vaccine and being pregnant orbreastfeeding
Theperceptionthattherehasbeenalackoftestingofthevaccinespriortorollout
AlackofunderstandingofhowvaccinesworkthecompositionofthevaccinesandwhattheywoulddotothebodyincludingmakingchangestoapersonrsquosDNA
Specificcommentsincluded
I have heard that the vaccine changes
your DNA
I am a mother I am not sure it [the vaccine] is safe for
me when I am breastfeeding
If you are young and healthy your body has the energy to fight the virus
You donrsquot need to have the vaccine You should just let
your body fight it itself
They donrsquot tell you what chemicals are in the
vaccine
Tamil Focus Group Feedback Sheet
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2120
Nobody knows what to do My GP doesnrsquot even know what I should do whether
I should have it or not
I am not sure what to do I have spoken to my
GP but they canrsquot tell me whether I should have the vaccine or not while I am
breastfeeding
They say one thing and then they tell you
something elsehellip it [the vaccine rollout] is so
confusing
Confusionaboutwhattodowheretogoandthe health impacts of the vaccine was a common threadintheconversationsaroundvaccinehesi-tancy
Onewomanwhosehusbandworkedforasecurityfirmsaidthatherhusbandhadhadtobevacci-natedinordertokeephisjob
In several focus groups the issue of government control was also raised A number of people re-portedstronglythattheyfearedthatthevaccinewas lsquoa means that the government was using to controlpeoplersquo
He [husband] had to have it He didnrsquot have a choice He was fine [no side effects] but Irsquom not
thinking I will have it I donrsquot need to Irsquom a mum Irsquom busy I have
to look after my children I donrsquot know how I feel about it whether
Irsquom going to have it
Vaccine refusal
Onlyasmallnumberofparticipants(24or13)saidtheywouldnotgetvacci-natedOfthisgroup21werewomenand 2 were men8 Respondents were bornintendifferentcountrieswithadiverse range of language backgrounds
I never get sick It is the same for all my family We have always been strong and healthy so I will be
saying no to the vaccine
Country of Birth Language Background Count Pakistan Urdu 4 China Taiwan Chinese
(MandarinCantonese) 4
Sri Lanka India Tamil 3 Chile Spanish and English 2 Italy Italian 2 Iraq Syria Arabic 2 Iraq Chaldean 1 Iran Farsi 1 Greece Macedonian 1 Poland Polish 1 Pakistan Punjabi 1 Sweden Swedish 1 Vietnam Vietnamese 1
Table 4 Vaccine refusal by country of birth and language background
8 ThisreflectstheoverallsamplebiastowardswomenThemajorityoffocusgroupparticipantswerewomenXwithYparticipantsbeingmen
Reason for not having the vaccine Percent Count The vaccine is not well tested 5455 12 I want to wait and see 5455 12 The vaccine is unsafe 3636 8 For medical reasons 3182 7 I am scared to have the vaccine 3182 7 I dont like vaccines 1364 3 For religious reasons 1364 3 For cultural reasons 909 2 Something else (please tell us what) 909 2
SomeinthiscategorywereadamantthattheywouldnotbehavingthevaccineandhadverystrongviewsonitlsquoForculturalreasonsIwonrsquotbehavingthevaccinersquoWhenwelookatrespons-esmorecloselyhoweveritwouldappearthatmanyareinfactmorelsquohesitantrsquothanfirmvaccinerefusers
One reluctant middle-aged Tamil-speaking wom-ansaidlsquoIftheysaywehavetogetvaccinatedthenIwillrsquoThissentimentwas stronglysup-portedbythe rest of the Tamil-speaking group
Studyparticipantswhosaidtheywouldnothavethe vaccine were also concerned that lsquothe vaccine wasnotwelltestedrsquo
The vaccine has been rushed out It has not been
properly tested
Table 5 Reasons for not having the vaccine
Peopleinthiscategorysaidthattheywouldlsquowaitandseersquowhathappenswiththewiderrolloutbe-foremakingtheirfinaldecisionThissuggeststhataproportionofthelsquonorsquogroupareinfacthesitantrather than outright refusing to have the vaccine
Therewerealsofearsexpressedbyfocusgroupparticipantsaboutthedangersofbeingvacci-natedParticipantsreportedbeingafraidofthehealthrisksespeciallyfrombloodclotsSomepeopledistinguishedclearlybetweenAstraZene-caandPfizerinthisregardHoweverformanythedistinctionbetweenthedifferentvaccineswaslostandtheyspokeofthevaccinesgenerallybeing unsafe and having a range of unwanted side effects
Other factors consideredInadditiontothebroaderquestionsofwhypeo-plewouldorwouldnotchoosetogetvaccinatedthe research team used the focus group discus-sionstoexplorewhetherthefollowingfactorshadanyimpactonapersonrsquoslikelihoodofbeingvaccine pre-disposed or hesitant
Knowing someone who had been vaccinated
Knowing someone who had contracted COVID-19
Knowing where to go to get vaccinated
Thesourcespeopleturntoforinformation about COVID-19 and COVID-19 vaccines
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2322
Knowing someone who has been vaccinatedOfthosewhorespondedtothisquestion125or70knewsomeonewhohadalreadyhadthevaccine
6983
2570
447
Yes No Dont know000
1000
2000
3000
4000
5000
6000
7000
8000
Figure 11 Do you know someone who has been vaccinated
Amongthe125participantswhoknewsomeonewhohadalreadybeenvaccinated100identifiedlsquoimmediatefamilymembersrsquo(parentschildrensiblingsandpartners)Somefocusgrouppartic-ipantsreportedthatalloftheirfamilymembersoverseas had been vaccinated Others reported thattheirrelativeshadbeenvaccinatedasarequirementoftheiremployment
Who Count Percent Other family member 41 313 Sister 24 1832 Community member 23 1756 Brother 18 1374 Father 17 1298 Mother 16 1221 Work colleague 14 1069 Husband or wife 11 84 Son or daughter 10 763 Partner 4 305 Someone else 45 3435 Total respondents 131
Table 6 Who do you know who has been vaccinated
When this issue was teased out further in focus groupdiscussionsarangeofreasonswere revealed including
My husband works in security and he had
to get it
My friend works as a COVID-19 cleaner and they all had to [get
vaccinated]
My family overseas have already been vaccinated
My son needs to travel for work so he is getting it
My brother in the UK is a doctor and he got it and
his wife
Knowing someone who has had COVID-19Almosthalfoftheparticipantsknewsomeonewho had contracted COVID-19 overseas Some reportedthatallthemembersoftheirfamilyormanymembersoftheirextendedfamilyhadcon-tracted COVID-19 In the older Italian group 10 of the15womenknewsomeoneinItalywhohadcontracted COVID-19
4716 4659
625
Yes No Not sure000
1000
2000
3000
4000
5000
Figure 12 Knowing someone who has had COVID-19
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2524
385 385
1538
2692
641 513000
4359
2051
1026385
1410
Mother
Father
BrotherSis
ter
Son or d
augh
ter
Husban
d or wife
Partner
Other family
mem
berFri
end
Community m
ember
Work co
lleag
ue
Someone else
(please
tell u
s who)
000500
100015002000250030003500400045005000
Figure 13 Who do you know who has had COVID-19
Four people in the focus groups knew someone who had died of COVID-19
All my family back home [Pakistan] got it [COVID-19] but
they are all fine now apart from my father He died But he was really sick before he
got it He had lots of underlying conditions Medical conditions so he was really unwell before he got COVID-19 But everyone else
they are fine now They were sick but they got betterhellip
If you are well and healthy you can fight this off
SurprisinglyknowingpeoplewhohadcontractedCOVID-19didnotseemtoinfluencefocusgroupparticipantsrsquopredispositiontowardseitherhavingthevaccineorbeingvaccinehesitantHowevertheolderItalianwomenrsquosgroupspokeabouttheimpactthatCOVID-19hadhadinItalyintheearlystagesofthepandemicandhowthishadaffectedthemdeeply13ofthe15womeninthisgroupwouldhaveorhadalreadyhadthevaccine
Knowing where to get vaccinated115people(81)whorespondedtothisquestion(n=142) knew where to go to get the vaccine 34 people(19)reportedthattheydidnotknowThisincluded15respondentsfromIraq3re-spondentsfromIndia2respondentsfromChina2 respondents from Pakistan and one respondent fromeachofthefollowingcountriesChinaEri-treaItalySriLankaSwedenSyriaandVietnamThese people were also less sure about whether ornottheywouldhavethevaccineItispossiblethat their lack of knowledge about where to go to get vaccinated was related to their general level ofvaccinehesitancy
7958
29582254
282 563
GPDoctor Vaccinecentre
Hospital Work place Somewhereelse (please
tell us where)
000100020003000400050006000700080009000
Figure 14 Where to go to get vaccinated
From the sample (n=199) GPs were the most commonlyidentifiedplacetogotogetvaccinat-edfollowedbythevaccinecentreatHomebushBayandthenhospitalsOtherplacesidentifiedincluded medical centres and pharmacies
Sources of information about COVID-19 and the vaccineThelargestsinglesourceofinformationaboutCOVID-19 and the vaccine was Facebook (417)
2743
3486
13141086
30862686
3429
2229 2286
41713714
2571
1086 971
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)000500
10001500200025003000350040004500
Figure 15 Sources of information about COVID-19 and the COVID-19 vaccine
Facebook I get my information from
Facebook But if I want to check it I watch the news
on 7 [Channel 7]
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2726
Thesecondlargestsourceofinformationforpeople in the sample was lsquoother forms of social mediarsquo(37)followedbySBStelevision(35)myfriends(34)andothertelevision(31)Oth-ersourcesofinformationpeoplereportedthattheyusedweretheNSWHealthwebsitenightlytelevisionnewsincludingChannel7Channel9andChannel10followedbytheABCtheAustral-iangovernmenthealthwebsitetheirGPlocalMedical Centres and the Red Cross
IntheLakembafocusgrouppredominantlymadeupofwomenfromPakistantherewasanani-mated discussion about Facebook which was the majorsourceofinformationalongwithGooglesearchesandcommunityandfriendship-basedWhatsApp groups There was a general consensus from most in the group that these were their pre-ferredormostcommonsourcesofinformationandnewsHoweveriftheywantedtolsquofactcheckrsquowhattheywerehearingtheywouldwatchthenightlynewsonChannel7orChannel9toverifywhattheyperceivedcouldsometimesbeunrelia-ble sources
IntheMtDruittfocusgroupseveralofthewom-enwithwell-developeddigitalliteracyandgener-alliteracyskillsusedhealthandfitnesswebsitesand social media sites as their source of infor-mationaboutlsquoallthingshealthrelatedrsquoincludingCOVID-19ThesewomenalsospokepositivelyabouttheinformationandsupporttheygotfromthestaffatCanterburyCouncilCommunityCentre(4Cs)whotheycouldrelyontofindoutthingsthattheyidentifiedtheyneededtoknowmoreabout
InthesmallerfocusgroupinGriffithwithrecently-arrived refugee women who had low levels of Englishlanguageliteracytherewaslittleknowledgeaboutthevaccinesnoawarenessofthedifferenttypesofvaccinesandlittleknow-ledgeaboutwheretogotogetvaccinatedorfindoutmoreaboutCOVID-19ingeneralThecommunityservicestaffandvolunteerspresentatthegroupwere working hard to assist these women to improve their English language skills and support themwithtranslatedinformation
In the older Italian women focus group in Wollon-gongparticipantsreportedgettingtheirinfor-mationfromslightlydifferentsourcesndashfamilyinAustralia(10women)Channel9(7women)
Italianradio(3women)andABCTV(3women)Onlytwowomenusedtheinternetandnoneofthe women reported using Facebook or social mediaasasourceoftheirinformationSeveralmentionedthattheygottheirinformationfromtheirGPorspecialistdoctorandonepartici-pantsaidrsquoIdonrsquotlistentoanyonersquoIntheSpan-ish-speaking focus group a comment was made thatseemedtoreflectmanyoftheotherfocusgroup discussions
Whenlsquosourcesofinformationrsquoiscorrelatedwiththegroupwhosaidtheywouldhavethevaccine(n=104)thereisashiftfromFacebookbeingthepreferredsourceofinformationtolsquoSBSTVrsquobeingthepreferredsourceThelsquovaccine-predisposedrsquogroupalsohadthelowestrateofrelyingonFace-bookasasourceofinformationaboutCOVID-19thoughitwasstillhighThegraphbelowhigh-lightshowotherlsquopreferredsourcesrsquoplayoutforthoseintendingtohaveorwhohavealreadyhadthe vaccine
ForthoseparticipantswhoindicatedthattheywouldnotorwerenotplanningtohavethevaccinelsquoFacebookrsquolsquomyfriendsrsquoandlsquomyfamilyrsquowerethesourcesofinformationaboutCOVID-19thatwereequallymostfrequentlycitedfollowedcloselybylsquomyfamilyoverseasrsquolsquoSBSradiorsquoandlsquoSBSTVrsquoassourcesofinformationreceivedthelowestmentionsfromthisgroup(SeeFigure16)
The vaccine-hesitant group were the group who identifiedlsquoFacebookrsquoastheirmostfrequentsourceofinformationaboutCOVID-19lsquoFace-bookrsquowasfollowedbylsquoothersocialmediarsquoandlsquomyfriendsrsquoasthenextmostfrequentsources
lsquoThiscommunityserviceproviderrsquo(theinterme-diaryorganisationwherethefocusgroupwasconducted)wasidentifiedby26ofrespondentsasasourceofinformationregardlessoftheirintentiontogetvaccinatedornotThefactthatboththelsquovaccinehesitantrsquoandthosewhoindi-catedtheywouldnrsquotbegettingthevaccinesoughtinformationfromthissourcesuggeststhatrolling
There is so much confusion about it [the vaccine] that I think my GP is the best
place to go
9 This group of the research sample included a small number ofpeoplewhohadalreadybeenvaccinated
2626
4141
14141111
323228282828
2424
1818
37373737
2828
10101212
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)00050010001500200025003000350040004500
2857
2381
952 952
2857
3333
42864286
3810
4286
23812381
1429
952
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another co
mmunity se
rvice
Somewhere
else (p
lease te
ll us w
here)000
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Figure 16 Sources of information for respondents who were planning to have the vaccine9
Figure 17 Sources of information for respondents who were not planning to have the vaccine
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2928
outpositivemessagingthroughtrusted communityserviceorganisationscouldbeaneffectivewayofshiftingpeoplefromvaccine hesitancytodecidingtohavethevaccine
31372549
980 980
25492157
4314
1176
2353
4902
4118
2157
980392
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)000
1000
2000
3000
4000
5000
6000
Figure 18 Sources of information for respondents who lsquodonrsquot knowrsquo if they will have the vaccine
DISCUSSION
wardstheCOVID-19vaccineareasvariedastheyarewithinthebroadercommunityTherearearangeofinfluencingfactorsincludingagehealthstatushowlongtheyhavebeeninAustraliahowmuchnewstheyreceivefromoverseasandhowbadlyimpactedbythepandemictheirhomecountries have been
The research also highlights that people from culturallyandlinguisticallydiversebackgroundsgettheirinformationaboutCOVID-19andtheCOVID-19vaccinefromawidevarietyofsourcesbothformalandinformalandthatforparticulargroupsinthisstudythereisahighrelianceonFacebookovermoreofficialsourcesofinforma-tion
VulnerabilityTheneedsofhighly-vulnerablegroupswithintheCALDcommunityhavetobetakenintoconsider-ationThisincludesolderpeoplewhohavelivedinAustraliaformanyyearsbuthavelowlevelsofEnglishliteracyndashespeciallywritingandreadingEnglishandsometimesspokenEnglishndashandwhoaremoresusceptibletoseriousillnessandhigherratesofhospitalisationanddeathfromCOVID-19Italsoincludesnewly-arrivedrefugeeswhohavinglowornoEnglishlanguageliteracylacktheconnectionstoandnetworksintothewidercommunityandcommunitysupportsItisalsothecase that some people in these groups are not health literate at all and cannot read and write in their own language
Akeytakeoutfromthehealthandcommunityserviceorganisationsurveyresponsesandinter-viewsundertakenwithmulticulturalhealthandcommunicationexpertsfortheprojectisthatlit-eracylevelsreallydomatterLowlevelsofhealthliteracylowlevelsofEnglishlanguageliteracyandpossiblylowlevelsofliteracyintheirownlan-guage-especiallyforsomenewly-arrivedrefu-gees and those who are part of the humanitarian program such as Dari language speakers from AfghanistanTigrinyalanguagespeakersfromEr-itrea and northern Ethiopia and Oromo language speakers from Ethiopia - need to be factored into anyplanstofurtherpromotethevaccinerolloutanduptaketoculturallyandlinguisticallydiversepeopleinthecommunityThereisaneedfor
The contextThisresearchisimportantgivenhowhighlyculturallydiverseNSWisandtheimpactthiscanhave on the success of public health messaging topeoplewhosefirstlanguageisnotEnglishPeople who were born overseas form almost one-thirdofthe7480228population(276)ofNSWandNSWishometo336ofAustraliarsquosoverseas-bornpopulationPeoplefromaround225 birthplaces have made NSW their home and 21oftheNSWpopulationisfromanon-EnglishspeakingbackgroundMorethan24000humani-tarianentrantshavesettledinNSWoverthepastfiveyearscomprisingalmostathird(32)ofthenationaltotalThe24000humanitarianentrantswhohavesettledinNSWoverthepastfiveyearscame from over 100 countries of origin10Sydneyhasthelargestoverseas-bornpopulationofallthecapitalcities11
Hearingdirectlyfrompeoplefromculturally-diverse backgrounds is important to ensure that policymakersandpublichealthadvocatescandesign responses that are both accessible and un-derstandabletopeopleforwhomEnglishmaybetheirsecondthirdorfourthlanguageApropor-tionofpeopleinthesecommunitieshavelowerlevelsofEnglishlanguageliteracyandinsomecaseslowlevelsofliteracyintheirlanguageoforiginsowillbehardertoreachviatraditionalormainstream methods
Itisalsocriticallyimportantthatduringatimewherethereissomuchlsquonoisersquoacrossmediachannelsrelatingtothevaccinethevaccineroll-outvaccineefficacyandvaccinesafetythatwetakesometimetolistentoandunderstandhowthislsquonoisersquoisbeingheardandmadesenseofbypeoplefromculturally-diversebackgrounds
ThatsaiditisimportanttoreconfirmthattheCALDcommunityisnotahomogenousgroupOurresearchhasfoundthattheviewsandattitudesofparticipantsfromdiverseculturalbackgroundsto-
10RefugeeCouncilofAustraliaHumanitarianEntrantsin New South Wales A resource for New South Wales governmentagencies6-711MulticulturalNSWCommunityRelationsReport2018-20199
29
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3130
groupsFortheparticipantsintheresearchtheirattitudetothevaccineappearedtobeinflu-encedbyanumberoffactorstheirownlevelsofhealthandpre-existinghealthconditionsandthoseoftheirfamilymembersandtheimpactofreceiving COVID-19-related news from overseas particularlyfrompeoplersquoscountryoforiginAnexampleofthiscanbeseenintheItaliangroupin Wollongong where people had received news fromoverseasearlyinthepandemicwhichscaredthemThisexperiencelsquofromhomersquohadinflu-enced most of the women in the Wollongong focus group (n=15) to choose to get vaccinated The interviewee from the Illawarra Shoalhaven Local Health District also spoke about the heightenedconcernthattheywitnessedinthelocalItaliancommunityintheearlystagesofthepandemicOtherpeoplewantedtolsquostayhealthyrsquoandtolsquoprotectthehealthofothersrsquoandformanytherewasasensethattheywantedtolsquogetbacktosomedegreeofnormalcyrsquoandtobeabletolsquotraveloverseastovisitrelativesrsquo
Vaccine hesitancyOfthe42inthisstudywhoappearedundecidedornotplanningtohavethevaccinemanywereinfactadoptingalsquowaitandseersquoapproachbeforemakingtheirfinaldecisionMostparticipantswereinterestedtohearmoreinformationaboutthevaccinesandwereopenedtogettingthevaccinebutdidhaveconcernsaboutthesafetyofthevaccinesespeciallyinregardtoAstraZeneca
The issue of blood clots has led to considerable fearandhesitancyinthecommunityandthisfearandhesitancywasreflectedinourstudyEssentialResearchrsquossurvey(April2021)reportedoneinsixpeople(16)indicatedtheywillnevergetvaccinatedagainstCOVID-19upfrom12thepreviousmonthwhile42saidtheywillgetvaccinatedbutnotrightawayTheproportionofpeople who would be willing to get vaccinated as soonaspossibleorarealreadyvaccinatedalsodeclineddownfrom47to4213Thissurveywas conducted prior to the most recent outbreak inNSWinvolvingthehighlyinfectiousDeltastrain
Therisk-benefitofhavingthevaccineneedstobecarefullyweighedbyeachindividualideallyinconsultationwiththeirdoctoranddependingon
The Hub has lsquobeen working in partnership with keystakeholdergroupstoguidecommunicationstomeetthehealthliteracyandculturallyandlinguisticallydiverse(CALD)needsofitspop-ulationStructuredworkinggroupshavebeencreatedtoprioritisecommunicationstovulner-ableyouthCALDgroupstheelderlyitinerateworkersasylumseekersandrefugeesTheaimsaretotestmessagingandbuildtrustwithprioritypopulationstoensureeffectivecommunicationoftheneedtosustainphysicaldistancingmeas-uresintheabsenceofavaccineSimilareffortsarenowneedednationallyandshouldstartatthetimeofdiseaseoutbreaksinthefuturealongsideplannedmassmediaandhealthcommunicationcampaignsrsquo
InthearticlebyDoddetaltheyreinforcetheimportanceofusingcommunicationformatswhich are lsquosuitable for people with low health literacyandeducationandwhichareappropriateforculturallyandlinguisticallydiversegroupsandIndigenouspopulationsrsquoThearticlearguesthatitisimportanttolookatmotivationsandconcernsabout vaccines when shaping messaging It also pointsoutthatprimarycaredoctorsareatrust-ed source and as such should be supported in deliveringinformationaboutthevaccinesandad-dressingcommunityconcernsThearticlestateslsquoWeneedtounderstandandaddresscitizenrsquosconcernsthatcanpreventoptimaluptakebuildmotivationsintomessagingandprioritisepublictrustbyinformingandinvolvingthecommunityintheprocessSupportinghealth-careprofession-als in their role as educators will ensure people haveadequateandaccessibleinformationfromatrustedsourcetooptimisevaccineuptakeandultimatelyreducecommunitytransmissionofCOVID-19rsquo15
RecentresearchbyAssociateProfessorHollySeale16withUNSWMedicinersquosSchoolofPublicHealthandDeputyChairfortheCollaborationonSocialScienceandImmunisationfoundthereisaneedtolsquodecentralisersquocommunicationsbytapping
translatedmaterialsandinformationaboutthevaccines to be tailored to the needs of people in these newly-emergingcommunitygroups
It was reported that in Wollongong there can sometimesbefourgenerationsoffamilymem-bersfromnewly-arrivedrefugeegroupslivingintheonehouseMostofthesefamilymembersgenerallyhavelimitedEnglishlanguageliteracywhichincreasestheirriskofnotreceivingkeyhealthmessagesandthereforeincreasingthepotentialimpactofCOVID-19-inparticulartheDeltastrainwhichhasprovenhighlyinfectiousamongst household members
Vaccine uptakeNotdissimilartothewidercommunitymorepeopleinourstudywereplanningtohavethevaccinethannotandanumberhadalreadybeenvaccinatedInarecentLancetarticle(February2021)ConcernsandmotivationsaboutCOVID-19vaccinationfindingsfromtwosurveysfromanAustralianlongitudinalstudyconductedinJuneandJuly2020includedthatlsquothetopthreerea-sons for agreeing to vaccinate were lsquoto protect themselvesandothersrsquohelliplsquobeliefinvaccinationandsciencersquohellipandlsquotohelpstopthevirusspreadrsquoEven among those willing to vaccinate there was somehesitancyaboutthesafetyofthevaccineTheLancetarticlenotedthatlsquowillingnesstovaccinatedifferedbybothageandeducationrsquoForthosewhowereindifferentorsaidtheywouldnot get the vaccine the top reasons across the twosurveyswerelsquoconcernaboutthesafetyofthevaccineinitsdevelopmentrsquoandlsquopotentialsideeffectsrsquo12
Olderpeopleinourstudywhocomprised23of the total sample (n=199) were the group most likelytosaythattheywantedtogetthevaccine85ofthoseover65saidtheywouldhaveorhadalreadyhadthevaccineVaccinepredispo-sitionwashoweveralsostrongacrossotherage
12RHDoddKPicklesBNickelECvejicJAyreCBatcupCBonnerTCoppSCornellTDakinJIsautierKJMcCafferyConcerns and motivations about COVID-19 vaccination SydneyHealthLiteracyLabSydneySchoolofPublicHealthFacultyofMedicineandHealthUniversityofSydneypublishedintheLancetFebruary2021p162wwwthelancet cominfectionVol21February2021
theircircumstancesHoweverthesourcesofin-formationthatpeoplemostrelyuponortrustarecriticaltothedisseminationofaccurateandclearmessaging to dispel the fear surrounding events suchasbloodclottingandthemisconceptionsraisedinthefocusgroupsWithsomanypartici-pantsinthisstudygettingtheirinformationfromFacebookandothersocialmediasitesitisvitalthat these channels are used to promote simple positivemessagesandforanyfuturecommunityawareness campaigns
Effective communicationConfusionandmisconceptionsaboutthevac-cinersquosefficacyavailabilityandsafetywereallis-sues that were raised in the focus groups Finding waystoeffectivelycommunicatewithpeoplewithlowerEnglishlanguageliteracyandhealthliteracyisanimportantwaytoaddresstheconfusionandmisconceptionsaboutthevaccineashasbeen discussed in a number of recent Australian studies
Astudy14byMcCafferyetal(2020)concludedthattherearelsquoimportantdisparitiesinCOVID-19-relatedknowledgeattitudesandbehavioursaccordingtopeoplersquoshealthliteracyandlanguagersquoOneofthefindingswasthatlsquopeoplewithlowerhealthliteracywerealsomorelikelyto endorse misinformed beliefs about COVID-19 andvaccinations(ingeneral)thanthosewithadequatehealthliteracyThesamepatternofresults was observed among people who primar-ilyspeakalanguageotherthanEnglishathomersquoTheMcCafferystudyhighlightstheimportanceof tailoring health messages to those with lower healthliteracyandculturallyandlinguisticallydiversecommunitiesItpointsoutthatthereareexamplesofeffectivemanagementofdiversecommunityneedsthatusetailoredhealthmes-sagesandcitestheWesternSydneyLocalHealthDistrictHealthLiteracyHub
13TheEssentialReport-anonlinesurveyconductedbyEssentialResearchcompletedby1090people between 21ndash26 April14McCafferyKJDoddRHCvejicEAyreJBatcupCIsautierJMJCoppTBonnerCPicklesKNickelBDakinTCornellSWolf MS Health literacy and disparities in COVID-19ndashrelated knowledge attitudes beliefs and behaviours in Australia PublicHealthResPract202030(4)e30342012December2020
15 Op cit16 httpssphmedunsweduausitesdefaultfilessphcmNewsEnhancing-supporting-COVID-19-vaccination-programpdf
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
30 31
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3332
intodifferentnetworkingspacessuchaswork-placeslocalgymsmothersrsquogroupsandseniorsrsquoclubswithafocusonallagegroupsregardlessofcurrenteligibilityAccordingtoSealethechal-lengeislsquoensuringemerginginformationisadapt-edfortheintendedaudiencersquoShehasalsosaidlsquoThatrsquoswhatIrsquomalittlebitconcernedaboutatthemomenttherersquosalotofresourcesongov-ernmentwebsitesbutthesetermsaroundbloodclottingareverytechnicalWeactuallyneedtomake sure that we are breaking them down in a waythatwillmakeitmeaningfultopeopleThatrsquosnotjustabouttranslatingitrsquosaboutbeingcon-sciousofpeoplersquoshealthliteracyneedstooSomaybegettingsomemorevisualsintomaterialstotryandsupportthatrsquo17
Thereareanumberofmulticulturalhealthresourcesthatusecommunitylanguagetransla-tionsplainEnglishandvideosfromCALDcommu-nityleaderswhichcanbedownloadedandusedbyservicesandindividualsHowevermanyofthewrittenresourcesstillrelyontechnicalandscien-tifictermsthatrequireareasonablyhighlevelofEnglishlanguageliteracyorhighlevelsofliteracyin the translated language to comprehend Host websites can also be hard to navigate making itdifficulttolocateresourcesfromsimplewebsearchesAsummaryofsomeoftheavailableresourcescanbefoundatAttachment2
MulticulturalHealthUnitsinLocalHealthDis-trictshavestaffwhocanworkwithpeoplefromculturallyandlinguisticallydiversecommunitiesatthelocallevelandtranslateandcontextualisethese materials to the needs of the end user These teams respond to local needs and popu-lationdemographicsandareexpertsineffectivehealthliteracyandhealthcommunicationwiththeirlocalcommunitiesTheyworkcloselywithcommunityandvulnerablegroupstobuildhealthliteracyandimprovedhealthoutcomesintheircommunities
Case Study ndash Be a COVID Warrior ndash Responding to COVID-19 in Multicultural Communities InWollongongtheIllawarraShoalhavenLocalHealthDistrict(ISLHD)MulticulturalHealthSer-viceco-designedacommunityengagementandeducationprogramcalledlsquoBeaCOVIDWarriorrsquowhich commenced in 2020 in response to the pandemic This program was designed to respond tothelowlevelsofhealthliteracyaroundCOVID-19potentialexposuretothevirusandaddressfearandstigmainthelocalCALDcommunitiesThelsquoCOVIDWarriorrsquoprogramreachedaround880peopleranginginagefrom14to85years65ofCOVIDWarriorparticipantswerefemaleand35weremaleCOVIDWarriorparticipantsrepresented 21 language groups The outcomes of the program included increased levels of confidenceinapplyinginfectioncontrolmeasuresincreasedliteracyandhealthliteracyandawarenessofhowCOVID-19istransmittedUltimatelyanimprovedawarenessinapplyingCOVIDsafemeasures was also reported
InApril2020theservicecommencedwelfarechecksviaphoneonafortnightlybasistosup-portsocially-isolatedmulticulturalseniorswhoboretheemotionalstressofsocialisolationFrom these calls the ISLHD heard the needs and concernsofseniorsinthecommunityInadditionourexperiencewithCALDcommunitieshighlightedtheimportanceofyoungpeopleasconduitsofessentialinformationtoadultsincommunityandfamilygroupsduetoEnglishlanguageaccessandeducation
InresponsetheISLHDinitiatedthelsquoCOVIDWarri-orrsquoprogramusingbi-culturalhighschoolstudentsthroughthelocalhighschoolsByincreasingthehealthliteracyofstudentsatschooltheselsquocham-pionsrsquocouldtalktotheirfamiliesincludingolderfamilymembersininformalsettingsandthroughsocialmediawiththeirpeersasastrategytoraisethe level of knowledge of COVID-19 trans-mission preventionandtestingTheprogrambecamesopopularthatitwasextendedintomorelocalhighschools and adults accessing the Adult Migrant EnglishProgramTheprogramwassupportedbylocalsettlementservicesprovidedbybothMaxSolutionsandtheRedCrossItwas
17 httpstheconversationcomhow-can-governments-communicate-with-multicultural-australians-about-COVID-19-vaccines-its-not-as-simple-as-having-a-poster-in-their-language-156097
later extendedtoCALDSeniorsthroughtheMulticulturalCommunitiesCouncilIllawarra(MCCI)supportprograms
AkeycomponentoftheprogramwastoprovideparticipantswithlsquoCOVIDWarriorrsquoKitswhichincludedtworeusablemaskshandsanitiserinfographicsaboutCOVID-19symptomsandinfor-mationaboutwheretestingclinicswereavailablelocallyMCCIandRuralAustraliaforRefugeesdonatedreusablemasksforeveryparticipant
AsthelsquoCOVIDWarriorrsquoprogramwasevolvingsowasthenationalvaccinerolloutplanInforma-tionwasthereforeadaptedtomeetthisinfor-mationgapForexampleadultparticipantsandseniors were supported to understand how to accesstheCOVIDvaccinelsquoeligibilitycheckersrsquoandCALD people were shown how to use the NSW HealthwebsiteCOVID-19informationpages18
Decision makingHowpeoplearecurrentlyconsideringtheriskofCOVID-19isinfluencedbyarangeoffactorsincludingratesoftransmissioninthecommunitynumbersofnewcasesreportsinthemediaofrisksandsideeffectsPeopletendtobasetheirassessmentonwhattheyarecurrentlyexperi-encingandthencheckthisagainstwhattheyarehearinginthemediaincludingandespeciallyonsocialmediaandfromfamilyandfriendsMostoftheparticipantsinourstudyspokeclearlyandarticulatelyabouthowtheyweigheduptherisk-benefitofhavingtheCOVID-19vaccineintheir decision making Low case numbers ndash at the timeofconductingtheresearchndashandasensethat Australia was lsquodoing well in safeguarding the communityagainstCOVID-19rsquoweresignificantfactorsinpeoplersquosdecisionnottobevaccinatedortoadoptalsquowaitandseersquoapproachFamilyfriends and social media were reported as having aconsiderableinfluenceondecisionmakingaswerereportsinthemediaofthebloodclottingsideeffectsofAstraZeneca
ThefactthatFacebookwasreportedlythemostpopularsourceofinformationaboutCOVID-19
18httpswwwhealthnswgovauInfectiouscovid-19Pagesdefaultaspx
andtheCOVID-19vaccineforpeopleinthestudyraisesconcernsaboutthepossibledisseminationofmisconceptionsandlsquofakenewsrsquothatmaybespread or compounded via social media Closed social media groups such as WhatsApp and WeChatwithfamilyandfriendsmayalsoleadtopeoplereinforcingtheirpre-existingbiasesThesefactorscoupledwithasensethatAustraliaisfaringwellcomparedtomanycountriesoverseasappear to have resulted in increased vaccine hesi-tancyamongparticipantsofthestudy
Factorsthatwereidentifiedaschangingvaccine-hesitantparticipantsrsquoperceptionswereanincreased risk from COVID-19 and a correspond-ingincreaseinthenumberofinfectionsandonthebenefitsidetheabilitytotraveloverseastovisitfamilyIntherecentresearchfromtheUniversityofNSWcitedaboveSearlearguesthatlsquotheremaybeotherthingsthatweneedtonowstartfocusingonhellipthatwillstarttopromoteandmotivatepeoplesuchasthechancetotravelmorefreelyforexamplersquoThisappearstobeborneoutbyourfocusgroupfindings19
Untilrecentlytherehavebeenverylowcasenumbers and few lockdowns across most of Aus-tralia and NSW The recent outbreak from mid-JuneinGreaterSydneyandintroductionofthehighlyinfectiousDeltavariantinNSWislikelytoimpactonpeoplersquosassessmentsoftherisk-benefitofhavingthevaccineandonewouldassumereducehesitancyrates
GiventheheightenedcommunityanxietycausedbythisrecentCOVID-19outbreaktheproductionofshortsharpandtargetedmessagingtoCALDgroupsincommunitylanguagesthatisaccessibleandmotivationalfeaturescommunityleadershigh-profilecelebritiesandsportsstarsfromCALDbackgroundsandisdirectedatastate-wideandlocal level would appear to be more urgent than everItisclearthatformessagingtobeeffectiveandreachitsintendedaudiencedistributionchannelsshouldincludeFacebookWhatsAppandothersocialmediaplatformsaswellastrustedsourcessuchasmulticulturalhealthworkersmulticulturalservicesandthroughGPsandMedical Centres If mainstream COVID-19 vaccine
19 Op cit
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
32 33
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3534
awareness campaigns are produced in Australia suchashavebeenproducedinNewZealandtheUnitedKingdomandNorthAmericatheyshouldincludehighprofilewell-knowncommunityfig-uresandsportingstarsfromCALDbackgroundsandincludestrategiesspecificallytargetingCALDcommunitiesincludinggroupsidentifiedaspar-ticularlyhigh-risk
It is also important that informationonvaccinesistranslatedintolanguagesfromnewerandemergingcommunitiesOthersuggestionsaroundreachingthesecommunitiesincludeface-to-facemeetingsorganisedbycrossagencypartnershipsandpeer-ledstrategiessuchas mobilising community champions and influenc-ers Messaging needs to be inclusive and framed around the collective values held by commu-n5
It is clear that reinforcing the benefits of being vaccinated at this time rather than dwelling on the risks is more likely to generate behavioural
changeandapositivevaccineresponsefrombothCALDcommunitiesandthegeneralpopulationAppropriately-designedandtargetedCOVID-19vaccinehealthinformationthatiseasytoreadinanylanguagecanbeconveyedbycommunityleadersandcommunitynetworksandpromotesthepositivebenefitsofgettingvaccinatedwouldbevaluableatthistimeBuildingontheworkofpeerchampionssuchastheCOVIDWarriorprogramisalsoasuccessfulmodeltoincreasingCOVID-19vaccinehealthliteracyandinformed decision making
Mostimportantlypositivelymotivatingculturallyandlinguisticallydiversecommunitymemberstolsquogetthejabrsquoespeciallythosewhoareadoptingalsquowaitandseersquoapproachorarevaccinehesitantwould lead to greater vaccine uptake among culturallyandlinguisticallydiversecommunitiesandthereforethecommunityasawhole
Inner West Multicultural Network Addison Road Community Centre DateWednesday12May
A focus group session of members of the Inner WestMulticulturalNetworkpluscustomersoftheFoodPantryatAddisonRoadwasheldattheAddisonRoadCommunityCentreinMarrickvilleon12Mayat200pmThesessionwaspartoftheregularmeetingoftheInnerWestMulticul-turalNetworkTheconsultationinvolvedabout26peopleandwasconductedbyRosannaBarbero
Thegroupbrainstormedresponsestoquestionsaroundvaccinehesitancyinmulticulturalcom-munitiesandmoreeffectivemessagingTheseresponseshavebeenincorporatedinthefindingsof the report
Griffith Women on Fire Focus Group Griffith Community Centre DateFriday14May
This small focus group of women was held at GriffithCommunityCentreonMay14at11amMargCouchSeniorProjectOfficerRegionalDevelopmentAustralia(RDA)-RiverinaandJoanneFitzpatrickSettlementEngagementandTransitionSupport Worker from Centacare Southwest NSW werethekeylinksandnetworkcontactsfortheGriffithcommunityTheWomenonFire(WOF)group was established as part of the Red Cross RuralFireServiceprogramlsquoManyCulturesOneCommunityrsquoInitiallyitwasestablishedtoeducatewomenonemergencypreparednessandtoen-courage NSW Rural Fire Service (RFS) volunteering andnowhastransformedintoacommunityac-tionsupportgroupTheGriffithSoroptimistInter-nationalnowauspicetheirfinancesandsupporttheWOFgroupactivitiesThefocusgroupwasfacilitatedbyCamillaCouchandlocalcommunityvolunteersledbytheGriffithSoroptimistClub
The women in the group were from Pakistan and IndonesiaThegroupweremainlyyoungmotherswithyoungchildrenandtheprogramhadchild-minding arrangements The language level of the womenwaslowandmostwerestudyingESOLat
ATTACHMENTS
ATTACHMENT 1 A Description of the Focus Groups
TAFEThedeliveryoftheinformationwaslimiteddue to language levels and the lack of bilingual interpretersEachparticipantworkedoneononewithavolunteertoslowlyfillinthesurveyandonewomantookthesurveyhometodiscusswithherhusbandThisgroupexperiencehighlightedthe lack of bilingual workers and services in some rural areas
Arabic speaking group Syd West Multicultural Services Mount Druitt Community worker Zaid Naoum Generalist Caseworker SydWest Multicultural Services DateMonday24May
ThefocusgroupfromSydWestMulticulturalSer-viceswasconductedonMonday24May2021atSydWestMulticulturalServicesMountDruittat300pmItwasfacilitatedbyPatriciaMcCormickandsupportedbyZaidNaoumGeneralistCase-workerSydWestMulticulturalServices
Therewere10womenandmenfromSyriainthegroupThegroupweremostlymaturetoolderparticipantsMostparticipantsrequiredassistancewithEnglishandthecaseworkerZaidNaoumhadtranslatedthesurveyintoArabicpriorto the focus group Zaid also translated during the focus group
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Canterbury City Community Centre (4Cs) group The Cottage Lakemba DateTuesday25May
ThefocusgroupfromCanterburyCityCommunityCentre(4Cs)wasconductedonTuesday25MayattheCottageat28CroydonStreetLakembaat10amItwasfacilitatedbyRobinMilesandsup-portedbyRomanaWaseemCommunityWorkerfrom 4Cs
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
34
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3736
The group was comprised of 14 women from PakistanIndiaandSriLankaThewomenrangedinagefrom23to65MostwerefluentEnglishspeakershoweveronewomanrequiredtransla-tionintoUrdufromoneoftheotherwomeninthegrouptoanswerthequestionsdirectly
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
NSW Chaldean League group Community worker Randa Goriya DateTuesday25May
ThefocusgroupfromNSWChaldeanLeagueMountDruittwasconductedonTuesday25May2021 at 1000am at the NSW Chaldean League premisesItwasfacilitatedbyPatriciaMcCormickandsupportedbyRandaGoriyaacommunityworker for the NSW Chaldean League in Mount DruittRandatranslatedtheintroductionandpromptsforthediscussionandhelpedthepartic-ipantstocompletethesurveyMostofthegrouprequiredhelptodothesurvey
ThegroupoftwelveparticipantswereallChaldeanandwerematuretoolderinageTheywereamixed-gendergroup
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Arabic speaking group Red Cross premises Wollongong DateTuesday25May
ThefocusgrouptookplaceonTuesday25Mayat 3pm at the Red Cross premises at Wollongong Therewere22womenandmenparticipatinginthegroupThefocusgroupwasfacilitatedbyCamilla Couch with support from Khalid Zainu-labdeenBilingualSupportWorkerHumanitarianSettlementProgram(ACTampNSW)
There were diverse ages in the group ranging fromyoungpeopletoolderagedMostofthegroupwereyoungerrecently-arrivedrefugeesfrom diverse backgrounds There was also a small-eroldercohortofparticipantswithhigherliteracylevelsandstrongercommunityengagementwith the local services in the area Camilla Couch facilitated the focus group which was conducted inArabicandEnglishwiththeArabictranslationprovidedbyKhalidZainulabdeen
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Work Opportunities for Women group Mt Druitt TAFE DateWednesday26May
TheWorkOpportunitiesforWomen(WOW)focusgroupwasheldonWednesdayMay261100ndash 100pmatMtDruittTAFEItwasfacilitatedbyCamilla Couch and built on the knowledge gainedintheprevioussessiononcriticalandanalyticalthinkingTheWOWgroupisaTAFECertificatelevel course
There were 14 women from diverse cultural backgroundsinthegroupThegroupweremainlyMuslimwomenwithschoolagechildrenandsome were mature aged Due to the learning fo-custhegroupwasfacilitatedasaclasswithguid-eddiscussionontheissuesandcarefulanalysisofthequestionsNotranslationwasneededduetotheeducationalcontextThestudentswereadeptatusingITandcompletedallthesurveysonline
STARTTS Tamil group Toongabbie Community Centre Community worker Sivaharani (Harani) Mayuran DateThursday27May
Thefocusgroupconsistedof18femalepartic-ipantswhowereyoungertomatureagedThefocus group was held at 1000am at Toongabbie CommunityCentreinTargoRdToongabbie
ThefocusgroupwasfacilitatedbyPatriciaMc-CormickandsupportedbyacommunityworkerSivaharani(Harani)MayuranfromtheSTARTTSTamil Group
ThegrouphadmixedlevelsofspokenandwrittenEnglishTheintroductionanddiscussionpromptsweretranslatedbythecommunityworkerSivaha-rani(Harani)Mayuranandsheandthemorepro-ficientstudentssupportedthosewithlowliteracytoanswerthesurveyquestions
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Spanish Speakers Seniors group SydWest Multicultural Services Blacktown DateTuesday1June
TheFocusGrouptookplaceonTuesday1Juneat1100amattheBlacktownShowgroundsandconsistedof16participants(15womenandoneman)AllparticipantswerebornincountriesinSouthAmericaTheirEnglish-fluencylevelsvariedand one of the members of the group translated thesurveyquestionsanddiscussionintoSpanish
ThegrouphadbeenmeetingforseveralyearsThegroupwasfacilitatedbyLindyCassidyandwassupportedbySreeVithyaHarilingamDayRespiteampSocialSupportTeamLeaderatSydWestMulticulturalServicesBlacktownThegroupwerematureagedtoolderparticipants
Thegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyform There was a more focused discussion on somekeyquestionsaftersurveycompletionThetranslatorassistedconsiderablyinthisprocess
Italian Speakers group Warrawong Community Centre DateMonday7June
The focus group of Italian speakers was held on Monday7Juneat1015amattheWarrawongCommunityCentreItwasfacilitatedbyCamillaCouchandsupportedbyJohnPaulTroianiand
SofiaLemafromIllawarraShoalhavenLHDMulti-cultural Health
There were 15 women in the group The group weremostlymaturetoolderparticipantsandwasconductedinItalianandEnglishwithtranslationprovidedbyJohnPaulThisgroupmeetsregularlyandissupportedbyanumberofservicesintheareaespeciallymulticulturalhealth
The group had a general facilitated discussion aboutthequestionsinthesurveyDuetolittleornoliteracytheindividualsurveyresponseswerethencollectedintooneresponseThesesurveyresponses have been included in the general surveyresponses
Mothers Group SydWest Multicultural Services Blacktown DateThursday10June
ThefocusgrouptookplaceonThursday10Juneat1030amandconsistedof14youngwomen13 of whom had a CALD background The focus groupweremainlymothersfromasupportgroupatSydWestMulticulturalServicesinBlacktown
EightofthewomenwereborninIndiatwofromPakistantwofromSriLankaonefromHausaGhana and one was born in Australia (the Austral-ianbornyoungwomanwasasocialworkstudenthelpingwiththegroup)LindyCassidyfacilitatedthe group with support from Wilma Garguath a projectofficerfromSydWestMulticultural Services
The group varied in age One was between 18-24 yearsoldSevenwereagedbetween25-34yearsSixwereagedbetween35=44yearsGiventheirage and circumstances most of the group did not consider themselves eligible at this stage for vac-cinationThiswasanimportantdifferencefromotherfocusgroupsinthattheemphasiswasmoreonwhattheywoulddooncetheybecameeligible
Participantsdidnotrequireassistancewithspo-kenEnglishThegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyformTherewasamorefocuseddiscussiononsomekeyquestions
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3938
ATTACHMENT 2 COVID-19 Vaccine Information in multiple languagesThefollowingsitesappsprovidetranslatedinformationaboutCOVID-19vaccines
Type of information KeyinformationongettingvaccinatedinNew South Wales and on the vaccines available The websiteusesanautomaticservicetotranslate thecontentintodifferentlanguages
Source of information NSW Government website
Link httpswwwnswgovauCOVID-19health-and-wellbeingCOVID-19-vaccina-tion-nswgetting-vaccinated
Type of information COVID-19ResourcessectionontheServiceNSWapp The app has a link to NSW Government websiteinformationonldquoGettingaCOVID-19vaccinationrdquo(seeabove)ItalsoincludesalinktoCOVID-19vaccinationresourcesinotherlan-guages available from the Department of Health
Source of information Service NSW NSW Government
Link Service NSW App
Type of information ArangeoftranslatedresourcesonCOVID-19bytitleincludingafactsheetonCOVID-19VaccineAstraZeneca(ChAdOx1-S)
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCOV-ID-19Pagestranslatedresources-by-titleaspx
Type of information ADigitalCOVID-19resourcelibrarywithtranslated materials
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiouscov-id-19Pagesdigital-resourcesaspx
Type of information AMultilingualCommunityToolkitontheCOVID-19vaccinationprogramtoassist communityworkersprovideseasytoreadresourcesvideosandlinkstokeyservicesandresources
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCovid-19DocumentsNSW-COVID-19-vaccina-tion-program-presentation-20210527pdf
Type of information TheNSWMulticulturalHealthCommunicationServiceoffershealthresourcesandinformationin a wide range of languages It has translated resources on COVID-19 and links to translated resourcesonCOVID-19vaccination
Source of information MulticulturalHealthCommunicationServiceisa New South Wales-wide health service hosted bySouth-easternSydneyLocalHealthDistrict(SESLHD)
Link httpswwwmhcshealthnswgovau
Type of information COVID-19vaccineinformationaddressingkeyquestionsaboutCOVID-19vaccinationandincludesvideosposterstilesfactsheetsandaudio material Translated into 63 languages
Source of information Department of Health Australian Government website
Link httpswwwhealthgovauinitiatives-and-pro-gramsCOVID-19-vaccinesCOVID-19-vaccine-in-formation-in-your-language
Type of information ThisinformationaddressessomecommonmisinformationaboutCOVID-19Translatedintomultiplelanguages
Source of information DepartmentofHomeAffairs Australian Government website
Link httpscovid19inlanguagehomeaffairsgovaumisinformation-and-truths-about-coronavirus
Type of information Australianandinternationalnewsand informationaboutCOVID-19andCOVID-19 vaccinesisavailableontheSBSCoronavirusPortal in more than 60 languages
Source of information SBSwebsite
Link httpswwwsbscomaulanguagecoronavirus
Type of information InformationprovidedaboutCOVID-19vaccinerolloutandsafetyinlanguagesotherthan English
Source of information Department of Health and Human Services Victorian Government
Link httpswwwcoronavirusvicgovautranslat-ed-information-about-COVID-19-vaccines
Type of information HealthTranslationsprovidestranslatedmateri-alsonhealthandwellbeingInformationaboutCOVID-19isregularlyupdatedincludessomeinformationonvaccinationandisavailableinover60communitylanguages
Source of information Victoriangovernmentinitiative
Link httpswwwhealthtranslationsvicgovaubhcv2bhchtnsfPresentEnglishResource-AllOpenampx=amps=Coronavirus
Type of information A one-stop shop for translated materials in multiplelanguagesonCOVID-19
Source of information Ethnolink Language Services
Link httpswwwethnolinkcomauCOVID-19-coro-navirus-translated-resources
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
40
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1716
alreadyhadthevaccineThosewhoindicatedthattheywouldnotbehavingthevaccinewerefairlyevenlydistributedacrossagegroupswithyoung-er people aged 18-24 being the age group with thehighestproportionofparticipantsexpressinguncertaintyabouthavingthevaccineTheagegroupwiththesecondhighestlevelofhesitancyproportionatetoothercategorieswerethe35-44yearolds
02468
10121416
Iraq
Vietnam Italy
South Americ
a
Sri La
nkaIndia
Syria
Other South East
AsiaAfric
a
Australia
Sweden
China
Pakistan
Iran
Eastern Europe
Afghanistan
Japan
Coun
t
Yes No Dont know
8095 8190
70486095
4571
6190
095
To stayhealthy and
well
To keep myfamily
healthy andwell
For publichealth
To travel To work It is theright thing
to do
Somethingelse (pleasetell us what)
000100020003000400050006000700080009000
Figure 8 Respondents COVID-19 Vaccine intention by Country of Origin
Figure 9 Reasons for getting vaccinated against COVID-19
Countryoforiginalsoseemedtoplayaroleinpeoplersquosviewsabouthavingthevaccinewithhighvaccinepre-dispositionreportedbyVietnameserespondentstotheonlinesurveyandwomenintheItalian-speakinggroupWhileparticipantsfromIraqrecordedthehighestlsquoyesrsquoresponsethiswasalmostmatchedbyIraqiparticipantswhoreportedthattheywerelsquounsurersquoorlsquodidnotknowrsquowhethertheywouldhavethevaccineTherelevanceofcountryoforigininthisregardwouldbeworthyoffurtherresearch
The Italian focus group held in Wollongong was an olderwomenrsquossocialgroupwithallparticipants(15) agedabove65yearsMostinfactwereaged over75yearswithoneparticipantinher90s 87 of the group had either been vaccinated (3) or were planning to get vaccinated (10)
Of course I will get vaccinated It is important to do this It is a very bad
disease
Thesewomenweremotivatedtostayhealthyandwellkeeptheirfamilyhealthyandwellforpublichealthreasonstobeabletotravelandforgen-eralsafetyMembersofthegroupalsoreportedthattheywantedtogetvaccinatedsothattheywouldbeabletolsquodancersquoandlsquosocialisersquo
Reasons for having the vaccine
Ofthe117participantswhoreportedthattheyhadeitheralreadybeenvaccinatedorwereplan-ningtogetvaccinatedlsquokeepingmyfamilyhealthyandwellrsquo(82)andlsquokeepingmyselfhealthyandwellrsquo(81)werethetwomostpopularreasonsforhavingthevaccineThiswasfollowedbylsquoforpublichealthrsquo(70)lsquoitistherightthingtodorsquo(62)andinorderlsquototravelrsquo(61)(SeeFigure9)
I donrsquot want to
die
Irsquom over 65 I have some health issues I think itrsquos
[having the vaccine] very important to
keep safe
I want to see my family I usually go every year but now I havenrsquot seen them
because of COVID-19 Having it will help
I am well but my parents are older It is important to
keep them well
Otherreasonsthatpeoplegaveforgettingvacci-natedincludedtheneedtocontinueworkinginessentiallsquofrontlinersquoemploymentsuchassecuritycleaningandagedcaresettingsOnewomanintheLakembafocusgroupwhohadalreadyhadherfirstdoseoftheAstraZenecavaccinesaidthatlsquothebenefitsoutweightherisksrsquoandasanolderwomanrsquoIdonotwanttodiersquo
All but one of the focus groups were familiar with thedifferentvaccinescurrentlyavailableinAus-traliaAstraZenecaandPfizerMostparticipantswere also aware of blood clots being associated with the Astra Zeneca vaccine One group of newly-arrivedrefugeesinGriffithhadnotheardofeithertheAstraZenecaorPfizervaccinesandhadamorelimitedunderstandingofthevaccinationprogram in general
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1918
Reasons for not having the vaccine
At the moment the situation is under control and donrsquot feel the need Also I have no plans to
travel in the near future so I donrsquot see the need
3514
21622703
3243
1892
811 541
4865
1081
Thevaccine isnot welltested
Thevaccine is
unsafe
Formedicalreasons
I amscared tohave thevaccine
I dont likevaccines
Forreligiousreasons
Forculturalreasons
I want towait and
see
Somethingelse
(pleasetell uswhat)
000
1000
2000
3000
4000
5000
6000
Figure 10 Reasons for not getting vaccinated against COVID-19
Theperceivedlsquolackofadequatetestingrsquoofthevaccineandlsquofearofbeingvaccinatedrsquoalsore-ceivedhighresponseratesselectedby3514and3243ofparticipantsrespectivelyOnly1355 of respondents cited religious or cultural reasonsasbeingbehindtheirvaccinehesitancy
Open-endedresponsestothisquestionincluded
The vaccine is not 100 working It cannot offer
100 protection
Ofthe42participantswhosaidthattheywouldnothaveorwerehesitanttohavethevaccine4865saidthattheypreferredtolsquowaitandseersquobeforegettingvaccinated
Thediscussioninthefocusgroupsaboutpeoplersquoshesitancytobevaccinatedfocusedonanumberofconcernswhichreflected
poorcommunicationfromanumberof trusted sources including GPs and some media sources
conflictinginformationaboutthevaccinefrom healthauthorities
fearsaboutvaccinesafetythataresharedby thegeneralcommunity
misconceptionsabouttheeffectivenessof andhowthevaccineswork
I will not have it because make me sick
Issuesraisedinfocusgroupsascontributingtoincreasedhesitancyincluded
Some GPs being hesitant to recommendvaccination
Theinformationbeingprovidedisconflicting
Theinformationisoverlycomplexandnotcomprehensibleregardlessofwhetherithasbeen translated
The risk of blood clots
Perceptionsthatthevaccinesaregenerallyunsafe
Concernsthatsomepeoplearedyingafterbeing vaccinated
Not being sure about the risks associated withhaving the vaccine and being pregnant orbreastfeeding
Theperceptionthattherehasbeenalackoftestingofthevaccinespriortorollout
AlackofunderstandingofhowvaccinesworkthecompositionofthevaccinesandwhattheywoulddotothebodyincludingmakingchangestoapersonrsquosDNA
Specificcommentsincluded
I have heard that the vaccine changes
your DNA
I am a mother I am not sure it [the vaccine] is safe for
me when I am breastfeeding
If you are young and healthy your body has the energy to fight the virus
You donrsquot need to have the vaccine You should just let
your body fight it itself
They donrsquot tell you what chemicals are in the
vaccine
Tamil Focus Group Feedback Sheet
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2120
Nobody knows what to do My GP doesnrsquot even know what I should do whether
I should have it or not
I am not sure what to do I have spoken to my
GP but they canrsquot tell me whether I should have the vaccine or not while I am
breastfeeding
They say one thing and then they tell you
something elsehellip it [the vaccine rollout] is so
confusing
Confusionaboutwhattodowheretogoandthe health impacts of the vaccine was a common threadintheconversationsaroundvaccinehesi-tancy
Onewomanwhosehusbandworkedforasecurityfirmsaidthatherhusbandhadhadtobevacci-natedinordertokeephisjob
In several focus groups the issue of government control was also raised A number of people re-portedstronglythattheyfearedthatthevaccinewas lsquoa means that the government was using to controlpeoplersquo
He [husband] had to have it He didnrsquot have a choice He was fine [no side effects] but Irsquom not
thinking I will have it I donrsquot need to Irsquom a mum Irsquom busy I have
to look after my children I donrsquot know how I feel about it whether
Irsquom going to have it
Vaccine refusal
Onlyasmallnumberofparticipants(24or13)saidtheywouldnotgetvacci-natedOfthisgroup21werewomenand 2 were men8 Respondents were bornintendifferentcountrieswithadiverse range of language backgrounds
I never get sick It is the same for all my family We have always been strong and healthy so I will be
saying no to the vaccine
Country of Birth Language Background Count Pakistan Urdu 4 China Taiwan Chinese
(MandarinCantonese) 4
Sri Lanka India Tamil 3 Chile Spanish and English 2 Italy Italian 2 Iraq Syria Arabic 2 Iraq Chaldean 1 Iran Farsi 1 Greece Macedonian 1 Poland Polish 1 Pakistan Punjabi 1 Sweden Swedish 1 Vietnam Vietnamese 1
Table 4 Vaccine refusal by country of birth and language background
8 ThisreflectstheoverallsamplebiastowardswomenThemajorityoffocusgroupparticipantswerewomenXwithYparticipantsbeingmen
Reason for not having the vaccine Percent Count The vaccine is not well tested 5455 12 I want to wait and see 5455 12 The vaccine is unsafe 3636 8 For medical reasons 3182 7 I am scared to have the vaccine 3182 7 I dont like vaccines 1364 3 For religious reasons 1364 3 For cultural reasons 909 2 Something else (please tell us what) 909 2
SomeinthiscategorywereadamantthattheywouldnotbehavingthevaccineandhadverystrongviewsonitlsquoForculturalreasonsIwonrsquotbehavingthevaccinersquoWhenwelookatrespons-esmorecloselyhoweveritwouldappearthatmanyareinfactmorelsquohesitantrsquothanfirmvaccinerefusers
One reluctant middle-aged Tamil-speaking wom-ansaidlsquoIftheysaywehavetogetvaccinatedthenIwillrsquoThissentimentwas stronglysup-portedbythe rest of the Tamil-speaking group
Studyparticipantswhosaidtheywouldnothavethe vaccine were also concerned that lsquothe vaccine wasnotwelltestedrsquo
The vaccine has been rushed out It has not been
properly tested
Table 5 Reasons for not having the vaccine
Peopleinthiscategorysaidthattheywouldlsquowaitandseersquowhathappenswiththewiderrolloutbe-foremakingtheirfinaldecisionThissuggeststhataproportionofthelsquonorsquogroupareinfacthesitantrather than outright refusing to have the vaccine
Therewerealsofearsexpressedbyfocusgroupparticipantsaboutthedangersofbeingvacci-natedParticipantsreportedbeingafraidofthehealthrisksespeciallyfrombloodclotsSomepeopledistinguishedclearlybetweenAstraZene-caandPfizerinthisregardHoweverformanythedistinctionbetweenthedifferentvaccineswaslostandtheyspokeofthevaccinesgenerallybeing unsafe and having a range of unwanted side effects
Other factors consideredInadditiontothebroaderquestionsofwhypeo-plewouldorwouldnotchoosetogetvaccinatedthe research team used the focus group discus-sionstoexplorewhetherthefollowingfactorshadanyimpactonapersonrsquoslikelihoodofbeingvaccine pre-disposed or hesitant
Knowing someone who had been vaccinated
Knowing someone who had contracted COVID-19
Knowing where to go to get vaccinated
Thesourcespeopleturntoforinformation about COVID-19 and COVID-19 vaccines
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2322
Knowing someone who has been vaccinatedOfthosewhorespondedtothisquestion125or70knewsomeonewhohadalreadyhadthevaccine
6983
2570
447
Yes No Dont know000
1000
2000
3000
4000
5000
6000
7000
8000
Figure 11 Do you know someone who has been vaccinated
Amongthe125participantswhoknewsomeonewhohadalreadybeenvaccinated100identifiedlsquoimmediatefamilymembersrsquo(parentschildrensiblingsandpartners)Somefocusgrouppartic-ipantsreportedthatalloftheirfamilymembersoverseas had been vaccinated Others reported thattheirrelativeshadbeenvaccinatedasarequirementoftheiremployment
Who Count Percent Other family member 41 313 Sister 24 1832 Community member 23 1756 Brother 18 1374 Father 17 1298 Mother 16 1221 Work colleague 14 1069 Husband or wife 11 84 Son or daughter 10 763 Partner 4 305 Someone else 45 3435 Total respondents 131
Table 6 Who do you know who has been vaccinated
When this issue was teased out further in focus groupdiscussionsarangeofreasonswere revealed including
My husband works in security and he had
to get it
My friend works as a COVID-19 cleaner and they all had to [get
vaccinated]
My family overseas have already been vaccinated
My son needs to travel for work so he is getting it
My brother in the UK is a doctor and he got it and
his wife
Knowing someone who has had COVID-19Almosthalfoftheparticipantsknewsomeonewho had contracted COVID-19 overseas Some reportedthatallthemembersoftheirfamilyormanymembersoftheirextendedfamilyhadcon-tracted COVID-19 In the older Italian group 10 of the15womenknewsomeoneinItalywhohadcontracted COVID-19
4716 4659
625
Yes No Not sure000
1000
2000
3000
4000
5000
Figure 12 Knowing someone who has had COVID-19
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2524
385 385
1538
2692
641 513000
4359
2051
1026385
1410
Mother
Father
BrotherSis
ter
Son or d
augh
ter
Husban
d or wife
Partner
Other family
mem
berFri
end
Community m
ember
Work co
lleag
ue
Someone else
(please
tell u
s who)
000500
100015002000250030003500400045005000
Figure 13 Who do you know who has had COVID-19
Four people in the focus groups knew someone who had died of COVID-19
All my family back home [Pakistan] got it [COVID-19] but
they are all fine now apart from my father He died But he was really sick before he
got it He had lots of underlying conditions Medical conditions so he was really unwell before he got COVID-19 But everyone else
they are fine now They were sick but they got betterhellip
If you are well and healthy you can fight this off
SurprisinglyknowingpeoplewhohadcontractedCOVID-19didnotseemtoinfluencefocusgroupparticipantsrsquopredispositiontowardseitherhavingthevaccineorbeingvaccinehesitantHowevertheolderItalianwomenrsquosgroupspokeabouttheimpactthatCOVID-19hadhadinItalyintheearlystagesofthepandemicandhowthishadaffectedthemdeeply13ofthe15womeninthisgroupwouldhaveorhadalreadyhadthevaccine
Knowing where to get vaccinated115people(81)whorespondedtothisquestion(n=142) knew where to go to get the vaccine 34 people(19)reportedthattheydidnotknowThisincluded15respondentsfromIraq3re-spondentsfromIndia2respondentsfromChina2 respondents from Pakistan and one respondent fromeachofthefollowingcountriesChinaEri-treaItalySriLankaSwedenSyriaandVietnamThese people were also less sure about whether ornottheywouldhavethevaccineItispossiblethat their lack of knowledge about where to go to get vaccinated was related to their general level ofvaccinehesitancy
7958
29582254
282 563
GPDoctor Vaccinecentre
Hospital Work place Somewhereelse (please
tell us where)
000100020003000400050006000700080009000
Figure 14 Where to go to get vaccinated
From the sample (n=199) GPs were the most commonlyidentifiedplacetogotogetvaccinat-edfollowedbythevaccinecentreatHomebushBayandthenhospitalsOtherplacesidentifiedincluded medical centres and pharmacies
Sources of information about COVID-19 and the vaccineThelargestsinglesourceofinformationaboutCOVID-19 and the vaccine was Facebook (417)
2743
3486
13141086
30862686
3429
2229 2286
41713714
2571
1086 971
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)000500
10001500200025003000350040004500
Figure 15 Sources of information about COVID-19 and the COVID-19 vaccine
Facebook I get my information from
Facebook But if I want to check it I watch the news
on 7 [Channel 7]
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2726
Thesecondlargestsourceofinformationforpeople in the sample was lsquoother forms of social mediarsquo(37)followedbySBStelevision(35)myfriends(34)andothertelevision(31)Oth-ersourcesofinformationpeoplereportedthattheyusedweretheNSWHealthwebsitenightlytelevisionnewsincludingChannel7Channel9andChannel10followedbytheABCtheAustral-iangovernmenthealthwebsitetheirGPlocalMedical Centres and the Red Cross
IntheLakembafocusgrouppredominantlymadeupofwomenfromPakistantherewasanani-mated discussion about Facebook which was the majorsourceofinformationalongwithGooglesearchesandcommunityandfriendship-basedWhatsApp groups There was a general consensus from most in the group that these were their pre-ferredormostcommonsourcesofinformationandnewsHoweveriftheywantedtolsquofactcheckrsquowhattheywerehearingtheywouldwatchthenightlynewsonChannel7orChannel9toverifywhattheyperceivedcouldsometimesbeunrelia-ble sources
IntheMtDruittfocusgroupseveralofthewom-enwithwell-developeddigitalliteracyandgener-alliteracyskillsusedhealthandfitnesswebsitesand social media sites as their source of infor-mationaboutlsquoallthingshealthrelatedrsquoincludingCOVID-19ThesewomenalsospokepositivelyabouttheinformationandsupporttheygotfromthestaffatCanterburyCouncilCommunityCentre(4Cs)whotheycouldrelyontofindoutthingsthattheyidentifiedtheyneededtoknowmoreabout
InthesmallerfocusgroupinGriffithwithrecently-arrived refugee women who had low levels of Englishlanguageliteracytherewaslittleknowledgeaboutthevaccinesnoawarenessofthedifferenttypesofvaccinesandlittleknow-ledgeaboutwheretogotogetvaccinatedorfindoutmoreaboutCOVID-19ingeneralThecommunityservicestaffandvolunteerspresentatthegroupwere working hard to assist these women to improve their English language skills and support themwithtranslatedinformation
In the older Italian women focus group in Wollon-gongparticipantsreportedgettingtheirinfor-mationfromslightlydifferentsourcesndashfamilyinAustralia(10women)Channel9(7women)
Italianradio(3women)andABCTV(3women)Onlytwowomenusedtheinternetandnoneofthe women reported using Facebook or social mediaasasourceoftheirinformationSeveralmentionedthattheygottheirinformationfromtheirGPorspecialistdoctorandonepartici-pantsaidrsquoIdonrsquotlistentoanyonersquoIntheSpan-ish-speaking focus group a comment was made thatseemedtoreflectmanyoftheotherfocusgroup discussions
Whenlsquosourcesofinformationrsquoiscorrelatedwiththegroupwhosaidtheywouldhavethevaccine(n=104)thereisashiftfromFacebookbeingthepreferredsourceofinformationtolsquoSBSTVrsquobeingthepreferredsourceThelsquovaccine-predisposedrsquogroupalsohadthelowestrateofrelyingonFace-bookasasourceofinformationaboutCOVID-19thoughitwasstillhighThegraphbelowhigh-lightshowotherlsquopreferredsourcesrsquoplayoutforthoseintendingtohaveorwhohavealreadyhadthe vaccine
ForthoseparticipantswhoindicatedthattheywouldnotorwerenotplanningtohavethevaccinelsquoFacebookrsquolsquomyfriendsrsquoandlsquomyfamilyrsquowerethesourcesofinformationaboutCOVID-19thatwereequallymostfrequentlycitedfollowedcloselybylsquomyfamilyoverseasrsquolsquoSBSradiorsquoandlsquoSBSTVrsquoassourcesofinformationreceivedthelowestmentionsfromthisgroup(SeeFigure16)
The vaccine-hesitant group were the group who identifiedlsquoFacebookrsquoastheirmostfrequentsourceofinformationaboutCOVID-19lsquoFace-bookrsquowasfollowedbylsquoothersocialmediarsquoandlsquomyfriendsrsquoasthenextmostfrequentsources
lsquoThiscommunityserviceproviderrsquo(theinterme-diaryorganisationwherethefocusgroupwasconducted)wasidentifiedby26ofrespondentsasasourceofinformationregardlessoftheirintentiontogetvaccinatedornotThefactthatboththelsquovaccinehesitantrsquoandthosewhoindi-catedtheywouldnrsquotbegettingthevaccinesoughtinformationfromthissourcesuggeststhatrolling
There is so much confusion about it [the vaccine] that I think my GP is the best
place to go
9 This group of the research sample included a small number ofpeoplewhohadalreadybeenvaccinated
2626
4141
14141111
323228282828
2424
1818
37373737
2828
10101212
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)00050010001500200025003000350040004500
2857
2381
952 952
2857
3333
42864286
3810
4286
23812381
1429
952
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another co
mmunity se
rvice
Somewhere
else (p
lease te
ll us w
here)000
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Figure 16 Sources of information for respondents who were planning to have the vaccine9
Figure 17 Sources of information for respondents who were not planning to have the vaccine
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2928
outpositivemessagingthroughtrusted communityserviceorganisationscouldbeaneffectivewayofshiftingpeoplefromvaccine hesitancytodecidingtohavethevaccine
31372549
980 980
25492157
4314
1176
2353
4902
4118
2157
980392
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)000
1000
2000
3000
4000
5000
6000
Figure 18 Sources of information for respondents who lsquodonrsquot knowrsquo if they will have the vaccine
DISCUSSION
wardstheCOVID-19vaccineareasvariedastheyarewithinthebroadercommunityTherearearangeofinfluencingfactorsincludingagehealthstatushowlongtheyhavebeeninAustraliahowmuchnewstheyreceivefromoverseasandhowbadlyimpactedbythepandemictheirhomecountries have been
The research also highlights that people from culturallyandlinguisticallydiversebackgroundsgettheirinformationaboutCOVID-19andtheCOVID-19vaccinefromawidevarietyofsourcesbothformalandinformalandthatforparticulargroupsinthisstudythereisahighrelianceonFacebookovermoreofficialsourcesofinforma-tion
VulnerabilityTheneedsofhighly-vulnerablegroupswithintheCALDcommunityhavetobetakenintoconsider-ationThisincludesolderpeoplewhohavelivedinAustraliaformanyyearsbuthavelowlevelsofEnglishliteracyndashespeciallywritingandreadingEnglishandsometimesspokenEnglishndashandwhoaremoresusceptibletoseriousillnessandhigherratesofhospitalisationanddeathfromCOVID-19Italsoincludesnewly-arrivedrefugeeswhohavinglowornoEnglishlanguageliteracylacktheconnectionstoandnetworksintothewidercommunityandcommunitysupportsItisalsothecase that some people in these groups are not health literate at all and cannot read and write in their own language
Akeytakeoutfromthehealthandcommunityserviceorganisationsurveyresponsesandinter-viewsundertakenwithmulticulturalhealthandcommunicationexpertsfortheprojectisthatlit-eracylevelsreallydomatterLowlevelsofhealthliteracylowlevelsofEnglishlanguageliteracyandpossiblylowlevelsofliteracyintheirownlan-guage-especiallyforsomenewly-arrivedrefu-gees and those who are part of the humanitarian program such as Dari language speakers from AfghanistanTigrinyalanguagespeakersfromEr-itrea and northern Ethiopia and Oromo language speakers from Ethiopia - need to be factored into anyplanstofurtherpromotethevaccinerolloutanduptaketoculturallyandlinguisticallydiversepeopleinthecommunityThereisaneedfor
The contextThisresearchisimportantgivenhowhighlyculturallydiverseNSWisandtheimpactthiscanhave on the success of public health messaging topeoplewhosefirstlanguageisnotEnglishPeople who were born overseas form almost one-thirdofthe7480228population(276)ofNSWandNSWishometo336ofAustraliarsquosoverseas-bornpopulationPeoplefromaround225 birthplaces have made NSW their home and 21oftheNSWpopulationisfromanon-EnglishspeakingbackgroundMorethan24000humani-tarianentrantshavesettledinNSWoverthepastfiveyearscomprisingalmostathird(32)ofthenationaltotalThe24000humanitarianentrantswhohavesettledinNSWoverthepastfiveyearscame from over 100 countries of origin10Sydneyhasthelargestoverseas-bornpopulationofallthecapitalcities11
Hearingdirectlyfrompeoplefromculturally-diverse backgrounds is important to ensure that policymakersandpublichealthadvocatescandesign responses that are both accessible and un-derstandabletopeopleforwhomEnglishmaybetheirsecondthirdorfourthlanguageApropor-tionofpeopleinthesecommunitieshavelowerlevelsofEnglishlanguageliteracyandinsomecaseslowlevelsofliteracyintheirlanguageoforiginsowillbehardertoreachviatraditionalormainstream methods
Itisalsocriticallyimportantthatduringatimewherethereissomuchlsquonoisersquoacrossmediachannelsrelatingtothevaccinethevaccineroll-outvaccineefficacyandvaccinesafetythatwetakesometimetolistentoandunderstandhowthislsquonoisersquoisbeingheardandmadesenseofbypeoplefromculturally-diversebackgrounds
ThatsaiditisimportanttoreconfirmthattheCALDcommunityisnotahomogenousgroupOurresearchhasfoundthattheviewsandattitudesofparticipantsfromdiverseculturalbackgroundsto-
10RefugeeCouncilofAustraliaHumanitarianEntrantsin New South Wales A resource for New South Wales governmentagencies6-711MulticulturalNSWCommunityRelationsReport2018-20199
29
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3130
groupsFortheparticipantsintheresearchtheirattitudetothevaccineappearedtobeinflu-encedbyanumberoffactorstheirownlevelsofhealthandpre-existinghealthconditionsandthoseoftheirfamilymembersandtheimpactofreceiving COVID-19-related news from overseas particularlyfrompeoplersquoscountryoforiginAnexampleofthiscanbeseenintheItaliangroupin Wollongong where people had received news fromoverseasearlyinthepandemicwhichscaredthemThisexperiencelsquofromhomersquohadinflu-enced most of the women in the Wollongong focus group (n=15) to choose to get vaccinated The interviewee from the Illawarra Shoalhaven Local Health District also spoke about the heightenedconcernthattheywitnessedinthelocalItaliancommunityintheearlystagesofthepandemicOtherpeoplewantedtolsquostayhealthyrsquoandtolsquoprotectthehealthofothersrsquoandformanytherewasasensethattheywantedtolsquogetbacktosomedegreeofnormalcyrsquoandtobeabletolsquotraveloverseastovisitrelativesrsquo
Vaccine hesitancyOfthe42inthisstudywhoappearedundecidedornotplanningtohavethevaccinemanywereinfactadoptingalsquowaitandseersquoapproachbeforemakingtheirfinaldecisionMostparticipantswereinterestedtohearmoreinformationaboutthevaccinesandwereopenedtogettingthevaccinebutdidhaveconcernsaboutthesafetyofthevaccinesespeciallyinregardtoAstraZeneca
The issue of blood clots has led to considerable fearandhesitancyinthecommunityandthisfearandhesitancywasreflectedinourstudyEssentialResearchrsquossurvey(April2021)reportedoneinsixpeople(16)indicatedtheywillnevergetvaccinatedagainstCOVID-19upfrom12thepreviousmonthwhile42saidtheywillgetvaccinatedbutnotrightawayTheproportionofpeople who would be willing to get vaccinated as soonaspossibleorarealreadyvaccinatedalsodeclineddownfrom47to4213Thissurveywas conducted prior to the most recent outbreak inNSWinvolvingthehighlyinfectiousDeltastrain
Therisk-benefitofhavingthevaccineneedstobecarefullyweighedbyeachindividualideallyinconsultationwiththeirdoctoranddependingon
The Hub has lsquobeen working in partnership with keystakeholdergroupstoguidecommunicationstomeetthehealthliteracyandculturallyandlinguisticallydiverse(CALD)needsofitspop-ulationStructuredworkinggroupshavebeencreatedtoprioritisecommunicationstovulner-ableyouthCALDgroupstheelderlyitinerateworkersasylumseekersandrefugeesTheaimsaretotestmessagingandbuildtrustwithprioritypopulationstoensureeffectivecommunicationoftheneedtosustainphysicaldistancingmeas-uresintheabsenceofavaccineSimilareffortsarenowneedednationallyandshouldstartatthetimeofdiseaseoutbreaksinthefuturealongsideplannedmassmediaandhealthcommunicationcampaignsrsquo
InthearticlebyDoddetaltheyreinforcetheimportanceofusingcommunicationformatswhich are lsquosuitable for people with low health literacyandeducationandwhichareappropriateforculturallyandlinguisticallydiversegroupsandIndigenouspopulationsrsquoThearticlearguesthatitisimportanttolookatmotivationsandconcernsabout vaccines when shaping messaging It also pointsoutthatprimarycaredoctorsareatrust-ed source and as such should be supported in deliveringinformationaboutthevaccinesandad-dressingcommunityconcernsThearticlestateslsquoWeneedtounderstandandaddresscitizenrsquosconcernsthatcanpreventoptimaluptakebuildmotivationsintomessagingandprioritisepublictrustbyinformingandinvolvingthecommunityintheprocessSupportinghealth-careprofession-als in their role as educators will ensure people haveadequateandaccessibleinformationfromatrustedsourcetooptimisevaccineuptakeandultimatelyreducecommunitytransmissionofCOVID-19rsquo15
RecentresearchbyAssociateProfessorHollySeale16withUNSWMedicinersquosSchoolofPublicHealthandDeputyChairfortheCollaborationonSocialScienceandImmunisationfoundthereisaneedtolsquodecentralisersquocommunicationsbytapping
translatedmaterialsandinformationaboutthevaccines to be tailored to the needs of people in these newly-emergingcommunitygroups
It was reported that in Wollongong there can sometimesbefourgenerationsoffamilymem-bersfromnewly-arrivedrefugeegroupslivingintheonehouseMostofthesefamilymembersgenerallyhavelimitedEnglishlanguageliteracywhichincreasestheirriskofnotreceivingkeyhealthmessagesandthereforeincreasingthepotentialimpactofCOVID-19-inparticulartheDeltastrainwhichhasprovenhighlyinfectiousamongst household members
Vaccine uptakeNotdissimilartothewidercommunitymorepeopleinourstudywereplanningtohavethevaccinethannotandanumberhadalreadybeenvaccinatedInarecentLancetarticle(February2021)ConcernsandmotivationsaboutCOVID-19vaccinationfindingsfromtwosurveysfromanAustralianlongitudinalstudyconductedinJuneandJuly2020includedthatlsquothetopthreerea-sons for agreeing to vaccinate were lsquoto protect themselvesandothersrsquohelliplsquobeliefinvaccinationandsciencersquohellipandlsquotohelpstopthevirusspreadrsquoEven among those willing to vaccinate there was somehesitancyaboutthesafetyofthevaccineTheLancetarticlenotedthatlsquowillingnesstovaccinatedifferedbybothageandeducationrsquoForthosewhowereindifferentorsaidtheywouldnot get the vaccine the top reasons across the twosurveyswerelsquoconcernaboutthesafetyofthevaccineinitsdevelopmentrsquoandlsquopotentialsideeffectsrsquo12
Olderpeopleinourstudywhocomprised23of the total sample (n=199) were the group most likelytosaythattheywantedtogetthevaccine85ofthoseover65saidtheywouldhaveorhadalreadyhadthevaccineVaccinepredispo-sitionwashoweveralsostrongacrossotherage
12RHDoddKPicklesBNickelECvejicJAyreCBatcupCBonnerTCoppSCornellTDakinJIsautierKJMcCafferyConcerns and motivations about COVID-19 vaccination SydneyHealthLiteracyLabSydneySchoolofPublicHealthFacultyofMedicineandHealthUniversityofSydneypublishedintheLancetFebruary2021p162wwwthelancet cominfectionVol21February2021
theircircumstancesHoweverthesourcesofin-formationthatpeoplemostrelyuponortrustarecriticaltothedisseminationofaccurateandclearmessaging to dispel the fear surrounding events suchasbloodclottingandthemisconceptionsraisedinthefocusgroupsWithsomanypartici-pantsinthisstudygettingtheirinformationfromFacebookandothersocialmediasitesitisvitalthat these channels are used to promote simple positivemessagesandforanyfuturecommunityawareness campaigns
Effective communicationConfusionandmisconceptionsaboutthevac-cinersquosefficacyavailabilityandsafetywereallis-sues that were raised in the focus groups Finding waystoeffectivelycommunicatewithpeoplewithlowerEnglishlanguageliteracyandhealthliteracyisanimportantwaytoaddresstheconfusionandmisconceptionsaboutthevaccineashasbeen discussed in a number of recent Australian studies
Astudy14byMcCafferyetal(2020)concludedthattherearelsquoimportantdisparitiesinCOVID-19-relatedknowledgeattitudesandbehavioursaccordingtopeoplersquoshealthliteracyandlanguagersquoOneofthefindingswasthatlsquopeoplewithlowerhealthliteracywerealsomorelikelyto endorse misinformed beliefs about COVID-19 andvaccinations(ingeneral)thanthosewithadequatehealthliteracyThesamepatternofresults was observed among people who primar-ilyspeakalanguageotherthanEnglishathomersquoTheMcCafferystudyhighlightstheimportanceof tailoring health messages to those with lower healthliteracyandculturallyandlinguisticallydiversecommunitiesItpointsoutthatthereareexamplesofeffectivemanagementofdiversecommunityneedsthatusetailoredhealthmes-sagesandcitestheWesternSydneyLocalHealthDistrictHealthLiteracyHub
13TheEssentialReport-anonlinesurveyconductedbyEssentialResearchcompletedby1090people between 21ndash26 April14McCafferyKJDoddRHCvejicEAyreJBatcupCIsautierJMJCoppTBonnerCPicklesKNickelBDakinTCornellSWolf MS Health literacy and disparities in COVID-19ndashrelated knowledge attitudes beliefs and behaviours in Australia PublicHealthResPract202030(4)e30342012December2020
15 Op cit16 httpssphmedunsweduausitesdefaultfilessphcmNewsEnhancing-supporting-COVID-19-vaccination-programpdf
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
30 31
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3332
intodifferentnetworkingspacessuchaswork-placeslocalgymsmothersrsquogroupsandseniorsrsquoclubswithafocusonallagegroupsregardlessofcurrenteligibilityAccordingtoSealethechal-lengeislsquoensuringemerginginformationisadapt-edfortheintendedaudiencersquoShehasalsosaidlsquoThatrsquoswhatIrsquomalittlebitconcernedaboutatthemomenttherersquosalotofresourcesongov-ernmentwebsitesbutthesetermsaroundbloodclottingareverytechnicalWeactuallyneedtomake sure that we are breaking them down in a waythatwillmakeitmeaningfultopeopleThatrsquosnotjustabouttranslatingitrsquosaboutbeingcon-sciousofpeoplersquoshealthliteracyneedstooSomaybegettingsomemorevisualsintomaterialstotryandsupportthatrsquo17
Thereareanumberofmulticulturalhealthresourcesthatusecommunitylanguagetransla-tionsplainEnglishandvideosfromCALDcommu-nityleaderswhichcanbedownloadedandusedbyservicesandindividualsHowevermanyofthewrittenresourcesstillrelyontechnicalandscien-tifictermsthatrequireareasonablyhighlevelofEnglishlanguageliteracyorhighlevelsofliteracyin the translated language to comprehend Host websites can also be hard to navigate making itdifficulttolocateresourcesfromsimplewebsearchesAsummaryofsomeoftheavailableresourcescanbefoundatAttachment2
MulticulturalHealthUnitsinLocalHealthDis-trictshavestaffwhocanworkwithpeoplefromculturallyandlinguisticallydiversecommunitiesatthelocallevelandtranslateandcontextualisethese materials to the needs of the end user These teams respond to local needs and popu-lationdemographicsandareexpertsineffectivehealthliteracyandhealthcommunicationwiththeirlocalcommunitiesTheyworkcloselywithcommunityandvulnerablegroupstobuildhealthliteracyandimprovedhealthoutcomesintheircommunities
Case Study ndash Be a COVID Warrior ndash Responding to COVID-19 in Multicultural Communities InWollongongtheIllawarraShoalhavenLocalHealthDistrict(ISLHD)MulticulturalHealthSer-viceco-designedacommunityengagementandeducationprogramcalledlsquoBeaCOVIDWarriorrsquowhich commenced in 2020 in response to the pandemic This program was designed to respond tothelowlevelsofhealthliteracyaroundCOVID-19potentialexposuretothevirusandaddressfearandstigmainthelocalCALDcommunitiesThelsquoCOVIDWarriorrsquoprogramreachedaround880peopleranginginagefrom14to85years65ofCOVIDWarriorparticipantswerefemaleand35weremaleCOVIDWarriorparticipantsrepresented 21 language groups The outcomes of the program included increased levels of confidenceinapplyinginfectioncontrolmeasuresincreasedliteracyandhealthliteracyandawarenessofhowCOVID-19istransmittedUltimatelyanimprovedawarenessinapplyingCOVIDsafemeasures was also reported
InApril2020theservicecommencedwelfarechecksviaphoneonafortnightlybasistosup-portsocially-isolatedmulticulturalseniorswhoboretheemotionalstressofsocialisolationFrom these calls the ISLHD heard the needs and concernsofseniorsinthecommunityInadditionourexperiencewithCALDcommunitieshighlightedtheimportanceofyoungpeopleasconduitsofessentialinformationtoadultsincommunityandfamilygroupsduetoEnglishlanguageaccessandeducation
InresponsetheISLHDinitiatedthelsquoCOVIDWarri-orrsquoprogramusingbi-culturalhighschoolstudentsthroughthelocalhighschoolsByincreasingthehealthliteracyofstudentsatschooltheselsquocham-pionsrsquocouldtalktotheirfamiliesincludingolderfamilymembersininformalsettingsandthroughsocialmediawiththeirpeersasastrategytoraisethe level of knowledge of COVID-19 trans-mission preventionandtestingTheprogrambecamesopopularthatitwasextendedintomorelocalhighschools and adults accessing the Adult Migrant EnglishProgramTheprogramwassupportedbylocalsettlementservicesprovidedbybothMaxSolutionsandtheRedCrossItwas
17 httpstheconversationcomhow-can-governments-communicate-with-multicultural-australians-about-COVID-19-vaccines-its-not-as-simple-as-having-a-poster-in-their-language-156097
later extendedtoCALDSeniorsthroughtheMulticulturalCommunitiesCouncilIllawarra(MCCI)supportprograms
AkeycomponentoftheprogramwastoprovideparticipantswithlsquoCOVIDWarriorrsquoKitswhichincludedtworeusablemaskshandsanitiserinfographicsaboutCOVID-19symptomsandinfor-mationaboutwheretestingclinicswereavailablelocallyMCCIandRuralAustraliaforRefugeesdonatedreusablemasksforeveryparticipant
AsthelsquoCOVIDWarriorrsquoprogramwasevolvingsowasthenationalvaccinerolloutplanInforma-tionwasthereforeadaptedtomeetthisinfor-mationgapForexampleadultparticipantsandseniors were supported to understand how to accesstheCOVIDvaccinelsquoeligibilitycheckersrsquoandCALD people were shown how to use the NSW HealthwebsiteCOVID-19informationpages18
Decision makingHowpeoplearecurrentlyconsideringtheriskofCOVID-19isinfluencedbyarangeoffactorsincludingratesoftransmissioninthecommunitynumbersofnewcasesreportsinthemediaofrisksandsideeffectsPeopletendtobasetheirassessmentonwhattheyarecurrentlyexperi-encingandthencheckthisagainstwhattheyarehearinginthemediaincludingandespeciallyonsocialmediaandfromfamilyandfriendsMostoftheparticipantsinourstudyspokeclearlyandarticulatelyabouthowtheyweigheduptherisk-benefitofhavingtheCOVID-19vaccineintheir decision making Low case numbers ndash at the timeofconductingtheresearchndashandasensethat Australia was lsquodoing well in safeguarding the communityagainstCOVID-19rsquoweresignificantfactorsinpeoplersquosdecisionnottobevaccinatedortoadoptalsquowaitandseersquoapproachFamilyfriends and social media were reported as having aconsiderableinfluenceondecisionmakingaswerereportsinthemediaofthebloodclottingsideeffectsofAstraZeneca
ThefactthatFacebookwasreportedlythemostpopularsourceofinformationaboutCOVID-19
18httpswwwhealthnswgovauInfectiouscovid-19Pagesdefaultaspx
andtheCOVID-19vaccineforpeopleinthestudyraisesconcernsaboutthepossibledisseminationofmisconceptionsandlsquofakenewsrsquothatmaybespread or compounded via social media Closed social media groups such as WhatsApp and WeChatwithfamilyandfriendsmayalsoleadtopeoplereinforcingtheirpre-existingbiasesThesefactorscoupledwithasensethatAustraliaisfaringwellcomparedtomanycountriesoverseasappear to have resulted in increased vaccine hesi-tancyamongparticipantsofthestudy
Factorsthatwereidentifiedaschangingvaccine-hesitantparticipantsrsquoperceptionswereanincreased risk from COVID-19 and a correspond-ingincreaseinthenumberofinfectionsandonthebenefitsidetheabilitytotraveloverseastovisitfamilyIntherecentresearchfromtheUniversityofNSWcitedaboveSearlearguesthatlsquotheremaybeotherthingsthatweneedtonowstartfocusingonhellipthatwillstarttopromoteandmotivatepeoplesuchasthechancetotravelmorefreelyforexamplersquoThisappearstobeborneoutbyourfocusgroupfindings19
Untilrecentlytherehavebeenverylowcasenumbers and few lockdowns across most of Aus-tralia and NSW The recent outbreak from mid-JuneinGreaterSydneyandintroductionofthehighlyinfectiousDeltavariantinNSWislikelytoimpactonpeoplersquosassessmentsoftherisk-benefitofhavingthevaccineandonewouldassumereducehesitancyrates
GiventheheightenedcommunityanxietycausedbythisrecentCOVID-19outbreaktheproductionofshortsharpandtargetedmessagingtoCALDgroupsincommunitylanguagesthatisaccessibleandmotivationalfeaturescommunityleadershigh-profilecelebritiesandsportsstarsfromCALDbackgroundsandisdirectedatastate-wideandlocal level would appear to be more urgent than everItisclearthatformessagingtobeeffectiveandreachitsintendedaudiencedistributionchannelsshouldincludeFacebookWhatsAppandothersocialmediaplatformsaswellastrustedsourcessuchasmulticulturalhealthworkersmulticulturalservicesandthroughGPsandMedical Centres If mainstream COVID-19 vaccine
19 Op cit
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
32 33
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3534
awareness campaigns are produced in Australia suchashavebeenproducedinNewZealandtheUnitedKingdomandNorthAmericatheyshouldincludehighprofilewell-knowncommunityfig-uresandsportingstarsfromCALDbackgroundsandincludestrategiesspecificallytargetingCALDcommunitiesincludinggroupsidentifiedaspar-ticularlyhigh-risk
It is also important that informationonvaccinesistranslatedintolanguagesfromnewerandemergingcommunitiesOthersuggestionsaroundreachingthesecommunitiesincludeface-to-facemeetingsorganisedbycrossagencypartnershipsandpeer-ledstrategiessuchas mobilising community champions and influenc-ers Messaging needs to be inclusive and framed around the collective values held by commu-n5
It is clear that reinforcing the benefits of being vaccinated at this time rather than dwelling on the risks is more likely to generate behavioural
changeandapositivevaccineresponsefrombothCALDcommunitiesandthegeneralpopulationAppropriately-designedandtargetedCOVID-19vaccinehealthinformationthatiseasytoreadinanylanguagecanbeconveyedbycommunityleadersandcommunitynetworksandpromotesthepositivebenefitsofgettingvaccinatedwouldbevaluableatthistimeBuildingontheworkofpeerchampionssuchastheCOVIDWarriorprogramisalsoasuccessfulmodeltoincreasingCOVID-19vaccinehealthliteracyandinformed decision making
Mostimportantlypositivelymotivatingculturallyandlinguisticallydiversecommunitymemberstolsquogetthejabrsquoespeciallythosewhoareadoptingalsquowaitandseersquoapproachorarevaccinehesitantwould lead to greater vaccine uptake among culturallyandlinguisticallydiversecommunitiesandthereforethecommunityasawhole
Inner West Multicultural Network Addison Road Community Centre DateWednesday12May
A focus group session of members of the Inner WestMulticulturalNetworkpluscustomersoftheFoodPantryatAddisonRoadwasheldattheAddisonRoadCommunityCentreinMarrickvilleon12Mayat200pmThesessionwaspartoftheregularmeetingoftheInnerWestMulticul-turalNetworkTheconsultationinvolvedabout26peopleandwasconductedbyRosannaBarbero
Thegroupbrainstormedresponsestoquestionsaroundvaccinehesitancyinmulticulturalcom-munitiesandmoreeffectivemessagingTheseresponseshavebeenincorporatedinthefindingsof the report
Griffith Women on Fire Focus Group Griffith Community Centre DateFriday14May
This small focus group of women was held at GriffithCommunityCentreonMay14at11amMargCouchSeniorProjectOfficerRegionalDevelopmentAustralia(RDA)-RiverinaandJoanneFitzpatrickSettlementEngagementandTransitionSupport Worker from Centacare Southwest NSW werethekeylinksandnetworkcontactsfortheGriffithcommunityTheWomenonFire(WOF)group was established as part of the Red Cross RuralFireServiceprogramlsquoManyCulturesOneCommunityrsquoInitiallyitwasestablishedtoeducatewomenonemergencypreparednessandtoen-courage NSW Rural Fire Service (RFS) volunteering andnowhastransformedintoacommunityac-tionsupportgroupTheGriffithSoroptimistInter-nationalnowauspicetheirfinancesandsupporttheWOFgroupactivitiesThefocusgroupwasfacilitatedbyCamillaCouchandlocalcommunityvolunteersledbytheGriffithSoroptimistClub
The women in the group were from Pakistan and IndonesiaThegroupweremainlyyoungmotherswithyoungchildrenandtheprogramhadchild-minding arrangements The language level of the womenwaslowandmostwerestudyingESOLat
ATTACHMENTS
ATTACHMENT 1 A Description of the Focus Groups
TAFEThedeliveryoftheinformationwaslimiteddue to language levels and the lack of bilingual interpretersEachparticipantworkedoneononewithavolunteertoslowlyfillinthesurveyandonewomantookthesurveyhometodiscusswithherhusbandThisgroupexperiencehighlightedthe lack of bilingual workers and services in some rural areas
Arabic speaking group Syd West Multicultural Services Mount Druitt Community worker Zaid Naoum Generalist Caseworker SydWest Multicultural Services DateMonday24May
ThefocusgroupfromSydWestMulticulturalSer-viceswasconductedonMonday24May2021atSydWestMulticulturalServicesMountDruittat300pmItwasfacilitatedbyPatriciaMcCormickandsupportedbyZaidNaoumGeneralistCase-workerSydWestMulticulturalServices
Therewere10womenandmenfromSyriainthegroupThegroupweremostlymaturetoolderparticipantsMostparticipantsrequiredassistancewithEnglishandthecaseworkerZaidNaoumhadtranslatedthesurveyintoArabicpriorto the focus group Zaid also translated during the focus group
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Canterbury City Community Centre (4Cs) group The Cottage Lakemba DateTuesday25May
ThefocusgroupfromCanterburyCityCommunityCentre(4Cs)wasconductedonTuesday25MayattheCottageat28CroydonStreetLakembaat10amItwasfacilitatedbyRobinMilesandsup-portedbyRomanaWaseemCommunityWorkerfrom 4Cs
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
34
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3736
The group was comprised of 14 women from PakistanIndiaandSriLankaThewomenrangedinagefrom23to65MostwerefluentEnglishspeakershoweveronewomanrequiredtransla-tionintoUrdufromoneoftheotherwomeninthegrouptoanswerthequestionsdirectly
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
NSW Chaldean League group Community worker Randa Goriya DateTuesday25May
ThefocusgroupfromNSWChaldeanLeagueMountDruittwasconductedonTuesday25May2021 at 1000am at the NSW Chaldean League premisesItwasfacilitatedbyPatriciaMcCormickandsupportedbyRandaGoriyaacommunityworker for the NSW Chaldean League in Mount DruittRandatranslatedtheintroductionandpromptsforthediscussionandhelpedthepartic-ipantstocompletethesurveyMostofthegrouprequiredhelptodothesurvey
ThegroupoftwelveparticipantswereallChaldeanandwerematuretoolderinageTheywereamixed-gendergroup
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Arabic speaking group Red Cross premises Wollongong DateTuesday25May
ThefocusgrouptookplaceonTuesday25Mayat 3pm at the Red Cross premises at Wollongong Therewere22womenandmenparticipatinginthegroupThefocusgroupwasfacilitatedbyCamilla Couch with support from Khalid Zainu-labdeenBilingualSupportWorkerHumanitarianSettlementProgram(ACTampNSW)
There were diverse ages in the group ranging fromyoungpeopletoolderagedMostofthegroupwereyoungerrecently-arrivedrefugeesfrom diverse backgrounds There was also a small-eroldercohortofparticipantswithhigherliteracylevelsandstrongercommunityengagementwith the local services in the area Camilla Couch facilitated the focus group which was conducted inArabicandEnglishwiththeArabictranslationprovidedbyKhalidZainulabdeen
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Work Opportunities for Women group Mt Druitt TAFE DateWednesday26May
TheWorkOpportunitiesforWomen(WOW)focusgroupwasheldonWednesdayMay261100ndash 100pmatMtDruittTAFEItwasfacilitatedbyCamilla Couch and built on the knowledge gainedintheprevioussessiononcriticalandanalyticalthinkingTheWOWgroupisaTAFECertificatelevel course
There were 14 women from diverse cultural backgroundsinthegroupThegroupweremainlyMuslimwomenwithschoolagechildrenandsome were mature aged Due to the learning fo-custhegroupwasfacilitatedasaclasswithguid-eddiscussionontheissuesandcarefulanalysisofthequestionsNotranslationwasneededduetotheeducationalcontextThestudentswereadeptatusingITandcompletedallthesurveysonline
STARTTS Tamil group Toongabbie Community Centre Community worker Sivaharani (Harani) Mayuran DateThursday27May
Thefocusgroupconsistedof18femalepartic-ipantswhowereyoungertomatureagedThefocus group was held at 1000am at Toongabbie CommunityCentreinTargoRdToongabbie
ThefocusgroupwasfacilitatedbyPatriciaMc-CormickandsupportedbyacommunityworkerSivaharani(Harani)MayuranfromtheSTARTTSTamil Group
ThegrouphadmixedlevelsofspokenandwrittenEnglishTheintroductionanddiscussionpromptsweretranslatedbythecommunityworkerSivaha-rani(Harani)Mayuranandsheandthemorepro-ficientstudentssupportedthosewithlowliteracytoanswerthesurveyquestions
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Spanish Speakers Seniors group SydWest Multicultural Services Blacktown DateTuesday1June
TheFocusGrouptookplaceonTuesday1Juneat1100amattheBlacktownShowgroundsandconsistedof16participants(15womenandoneman)AllparticipantswerebornincountriesinSouthAmericaTheirEnglish-fluencylevelsvariedand one of the members of the group translated thesurveyquestionsanddiscussionintoSpanish
ThegrouphadbeenmeetingforseveralyearsThegroupwasfacilitatedbyLindyCassidyandwassupportedbySreeVithyaHarilingamDayRespiteampSocialSupportTeamLeaderatSydWestMulticulturalServicesBlacktownThegroupwerematureagedtoolderparticipants
Thegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyform There was a more focused discussion on somekeyquestionsaftersurveycompletionThetranslatorassistedconsiderablyinthisprocess
Italian Speakers group Warrawong Community Centre DateMonday7June
The focus group of Italian speakers was held on Monday7Juneat1015amattheWarrawongCommunityCentreItwasfacilitatedbyCamillaCouchandsupportedbyJohnPaulTroianiand
SofiaLemafromIllawarraShoalhavenLHDMulti-cultural Health
There were 15 women in the group The group weremostlymaturetoolderparticipantsandwasconductedinItalianandEnglishwithtranslationprovidedbyJohnPaulThisgroupmeetsregularlyandissupportedbyanumberofservicesintheareaespeciallymulticulturalhealth
The group had a general facilitated discussion aboutthequestionsinthesurveyDuetolittleornoliteracytheindividualsurveyresponseswerethencollectedintooneresponseThesesurveyresponses have been included in the general surveyresponses
Mothers Group SydWest Multicultural Services Blacktown DateThursday10June
ThefocusgrouptookplaceonThursday10Juneat1030amandconsistedof14youngwomen13 of whom had a CALD background The focus groupweremainlymothersfromasupportgroupatSydWestMulticulturalServicesinBlacktown
EightofthewomenwereborninIndiatwofromPakistantwofromSriLankaonefromHausaGhana and one was born in Australia (the Austral-ianbornyoungwomanwasasocialworkstudenthelpingwiththegroup)LindyCassidyfacilitatedthe group with support from Wilma Garguath a projectofficerfromSydWestMulticultural Services
The group varied in age One was between 18-24 yearsoldSevenwereagedbetween25-34yearsSixwereagedbetween35=44yearsGiventheirage and circumstances most of the group did not consider themselves eligible at this stage for vac-cinationThiswasanimportantdifferencefromotherfocusgroupsinthattheemphasiswasmoreonwhattheywoulddooncetheybecameeligible
Participantsdidnotrequireassistancewithspo-kenEnglishThegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyformTherewasamorefocuseddiscussiononsomekeyquestions
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3938
ATTACHMENT 2 COVID-19 Vaccine Information in multiple languagesThefollowingsitesappsprovidetranslatedinformationaboutCOVID-19vaccines
Type of information KeyinformationongettingvaccinatedinNew South Wales and on the vaccines available The websiteusesanautomaticservicetotranslate thecontentintodifferentlanguages
Source of information NSW Government website
Link httpswwwnswgovauCOVID-19health-and-wellbeingCOVID-19-vaccina-tion-nswgetting-vaccinated
Type of information COVID-19ResourcessectionontheServiceNSWapp The app has a link to NSW Government websiteinformationonldquoGettingaCOVID-19vaccinationrdquo(seeabove)ItalsoincludesalinktoCOVID-19vaccinationresourcesinotherlan-guages available from the Department of Health
Source of information Service NSW NSW Government
Link Service NSW App
Type of information ArangeoftranslatedresourcesonCOVID-19bytitleincludingafactsheetonCOVID-19VaccineAstraZeneca(ChAdOx1-S)
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCOV-ID-19Pagestranslatedresources-by-titleaspx
Type of information ADigitalCOVID-19resourcelibrarywithtranslated materials
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiouscov-id-19Pagesdigital-resourcesaspx
Type of information AMultilingualCommunityToolkitontheCOVID-19vaccinationprogramtoassist communityworkersprovideseasytoreadresourcesvideosandlinkstokeyservicesandresources
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCovid-19DocumentsNSW-COVID-19-vaccina-tion-program-presentation-20210527pdf
Type of information TheNSWMulticulturalHealthCommunicationServiceoffershealthresourcesandinformationin a wide range of languages It has translated resources on COVID-19 and links to translated resourcesonCOVID-19vaccination
Source of information MulticulturalHealthCommunicationServiceisa New South Wales-wide health service hosted bySouth-easternSydneyLocalHealthDistrict(SESLHD)
Link httpswwwmhcshealthnswgovau
Type of information COVID-19vaccineinformationaddressingkeyquestionsaboutCOVID-19vaccinationandincludesvideosposterstilesfactsheetsandaudio material Translated into 63 languages
Source of information Department of Health Australian Government website
Link httpswwwhealthgovauinitiatives-and-pro-gramsCOVID-19-vaccinesCOVID-19-vaccine-in-formation-in-your-language
Type of information ThisinformationaddressessomecommonmisinformationaboutCOVID-19Translatedintomultiplelanguages
Source of information DepartmentofHomeAffairs Australian Government website
Link httpscovid19inlanguagehomeaffairsgovaumisinformation-and-truths-about-coronavirus
Type of information Australianandinternationalnewsand informationaboutCOVID-19andCOVID-19 vaccinesisavailableontheSBSCoronavirusPortal in more than 60 languages
Source of information SBSwebsite
Link httpswwwsbscomaulanguagecoronavirus
Type of information InformationprovidedaboutCOVID-19vaccinerolloutandsafetyinlanguagesotherthan English
Source of information Department of Health and Human Services Victorian Government
Link httpswwwcoronavirusvicgovautranslat-ed-information-about-COVID-19-vaccines
Type of information HealthTranslationsprovidestranslatedmateri-alsonhealthandwellbeingInformationaboutCOVID-19isregularlyupdatedincludessomeinformationonvaccinationandisavailableinover60communitylanguages
Source of information Victoriangovernmentinitiative
Link httpswwwhealthtranslationsvicgovaubhcv2bhchtnsfPresentEnglishResource-AllOpenampx=amps=Coronavirus
Type of information A one-stop shop for translated materials in multiplelanguagesonCOVID-19
Source of information Ethnolink Language Services
Link httpswwwethnolinkcomauCOVID-19-coro-navirus-translated-resources
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
40
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
1918
Reasons for not having the vaccine
At the moment the situation is under control and donrsquot feel the need Also I have no plans to
travel in the near future so I donrsquot see the need
3514
21622703
3243
1892
811 541
4865
1081
Thevaccine isnot welltested
Thevaccine is
unsafe
Formedicalreasons
I amscared tohave thevaccine
I dont likevaccines
Forreligiousreasons
Forculturalreasons
I want towait and
see
Somethingelse
(pleasetell uswhat)
000
1000
2000
3000
4000
5000
6000
Figure 10 Reasons for not getting vaccinated against COVID-19
Theperceivedlsquolackofadequatetestingrsquoofthevaccineandlsquofearofbeingvaccinatedrsquoalsore-ceivedhighresponseratesselectedby3514and3243ofparticipantsrespectivelyOnly1355 of respondents cited religious or cultural reasonsasbeingbehindtheirvaccinehesitancy
Open-endedresponsestothisquestionincluded
The vaccine is not 100 working It cannot offer
100 protection
Ofthe42participantswhosaidthattheywouldnothaveorwerehesitanttohavethevaccine4865saidthattheypreferredtolsquowaitandseersquobeforegettingvaccinated
Thediscussioninthefocusgroupsaboutpeoplersquoshesitancytobevaccinatedfocusedonanumberofconcernswhichreflected
poorcommunicationfromanumberof trusted sources including GPs and some media sources
conflictinginformationaboutthevaccinefrom healthauthorities
fearsaboutvaccinesafetythataresharedby thegeneralcommunity
misconceptionsabouttheeffectivenessof andhowthevaccineswork
I will not have it because make me sick
Issuesraisedinfocusgroupsascontributingtoincreasedhesitancyincluded
Some GPs being hesitant to recommendvaccination
Theinformationbeingprovidedisconflicting
Theinformationisoverlycomplexandnotcomprehensibleregardlessofwhetherithasbeen translated
The risk of blood clots
Perceptionsthatthevaccinesaregenerallyunsafe
Concernsthatsomepeoplearedyingafterbeing vaccinated
Not being sure about the risks associated withhaving the vaccine and being pregnant orbreastfeeding
Theperceptionthattherehasbeenalackoftestingofthevaccinespriortorollout
AlackofunderstandingofhowvaccinesworkthecompositionofthevaccinesandwhattheywoulddotothebodyincludingmakingchangestoapersonrsquosDNA
Specificcommentsincluded
I have heard that the vaccine changes
your DNA
I am a mother I am not sure it [the vaccine] is safe for
me when I am breastfeeding
If you are young and healthy your body has the energy to fight the virus
You donrsquot need to have the vaccine You should just let
your body fight it itself
They donrsquot tell you what chemicals are in the
vaccine
Tamil Focus Group Feedback Sheet
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2120
Nobody knows what to do My GP doesnrsquot even know what I should do whether
I should have it or not
I am not sure what to do I have spoken to my
GP but they canrsquot tell me whether I should have the vaccine or not while I am
breastfeeding
They say one thing and then they tell you
something elsehellip it [the vaccine rollout] is so
confusing
Confusionaboutwhattodowheretogoandthe health impacts of the vaccine was a common threadintheconversationsaroundvaccinehesi-tancy
Onewomanwhosehusbandworkedforasecurityfirmsaidthatherhusbandhadhadtobevacci-natedinordertokeephisjob
In several focus groups the issue of government control was also raised A number of people re-portedstronglythattheyfearedthatthevaccinewas lsquoa means that the government was using to controlpeoplersquo
He [husband] had to have it He didnrsquot have a choice He was fine [no side effects] but Irsquom not
thinking I will have it I donrsquot need to Irsquom a mum Irsquom busy I have
to look after my children I donrsquot know how I feel about it whether
Irsquom going to have it
Vaccine refusal
Onlyasmallnumberofparticipants(24or13)saidtheywouldnotgetvacci-natedOfthisgroup21werewomenand 2 were men8 Respondents were bornintendifferentcountrieswithadiverse range of language backgrounds
I never get sick It is the same for all my family We have always been strong and healthy so I will be
saying no to the vaccine
Country of Birth Language Background Count Pakistan Urdu 4 China Taiwan Chinese
(MandarinCantonese) 4
Sri Lanka India Tamil 3 Chile Spanish and English 2 Italy Italian 2 Iraq Syria Arabic 2 Iraq Chaldean 1 Iran Farsi 1 Greece Macedonian 1 Poland Polish 1 Pakistan Punjabi 1 Sweden Swedish 1 Vietnam Vietnamese 1
Table 4 Vaccine refusal by country of birth and language background
8 ThisreflectstheoverallsamplebiastowardswomenThemajorityoffocusgroupparticipantswerewomenXwithYparticipantsbeingmen
Reason for not having the vaccine Percent Count The vaccine is not well tested 5455 12 I want to wait and see 5455 12 The vaccine is unsafe 3636 8 For medical reasons 3182 7 I am scared to have the vaccine 3182 7 I dont like vaccines 1364 3 For religious reasons 1364 3 For cultural reasons 909 2 Something else (please tell us what) 909 2
SomeinthiscategorywereadamantthattheywouldnotbehavingthevaccineandhadverystrongviewsonitlsquoForculturalreasonsIwonrsquotbehavingthevaccinersquoWhenwelookatrespons-esmorecloselyhoweveritwouldappearthatmanyareinfactmorelsquohesitantrsquothanfirmvaccinerefusers
One reluctant middle-aged Tamil-speaking wom-ansaidlsquoIftheysaywehavetogetvaccinatedthenIwillrsquoThissentimentwas stronglysup-portedbythe rest of the Tamil-speaking group
Studyparticipantswhosaidtheywouldnothavethe vaccine were also concerned that lsquothe vaccine wasnotwelltestedrsquo
The vaccine has been rushed out It has not been
properly tested
Table 5 Reasons for not having the vaccine
Peopleinthiscategorysaidthattheywouldlsquowaitandseersquowhathappenswiththewiderrolloutbe-foremakingtheirfinaldecisionThissuggeststhataproportionofthelsquonorsquogroupareinfacthesitantrather than outright refusing to have the vaccine
Therewerealsofearsexpressedbyfocusgroupparticipantsaboutthedangersofbeingvacci-natedParticipantsreportedbeingafraidofthehealthrisksespeciallyfrombloodclotsSomepeopledistinguishedclearlybetweenAstraZene-caandPfizerinthisregardHoweverformanythedistinctionbetweenthedifferentvaccineswaslostandtheyspokeofthevaccinesgenerallybeing unsafe and having a range of unwanted side effects
Other factors consideredInadditiontothebroaderquestionsofwhypeo-plewouldorwouldnotchoosetogetvaccinatedthe research team used the focus group discus-sionstoexplorewhetherthefollowingfactorshadanyimpactonapersonrsquoslikelihoodofbeingvaccine pre-disposed or hesitant
Knowing someone who had been vaccinated
Knowing someone who had contracted COVID-19
Knowing where to go to get vaccinated
Thesourcespeopleturntoforinformation about COVID-19 and COVID-19 vaccines
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2322
Knowing someone who has been vaccinatedOfthosewhorespondedtothisquestion125or70knewsomeonewhohadalreadyhadthevaccine
6983
2570
447
Yes No Dont know000
1000
2000
3000
4000
5000
6000
7000
8000
Figure 11 Do you know someone who has been vaccinated
Amongthe125participantswhoknewsomeonewhohadalreadybeenvaccinated100identifiedlsquoimmediatefamilymembersrsquo(parentschildrensiblingsandpartners)Somefocusgrouppartic-ipantsreportedthatalloftheirfamilymembersoverseas had been vaccinated Others reported thattheirrelativeshadbeenvaccinatedasarequirementoftheiremployment
Who Count Percent Other family member 41 313 Sister 24 1832 Community member 23 1756 Brother 18 1374 Father 17 1298 Mother 16 1221 Work colleague 14 1069 Husband or wife 11 84 Son or daughter 10 763 Partner 4 305 Someone else 45 3435 Total respondents 131
Table 6 Who do you know who has been vaccinated
When this issue was teased out further in focus groupdiscussionsarangeofreasonswere revealed including
My husband works in security and he had
to get it
My friend works as a COVID-19 cleaner and they all had to [get
vaccinated]
My family overseas have already been vaccinated
My son needs to travel for work so he is getting it
My brother in the UK is a doctor and he got it and
his wife
Knowing someone who has had COVID-19Almosthalfoftheparticipantsknewsomeonewho had contracted COVID-19 overseas Some reportedthatallthemembersoftheirfamilyormanymembersoftheirextendedfamilyhadcon-tracted COVID-19 In the older Italian group 10 of the15womenknewsomeoneinItalywhohadcontracted COVID-19
4716 4659
625
Yes No Not sure000
1000
2000
3000
4000
5000
Figure 12 Knowing someone who has had COVID-19
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2524
385 385
1538
2692
641 513000
4359
2051
1026385
1410
Mother
Father
BrotherSis
ter
Son or d
augh
ter
Husban
d or wife
Partner
Other family
mem
berFri
end
Community m
ember
Work co
lleag
ue
Someone else
(please
tell u
s who)
000500
100015002000250030003500400045005000
Figure 13 Who do you know who has had COVID-19
Four people in the focus groups knew someone who had died of COVID-19
All my family back home [Pakistan] got it [COVID-19] but
they are all fine now apart from my father He died But he was really sick before he
got it He had lots of underlying conditions Medical conditions so he was really unwell before he got COVID-19 But everyone else
they are fine now They were sick but they got betterhellip
If you are well and healthy you can fight this off
SurprisinglyknowingpeoplewhohadcontractedCOVID-19didnotseemtoinfluencefocusgroupparticipantsrsquopredispositiontowardseitherhavingthevaccineorbeingvaccinehesitantHowevertheolderItalianwomenrsquosgroupspokeabouttheimpactthatCOVID-19hadhadinItalyintheearlystagesofthepandemicandhowthishadaffectedthemdeeply13ofthe15womeninthisgroupwouldhaveorhadalreadyhadthevaccine
Knowing where to get vaccinated115people(81)whorespondedtothisquestion(n=142) knew where to go to get the vaccine 34 people(19)reportedthattheydidnotknowThisincluded15respondentsfromIraq3re-spondentsfromIndia2respondentsfromChina2 respondents from Pakistan and one respondent fromeachofthefollowingcountriesChinaEri-treaItalySriLankaSwedenSyriaandVietnamThese people were also less sure about whether ornottheywouldhavethevaccineItispossiblethat their lack of knowledge about where to go to get vaccinated was related to their general level ofvaccinehesitancy
7958
29582254
282 563
GPDoctor Vaccinecentre
Hospital Work place Somewhereelse (please
tell us where)
000100020003000400050006000700080009000
Figure 14 Where to go to get vaccinated
From the sample (n=199) GPs were the most commonlyidentifiedplacetogotogetvaccinat-edfollowedbythevaccinecentreatHomebushBayandthenhospitalsOtherplacesidentifiedincluded medical centres and pharmacies
Sources of information about COVID-19 and the vaccineThelargestsinglesourceofinformationaboutCOVID-19 and the vaccine was Facebook (417)
2743
3486
13141086
30862686
3429
2229 2286
41713714
2571
1086 971
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)000500
10001500200025003000350040004500
Figure 15 Sources of information about COVID-19 and the COVID-19 vaccine
Facebook I get my information from
Facebook But if I want to check it I watch the news
on 7 [Channel 7]
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2726
Thesecondlargestsourceofinformationforpeople in the sample was lsquoother forms of social mediarsquo(37)followedbySBStelevision(35)myfriends(34)andothertelevision(31)Oth-ersourcesofinformationpeoplereportedthattheyusedweretheNSWHealthwebsitenightlytelevisionnewsincludingChannel7Channel9andChannel10followedbytheABCtheAustral-iangovernmenthealthwebsitetheirGPlocalMedical Centres and the Red Cross
IntheLakembafocusgrouppredominantlymadeupofwomenfromPakistantherewasanani-mated discussion about Facebook which was the majorsourceofinformationalongwithGooglesearchesandcommunityandfriendship-basedWhatsApp groups There was a general consensus from most in the group that these were their pre-ferredormostcommonsourcesofinformationandnewsHoweveriftheywantedtolsquofactcheckrsquowhattheywerehearingtheywouldwatchthenightlynewsonChannel7orChannel9toverifywhattheyperceivedcouldsometimesbeunrelia-ble sources
IntheMtDruittfocusgroupseveralofthewom-enwithwell-developeddigitalliteracyandgener-alliteracyskillsusedhealthandfitnesswebsitesand social media sites as their source of infor-mationaboutlsquoallthingshealthrelatedrsquoincludingCOVID-19ThesewomenalsospokepositivelyabouttheinformationandsupporttheygotfromthestaffatCanterburyCouncilCommunityCentre(4Cs)whotheycouldrelyontofindoutthingsthattheyidentifiedtheyneededtoknowmoreabout
InthesmallerfocusgroupinGriffithwithrecently-arrived refugee women who had low levels of Englishlanguageliteracytherewaslittleknowledgeaboutthevaccinesnoawarenessofthedifferenttypesofvaccinesandlittleknow-ledgeaboutwheretogotogetvaccinatedorfindoutmoreaboutCOVID-19ingeneralThecommunityservicestaffandvolunteerspresentatthegroupwere working hard to assist these women to improve their English language skills and support themwithtranslatedinformation
In the older Italian women focus group in Wollon-gongparticipantsreportedgettingtheirinfor-mationfromslightlydifferentsourcesndashfamilyinAustralia(10women)Channel9(7women)
Italianradio(3women)andABCTV(3women)Onlytwowomenusedtheinternetandnoneofthe women reported using Facebook or social mediaasasourceoftheirinformationSeveralmentionedthattheygottheirinformationfromtheirGPorspecialistdoctorandonepartici-pantsaidrsquoIdonrsquotlistentoanyonersquoIntheSpan-ish-speaking focus group a comment was made thatseemedtoreflectmanyoftheotherfocusgroup discussions
Whenlsquosourcesofinformationrsquoiscorrelatedwiththegroupwhosaidtheywouldhavethevaccine(n=104)thereisashiftfromFacebookbeingthepreferredsourceofinformationtolsquoSBSTVrsquobeingthepreferredsourceThelsquovaccine-predisposedrsquogroupalsohadthelowestrateofrelyingonFace-bookasasourceofinformationaboutCOVID-19thoughitwasstillhighThegraphbelowhigh-lightshowotherlsquopreferredsourcesrsquoplayoutforthoseintendingtohaveorwhohavealreadyhadthe vaccine
ForthoseparticipantswhoindicatedthattheywouldnotorwerenotplanningtohavethevaccinelsquoFacebookrsquolsquomyfriendsrsquoandlsquomyfamilyrsquowerethesourcesofinformationaboutCOVID-19thatwereequallymostfrequentlycitedfollowedcloselybylsquomyfamilyoverseasrsquolsquoSBSradiorsquoandlsquoSBSTVrsquoassourcesofinformationreceivedthelowestmentionsfromthisgroup(SeeFigure16)
The vaccine-hesitant group were the group who identifiedlsquoFacebookrsquoastheirmostfrequentsourceofinformationaboutCOVID-19lsquoFace-bookrsquowasfollowedbylsquoothersocialmediarsquoandlsquomyfriendsrsquoasthenextmostfrequentsources
lsquoThiscommunityserviceproviderrsquo(theinterme-diaryorganisationwherethefocusgroupwasconducted)wasidentifiedby26ofrespondentsasasourceofinformationregardlessoftheirintentiontogetvaccinatedornotThefactthatboththelsquovaccinehesitantrsquoandthosewhoindi-catedtheywouldnrsquotbegettingthevaccinesoughtinformationfromthissourcesuggeststhatrolling
There is so much confusion about it [the vaccine] that I think my GP is the best
place to go
9 This group of the research sample included a small number ofpeoplewhohadalreadybeenvaccinated
2626
4141
14141111
323228282828
2424
1818
37373737
2828
10101212
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)00050010001500200025003000350040004500
2857
2381
952 952
2857
3333
42864286
3810
4286
23812381
1429
952
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another co
mmunity se
rvice
Somewhere
else (p
lease te
ll us w
here)000
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Figure 16 Sources of information for respondents who were planning to have the vaccine9
Figure 17 Sources of information for respondents who were not planning to have the vaccine
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2928
outpositivemessagingthroughtrusted communityserviceorganisationscouldbeaneffectivewayofshiftingpeoplefromvaccine hesitancytodecidingtohavethevaccine
31372549
980 980
25492157
4314
1176
2353
4902
4118
2157
980392
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)000
1000
2000
3000
4000
5000
6000
Figure 18 Sources of information for respondents who lsquodonrsquot knowrsquo if they will have the vaccine
DISCUSSION
wardstheCOVID-19vaccineareasvariedastheyarewithinthebroadercommunityTherearearangeofinfluencingfactorsincludingagehealthstatushowlongtheyhavebeeninAustraliahowmuchnewstheyreceivefromoverseasandhowbadlyimpactedbythepandemictheirhomecountries have been
The research also highlights that people from culturallyandlinguisticallydiversebackgroundsgettheirinformationaboutCOVID-19andtheCOVID-19vaccinefromawidevarietyofsourcesbothformalandinformalandthatforparticulargroupsinthisstudythereisahighrelianceonFacebookovermoreofficialsourcesofinforma-tion
VulnerabilityTheneedsofhighly-vulnerablegroupswithintheCALDcommunityhavetobetakenintoconsider-ationThisincludesolderpeoplewhohavelivedinAustraliaformanyyearsbuthavelowlevelsofEnglishliteracyndashespeciallywritingandreadingEnglishandsometimesspokenEnglishndashandwhoaremoresusceptibletoseriousillnessandhigherratesofhospitalisationanddeathfromCOVID-19Italsoincludesnewly-arrivedrefugeeswhohavinglowornoEnglishlanguageliteracylacktheconnectionstoandnetworksintothewidercommunityandcommunitysupportsItisalsothecase that some people in these groups are not health literate at all and cannot read and write in their own language
Akeytakeoutfromthehealthandcommunityserviceorganisationsurveyresponsesandinter-viewsundertakenwithmulticulturalhealthandcommunicationexpertsfortheprojectisthatlit-eracylevelsreallydomatterLowlevelsofhealthliteracylowlevelsofEnglishlanguageliteracyandpossiblylowlevelsofliteracyintheirownlan-guage-especiallyforsomenewly-arrivedrefu-gees and those who are part of the humanitarian program such as Dari language speakers from AfghanistanTigrinyalanguagespeakersfromEr-itrea and northern Ethiopia and Oromo language speakers from Ethiopia - need to be factored into anyplanstofurtherpromotethevaccinerolloutanduptaketoculturallyandlinguisticallydiversepeopleinthecommunityThereisaneedfor
The contextThisresearchisimportantgivenhowhighlyculturallydiverseNSWisandtheimpactthiscanhave on the success of public health messaging topeoplewhosefirstlanguageisnotEnglishPeople who were born overseas form almost one-thirdofthe7480228population(276)ofNSWandNSWishometo336ofAustraliarsquosoverseas-bornpopulationPeoplefromaround225 birthplaces have made NSW their home and 21oftheNSWpopulationisfromanon-EnglishspeakingbackgroundMorethan24000humani-tarianentrantshavesettledinNSWoverthepastfiveyearscomprisingalmostathird(32)ofthenationaltotalThe24000humanitarianentrantswhohavesettledinNSWoverthepastfiveyearscame from over 100 countries of origin10Sydneyhasthelargestoverseas-bornpopulationofallthecapitalcities11
Hearingdirectlyfrompeoplefromculturally-diverse backgrounds is important to ensure that policymakersandpublichealthadvocatescandesign responses that are both accessible and un-derstandabletopeopleforwhomEnglishmaybetheirsecondthirdorfourthlanguageApropor-tionofpeopleinthesecommunitieshavelowerlevelsofEnglishlanguageliteracyandinsomecaseslowlevelsofliteracyintheirlanguageoforiginsowillbehardertoreachviatraditionalormainstream methods
Itisalsocriticallyimportantthatduringatimewherethereissomuchlsquonoisersquoacrossmediachannelsrelatingtothevaccinethevaccineroll-outvaccineefficacyandvaccinesafetythatwetakesometimetolistentoandunderstandhowthislsquonoisersquoisbeingheardandmadesenseofbypeoplefromculturally-diversebackgrounds
ThatsaiditisimportanttoreconfirmthattheCALDcommunityisnotahomogenousgroupOurresearchhasfoundthattheviewsandattitudesofparticipantsfromdiverseculturalbackgroundsto-
10RefugeeCouncilofAustraliaHumanitarianEntrantsin New South Wales A resource for New South Wales governmentagencies6-711MulticulturalNSWCommunityRelationsReport2018-20199
29
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3130
groupsFortheparticipantsintheresearchtheirattitudetothevaccineappearedtobeinflu-encedbyanumberoffactorstheirownlevelsofhealthandpre-existinghealthconditionsandthoseoftheirfamilymembersandtheimpactofreceiving COVID-19-related news from overseas particularlyfrompeoplersquoscountryoforiginAnexampleofthiscanbeseenintheItaliangroupin Wollongong where people had received news fromoverseasearlyinthepandemicwhichscaredthemThisexperiencelsquofromhomersquohadinflu-enced most of the women in the Wollongong focus group (n=15) to choose to get vaccinated The interviewee from the Illawarra Shoalhaven Local Health District also spoke about the heightenedconcernthattheywitnessedinthelocalItaliancommunityintheearlystagesofthepandemicOtherpeoplewantedtolsquostayhealthyrsquoandtolsquoprotectthehealthofothersrsquoandformanytherewasasensethattheywantedtolsquogetbacktosomedegreeofnormalcyrsquoandtobeabletolsquotraveloverseastovisitrelativesrsquo
Vaccine hesitancyOfthe42inthisstudywhoappearedundecidedornotplanningtohavethevaccinemanywereinfactadoptingalsquowaitandseersquoapproachbeforemakingtheirfinaldecisionMostparticipantswereinterestedtohearmoreinformationaboutthevaccinesandwereopenedtogettingthevaccinebutdidhaveconcernsaboutthesafetyofthevaccinesespeciallyinregardtoAstraZeneca
The issue of blood clots has led to considerable fearandhesitancyinthecommunityandthisfearandhesitancywasreflectedinourstudyEssentialResearchrsquossurvey(April2021)reportedoneinsixpeople(16)indicatedtheywillnevergetvaccinatedagainstCOVID-19upfrom12thepreviousmonthwhile42saidtheywillgetvaccinatedbutnotrightawayTheproportionofpeople who would be willing to get vaccinated as soonaspossibleorarealreadyvaccinatedalsodeclineddownfrom47to4213Thissurveywas conducted prior to the most recent outbreak inNSWinvolvingthehighlyinfectiousDeltastrain
Therisk-benefitofhavingthevaccineneedstobecarefullyweighedbyeachindividualideallyinconsultationwiththeirdoctoranddependingon
The Hub has lsquobeen working in partnership with keystakeholdergroupstoguidecommunicationstomeetthehealthliteracyandculturallyandlinguisticallydiverse(CALD)needsofitspop-ulationStructuredworkinggroupshavebeencreatedtoprioritisecommunicationstovulner-ableyouthCALDgroupstheelderlyitinerateworkersasylumseekersandrefugeesTheaimsaretotestmessagingandbuildtrustwithprioritypopulationstoensureeffectivecommunicationoftheneedtosustainphysicaldistancingmeas-uresintheabsenceofavaccineSimilareffortsarenowneedednationallyandshouldstartatthetimeofdiseaseoutbreaksinthefuturealongsideplannedmassmediaandhealthcommunicationcampaignsrsquo
InthearticlebyDoddetaltheyreinforcetheimportanceofusingcommunicationformatswhich are lsquosuitable for people with low health literacyandeducationandwhichareappropriateforculturallyandlinguisticallydiversegroupsandIndigenouspopulationsrsquoThearticlearguesthatitisimportanttolookatmotivationsandconcernsabout vaccines when shaping messaging It also pointsoutthatprimarycaredoctorsareatrust-ed source and as such should be supported in deliveringinformationaboutthevaccinesandad-dressingcommunityconcernsThearticlestateslsquoWeneedtounderstandandaddresscitizenrsquosconcernsthatcanpreventoptimaluptakebuildmotivationsintomessagingandprioritisepublictrustbyinformingandinvolvingthecommunityintheprocessSupportinghealth-careprofession-als in their role as educators will ensure people haveadequateandaccessibleinformationfromatrustedsourcetooptimisevaccineuptakeandultimatelyreducecommunitytransmissionofCOVID-19rsquo15
RecentresearchbyAssociateProfessorHollySeale16withUNSWMedicinersquosSchoolofPublicHealthandDeputyChairfortheCollaborationonSocialScienceandImmunisationfoundthereisaneedtolsquodecentralisersquocommunicationsbytapping
translatedmaterialsandinformationaboutthevaccines to be tailored to the needs of people in these newly-emergingcommunitygroups
It was reported that in Wollongong there can sometimesbefourgenerationsoffamilymem-bersfromnewly-arrivedrefugeegroupslivingintheonehouseMostofthesefamilymembersgenerallyhavelimitedEnglishlanguageliteracywhichincreasestheirriskofnotreceivingkeyhealthmessagesandthereforeincreasingthepotentialimpactofCOVID-19-inparticulartheDeltastrainwhichhasprovenhighlyinfectiousamongst household members
Vaccine uptakeNotdissimilartothewidercommunitymorepeopleinourstudywereplanningtohavethevaccinethannotandanumberhadalreadybeenvaccinatedInarecentLancetarticle(February2021)ConcernsandmotivationsaboutCOVID-19vaccinationfindingsfromtwosurveysfromanAustralianlongitudinalstudyconductedinJuneandJuly2020includedthatlsquothetopthreerea-sons for agreeing to vaccinate were lsquoto protect themselvesandothersrsquohelliplsquobeliefinvaccinationandsciencersquohellipandlsquotohelpstopthevirusspreadrsquoEven among those willing to vaccinate there was somehesitancyaboutthesafetyofthevaccineTheLancetarticlenotedthatlsquowillingnesstovaccinatedifferedbybothageandeducationrsquoForthosewhowereindifferentorsaidtheywouldnot get the vaccine the top reasons across the twosurveyswerelsquoconcernaboutthesafetyofthevaccineinitsdevelopmentrsquoandlsquopotentialsideeffectsrsquo12
Olderpeopleinourstudywhocomprised23of the total sample (n=199) were the group most likelytosaythattheywantedtogetthevaccine85ofthoseover65saidtheywouldhaveorhadalreadyhadthevaccineVaccinepredispo-sitionwashoweveralsostrongacrossotherage
12RHDoddKPicklesBNickelECvejicJAyreCBatcupCBonnerTCoppSCornellTDakinJIsautierKJMcCafferyConcerns and motivations about COVID-19 vaccination SydneyHealthLiteracyLabSydneySchoolofPublicHealthFacultyofMedicineandHealthUniversityofSydneypublishedintheLancetFebruary2021p162wwwthelancet cominfectionVol21February2021
theircircumstancesHoweverthesourcesofin-formationthatpeoplemostrelyuponortrustarecriticaltothedisseminationofaccurateandclearmessaging to dispel the fear surrounding events suchasbloodclottingandthemisconceptionsraisedinthefocusgroupsWithsomanypartici-pantsinthisstudygettingtheirinformationfromFacebookandothersocialmediasitesitisvitalthat these channels are used to promote simple positivemessagesandforanyfuturecommunityawareness campaigns
Effective communicationConfusionandmisconceptionsaboutthevac-cinersquosefficacyavailabilityandsafetywereallis-sues that were raised in the focus groups Finding waystoeffectivelycommunicatewithpeoplewithlowerEnglishlanguageliteracyandhealthliteracyisanimportantwaytoaddresstheconfusionandmisconceptionsaboutthevaccineashasbeen discussed in a number of recent Australian studies
Astudy14byMcCafferyetal(2020)concludedthattherearelsquoimportantdisparitiesinCOVID-19-relatedknowledgeattitudesandbehavioursaccordingtopeoplersquoshealthliteracyandlanguagersquoOneofthefindingswasthatlsquopeoplewithlowerhealthliteracywerealsomorelikelyto endorse misinformed beliefs about COVID-19 andvaccinations(ingeneral)thanthosewithadequatehealthliteracyThesamepatternofresults was observed among people who primar-ilyspeakalanguageotherthanEnglishathomersquoTheMcCafferystudyhighlightstheimportanceof tailoring health messages to those with lower healthliteracyandculturallyandlinguisticallydiversecommunitiesItpointsoutthatthereareexamplesofeffectivemanagementofdiversecommunityneedsthatusetailoredhealthmes-sagesandcitestheWesternSydneyLocalHealthDistrictHealthLiteracyHub
13TheEssentialReport-anonlinesurveyconductedbyEssentialResearchcompletedby1090people between 21ndash26 April14McCafferyKJDoddRHCvejicEAyreJBatcupCIsautierJMJCoppTBonnerCPicklesKNickelBDakinTCornellSWolf MS Health literacy and disparities in COVID-19ndashrelated knowledge attitudes beliefs and behaviours in Australia PublicHealthResPract202030(4)e30342012December2020
15 Op cit16 httpssphmedunsweduausitesdefaultfilessphcmNewsEnhancing-supporting-COVID-19-vaccination-programpdf
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
30 31
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3332
intodifferentnetworkingspacessuchaswork-placeslocalgymsmothersrsquogroupsandseniorsrsquoclubswithafocusonallagegroupsregardlessofcurrenteligibilityAccordingtoSealethechal-lengeislsquoensuringemerginginformationisadapt-edfortheintendedaudiencersquoShehasalsosaidlsquoThatrsquoswhatIrsquomalittlebitconcernedaboutatthemomenttherersquosalotofresourcesongov-ernmentwebsitesbutthesetermsaroundbloodclottingareverytechnicalWeactuallyneedtomake sure that we are breaking them down in a waythatwillmakeitmeaningfultopeopleThatrsquosnotjustabouttranslatingitrsquosaboutbeingcon-sciousofpeoplersquoshealthliteracyneedstooSomaybegettingsomemorevisualsintomaterialstotryandsupportthatrsquo17
Thereareanumberofmulticulturalhealthresourcesthatusecommunitylanguagetransla-tionsplainEnglishandvideosfromCALDcommu-nityleaderswhichcanbedownloadedandusedbyservicesandindividualsHowevermanyofthewrittenresourcesstillrelyontechnicalandscien-tifictermsthatrequireareasonablyhighlevelofEnglishlanguageliteracyorhighlevelsofliteracyin the translated language to comprehend Host websites can also be hard to navigate making itdifficulttolocateresourcesfromsimplewebsearchesAsummaryofsomeoftheavailableresourcescanbefoundatAttachment2
MulticulturalHealthUnitsinLocalHealthDis-trictshavestaffwhocanworkwithpeoplefromculturallyandlinguisticallydiversecommunitiesatthelocallevelandtranslateandcontextualisethese materials to the needs of the end user These teams respond to local needs and popu-lationdemographicsandareexpertsineffectivehealthliteracyandhealthcommunicationwiththeirlocalcommunitiesTheyworkcloselywithcommunityandvulnerablegroupstobuildhealthliteracyandimprovedhealthoutcomesintheircommunities
Case Study ndash Be a COVID Warrior ndash Responding to COVID-19 in Multicultural Communities InWollongongtheIllawarraShoalhavenLocalHealthDistrict(ISLHD)MulticulturalHealthSer-viceco-designedacommunityengagementandeducationprogramcalledlsquoBeaCOVIDWarriorrsquowhich commenced in 2020 in response to the pandemic This program was designed to respond tothelowlevelsofhealthliteracyaroundCOVID-19potentialexposuretothevirusandaddressfearandstigmainthelocalCALDcommunitiesThelsquoCOVIDWarriorrsquoprogramreachedaround880peopleranginginagefrom14to85years65ofCOVIDWarriorparticipantswerefemaleand35weremaleCOVIDWarriorparticipantsrepresented 21 language groups The outcomes of the program included increased levels of confidenceinapplyinginfectioncontrolmeasuresincreasedliteracyandhealthliteracyandawarenessofhowCOVID-19istransmittedUltimatelyanimprovedawarenessinapplyingCOVIDsafemeasures was also reported
InApril2020theservicecommencedwelfarechecksviaphoneonafortnightlybasistosup-portsocially-isolatedmulticulturalseniorswhoboretheemotionalstressofsocialisolationFrom these calls the ISLHD heard the needs and concernsofseniorsinthecommunityInadditionourexperiencewithCALDcommunitieshighlightedtheimportanceofyoungpeopleasconduitsofessentialinformationtoadultsincommunityandfamilygroupsduetoEnglishlanguageaccessandeducation
InresponsetheISLHDinitiatedthelsquoCOVIDWarri-orrsquoprogramusingbi-culturalhighschoolstudentsthroughthelocalhighschoolsByincreasingthehealthliteracyofstudentsatschooltheselsquocham-pionsrsquocouldtalktotheirfamiliesincludingolderfamilymembersininformalsettingsandthroughsocialmediawiththeirpeersasastrategytoraisethe level of knowledge of COVID-19 trans-mission preventionandtestingTheprogrambecamesopopularthatitwasextendedintomorelocalhighschools and adults accessing the Adult Migrant EnglishProgramTheprogramwassupportedbylocalsettlementservicesprovidedbybothMaxSolutionsandtheRedCrossItwas
17 httpstheconversationcomhow-can-governments-communicate-with-multicultural-australians-about-COVID-19-vaccines-its-not-as-simple-as-having-a-poster-in-their-language-156097
later extendedtoCALDSeniorsthroughtheMulticulturalCommunitiesCouncilIllawarra(MCCI)supportprograms
AkeycomponentoftheprogramwastoprovideparticipantswithlsquoCOVIDWarriorrsquoKitswhichincludedtworeusablemaskshandsanitiserinfographicsaboutCOVID-19symptomsandinfor-mationaboutwheretestingclinicswereavailablelocallyMCCIandRuralAustraliaforRefugeesdonatedreusablemasksforeveryparticipant
AsthelsquoCOVIDWarriorrsquoprogramwasevolvingsowasthenationalvaccinerolloutplanInforma-tionwasthereforeadaptedtomeetthisinfor-mationgapForexampleadultparticipantsandseniors were supported to understand how to accesstheCOVIDvaccinelsquoeligibilitycheckersrsquoandCALD people were shown how to use the NSW HealthwebsiteCOVID-19informationpages18
Decision makingHowpeoplearecurrentlyconsideringtheriskofCOVID-19isinfluencedbyarangeoffactorsincludingratesoftransmissioninthecommunitynumbersofnewcasesreportsinthemediaofrisksandsideeffectsPeopletendtobasetheirassessmentonwhattheyarecurrentlyexperi-encingandthencheckthisagainstwhattheyarehearinginthemediaincludingandespeciallyonsocialmediaandfromfamilyandfriendsMostoftheparticipantsinourstudyspokeclearlyandarticulatelyabouthowtheyweigheduptherisk-benefitofhavingtheCOVID-19vaccineintheir decision making Low case numbers ndash at the timeofconductingtheresearchndashandasensethat Australia was lsquodoing well in safeguarding the communityagainstCOVID-19rsquoweresignificantfactorsinpeoplersquosdecisionnottobevaccinatedortoadoptalsquowaitandseersquoapproachFamilyfriends and social media were reported as having aconsiderableinfluenceondecisionmakingaswerereportsinthemediaofthebloodclottingsideeffectsofAstraZeneca
ThefactthatFacebookwasreportedlythemostpopularsourceofinformationaboutCOVID-19
18httpswwwhealthnswgovauInfectiouscovid-19Pagesdefaultaspx
andtheCOVID-19vaccineforpeopleinthestudyraisesconcernsaboutthepossibledisseminationofmisconceptionsandlsquofakenewsrsquothatmaybespread or compounded via social media Closed social media groups such as WhatsApp and WeChatwithfamilyandfriendsmayalsoleadtopeoplereinforcingtheirpre-existingbiasesThesefactorscoupledwithasensethatAustraliaisfaringwellcomparedtomanycountriesoverseasappear to have resulted in increased vaccine hesi-tancyamongparticipantsofthestudy
Factorsthatwereidentifiedaschangingvaccine-hesitantparticipantsrsquoperceptionswereanincreased risk from COVID-19 and a correspond-ingincreaseinthenumberofinfectionsandonthebenefitsidetheabilitytotraveloverseastovisitfamilyIntherecentresearchfromtheUniversityofNSWcitedaboveSearlearguesthatlsquotheremaybeotherthingsthatweneedtonowstartfocusingonhellipthatwillstarttopromoteandmotivatepeoplesuchasthechancetotravelmorefreelyforexamplersquoThisappearstobeborneoutbyourfocusgroupfindings19
Untilrecentlytherehavebeenverylowcasenumbers and few lockdowns across most of Aus-tralia and NSW The recent outbreak from mid-JuneinGreaterSydneyandintroductionofthehighlyinfectiousDeltavariantinNSWislikelytoimpactonpeoplersquosassessmentsoftherisk-benefitofhavingthevaccineandonewouldassumereducehesitancyrates
GiventheheightenedcommunityanxietycausedbythisrecentCOVID-19outbreaktheproductionofshortsharpandtargetedmessagingtoCALDgroupsincommunitylanguagesthatisaccessibleandmotivationalfeaturescommunityleadershigh-profilecelebritiesandsportsstarsfromCALDbackgroundsandisdirectedatastate-wideandlocal level would appear to be more urgent than everItisclearthatformessagingtobeeffectiveandreachitsintendedaudiencedistributionchannelsshouldincludeFacebookWhatsAppandothersocialmediaplatformsaswellastrustedsourcessuchasmulticulturalhealthworkersmulticulturalservicesandthroughGPsandMedical Centres If mainstream COVID-19 vaccine
19 Op cit
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
32 33
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3534
awareness campaigns are produced in Australia suchashavebeenproducedinNewZealandtheUnitedKingdomandNorthAmericatheyshouldincludehighprofilewell-knowncommunityfig-uresandsportingstarsfromCALDbackgroundsandincludestrategiesspecificallytargetingCALDcommunitiesincludinggroupsidentifiedaspar-ticularlyhigh-risk
It is also important that informationonvaccinesistranslatedintolanguagesfromnewerandemergingcommunitiesOthersuggestionsaroundreachingthesecommunitiesincludeface-to-facemeetingsorganisedbycrossagencypartnershipsandpeer-ledstrategiessuchas mobilising community champions and influenc-ers Messaging needs to be inclusive and framed around the collective values held by commu-n5
It is clear that reinforcing the benefits of being vaccinated at this time rather than dwelling on the risks is more likely to generate behavioural
changeandapositivevaccineresponsefrombothCALDcommunitiesandthegeneralpopulationAppropriately-designedandtargetedCOVID-19vaccinehealthinformationthatiseasytoreadinanylanguagecanbeconveyedbycommunityleadersandcommunitynetworksandpromotesthepositivebenefitsofgettingvaccinatedwouldbevaluableatthistimeBuildingontheworkofpeerchampionssuchastheCOVIDWarriorprogramisalsoasuccessfulmodeltoincreasingCOVID-19vaccinehealthliteracyandinformed decision making
Mostimportantlypositivelymotivatingculturallyandlinguisticallydiversecommunitymemberstolsquogetthejabrsquoespeciallythosewhoareadoptingalsquowaitandseersquoapproachorarevaccinehesitantwould lead to greater vaccine uptake among culturallyandlinguisticallydiversecommunitiesandthereforethecommunityasawhole
Inner West Multicultural Network Addison Road Community Centre DateWednesday12May
A focus group session of members of the Inner WestMulticulturalNetworkpluscustomersoftheFoodPantryatAddisonRoadwasheldattheAddisonRoadCommunityCentreinMarrickvilleon12Mayat200pmThesessionwaspartoftheregularmeetingoftheInnerWestMulticul-turalNetworkTheconsultationinvolvedabout26peopleandwasconductedbyRosannaBarbero
Thegroupbrainstormedresponsestoquestionsaroundvaccinehesitancyinmulticulturalcom-munitiesandmoreeffectivemessagingTheseresponseshavebeenincorporatedinthefindingsof the report
Griffith Women on Fire Focus Group Griffith Community Centre DateFriday14May
This small focus group of women was held at GriffithCommunityCentreonMay14at11amMargCouchSeniorProjectOfficerRegionalDevelopmentAustralia(RDA)-RiverinaandJoanneFitzpatrickSettlementEngagementandTransitionSupport Worker from Centacare Southwest NSW werethekeylinksandnetworkcontactsfortheGriffithcommunityTheWomenonFire(WOF)group was established as part of the Red Cross RuralFireServiceprogramlsquoManyCulturesOneCommunityrsquoInitiallyitwasestablishedtoeducatewomenonemergencypreparednessandtoen-courage NSW Rural Fire Service (RFS) volunteering andnowhastransformedintoacommunityac-tionsupportgroupTheGriffithSoroptimistInter-nationalnowauspicetheirfinancesandsupporttheWOFgroupactivitiesThefocusgroupwasfacilitatedbyCamillaCouchandlocalcommunityvolunteersledbytheGriffithSoroptimistClub
The women in the group were from Pakistan and IndonesiaThegroupweremainlyyoungmotherswithyoungchildrenandtheprogramhadchild-minding arrangements The language level of the womenwaslowandmostwerestudyingESOLat
ATTACHMENTS
ATTACHMENT 1 A Description of the Focus Groups
TAFEThedeliveryoftheinformationwaslimiteddue to language levels and the lack of bilingual interpretersEachparticipantworkedoneononewithavolunteertoslowlyfillinthesurveyandonewomantookthesurveyhometodiscusswithherhusbandThisgroupexperiencehighlightedthe lack of bilingual workers and services in some rural areas
Arabic speaking group Syd West Multicultural Services Mount Druitt Community worker Zaid Naoum Generalist Caseworker SydWest Multicultural Services DateMonday24May
ThefocusgroupfromSydWestMulticulturalSer-viceswasconductedonMonday24May2021atSydWestMulticulturalServicesMountDruittat300pmItwasfacilitatedbyPatriciaMcCormickandsupportedbyZaidNaoumGeneralistCase-workerSydWestMulticulturalServices
Therewere10womenandmenfromSyriainthegroupThegroupweremostlymaturetoolderparticipantsMostparticipantsrequiredassistancewithEnglishandthecaseworkerZaidNaoumhadtranslatedthesurveyintoArabicpriorto the focus group Zaid also translated during the focus group
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Canterbury City Community Centre (4Cs) group The Cottage Lakemba DateTuesday25May
ThefocusgroupfromCanterburyCityCommunityCentre(4Cs)wasconductedonTuesday25MayattheCottageat28CroydonStreetLakembaat10amItwasfacilitatedbyRobinMilesandsup-portedbyRomanaWaseemCommunityWorkerfrom 4Cs
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
34
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3736
The group was comprised of 14 women from PakistanIndiaandSriLankaThewomenrangedinagefrom23to65MostwerefluentEnglishspeakershoweveronewomanrequiredtransla-tionintoUrdufromoneoftheotherwomeninthegrouptoanswerthequestionsdirectly
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
NSW Chaldean League group Community worker Randa Goriya DateTuesday25May
ThefocusgroupfromNSWChaldeanLeagueMountDruittwasconductedonTuesday25May2021 at 1000am at the NSW Chaldean League premisesItwasfacilitatedbyPatriciaMcCormickandsupportedbyRandaGoriyaacommunityworker for the NSW Chaldean League in Mount DruittRandatranslatedtheintroductionandpromptsforthediscussionandhelpedthepartic-ipantstocompletethesurveyMostofthegrouprequiredhelptodothesurvey
ThegroupoftwelveparticipantswereallChaldeanandwerematuretoolderinageTheywereamixed-gendergroup
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Arabic speaking group Red Cross premises Wollongong DateTuesday25May
ThefocusgrouptookplaceonTuesday25Mayat 3pm at the Red Cross premises at Wollongong Therewere22womenandmenparticipatinginthegroupThefocusgroupwasfacilitatedbyCamilla Couch with support from Khalid Zainu-labdeenBilingualSupportWorkerHumanitarianSettlementProgram(ACTampNSW)
There were diverse ages in the group ranging fromyoungpeopletoolderagedMostofthegroupwereyoungerrecently-arrivedrefugeesfrom diverse backgrounds There was also a small-eroldercohortofparticipantswithhigherliteracylevelsandstrongercommunityengagementwith the local services in the area Camilla Couch facilitated the focus group which was conducted inArabicandEnglishwiththeArabictranslationprovidedbyKhalidZainulabdeen
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Work Opportunities for Women group Mt Druitt TAFE DateWednesday26May
TheWorkOpportunitiesforWomen(WOW)focusgroupwasheldonWednesdayMay261100ndash 100pmatMtDruittTAFEItwasfacilitatedbyCamilla Couch and built on the knowledge gainedintheprevioussessiononcriticalandanalyticalthinkingTheWOWgroupisaTAFECertificatelevel course
There were 14 women from diverse cultural backgroundsinthegroupThegroupweremainlyMuslimwomenwithschoolagechildrenandsome were mature aged Due to the learning fo-custhegroupwasfacilitatedasaclasswithguid-eddiscussionontheissuesandcarefulanalysisofthequestionsNotranslationwasneededduetotheeducationalcontextThestudentswereadeptatusingITandcompletedallthesurveysonline
STARTTS Tamil group Toongabbie Community Centre Community worker Sivaharani (Harani) Mayuran DateThursday27May
Thefocusgroupconsistedof18femalepartic-ipantswhowereyoungertomatureagedThefocus group was held at 1000am at Toongabbie CommunityCentreinTargoRdToongabbie
ThefocusgroupwasfacilitatedbyPatriciaMc-CormickandsupportedbyacommunityworkerSivaharani(Harani)MayuranfromtheSTARTTSTamil Group
ThegrouphadmixedlevelsofspokenandwrittenEnglishTheintroductionanddiscussionpromptsweretranslatedbythecommunityworkerSivaha-rani(Harani)Mayuranandsheandthemorepro-ficientstudentssupportedthosewithlowliteracytoanswerthesurveyquestions
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Spanish Speakers Seniors group SydWest Multicultural Services Blacktown DateTuesday1June
TheFocusGrouptookplaceonTuesday1Juneat1100amattheBlacktownShowgroundsandconsistedof16participants(15womenandoneman)AllparticipantswerebornincountriesinSouthAmericaTheirEnglish-fluencylevelsvariedand one of the members of the group translated thesurveyquestionsanddiscussionintoSpanish
ThegrouphadbeenmeetingforseveralyearsThegroupwasfacilitatedbyLindyCassidyandwassupportedbySreeVithyaHarilingamDayRespiteampSocialSupportTeamLeaderatSydWestMulticulturalServicesBlacktownThegroupwerematureagedtoolderparticipants
Thegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyform There was a more focused discussion on somekeyquestionsaftersurveycompletionThetranslatorassistedconsiderablyinthisprocess
Italian Speakers group Warrawong Community Centre DateMonday7June
The focus group of Italian speakers was held on Monday7Juneat1015amattheWarrawongCommunityCentreItwasfacilitatedbyCamillaCouchandsupportedbyJohnPaulTroianiand
SofiaLemafromIllawarraShoalhavenLHDMulti-cultural Health
There were 15 women in the group The group weremostlymaturetoolderparticipantsandwasconductedinItalianandEnglishwithtranslationprovidedbyJohnPaulThisgroupmeetsregularlyandissupportedbyanumberofservicesintheareaespeciallymulticulturalhealth
The group had a general facilitated discussion aboutthequestionsinthesurveyDuetolittleornoliteracytheindividualsurveyresponseswerethencollectedintooneresponseThesesurveyresponses have been included in the general surveyresponses
Mothers Group SydWest Multicultural Services Blacktown DateThursday10June
ThefocusgrouptookplaceonThursday10Juneat1030amandconsistedof14youngwomen13 of whom had a CALD background The focus groupweremainlymothersfromasupportgroupatSydWestMulticulturalServicesinBlacktown
EightofthewomenwereborninIndiatwofromPakistantwofromSriLankaonefromHausaGhana and one was born in Australia (the Austral-ianbornyoungwomanwasasocialworkstudenthelpingwiththegroup)LindyCassidyfacilitatedthe group with support from Wilma Garguath a projectofficerfromSydWestMulticultural Services
The group varied in age One was between 18-24 yearsoldSevenwereagedbetween25-34yearsSixwereagedbetween35=44yearsGiventheirage and circumstances most of the group did not consider themselves eligible at this stage for vac-cinationThiswasanimportantdifferencefromotherfocusgroupsinthattheemphasiswasmoreonwhattheywoulddooncetheybecameeligible
Participantsdidnotrequireassistancewithspo-kenEnglishThegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyformTherewasamorefocuseddiscussiononsomekeyquestions
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3938
ATTACHMENT 2 COVID-19 Vaccine Information in multiple languagesThefollowingsitesappsprovidetranslatedinformationaboutCOVID-19vaccines
Type of information KeyinformationongettingvaccinatedinNew South Wales and on the vaccines available The websiteusesanautomaticservicetotranslate thecontentintodifferentlanguages
Source of information NSW Government website
Link httpswwwnswgovauCOVID-19health-and-wellbeingCOVID-19-vaccina-tion-nswgetting-vaccinated
Type of information COVID-19ResourcessectionontheServiceNSWapp The app has a link to NSW Government websiteinformationonldquoGettingaCOVID-19vaccinationrdquo(seeabove)ItalsoincludesalinktoCOVID-19vaccinationresourcesinotherlan-guages available from the Department of Health
Source of information Service NSW NSW Government
Link Service NSW App
Type of information ArangeoftranslatedresourcesonCOVID-19bytitleincludingafactsheetonCOVID-19VaccineAstraZeneca(ChAdOx1-S)
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCOV-ID-19Pagestranslatedresources-by-titleaspx
Type of information ADigitalCOVID-19resourcelibrarywithtranslated materials
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiouscov-id-19Pagesdigital-resourcesaspx
Type of information AMultilingualCommunityToolkitontheCOVID-19vaccinationprogramtoassist communityworkersprovideseasytoreadresourcesvideosandlinkstokeyservicesandresources
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCovid-19DocumentsNSW-COVID-19-vaccina-tion-program-presentation-20210527pdf
Type of information TheNSWMulticulturalHealthCommunicationServiceoffershealthresourcesandinformationin a wide range of languages It has translated resources on COVID-19 and links to translated resourcesonCOVID-19vaccination
Source of information MulticulturalHealthCommunicationServiceisa New South Wales-wide health service hosted bySouth-easternSydneyLocalHealthDistrict(SESLHD)
Link httpswwwmhcshealthnswgovau
Type of information COVID-19vaccineinformationaddressingkeyquestionsaboutCOVID-19vaccinationandincludesvideosposterstilesfactsheetsandaudio material Translated into 63 languages
Source of information Department of Health Australian Government website
Link httpswwwhealthgovauinitiatives-and-pro-gramsCOVID-19-vaccinesCOVID-19-vaccine-in-formation-in-your-language
Type of information ThisinformationaddressessomecommonmisinformationaboutCOVID-19Translatedintomultiplelanguages
Source of information DepartmentofHomeAffairs Australian Government website
Link httpscovid19inlanguagehomeaffairsgovaumisinformation-and-truths-about-coronavirus
Type of information Australianandinternationalnewsand informationaboutCOVID-19andCOVID-19 vaccinesisavailableontheSBSCoronavirusPortal in more than 60 languages
Source of information SBSwebsite
Link httpswwwsbscomaulanguagecoronavirus
Type of information InformationprovidedaboutCOVID-19vaccinerolloutandsafetyinlanguagesotherthan English
Source of information Department of Health and Human Services Victorian Government
Link httpswwwcoronavirusvicgovautranslat-ed-information-about-COVID-19-vaccines
Type of information HealthTranslationsprovidestranslatedmateri-alsonhealthandwellbeingInformationaboutCOVID-19isregularlyupdatedincludessomeinformationonvaccinationandisavailableinover60communitylanguages
Source of information Victoriangovernmentinitiative
Link httpswwwhealthtranslationsvicgovaubhcv2bhchtnsfPresentEnglishResource-AllOpenampx=amps=Coronavirus
Type of information A one-stop shop for translated materials in multiplelanguagesonCOVID-19
Source of information Ethnolink Language Services
Link httpswwwethnolinkcomauCOVID-19-coro-navirus-translated-resources
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
40
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2120
Nobody knows what to do My GP doesnrsquot even know what I should do whether
I should have it or not
I am not sure what to do I have spoken to my
GP but they canrsquot tell me whether I should have the vaccine or not while I am
breastfeeding
They say one thing and then they tell you
something elsehellip it [the vaccine rollout] is so
confusing
Confusionaboutwhattodowheretogoandthe health impacts of the vaccine was a common threadintheconversationsaroundvaccinehesi-tancy
Onewomanwhosehusbandworkedforasecurityfirmsaidthatherhusbandhadhadtobevacci-natedinordertokeephisjob
In several focus groups the issue of government control was also raised A number of people re-portedstronglythattheyfearedthatthevaccinewas lsquoa means that the government was using to controlpeoplersquo
He [husband] had to have it He didnrsquot have a choice He was fine [no side effects] but Irsquom not
thinking I will have it I donrsquot need to Irsquom a mum Irsquom busy I have
to look after my children I donrsquot know how I feel about it whether
Irsquom going to have it
Vaccine refusal
Onlyasmallnumberofparticipants(24or13)saidtheywouldnotgetvacci-natedOfthisgroup21werewomenand 2 were men8 Respondents were bornintendifferentcountrieswithadiverse range of language backgrounds
I never get sick It is the same for all my family We have always been strong and healthy so I will be
saying no to the vaccine
Country of Birth Language Background Count Pakistan Urdu 4 China Taiwan Chinese
(MandarinCantonese) 4
Sri Lanka India Tamil 3 Chile Spanish and English 2 Italy Italian 2 Iraq Syria Arabic 2 Iraq Chaldean 1 Iran Farsi 1 Greece Macedonian 1 Poland Polish 1 Pakistan Punjabi 1 Sweden Swedish 1 Vietnam Vietnamese 1
Table 4 Vaccine refusal by country of birth and language background
8 ThisreflectstheoverallsamplebiastowardswomenThemajorityoffocusgroupparticipantswerewomenXwithYparticipantsbeingmen
Reason for not having the vaccine Percent Count The vaccine is not well tested 5455 12 I want to wait and see 5455 12 The vaccine is unsafe 3636 8 For medical reasons 3182 7 I am scared to have the vaccine 3182 7 I dont like vaccines 1364 3 For religious reasons 1364 3 For cultural reasons 909 2 Something else (please tell us what) 909 2
SomeinthiscategorywereadamantthattheywouldnotbehavingthevaccineandhadverystrongviewsonitlsquoForculturalreasonsIwonrsquotbehavingthevaccinersquoWhenwelookatrespons-esmorecloselyhoweveritwouldappearthatmanyareinfactmorelsquohesitantrsquothanfirmvaccinerefusers
One reluctant middle-aged Tamil-speaking wom-ansaidlsquoIftheysaywehavetogetvaccinatedthenIwillrsquoThissentimentwas stronglysup-portedbythe rest of the Tamil-speaking group
Studyparticipantswhosaidtheywouldnothavethe vaccine were also concerned that lsquothe vaccine wasnotwelltestedrsquo
The vaccine has been rushed out It has not been
properly tested
Table 5 Reasons for not having the vaccine
Peopleinthiscategorysaidthattheywouldlsquowaitandseersquowhathappenswiththewiderrolloutbe-foremakingtheirfinaldecisionThissuggeststhataproportionofthelsquonorsquogroupareinfacthesitantrather than outright refusing to have the vaccine
Therewerealsofearsexpressedbyfocusgroupparticipantsaboutthedangersofbeingvacci-natedParticipantsreportedbeingafraidofthehealthrisksespeciallyfrombloodclotsSomepeopledistinguishedclearlybetweenAstraZene-caandPfizerinthisregardHoweverformanythedistinctionbetweenthedifferentvaccineswaslostandtheyspokeofthevaccinesgenerallybeing unsafe and having a range of unwanted side effects
Other factors consideredInadditiontothebroaderquestionsofwhypeo-plewouldorwouldnotchoosetogetvaccinatedthe research team used the focus group discus-sionstoexplorewhetherthefollowingfactorshadanyimpactonapersonrsquoslikelihoodofbeingvaccine pre-disposed or hesitant
Knowing someone who had been vaccinated
Knowing someone who had contracted COVID-19
Knowing where to go to get vaccinated
Thesourcespeopleturntoforinformation about COVID-19 and COVID-19 vaccines
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2322
Knowing someone who has been vaccinatedOfthosewhorespondedtothisquestion125or70knewsomeonewhohadalreadyhadthevaccine
6983
2570
447
Yes No Dont know000
1000
2000
3000
4000
5000
6000
7000
8000
Figure 11 Do you know someone who has been vaccinated
Amongthe125participantswhoknewsomeonewhohadalreadybeenvaccinated100identifiedlsquoimmediatefamilymembersrsquo(parentschildrensiblingsandpartners)Somefocusgrouppartic-ipantsreportedthatalloftheirfamilymembersoverseas had been vaccinated Others reported thattheirrelativeshadbeenvaccinatedasarequirementoftheiremployment
Who Count Percent Other family member 41 313 Sister 24 1832 Community member 23 1756 Brother 18 1374 Father 17 1298 Mother 16 1221 Work colleague 14 1069 Husband or wife 11 84 Son or daughter 10 763 Partner 4 305 Someone else 45 3435 Total respondents 131
Table 6 Who do you know who has been vaccinated
When this issue was teased out further in focus groupdiscussionsarangeofreasonswere revealed including
My husband works in security and he had
to get it
My friend works as a COVID-19 cleaner and they all had to [get
vaccinated]
My family overseas have already been vaccinated
My son needs to travel for work so he is getting it
My brother in the UK is a doctor and he got it and
his wife
Knowing someone who has had COVID-19Almosthalfoftheparticipantsknewsomeonewho had contracted COVID-19 overseas Some reportedthatallthemembersoftheirfamilyormanymembersoftheirextendedfamilyhadcon-tracted COVID-19 In the older Italian group 10 of the15womenknewsomeoneinItalywhohadcontracted COVID-19
4716 4659
625
Yes No Not sure000
1000
2000
3000
4000
5000
Figure 12 Knowing someone who has had COVID-19
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2524
385 385
1538
2692
641 513000
4359
2051
1026385
1410
Mother
Father
BrotherSis
ter
Son or d
augh
ter
Husban
d or wife
Partner
Other family
mem
berFri
end
Community m
ember
Work co
lleag
ue
Someone else
(please
tell u
s who)
000500
100015002000250030003500400045005000
Figure 13 Who do you know who has had COVID-19
Four people in the focus groups knew someone who had died of COVID-19
All my family back home [Pakistan] got it [COVID-19] but
they are all fine now apart from my father He died But he was really sick before he
got it He had lots of underlying conditions Medical conditions so he was really unwell before he got COVID-19 But everyone else
they are fine now They were sick but they got betterhellip
If you are well and healthy you can fight this off
SurprisinglyknowingpeoplewhohadcontractedCOVID-19didnotseemtoinfluencefocusgroupparticipantsrsquopredispositiontowardseitherhavingthevaccineorbeingvaccinehesitantHowevertheolderItalianwomenrsquosgroupspokeabouttheimpactthatCOVID-19hadhadinItalyintheearlystagesofthepandemicandhowthishadaffectedthemdeeply13ofthe15womeninthisgroupwouldhaveorhadalreadyhadthevaccine
Knowing where to get vaccinated115people(81)whorespondedtothisquestion(n=142) knew where to go to get the vaccine 34 people(19)reportedthattheydidnotknowThisincluded15respondentsfromIraq3re-spondentsfromIndia2respondentsfromChina2 respondents from Pakistan and one respondent fromeachofthefollowingcountriesChinaEri-treaItalySriLankaSwedenSyriaandVietnamThese people were also less sure about whether ornottheywouldhavethevaccineItispossiblethat their lack of knowledge about where to go to get vaccinated was related to their general level ofvaccinehesitancy
7958
29582254
282 563
GPDoctor Vaccinecentre
Hospital Work place Somewhereelse (please
tell us where)
000100020003000400050006000700080009000
Figure 14 Where to go to get vaccinated
From the sample (n=199) GPs were the most commonlyidentifiedplacetogotogetvaccinat-edfollowedbythevaccinecentreatHomebushBayandthenhospitalsOtherplacesidentifiedincluded medical centres and pharmacies
Sources of information about COVID-19 and the vaccineThelargestsinglesourceofinformationaboutCOVID-19 and the vaccine was Facebook (417)
2743
3486
13141086
30862686
3429
2229 2286
41713714
2571
1086 971
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)000500
10001500200025003000350040004500
Figure 15 Sources of information about COVID-19 and the COVID-19 vaccine
Facebook I get my information from
Facebook But if I want to check it I watch the news
on 7 [Channel 7]
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2726
Thesecondlargestsourceofinformationforpeople in the sample was lsquoother forms of social mediarsquo(37)followedbySBStelevision(35)myfriends(34)andothertelevision(31)Oth-ersourcesofinformationpeoplereportedthattheyusedweretheNSWHealthwebsitenightlytelevisionnewsincludingChannel7Channel9andChannel10followedbytheABCtheAustral-iangovernmenthealthwebsitetheirGPlocalMedical Centres and the Red Cross
IntheLakembafocusgrouppredominantlymadeupofwomenfromPakistantherewasanani-mated discussion about Facebook which was the majorsourceofinformationalongwithGooglesearchesandcommunityandfriendship-basedWhatsApp groups There was a general consensus from most in the group that these were their pre-ferredormostcommonsourcesofinformationandnewsHoweveriftheywantedtolsquofactcheckrsquowhattheywerehearingtheywouldwatchthenightlynewsonChannel7orChannel9toverifywhattheyperceivedcouldsometimesbeunrelia-ble sources
IntheMtDruittfocusgroupseveralofthewom-enwithwell-developeddigitalliteracyandgener-alliteracyskillsusedhealthandfitnesswebsitesand social media sites as their source of infor-mationaboutlsquoallthingshealthrelatedrsquoincludingCOVID-19ThesewomenalsospokepositivelyabouttheinformationandsupporttheygotfromthestaffatCanterburyCouncilCommunityCentre(4Cs)whotheycouldrelyontofindoutthingsthattheyidentifiedtheyneededtoknowmoreabout
InthesmallerfocusgroupinGriffithwithrecently-arrived refugee women who had low levels of Englishlanguageliteracytherewaslittleknowledgeaboutthevaccinesnoawarenessofthedifferenttypesofvaccinesandlittleknow-ledgeaboutwheretogotogetvaccinatedorfindoutmoreaboutCOVID-19ingeneralThecommunityservicestaffandvolunteerspresentatthegroupwere working hard to assist these women to improve their English language skills and support themwithtranslatedinformation
In the older Italian women focus group in Wollon-gongparticipantsreportedgettingtheirinfor-mationfromslightlydifferentsourcesndashfamilyinAustralia(10women)Channel9(7women)
Italianradio(3women)andABCTV(3women)Onlytwowomenusedtheinternetandnoneofthe women reported using Facebook or social mediaasasourceoftheirinformationSeveralmentionedthattheygottheirinformationfromtheirGPorspecialistdoctorandonepartici-pantsaidrsquoIdonrsquotlistentoanyonersquoIntheSpan-ish-speaking focus group a comment was made thatseemedtoreflectmanyoftheotherfocusgroup discussions
Whenlsquosourcesofinformationrsquoiscorrelatedwiththegroupwhosaidtheywouldhavethevaccine(n=104)thereisashiftfromFacebookbeingthepreferredsourceofinformationtolsquoSBSTVrsquobeingthepreferredsourceThelsquovaccine-predisposedrsquogroupalsohadthelowestrateofrelyingonFace-bookasasourceofinformationaboutCOVID-19thoughitwasstillhighThegraphbelowhigh-lightshowotherlsquopreferredsourcesrsquoplayoutforthoseintendingtohaveorwhohavealreadyhadthe vaccine
ForthoseparticipantswhoindicatedthattheywouldnotorwerenotplanningtohavethevaccinelsquoFacebookrsquolsquomyfriendsrsquoandlsquomyfamilyrsquowerethesourcesofinformationaboutCOVID-19thatwereequallymostfrequentlycitedfollowedcloselybylsquomyfamilyoverseasrsquolsquoSBSradiorsquoandlsquoSBSTVrsquoassourcesofinformationreceivedthelowestmentionsfromthisgroup(SeeFigure16)
The vaccine-hesitant group were the group who identifiedlsquoFacebookrsquoastheirmostfrequentsourceofinformationaboutCOVID-19lsquoFace-bookrsquowasfollowedbylsquoothersocialmediarsquoandlsquomyfriendsrsquoasthenextmostfrequentsources
lsquoThiscommunityserviceproviderrsquo(theinterme-diaryorganisationwherethefocusgroupwasconducted)wasidentifiedby26ofrespondentsasasourceofinformationregardlessoftheirintentiontogetvaccinatedornotThefactthatboththelsquovaccinehesitantrsquoandthosewhoindi-catedtheywouldnrsquotbegettingthevaccinesoughtinformationfromthissourcesuggeststhatrolling
There is so much confusion about it [the vaccine] that I think my GP is the best
place to go
9 This group of the research sample included a small number ofpeoplewhohadalreadybeenvaccinated
2626
4141
14141111
323228282828
2424
1818
37373737
2828
10101212
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)00050010001500200025003000350040004500
2857
2381
952 952
2857
3333
42864286
3810
4286
23812381
1429
952
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another co
mmunity se
rvice
Somewhere
else (p
lease te
ll us w
here)000
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Figure 16 Sources of information for respondents who were planning to have the vaccine9
Figure 17 Sources of information for respondents who were not planning to have the vaccine
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2928
outpositivemessagingthroughtrusted communityserviceorganisationscouldbeaneffectivewayofshiftingpeoplefromvaccine hesitancytodecidingtohavethevaccine
31372549
980 980
25492157
4314
1176
2353
4902
4118
2157
980392
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)000
1000
2000
3000
4000
5000
6000
Figure 18 Sources of information for respondents who lsquodonrsquot knowrsquo if they will have the vaccine
DISCUSSION
wardstheCOVID-19vaccineareasvariedastheyarewithinthebroadercommunityTherearearangeofinfluencingfactorsincludingagehealthstatushowlongtheyhavebeeninAustraliahowmuchnewstheyreceivefromoverseasandhowbadlyimpactedbythepandemictheirhomecountries have been
The research also highlights that people from culturallyandlinguisticallydiversebackgroundsgettheirinformationaboutCOVID-19andtheCOVID-19vaccinefromawidevarietyofsourcesbothformalandinformalandthatforparticulargroupsinthisstudythereisahighrelianceonFacebookovermoreofficialsourcesofinforma-tion
VulnerabilityTheneedsofhighly-vulnerablegroupswithintheCALDcommunityhavetobetakenintoconsider-ationThisincludesolderpeoplewhohavelivedinAustraliaformanyyearsbuthavelowlevelsofEnglishliteracyndashespeciallywritingandreadingEnglishandsometimesspokenEnglishndashandwhoaremoresusceptibletoseriousillnessandhigherratesofhospitalisationanddeathfromCOVID-19Italsoincludesnewly-arrivedrefugeeswhohavinglowornoEnglishlanguageliteracylacktheconnectionstoandnetworksintothewidercommunityandcommunitysupportsItisalsothecase that some people in these groups are not health literate at all and cannot read and write in their own language
Akeytakeoutfromthehealthandcommunityserviceorganisationsurveyresponsesandinter-viewsundertakenwithmulticulturalhealthandcommunicationexpertsfortheprojectisthatlit-eracylevelsreallydomatterLowlevelsofhealthliteracylowlevelsofEnglishlanguageliteracyandpossiblylowlevelsofliteracyintheirownlan-guage-especiallyforsomenewly-arrivedrefu-gees and those who are part of the humanitarian program such as Dari language speakers from AfghanistanTigrinyalanguagespeakersfromEr-itrea and northern Ethiopia and Oromo language speakers from Ethiopia - need to be factored into anyplanstofurtherpromotethevaccinerolloutanduptaketoculturallyandlinguisticallydiversepeopleinthecommunityThereisaneedfor
The contextThisresearchisimportantgivenhowhighlyculturallydiverseNSWisandtheimpactthiscanhave on the success of public health messaging topeoplewhosefirstlanguageisnotEnglishPeople who were born overseas form almost one-thirdofthe7480228population(276)ofNSWandNSWishometo336ofAustraliarsquosoverseas-bornpopulationPeoplefromaround225 birthplaces have made NSW their home and 21oftheNSWpopulationisfromanon-EnglishspeakingbackgroundMorethan24000humani-tarianentrantshavesettledinNSWoverthepastfiveyearscomprisingalmostathird(32)ofthenationaltotalThe24000humanitarianentrantswhohavesettledinNSWoverthepastfiveyearscame from over 100 countries of origin10Sydneyhasthelargestoverseas-bornpopulationofallthecapitalcities11
Hearingdirectlyfrompeoplefromculturally-diverse backgrounds is important to ensure that policymakersandpublichealthadvocatescandesign responses that are both accessible and un-derstandabletopeopleforwhomEnglishmaybetheirsecondthirdorfourthlanguageApropor-tionofpeopleinthesecommunitieshavelowerlevelsofEnglishlanguageliteracyandinsomecaseslowlevelsofliteracyintheirlanguageoforiginsowillbehardertoreachviatraditionalormainstream methods
Itisalsocriticallyimportantthatduringatimewherethereissomuchlsquonoisersquoacrossmediachannelsrelatingtothevaccinethevaccineroll-outvaccineefficacyandvaccinesafetythatwetakesometimetolistentoandunderstandhowthislsquonoisersquoisbeingheardandmadesenseofbypeoplefromculturally-diversebackgrounds
ThatsaiditisimportanttoreconfirmthattheCALDcommunityisnotahomogenousgroupOurresearchhasfoundthattheviewsandattitudesofparticipantsfromdiverseculturalbackgroundsto-
10RefugeeCouncilofAustraliaHumanitarianEntrantsin New South Wales A resource for New South Wales governmentagencies6-711MulticulturalNSWCommunityRelationsReport2018-20199
29
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3130
groupsFortheparticipantsintheresearchtheirattitudetothevaccineappearedtobeinflu-encedbyanumberoffactorstheirownlevelsofhealthandpre-existinghealthconditionsandthoseoftheirfamilymembersandtheimpactofreceiving COVID-19-related news from overseas particularlyfrompeoplersquoscountryoforiginAnexampleofthiscanbeseenintheItaliangroupin Wollongong where people had received news fromoverseasearlyinthepandemicwhichscaredthemThisexperiencelsquofromhomersquohadinflu-enced most of the women in the Wollongong focus group (n=15) to choose to get vaccinated The interviewee from the Illawarra Shoalhaven Local Health District also spoke about the heightenedconcernthattheywitnessedinthelocalItaliancommunityintheearlystagesofthepandemicOtherpeoplewantedtolsquostayhealthyrsquoandtolsquoprotectthehealthofothersrsquoandformanytherewasasensethattheywantedtolsquogetbacktosomedegreeofnormalcyrsquoandtobeabletolsquotraveloverseastovisitrelativesrsquo
Vaccine hesitancyOfthe42inthisstudywhoappearedundecidedornotplanningtohavethevaccinemanywereinfactadoptingalsquowaitandseersquoapproachbeforemakingtheirfinaldecisionMostparticipantswereinterestedtohearmoreinformationaboutthevaccinesandwereopenedtogettingthevaccinebutdidhaveconcernsaboutthesafetyofthevaccinesespeciallyinregardtoAstraZeneca
The issue of blood clots has led to considerable fearandhesitancyinthecommunityandthisfearandhesitancywasreflectedinourstudyEssentialResearchrsquossurvey(April2021)reportedoneinsixpeople(16)indicatedtheywillnevergetvaccinatedagainstCOVID-19upfrom12thepreviousmonthwhile42saidtheywillgetvaccinatedbutnotrightawayTheproportionofpeople who would be willing to get vaccinated as soonaspossibleorarealreadyvaccinatedalsodeclineddownfrom47to4213Thissurveywas conducted prior to the most recent outbreak inNSWinvolvingthehighlyinfectiousDeltastrain
Therisk-benefitofhavingthevaccineneedstobecarefullyweighedbyeachindividualideallyinconsultationwiththeirdoctoranddependingon
The Hub has lsquobeen working in partnership with keystakeholdergroupstoguidecommunicationstomeetthehealthliteracyandculturallyandlinguisticallydiverse(CALD)needsofitspop-ulationStructuredworkinggroupshavebeencreatedtoprioritisecommunicationstovulner-ableyouthCALDgroupstheelderlyitinerateworkersasylumseekersandrefugeesTheaimsaretotestmessagingandbuildtrustwithprioritypopulationstoensureeffectivecommunicationoftheneedtosustainphysicaldistancingmeas-uresintheabsenceofavaccineSimilareffortsarenowneedednationallyandshouldstartatthetimeofdiseaseoutbreaksinthefuturealongsideplannedmassmediaandhealthcommunicationcampaignsrsquo
InthearticlebyDoddetaltheyreinforcetheimportanceofusingcommunicationformatswhich are lsquosuitable for people with low health literacyandeducationandwhichareappropriateforculturallyandlinguisticallydiversegroupsandIndigenouspopulationsrsquoThearticlearguesthatitisimportanttolookatmotivationsandconcernsabout vaccines when shaping messaging It also pointsoutthatprimarycaredoctorsareatrust-ed source and as such should be supported in deliveringinformationaboutthevaccinesandad-dressingcommunityconcernsThearticlestateslsquoWeneedtounderstandandaddresscitizenrsquosconcernsthatcanpreventoptimaluptakebuildmotivationsintomessagingandprioritisepublictrustbyinformingandinvolvingthecommunityintheprocessSupportinghealth-careprofession-als in their role as educators will ensure people haveadequateandaccessibleinformationfromatrustedsourcetooptimisevaccineuptakeandultimatelyreducecommunitytransmissionofCOVID-19rsquo15
RecentresearchbyAssociateProfessorHollySeale16withUNSWMedicinersquosSchoolofPublicHealthandDeputyChairfortheCollaborationonSocialScienceandImmunisationfoundthereisaneedtolsquodecentralisersquocommunicationsbytapping
translatedmaterialsandinformationaboutthevaccines to be tailored to the needs of people in these newly-emergingcommunitygroups
It was reported that in Wollongong there can sometimesbefourgenerationsoffamilymem-bersfromnewly-arrivedrefugeegroupslivingintheonehouseMostofthesefamilymembersgenerallyhavelimitedEnglishlanguageliteracywhichincreasestheirriskofnotreceivingkeyhealthmessagesandthereforeincreasingthepotentialimpactofCOVID-19-inparticulartheDeltastrainwhichhasprovenhighlyinfectiousamongst household members
Vaccine uptakeNotdissimilartothewidercommunitymorepeopleinourstudywereplanningtohavethevaccinethannotandanumberhadalreadybeenvaccinatedInarecentLancetarticle(February2021)ConcernsandmotivationsaboutCOVID-19vaccinationfindingsfromtwosurveysfromanAustralianlongitudinalstudyconductedinJuneandJuly2020includedthatlsquothetopthreerea-sons for agreeing to vaccinate were lsquoto protect themselvesandothersrsquohelliplsquobeliefinvaccinationandsciencersquohellipandlsquotohelpstopthevirusspreadrsquoEven among those willing to vaccinate there was somehesitancyaboutthesafetyofthevaccineTheLancetarticlenotedthatlsquowillingnesstovaccinatedifferedbybothageandeducationrsquoForthosewhowereindifferentorsaidtheywouldnot get the vaccine the top reasons across the twosurveyswerelsquoconcernaboutthesafetyofthevaccineinitsdevelopmentrsquoandlsquopotentialsideeffectsrsquo12
Olderpeopleinourstudywhocomprised23of the total sample (n=199) were the group most likelytosaythattheywantedtogetthevaccine85ofthoseover65saidtheywouldhaveorhadalreadyhadthevaccineVaccinepredispo-sitionwashoweveralsostrongacrossotherage
12RHDoddKPicklesBNickelECvejicJAyreCBatcupCBonnerTCoppSCornellTDakinJIsautierKJMcCafferyConcerns and motivations about COVID-19 vaccination SydneyHealthLiteracyLabSydneySchoolofPublicHealthFacultyofMedicineandHealthUniversityofSydneypublishedintheLancetFebruary2021p162wwwthelancet cominfectionVol21February2021
theircircumstancesHoweverthesourcesofin-formationthatpeoplemostrelyuponortrustarecriticaltothedisseminationofaccurateandclearmessaging to dispel the fear surrounding events suchasbloodclottingandthemisconceptionsraisedinthefocusgroupsWithsomanypartici-pantsinthisstudygettingtheirinformationfromFacebookandothersocialmediasitesitisvitalthat these channels are used to promote simple positivemessagesandforanyfuturecommunityawareness campaigns
Effective communicationConfusionandmisconceptionsaboutthevac-cinersquosefficacyavailabilityandsafetywereallis-sues that were raised in the focus groups Finding waystoeffectivelycommunicatewithpeoplewithlowerEnglishlanguageliteracyandhealthliteracyisanimportantwaytoaddresstheconfusionandmisconceptionsaboutthevaccineashasbeen discussed in a number of recent Australian studies
Astudy14byMcCafferyetal(2020)concludedthattherearelsquoimportantdisparitiesinCOVID-19-relatedknowledgeattitudesandbehavioursaccordingtopeoplersquoshealthliteracyandlanguagersquoOneofthefindingswasthatlsquopeoplewithlowerhealthliteracywerealsomorelikelyto endorse misinformed beliefs about COVID-19 andvaccinations(ingeneral)thanthosewithadequatehealthliteracyThesamepatternofresults was observed among people who primar-ilyspeakalanguageotherthanEnglishathomersquoTheMcCafferystudyhighlightstheimportanceof tailoring health messages to those with lower healthliteracyandculturallyandlinguisticallydiversecommunitiesItpointsoutthatthereareexamplesofeffectivemanagementofdiversecommunityneedsthatusetailoredhealthmes-sagesandcitestheWesternSydneyLocalHealthDistrictHealthLiteracyHub
13TheEssentialReport-anonlinesurveyconductedbyEssentialResearchcompletedby1090people between 21ndash26 April14McCafferyKJDoddRHCvejicEAyreJBatcupCIsautierJMJCoppTBonnerCPicklesKNickelBDakinTCornellSWolf MS Health literacy and disparities in COVID-19ndashrelated knowledge attitudes beliefs and behaviours in Australia PublicHealthResPract202030(4)e30342012December2020
15 Op cit16 httpssphmedunsweduausitesdefaultfilessphcmNewsEnhancing-supporting-COVID-19-vaccination-programpdf
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
30 31
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3332
intodifferentnetworkingspacessuchaswork-placeslocalgymsmothersrsquogroupsandseniorsrsquoclubswithafocusonallagegroupsregardlessofcurrenteligibilityAccordingtoSealethechal-lengeislsquoensuringemerginginformationisadapt-edfortheintendedaudiencersquoShehasalsosaidlsquoThatrsquoswhatIrsquomalittlebitconcernedaboutatthemomenttherersquosalotofresourcesongov-ernmentwebsitesbutthesetermsaroundbloodclottingareverytechnicalWeactuallyneedtomake sure that we are breaking them down in a waythatwillmakeitmeaningfultopeopleThatrsquosnotjustabouttranslatingitrsquosaboutbeingcon-sciousofpeoplersquoshealthliteracyneedstooSomaybegettingsomemorevisualsintomaterialstotryandsupportthatrsquo17
Thereareanumberofmulticulturalhealthresourcesthatusecommunitylanguagetransla-tionsplainEnglishandvideosfromCALDcommu-nityleaderswhichcanbedownloadedandusedbyservicesandindividualsHowevermanyofthewrittenresourcesstillrelyontechnicalandscien-tifictermsthatrequireareasonablyhighlevelofEnglishlanguageliteracyorhighlevelsofliteracyin the translated language to comprehend Host websites can also be hard to navigate making itdifficulttolocateresourcesfromsimplewebsearchesAsummaryofsomeoftheavailableresourcescanbefoundatAttachment2
MulticulturalHealthUnitsinLocalHealthDis-trictshavestaffwhocanworkwithpeoplefromculturallyandlinguisticallydiversecommunitiesatthelocallevelandtranslateandcontextualisethese materials to the needs of the end user These teams respond to local needs and popu-lationdemographicsandareexpertsineffectivehealthliteracyandhealthcommunicationwiththeirlocalcommunitiesTheyworkcloselywithcommunityandvulnerablegroupstobuildhealthliteracyandimprovedhealthoutcomesintheircommunities
Case Study ndash Be a COVID Warrior ndash Responding to COVID-19 in Multicultural Communities InWollongongtheIllawarraShoalhavenLocalHealthDistrict(ISLHD)MulticulturalHealthSer-viceco-designedacommunityengagementandeducationprogramcalledlsquoBeaCOVIDWarriorrsquowhich commenced in 2020 in response to the pandemic This program was designed to respond tothelowlevelsofhealthliteracyaroundCOVID-19potentialexposuretothevirusandaddressfearandstigmainthelocalCALDcommunitiesThelsquoCOVIDWarriorrsquoprogramreachedaround880peopleranginginagefrom14to85years65ofCOVIDWarriorparticipantswerefemaleand35weremaleCOVIDWarriorparticipantsrepresented 21 language groups The outcomes of the program included increased levels of confidenceinapplyinginfectioncontrolmeasuresincreasedliteracyandhealthliteracyandawarenessofhowCOVID-19istransmittedUltimatelyanimprovedawarenessinapplyingCOVIDsafemeasures was also reported
InApril2020theservicecommencedwelfarechecksviaphoneonafortnightlybasistosup-portsocially-isolatedmulticulturalseniorswhoboretheemotionalstressofsocialisolationFrom these calls the ISLHD heard the needs and concernsofseniorsinthecommunityInadditionourexperiencewithCALDcommunitieshighlightedtheimportanceofyoungpeopleasconduitsofessentialinformationtoadultsincommunityandfamilygroupsduetoEnglishlanguageaccessandeducation
InresponsetheISLHDinitiatedthelsquoCOVIDWarri-orrsquoprogramusingbi-culturalhighschoolstudentsthroughthelocalhighschoolsByincreasingthehealthliteracyofstudentsatschooltheselsquocham-pionsrsquocouldtalktotheirfamiliesincludingolderfamilymembersininformalsettingsandthroughsocialmediawiththeirpeersasastrategytoraisethe level of knowledge of COVID-19 trans-mission preventionandtestingTheprogrambecamesopopularthatitwasextendedintomorelocalhighschools and adults accessing the Adult Migrant EnglishProgramTheprogramwassupportedbylocalsettlementservicesprovidedbybothMaxSolutionsandtheRedCrossItwas
17 httpstheconversationcomhow-can-governments-communicate-with-multicultural-australians-about-COVID-19-vaccines-its-not-as-simple-as-having-a-poster-in-their-language-156097
later extendedtoCALDSeniorsthroughtheMulticulturalCommunitiesCouncilIllawarra(MCCI)supportprograms
AkeycomponentoftheprogramwastoprovideparticipantswithlsquoCOVIDWarriorrsquoKitswhichincludedtworeusablemaskshandsanitiserinfographicsaboutCOVID-19symptomsandinfor-mationaboutwheretestingclinicswereavailablelocallyMCCIandRuralAustraliaforRefugeesdonatedreusablemasksforeveryparticipant
AsthelsquoCOVIDWarriorrsquoprogramwasevolvingsowasthenationalvaccinerolloutplanInforma-tionwasthereforeadaptedtomeetthisinfor-mationgapForexampleadultparticipantsandseniors were supported to understand how to accesstheCOVIDvaccinelsquoeligibilitycheckersrsquoandCALD people were shown how to use the NSW HealthwebsiteCOVID-19informationpages18
Decision makingHowpeoplearecurrentlyconsideringtheriskofCOVID-19isinfluencedbyarangeoffactorsincludingratesoftransmissioninthecommunitynumbersofnewcasesreportsinthemediaofrisksandsideeffectsPeopletendtobasetheirassessmentonwhattheyarecurrentlyexperi-encingandthencheckthisagainstwhattheyarehearinginthemediaincludingandespeciallyonsocialmediaandfromfamilyandfriendsMostoftheparticipantsinourstudyspokeclearlyandarticulatelyabouthowtheyweigheduptherisk-benefitofhavingtheCOVID-19vaccineintheir decision making Low case numbers ndash at the timeofconductingtheresearchndashandasensethat Australia was lsquodoing well in safeguarding the communityagainstCOVID-19rsquoweresignificantfactorsinpeoplersquosdecisionnottobevaccinatedortoadoptalsquowaitandseersquoapproachFamilyfriends and social media were reported as having aconsiderableinfluenceondecisionmakingaswerereportsinthemediaofthebloodclottingsideeffectsofAstraZeneca
ThefactthatFacebookwasreportedlythemostpopularsourceofinformationaboutCOVID-19
18httpswwwhealthnswgovauInfectiouscovid-19Pagesdefaultaspx
andtheCOVID-19vaccineforpeopleinthestudyraisesconcernsaboutthepossibledisseminationofmisconceptionsandlsquofakenewsrsquothatmaybespread or compounded via social media Closed social media groups such as WhatsApp and WeChatwithfamilyandfriendsmayalsoleadtopeoplereinforcingtheirpre-existingbiasesThesefactorscoupledwithasensethatAustraliaisfaringwellcomparedtomanycountriesoverseasappear to have resulted in increased vaccine hesi-tancyamongparticipantsofthestudy
Factorsthatwereidentifiedaschangingvaccine-hesitantparticipantsrsquoperceptionswereanincreased risk from COVID-19 and a correspond-ingincreaseinthenumberofinfectionsandonthebenefitsidetheabilitytotraveloverseastovisitfamilyIntherecentresearchfromtheUniversityofNSWcitedaboveSearlearguesthatlsquotheremaybeotherthingsthatweneedtonowstartfocusingonhellipthatwillstarttopromoteandmotivatepeoplesuchasthechancetotravelmorefreelyforexamplersquoThisappearstobeborneoutbyourfocusgroupfindings19
Untilrecentlytherehavebeenverylowcasenumbers and few lockdowns across most of Aus-tralia and NSW The recent outbreak from mid-JuneinGreaterSydneyandintroductionofthehighlyinfectiousDeltavariantinNSWislikelytoimpactonpeoplersquosassessmentsoftherisk-benefitofhavingthevaccineandonewouldassumereducehesitancyrates
GiventheheightenedcommunityanxietycausedbythisrecentCOVID-19outbreaktheproductionofshortsharpandtargetedmessagingtoCALDgroupsincommunitylanguagesthatisaccessibleandmotivationalfeaturescommunityleadershigh-profilecelebritiesandsportsstarsfromCALDbackgroundsandisdirectedatastate-wideandlocal level would appear to be more urgent than everItisclearthatformessagingtobeeffectiveandreachitsintendedaudiencedistributionchannelsshouldincludeFacebookWhatsAppandothersocialmediaplatformsaswellastrustedsourcessuchasmulticulturalhealthworkersmulticulturalservicesandthroughGPsandMedical Centres If mainstream COVID-19 vaccine
19 Op cit
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
32 33
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3534
awareness campaigns are produced in Australia suchashavebeenproducedinNewZealandtheUnitedKingdomandNorthAmericatheyshouldincludehighprofilewell-knowncommunityfig-uresandsportingstarsfromCALDbackgroundsandincludestrategiesspecificallytargetingCALDcommunitiesincludinggroupsidentifiedaspar-ticularlyhigh-risk
It is also important that informationonvaccinesistranslatedintolanguagesfromnewerandemergingcommunitiesOthersuggestionsaroundreachingthesecommunitiesincludeface-to-facemeetingsorganisedbycrossagencypartnershipsandpeer-ledstrategiessuchas mobilising community champions and influenc-ers Messaging needs to be inclusive and framed around the collective values held by commu-n5
It is clear that reinforcing the benefits of being vaccinated at this time rather than dwelling on the risks is more likely to generate behavioural
changeandapositivevaccineresponsefrombothCALDcommunitiesandthegeneralpopulationAppropriately-designedandtargetedCOVID-19vaccinehealthinformationthatiseasytoreadinanylanguagecanbeconveyedbycommunityleadersandcommunitynetworksandpromotesthepositivebenefitsofgettingvaccinatedwouldbevaluableatthistimeBuildingontheworkofpeerchampionssuchastheCOVIDWarriorprogramisalsoasuccessfulmodeltoincreasingCOVID-19vaccinehealthliteracyandinformed decision making
Mostimportantlypositivelymotivatingculturallyandlinguisticallydiversecommunitymemberstolsquogetthejabrsquoespeciallythosewhoareadoptingalsquowaitandseersquoapproachorarevaccinehesitantwould lead to greater vaccine uptake among culturallyandlinguisticallydiversecommunitiesandthereforethecommunityasawhole
Inner West Multicultural Network Addison Road Community Centre DateWednesday12May
A focus group session of members of the Inner WestMulticulturalNetworkpluscustomersoftheFoodPantryatAddisonRoadwasheldattheAddisonRoadCommunityCentreinMarrickvilleon12Mayat200pmThesessionwaspartoftheregularmeetingoftheInnerWestMulticul-turalNetworkTheconsultationinvolvedabout26peopleandwasconductedbyRosannaBarbero
Thegroupbrainstormedresponsestoquestionsaroundvaccinehesitancyinmulticulturalcom-munitiesandmoreeffectivemessagingTheseresponseshavebeenincorporatedinthefindingsof the report
Griffith Women on Fire Focus Group Griffith Community Centre DateFriday14May
This small focus group of women was held at GriffithCommunityCentreonMay14at11amMargCouchSeniorProjectOfficerRegionalDevelopmentAustralia(RDA)-RiverinaandJoanneFitzpatrickSettlementEngagementandTransitionSupport Worker from Centacare Southwest NSW werethekeylinksandnetworkcontactsfortheGriffithcommunityTheWomenonFire(WOF)group was established as part of the Red Cross RuralFireServiceprogramlsquoManyCulturesOneCommunityrsquoInitiallyitwasestablishedtoeducatewomenonemergencypreparednessandtoen-courage NSW Rural Fire Service (RFS) volunteering andnowhastransformedintoacommunityac-tionsupportgroupTheGriffithSoroptimistInter-nationalnowauspicetheirfinancesandsupporttheWOFgroupactivitiesThefocusgroupwasfacilitatedbyCamillaCouchandlocalcommunityvolunteersledbytheGriffithSoroptimistClub
The women in the group were from Pakistan and IndonesiaThegroupweremainlyyoungmotherswithyoungchildrenandtheprogramhadchild-minding arrangements The language level of the womenwaslowandmostwerestudyingESOLat
ATTACHMENTS
ATTACHMENT 1 A Description of the Focus Groups
TAFEThedeliveryoftheinformationwaslimiteddue to language levels and the lack of bilingual interpretersEachparticipantworkedoneononewithavolunteertoslowlyfillinthesurveyandonewomantookthesurveyhometodiscusswithherhusbandThisgroupexperiencehighlightedthe lack of bilingual workers and services in some rural areas
Arabic speaking group Syd West Multicultural Services Mount Druitt Community worker Zaid Naoum Generalist Caseworker SydWest Multicultural Services DateMonday24May
ThefocusgroupfromSydWestMulticulturalSer-viceswasconductedonMonday24May2021atSydWestMulticulturalServicesMountDruittat300pmItwasfacilitatedbyPatriciaMcCormickandsupportedbyZaidNaoumGeneralistCase-workerSydWestMulticulturalServices
Therewere10womenandmenfromSyriainthegroupThegroupweremostlymaturetoolderparticipantsMostparticipantsrequiredassistancewithEnglishandthecaseworkerZaidNaoumhadtranslatedthesurveyintoArabicpriorto the focus group Zaid also translated during the focus group
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Canterbury City Community Centre (4Cs) group The Cottage Lakemba DateTuesday25May
ThefocusgroupfromCanterburyCityCommunityCentre(4Cs)wasconductedonTuesday25MayattheCottageat28CroydonStreetLakembaat10amItwasfacilitatedbyRobinMilesandsup-portedbyRomanaWaseemCommunityWorkerfrom 4Cs
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
34
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3736
The group was comprised of 14 women from PakistanIndiaandSriLankaThewomenrangedinagefrom23to65MostwerefluentEnglishspeakershoweveronewomanrequiredtransla-tionintoUrdufromoneoftheotherwomeninthegrouptoanswerthequestionsdirectly
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
NSW Chaldean League group Community worker Randa Goriya DateTuesday25May
ThefocusgroupfromNSWChaldeanLeagueMountDruittwasconductedonTuesday25May2021 at 1000am at the NSW Chaldean League premisesItwasfacilitatedbyPatriciaMcCormickandsupportedbyRandaGoriyaacommunityworker for the NSW Chaldean League in Mount DruittRandatranslatedtheintroductionandpromptsforthediscussionandhelpedthepartic-ipantstocompletethesurveyMostofthegrouprequiredhelptodothesurvey
ThegroupoftwelveparticipantswereallChaldeanandwerematuretoolderinageTheywereamixed-gendergroup
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Arabic speaking group Red Cross premises Wollongong DateTuesday25May
ThefocusgrouptookplaceonTuesday25Mayat 3pm at the Red Cross premises at Wollongong Therewere22womenandmenparticipatinginthegroupThefocusgroupwasfacilitatedbyCamilla Couch with support from Khalid Zainu-labdeenBilingualSupportWorkerHumanitarianSettlementProgram(ACTampNSW)
There were diverse ages in the group ranging fromyoungpeopletoolderagedMostofthegroupwereyoungerrecently-arrivedrefugeesfrom diverse backgrounds There was also a small-eroldercohortofparticipantswithhigherliteracylevelsandstrongercommunityengagementwith the local services in the area Camilla Couch facilitated the focus group which was conducted inArabicandEnglishwiththeArabictranslationprovidedbyKhalidZainulabdeen
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Work Opportunities for Women group Mt Druitt TAFE DateWednesday26May
TheWorkOpportunitiesforWomen(WOW)focusgroupwasheldonWednesdayMay261100ndash 100pmatMtDruittTAFEItwasfacilitatedbyCamilla Couch and built on the knowledge gainedintheprevioussessiononcriticalandanalyticalthinkingTheWOWgroupisaTAFECertificatelevel course
There were 14 women from diverse cultural backgroundsinthegroupThegroupweremainlyMuslimwomenwithschoolagechildrenandsome were mature aged Due to the learning fo-custhegroupwasfacilitatedasaclasswithguid-eddiscussionontheissuesandcarefulanalysisofthequestionsNotranslationwasneededduetotheeducationalcontextThestudentswereadeptatusingITandcompletedallthesurveysonline
STARTTS Tamil group Toongabbie Community Centre Community worker Sivaharani (Harani) Mayuran DateThursday27May
Thefocusgroupconsistedof18femalepartic-ipantswhowereyoungertomatureagedThefocus group was held at 1000am at Toongabbie CommunityCentreinTargoRdToongabbie
ThefocusgroupwasfacilitatedbyPatriciaMc-CormickandsupportedbyacommunityworkerSivaharani(Harani)MayuranfromtheSTARTTSTamil Group
ThegrouphadmixedlevelsofspokenandwrittenEnglishTheintroductionanddiscussionpromptsweretranslatedbythecommunityworkerSivaha-rani(Harani)Mayuranandsheandthemorepro-ficientstudentssupportedthosewithlowliteracytoanswerthesurveyquestions
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Spanish Speakers Seniors group SydWest Multicultural Services Blacktown DateTuesday1June
TheFocusGrouptookplaceonTuesday1Juneat1100amattheBlacktownShowgroundsandconsistedof16participants(15womenandoneman)AllparticipantswerebornincountriesinSouthAmericaTheirEnglish-fluencylevelsvariedand one of the members of the group translated thesurveyquestionsanddiscussionintoSpanish
ThegrouphadbeenmeetingforseveralyearsThegroupwasfacilitatedbyLindyCassidyandwassupportedbySreeVithyaHarilingamDayRespiteampSocialSupportTeamLeaderatSydWestMulticulturalServicesBlacktownThegroupwerematureagedtoolderparticipants
Thegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyform There was a more focused discussion on somekeyquestionsaftersurveycompletionThetranslatorassistedconsiderablyinthisprocess
Italian Speakers group Warrawong Community Centre DateMonday7June
The focus group of Italian speakers was held on Monday7Juneat1015amattheWarrawongCommunityCentreItwasfacilitatedbyCamillaCouchandsupportedbyJohnPaulTroianiand
SofiaLemafromIllawarraShoalhavenLHDMulti-cultural Health
There were 15 women in the group The group weremostlymaturetoolderparticipantsandwasconductedinItalianandEnglishwithtranslationprovidedbyJohnPaulThisgroupmeetsregularlyandissupportedbyanumberofservicesintheareaespeciallymulticulturalhealth
The group had a general facilitated discussion aboutthequestionsinthesurveyDuetolittleornoliteracytheindividualsurveyresponseswerethencollectedintooneresponseThesesurveyresponses have been included in the general surveyresponses
Mothers Group SydWest Multicultural Services Blacktown DateThursday10June
ThefocusgrouptookplaceonThursday10Juneat1030amandconsistedof14youngwomen13 of whom had a CALD background The focus groupweremainlymothersfromasupportgroupatSydWestMulticulturalServicesinBlacktown
EightofthewomenwereborninIndiatwofromPakistantwofromSriLankaonefromHausaGhana and one was born in Australia (the Austral-ianbornyoungwomanwasasocialworkstudenthelpingwiththegroup)LindyCassidyfacilitatedthe group with support from Wilma Garguath a projectofficerfromSydWestMulticultural Services
The group varied in age One was between 18-24 yearsoldSevenwereagedbetween25-34yearsSixwereagedbetween35=44yearsGiventheirage and circumstances most of the group did not consider themselves eligible at this stage for vac-cinationThiswasanimportantdifferencefromotherfocusgroupsinthattheemphasiswasmoreonwhattheywoulddooncetheybecameeligible
Participantsdidnotrequireassistancewithspo-kenEnglishThegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyformTherewasamorefocuseddiscussiononsomekeyquestions
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3938
ATTACHMENT 2 COVID-19 Vaccine Information in multiple languagesThefollowingsitesappsprovidetranslatedinformationaboutCOVID-19vaccines
Type of information KeyinformationongettingvaccinatedinNew South Wales and on the vaccines available The websiteusesanautomaticservicetotranslate thecontentintodifferentlanguages
Source of information NSW Government website
Link httpswwwnswgovauCOVID-19health-and-wellbeingCOVID-19-vaccina-tion-nswgetting-vaccinated
Type of information COVID-19ResourcessectionontheServiceNSWapp The app has a link to NSW Government websiteinformationonldquoGettingaCOVID-19vaccinationrdquo(seeabove)ItalsoincludesalinktoCOVID-19vaccinationresourcesinotherlan-guages available from the Department of Health
Source of information Service NSW NSW Government
Link Service NSW App
Type of information ArangeoftranslatedresourcesonCOVID-19bytitleincludingafactsheetonCOVID-19VaccineAstraZeneca(ChAdOx1-S)
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCOV-ID-19Pagestranslatedresources-by-titleaspx
Type of information ADigitalCOVID-19resourcelibrarywithtranslated materials
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiouscov-id-19Pagesdigital-resourcesaspx
Type of information AMultilingualCommunityToolkitontheCOVID-19vaccinationprogramtoassist communityworkersprovideseasytoreadresourcesvideosandlinkstokeyservicesandresources
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCovid-19DocumentsNSW-COVID-19-vaccina-tion-program-presentation-20210527pdf
Type of information TheNSWMulticulturalHealthCommunicationServiceoffershealthresourcesandinformationin a wide range of languages It has translated resources on COVID-19 and links to translated resourcesonCOVID-19vaccination
Source of information MulticulturalHealthCommunicationServiceisa New South Wales-wide health service hosted bySouth-easternSydneyLocalHealthDistrict(SESLHD)
Link httpswwwmhcshealthnswgovau
Type of information COVID-19vaccineinformationaddressingkeyquestionsaboutCOVID-19vaccinationandincludesvideosposterstilesfactsheetsandaudio material Translated into 63 languages
Source of information Department of Health Australian Government website
Link httpswwwhealthgovauinitiatives-and-pro-gramsCOVID-19-vaccinesCOVID-19-vaccine-in-formation-in-your-language
Type of information ThisinformationaddressessomecommonmisinformationaboutCOVID-19Translatedintomultiplelanguages
Source of information DepartmentofHomeAffairs Australian Government website
Link httpscovid19inlanguagehomeaffairsgovaumisinformation-and-truths-about-coronavirus
Type of information Australianandinternationalnewsand informationaboutCOVID-19andCOVID-19 vaccinesisavailableontheSBSCoronavirusPortal in more than 60 languages
Source of information SBSwebsite
Link httpswwwsbscomaulanguagecoronavirus
Type of information InformationprovidedaboutCOVID-19vaccinerolloutandsafetyinlanguagesotherthan English
Source of information Department of Health and Human Services Victorian Government
Link httpswwwcoronavirusvicgovautranslat-ed-information-about-COVID-19-vaccines
Type of information HealthTranslationsprovidestranslatedmateri-alsonhealthandwellbeingInformationaboutCOVID-19isregularlyupdatedincludessomeinformationonvaccinationandisavailableinover60communitylanguages
Source of information Victoriangovernmentinitiative
Link httpswwwhealthtranslationsvicgovaubhcv2bhchtnsfPresentEnglishResource-AllOpenampx=amps=Coronavirus
Type of information A one-stop shop for translated materials in multiplelanguagesonCOVID-19
Source of information Ethnolink Language Services
Link httpswwwethnolinkcomauCOVID-19-coro-navirus-translated-resources
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
40
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2322
Knowing someone who has been vaccinatedOfthosewhorespondedtothisquestion125or70knewsomeonewhohadalreadyhadthevaccine
6983
2570
447
Yes No Dont know000
1000
2000
3000
4000
5000
6000
7000
8000
Figure 11 Do you know someone who has been vaccinated
Amongthe125participantswhoknewsomeonewhohadalreadybeenvaccinated100identifiedlsquoimmediatefamilymembersrsquo(parentschildrensiblingsandpartners)Somefocusgrouppartic-ipantsreportedthatalloftheirfamilymembersoverseas had been vaccinated Others reported thattheirrelativeshadbeenvaccinatedasarequirementoftheiremployment
Who Count Percent Other family member 41 313 Sister 24 1832 Community member 23 1756 Brother 18 1374 Father 17 1298 Mother 16 1221 Work colleague 14 1069 Husband or wife 11 84 Son or daughter 10 763 Partner 4 305 Someone else 45 3435 Total respondents 131
Table 6 Who do you know who has been vaccinated
When this issue was teased out further in focus groupdiscussionsarangeofreasonswere revealed including
My husband works in security and he had
to get it
My friend works as a COVID-19 cleaner and they all had to [get
vaccinated]
My family overseas have already been vaccinated
My son needs to travel for work so he is getting it
My brother in the UK is a doctor and he got it and
his wife
Knowing someone who has had COVID-19Almosthalfoftheparticipantsknewsomeonewho had contracted COVID-19 overseas Some reportedthatallthemembersoftheirfamilyormanymembersoftheirextendedfamilyhadcon-tracted COVID-19 In the older Italian group 10 of the15womenknewsomeoneinItalywhohadcontracted COVID-19
4716 4659
625
Yes No Not sure000
1000
2000
3000
4000
5000
Figure 12 Knowing someone who has had COVID-19
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2524
385 385
1538
2692
641 513000
4359
2051
1026385
1410
Mother
Father
BrotherSis
ter
Son or d
augh
ter
Husban
d or wife
Partner
Other family
mem
berFri
end
Community m
ember
Work co
lleag
ue
Someone else
(please
tell u
s who)
000500
100015002000250030003500400045005000
Figure 13 Who do you know who has had COVID-19
Four people in the focus groups knew someone who had died of COVID-19
All my family back home [Pakistan] got it [COVID-19] but
they are all fine now apart from my father He died But he was really sick before he
got it He had lots of underlying conditions Medical conditions so he was really unwell before he got COVID-19 But everyone else
they are fine now They were sick but they got betterhellip
If you are well and healthy you can fight this off
SurprisinglyknowingpeoplewhohadcontractedCOVID-19didnotseemtoinfluencefocusgroupparticipantsrsquopredispositiontowardseitherhavingthevaccineorbeingvaccinehesitantHowevertheolderItalianwomenrsquosgroupspokeabouttheimpactthatCOVID-19hadhadinItalyintheearlystagesofthepandemicandhowthishadaffectedthemdeeply13ofthe15womeninthisgroupwouldhaveorhadalreadyhadthevaccine
Knowing where to get vaccinated115people(81)whorespondedtothisquestion(n=142) knew where to go to get the vaccine 34 people(19)reportedthattheydidnotknowThisincluded15respondentsfromIraq3re-spondentsfromIndia2respondentsfromChina2 respondents from Pakistan and one respondent fromeachofthefollowingcountriesChinaEri-treaItalySriLankaSwedenSyriaandVietnamThese people were also less sure about whether ornottheywouldhavethevaccineItispossiblethat their lack of knowledge about where to go to get vaccinated was related to their general level ofvaccinehesitancy
7958
29582254
282 563
GPDoctor Vaccinecentre
Hospital Work place Somewhereelse (please
tell us where)
000100020003000400050006000700080009000
Figure 14 Where to go to get vaccinated
From the sample (n=199) GPs were the most commonlyidentifiedplacetogotogetvaccinat-edfollowedbythevaccinecentreatHomebushBayandthenhospitalsOtherplacesidentifiedincluded medical centres and pharmacies
Sources of information about COVID-19 and the vaccineThelargestsinglesourceofinformationaboutCOVID-19 and the vaccine was Facebook (417)
2743
3486
13141086
30862686
3429
2229 2286
41713714
2571
1086 971
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)000500
10001500200025003000350040004500
Figure 15 Sources of information about COVID-19 and the COVID-19 vaccine
Facebook I get my information from
Facebook But if I want to check it I watch the news
on 7 [Channel 7]
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2726
Thesecondlargestsourceofinformationforpeople in the sample was lsquoother forms of social mediarsquo(37)followedbySBStelevision(35)myfriends(34)andothertelevision(31)Oth-ersourcesofinformationpeoplereportedthattheyusedweretheNSWHealthwebsitenightlytelevisionnewsincludingChannel7Channel9andChannel10followedbytheABCtheAustral-iangovernmenthealthwebsitetheirGPlocalMedical Centres and the Red Cross
IntheLakembafocusgrouppredominantlymadeupofwomenfromPakistantherewasanani-mated discussion about Facebook which was the majorsourceofinformationalongwithGooglesearchesandcommunityandfriendship-basedWhatsApp groups There was a general consensus from most in the group that these were their pre-ferredormostcommonsourcesofinformationandnewsHoweveriftheywantedtolsquofactcheckrsquowhattheywerehearingtheywouldwatchthenightlynewsonChannel7orChannel9toverifywhattheyperceivedcouldsometimesbeunrelia-ble sources
IntheMtDruittfocusgroupseveralofthewom-enwithwell-developeddigitalliteracyandgener-alliteracyskillsusedhealthandfitnesswebsitesand social media sites as their source of infor-mationaboutlsquoallthingshealthrelatedrsquoincludingCOVID-19ThesewomenalsospokepositivelyabouttheinformationandsupporttheygotfromthestaffatCanterburyCouncilCommunityCentre(4Cs)whotheycouldrelyontofindoutthingsthattheyidentifiedtheyneededtoknowmoreabout
InthesmallerfocusgroupinGriffithwithrecently-arrived refugee women who had low levels of Englishlanguageliteracytherewaslittleknowledgeaboutthevaccinesnoawarenessofthedifferenttypesofvaccinesandlittleknow-ledgeaboutwheretogotogetvaccinatedorfindoutmoreaboutCOVID-19ingeneralThecommunityservicestaffandvolunteerspresentatthegroupwere working hard to assist these women to improve their English language skills and support themwithtranslatedinformation
In the older Italian women focus group in Wollon-gongparticipantsreportedgettingtheirinfor-mationfromslightlydifferentsourcesndashfamilyinAustralia(10women)Channel9(7women)
Italianradio(3women)andABCTV(3women)Onlytwowomenusedtheinternetandnoneofthe women reported using Facebook or social mediaasasourceoftheirinformationSeveralmentionedthattheygottheirinformationfromtheirGPorspecialistdoctorandonepartici-pantsaidrsquoIdonrsquotlistentoanyonersquoIntheSpan-ish-speaking focus group a comment was made thatseemedtoreflectmanyoftheotherfocusgroup discussions
Whenlsquosourcesofinformationrsquoiscorrelatedwiththegroupwhosaidtheywouldhavethevaccine(n=104)thereisashiftfromFacebookbeingthepreferredsourceofinformationtolsquoSBSTVrsquobeingthepreferredsourceThelsquovaccine-predisposedrsquogroupalsohadthelowestrateofrelyingonFace-bookasasourceofinformationaboutCOVID-19thoughitwasstillhighThegraphbelowhigh-lightshowotherlsquopreferredsourcesrsquoplayoutforthoseintendingtohaveorwhohavealreadyhadthe vaccine
ForthoseparticipantswhoindicatedthattheywouldnotorwerenotplanningtohavethevaccinelsquoFacebookrsquolsquomyfriendsrsquoandlsquomyfamilyrsquowerethesourcesofinformationaboutCOVID-19thatwereequallymostfrequentlycitedfollowedcloselybylsquomyfamilyoverseasrsquolsquoSBSradiorsquoandlsquoSBSTVrsquoassourcesofinformationreceivedthelowestmentionsfromthisgroup(SeeFigure16)
The vaccine-hesitant group were the group who identifiedlsquoFacebookrsquoastheirmostfrequentsourceofinformationaboutCOVID-19lsquoFace-bookrsquowasfollowedbylsquoothersocialmediarsquoandlsquomyfriendsrsquoasthenextmostfrequentsources
lsquoThiscommunityserviceproviderrsquo(theinterme-diaryorganisationwherethefocusgroupwasconducted)wasidentifiedby26ofrespondentsasasourceofinformationregardlessoftheirintentiontogetvaccinatedornotThefactthatboththelsquovaccinehesitantrsquoandthosewhoindi-catedtheywouldnrsquotbegettingthevaccinesoughtinformationfromthissourcesuggeststhatrolling
There is so much confusion about it [the vaccine] that I think my GP is the best
place to go
9 This group of the research sample included a small number ofpeoplewhohadalreadybeenvaccinated
2626
4141
14141111
323228282828
2424
1818
37373737
2828
10101212
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)00050010001500200025003000350040004500
2857
2381
952 952
2857
3333
42864286
3810
4286
23812381
1429
952
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another co
mmunity se
rvice
Somewhere
else (p
lease te
ll us w
here)000
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Figure 16 Sources of information for respondents who were planning to have the vaccine9
Figure 17 Sources of information for respondents who were not planning to have the vaccine
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2928
outpositivemessagingthroughtrusted communityserviceorganisationscouldbeaneffectivewayofshiftingpeoplefromvaccine hesitancytodecidingtohavethevaccine
31372549
980 980
25492157
4314
1176
2353
4902
4118
2157
980392
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)000
1000
2000
3000
4000
5000
6000
Figure 18 Sources of information for respondents who lsquodonrsquot knowrsquo if they will have the vaccine
DISCUSSION
wardstheCOVID-19vaccineareasvariedastheyarewithinthebroadercommunityTherearearangeofinfluencingfactorsincludingagehealthstatushowlongtheyhavebeeninAustraliahowmuchnewstheyreceivefromoverseasandhowbadlyimpactedbythepandemictheirhomecountries have been
The research also highlights that people from culturallyandlinguisticallydiversebackgroundsgettheirinformationaboutCOVID-19andtheCOVID-19vaccinefromawidevarietyofsourcesbothformalandinformalandthatforparticulargroupsinthisstudythereisahighrelianceonFacebookovermoreofficialsourcesofinforma-tion
VulnerabilityTheneedsofhighly-vulnerablegroupswithintheCALDcommunityhavetobetakenintoconsider-ationThisincludesolderpeoplewhohavelivedinAustraliaformanyyearsbuthavelowlevelsofEnglishliteracyndashespeciallywritingandreadingEnglishandsometimesspokenEnglishndashandwhoaremoresusceptibletoseriousillnessandhigherratesofhospitalisationanddeathfromCOVID-19Italsoincludesnewly-arrivedrefugeeswhohavinglowornoEnglishlanguageliteracylacktheconnectionstoandnetworksintothewidercommunityandcommunitysupportsItisalsothecase that some people in these groups are not health literate at all and cannot read and write in their own language
Akeytakeoutfromthehealthandcommunityserviceorganisationsurveyresponsesandinter-viewsundertakenwithmulticulturalhealthandcommunicationexpertsfortheprojectisthatlit-eracylevelsreallydomatterLowlevelsofhealthliteracylowlevelsofEnglishlanguageliteracyandpossiblylowlevelsofliteracyintheirownlan-guage-especiallyforsomenewly-arrivedrefu-gees and those who are part of the humanitarian program such as Dari language speakers from AfghanistanTigrinyalanguagespeakersfromEr-itrea and northern Ethiopia and Oromo language speakers from Ethiopia - need to be factored into anyplanstofurtherpromotethevaccinerolloutanduptaketoculturallyandlinguisticallydiversepeopleinthecommunityThereisaneedfor
The contextThisresearchisimportantgivenhowhighlyculturallydiverseNSWisandtheimpactthiscanhave on the success of public health messaging topeoplewhosefirstlanguageisnotEnglishPeople who were born overseas form almost one-thirdofthe7480228population(276)ofNSWandNSWishometo336ofAustraliarsquosoverseas-bornpopulationPeoplefromaround225 birthplaces have made NSW their home and 21oftheNSWpopulationisfromanon-EnglishspeakingbackgroundMorethan24000humani-tarianentrantshavesettledinNSWoverthepastfiveyearscomprisingalmostathird(32)ofthenationaltotalThe24000humanitarianentrantswhohavesettledinNSWoverthepastfiveyearscame from over 100 countries of origin10Sydneyhasthelargestoverseas-bornpopulationofallthecapitalcities11
Hearingdirectlyfrompeoplefromculturally-diverse backgrounds is important to ensure that policymakersandpublichealthadvocatescandesign responses that are both accessible and un-derstandabletopeopleforwhomEnglishmaybetheirsecondthirdorfourthlanguageApropor-tionofpeopleinthesecommunitieshavelowerlevelsofEnglishlanguageliteracyandinsomecaseslowlevelsofliteracyintheirlanguageoforiginsowillbehardertoreachviatraditionalormainstream methods
Itisalsocriticallyimportantthatduringatimewherethereissomuchlsquonoisersquoacrossmediachannelsrelatingtothevaccinethevaccineroll-outvaccineefficacyandvaccinesafetythatwetakesometimetolistentoandunderstandhowthislsquonoisersquoisbeingheardandmadesenseofbypeoplefromculturally-diversebackgrounds
ThatsaiditisimportanttoreconfirmthattheCALDcommunityisnotahomogenousgroupOurresearchhasfoundthattheviewsandattitudesofparticipantsfromdiverseculturalbackgroundsto-
10RefugeeCouncilofAustraliaHumanitarianEntrantsin New South Wales A resource for New South Wales governmentagencies6-711MulticulturalNSWCommunityRelationsReport2018-20199
29
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3130
groupsFortheparticipantsintheresearchtheirattitudetothevaccineappearedtobeinflu-encedbyanumberoffactorstheirownlevelsofhealthandpre-existinghealthconditionsandthoseoftheirfamilymembersandtheimpactofreceiving COVID-19-related news from overseas particularlyfrompeoplersquoscountryoforiginAnexampleofthiscanbeseenintheItaliangroupin Wollongong where people had received news fromoverseasearlyinthepandemicwhichscaredthemThisexperiencelsquofromhomersquohadinflu-enced most of the women in the Wollongong focus group (n=15) to choose to get vaccinated The interviewee from the Illawarra Shoalhaven Local Health District also spoke about the heightenedconcernthattheywitnessedinthelocalItaliancommunityintheearlystagesofthepandemicOtherpeoplewantedtolsquostayhealthyrsquoandtolsquoprotectthehealthofothersrsquoandformanytherewasasensethattheywantedtolsquogetbacktosomedegreeofnormalcyrsquoandtobeabletolsquotraveloverseastovisitrelativesrsquo
Vaccine hesitancyOfthe42inthisstudywhoappearedundecidedornotplanningtohavethevaccinemanywereinfactadoptingalsquowaitandseersquoapproachbeforemakingtheirfinaldecisionMostparticipantswereinterestedtohearmoreinformationaboutthevaccinesandwereopenedtogettingthevaccinebutdidhaveconcernsaboutthesafetyofthevaccinesespeciallyinregardtoAstraZeneca
The issue of blood clots has led to considerable fearandhesitancyinthecommunityandthisfearandhesitancywasreflectedinourstudyEssentialResearchrsquossurvey(April2021)reportedoneinsixpeople(16)indicatedtheywillnevergetvaccinatedagainstCOVID-19upfrom12thepreviousmonthwhile42saidtheywillgetvaccinatedbutnotrightawayTheproportionofpeople who would be willing to get vaccinated as soonaspossibleorarealreadyvaccinatedalsodeclineddownfrom47to4213Thissurveywas conducted prior to the most recent outbreak inNSWinvolvingthehighlyinfectiousDeltastrain
Therisk-benefitofhavingthevaccineneedstobecarefullyweighedbyeachindividualideallyinconsultationwiththeirdoctoranddependingon
The Hub has lsquobeen working in partnership with keystakeholdergroupstoguidecommunicationstomeetthehealthliteracyandculturallyandlinguisticallydiverse(CALD)needsofitspop-ulationStructuredworkinggroupshavebeencreatedtoprioritisecommunicationstovulner-ableyouthCALDgroupstheelderlyitinerateworkersasylumseekersandrefugeesTheaimsaretotestmessagingandbuildtrustwithprioritypopulationstoensureeffectivecommunicationoftheneedtosustainphysicaldistancingmeas-uresintheabsenceofavaccineSimilareffortsarenowneedednationallyandshouldstartatthetimeofdiseaseoutbreaksinthefuturealongsideplannedmassmediaandhealthcommunicationcampaignsrsquo
InthearticlebyDoddetaltheyreinforcetheimportanceofusingcommunicationformatswhich are lsquosuitable for people with low health literacyandeducationandwhichareappropriateforculturallyandlinguisticallydiversegroupsandIndigenouspopulationsrsquoThearticlearguesthatitisimportanttolookatmotivationsandconcernsabout vaccines when shaping messaging It also pointsoutthatprimarycaredoctorsareatrust-ed source and as such should be supported in deliveringinformationaboutthevaccinesandad-dressingcommunityconcernsThearticlestateslsquoWeneedtounderstandandaddresscitizenrsquosconcernsthatcanpreventoptimaluptakebuildmotivationsintomessagingandprioritisepublictrustbyinformingandinvolvingthecommunityintheprocessSupportinghealth-careprofession-als in their role as educators will ensure people haveadequateandaccessibleinformationfromatrustedsourcetooptimisevaccineuptakeandultimatelyreducecommunitytransmissionofCOVID-19rsquo15
RecentresearchbyAssociateProfessorHollySeale16withUNSWMedicinersquosSchoolofPublicHealthandDeputyChairfortheCollaborationonSocialScienceandImmunisationfoundthereisaneedtolsquodecentralisersquocommunicationsbytapping
translatedmaterialsandinformationaboutthevaccines to be tailored to the needs of people in these newly-emergingcommunitygroups
It was reported that in Wollongong there can sometimesbefourgenerationsoffamilymem-bersfromnewly-arrivedrefugeegroupslivingintheonehouseMostofthesefamilymembersgenerallyhavelimitedEnglishlanguageliteracywhichincreasestheirriskofnotreceivingkeyhealthmessagesandthereforeincreasingthepotentialimpactofCOVID-19-inparticulartheDeltastrainwhichhasprovenhighlyinfectiousamongst household members
Vaccine uptakeNotdissimilartothewidercommunitymorepeopleinourstudywereplanningtohavethevaccinethannotandanumberhadalreadybeenvaccinatedInarecentLancetarticle(February2021)ConcernsandmotivationsaboutCOVID-19vaccinationfindingsfromtwosurveysfromanAustralianlongitudinalstudyconductedinJuneandJuly2020includedthatlsquothetopthreerea-sons for agreeing to vaccinate were lsquoto protect themselvesandothersrsquohelliplsquobeliefinvaccinationandsciencersquohellipandlsquotohelpstopthevirusspreadrsquoEven among those willing to vaccinate there was somehesitancyaboutthesafetyofthevaccineTheLancetarticlenotedthatlsquowillingnesstovaccinatedifferedbybothageandeducationrsquoForthosewhowereindifferentorsaidtheywouldnot get the vaccine the top reasons across the twosurveyswerelsquoconcernaboutthesafetyofthevaccineinitsdevelopmentrsquoandlsquopotentialsideeffectsrsquo12
Olderpeopleinourstudywhocomprised23of the total sample (n=199) were the group most likelytosaythattheywantedtogetthevaccine85ofthoseover65saidtheywouldhaveorhadalreadyhadthevaccineVaccinepredispo-sitionwashoweveralsostrongacrossotherage
12RHDoddKPicklesBNickelECvejicJAyreCBatcupCBonnerTCoppSCornellTDakinJIsautierKJMcCafferyConcerns and motivations about COVID-19 vaccination SydneyHealthLiteracyLabSydneySchoolofPublicHealthFacultyofMedicineandHealthUniversityofSydneypublishedintheLancetFebruary2021p162wwwthelancet cominfectionVol21February2021
theircircumstancesHoweverthesourcesofin-formationthatpeoplemostrelyuponortrustarecriticaltothedisseminationofaccurateandclearmessaging to dispel the fear surrounding events suchasbloodclottingandthemisconceptionsraisedinthefocusgroupsWithsomanypartici-pantsinthisstudygettingtheirinformationfromFacebookandothersocialmediasitesitisvitalthat these channels are used to promote simple positivemessagesandforanyfuturecommunityawareness campaigns
Effective communicationConfusionandmisconceptionsaboutthevac-cinersquosefficacyavailabilityandsafetywereallis-sues that were raised in the focus groups Finding waystoeffectivelycommunicatewithpeoplewithlowerEnglishlanguageliteracyandhealthliteracyisanimportantwaytoaddresstheconfusionandmisconceptionsaboutthevaccineashasbeen discussed in a number of recent Australian studies
Astudy14byMcCafferyetal(2020)concludedthattherearelsquoimportantdisparitiesinCOVID-19-relatedknowledgeattitudesandbehavioursaccordingtopeoplersquoshealthliteracyandlanguagersquoOneofthefindingswasthatlsquopeoplewithlowerhealthliteracywerealsomorelikelyto endorse misinformed beliefs about COVID-19 andvaccinations(ingeneral)thanthosewithadequatehealthliteracyThesamepatternofresults was observed among people who primar-ilyspeakalanguageotherthanEnglishathomersquoTheMcCafferystudyhighlightstheimportanceof tailoring health messages to those with lower healthliteracyandculturallyandlinguisticallydiversecommunitiesItpointsoutthatthereareexamplesofeffectivemanagementofdiversecommunityneedsthatusetailoredhealthmes-sagesandcitestheWesternSydneyLocalHealthDistrictHealthLiteracyHub
13TheEssentialReport-anonlinesurveyconductedbyEssentialResearchcompletedby1090people between 21ndash26 April14McCafferyKJDoddRHCvejicEAyreJBatcupCIsautierJMJCoppTBonnerCPicklesKNickelBDakinTCornellSWolf MS Health literacy and disparities in COVID-19ndashrelated knowledge attitudes beliefs and behaviours in Australia PublicHealthResPract202030(4)e30342012December2020
15 Op cit16 httpssphmedunsweduausitesdefaultfilessphcmNewsEnhancing-supporting-COVID-19-vaccination-programpdf
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
30 31
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3332
intodifferentnetworkingspacessuchaswork-placeslocalgymsmothersrsquogroupsandseniorsrsquoclubswithafocusonallagegroupsregardlessofcurrenteligibilityAccordingtoSealethechal-lengeislsquoensuringemerginginformationisadapt-edfortheintendedaudiencersquoShehasalsosaidlsquoThatrsquoswhatIrsquomalittlebitconcernedaboutatthemomenttherersquosalotofresourcesongov-ernmentwebsitesbutthesetermsaroundbloodclottingareverytechnicalWeactuallyneedtomake sure that we are breaking them down in a waythatwillmakeitmeaningfultopeopleThatrsquosnotjustabouttranslatingitrsquosaboutbeingcon-sciousofpeoplersquoshealthliteracyneedstooSomaybegettingsomemorevisualsintomaterialstotryandsupportthatrsquo17
Thereareanumberofmulticulturalhealthresourcesthatusecommunitylanguagetransla-tionsplainEnglishandvideosfromCALDcommu-nityleaderswhichcanbedownloadedandusedbyservicesandindividualsHowevermanyofthewrittenresourcesstillrelyontechnicalandscien-tifictermsthatrequireareasonablyhighlevelofEnglishlanguageliteracyorhighlevelsofliteracyin the translated language to comprehend Host websites can also be hard to navigate making itdifficulttolocateresourcesfromsimplewebsearchesAsummaryofsomeoftheavailableresourcescanbefoundatAttachment2
MulticulturalHealthUnitsinLocalHealthDis-trictshavestaffwhocanworkwithpeoplefromculturallyandlinguisticallydiversecommunitiesatthelocallevelandtranslateandcontextualisethese materials to the needs of the end user These teams respond to local needs and popu-lationdemographicsandareexpertsineffectivehealthliteracyandhealthcommunicationwiththeirlocalcommunitiesTheyworkcloselywithcommunityandvulnerablegroupstobuildhealthliteracyandimprovedhealthoutcomesintheircommunities
Case Study ndash Be a COVID Warrior ndash Responding to COVID-19 in Multicultural Communities InWollongongtheIllawarraShoalhavenLocalHealthDistrict(ISLHD)MulticulturalHealthSer-viceco-designedacommunityengagementandeducationprogramcalledlsquoBeaCOVIDWarriorrsquowhich commenced in 2020 in response to the pandemic This program was designed to respond tothelowlevelsofhealthliteracyaroundCOVID-19potentialexposuretothevirusandaddressfearandstigmainthelocalCALDcommunitiesThelsquoCOVIDWarriorrsquoprogramreachedaround880peopleranginginagefrom14to85years65ofCOVIDWarriorparticipantswerefemaleand35weremaleCOVIDWarriorparticipantsrepresented 21 language groups The outcomes of the program included increased levels of confidenceinapplyinginfectioncontrolmeasuresincreasedliteracyandhealthliteracyandawarenessofhowCOVID-19istransmittedUltimatelyanimprovedawarenessinapplyingCOVIDsafemeasures was also reported
InApril2020theservicecommencedwelfarechecksviaphoneonafortnightlybasistosup-portsocially-isolatedmulticulturalseniorswhoboretheemotionalstressofsocialisolationFrom these calls the ISLHD heard the needs and concernsofseniorsinthecommunityInadditionourexperiencewithCALDcommunitieshighlightedtheimportanceofyoungpeopleasconduitsofessentialinformationtoadultsincommunityandfamilygroupsduetoEnglishlanguageaccessandeducation
InresponsetheISLHDinitiatedthelsquoCOVIDWarri-orrsquoprogramusingbi-culturalhighschoolstudentsthroughthelocalhighschoolsByincreasingthehealthliteracyofstudentsatschooltheselsquocham-pionsrsquocouldtalktotheirfamiliesincludingolderfamilymembersininformalsettingsandthroughsocialmediawiththeirpeersasastrategytoraisethe level of knowledge of COVID-19 trans-mission preventionandtestingTheprogrambecamesopopularthatitwasextendedintomorelocalhighschools and adults accessing the Adult Migrant EnglishProgramTheprogramwassupportedbylocalsettlementservicesprovidedbybothMaxSolutionsandtheRedCrossItwas
17 httpstheconversationcomhow-can-governments-communicate-with-multicultural-australians-about-COVID-19-vaccines-its-not-as-simple-as-having-a-poster-in-their-language-156097
later extendedtoCALDSeniorsthroughtheMulticulturalCommunitiesCouncilIllawarra(MCCI)supportprograms
AkeycomponentoftheprogramwastoprovideparticipantswithlsquoCOVIDWarriorrsquoKitswhichincludedtworeusablemaskshandsanitiserinfographicsaboutCOVID-19symptomsandinfor-mationaboutwheretestingclinicswereavailablelocallyMCCIandRuralAustraliaforRefugeesdonatedreusablemasksforeveryparticipant
AsthelsquoCOVIDWarriorrsquoprogramwasevolvingsowasthenationalvaccinerolloutplanInforma-tionwasthereforeadaptedtomeetthisinfor-mationgapForexampleadultparticipantsandseniors were supported to understand how to accesstheCOVIDvaccinelsquoeligibilitycheckersrsquoandCALD people were shown how to use the NSW HealthwebsiteCOVID-19informationpages18
Decision makingHowpeoplearecurrentlyconsideringtheriskofCOVID-19isinfluencedbyarangeoffactorsincludingratesoftransmissioninthecommunitynumbersofnewcasesreportsinthemediaofrisksandsideeffectsPeopletendtobasetheirassessmentonwhattheyarecurrentlyexperi-encingandthencheckthisagainstwhattheyarehearinginthemediaincludingandespeciallyonsocialmediaandfromfamilyandfriendsMostoftheparticipantsinourstudyspokeclearlyandarticulatelyabouthowtheyweigheduptherisk-benefitofhavingtheCOVID-19vaccineintheir decision making Low case numbers ndash at the timeofconductingtheresearchndashandasensethat Australia was lsquodoing well in safeguarding the communityagainstCOVID-19rsquoweresignificantfactorsinpeoplersquosdecisionnottobevaccinatedortoadoptalsquowaitandseersquoapproachFamilyfriends and social media were reported as having aconsiderableinfluenceondecisionmakingaswerereportsinthemediaofthebloodclottingsideeffectsofAstraZeneca
ThefactthatFacebookwasreportedlythemostpopularsourceofinformationaboutCOVID-19
18httpswwwhealthnswgovauInfectiouscovid-19Pagesdefaultaspx
andtheCOVID-19vaccineforpeopleinthestudyraisesconcernsaboutthepossibledisseminationofmisconceptionsandlsquofakenewsrsquothatmaybespread or compounded via social media Closed social media groups such as WhatsApp and WeChatwithfamilyandfriendsmayalsoleadtopeoplereinforcingtheirpre-existingbiasesThesefactorscoupledwithasensethatAustraliaisfaringwellcomparedtomanycountriesoverseasappear to have resulted in increased vaccine hesi-tancyamongparticipantsofthestudy
Factorsthatwereidentifiedaschangingvaccine-hesitantparticipantsrsquoperceptionswereanincreased risk from COVID-19 and a correspond-ingincreaseinthenumberofinfectionsandonthebenefitsidetheabilitytotraveloverseastovisitfamilyIntherecentresearchfromtheUniversityofNSWcitedaboveSearlearguesthatlsquotheremaybeotherthingsthatweneedtonowstartfocusingonhellipthatwillstarttopromoteandmotivatepeoplesuchasthechancetotravelmorefreelyforexamplersquoThisappearstobeborneoutbyourfocusgroupfindings19
Untilrecentlytherehavebeenverylowcasenumbers and few lockdowns across most of Aus-tralia and NSW The recent outbreak from mid-JuneinGreaterSydneyandintroductionofthehighlyinfectiousDeltavariantinNSWislikelytoimpactonpeoplersquosassessmentsoftherisk-benefitofhavingthevaccineandonewouldassumereducehesitancyrates
GiventheheightenedcommunityanxietycausedbythisrecentCOVID-19outbreaktheproductionofshortsharpandtargetedmessagingtoCALDgroupsincommunitylanguagesthatisaccessibleandmotivationalfeaturescommunityleadershigh-profilecelebritiesandsportsstarsfromCALDbackgroundsandisdirectedatastate-wideandlocal level would appear to be more urgent than everItisclearthatformessagingtobeeffectiveandreachitsintendedaudiencedistributionchannelsshouldincludeFacebookWhatsAppandothersocialmediaplatformsaswellastrustedsourcessuchasmulticulturalhealthworkersmulticulturalservicesandthroughGPsandMedical Centres If mainstream COVID-19 vaccine
19 Op cit
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
32 33
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3534
awareness campaigns are produced in Australia suchashavebeenproducedinNewZealandtheUnitedKingdomandNorthAmericatheyshouldincludehighprofilewell-knowncommunityfig-uresandsportingstarsfromCALDbackgroundsandincludestrategiesspecificallytargetingCALDcommunitiesincludinggroupsidentifiedaspar-ticularlyhigh-risk
It is also important that informationonvaccinesistranslatedintolanguagesfromnewerandemergingcommunitiesOthersuggestionsaroundreachingthesecommunitiesincludeface-to-facemeetingsorganisedbycrossagencypartnershipsandpeer-ledstrategiessuchas mobilising community champions and influenc-ers Messaging needs to be inclusive and framed around the collective values held by commu-n5
It is clear that reinforcing the benefits of being vaccinated at this time rather than dwelling on the risks is more likely to generate behavioural
changeandapositivevaccineresponsefrombothCALDcommunitiesandthegeneralpopulationAppropriately-designedandtargetedCOVID-19vaccinehealthinformationthatiseasytoreadinanylanguagecanbeconveyedbycommunityleadersandcommunitynetworksandpromotesthepositivebenefitsofgettingvaccinatedwouldbevaluableatthistimeBuildingontheworkofpeerchampionssuchastheCOVIDWarriorprogramisalsoasuccessfulmodeltoincreasingCOVID-19vaccinehealthliteracyandinformed decision making
Mostimportantlypositivelymotivatingculturallyandlinguisticallydiversecommunitymemberstolsquogetthejabrsquoespeciallythosewhoareadoptingalsquowaitandseersquoapproachorarevaccinehesitantwould lead to greater vaccine uptake among culturallyandlinguisticallydiversecommunitiesandthereforethecommunityasawhole
Inner West Multicultural Network Addison Road Community Centre DateWednesday12May
A focus group session of members of the Inner WestMulticulturalNetworkpluscustomersoftheFoodPantryatAddisonRoadwasheldattheAddisonRoadCommunityCentreinMarrickvilleon12Mayat200pmThesessionwaspartoftheregularmeetingoftheInnerWestMulticul-turalNetworkTheconsultationinvolvedabout26peopleandwasconductedbyRosannaBarbero
Thegroupbrainstormedresponsestoquestionsaroundvaccinehesitancyinmulticulturalcom-munitiesandmoreeffectivemessagingTheseresponseshavebeenincorporatedinthefindingsof the report
Griffith Women on Fire Focus Group Griffith Community Centre DateFriday14May
This small focus group of women was held at GriffithCommunityCentreonMay14at11amMargCouchSeniorProjectOfficerRegionalDevelopmentAustralia(RDA)-RiverinaandJoanneFitzpatrickSettlementEngagementandTransitionSupport Worker from Centacare Southwest NSW werethekeylinksandnetworkcontactsfortheGriffithcommunityTheWomenonFire(WOF)group was established as part of the Red Cross RuralFireServiceprogramlsquoManyCulturesOneCommunityrsquoInitiallyitwasestablishedtoeducatewomenonemergencypreparednessandtoen-courage NSW Rural Fire Service (RFS) volunteering andnowhastransformedintoacommunityac-tionsupportgroupTheGriffithSoroptimistInter-nationalnowauspicetheirfinancesandsupporttheWOFgroupactivitiesThefocusgroupwasfacilitatedbyCamillaCouchandlocalcommunityvolunteersledbytheGriffithSoroptimistClub
The women in the group were from Pakistan and IndonesiaThegroupweremainlyyoungmotherswithyoungchildrenandtheprogramhadchild-minding arrangements The language level of the womenwaslowandmostwerestudyingESOLat
ATTACHMENTS
ATTACHMENT 1 A Description of the Focus Groups
TAFEThedeliveryoftheinformationwaslimiteddue to language levels and the lack of bilingual interpretersEachparticipantworkedoneononewithavolunteertoslowlyfillinthesurveyandonewomantookthesurveyhometodiscusswithherhusbandThisgroupexperiencehighlightedthe lack of bilingual workers and services in some rural areas
Arabic speaking group Syd West Multicultural Services Mount Druitt Community worker Zaid Naoum Generalist Caseworker SydWest Multicultural Services DateMonday24May
ThefocusgroupfromSydWestMulticulturalSer-viceswasconductedonMonday24May2021atSydWestMulticulturalServicesMountDruittat300pmItwasfacilitatedbyPatriciaMcCormickandsupportedbyZaidNaoumGeneralistCase-workerSydWestMulticulturalServices
Therewere10womenandmenfromSyriainthegroupThegroupweremostlymaturetoolderparticipantsMostparticipantsrequiredassistancewithEnglishandthecaseworkerZaidNaoumhadtranslatedthesurveyintoArabicpriorto the focus group Zaid also translated during the focus group
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Canterbury City Community Centre (4Cs) group The Cottage Lakemba DateTuesday25May
ThefocusgroupfromCanterburyCityCommunityCentre(4Cs)wasconductedonTuesday25MayattheCottageat28CroydonStreetLakembaat10amItwasfacilitatedbyRobinMilesandsup-portedbyRomanaWaseemCommunityWorkerfrom 4Cs
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
34
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3736
The group was comprised of 14 women from PakistanIndiaandSriLankaThewomenrangedinagefrom23to65MostwerefluentEnglishspeakershoweveronewomanrequiredtransla-tionintoUrdufromoneoftheotherwomeninthegrouptoanswerthequestionsdirectly
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
NSW Chaldean League group Community worker Randa Goriya DateTuesday25May
ThefocusgroupfromNSWChaldeanLeagueMountDruittwasconductedonTuesday25May2021 at 1000am at the NSW Chaldean League premisesItwasfacilitatedbyPatriciaMcCormickandsupportedbyRandaGoriyaacommunityworker for the NSW Chaldean League in Mount DruittRandatranslatedtheintroductionandpromptsforthediscussionandhelpedthepartic-ipantstocompletethesurveyMostofthegrouprequiredhelptodothesurvey
ThegroupoftwelveparticipantswereallChaldeanandwerematuretoolderinageTheywereamixed-gendergroup
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Arabic speaking group Red Cross premises Wollongong DateTuesday25May
ThefocusgrouptookplaceonTuesday25Mayat 3pm at the Red Cross premises at Wollongong Therewere22womenandmenparticipatinginthegroupThefocusgroupwasfacilitatedbyCamilla Couch with support from Khalid Zainu-labdeenBilingualSupportWorkerHumanitarianSettlementProgram(ACTampNSW)
There were diverse ages in the group ranging fromyoungpeopletoolderagedMostofthegroupwereyoungerrecently-arrivedrefugeesfrom diverse backgrounds There was also a small-eroldercohortofparticipantswithhigherliteracylevelsandstrongercommunityengagementwith the local services in the area Camilla Couch facilitated the focus group which was conducted inArabicandEnglishwiththeArabictranslationprovidedbyKhalidZainulabdeen
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Work Opportunities for Women group Mt Druitt TAFE DateWednesday26May
TheWorkOpportunitiesforWomen(WOW)focusgroupwasheldonWednesdayMay261100ndash 100pmatMtDruittTAFEItwasfacilitatedbyCamilla Couch and built on the knowledge gainedintheprevioussessiononcriticalandanalyticalthinkingTheWOWgroupisaTAFECertificatelevel course
There were 14 women from diverse cultural backgroundsinthegroupThegroupweremainlyMuslimwomenwithschoolagechildrenandsome were mature aged Due to the learning fo-custhegroupwasfacilitatedasaclasswithguid-eddiscussionontheissuesandcarefulanalysisofthequestionsNotranslationwasneededduetotheeducationalcontextThestudentswereadeptatusingITandcompletedallthesurveysonline
STARTTS Tamil group Toongabbie Community Centre Community worker Sivaharani (Harani) Mayuran DateThursday27May
Thefocusgroupconsistedof18femalepartic-ipantswhowereyoungertomatureagedThefocus group was held at 1000am at Toongabbie CommunityCentreinTargoRdToongabbie
ThefocusgroupwasfacilitatedbyPatriciaMc-CormickandsupportedbyacommunityworkerSivaharani(Harani)MayuranfromtheSTARTTSTamil Group
ThegrouphadmixedlevelsofspokenandwrittenEnglishTheintroductionanddiscussionpromptsweretranslatedbythecommunityworkerSivaha-rani(Harani)Mayuranandsheandthemorepro-ficientstudentssupportedthosewithlowliteracytoanswerthesurveyquestions
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Spanish Speakers Seniors group SydWest Multicultural Services Blacktown DateTuesday1June
TheFocusGrouptookplaceonTuesday1Juneat1100amattheBlacktownShowgroundsandconsistedof16participants(15womenandoneman)AllparticipantswerebornincountriesinSouthAmericaTheirEnglish-fluencylevelsvariedand one of the members of the group translated thesurveyquestionsanddiscussionintoSpanish
ThegrouphadbeenmeetingforseveralyearsThegroupwasfacilitatedbyLindyCassidyandwassupportedbySreeVithyaHarilingamDayRespiteampSocialSupportTeamLeaderatSydWestMulticulturalServicesBlacktownThegroupwerematureagedtoolderparticipants
Thegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyform There was a more focused discussion on somekeyquestionsaftersurveycompletionThetranslatorassistedconsiderablyinthisprocess
Italian Speakers group Warrawong Community Centre DateMonday7June
The focus group of Italian speakers was held on Monday7Juneat1015amattheWarrawongCommunityCentreItwasfacilitatedbyCamillaCouchandsupportedbyJohnPaulTroianiand
SofiaLemafromIllawarraShoalhavenLHDMulti-cultural Health
There were 15 women in the group The group weremostlymaturetoolderparticipantsandwasconductedinItalianandEnglishwithtranslationprovidedbyJohnPaulThisgroupmeetsregularlyandissupportedbyanumberofservicesintheareaespeciallymulticulturalhealth
The group had a general facilitated discussion aboutthequestionsinthesurveyDuetolittleornoliteracytheindividualsurveyresponseswerethencollectedintooneresponseThesesurveyresponses have been included in the general surveyresponses
Mothers Group SydWest Multicultural Services Blacktown DateThursday10June
ThefocusgrouptookplaceonThursday10Juneat1030amandconsistedof14youngwomen13 of whom had a CALD background The focus groupweremainlymothersfromasupportgroupatSydWestMulticulturalServicesinBlacktown
EightofthewomenwereborninIndiatwofromPakistantwofromSriLankaonefromHausaGhana and one was born in Australia (the Austral-ianbornyoungwomanwasasocialworkstudenthelpingwiththegroup)LindyCassidyfacilitatedthe group with support from Wilma Garguath a projectofficerfromSydWestMulticultural Services
The group varied in age One was between 18-24 yearsoldSevenwereagedbetween25-34yearsSixwereagedbetween35=44yearsGiventheirage and circumstances most of the group did not consider themselves eligible at this stage for vac-cinationThiswasanimportantdifferencefromotherfocusgroupsinthattheemphasiswasmoreonwhattheywoulddooncetheybecameeligible
Participantsdidnotrequireassistancewithspo-kenEnglishThegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyformTherewasamorefocuseddiscussiononsomekeyquestions
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3938
ATTACHMENT 2 COVID-19 Vaccine Information in multiple languagesThefollowingsitesappsprovidetranslatedinformationaboutCOVID-19vaccines
Type of information KeyinformationongettingvaccinatedinNew South Wales and on the vaccines available The websiteusesanautomaticservicetotranslate thecontentintodifferentlanguages
Source of information NSW Government website
Link httpswwwnswgovauCOVID-19health-and-wellbeingCOVID-19-vaccina-tion-nswgetting-vaccinated
Type of information COVID-19ResourcessectionontheServiceNSWapp The app has a link to NSW Government websiteinformationonldquoGettingaCOVID-19vaccinationrdquo(seeabove)ItalsoincludesalinktoCOVID-19vaccinationresourcesinotherlan-guages available from the Department of Health
Source of information Service NSW NSW Government
Link Service NSW App
Type of information ArangeoftranslatedresourcesonCOVID-19bytitleincludingafactsheetonCOVID-19VaccineAstraZeneca(ChAdOx1-S)
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCOV-ID-19Pagestranslatedresources-by-titleaspx
Type of information ADigitalCOVID-19resourcelibrarywithtranslated materials
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiouscov-id-19Pagesdigital-resourcesaspx
Type of information AMultilingualCommunityToolkitontheCOVID-19vaccinationprogramtoassist communityworkersprovideseasytoreadresourcesvideosandlinkstokeyservicesandresources
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCovid-19DocumentsNSW-COVID-19-vaccina-tion-program-presentation-20210527pdf
Type of information TheNSWMulticulturalHealthCommunicationServiceoffershealthresourcesandinformationin a wide range of languages It has translated resources on COVID-19 and links to translated resourcesonCOVID-19vaccination
Source of information MulticulturalHealthCommunicationServiceisa New South Wales-wide health service hosted bySouth-easternSydneyLocalHealthDistrict(SESLHD)
Link httpswwwmhcshealthnswgovau
Type of information COVID-19vaccineinformationaddressingkeyquestionsaboutCOVID-19vaccinationandincludesvideosposterstilesfactsheetsandaudio material Translated into 63 languages
Source of information Department of Health Australian Government website
Link httpswwwhealthgovauinitiatives-and-pro-gramsCOVID-19-vaccinesCOVID-19-vaccine-in-formation-in-your-language
Type of information ThisinformationaddressessomecommonmisinformationaboutCOVID-19Translatedintomultiplelanguages
Source of information DepartmentofHomeAffairs Australian Government website
Link httpscovid19inlanguagehomeaffairsgovaumisinformation-and-truths-about-coronavirus
Type of information Australianandinternationalnewsand informationaboutCOVID-19andCOVID-19 vaccinesisavailableontheSBSCoronavirusPortal in more than 60 languages
Source of information SBSwebsite
Link httpswwwsbscomaulanguagecoronavirus
Type of information InformationprovidedaboutCOVID-19vaccinerolloutandsafetyinlanguagesotherthan English
Source of information Department of Health and Human Services Victorian Government
Link httpswwwcoronavirusvicgovautranslat-ed-information-about-COVID-19-vaccines
Type of information HealthTranslationsprovidestranslatedmateri-alsonhealthandwellbeingInformationaboutCOVID-19isregularlyupdatedincludessomeinformationonvaccinationandisavailableinover60communitylanguages
Source of information Victoriangovernmentinitiative
Link httpswwwhealthtranslationsvicgovaubhcv2bhchtnsfPresentEnglishResource-AllOpenampx=amps=Coronavirus
Type of information A one-stop shop for translated materials in multiplelanguagesonCOVID-19
Source of information Ethnolink Language Services
Link httpswwwethnolinkcomauCOVID-19-coro-navirus-translated-resources
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
40
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2524
385 385
1538
2692
641 513000
4359
2051
1026385
1410
Mother
Father
BrotherSis
ter
Son or d
augh
ter
Husban
d or wife
Partner
Other family
mem
berFri
end
Community m
ember
Work co
lleag
ue
Someone else
(please
tell u
s who)
000500
100015002000250030003500400045005000
Figure 13 Who do you know who has had COVID-19
Four people in the focus groups knew someone who had died of COVID-19
All my family back home [Pakistan] got it [COVID-19] but
they are all fine now apart from my father He died But he was really sick before he
got it He had lots of underlying conditions Medical conditions so he was really unwell before he got COVID-19 But everyone else
they are fine now They were sick but they got betterhellip
If you are well and healthy you can fight this off
SurprisinglyknowingpeoplewhohadcontractedCOVID-19didnotseemtoinfluencefocusgroupparticipantsrsquopredispositiontowardseitherhavingthevaccineorbeingvaccinehesitantHowevertheolderItalianwomenrsquosgroupspokeabouttheimpactthatCOVID-19hadhadinItalyintheearlystagesofthepandemicandhowthishadaffectedthemdeeply13ofthe15womeninthisgroupwouldhaveorhadalreadyhadthevaccine
Knowing where to get vaccinated115people(81)whorespondedtothisquestion(n=142) knew where to go to get the vaccine 34 people(19)reportedthattheydidnotknowThisincluded15respondentsfromIraq3re-spondentsfromIndia2respondentsfromChina2 respondents from Pakistan and one respondent fromeachofthefollowingcountriesChinaEri-treaItalySriLankaSwedenSyriaandVietnamThese people were also less sure about whether ornottheywouldhavethevaccineItispossiblethat their lack of knowledge about where to go to get vaccinated was related to their general level ofvaccinehesitancy
7958
29582254
282 563
GPDoctor Vaccinecentre
Hospital Work place Somewhereelse (please
tell us where)
000100020003000400050006000700080009000
Figure 14 Where to go to get vaccinated
From the sample (n=199) GPs were the most commonlyidentifiedplacetogotogetvaccinat-edfollowedbythevaccinecentreatHomebushBayandthenhospitalsOtherplacesidentifiedincluded medical centres and pharmacies
Sources of information about COVID-19 and the vaccineThelargestsinglesourceofinformationaboutCOVID-19 and the vaccine was Facebook (417)
2743
3486
13141086
30862686
3429
2229 2286
41713714
2571
1086 971
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)000500
10001500200025003000350040004500
Figure 15 Sources of information about COVID-19 and the COVID-19 vaccine
Facebook I get my information from
Facebook But if I want to check it I watch the news
on 7 [Channel 7]
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2726
Thesecondlargestsourceofinformationforpeople in the sample was lsquoother forms of social mediarsquo(37)followedbySBStelevision(35)myfriends(34)andothertelevision(31)Oth-ersourcesofinformationpeoplereportedthattheyusedweretheNSWHealthwebsitenightlytelevisionnewsincludingChannel7Channel9andChannel10followedbytheABCtheAustral-iangovernmenthealthwebsitetheirGPlocalMedical Centres and the Red Cross
IntheLakembafocusgrouppredominantlymadeupofwomenfromPakistantherewasanani-mated discussion about Facebook which was the majorsourceofinformationalongwithGooglesearchesandcommunityandfriendship-basedWhatsApp groups There was a general consensus from most in the group that these were their pre-ferredormostcommonsourcesofinformationandnewsHoweveriftheywantedtolsquofactcheckrsquowhattheywerehearingtheywouldwatchthenightlynewsonChannel7orChannel9toverifywhattheyperceivedcouldsometimesbeunrelia-ble sources
IntheMtDruittfocusgroupseveralofthewom-enwithwell-developeddigitalliteracyandgener-alliteracyskillsusedhealthandfitnesswebsitesand social media sites as their source of infor-mationaboutlsquoallthingshealthrelatedrsquoincludingCOVID-19ThesewomenalsospokepositivelyabouttheinformationandsupporttheygotfromthestaffatCanterburyCouncilCommunityCentre(4Cs)whotheycouldrelyontofindoutthingsthattheyidentifiedtheyneededtoknowmoreabout
InthesmallerfocusgroupinGriffithwithrecently-arrived refugee women who had low levels of Englishlanguageliteracytherewaslittleknowledgeaboutthevaccinesnoawarenessofthedifferenttypesofvaccinesandlittleknow-ledgeaboutwheretogotogetvaccinatedorfindoutmoreaboutCOVID-19ingeneralThecommunityservicestaffandvolunteerspresentatthegroupwere working hard to assist these women to improve their English language skills and support themwithtranslatedinformation
In the older Italian women focus group in Wollon-gongparticipantsreportedgettingtheirinfor-mationfromslightlydifferentsourcesndashfamilyinAustralia(10women)Channel9(7women)
Italianradio(3women)andABCTV(3women)Onlytwowomenusedtheinternetandnoneofthe women reported using Facebook or social mediaasasourceoftheirinformationSeveralmentionedthattheygottheirinformationfromtheirGPorspecialistdoctorandonepartici-pantsaidrsquoIdonrsquotlistentoanyonersquoIntheSpan-ish-speaking focus group a comment was made thatseemedtoreflectmanyoftheotherfocusgroup discussions
Whenlsquosourcesofinformationrsquoiscorrelatedwiththegroupwhosaidtheywouldhavethevaccine(n=104)thereisashiftfromFacebookbeingthepreferredsourceofinformationtolsquoSBSTVrsquobeingthepreferredsourceThelsquovaccine-predisposedrsquogroupalsohadthelowestrateofrelyingonFace-bookasasourceofinformationaboutCOVID-19thoughitwasstillhighThegraphbelowhigh-lightshowotherlsquopreferredsourcesrsquoplayoutforthoseintendingtohaveorwhohavealreadyhadthe vaccine
ForthoseparticipantswhoindicatedthattheywouldnotorwerenotplanningtohavethevaccinelsquoFacebookrsquolsquomyfriendsrsquoandlsquomyfamilyrsquowerethesourcesofinformationaboutCOVID-19thatwereequallymostfrequentlycitedfollowedcloselybylsquomyfamilyoverseasrsquolsquoSBSradiorsquoandlsquoSBSTVrsquoassourcesofinformationreceivedthelowestmentionsfromthisgroup(SeeFigure16)
The vaccine-hesitant group were the group who identifiedlsquoFacebookrsquoastheirmostfrequentsourceofinformationaboutCOVID-19lsquoFace-bookrsquowasfollowedbylsquoothersocialmediarsquoandlsquomyfriendsrsquoasthenextmostfrequentsources
lsquoThiscommunityserviceproviderrsquo(theinterme-diaryorganisationwherethefocusgroupwasconducted)wasidentifiedby26ofrespondentsasasourceofinformationregardlessoftheirintentiontogetvaccinatedornotThefactthatboththelsquovaccinehesitantrsquoandthosewhoindi-catedtheywouldnrsquotbegettingthevaccinesoughtinformationfromthissourcesuggeststhatrolling
There is so much confusion about it [the vaccine] that I think my GP is the best
place to go
9 This group of the research sample included a small number ofpeoplewhohadalreadybeenvaccinated
2626
4141
14141111
323228282828
2424
1818
37373737
2828
10101212
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)00050010001500200025003000350040004500
2857
2381
952 952
2857
3333
42864286
3810
4286
23812381
1429
952
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another co
mmunity se
rvice
Somewhere
else (p
lease te
ll us w
here)000
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Figure 16 Sources of information for respondents who were planning to have the vaccine9
Figure 17 Sources of information for respondents who were not planning to have the vaccine
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2928
outpositivemessagingthroughtrusted communityserviceorganisationscouldbeaneffectivewayofshiftingpeoplefromvaccine hesitancytodecidingtohavethevaccine
31372549
980 980
25492157
4314
1176
2353
4902
4118
2157
980392
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)000
1000
2000
3000
4000
5000
6000
Figure 18 Sources of information for respondents who lsquodonrsquot knowrsquo if they will have the vaccine
DISCUSSION
wardstheCOVID-19vaccineareasvariedastheyarewithinthebroadercommunityTherearearangeofinfluencingfactorsincludingagehealthstatushowlongtheyhavebeeninAustraliahowmuchnewstheyreceivefromoverseasandhowbadlyimpactedbythepandemictheirhomecountries have been
The research also highlights that people from culturallyandlinguisticallydiversebackgroundsgettheirinformationaboutCOVID-19andtheCOVID-19vaccinefromawidevarietyofsourcesbothformalandinformalandthatforparticulargroupsinthisstudythereisahighrelianceonFacebookovermoreofficialsourcesofinforma-tion
VulnerabilityTheneedsofhighly-vulnerablegroupswithintheCALDcommunityhavetobetakenintoconsider-ationThisincludesolderpeoplewhohavelivedinAustraliaformanyyearsbuthavelowlevelsofEnglishliteracyndashespeciallywritingandreadingEnglishandsometimesspokenEnglishndashandwhoaremoresusceptibletoseriousillnessandhigherratesofhospitalisationanddeathfromCOVID-19Italsoincludesnewly-arrivedrefugeeswhohavinglowornoEnglishlanguageliteracylacktheconnectionstoandnetworksintothewidercommunityandcommunitysupportsItisalsothecase that some people in these groups are not health literate at all and cannot read and write in their own language
Akeytakeoutfromthehealthandcommunityserviceorganisationsurveyresponsesandinter-viewsundertakenwithmulticulturalhealthandcommunicationexpertsfortheprojectisthatlit-eracylevelsreallydomatterLowlevelsofhealthliteracylowlevelsofEnglishlanguageliteracyandpossiblylowlevelsofliteracyintheirownlan-guage-especiallyforsomenewly-arrivedrefu-gees and those who are part of the humanitarian program such as Dari language speakers from AfghanistanTigrinyalanguagespeakersfromEr-itrea and northern Ethiopia and Oromo language speakers from Ethiopia - need to be factored into anyplanstofurtherpromotethevaccinerolloutanduptaketoculturallyandlinguisticallydiversepeopleinthecommunityThereisaneedfor
The contextThisresearchisimportantgivenhowhighlyculturallydiverseNSWisandtheimpactthiscanhave on the success of public health messaging topeoplewhosefirstlanguageisnotEnglishPeople who were born overseas form almost one-thirdofthe7480228population(276)ofNSWandNSWishometo336ofAustraliarsquosoverseas-bornpopulationPeoplefromaround225 birthplaces have made NSW their home and 21oftheNSWpopulationisfromanon-EnglishspeakingbackgroundMorethan24000humani-tarianentrantshavesettledinNSWoverthepastfiveyearscomprisingalmostathird(32)ofthenationaltotalThe24000humanitarianentrantswhohavesettledinNSWoverthepastfiveyearscame from over 100 countries of origin10Sydneyhasthelargestoverseas-bornpopulationofallthecapitalcities11
Hearingdirectlyfrompeoplefromculturally-diverse backgrounds is important to ensure that policymakersandpublichealthadvocatescandesign responses that are both accessible and un-derstandabletopeopleforwhomEnglishmaybetheirsecondthirdorfourthlanguageApropor-tionofpeopleinthesecommunitieshavelowerlevelsofEnglishlanguageliteracyandinsomecaseslowlevelsofliteracyintheirlanguageoforiginsowillbehardertoreachviatraditionalormainstream methods
Itisalsocriticallyimportantthatduringatimewherethereissomuchlsquonoisersquoacrossmediachannelsrelatingtothevaccinethevaccineroll-outvaccineefficacyandvaccinesafetythatwetakesometimetolistentoandunderstandhowthislsquonoisersquoisbeingheardandmadesenseofbypeoplefromculturally-diversebackgrounds
ThatsaiditisimportanttoreconfirmthattheCALDcommunityisnotahomogenousgroupOurresearchhasfoundthattheviewsandattitudesofparticipantsfromdiverseculturalbackgroundsto-
10RefugeeCouncilofAustraliaHumanitarianEntrantsin New South Wales A resource for New South Wales governmentagencies6-711MulticulturalNSWCommunityRelationsReport2018-20199
29
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3130
groupsFortheparticipantsintheresearchtheirattitudetothevaccineappearedtobeinflu-encedbyanumberoffactorstheirownlevelsofhealthandpre-existinghealthconditionsandthoseoftheirfamilymembersandtheimpactofreceiving COVID-19-related news from overseas particularlyfrompeoplersquoscountryoforiginAnexampleofthiscanbeseenintheItaliangroupin Wollongong where people had received news fromoverseasearlyinthepandemicwhichscaredthemThisexperiencelsquofromhomersquohadinflu-enced most of the women in the Wollongong focus group (n=15) to choose to get vaccinated The interviewee from the Illawarra Shoalhaven Local Health District also spoke about the heightenedconcernthattheywitnessedinthelocalItaliancommunityintheearlystagesofthepandemicOtherpeoplewantedtolsquostayhealthyrsquoandtolsquoprotectthehealthofothersrsquoandformanytherewasasensethattheywantedtolsquogetbacktosomedegreeofnormalcyrsquoandtobeabletolsquotraveloverseastovisitrelativesrsquo
Vaccine hesitancyOfthe42inthisstudywhoappearedundecidedornotplanningtohavethevaccinemanywereinfactadoptingalsquowaitandseersquoapproachbeforemakingtheirfinaldecisionMostparticipantswereinterestedtohearmoreinformationaboutthevaccinesandwereopenedtogettingthevaccinebutdidhaveconcernsaboutthesafetyofthevaccinesespeciallyinregardtoAstraZeneca
The issue of blood clots has led to considerable fearandhesitancyinthecommunityandthisfearandhesitancywasreflectedinourstudyEssentialResearchrsquossurvey(April2021)reportedoneinsixpeople(16)indicatedtheywillnevergetvaccinatedagainstCOVID-19upfrom12thepreviousmonthwhile42saidtheywillgetvaccinatedbutnotrightawayTheproportionofpeople who would be willing to get vaccinated as soonaspossibleorarealreadyvaccinatedalsodeclineddownfrom47to4213Thissurveywas conducted prior to the most recent outbreak inNSWinvolvingthehighlyinfectiousDeltastrain
Therisk-benefitofhavingthevaccineneedstobecarefullyweighedbyeachindividualideallyinconsultationwiththeirdoctoranddependingon
The Hub has lsquobeen working in partnership with keystakeholdergroupstoguidecommunicationstomeetthehealthliteracyandculturallyandlinguisticallydiverse(CALD)needsofitspop-ulationStructuredworkinggroupshavebeencreatedtoprioritisecommunicationstovulner-ableyouthCALDgroupstheelderlyitinerateworkersasylumseekersandrefugeesTheaimsaretotestmessagingandbuildtrustwithprioritypopulationstoensureeffectivecommunicationoftheneedtosustainphysicaldistancingmeas-uresintheabsenceofavaccineSimilareffortsarenowneedednationallyandshouldstartatthetimeofdiseaseoutbreaksinthefuturealongsideplannedmassmediaandhealthcommunicationcampaignsrsquo
InthearticlebyDoddetaltheyreinforcetheimportanceofusingcommunicationformatswhich are lsquosuitable for people with low health literacyandeducationandwhichareappropriateforculturallyandlinguisticallydiversegroupsandIndigenouspopulationsrsquoThearticlearguesthatitisimportanttolookatmotivationsandconcernsabout vaccines when shaping messaging It also pointsoutthatprimarycaredoctorsareatrust-ed source and as such should be supported in deliveringinformationaboutthevaccinesandad-dressingcommunityconcernsThearticlestateslsquoWeneedtounderstandandaddresscitizenrsquosconcernsthatcanpreventoptimaluptakebuildmotivationsintomessagingandprioritisepublictrustbyinformingandinvolvingthecommunityintheprocessSupportinghealth-careprofession-als in their role as educators will ensure people haveadequateandaccessibleinformationfromatrustedsourcetooptimisevaccineuptakeandultimatelyreducecommunitytransmissionofCOVID-19rsquo15
RecentresearchbyAssociateProfessorHollySeale16withUNSWMedicinersquosSchoolofPublicHealthandDeputyChairfortheCollaborationonSocialScienceandImmunisationfoundthereisaneedtolsquodecentralisersquocommunicationsbytapping
translatedmaterialsandinformationaboutthevaccines to be tailored to the needs of people in these newly-emergingcommunitygroups
It was reported that in Wollongong there can sometimesbefourgenerationsoffamilymem-bersfromnewly-arrivedrefugeegroupslivingintheonehouseMostofthesefamilymembersgenerallyhavelimitedEnglishlanguageliteracywhichincreasestheirriskofnotreceivingkeyhealthmessagesandthereforeincreasingthepotentialimpactofCOVID-19-inparticulartheDeltastrainwhichhasprovenhighlyinfectiousamongst household members
Vaccine uptakeNotdissimilartothewidercommunitymorepeopleinourstudywereplanningtohavethevaccinethannotandanumberhadalreadybeenvaccinatedInarecentLancetarticle(February2021)ConcernsandmotivationsaboutCOVID-19vaccinationfindingsfromtwosurveysfromanAustralianlongitudinalstudyconductedinJuneandJuly2020includedthatlsquothetopthreerea-sons for agreeing to vaccinate were lsquoto protect themselvesandothersrsquohelliplsquobeliefinvaccinationandsciencersquohellipandlsquotohelpstopthevirusspreadrsquoEven among those willing to vaccinate there was somehesitancyaboutthesafetyofthevaccineTheLancetarticlenotedthatlsquowillingnesstovaccinatedifferedbybothageandeducationrsquoForthosewhowereindifferentorsaidtheywouldnot get the vaccine the top reasons across the twosurveyswerelsquoconcernaboutthesafetyofthevaccineinitsdevelopmentrsquoandlsquopotentialsideeffectsrsquo12
Olderpeopleinourstudywhocomprised23of the total sample (n=199) were the group most likelytosaythattheywantedtogetthevaccine85ofthoseover65saidtheywouldhaveorhadalreadyhadthevaccineVaccinepredispo-sitionwashoweveralsostrongacrossotherage
12RHDoddKPicklesBNickelECvejicJAyreCBatcupCBonnerTCoppSCornellTDakinJIsautierKJMcCafferyConcerns and motivations about COVID-19 vaccination SydneyHealthLiteracyLabSydneySchoolofPublicHealthFacultyofMedicineandHealthUniversityofSydneypublishedintheLancetFebruary2021p162wwwthelancet cominfectionVol21February2021
theircircumstancesHoweverthesourcesofin-formationthatpeoplemostrelyuponortrustarecriticaltothedisseminationofaccurateandclearmessaging to dispel the fear surrounding events suchasbloodclottingandthemisconceptionsraisedinthefocusgroupsWithsomanypartici-pantsinthisstudygettingtheirinformationfromFacebookandothersocialmediasitesitisvitalthat these channels are used to promote simple positivemessagesandforanyfuturecommunityawareness campaigns
Effective communicationConfusionandmisconceptionsaboutthevac-cinersquosefficacyavailabilityandsafetywereallis-sues that were raised in the focus groups Finding waystoeffectivelycommunicatewithpeoplewithlowerEnglishlanguageliteracyandhealthliteracyisanimportantwaytoaddresstheconfusionandmisconceptionsaboutthevaccineashasbeen discussed in a number of recent Australian studies
Astudy14byMcCafferyetal(2020)concludedthattherearelsquoimportantdisparitiesinCOVID-19-relatedknowledgeattitudesandbehavioursaccordingtopeoplersquoshealthliteracyandlanguagersquoOneofthefindingswasthatlsquopeoplewithlowerhealthliteracywerealsomorelikelyto endorse misinformed beliefs about COVID-19 andvaccinations(ingeneral)thanthosewithadequatehealthliteracyThesamepatternofresults was observed among people who primar-ilyspeakalanguageotherthanEnglishathomersquoTheMcCafferystudyhighlightstheimportanceof tailoring health messages to those with lower healthliteracyandculturallyandlinguisticallydiversecommunitiesItpointsoutthatthereareexamplesofeffectivemanagementofdiversecommunityneedsthatusetailoredhealthmes-sagesandcitestheWesternSydneyLocalHealthDistrictHealthLiteracyHub
13TheEssentialReport-anonlinesurveyconductedbyEssentialResearchcompletedby1090people between 21ndash26 April14McCafferyKJDoddRHCvejicEAyreJBatcupCIsautierJMJCoppTBonnerCPicklesKNickelBDakinTCornellSWolf MS Health literacy and disparities in COVID-19ndashrelated knowledge attitudes beliefs and behaviours in Australia PublicHealthResPract202030(4)e30342012December2020
15 Op cit16 httpssphmedunsweduausitesdefaultfilessphcmNewsEnhancing-supporting-COVID-19-vaccination-programpdf
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
30 31
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3332
intodifferentnetworkingspacessuchaswork-placeslocalgymsmothersrsquogroupsandseniorsrsquoclubswithafocusonallagegroupsregardlessofcurrenteligibilityAccordingtoSealethechal-lengeislsquoensuringemerginginformationisadapt-edfortheintendedaudiencersquoShehasalsosaidlsquoThatrsquoswhatIrsquomalittlebitconcernedaboutatthemomenttherersquosalotofresourcesongov-ernmentwebsitesbutthesetermsaroundbloodclottingareverytechnicalWeactuallyneedtomake sure that we are breaking them down in a waythatwillmakeitmeaningfultopeopleThatrsquosnotjustabouttranslatingitrsquosaboutbeingcon-sciousofpeoplersquoshealthliteracyneedstooSomaybegettingsomemorevisualsintomaterialstotryandsupportthatrsquo17
Thereareanumberofmulticulturalhealthresourcesthatusecommunitylanguagetransla-tionsplainEnglishandvideosfromCALDcommu-nityleaderswhichcanbedownloadedandusedbyservicesandindividualsHowevermanyofthewrittenresourcesstillrelyontechnicalandscien-tifictermsthatrequireareasonablyhighlevelofEnglishlanguageliteracyorhighlevelsofliteracyin the translated language to comprehend Host websites can also be hard to navigate making itdifficulttolocateresourcesfromsimplewebsearchesAsummaryofsomeoftheavailableresourcescanbefoundatAttachment2
MulticulturalHealthUnitsinLocalHealthDis-trictshavestaffwhocanworkwithpeoplefromculturallyandlinguisticallydiversecommunitiesatthelocallevelandtranslateandcontextualisethese materials to the needs of the end user These teams respond to local needs and popu-lationdemographicsandareexpertsineffectivehealthliteracyandhealthcommunicationwiththeirlocalcommunitiesTheyworkcloselywithcommunityandvulnerablegroupstobuildhealthliteracyandimprovedhealthoutcomesintheircommunities
Case Study ndash Be a COVID Warrior ndash Responding to COVID-19 in Multicultural Communities InWollongongtheIllawarraShoalhavenLocalHealthDistrict(ISLHD)MulticulturalHealthSer-viceco-designedacommunityengagementandeducationprogramcalledlsquoBeaCOVIDWarriorrsquowhich commenced in 2020 in response to the pandemic This program was designed to respond tothelowlevelsofhealthliteracyaroundCOVID-19potentialexposuretothevirusandaddressfearandstigmainthelocalCALDcommunitiesThelsquoCOVIDWarriorrsquoprogramreachedaround880peopleranginginagefrom14to85years65ofCOVIDWarriorparticipantswerefemaleand35weremaleCOVIDWarriorparticipantsrepresented 21 language groups The outcomes of the program included increased levels of confidenceinapplyinginfectioncontrolmeasuresincreasedliteracyandhealthliteracyandawarenessofhowCOVID-19istransmittedUltimatelyanimprovedawarenessinapplyingCOVIDsafemeasures was also reported
InApril2020theservicecommencedwelfarechecksviaphoneonafortnightlybasistosup-portsocially-isolatedmulticulturalseniorswhoboretheemotionalstressofsocialisolationFrom these calls the ISLHD heard the needs and concernsofseniorsinthecommunityInadditionourexperiencewithCALDcommunitieshighlightedtheimportanceofyoungpeopleasconduitsofessentialinformationtoadultsincommunityandfamilygroupsduetoEnglishlanguageaccessandeducation
InresponsetheISLHDinitiatedthelsquoCOVIDWarri-orrsquoprogramusingbi-culturalhighschoolstudentsthroughthelocalhighschoolsByincreasingthehealthliteracyofstudentsatschooltheselsquocham-pionsrsquocouldtalktotheirfamiliesincludingolderfamilymembersininformalsettingsandthroughsocialmediawiththeirpeersasastrategytoraisethe level of knowledge of COVID-19 trans-mission preventionandtestingTheprogrambecamesopopularthatitwasextendedintomorelocalhighschools and adults accessing the Adult Migrant EnglishProgramTheprogramwassupportedbylocalsettlementservicesprovidedbybothMaxSolutionsandtheRedCrossItwas
17 httpstheconversationcomhow-can-governments-communicate-with-multicultural-australians-about-COVID-19-vaccines-its-not-as-simple-as-having-a-poster-in-their-language-156097
later extendedtoCALDSeniorsthroughtheMulticulturalCommunitiesCouncilIllawarra(MCCI)supportprograms
AkeycomponentoftheprogramwastoprovideparticipantswithlsquoCOVIDWarriorrsquoKitswhichincludedtworeusablemaskshandsanitiserinfographicsaboutCOVID-19symptomsandinfor-mationaboutwheretestingclinicswereavailablelocallyMCCIandRuralAustraliaforRefugeesdonatedreusablemasksforeveryparticipant
AsthelsquoCOVIDWarriorrsquoprogramwasevolvingsowasthenationalvaccinerolloutplanInforma-tionwasthereforeadaptedtomeetthisinfor-mationgapForexampleadultparticipantsandseniors were supported to understand how to accesstheCOVIDvaccinelsquoeligibilitycheckersrsquoandCALD people were shown how to use the NSW HealthwebsiteCOVID-19informationpages18
Decision makingHowpeoplearecurrentlyconsideringtheriskofCOVID-19isinfluencedbyarangeoffactorsincludingratesoftransmissioninthecommunitynumbersofnewcasesreportsinthemediaofrisksandsideeffectsPeopletendtobasetheirassessmentonwhattheyarecurrentlyexperi-encingandthencheckthisagainstwhattheyarehearinginthemediaincludingandespeciallyonsocialmediaandfromfamilyandfriendsMostoftheparticipantsinourstudyspokeclearlyandarticulatelyabouthowtheyweigheduptherisk-benefitofhavingtheCOVID-19vaccineintheir decision making Low case numbers ndash at the timeofconductingtheresearchndashandasensethat Australia was lsquodoing well in safeguarding the communityagainstCOVID-19rsquoweresignificantfactorsinpeoplersquosdecisionnottobevaccinatedortoadoptalsquowaitandseersquoapproachFamilyfriends and social media were reported as having aconsiderableinfluenceondecisionmakingaswerereportsinthemediaofthebloodclottingsideeffectsofAstraZeneca
ThefactthatFacebookwasreportedlythemostpopularsourceofinformationaboutCOVID-19
18httpswwwhealthnswgovauInfectiouscovid-19Pagesdefaultaspx
andtheCOVID-19vaccineforpeopleinthestudyraisesconcernsaboutthepossibledisseminationofmisconceptionsandlsquofakenewsrsquothatmaybespread or compounded via social media Closed social media groups such as WhatsApp and WeChatwithfamilyandfriendsmayalsoleadtopeoplereinforcingtheirpre-existingbiasesThesefactorscoupledwithasensethatAustraliaisfaringwellcomparedtomanycountriesoverseasappear to have resulted in increased vaccine hesi-tancyamongparticipantsofthestudy
Factorsthatwereidentifiedaschangingvaccine-hesitantparticipantsrsquoperceptionswereanincreased risk from COVID-19 and a correspond-ingincreaseinthenumberofinfectionsandonthebenefitsidetheabilitytotraveloverseastovisitfamilyIntherecentresearchfromtheUniversityofNSWcitedaboveSearlearguesthatlsquotheremaybeotherthingsthatweneedtonowstartfocusingonhellipthatwillstarttopromoteandmotivatepeoplesuchasthechancetotravelmorefreelyforexamplersquoThisappearstobeborneoutbyourfocusgroupfindings19
Untilrecentlytherehavebeenverylowcasenumbers and few lockdowns across most of Aus-tralia and NSW The recent outbreak from mid-JuneinGreaterSydneyandintroductionofthehighlyinfectiousDeltavariantinNSWislikelytoimpactonpeoplersquosassessmentsoftherisk-benefitofhavingthevaccineandonewouldassumereducehesitancyrates
GiventheheightenedcommunityanxietycausedbythisrecentCOVID-19outbreaktheproductionofshortsharpandtargetedmessagingtoCALDgroupsincommunitylanguagesthatisaccessibleandmotivationalfeaturescommunityleadershigh-profilecelebritiesandsportsstarsfromCALDbackgroundsandisdirectedatastate-wideandlocal level would appear to be more urgent than everItisclearthatformessagingtobeeffectiveandreachitsintendedaudiencedistributionchannelsshouldincludeFacebookWhatsAppandothersocialmediaplatformsaswellastrustedsourcessuchasmulticulturalhealthworkersmulticulturalservicesandthroughGPsandMedical Centres If mainstream COVID-19 vaccine
19 Op cit
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
32 33
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3534
awareness campaigns are produced in Australia suchashavebeenproducedinNewZealandtheUnitedKingdomandNorthAmericatheyshouldincludehighprofilewell-knowncommunityfig-uresandsportingstarsfromCALDbackgroundsandincludestrategiesspecificallytargetingCALDcommunitiesincludinggroupsidentifiedaspar-ticularlyhigh-risk
It is also important that informationonvaccinesistranslatedintolanguagesfromnewerandemergingcommunitiesOthersuggestionsaroundreachingthesecommunitiesincludeface-to-facemeetingsorganisedbycrossagencypartnershipsandpeer-ledstrategiessuchas mobilising community champions and influenc-ers Messaging needs to be inclusive and framed around the collective values held by commu-n5
It is clear that reinforcing the benefits of being vaccinated at this time rather than dwelling on the risks is more likely to generate behavioural
changeandapositivevaccineresponsefrombothCALDcommunitiesandthegeneralpopulationAppropriately-designedandtargetedCOVID-19vaccinehealthinformationthatiseasytoreadinanylanguagecanbeconveyedbycommunityleadersandcommunitynetworksandpromotesthepositivebenefitsofgettingvaccinatedwouldbevaluableatthistimeBuildingontheworkofpeerchampionssuchastheCOVIDWarriorprogramisalsoasuccessfulmodeltoincreasingCOVID-19vaccinehealthliteracyandinformed decision making
Mostimportantlypositivelymotivatingculturallyandlinguisticallydiversecommunitymemberstolsquogetthejabrsquoespeciallythosewhoareadoptingalsquowaitandseersquoapproachorarevaccinehesitantwould lead to greater vaccine uptake among culturallyandlinguisticallydiversecommunitiesandthereforethecommunityasawhole
Inner West Multicultural Network Addison Road Community Centre DateWednesday12May
A focus group session of members of the Inner WestMulticulturalNetworkpluscustomersoftheFoodPantryatAddisonRoadwasheldattheAddisonRoadCommunityCentreinMarrickvilleon12Mayat200pmThesessionwaspartoftheregularmeetingoftheInnerWestMulticul-turalNetworkTheconsultationinvolvedabout26peopleandwasconductedbyRosannaBarbero
Thegroupbrainstormedresponsestoquestionsaroundvaccinehesitancyinmulticulturalcom-munitiesandmoreeffectivemessagingTheseresponseshavebeenincorporatedinthefindingsof the report
Griffith Women on Fire Focus Group Griffith Community Centre DateFriday14May
This small focus group of women was held at GriffithCommunityCentreonMay14at11amMargCouchSeniorProjectOfficerRegionalDevelopmentAustralia(RDA)-RiverinaandJoanneFitzpatrickSettlementEngagementandTransitionSupport Worker from Centacare Southwest NSW werethekeylinksandnetworkcontactsfortheGriffithcommunityTheWomenonFire(WOF)group was established as part of the Red Cross RuralFireServiceprogramlsquoManyCulturesOneCommunityrsquoInitiallyitwasestablishedtoeducatewomenonemergencypreparednessandtoen-courage NSW Rural Fire Service (RFS) volunteering andnowhastransformedintoacommunityac-tionsupportgroupTheGriffithSoroptimistInter-nationalnowauspicetheirfinancesandsupporttheWOFgroupactivitiesThefocusgroupwasfacilitatedbyCamillaCouchandlocalcommunityvolunteersledbytheGriffithSoroptimistClub
The women in the group were from Pakistan and IndonesiaThegroupweremainlyyoungmotherswithyoungchildrenandtheprogramhadchild-minding arrangements The language level of the womenwaslowandmostwerestudyingESOLat
ATTACHMENTS
ATTACHMENT 1 A Description of the Focus Groups
TAFEThedeliveryoftheinformationwaslimiteddue to language levels and the lack of bilingual interpretersEachparticipantworkedoneononewithavolunteertoslowlyfillinthesurveyandonewomantookthesurveyhometodiscusswithherhusbandThisgroupexperiencehighlightedthe lack of bilingual workers and services in some rural areas
Arabic speaking group Syd West Multicultural Services Mount Druitt Community worker Zaid Naoum Generalist Caseworker SydWest Multicultural Services DateMonday24May
ThefocusgroupfromSydWestMulticulturalSer-viceswasconductedonMonday24May2021atSydWestMulticulturalServicesMountDruittat300pmItwasfacilitatedbyPatriciaMcCormickandsupportedbyZaidNaoumGeneralistCase-workerSydWestMulticulturalServices
Therewere10womenandmenfromSyriainthegroupThegroupweremostlymaturetoolderparticipantsMostparticipantsrequiredassistancewithEnglishandthecaseworkerZaidNaoumhadtranslatedthesurveyintoArabicpriorto the focus group Zaid also translated during the focus group
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Canterbury City Community Centre (4Cs) group The Cottage Lakemba DateTuesday25May
ThefocusgroupfromCanterburyCityCommunityCentre(4Cs)wasconductedonTuesday25MayattheCottageat28CroydonStreetLakembaat10amItwasfacilitatedbyRobinMilesandsup-portedbyRomanaWaseemCommunityWorkerfrom 4Cs
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
34
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3736
The group was comprised of 14 women from PakistanIndiaandSriLankaThewomenrangedinagefrom23to65MostwerefluentEnglishspeakershoweveronewomanrequiredtransla-tionintoUrdufromoneoftheotherwomeninthegrouptoanswerthequestionsdirectly
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
NSW Chaldean League group Community worker Randa Goriya DateTuesday25May
ThefocusgroupfromNSWChaldeanLeagueMountDruittwasconductedonTuesday25May2021 at 1000am at the NSW Chaldean League premisesItwasfacilitatedbyPatriciaMcCormickandsupportedbyRandaGoriyaacommunityworker for the NSW Chaldean League in Mount DruittRandatranslatedtheintroductionandpromptsforthediscussionandhelpedthepartic-ipantstocompletethesurveyMostofthegrouprequiredhelptodothesurvey
ThegroupoftwelveparticipantswereallChaldeanandwerematuretoolderinageTheywereamixed-gendergroup
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Arabic speaking group Red Cross premises Wollongong DateTuesday25May
ThefocusgrouptookplaceonTuesday25Mayat 3pm at the Red Cross premises at Wollongong Therewere22womenandmenparticipatinginthegroupThefocusgroupwasfacilitatedbyCamilla Couch with support from Khalid Zainu-labdeenBilingualSupportWorkerHumanitarianSettlementProgram(ACTampNSW)
There were diverse ages in the group ranging fromyoungpeopletoolderagedMostofthegroupwereyoungerrecently-arrivedrefugeesfrom diverse backgrounds There was also a small-eroldercohortofparticipantswithhigherliteracylevelsandstrongercommunityengagementwith the local services in the area Camilla Couch facilitated the focus group which was conducted inArabicandEnglishwiththeArabictranslationprovidedbyKhalidZainulabdeen
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Work Opportunities for Women group Mt Druitt TAFE DateWednesday26May
TheWorkOpportunitiesforWomen(WOW)focusgroupwasheldonWednesdayMay261100ndash 100pmatMtDruittTAFEItwasfacilitatedbyCamilla Couch and built on the knowledge gainedintheprevioussessiononcriticalandanalyticalthinkingTheWOWgroupisaTAFECertificatelevel course
There were 14 women from diverse cultural backgroundsinthegroupThegroupweremainlyMuslimwomenwithschoolagechildrenandsome were mature aged Due to the learning fo-custhegroupwasfacilitatedasaclasswithguid-eddiscussionontheissuesandcarefulanalysisofthequestionsNotranslationwasneededduetotheeducationalcontextThestudentswereadeptatusingITandcompletedallthesurveysonline
STARTTS Tamil group Toongabbie Community Centre Community worker Sivaharani (Harani) Mayuran DateThursday27May
Thefocusgroupconsistedof18femalepartic-ipantswhowereyoungertomatureagedThefocus group was held at 1000am at Toongabbie CommunityCentreinTargoRdToongabbie
ThefocusgroupwasfacilitatedbyPatriciaMc-CormickandsupportedbyacommunityworkerSivaharani(Harani)MayuranfromtheSTARTTSTamil Group
ThegrouphadmixedlevelsofspokenandwrittenEnglishTheintroductionanddiscussionpromptsweretranslatedbythecommunityworkerSivaha-rani(Harani)Mayuranandsheandthemorepro-ficientstudentssupportedthosewithlowliteracytoanswerthesurveyquestions
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Spanish Speakers Seniors group SydWest Multicultural Services Blacktown DateTuesday1June
TheFocusGrouptookplaceonTuesday1Juneat1100amattheBlacktownShowgroundsandconsistedof16participants(15womenandoneman)AllparticipantswerebornincountriesinSouthAmericaTheirEnglish-fluencylevelsvariedand one of the members of the group translated thesurveyquestionsanddiscussionintoSpanish
ThegrouphadbeenmeetingforseveralyearsThegroupwasfacilitatedbyLindyCassidyandwassupportedbySreeVithyaHarilingamDayRespiteampSocialSupportTeamLeaderatSydWestMulticulturalServicesBlacktownThegroupwerematureagedtoolderparticipants
Thegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyform There was a more focused discussion on somekeyquestionsaftersurveycompletionThetranslatorassistedconsiderablyinthisprocess
Italian Speakers group Warrawong Community Centre DateMonday7June
The focus group of Italian speakers was held on Monday7Juneat1015amattheWarrawongCommunityCentreItwasfacilitatedbyCamillaCouchandsupportedbyJohnPaulTroianiand
SofiaLemafromIllawarraShoalhavenLHDMulti-cultural Health
There were 15 women in the group The group weremostlymaturetoolderparticipantsandwasconductedinItalianandEnglishwithtranslationprovidedbyJohnPaulThisgroupmeetsregularlyandissupportedbyanumberofservicesintheareaespeciallymulticulturalhealth
The group had a general facilitated discussion aboutthequestionsinthesurveyDuetolittleornoliteracytheindividualsurveyresponseswerethencollectedintooneresponseThesesurveyresponses have been included in the general surveyresponses
Mothers Group SydWest Multicultural Services Blacktown DateThursday10June
ThefocusgrouptookplaceonThursday10Juneat1030amandconsistedof14youngwomen13 of whom had a CALD background The focus groupweremainlymothersfromasupportgroupatSydWestMulticulturalServicesinBlacktown
EightofthewomenwereborninIndiatwofromPakistantwofromSriLankaonefromHausaGhana and one was born in Australia (the Austral-ianbornyoungwomanwasasocialworkstudenthelpingwiththegroup)LindyCassidyfacilitatedthe group with support from Wilma Garguath a projectofficerfromSydWestMulticultural Services
The group varied in age One was between 18-24 yearsoldSevenwereagedbetween25-34yearsSixwereagedbetween35=44yearsGiventheirage and circumstances most of the group did not consider themselves eligible at this stage for vac-cinationThiswasanimportantdifferencefromotherfocusgroupsinthattheemphasiswasmoreonwhattheywoulddooncetheybecameeligible
Participantsdidnotrequireassistancewithspo-kenEnglishThegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyformTherewasamorefocuseddiscussiononsomekeyquestions
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3938
ATTACHMENT 2 COVID-19 Vaccine Information in multiple languagesThefollowingsitesappsprovidetranslatedinformationaboutCOVID-19vaccines
Type of information KeyinformationongettingvaccinatedinNew South Wales and on the vaccines available The websiteusesanautomaticservicetotranslate thecontentintodifferentlanguages
Source of information NSW Government website
Link httpswwwnswgovauCOVID-19health-and-wellbeingCOVID-19-vaccina-tion-nswgetting-vaccinated
Type of information COVID-19ResourcessectionontheServiceNSWapp The app has a link to NSW Government websiteinformationonldquoGettingaCOVID-19vaccinationrdquo(seeabove)ItalsoincludesalinktoCOVID-19vaccinationresourcesinotherlan-guages available from the Department of Health
Source of information Service NSW NSW Government
Link Service NSW App
Type of information ArangeoftranslatedresourcesonCOVID-19bytitleincludingafactsheetonCOVID-19VaccineAstraZeneca(ChAdOx1-S)
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCOV-ID-19Pagestranslatedresources-by-titleaspx
Type of information ADigitalCOVID-19resourcelibrarywithtranslated materials
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiouscov-id-19Pagesdigital-resourcesaspx
Type of information AMultilingualCommunityToolkitontheCOVID-19vaccinationprogramtoassist communityworkersprovideseasytoreadresourcesvideosandlinkstokeyservicesandresources
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCovid-19DocumentsNSW-COVID-19-vaccina-tion-program-presentation-20210527pdf
Type of information TheNSWMulticulturalHealthCommunicationServiceoffershealthresourcesandinformationin a wide range of languages It has translated resources on COVID-19 and links to translated resourcesonCOVID-19vaccination
Source of information MulticulturalHealthCommunicationServiceisa New South Wales-wide health service hosted bySouth-easternSydneyLocalHealthDistrict(SESLHD)
Link httpswwwmhcshealthnswgovau
Type of information COVID-19vaccineinformationaddressingkeyquestionsaboutCOVID-19vaccinationandincludesvideosposterstilesfactsheetsandaudio material Translated into 63 languages
Source of information Department of Health Australian Government website
Link httpswwwhealthgovauinitiatives-and-pro-gramsCOVID-19-vaccinesCOVID-19-vaccine-in-formation-in-your-language
Type of information ThisinformationaddressessomecommonmisinformationaboutCOVID-19Translatedintomultiplelanguages
Source of information DepartmentofHomeAffairs Australian Government website
Link httpscovid19inlanguagehomeaffairsgovaumisinformation-and-truths-about-coronavirus
Type of information Australianandinternationalnewsand informationaboutCOVID-19andCOVID-19 vaccinesisavailableontheSBSCoronavirusPortal in more than 60 languages
Source of information SBSwebsite
Link httpswwwsbscomaulanguagecoronavirus
Type of information InformationprovidedaboutCOVID-19vaccinerolloutandsafetyinlanguagesotherthan English
Source of information Department of Health and Human Services Victorian Government
Link httpswwwcoronavirusvicgovautranslat-ed-information-about-COVID-19-vaccines
Type of information HealthTranslationsprovidestranslatedmateri-alsonhealthandwellbeingInformationaboutCOVID-19isregularlyupdatedincludessomeinformationonvaccinationandisavailableinover60communitylanguages
Source of information Victoriangovernmentinitiative
Link httpswwwhealthtranslationsvicgovaubhcv2bhchtnsfPresentEnglishResource-AllOpenampx=amps=Coronavirus
Type of information A one-stop shop for translated materials in multiplelanguagesonCOVID-19
Source of information Ethnolink Language Services
Link httpswwwethnolinkcomauCOVID-19-coro-navirus-translated-resources
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
40
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2726
Thesecondlargestsourceofinformationforpeople in the sample was lsquoother forms of social mediarsquo(37)followedbySBStelevision(35)myfriends(34)andothertelevision(31)Oth-ersourcesofinformationpeoplereportedthattheyusedweretheNSWHealthwebsitenightlytelevisionnewsincludingChannel7Channel9andChannel10followedbytheABCtheAustral-iangovernmenthealthwebsitetheirGPlocalMedical Centres and the Red Cross
IntheLakembafocusgrouppredominantlymadeupofwomenfromPakistantherewasanani-mated discussion about Facebook which was the majorsourceofinformationalongwithGooglesearchesandcommunityandfriendship-basedWhatsApp groups There was a general consensus from most in the group that these were their pre-ferredormostcommonsourcesofinformationandnewsHoweveriftheywantedtolsquofactcheckrsquowhattheywerehearingtheywouldwatchthenightlynewsonChannel7orChannel9toverifywhattheyperceivedcouldsometimesbeunrelia-ble sources
IntheMtDruittfocusgroupseveralofthewom-enwithwell-developeddigitalliteracyandgener-alliteracyskillsusedhealthandfitnesswebsitesand social media sites as their source of infor-mationaboutlsquoallthingshealthrelatedrsquoincludingCOVID-19ThesewomenalsospokepositivelyabouttheinformationandsupporttheygotfromthestaffatCanterburyCouncilCommunityCentre(4Cs)whotheycouldrelyontofindoutthingsthattheyidentifiedtheyneededtoknowmoreabout
InthesmallerfocusgroupinGriffithwithrecently-arrived refugee women who had low levels of Englishlanguageliteracytherewaslittleknowledgeaboutthevaccinesnoawarenessofthedifferenttypesofvaccinesandlittleknow-ledgeaboutwheretogotogetvaccinatedorfindoutmoreaboutCOVID-19ingeneralThecommunityservicestaffandvolunteerspresentatthegroupwere working hard to assist these women to improve their English language skills and support themwithtranslatedinformation
In the older Italian women focus group in Wollon-gongparticipantsreportedgettingtheirinfor-mationfromslightlydifferentsourcesndashfamilyinAustralia(10women)Channel9(7women)
Italianradio(3women)andABCTV(3women)Onlytwowomenusedtheinternetandnoneofthe women reported using Facebook or social mediaasasourceoftheirinformationSeveralmentionedthattheygottheirinformationfromtheirGPorspecialistdoctorandonepartici-pantsaidrsquoIdonrsquotlistentoanyonersquoIntheSpan-ish-speaking focus group a comment was made thatseemedtoreflectmanyoftheotherfocusgroup discussions
Whenlsquosourcesofinformationrsquoiscorrelatedwiththegroupwhosaidtheywouldhavethevaccine(n=104)thereisashiftfromFacebookbeingthepreferredsourceofinformationtolsquoSBSTVrsquobeingthepreferredsourceThelsquovaccine-predisposedrsquogroupalsohadthelowestrateofrelyingonFace-bookasasourceofinformationaboutCOVID-19thoughitwasstillhighThegraphbelowhigh-lightshowotherlsquopreferredsourcesrsquoplayoutforthoseintendingtohaveorwhohavealreadyhadthe vaccine
ForthoseparticipantswhoindicatedthattheywouldnotorwerenotplanningtohavethevaccinelsquoFacebookrsquolsquomyfriendsrsquoandlsquomyfamilyrsquowerethesourcesofinformationaboutCOVID-19thatwereequallymostfrequentlycitedfollowedcloselybylsquomyfamilyoverseasrsquolsquoSBSradiorsquoandlsquoSBSTVrsquoassourcesofinformationreceivedthelowestmentionsfromthisgroup(SeeFigure16)
The vaccine-hesitant group were the group who identifiedlsquoFacebookrsquoastheirmostfrequentsourceofinformationaboutCOVID-19lsquoFace-bookrsquowasfollowedbylsquoothersocialmediarsquoandlsquomyfriendsrsquoasthenextmostfrequentsources
lsquoThiscommunityserviceproviderrsquo(theinterme-diaryorganisationwherethefocusgroupwasconducted)wasidentifiedby26ofrespondentsasasourceofinformationregardlessoftheirintentiontogetvaccinatedornotThefactthatboththelsquovaccinehesitantrsquoandthosewhoindi-catedtheywouldnrsquotbegettingthevaccinesoughtinformationfromthissourcesuggeststhatrolling
There is so much confusion about it [the vaccine] that I think my GP is the best
place to go
9 This group of the research sample included a small number ofpeoplewhohadalreadybeenvaccinated
2626
4141
14141111
323228282828
2424
1818
37373737
2828
10101212
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)00050010001500200025003000350040004500
2857
2381
952 952
2857
3333
42864286
3810
4286
23812381
1429
952
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another co
mmunity se
rvice
Somewhere
else (p
lease te
ll us w
here)000
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Figure 16 Sources of information for respondents who were planning to have the vaccine9
Figure 17 Sources of information for respondents who were not planning to have the vaccine
FINDINGS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2928
outpositivemessagingthroughtrusted communityserviceorganisationscouldbeaneffectivewayofshiftingpeoplefromvaccine hesitancytodecidingtohavethevaccine
31372549
980 980
25492157
4314
1176
2353
4902
4118
2157
980392
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)000
1000
2000
3000
4000
5000
6000
Figure 18 Sources of information for respondents who lsquodonrsquot knowrsquo if they will have the vaccine
DISCUSSION
wardstheCOVID-19vaccineareasvariedastheyarewithinthebroadercommunityTherearearangeofinfluencingfactorsincludingagehealthstatushowlongtheyhavebeeninAustraliahowmuchnewstheyreceivefromoverseasandhowbadlyimpactedbythepandemictheirhomecountries have been
The research also highlights that people from culturallyandlinguisticallydiversebackgroundsgettheirinformationaboutCOVID-19andtheCOVID-19vaccinefromawidevarietyofsourcesbothformalandinformalandthatforparticulargroupsinthisstudythereisahighrelianceonFacebookovermoreofficialsourcesofinforma-tion
VulnerabilityTheneedsofhighly-vulnerablegroupswithintheCALDcommunityhavetobetakenintoconsider-ationThisincludesolderpeoplewhohavelivedinAustraliaformanyyearsbuthavelowlevelsofEnglishliteracyndashespeciallywritingandreadingEnglishandsometimesspokenEnglishndashandwhoaremoresusceptibletoseriousillnessandhigherratesofhospitalisationanddeathfromCOVID-19Italsoincludesnewly-arrivedrefugeeswhohavinglowornoEnglishlanguageliteracylacktheconnectionstoandnetworksintothewidercommunityandcommunitysupportsItisalsothecase that some people in these groups are not health literate at all and cannot read and write in their own language
Akeytakeoutfromthehealthandcommunityserviceorganisationsurveyresponsesandinter-viewsundertakenwithmulticulturalhealthandcommunicationexpertsfortheprojectisthatlit-eracylevelsreallydomatterLowlevelsofhealthliteracylowlevelsofEnglishlanguageliteracyandpossiblylowlevelsofliteracyintheirownlan-guage-especiallyforsomenewly-arrivedrefu-gees and those who are part of the humanitarian program such as Dari language speakers from AfghanistanTigrinyalanguagespeakersfromEr-itrea and northern Ethiopia and Oromo language speakers from Ethiopia - need to be factored into anyplanstofurtherpromotethevaccinerolloutanduptaketoculturallyandlinguisticallydiversepeopleinthecommunityThereisaneedfor
The contextThisresearchisimportantgivenhowhighlyculturallydiverseNSWisandtheimpactthiscanhave on the success of public health messaging topeoplewhosefirstlanguageisnotEnglishPeople who were born overseas form almost one-thirdofthe7480228population(276)ofNSWandNSWishometo336ofAustraliarsquosoverseas-bornpopulationPeoplefromaround225 birthplaces have made NSW their home and 21oftheNSWpopulationisfromanon-EnglishspeakingbackgroundMorethan24000humani-tarianentrantshavesettledinNSWoverthepastfiveyearscomprisingalmostathird(32)ofthenationaltotalThe24000humanitarianentrantswhohavesettledinNSWoverthepastfiveyearscame from over 100 countries of origin10Sydneyhasthelargestoverseas-bornpopulationofallthecapitalcities11
Hearingdirectlyfrompeoplefromculturally-diverse backgrounds is important to ensure that policymakersandpublichealthadvocatescandesign responses that are both accessible and un-derstandabletopeopleforwhomEnglishmaybetheirsecondthirdorfourthlanguageApropor-tionofpeopleinthesecommunitieshavelowerlevelsofEnglishlanguageliteracyandinsomecaseslowlevelsofliteracyintheirlanguageoforiginsowillbehardertoreachviatraditionalormainstream methods
Itisalsocriticallyimportantthatduringatimewherethereissomuchlsquonoisersquoacrossmediachannelsrelatingtothevaccinethevaccineroll-outvaccineefficacyandvaccinesafetythatwetakesometimetolistentoandunderstandhowthislsquonoisersquoisbeingheardandmadesenseofbypeoplefromculturally-diversebackgrounds
ThatsaiditisimportanttoreconfirmthattheCALDcommunityisnotahomogenousgroupOurresearchhasfoundthattheviewsandattitudesofparticipantsfromdiverseculturalbackgroundsto-
10RefugeeCouncilofAustraliaHumanitarianEntrantsin New South Wales A resource for New South Wales governmentagencies6-711MulticulturalNSWCommunityRelationsReport2018-20199
29
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3130
groupsFortheparticipantsintheresearchtheirattitudetothevaccineappearedtobeinflu-encedbyanumberoffactorstheirownlevelsofhealthandpre-existinghealthconditionsandthoseoftheirfamilymembersandtheimpactofreceiving COVID-19-related news from overseas particularlyfrompeoplersquoscountryoforiginAnexampleofthiscanbeseenintheItaliangroupin Wollongong where people had received news fromoverseasearlyinthepandemicwhichscaredthemThisexperiencelsquofromhomersquohadinflu-enced most of the women in the Wollongong focus group (n=15) to choose to get vaccinated The interviewee from the Illawarra Shoalhaven Local Health District also spoke about the heightenedconcernthattheywitnessedinthelocalItaliancommunityintheearlystagesofthepandemicOtherpeoplewantedtolsquostayhealthyrsquoandtolsquoprotectthehealthofothersrsquoandformanytherewasasensethattheywantedtolsquogetbacktosomedegreeofnormalcyrsquoandtobeabletolsquotraveloverseastovisitrelativesrsquo
Vaccine hesitancyOfthe42inthisstudywhoappearedundecidedornotplanningtohavethevaccinemanywereinfactadoptingalsquowaitandseersquoapproachbeforemakingtheirfinaldecisionMostparticipantswereinterestedtohearmoreinformationaboutthevaccinesandwereopenedtogettingthevaccinebutdidhaveconcernsaboutthesafetyofthevaccinesespeciallyinregardtoAstraZeneca
The issue of blood clots has led to considerable fearandhesitancyinthecommunityandthisfearandhesitancywasreflectedinourstudyEssentialResearchrsquossurvey(April2021)reportedoneinsixpeople(16)indicatedtheywillnevergetvaccinatedagainstCOVID-19upfrom12thepreviousmonthwhile42saidtheywillgetvaccinatedbutnotrightawayTheproportionofpeople who would be willing to get vaccinated as soonaspossibleorarealreadyvaccinatedalsodeclineddownfrom47to4213Thissurveywas conducted prior to the most recent outbreak inNSWinvolvingthehighlyinfectiousDeltastrain
Therisk-benefitofhavingthevaccineneedstobecarefullyweighedbyeachindividualideallyinconsultationwiththeirdoctoranddependingon
The Hub has lsquobeen working in partnership with keystakeholdergroupstoguidecommunicationstomeetthehealthliteracyandculturallyandlinguisticallydiverse(CALD)needsofitspop-ulationStructuredworkinggroupshavebeencreatedtoprioritisecommunicationstovulner-ableyouthCALDgroupstheelderlyitinerateworkersasylumseekersandrefugeesTheaimsaretotestmessagingandbuildtrustwithprioritypopulationstoensureeffectivecommunicationoftheneedtosustainphysicaldistancingmeas-uresintheabsenceofavaccineSimilareffortsarenowneedednationallyandshouldstartatthetimeofdiseaseoutbreaksinthefuturealongsideplannedmassmediaandhealthcommunicationcampaignsrsquo
InthearticlebyDoddetaltheyreinforcetheimportanceofusingcommunicationformatswhich are lsquosuitable for people with low health literacyandeducationandwhichareappropriateforculturallyandlinguisticallydiversegroupsandIndigenouspopulationsrsquoThearticlearguesthatitisimportanttolookatmotivationsandconcernsabout vaccines when shaping messaging It also pointsoutthatprimarycaredoctorsareatrust-ed source and as such should be supported in deliveringinformationaboutthevaccinesandad-dressingcommunityconcernsThearticlestateslsquoWeneedtounderstandandaddresscitizenrsquosconcernsthatcanpreventoptimaluptakebuildmotivationsintomessagingandprioritisepublictrustbyinformingandinvolvingthecommunityintheprocessSupportinghealth-careprofession-als in their role as educators will ensure people haveadequateandaccessibleinformationfromatrustedsourcetooptimisevaccineuptakeandultimatelyreducecommunitytransmissionofCOVID-19rsquo15
RecentresearchbyAssociateProfessorHollySeale16withUNSWMedicinersquosSchoolofPublicHealthandDeputyChairfortheCollaborationonSocialScienceandImmunisationfoundthereisaneedtolsquodecentralisersquocommunicationsbytapping
translatedmaterialsandinformationaboutthevaccines to be tailored to the needs of people in these newly-emergingcommunitygroups
It was reported that in Wollongong there can sometimesbefourgenerationsoffamilymem-bersfromnewly-arrivedrefugeegroupslivingintheonehouseMostofthesefamilymembersgenerallyhavelimitedEnglishlanguageliteracywhichincreasestheirriskofnotreceivingkeyhealthmessagesandthereforeincreasingthepotentialimpactofCOVID-19-inparticulartheDeltastrainwhichhasprovenhighlyinfectiousamongst household members
Vaccine uptakeNotdissimilartothewidercommunitymorepeopleinourstudywereplanningtohavethevaccinethannotandanumberhadalreadybeenvaccinatedInarecentLancetarticle(February2021)ConcernsandmotivationsaboutCOVID-19vaccinationfindingsfromtwosurveysfromanAustralianlongitudinalstudyconductedinJuneandJuly2020includedthatlsquothetopthreerea-sons for agreeing to vaccinate were lsquoto protect themselvesandothersrsquohelliplsquobeliefinvaccinationandsciencersquohellipandlsquotohelpstopthevirusspreadrsquoEven among those willing to vaccinate there was somehesitancyaboutthesafetyofthevaccineTheLancetarticlenotedthatlsquowillingnesstovaccinatedifferedbybothageandeducationrsquoForthosewhowereindifferentorsaidtheywouldnot get the vaccine the top reasons across the twosurveyswerelsquoconcernaboutthesafetyofthevaccineinitsdevelopmentrsquoandlsquopotentialsideeffectsrsquo12
Olderpeopleinourstudywhocomprised23of the total sample (n=199) were the group most likelytosaythattheywantedtogetthevaccine85ofthoseover65saidtheywouldhaveorhadalreadyhadthevaccineVaccinepredispo-sitionwashoweveralsostrongacrossotherage
12RHDoddKPicklesBNickelECvejicJAyreCBatcupCBonnerTCoppSCornellTDakinJIsautierKJMcCafferyConcerns and motivations about COVID-19 vaccination SydneyHealthLiteracyLabSydneySchoolofPublicHealthFacultyofMedicineandHealthUniversityofSydneypublishedintheLancetFebruary2021p162wwwthelancet cominfectionVol21February2021
theircircumstancesHoweverthesourcesofin-formationthatpeoplemostrelyuponortrustarecriticaltothedisseminationofaccurateandclearmessaging to dispel the fear surrounding events suchasbloodclottingandthemisconceptionsraisedinthefocusgroupsWithsomanypartici-pantsinthisstudygettingtheirinformationfromFacebookandothersocialmediasitesitisvitalthat these channels are used to promote simple positivemessagesandforanyfuturecommunityawareness campaigns
Effective communicationConfusionandmisconceptionsaboutthevac-cinersquosefficacyavailabilityandsafetywereallis-sues that were raised in the focus groups Finding waystoeffectivelycommunicatewithpeoplewithlowerEnglishlanguageliteracyandhealthliteracyisanimportantwaytoaddresstheconfusionandmisconceptionsaboutthevaccineashasbeen discussed in a number of recent Australian studies
Astudy14byMcCafferyetal(2020)concludedthattherearelsquoimportantdisparitiesinCOVID-19-relatedknowledgeattitudesandbehavioursaccordingtopeoplersquoshealthliteracyandlanguagersquoOneofthefindingswasthatlsquopeoplewithlowerhealthliteracywerealsomorelikelyto endorse misinformed beliefs about COVID-19 andvaccinations(ingeneral)thanthosewithadequatehealthliteracyThesamepatternofresults was observed among people who primar-ilyspeakalanguageotherthanEnglishathomersquoTheMcCafferystudyhighlightstheimportanceof tailoring health messages to those with lower healthliteracyandculturallyandlinguisticallydiversecommunitiesItpointsoutthatthereareexamplesofeffectivemanagementofdiversecommunityneedsthatusetailoredhealthmes-sagesandcitestheWesternSydneyLocalHealthDistrictHealthLiteracyHub
13TheEssentialReport-anonlinesurveyconductedbyEssentialResearchcompletedby1090people between 21ndash26 April14McCafferyKJDoddRHCvejicEAyreJBatcupCIsautierJMJCoppTBonnerCPicklesKNickelBDakinTCornellSWolf MS Health literacy and disparities in COVID-19ndashrelated knowledge attitudes beliefs and behaviours in Australia PublicHealthResPract202030(4)e30342012December2020
15 Op cit16 httpssphmedunsweduausitesdefaultfilessphcmNewsEnhancing-supporting-COVID-19-vaccination-programpdf
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
30 31
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3332
intodifferentnetworkingspacessuchaswork-placeslocalgymsmothersrsquogroupsandseniorsrsquoclubswithafocusonallagegroupsregardlessofcurrenteligibilityAccordingtoSealethechal-lengeislsquoensuringemerginginformationisadapt-edfortheintendedaudiencersquoShehasalsosaidlsquoThatrsquoswhatIrsquomalittlebitconcernedaboutatthemomenttherersquosalotofresourcesongov-ernmentwebsitesbutthesetermsaroundbloodclottingareverytechnicalWeactuallyneedtomake sure that we are breaking them down in a waythatwillmakeitmeaningfultopeopleThatrsquosnotjustabouttranslatingitrsquosaboutbeingcon-sciousofpeoplersquoshealthliteracyneedstooSomaybegettingsomemorevisualsintomaterialstotryandsupportthatrsquo17
Thereareanumberofmulticulturalhealthresourcesthatusecommunitylanguagetransla-tionsplainEnglishandvideosfromCALDcommu-nityleaderswhichcanbedownloadedandusedbyservicesandindividualsHowevermanyofthewrittenresourcesstillrelyontechnicalandscien-tifictermsthatrequireareasonablyhighlevelofEnglishlanguageliteracyorhighlevelsofliteracyin the translated language to comprehend Host websites can also be hard to navigate making itdifficulttolocateresourcesfromsimplewebsearchesAsummaryofsomeoftheavailableresourcescanbefoundatAttachment2
MulticulturalHealthUnitsinLocalHealthDis-trictshavestaffwhocanworkwithpeoplefromculturallyandlinguisticallydiversecommunitiesatthelocallevelandtranslateandcontextualisethese materials to the needs of the end user These teams respond to local needs and popu-lationdemographicsandareexpertsineffectivehealthliteracyandhealthcommunicationwiththeirlocalcommunitiesTheyworkcloselywithcommunityandvulnerablegroupstobuildhealthliteracyandimprovedhealthoutcomesintheircommunities
Case Study ndash Be a COVID Warrior ndash Responding to COVID-19 in Multicultural Communities InWollongongtheIllawarraShoalhavenLocalHealthDistrict(ISLHD)MulticulturalHealthSer-viceco-designedacommunityengagementandeducationprogramcalledlsquoBeaCOVIDWarriorrsquowhich commenced in 2020 in response to the pandemic This program was designed to respond tothelowlevelsofhealthliteracyaroundCOVID-19potentialexposuretothevirusandaddressfearandstigmainthelocalCALDcommunitiesThelsquoCOVIDWarriorrsquoprogramreachedaround880peopleranginginagefrom14to85years65ofCOVIDWarriorparticipantswerefemaleand35weremaleCOVIDWarriorparticipantsrepresented 21 language groups The outcomes of the program included increased levels of confidenceinapplyinginfectioncontrolmeasuresincreasedliteracyandhealthliteracyandawarenessofhowCOVID-19istransmittedUltimatelyanimprovedawarenessinapplyingCOVIDsafemeasures was also reported
InApril2020theservicecommencedwelfarechecksviaphoneonafortnightlybasistosup-portsocially-isolatedmulticulturalseniorswhoboretheemotionalstressofsocialisolationFrom these calls the ISLHD heard the needs and concernsofseniorsinthecommunityInadditionourexperiencewithCALDcommunitieshighlightedtheimportanceofyoungpeopleasconduitsofessentialinformationtoadultsincommunityandfamilygroupsduetoEnglishlanguageaccessandeducation
InresponsetheISLHDinitiatedthelsquoCOVIDWarri-orrsquoprogramusingbi-culturalhighschoolstudentsthroughthelocalhighschoolsByincreasingthehealthliteracyofstudentsatschooltheselsquocham-pionsrsquocouldtalktotheirfamiliesincludingolderfamilymembersininformalsettingsandthroughsocialmediawiththeirpeersasastrategytoraisethe level of knowledge of COVID-19 trans-mission preventionandtestingTheprogrambecamesopopularthatitwasextendedintomorelocalhighschools and adults accessing the Adult Migrant EnglishProgramTheprogramwassupportedbylocalsettlementservicesprovidedbybothMaxSolutionsandtheRedCrossItwas
17 httpstheconversationcomhow-can-governments-communicate-with-multicultural-australians-about-COVID-19-vaccines-its-not-as-simple-as-having-a-poster-in-their-language-156097
later extendedtoCALDSeniorsthroughtheMulticulturalCommunitiesCouncilIllawarra(MCCI)supportprograms
AkeycomponentoftheprogramwastoprovideparticipantswithlsquoCOVIDWarriorrsquoKitswhichincludedtworeusablemaskshandsanitiserinfographicsaboutCOVID-19symptomsandinfor-mationaboutwheretestingclinicswereavailablelocallyMCCIandRuralAustraliaforRefugeesdonatedreusablemasksforeveryparticipant
AsthelsquoCOVIDWarriorrsquoprogramwasevolvingsowasthenationalvaccinerolloutplanInforma-tionwasthereforeadaptedtomeetthisinfor-mationgapForexampleadultparticipantsandseniors were supported to understand how to accesstheCOVIDvaccinelsquoeligibilitycheckersrsquoandCALD people were shown how to use the NSW HealthwebsiteCOVID-19informationpages18
Decision makingHowpeoplearecurrentlyconsideringtheriskofCOVID-19isinfluencedbyarangeoffactorsincludingratesoftransmissioninthecommunitynumbersofnewcasesreportsinthemediaofrisksandsideeffectsPeopletendtobasetheirassessmentonwhattheyarecurrentlyexperi-encingandthencheckthisagainstwhattheyarehearinginthemediaincludingandespeciallyonsocialmediaandfromfamilyandfriendsMostoftheparticipantsinourstudyspokeclearlyandarticulatelyabouthowtheyweigheduptherisk-benefitofhavingtheCOVID-19vaccineintheir decision making Low case numbers ndash at the timeofconductingtheresearchndashandasensethat Australia was lsquodoing well in safeguarding the communityagainstCOVID-19rsquoweresignificantfactorsinpeoplersquosdecisionnottobevaccinatedortoadoptalsquowaitandseersquoapproachFamilyfriends and social media were reported as having aconsiderableinfluenceondecisionmakingaswerereportsinthemediaofthebloodclottingsideeffectsofAstraZeneca
ThefactthatFacebookwasreportedlythemostpopularsourceofinformationaboutCOVID-19
18httpswwwhealthnswgovauInfectiouscovid-19Pagesdefaultaspx
andtheCOVID-19vaccineforpeopleinthestudyraisesconcernsaboutthepossibledisseminationofmisconceptionsandlsquofakenewsrsquothatmaybespread or compounded via social media Closed social media groups such as WhatsApp and WeChatwithfamilyandfriendsmayalsoleadtopeoplereinforcingtheirpre-existingbiasesThesefactorscoupledwithasensethatAustraliaisfaringwellcomparedtomanycountriesoverseasappear to have resulted in increased vaccine hesi-tancyamongparticipantsofthestudy
Factorsthatwereidentifiedaschangingvaccine-hesitantparticipantsrsquoperceptionswereanincreased risk from COVID-19 and a correspond-ingincreaseinthenumberofinfectionsandonthebenefitsidetheabilitytotraveloverseastovisitfamilyIntherecentresearchfromtheUniversityofNSWcitedaboveSearlearguesthatlsquotheremaybeotherthingsthatweneedtonowstartfocusingonhellipthatwillstarttopromoteandmotivatepeoplesuchasthechancetotravelmorefreelyforexamplersquoThisappearstobeborneoutbyourfocusgroupfindings19
Untilrecentlytherehavebeenverylowcasenumbers and few lockdowns across most of Aus-tralia and NSW The recent outbreak from mid-JuneinGreaterSydneyandintroductionofthehighlyinfectiousDeltavariantinNSWislikelytoimpactonpeoplersquosassessmentsoftherisk-benefitofhavingthevaccineandonewouldassumereducehesitancyrates
GiventheheightenedcommunityanxietycausedbythisrecentCOVID-19outbreaktheproductionofshortsharpandtargetedmessagingtoCALDgroupsincommunitylanguagesthatisaccessibleandmotivationalfeaturescommunityleadershigh-profilecelebritiesandsportsstarsfromCALDbackgroundsandisdirectedatastate-wideandlocal level would appear to be more urgent than everItisclearthatformessagingtobeeffectiveandreachitsintendedaudiencedistributionchannelsshouldincludeFacebookWhatsAppandothersocialmediaplatformsaswellastrustedsourcessuchasmulticulturalhealthworkersmulticulturalservicesandthroughGPsandMedical Centres If mainstream COVID-19 vaccine
19 Op cit
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
32 33
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3534
awareness campaigns are produced in Australia suchashavebeenproducedinNewZealandtheUnitedKingdomandNorthAmericatheyshouldincludehighprofilewell-knowncommunityfig-uresandsportingstarsfromCALDbackgroundsandincludestrategiesspecificallytargetingCALDcommunitiesincludinggroupsidentifiedaspar-ticularlyhigh-risk
It is also important that informationonvaccinesistranslatedintolanguagesfromnewerandemergingcommunitiesOthersuggestionsaroundreachingthesecommunitiesincludeface-to-facemeetingsorganisedbycrossagencypartnershipsandpeer-ledstrategiessuchas mobilising community champions and influenc-ers Messaging needs to be inclusive and framed around the collective values held by commu-n5
It is clear that reinforcing the benefits of being vaccinated at this time rather than dwelling on the risks is more likely to generate behavioural
changeandapositivevaccineresponsefrombothCALDcommunitiesandthegeneralpopulationAppropriately-designedandtargetedCOVID-19vaccinehealthinformationthatiseasytoreadinanylanguagecanbeconveyedbycommunityleadersandcommunitynetworksandpromotesthepositivebenefitsofgettingvaccinatedwouldbevaluableatthistimeBuildingontheworkofpeerchampionssuchastheCOVIDWarriorprogramisalsoasuccessfulmodeltoincreasingCOVID-19vaccinehealthliteracyandinformed decision making
Mostimportantlypositivelymotivatingculturallyandlinguisticallydiversecommunitymemberstolsquogetthejabrsquoespeciallythosewhoareadoptingalsquowaitandseersquoapproachorarevaccinehesitantwould lead to greater vaccine uptake among culturallyandlinguisticallydiversecommunitiesandthereforethecommunityasawhole
Inner West Multicultural Network Addison Road Community Centre DateWednesday12May
A focus group session of members of the Inner WestMulticulturalNetworkpluscustomersoftheFoodPantryatAddisonRoadwasheldattheAddisonRoadCommunityCentreinMarrickvilleon12Mayat200pmThesessionwaspartoftheregularmeetingoftheInnerWestMulticul-turalNetworkTheconsultationinvolvedabout26peopleandwasconductedbyRosannaBarbero
Thegroupbrainstormedresponsestoquestionsaroundvaccinehesitancyinmulticulturalcom-munitiesandmoreeffectivemessagingTheseresponseshavebeenincorporatedinthefindingsof the report
Griffith Women on Fire Focus Group Griffith Community Centre DateFriday14May
This small focus group of women was held at GriffithCommunityCentreonMay14at11amMargCouchSeniorProjectOfficerRegionalDevelopmentAustralia(RDA)-RiverinaandJoanneFitzpatrickSettlementEngagementandTransitionSupport Worker from Centacare Southwest NSW werethekeylinksandnetworkcontactsfortheGriffithcommunityTheWomenonFire(WOF)group was established as part of the Red Cross RuralFireServiceprogramlsquoManyCulturesOneCommunityrsquoInitiallyitwasestablishedtoeducatewomenonemergencypreparednessandtoen-courage NSW Rural Fire Service (RFS) volunteering andnowhastransformedintoacommunityac-tionsupportgroupTheGriffithSoroptimistInter-nationalnowauspicetheirfinancesandsupporttheWOFgroupactivitiesThefocusgroupwasfacilitatedbyCamillaCouchandlocalcommunityvolunteersledbytheGriffithSoroptimistClub
The women in the group were from Pakistan and IndonesiaThegroupweremainlyyoungmotherswithyoungchildrenandtheprogramhadchild-minding arrangements The language level of the womenwaslowandmostwerestudyingESOLat
ATTACHMENTS
ATTACHMENT 1 A Description of the Focus Groups
TAFEThedeliveryoftheinformationwaslimiteddue to language levels and the lack of bilingual interpretersEachparticipantworkedoneononewithavolunteertoslowlyfillinthesurveyandonewomantookthesurveyhometodiscusswithherhusbandThisgroupexperiencehighlightedthe lack of bilingual workers and services in some rural areas
Arabic speaking group Syd West Multicultural Services Mount Druitt Community worker Zaid Naoum Generalist Caseworker SydWest Multicultural Services DateMonday24May
ThefocusgroupfromSydWestMulticulturalSer-viceswasconductedonMonday24May2021atSydWestMulticulturalServicesMountDruittat300pmItwasfacilitatedbyPatriciaMcCormickandsupportedbyZaidNaoumGeneralistCase-workerSydWestMulticulturalServices
Therewere10womenandmenfromSyriainthegroupThegroupweremostlymaturetoolderparticipantsMostparticipantsrequiredassistancewithEnglishandthecaseworkerZaidNaoumhadtranslatedthesurveyintoArabicpriorto the focus group Zaid also translated during the focus group
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Canterbury City Community Centre (4Cs) group The Cottage Lakemba DateTuesday25May
ThefocusgroupfromCanterburyCityCommunityCentre(4Cs)wasconductedonTuesday25MayattheCottageat28CroydonStreetLakembaat10amItwasfacilitatedbyRobinMilesandsup-portedbyRomanaWaseemCommunityWorkerfrom 4Cs
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
34
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3736
The group was comprised of 14 women from PakistanIndiaandSriLankaThewomenrangedinagefrom23to65MostwerefluentEnglishspeakershoweveronewomanrequiredtransla-tionintoUrdufromoneoftheotherwomeninthegrouptoanswerthequestionsdirectly
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
NSW Chaldean League group Community worker Randa Goriya DateTuesday25May
ThefocusgroupfromNSWChaldeanLeagueMountDruittwasconductedonTuesday25May2021 at 1000am at the NSW Chaldean League premisesItwasfacilitatedbyPatriciaMcCormickandsupportedbyRandaGoriyaacommunityworker for the NSW Chaldean League in Mount DruittRandatranslatedtheintroductionandpromptsforthediscussionandhelpedthepartic-ipantstocompletethesurveyMostofthegrouprequiredhelptodothesurvey
ThegroupoftwelveparticipantswereallChaldeanandwerematuretoolderinageTheywereamixed-gendergroup
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Arabic speaking group Red Cross premises Wollongong DateTuesday25May
ThefocusgrouptookplaceonTuesday25Mayat 3pm at the Red Cross premises at Wollongong Therewere22womenandmenparticipatinginthegroupThefocusgroupwasfacilitatedbyCamilla Couch with support from Khalid Zainu-labdeenBilingualSupportWorkerHumanitarianSettlementProgram(ACTampNSW)
There were diverse ages in the group ranging fromyoungpeopletoolderagedMostofthegroupwereyoungerrecently-arrivedrefugeesfrom diverse backgrounds There was also a small-eroldercohortofparticipantswithhigherliteracylevelsandstrongercommunityengagementwith the local services in the area Camilla Couch facilitated the focus group which was conducted inArabicandEnglishwiththeArabictranslationprovidedbyKhalidZainulabdeen
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Work Opportunities for Women group Mt Druitt TAFE DateWednesday26May
TheWorkOpportunitiesforWomen(WOW)focusgroupwasheldonWednesdayMay261100ndash 100pmatMtDruittTAFEItwasfacilitatedbyCamilla Couch and built on the knowledge gainedintheprevioussessiononcriticalandanalyticalthinkingTheWOWgroupisaTAFECertificatelevel course
There were 14 women from diverse cultural backgroundsinthegroupThegroupweremainlyMuslimwomenwithschoolagechildrenandsome were mature aged Due to the learning fo-custhegroupwasfacilitatedasaclasswithguid-eddiscussionontheissuesandcarefulanalysisofthequestionsNotranslationwasneededduetotheeducationalcontextThestudentswereadeptatusingITandcompletedallthesurveysonline
STARTTS Tamil group Toongabbie Community Centre Community worker Sivaharani (Harani) Mayuran DateThursday27May
Thefocusgroupconsistedof18femalepartic-ipantswhowereyoungertomatureagedThefocus group was held at 1000am at Toongabbie CommunityCentreinTargoRdToongabbie
ThefocusgroupwasfacilitatedbyPatriciaMc-CormickandsupportedbyacommunityworkerSivaharani(Harani)MayuranfromtheSTARTTSTamil Group
ThegrouphadmixedlevelsofspokenandwrittenEnglishTheintroductionanddiscussionpromptsweretranslatedbythecommunityworkerSivaha-rani(Harani)Mayuranandsheandthemorepro-ficientstudentssupportedthosewithlowliteracytoanswerthesurveyquestions
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Spanish Speakers Seniors group SydWest Multicultural Services Blacktown DateTuesday1June
TheFocusGrouptookplaceonTuesday1Juneat1100amattheBlacktownShowgroundsandconsistedof16participants(15womenandoneman)AllparticipantswerebornincountriesinSouthAmericaTheirEnglish-fluencylevelsvariedand one of the members of the group translated thesurveyquestionsanddiscussionintoSpanish
ThegrouphadbeenmeetingforseveralyearsThegroupwasfacilitatedbyLindyCassidyandwassupportedbySreeVithyaHarilingamDayRespiteampSocialSupportTeamLeaderatSydWestMulticulturalServicesBlacktownThegroupwerematureagedtoolderparticipants
Thegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyform There was a more focused discussion on somekeyquestionsaftersurveycompletionThetranslatorassistedconsiderablyinthisprocess
Italian Speakers group Warrawong Community Centre DateMonday7June
The focus group of Italian speakers was held on Monday7Juneat1015amattheWarrawongCommunityCentreItwasfacilitatedbyCamillaCouchandsupportedbyJohnPaulTroianiand
SofiaLemafromIllawarraShoalhavenLHDMulti-cultural Health
There were 15 women in the group The group weremostlymaturetoolderparticipantsandwasconductedinItalianandEnglishwithtranslationprovidedbyJohnPaulThisgroupmeetsregularlyandissupportedbyanumberofservicesintheareaespeciallymulticulturalhealth
The group had a general facilitated discussion aboutthequestionsinthesurveyDuetolittleornoliteracytheindividualsurveyresponseswerethencollectedintooneresponseThesesurveyresponses have been included in the general surveyresponses
Mothers Group SydWest Multicultural Services Blacktown DateThursday10June
ThefocusgrouptookplaceonThursday10Juneat1030amandconsistedof14youngwomen13 of whom had a CALD background The focus groupweremainlymothersfromasupportgroupatSydWestMulticulturalServicesinBlacktown
EightofthewomenwereborninIndiatwofromPakistantwofromSriLankaonefromHausaGhana and one was born in Australia (the Austral-ianbornyoungwomanwasasocialworkstudenthelpingwiththegroup)LindyCassidyfacilitatedthe group with support from Wilma Garguath a projectofficerfromSydWestMulticultural Services
The group varied in age One was between 18-24 yearsoldSevenwereagedbetween25-34yearsSixwereagedbetween35=44yearsGiventheirage and circumstances most of the group did not consider themselves eligible at this stage for vac-cinationThiswasanimportantdifferencefromotherfocusgroupsinthattheemphasiswasmoreonwhattheywoulddooncetheybecameeligible
Participantsdidnotrequireassistancewithspo-kenEnglishThegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyformTherewasamorefocuseddiscussiononsomekeyquestions
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3938
ATTACHMENT 2 COVID-19 Vaccine Information in multiple languagesThefollowingsitesappsprovidetranslatedinformationaboutCOVID-19vaccines
Type of information KeyinformationongettingvaccinatedinNew South Wales and on the vaccines available The websiteusesanautomaticservicetotranslate thecontentintodifferentlanguages
Source of information NSW Government website
Link httpswwwnswgovauCOVID-19health-and-wellbeingCOVID-19-vaccina-tion-nswgetting-vaccinated
Type of information COVID-19ResourcessectionontheServiceNSWapp The app has a link to NSW Government websiteinformationonldquoGettingaCOVID-19vaccinationrdquo(seeabove)ItalsoincludesalinktoCOVID-19vaccinationresourcesinotherlan-guages available from the Department of Health
Source of information Service NSW NSW Government
Link Service NSW App
Type of information ArangeoftranslatedresourcesonCOVID-19bytitleincludingafactsheetonCOVID-19VaccineAstraZeneca(ChAdOx1-S)
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCOV-ID-19Pagestranslatedresources-by-titleaspx
Type of information ADigitalCOVID-19resourcelibrarywithtranslated materials
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiouscov-id-19Pagesdigital-resourcesaspx
Type of information AMultilingualCommunityToolkitontheCOVID-19vaccinationprogramtoassist communityworkersprovideseasytoreadresourcesvideosandlinkstokeyservicesandresources
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCovid-19DocumentsNSW-COVID-19-vaccina-tion-program-presentation-20210527pdf
Type of information TheNSWMulticulturalHealthCommunicationServiceoffershealthresourcesandinformationin a wide range of languages It has translated resources on COVID-19 and links to translated resourcesonCOVID-19vaccination
Source of information MulticulturalHealthCommunicationServiceisa New South Wales-wide health service hosted bySouth-easternSydneyLocalHealthDistrict(SESLHD)
Link httpswwwmhcshealthnswgovau
Type of information COVID-19vaccineinformationaddressingkeyquestionsaboutCOVID-19vaccinationandincludesvideosposterstilesfactsheetsandaudio material Translated into 63 languages
Source of information Department of Health Australian Government website
Link httpswwwhealthgovauinitiatives-and-pro-gramsCOVID-19-vaccinesCOVID-19-vaccine-in-formation-in-your-language
Type of information ThisinformationaddressessomecommonmisinformationaboutCOVID-19Translatedintomultiplelanguages
Source of information DepartmentofHomeAffairs Australian Government website
Link httpscovid19inlanguagehomeaffairsgovaumisinformation-and-truths-about-coronavirus
Type of information Australianandinternationalnewsand informationaboutCOVID-19andCOVID-19 vaccinesisavailableontheSBSCoronavirusPortal in more than 60 languages
Source of information SBSwebsite
Link httpswwwsbscomaulanguagecoronavirus
Type of information InformationprovidedaboutCOVID-19vaccinerolloutandsafetyinlanguagesotherthan English
Source of information Department of Health and Human Services Victorian Government
Link httpswwwcoronavirusvicgovautranslat-ed-information-about-COVID-19-vaccines
Type of information HealthTranslationsprovidestranslatedmateri-alsonhealthandwellbeingInformationaboutCOVID-19isregularlyupdatedincludessomeinformationonvaccinationandisavailableinover60communitylanguages
Source of information Victoriangovernmentinitiative
Link httpswwwhealthtranslationsvicgovaubhcv2bhchtnsfPresentEnglishResource-AllOpenampx=amps=Coronavirus
Type of information A one-stop shop for translated materials in multiplelanguagesonCOVID-19
Source of information Ethnolink Language Services
Link httpswwwethnolinkcomauCOVID-19-coro-navirus-translated-resources
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
40
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
2928
outpositivemessagingthroughtrusted communityserviceorganisationscouldbeaneffectivewayofshiftingpeoplefromvaccine hesitancytodecidingtohavethevaccine
31372549
980 980
25492157
4314
1176
2353
4902
4118
2157
980392
SBS r
adio
SBS T
V
Community ra
dio
Other rad
io
Other TV
Newspap
er
My frie
nds
My fam
ily in
Australi
a
My fam
ily ove
rseas
Face
book
Other socia
l media
This c
ommunity se
rvice
Another community
servi
ce
Somewhere else
(please
tell u
s where
)000
1000
2000
3000
4000
5000
6000
Figure 18 Sources of information for respondents who lsquodonrsquot knowrsquo if they will have the vaccine
DISCUSSION
wardstheCOVID-19vaccineareasvariedastheyarewithinthebroadercommunityTherearearangeofinfluencingfactorsincludingagehealthstatushowlongtheyhavebeeninAustraliahowmuchnewstheyreceivefromoverseasandhowbadlyimpactedbythepandemictheirhomecountries have been
The research also highlights that people from culturallyandlinguisticallydiversebackgroundsgettheirinformationaboutCOVID-19andtheCOVID-19vaccinefromawidevarietyofsourcesbothformalandinformalandthatforparticulargroupsinthisstudythereisahighrelianceonFacebookovermoreofficialsourcesofinforma-tion
VulnerabilityTheneedsofhighly-vulnerablegroupswithintheCALDcommunityhavetobetakenintoconsider-ationThisincludesolderpeoplewhohavelivedinAustraliaformanyyearsbuthavelowlevelsofEnglishliteracyndashespeciallywritingandreadingEnglishandsometimesspokenEnglishndashandwhoaremoresusceptibletoseriousillnessandhigherratesofhospitalisationanddeathfromCOVID-19Italsoincludesnewly-arrivedrefugeeswhohavinglowornoEnglishlanguageliteracylacktheconnectionstoandnetworksintothewidercommunityandcommunitysupportsItisalsothecase that some people in these groups are not health literate at all and cannot read and write in their own language
Akeytakeoutfromthehealthandcommunityserviceorganisationsurveyresponsesandinter-viewsundertakenwithmulticulturalhealthandcommunicationexpertsfortheprojectisthatlit-eracylevelsreallydomatterLowlevelsofhealthliteracylowlevelsofEnglishlanguageliteracyandpossiblylowlevelsofliteracyintheirownlan-guage-especiallyforsomenewly-arrivedrefu-gees and those who are part of the humanitarian program such as Dari language speakers from AfghanistanTigrinyalanguagespeakersfromEr-itrea and northern Ethiopia and Oromo language speakers from Ethiopia - need to be factored into anyplanstofurtherpromotethevaccinerolloutanduptaketoculturallyandlinguisticallydiversepeopleinthecommunityThereisaneedfor
The contextThisresearchisimportantgivenhowhighlyculturallydiverseNSWisandtheimpactthiscanhave on the success of public health messaging topeoplewhosefirstlanguageisnotEnglishPeople who were born overseas form almost one-thirdofthe7480228population(276)ofNSWandNSWishometo336ofAustraliarsquosoverseas-bornpopulationPeoplefromaround225 birthplaces have made NSW their home and 21oftheNSWpopulationisfromanon-EnglishspeakingbackgroundMorethan24000humani-tarianentrantshavesettledinNSWoverthepastfiveyearscomprisingalmostathird(32)ofthenationaltotalThe24000humanitarianentrantswhohavesettledinNSWoverthepastfiveyearscame from over 100 countries of origin10Sydneyhasthelargestoverseas-bornpopulationofallthecapitalcities11
Hearingdirectlyfrompeoplefromculturally-diverse backgrounds is important to ensure that policymakersandpublichealthadvocatescandesign responses that are both accessible and un-derstandabletopeopleforwhomEnglishmaybetheirsecondthirdorfourthlanguageApropor-tionofpeopleinthesecommunitieshavelowerlevelsofEnglishlanguageliteracyandinsomecaseslowlevelsofliteracyintheirlanguageoforiginsowillbehardertoreachviatraditionalormainstream methods
Itisalsocriticallyimportantthatduringatimewherethereissomuchlsquonoisersquoacrossmediachannelsrelatingtothevaccinethevaccineroll-outvaccineefficacyandvaccinesafetythatwetakesometimetolistentoandunderstandhowthislsquonoisersquoisbeingheardandmadesenseofbypeoplefromculturally-diversebackgrounds
ThatsaiditisimportanttoreconfirmthattheCALDcommunityisnotahomogenousgroupOurresearchhasfoundthattheviewsandattitudesofparticipantsfromdiverseculturalbackgroundsto-
10RefugeeCouncilofAustraliaHumanitarianEntrantsin New South Wales A resource for New South Wales governmentagencies6-711MulticulturalNSWCommunityRelationsReport2018-20199
29
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3130
groupsFortheparticipantsintheresearchtheirattitudetothevaccineappearedtobeinflu-encedbyanumberoffactorstheirownlevelsofhealthandpre-existinghealthconditionsandthoseoftheirfamilymembersandtheimpactofreceiving COVID-19-related news from overseas particularlyfrompeoplersquoscountryoforiginAnexampleofthiscanbeseenintheItaliangroupin Wollongong where people had received news fromoverseasearlyinthepandemicwhichscaredthemThisexperiencelsquofromhomersquohadinflu-enced most of the women in the Wollongong focus group (n=15) to choose to get vaccinated The interviewee from the Illawarra Shoalhaven Local Health District also spoke about the heightenedconcernthattheywitnessedinthelocalItaliancommunityintheearlystagesofthepandemicOtherpeoplewantedtolsquostayhealthyrsquoandtolsquoprotectthehealthofothersrsquoandformanytherewasasensethattheywantedtolsquogetbacktosomedegreeofnormalcyrsquoandtobeabletolsquotraveloverseastovisitrelativesrsquo
Vaccine hesitancyOfthe42inthisstudywhoappearedundecidedornotplanningtohavethevaccinemanywereinfactadoptingalsquowaitandseersquoapproachbeforemakingtheirfinaldecisionMostparticipantswereinterestedtohearmoreinformationaboutthevaccinesandwereopenedtogettingthevaccinebutdidhaveconcernsaboutthesafetyofthevaccinesespeciallyinregardtoAstraZeneca
The issue of blood clots has led to considerable fearandhesitancyinthecommunityandthisfearandhesitancywasreflectedinourstudyEssentialResearchrsquossurvey(April2021)reportedoneinsixpeople(16)indicatedtheywillnevergetvaccinatedagainstCOVID-19upfrom12thepreviousmonthwhile42saidtheywillgetvaccinatedbutnotrightawayTheproportionofpeople who would be willing to get vaccinated as soonaspossibleorarealreadyvaccinatedalsodeclineddownfrom47to4213Thissurveywas conducted prior to the most recent outbreak inNSWinvolvingthehighlyinfectiousDeltastrain
Therisk-benefitofhavingthevaccineneedstobecarefullyweighedbyeachindividualideallyinconsultationwiththeirdoctoranddependingon
The Hub has lsquobeen working in partnership with keystakeholdergroupstoguidecommunicationstomeetthehealthliteracyandculturallyandlinguisticallydiverse(CALD)needsofitspop-ulationStructuredworkinggroupshavebeencreatedtoprioritisecommunicationstovulner-ableyouthCALDgroupstheelderlyitinerateworkersasylumseekersandrefugeesTheaimsaretotestmessagingandbuildtrustwithprioritypopulationstoensureeffectivecommunicationoftheneedtosustainphysicaldistancingmeas-uresintheabsenceofavaccineSimilareffortsarenowneedednationallyandshouldstartatthetimeofdiseaseoutbreaksinthefuturealongsideplannedmassmediaandhealthcommunicationcampaignsrsquo
InthearticlebyDoddetaltheyreinforcetheimportanceofusingcommunicationformatswhich are lsquosuitable for people with low health literacyandeducationandwhichareappropriateforculturallyandlinguisticallydiversegroupsandIndigenouspopulationsrsquoThearticlearguesthatitisimportanttolookatmotivationsandconcernsabout vaccines when shaping messaging It also pointsoutthatprimarycaredoctorsareatrust-ed source and as such should be supported in deliveringinformationaboutthevaccinesandad-dressingcommunityconcernsThearticlestateslsquoWeneedtounderstandandaddresscitizenrsquosconcernsthatcanpreventoptimaluptakebuildmotivationsintomessagingandprioritisepublictrustbyinformingandinvolvingthecommunityintheprocessSupportinghealth-careprofession-als in their role as educators will ensure people haveadequateandaccessibleinformationfromatrustedsourcetooptimisevaccineuptakeandultimatelyreducecommunitytransmissionofCOVID-19rsquo15
RecentresearchbyAssociateProfessorHollySeale16withUNSWMedicinersquosSchoolofPublicHealthandDeputyChairfortheCollaborationonSocialScienceandImmunisationfoundthereisaneedtolsquodecentralisersquocommunicationsbytapping
translatedmaterialsandinformationaboutthevaccines to be tailored to the needs of people in these newly-emergingcommunitygroups
It was reported that in Wollongong there can sometimesbefourgenerationsoffamilymem-bersfromnewly-arrivedrefugeegroupslivingintheonehouseMostofthesefamilymembersgenerallyhavelimitedEnglishlanguageliteracywhichincreasestheirriskofnotreceivingkeyhealthmessagesandthereforeincreasingthepotentialimpactofCOVID-19-inparticulartheDeltastrainwhichhasprovenhighlyinfectiousamongst household members
Vaccine uptakeNotdissimilartothewidercommunitymorepeopleinourstudywereplanningtohavethevaccinethannotandanumberhadalreadybeenvaccinatedInarecentLancetarticle(February2021)ConcernsandmotivationsaboutCOVID-19vaccinationfindingsfromtwosurveysfromanAustralianlongitudinalstudyconductedinJuneandJuly2020includedthatlsquothetopthreerea-sons for agreeing to vaccinate were lsquoto protect themselvesandothersrsquohelliplsquobeliefinvaccinationandsciencersquohellipandlsquotohelpstopthevirusspreadrsquoEven among those willing to vaccinate there was somehesitancyaboutthesafetyofthevaccineTheLancetarticlenotedthatlsquowillingnesstovaccinatedifferedbybothageandeducationrsquoForthosewhowereindifferentorsaidtheywouldnot get the vaccine the top reasons across the twosurveyswerelsquoconcernaboutthesafetyofthevaccineinitsdevelopmentrsquoandlsquopotentialsideeffectsrsquo12
Olderpeopleinourstudywhocomprised23of the total sample (n=199) were the group most likelytosaythattheywantedtogetthevaccine85ofthoseover65saidtheywouldhaveorhadalreadyhadthevaccineVaccinepredispo-sitionwashoweveralsostrongacrossotherage
12RHDoddKPicklesBNickelECvejicJAyreCBatcupCBonnerTCoppSCornellTDakinJIsautierKJMcCafferyConcerns and motivations about COVID-19 vaccination SydneyHealthLiteracyLabSydneySchoolofPublicHealthFacultyofMedicineandHealthUniversityofSydneypublishedintheLancetFebruary2021p162wwwthelancet cominfectionVol21February2021
theircircumstancesHoweverthesourcesofin-formationthatpeoplemostrelyuponortrustarecriticaltothedisseminationofaccurateandclearmessaging to dispel the fear surrounding events suchasbloodclottingandthemisconceptionsraisedinthefocusgroupsWithsomanypartici-pantsinthisstudygettingtheirinformationfromFacebookandothersocialmediasitesitisvitalthat these channels are used to promote simple positivemessagesandforanyfuturecommunityawareness campaigns
Effective communicationConfusionandmisconceptionsaboutthevac-cinersquosefficacyavailabilityandsafetywereallis-sues that were raised in the focus groups Finding waystoeffectivelycommunicatewithpeoplewithlowerEnglishlanguageliteracyandhealthliteracyisanimportantwaytoaddresstheconfusionandmisconceptionsaboutthevaccineashasbeen discussed in a number of recent Australian studies
Astudy14byMcCafferyetal(2020)concludedthattherearelsquoimportantdisparitiesinCOVID-19-relatedknowledgeattitudesandbehavioursaccordingtopeoplersquoshealthliteracyandlanguagersquoOneofthefindingswasthatlsquopeoplewithlowerhealthliteracywerealsomorelikelyto endorse misinformed beliefs about COVID-19 andvaccinations(ingeneral)thanthosewithadequatehealthliteracyThesamepatternofresults was observed among people who primar-ilyspeakalanguageotherthanEnglishathomersquoTheMcCafferystudyhighlightstheimportanceof tailoring health messages to those with lower healthliteracyandculturallyandlinguisticallydiversecommunitiesItpointsoutthatthereareexamplesofeffectivemanagementofdiversecommunityneedsthatusetailoredhealthmes-sagesandcitestheWesternSydneyLocalHealthDistrictHealthLiteracyHub
13TheEssentialReport-anonlinesurveyconductedbyEssentialResearchcompletedby1090people between 21ndash26 April14McCafferyKJDoddRHCvejicEAyreJBatcupCIsautierJMJCoppTBonnerCPicklesKNickelBDakinTCornellSWolf MS Health literacy and disparities in COVID-19ndashrelated knowledge attitudes beliefs and behaviours in Australia PublicHealthResPract202030(4)e30342012December2020
15 Op cit16 httpssphmedunsweduausitesdefaultfilessphcmNewsEnhancing-supporting-COVID-19-vaccination-programpdf
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
30 31
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3332
intodifferentnetworkingspacessuchaswork-placeslocalgymsmothersrsquogroupsandseniorsrsquoclubswithafocusonallagegroupsregardlessofcurrenteligibilityAccordingtoSealethechal-lengeislsquoensuringemerginginformationisadapt-edfortheintendedaudiencersquoShehasalsosaidlsquoThatrsquoswhatIrsquomalittlebitconcernedaboutatthemomenttherersquosalotofresourcesongov-ernmentwebsitesbutthesetermsaroundbloodclottingareverytechnicalWeactuallyneedtomake sure that we are breaking them down in a waythatwillmakeitmeaningfultopeopleThatrsquosnotjustabouttranslatingitrsquosaboutbeingcon-sciousofpeoplersquoshealthliteracyneedstooSomaybegettingsomemorevisualsintomaterialstotryandsupportthatrsquo17
Thereareanumberofmulticulturalhealthresourcesthatusecommunitylanguagetransla-tionsplainEnglishandvideosfromCALDcommu-nityleaderswhichcanbedownloadedandusedbyservicesandindividualsHowevermanyofthewrittenresourcesstillrelyontechnicalandscien-tifictermsthatrequireareasonablyhighlevelofEnglishlanguageliteracyorhighlevelsofliteracyin the translated language to comprehend Host websites can also be hard to navigate making itdifficulttolocateresourcesfromsimplewebsearchesAsummaryofsomeoftheavailableresourcescanbefoundatAttachment2
MulticulturalHealthUnitsinLocalHealthDis-trictshavestaffwhocanworkwithpeoplefromculturallyandlinguisticallydiversecommunitiesatthelocallevelandtranslateandcontextualisethese materials to the needs of the end user These teams respond to local needs and popu-lationdemographicsandareexpertsineffectivehealthliteracyandhealthcommunicationwiththeirlocalcommunitiesTheyworkcloselywithcommunityandvulnerablegroupstobuildhealthliteracyandimprovedhealthoutcomesintheircommunities
Case Study ndash Be a COVID Warrior ndash Responding to COVID-19 in Multicultural Communities InWollongongtheIllawarraShoalhavenLocalHealthDistrict(ISLHD)MulticulturalHealthSer-viceco-designedacommunityengagementandeducationprogramcalledlsquoBeaCOVIDWarriorrsquowhich commenced in 2020 in response to the pandemic This program was designed to respond tothelowlevelsofhealthliteracyaroundCOVID-19potentialexposuretothevirusandaddressfearandstigmainthelocalCALDcommunitiesThelsquoCOVIDWarriorrsquoprogramreachedaround880peopleranginginagefrom14to85years65ofCOVIDWarriorparticipantswerefemaleand35weremaleCOVIDWarriorparticipantsrepresented 21 language groups The outcomes of the program included increased levels of confidenceinapplyinginfectioncontrolmeasuresincreasedliteracyandhealthliteracyandawarenessofhowCOVID-19istransmittedUltimatelyanimprovedawarenessinapplyingCOVIDsafemeasures was also reported
InApril2020theservicecommencedwelfarechecksviaphoneonafortnightlybasistosup-portsocially-isolatedmulticulturalseniorswhoboretheemotionalstressofsocialisolationFrom these calls the ISLHD heard the needs and concernsofseniorsinthecommunityInadditionourexperiencewithCALDcommunitieshighlightedtheimportanceofyoungpeopleasconduitsofessentialinformationtoadultsincommunityandfamilygroupsduetoEnglishlanguageaccessandeducation
InresponsetheISLHDinitiatedthelsquoCOVIDWarri-orrsquoprogramusingbi-culturalhighschoolstudentsthroughthelocalhighschoolsByincreasingthehealthliteracyofstudentsatschooltheselsquocham-pionsrsquocouldtalktotheirfamiliesincludingolderfamilymembersininformalsettingsandthroughsocialmediawiththeirpeersasastrategytoraisethe level of knowledge of COVID-19 trans-mission preventionandtestingTheprogrambecamesopopularthatitwasextendedintomorelocalhighschools and adults accessing the Adult Migrant EnglishProgramTheprogramwassupportedbylocalsettlementservicesprovidedbybothMaxSolutionsandtheRedCrossItwas
17 httpstheconversationcomhow-can-governments-communicate-with-multicultural-australians-about-COVID-19-vaccines-its-not-as-simple-as-having-a-poster-in-their-language-156097
later extendedtoCALDSeniorsthroughtheMulticulturalCommunitiesCouncilIllawarra(MCCI)supportprograms
AkeycomponentoftheprogramwastoprovideparticipantswithlsquoCOVIDWarriorrsquoKitswhichincludedtworeusablemaskshandsanitiserinfographicsaboutCOVID-19symptomsandinfor-mationaboutwheretestingclinicswereavailablelocallyMCCIandRuralAustraliaforRefugeesdonatedreusablemasksforeveryparticipant
AsthelsquoCOVIDWarriorrsquoprogramwasevolvingsowasthenationalvaccinerolloutplanInforma-tionwasthereforeadaptedtomeetthisinfor-mationgapForexampleadultparticipantsandseniors were supported to understand how to accesstheCOVIDvaccinelsquoeligibilitycheckersrsquoandCALD people were shown how to use the NSW HealthwebsiteCOVID-19informationpages18
Decision makingHowpeoplearecurrentlyconsideringtheriskofCOVID-19isinfluencedbyarangeoffactorsincludingratesoftransmissioninthecommunitynumbersofnewcasesreportsinthemediaofrisksandsideeffectsPeopletendtobasetheirassessmentonwhattheyarecurrentlyexperi-encingandthencheckthisagainstwhattheyarehearinginthemediaincludingandespeciallyonsocialmediaandfromfamilyandfriendsMostoftheparticipantsinourstudyspokeclearlyandarticulatelyabouthowtheyweigheduptherisk-benefitofhavingtheCOVID-19vaccineintheir decision making Low case numbers ndash at the timeofconductingtheresearchndashandasensethat Australia was lsquodoing well in safeguarding the communityagainstCOVID-19rsquoweresignificantfactorsinpeoplersquosdecisionnottobevaccinatedortoadoptalsquowaitandseersquoapproachFamilyfriends and social media were reported as having aconsiderableinfluenceondecisionmakingaswerereportsinthemediaofthebloodclottingsideeffectsofAstraZeneca
ThefactthatFacebookwasreportedlythemostpopularsourceofinformationaboutCOVID-19
18httpswwwhealthnswgovauInfectiouscovid-19Pagesdefaultaspx
andtheCOVID-19vaccineforpeopleinthestudyraisesconcernsaboutthepossibledisseminationofmisconceptionsandlsquofakenewsrsquothatmaybespread or compounded via social media Closed social media groups such as WhatsApp and WeChatwithfamilyandfriendsmayalsoleadtopeoplereinforcingtheirpre-existingbiasesThesefactorscoupledwithasensethatAustraliaisfaringwellcomparedtomanycountriesoverseasappear to have resulted in increased vaccine hesi-tancyamongparticipantsofthestudy
Factorsthatwereidentifiedaschangingvaccine-hesitantparticipantsrsquoperceptionswereanincreased risk from COVID-19 and a correspond-ingincreaseinthenumberofinfectionsandonthebenefitsidetheabilitytotraveloverseastovisitfamilyIntherecentresearchfromtheUniversityofNSWcitedaboveSearlearguesthatlsquotheremaybeotherthingsthatweneedtonowstartfocusingonhellipthatwillstarttopromoteandmotivatepeoplesuchasthechancetotravelmorefreelyforexamplersquoThisappearstobeborneoutbyourfocusgroupfindings19
Untilrecentlytherehavebeenverylowcasenumbers and few lockdowns across most of Aus-tralia and NSW The recent outbreak from mid-JuneinGreaterSydneyandintroductionofthehighlyinfectiousDeltavariantinNSWislikelytoimpactonpeoplersquosassessmentsoftherisk-benefitofhavingthevaccineandonewouldassumereducehesitancyrates
GiventheheightenedcommunityanxietycausedbythisrecentCOVID-19outbreaktheproductionofshortsharpandtargetedmessagingtoCALDgroupsincommunitylanguagesthatisaccessibleandmotivationalfeaturescommunityleadershigh-profilecelebritiesandsportsstarsfromCALDbackgroundsandisdirectedatastate-wideandlocal level would appear to be more urgent than everItisclearthatformessagingtobeeffectiveandreachitsintendedaudiencedistributionchannelsshouldincludeFacebookWhatsAppandothersocialmediaplatformsaswellastrustedsourcessuchasmulticulturalhealthworkersmulticulturalservicesandthroughGPsandMedical Centres If mainstream COVID-19 vaccine
19 Op cit
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
32 33
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3534
awareness campaigns are produced in Australia suchashavebeenproducedinNewZealandtheUnitedKingdomandNorthAmericatheyshouldincludehighprofilewell-knowncommunityfig-uresandsportingstarsfromCALDbackgroundsandincludestrategiesspecificallytargetingCALDcommunitiesincludinggroupsidentifiedaspar-ticularlyhigh-risk
It is also important that informationonvaccinesistranslatedintolanguagesfromnewerandemergingcommunitiesOthersuggestionsaroundreachingthesecommunitiesincludeface-to-facemeetingsorganisedbycrossagencypartnershipsandpeer-ledstrategiessuchas mobilising community champions and influenc-ers Messaging needs to be inclusive and framed around the collective values held by commu-n5
It is clear that reinforcing the benefits of being vaccinated at this time rather than dwelling on the risks is more likely to generate behavioural
changeandapositivevaccineresponsefrombothCALDcommunitiesandthegeneralpopulationAppropriately-designedandtargetedCOVID-19vaccinehealthinformationthatiseasytoreadinanylanguagecanbeconveyedbycommunityleadersandcommunitynetworksandpromotesthepositivebenefitsofgettingvaccinatedwouldbevaluableatthistimeBuildingontheworkofpeerchampionssuchastheCOVIDWarriorprogramisalsoasuccessfulmodeltoincreasingCOVID-19vaccinehealthliteracyandinformed decision making
Mostimportantlypositivelymotivatingculturallyandlinguisticallydiversecommunitymemberstolsquogetthejabrsquoespeciallythosewhoareadoptingalsquowaitandseersquoapproachorarevaccinehesitantwould lead to greater vaccine uptake among culturallyandlinguisticallydiversecommunitiesandthereforethecommunityasawhole
Inner West Multicultural Network Addison Road Community Centre DateWednesday12May
A focus group session of members of the Inner WestMulticulturalNetworkpluscustomersoftheFoodPantryatAddisonRoadwasheldattheAddisonRoadCommunityCentreinMarrickvilleon12Mayat200pmThesessionwaspartoftheregularmeetingoftheInnerWestMulticul-turalNetworkTheconsultationinvolvedabout26peopleandwasconductedbyRosannaBarbero
Thegroupbrainstormedresponsestoquestionsaroundvaccinehesitancyinmulticulturalcom-munitiesandmoreeffectivemessagingTheseresponseshavebeenincorporatedinthefindingsof the report
Griffith Women on Fire Focus Group Griffith Community Centre DateFriday14May
This small focus group of women was held at GriffithCommunityCentreonMay14at11amMargCouchSeniorProjectOfficerRegionalDevelopmentAustralia(RDA)-RiverinaandJoanneFitzpatrickSettlementEngagementandTransitionSupport Worker from Centacare Southwest NSW werethekeylinksandnetworkcontactsfortheGriffithcommunityTheWomenonFire(WOF)group was established as part of the Red Cross RuralFireServiceprogramlsquoManyCulturesOneCommunityrsquoInitiallyitwasestablishedtoeducatewomenonemergencypreparednessandtoen-courage NSW Rural Fire Service (RFS) volunteering andnowhastransformedintoacommunityac-tionsupportgroupTheGriffithSoroptimistInter-nationalnowauspicetheirfinancesandsupporttheWOFgroupactivitiesThefocusgroupwasfacilitatedbyCamillaCouchandlocalcommunityvolunteersledbytheGriffithSoroptimistClub
The women in the group were from Pakistan and IndonesiaThegroupweremainlyyoungmotherswithyoungchildrenandtheprogramhadchild-minding arrangements The language level of the womenwaslowandmostwerestudyingESOLat
ATTACHMENTS
ATTACHMENT 1 A Description of the Focus Groups
TAFEThedeliveryoftheinformationwaslimiteddue to language levels and the lack of bilingual interpretersEachparticipantworkedoneononewithavolunteertoslowlyfillinthesurveyandonewomantookthesurveyhometodiscusswithherhusbandThisgroupexperiencehighlightedthe lack of bilingual workers and services in some rural areas
Arabic speaking group Syd West Multicultural Services Mount Druitt Community worker Zaid Naoum Generalist Caseworker SydWest Multicultural Services DateMonday24May
ThefocusgroupfromSydWestMulticulturalSer-viceswasconductedonMonday24May2021atSydWestMulticulturalServicesMountDruittat300pmItwasfacilitatedbyPatriciaMcCormickandsupportedbyZaidNaoumGeneralistCase-workerSydWestMulticulturalServices
Therewere10womenandmenfromSyriainthegroupThegroupweremostlymaturetoolderparticipantsMostparticipantsrequiredassistancewithEnglishandthecaseworkerZaidNaoumhadtranslatedthesurveyintoArabicpriorto the focus group Zaid also translated during the focus group
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Canterbury City Community Centre (4Cs) group The Cottage Lakemba DateTuesday25May
ThefocusgroupfromCanterburyCityCommunityCentre(4Cs)wasconductedonTuesday25MayattheCottageat28CroydonStreetLakembaat10amItwasfacilitatedbyRobinMilesandsup-portedbyRomanaWaseemCommunityWorkerfrom 4Cs
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
34
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3736
The group was comprised of 14 women from PakistanIndiaandSriLankaThewomenrangedinagefrom23to65MostwerefluentEnglishspeakershoweveronewomanrequiredtransla-tionintoUrdufromoneoftheotherwomeninthegrouptoanswerthequestionsdirectly
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
NSW Chaldean League group Community worker Randa Goriya DateTuesday25May
ThefocusgroupfromNSWChaldeanLeagueMountDruittwasconductedonTuesday25May2021 at 1000am at the NSW Chaldean League premisesItwasfacilitatedbyPatriciaMcCormickandsupportedbyRandaGoriyaacommunityworker for the NSW Chaldean League in Mount DruittRandatranslatedtheintroductionandpromptsforthediscussionandhelpedthepartic-ipantstocompletethesurveyMostofthegrouprequiredhelptodothesurvey
ThegroupoftwelveparticipantswereallChaldeanandwerematuretoolderinageTheywereamixed-gendergroup
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Arabic speaking group Red Cross premises Wollongong DateTuesday25May
ThefocusgrouptookplaceonTuesday25Mayat 3pm at the Red Cross premises at Wollongong Therewere22womenandmenparticipatinginthegroupThefocusgroupwasfacilitatedbyCamilla Couch with support from Khalid Zainu-labdeenBilingualSupportWorkerHumanitarianSettlementProgram(ACTampNSW)
There were diverse ages in the group ranging fromyoungpeopletoolderagedMostofthegroupwereyoungerrecently-arrivedrefugeesfrom diverse backgrounds There was also a small-eroldercohortofparticipantswithhigherliteracylevelsandstrongercommunityengagementwith the local services in the area Camilla Couch facilitated the focus group which was conducted inArabicandEnglishwiththeArabictranslationprovidedbyKhalidZainulabdeen
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Work Opportunities for Women group Mt Druitt TAFE DateWednesday26May
TheWorkOpportunitiesforWomen(WOW)focusgroupwasheldonWednesdayMay261100ndash 100pmatMtDruittTAFEItwasfacilitatedbyCamilla Couch and built on the knowledge gainedintheprevioussessiononcriticalandanalyticalthinkingTheWOWgroupisaTAFECertificatelevel course
There were 14 women from diverse cultural backgroundsinthegroupThegroupweremainlyMuslimwomenwithschoolagechildrenandsome were mature aged Due to the learning fo-custhegroupwasfacilitatedasaclasswithguid-eddiscussionontheissuesandcarefulanalysisofthequestionsNotranslationwasneededduetotheeducationalcontextThestudentswereadeptatusingITandcompletedallthesurveysonline
STARTTS Tamil group Toongabbie Community Centre Community worker Sivaharani (Harani) Mayuran DateThursday27May
Thefocusgroupconsistedof18femalepartic-ipantswhowereyoungertomatureagedThefocus group was held at 1000am at Toongabbie CommunityCentreinTargoRdToongabbie
ThefocusgroupwasfacilitatedbyPatriciaMc-CormickandsupportedbyacommunityworkerSivaharani(Harani)MayuranfromtheSTARTTSTamil Group
ThegrouphadmixedlevelsofspokenandwrittenEnglishTheintroductionanddiscussionpromptsweretranslatedbythecommunityworkerSivaha-rani(Harani)Mayuranandsheandthemorepro-ficientstudentssupportedthosewithlowliteracytoanswerthesurveyquestions
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Spanish Speakers Seniors group SydWest Multicultural Services Blacktown DateTuesday1June
TheFocusGrouptookplaceonTuesday1Juneat1100amattheBlacktownShowgroundsandconsistedof16participants(15womenandoneman)AllparticipantswerebornincountriesinSouthAmericaTheirEnglish-fluencylevelsvariedand one of the members of the group translated thesurveyquestionsanddiscussionintoSpanish
ThegrouphadbeenmeetingforseveralyearsThegroupwasfacilitatedbyLindyCassidyandwassupportedbySreeVithyaHarilingamDayRespiteampSocialSupportTeamLeaderatSydWestMulticulturalServicesBlacktownThegroupwerematureagedtoolderparticipants
Thegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyform There was a more focused discussion on somekeyquestionsaftersurveycompletionThetranslatorassistedconsiderablyinthisprocess
Italian Speakers group Warrawong Community Centre DateMonday7June
The focus group of Italian speakers was held on Monday7Juneat1015amattheWarrawongCommunityCentreItwasfacilitatedbyCamillaCouchandsupportedbyJohnPaulTroianiand
SofiaLemafromIllawarraShoalhavenLHDMulti-cultural Health
There were 15 women in the group The group weremostlymaturetoolderparticipantsandwasconductedinItalianandEnglishwithtranslationprovidedbyJohnPaulThisgroupmeetsregularlyandissupportedbyanumberofservicesintheareaespeciallymulticulturalhealth
The group had a general facilitated discussion aboutthequestionsinthesurveyDuetolittleornoliteracytheindividualsurveyresponseswerethencollectedintooneresponseThesesurveyresponses have been included in the general surveyresponses
Mothers Group SydWest Multicultural Services Blacktown DateThursday10June
ThefocusgrouptookplaceonThursday10Juneat1030amandconsistedof14youngwomen13 of whom had a CALD background The focus groupweremainlymothersfromasupportgroupatSydWestMulticulturalServicesinBlacktown
EightofthewomenwereborninIndiatwofromPakistantwofromSriLankaonefromHausaGhana and one was born in Australia (the Austral-ianbornyoungwomanwasasocialworkstudenthelpingwiththegroup)LindyCassidyfacilitatedthe group with support from Wilma Garguath a projectofficerfromSydWestMulticultural Services
The group varied in age One was between 18-24 yearsoldSevenwereagedbetween25-34yearsSixwereagedbetween35=44yearsGiventheirage and circumstances most of the group did not consider themselves eligible at this stage for vac-cinationThiswasanimportantdifferencefromotherfocusgroupsinthattheemphasiswasmoreonwhattheywoulddooncetheybecameeligible
Participantsdidnotrequireassistancewithspo-kenEnglishThegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyformTherewasamorefocuseddiscussiononsomekeyquestions
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3938
ATTACHMENT 2 COVID-19 Vaccine Information in multiple languagesThefollowingsitesappsprovidetranslatedinformationaboutCOVID-19vaccines
Type of information KeyinformationongettingvaccinatedinNew South Wales and on the vaccines available The websiteusesanautomaticservicetotranslate thecontentintodifferentlanguages
Source of information NSW Government website
Link httpswwwnswgovauCOVID-19health-and-wellbeingCOVID-19-vaccina-tion-nswgetting-vaccinated
Type of information COVID-19ResourcessectionontheServiceNSWapp The app has a link to NSW Government websiteinformationonldquoGettingaCOVID-19vaccinationrdquo(seeabove)ItalsoincludesalinktoCOVID-19vaccinationresourcesinotherlan-guages available from the Department of Health
Source of information Service NSW NSW Government
Link Service NSW App
Type of information ArangeoftranslatedresourcesonCOVID-19bytitleincludingafactsheetonCOVID-19VaccineAstraZeneca(ChAdOx1-S)
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCOV-ID-19Pagestranslatedresources-by-titleaspx
Type of information ADigitalCOVID-19resourcelibrarywithtranslated materials
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiouscov-id-19Pagesdigital-resourcesaspx
Type of information AMultilingualCommunityToolkitontheCOVID-19vaccinationprogramtoassist communityworkersprovideseasytoreadresourcesvideosandlinkstokeyservicesandresources
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCovid-19DocumentsNSW-COVID-19-vaccina-tion-program-presentation-20210527pdf
Type of information TheNSWMulticulturalHealthCommunicationServiceoffershealthresourcesandinformationin a wide range of languages It has translated resources on COVID-19 and links to translated resourcesonCOVID-19vaccination
Source of information MulticulturalHealthCommunicationServiceisa New South Wales-wide health service hosted bySouth-easternSydneyLocalHealthDistrict(SESLHD)
Link httpswwwmhcshealthnswgovau
Type of information COVID-19vaccineinformationaddressingkeyquestionsaboutCOVID-19vaccinationandincludesvideosposterstilesfactsheetsandaudio material Translated into 63 languages
Source of information Department of Health Australian Government website
Link httpswwwhealthgovauinitiatives-and-pro-gramsCOVID-19-vaccinesCOVID-19-vaccine-in-formation-in-your-language
Type of information ThisinformationaddressessomecommonmisinformationaboutCOVID-19Translatedintomultiplelanguages
Source of information DepartmentofHomeAffairs Australian Government website
Link httpscovid19inlanguagehomeaffairsgovaumisinformation-and-truths-about-coronavirus
Type of information Australianandinternationalnewsand informationaboutCOVID-19andCOVID-19 vaccinesisavailableontheSBSCoronavirusPortal in more than 60 languages
Source of information SBSwebsite
Link httpswwwsbscomaulanguagecoronavirus
Type of information InformationprovidedaboutCOVID-19vaccinerolloutandsafetyinlanguagesotherthan English
Source of information Department of Health and Human Services Victorian Government
Link httpswwwcoronavirusvicgovautranslat-ed-information-about-COVID-19-vaccines
Type of information HealthTranslationsprovidestranslatedmateri-alsonhealthandwellbeingInformationaboutCOVID-19isregularlyupdatedincludessomeinformationonvaccinationandisavailableinover60communitylanguages
Source of information Victoriangovernmentinitiative
Link httpswwwhealthtranslationsvicgovaubhcv2bhchtnsfPresentEnglishResource-AllOpenampx=amps=Coronavirus
Type of information A one-stop shop for translated materials in multiplelanguagesonCOVID-19
Source of information Ethnolink Language Services
Link httpswwwethnolinkcomauCOVID-19-coro-navirus-translated-resources
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
40
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3130
groupsFortheparticipantsintheresearchtheirattitudetothevaccineappearedtobeinflu-encedbyanumberoffactorstheirownlevelsofhealthandpre-existinghealthconditionsandthoseoftheirfamilymembersandtheimpactofreceiving COVID-19-related news from overseas particularlyfrompeoplersquoscountryoforiginAnexampleofthiscanbeseenintheItaliangroupin Wollongong where people had received news fromoverseasearlyinthepandemicwhichscaredthemThisexperiencelsquofromhomersquohadinflu-enced most of the women in the Wollongong focus group (n=15) to choose to get vaccinated The interviewee from the Illawarra Shoalhaven Local Health District also spoke about the heightenedconcernthattheywitnessedinthelocalItaliancommunityintheearlystagesofthepandemicOtherpeoplewantedtolsquostayhealthyrsquoandtolsquoprotectthehealthofothersrsquoandformanytherewasasensethattheywantedtolsquogetbacktosomedegreeofnormalcyrsquoandtobeabletolsquotraveloverseastovisitrelativesrsquo
Vaccine hesitancyOfthe42inthisstudywhoappearedundecidedornotplanningtohavethevaccinemanywereinfactadoptingalsquowaitandseersquoapproachbeforemakingtheirfinaldecisionMostparticipantswereinterestedtohearmoreinformationaboutthevaccinesandwereopenedtogettingthevaccinebutdidhaveconcernsaboutthesafetyofthevaccinesespeciallyinregardtoAstraZeneca
The issue of blood clots has led to considerable fearandhesitancyinthecommunityandthisfearandhesitancywasreflectedinourstudyEssentialResearchrsquossurvey(April2021)reportedoneinsixpeople(16)indicatedtheywillnevergetvaccinatedagainstCOVID-19upfrom12thepreviousmonthwhile42saidtheywillgetvaccinatedbutnotrightawayTheproportionofpeople who would be willing to get vaccinated as soonaspossibleorarealreadyvaccinatedalsodeclineddownfrom47to4213Thissurveywas conducted prior to the most recent outbreak inNSWinvolvingthehighlyinfectiousDeltastrain
Therisk-benefitofhavingthevaccineneedstobecarefullyweighedbyeachindividualideallyinconsultationwiththeirdoctoranddependingon
The Hub has lsquobeen working in partnership with keystakeholdergroupstoguidecommunicationstomeetthehealthliteracyandculturallyandlinguisticallydiverse(CALD)needsofitspop-ulationStructuredworkinggroupshavebeencreatedtoprioritisecommunicationstovulner-ableyouthCALDgroupstheelderlyitinerateworkersasylumseekersandrefugeesTheaimsaretotestmessagingandbuildtrustwithprioritypopulationstoensureeffectivecommunicationoftheneedtosustainphysicaldistancingmeas-uresintheabsenceofavaccineSimilareffortsarenowneedednationallyandshouldstartatthetimeofdiseaseoutbreaksinthefuturealongsideplannedmassmediaandhealthcommunicationcampaignsrsquo
InthearticlebyDoddetaltheyreinforcetheimportanceofusingcommunicationformatswhich are lsquosuitable for people with low health literacyandeducationandwhichareappropriateforculturallyandlinguisticallydiversegroupsandIndigenouspopulationsrsquoThearticlearguesthatitisimportanttolookatmotivationsandconcernsabout vaccines when shaping messaging It also pointsoutthatprimarycaredoctorsareatrust-ed source and as such should be supported in deliveringinformationaboutthevaccinesandad-dressingcommunityconcernsThearticlestateslsquoWeneedtounderstandandaddresscitizenrsquosconcernsthatcanpreventoptimaluptakebuildmotivationsintomessagingandprioritisepublictrustbyinformingandinvolvingthecommunityintheprocessSupportinghealth-careprofession-als in their role as educators will ensure people haveadequateandaccessibleinformationfromatrustedsourcetooptimisevaccineuptakeandultimatelyreducecommunitytransmissionofCOVID-19rsquo15
RecentresearchbyAssociateProfessorHollySeale16withUNSWMedicinersquosSchoolofPublicHealthandDeputyChairfortheCollaborationonSocialScienceandImmunisationfoundthereisaneedtolsquodecentralisersquocommunicationsbytapping
translatedmaterialsandinformationaboutthevaccines to be tailored to the needs of people in these newly-emergingcommunitygroups
It was reported that in Wollongong there can sometimesbefourgenerationsoffamilymem-bersfromnewly-arrivedrefugeegroupslivingintheonehouseMostofthesefamilymembersgenerallyhavelimitedEnglishlanguageliteracywhichincreasestheirriskofnotreceivingkeyhealthmessagesandthereforeincreasingthepotentialimpactofCOVID-19-inparticulartheDeltastrainwhichhasprovenhighlyinfectiousamongst household members
Vaccine uptakeNotdissimilartothewidercommunitymorepeopleinourstudywereplanningtohavethevaccinethannotandanumberhadalreadybeenvaccinatedInarecentLancetarticle(February2021)ConcernsandmotivationsaboutCOVID-19vaccinationfindingsfromtwosurveysfromanAustralianlongitudinalstudyconductedinJuneandJuly2020includedthatlsquothetopthreerea-sons for agreeing to vaccinate were lsquoto protect themselvesandothersrsquohelliplsquobeliefinvaccinationandsciencersquohellipandlsquotohelpstopthevirusspreadrsquoEven among those willing to vaccinate there was somehesitancyaboutthesafetyofthevaccineTheLancetarticlenotedthatlsquowillingnesstovaccinatedifferedbybothageandeducationrsquoForthosewhowereindifferentorsaidtheywouldnot get the vaccine the top reasons across the twosurveyswerelsquoconcernaboutthesafetyofthevaccineinitsdevelopmentrsquoandlsquopotentialsideeffectsrsquo12
Olderpeopleinourstudywhocomprised23of the total sample (n=199) were the group most likelytosaythattheywantedtogetthevaccine85ofthoseover65saidtheywouldhaveorhadalreadyhadthevaccineVaccinepredispo-sitionwashoweveralsostrongacrossotherage
12RHDoddKPicklesBNickelECvejicJAyreCBatcupCBonnerTCoppSCornellTDakinJIsautierKJMcCafferyConcerns and motivations about COVID-19 vaccination SydneyHealthLiteracyLabSydneySchoolofPublicHealthFacultyofMedicineandHealthUniversityofSydneypublishedintheLancetFebruary2021p162wwwthelancet cominfectionVol21February2021
theircircumstancesHoweverthesourcesofin-formationthatpeoplemostrelyuponortrustarecriticaltothedisseminationofaccurateandclearmessaging to dispel the fear surrounding events suchasbloodclottingandthemisconceptionsraisedinthefocusgroupsWithsomanypartici-pantsinthisstudygettingtheirinformationfromFacebookandothersocialmediasitesitisvitalthat these channels are used to promote simple positivemessagesandforanyfuturecommunityawareness campaigns
Effective communicationConfusionandmisconceptionsaboutthevac-cinersquosefficacyavailabilityandsafetywereallis-sues that were raised in the focus groups Finding waystoeffectivelycommunicatewithpeoplewithlowerEnglishlanguageliteracyandhealthliteracyisanimportantwaytoaddresstheconfusionandmisconceptionsaboutthevaccineashasbeen discussed in a number of recent Australian studies
Astudy14byMcCafferyetal(2020)concludedthattherearelsquoimportantdisparitiesinCOVID-19-relatedknowledgeattitudesandbehavioursaccordingtopeoplersquoshealthliteracyandlanguagersquoOneofthefindingswasthatlsquopeoplewithlowerhealthliteracywerealsomorelikelyto endorse misinformed beliefs about COVID-19 andvaccinations(ingeneral)thanthosewithadequatehealthliteracyThesamepatternofresults was observed among people who primar-ilyspeakalanguageotherthanEnglishathomersquoTheMcCafferystudyhighlightstheimportanceof tailoring health messages to those with lower healthliteracyandculturallyandlinguisticallydiversecommunitiesItpointsoutthatthereareexamplesofeffectivemanagementofdiversecommunityneedsthatusetailoredhealthmes-sagesandcitestheWesternSydneyLocalHealthDistrictHealthLiteracyHub
13TheEssentialReport-anonlinesurveyconductedbyEssentialResearchcompletedby1090people between 21ndash26 April14McCafferyKJDoddRHCvejicEAyreJBatcupCIsautierJMJCoppTBonnerCPicklesKNickelBDakinTCornellSWolf MS Health literacy and disparities in COVID-19ndashrelated knowledge attitudes beliefs and behaviours in Australia PublicHealthResPract202030(4)e30342012December2020
15 Op cit16 httpssphmedunsweduausitesdefaultfilessphcmNewsEnhancing-supporting-COVID-19-vaccination-programpdf
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
30 31
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3332
intodifferentnetworkingspacessuchaswork-placeslocalgymsmothersrsquogroupsandseniorsrsquoclubswithafocusonallagegroupsregardlessofcurrenteligibilityAccordingtoSealethechal-lengeislsquoensuringemerginginformationisadapt-edfortheintendedaudiencersquoShehasalsosaidlsquoThatrsquoswhatIrsquomalittlebitconcernedaboutatthemomenttherersquosalotofresourcesongov-ernmentwebsitesbutthesetermsaroundbloodclottingareverytechnicalWeactuallyneedtomake sure that we are breaking them down in a waythatwillmakeitmeaningfultopeopleThatrsquosnotjustabouttranslatingitrsquosaboutbeingcon-sciousofpeoplersquoshealthliteracyneedstooSomaybegettingsomemorevisualsintomaterialstotryandsupportthatrsquo17
Thereareanumberofmulticulturalhealthresourcesthatusecommunitylanguagetransla-tionsplainEnglishandvideosfromCALDcommu-nityleaderswhichcanbedownloadedandusedbyservicesandindividualsHowevermanyofthewrittenresourcesstillrelyontechnicalandscien-tifictermsthatrequireareasonablyhighlevelofEnglishlanguageliteracyorhighlevelsofliteracyin the translated language to comprehend Host websites can also be hard to navigate making itdifficulttolocateresourcesfromsimplewebsearchesAsummaryofsomeoftheavailableresourcescanbefoundatAttachment2
MulticulturalHealthUnitsinLocalHealthDis-trictshavestaffwhocanworkwithpeoplefromculturallyandlinguisticallydiversecommunitiesatthelocallevelandtranslateandcontextualisethese materials to the needs of the end user These teams respond to local needs and popu-lationdemographicsandareexpertsineffectivehealthliteracyandhealthcommunicationwiththeirlocalcommunitiesTheyworkcloselywithcommunityandvulnerablegroupstobuildhealthliteracyandimprovedhealthoutcomesintheircommunities
Case Study ndash Be a COVID Warrior ndash Responding to COVID-19 in Multicultural Communities InWollongongtheIllawarraShoalhavenLocalHealthDistrict(ISLHD)MulticulturalHealthSer-viceco-designedacommunityengagementandeducationprogramcalledlsquoBeaCOVIDWarriorrsquowhich commenced in 2020 in response to the pandemic This program was designed to respond tothelowlevelsofhealthliteracyaroundCOVID-19potentialexposuretothevirusandaddressfearandstigmainthelocalCALDcommunitiesThelsquoCOVIDWarriorrsquoprogramreachedaround880peopleranginginagefrom14to85years65ofCOVIDWarriorparticipantswerefemaleand35weremaleCOVIDWarriorparticipantsrepresented 21 language groups The outcomes of the program included increased levels of confidenceinapplyinginfectioncontrolmeasuresincreasedliteracyandhealthliteracyandawarenessofhowCOVID-19istransmittedUltimatelyanimprovedawarenessinapplyingCOVIDsafemeasures was also reported
InApril2020theservicecommencedwelfarechecksviaphoneonafortnightlybasistosup-portsocially-isolatedmulticulturalseniorswhoboretheemotionalstressofsocialisolationFrom these calls the ISLHD heard the needs and concernsofseniorsinthecommunityInadditionourexperiencewithCALDcommunitieshighlightedtheimportanceofyoungpeopleasconduitsofessentialinformationtoadultsincommunityandfamilygroupsduetoEnglishlanguageaccessandeducation
InresponsetheISLHDinitiatedthelsquoCOVIDWarri-orrsquoprogramusingbi-culturalhighschoolstudentsthroughthelocalhighschoolsByincreasingthehealthliteracyofstudentsatschooltheselsquocham-pionsrsquocouldtalktotheirfamiliesincludingolderfamilymembersininformalsettingsandthroughsocialmediawiththeirpeersasastrategytoraisethe level of knowledge of COVID-19 trans-mission preventionandtestingTheprogrambecamesopopularthatitwasextendedintomorelocalhighschools and adults accessing the Adult Migrant EnglishProgramTheprogramwassupportedbylocalsettlementservicesprovidedbybothMaxSolutionsandtheRedCrossItwas
17 httpstheconversationcomhow-can-governments-communicate-with-multicultural-australians-about-COVID-19-vaccines-its-not-as-simple-as-having-a-poster-in-their-language-156097
later extendedtoCALDSeniorsthroughtheMulticulturalCommunitiesCouncilIllawarra(MCCI)supportprograms
AkeycomponentoftheprogramwastoprovideparticipantswithlsquoCOVIDWarriorrsquoKitswhichincludedtworeusablemaskshandsanitiserinfographicsaboutCOVID-19symptomsandinfor-mationaboutwheretestingclinicswereavailablelocallyMCCIandRuralAustraliaforRefugeesdonatedreusablemasksforeveryparticipant
AsthelsquoCOVIDWarriorrsquoprogramwasevolvingsowasthenationalvaccinerolloutplanInforma-tionwasthereforeadaptedtomeetthisinfor-mationgapForexampleadultparticipantsandseniors were supported to understand how to accesstheCOVIDvaccinelsquoeligibilitycheckersrsquoandCALD people were shown how to use the NSW HealthwebsiteCOVID-19informationpages18
Decision makingHowpeoplearecurrentlyconsideringtheriskofCOVID-19isinfluencedbyarangeoffactorsincludingratesoftransmissioninthecommunitynumbersofnewcasesreportsinthemediaofrisksandsideeffectsPeopletendtobasetheirassessmentonwhattheyarecurrentlyexperi-encingandthencheckthisagainstwhattheyarehearinginthemediaincludingandespeciallyonsocialmediaandfromfamilyandfriendsMostoftheparticipantsinourstudyspokeclearlyandarticulatelyabouthowtheyweigheduptherisk-benefitofhavingtheCOVID-19vaccineintheir decision making Low case numbers ndash at the timeofconductingtheresearchndashandasensethat Australia was lsquodoing well in safeguarding the communityagainstCOVID-19rsquoweresignificantfactorsinpeoplersquosdecisionnottobevaccinatedortoadoptalsquowaitandseersquoapproachFamilyfriends and social media were reported as having aconsiderableinfluenceondecisionmakingaswerereportsinthemediaofthebloodclottingsideeffectsofAstraZeneca
ThefactthatFacebookwasreportedlythemostpopularsourceofinformationaboutCOVID-19
18httpswwwhealthnswgovauInfectiouscovid-19Pagesdefaultaspx
andtheCOVID-19vaccineforpeopleinthestudyraisesconcernsaboutthepossibledisseminationofmisconceptionsandlsquofakenewsrsquothatmaybespread or compounded via social media Closed social media groups such as WhatsApp and WeChatwithfamilyandfriendsmayalsoleadtopeoplereinforcingtheirpre-existingbiasesThesefactorscoupledwithasensethatAustraliaisfaringwellcomparedtomanycountriesoverseasappear to have resulted in increased vaccine hesi-tancyamongparticipantsofthestudy
Factorsthatwereidentifiedaschangingvaccine-hesitantparticipantsrsquoperceptionswereanincreased risk from COVID-19 and a correspond-ingincreaseinthenumberofinfectionsandonthebenefitsidetheabilitytotraveloverseastovisitfamilyIntherecentresearchfromtheUniversityofNSWcitedaboveSearlearguesthatlsquotheremaybeotherthingsthatweneedtonowstartfocusingonhellipthatwillstarttopromoteandmotivatepeoplesuchasthechancetotravelmorefreelyforexamplersquoThisappearstobeborneoutbyourfocusgroupfindings19
Untilrecentlytherehavebeenverylowcasenumbers and few lockdowns across most of Aus-tralia and NSW The recent outbreak from mid-JuneinGreaterSydneyandintroductionofthehighlyinfectiousDeltavariantinNSWislikelytoimpactonpeoplersquosassessmentsoftherisk-benefitofhavingthevaccineandonewouldassumereducehesitancyrates
GiventheheightenedcommunityanxietycausedbythisrecentCOVID-19outbreaktheproductionofshortsharpandtargetedmessagingtoCALDgroupsincommunitylanguagesthatisaccessibleandmotivationalfeaturescommunityleadershigh-profilecelebritiesandsportsstarsfromCALDbackgroundsandisdirectedatastate-wideandlocal level would appear to be more urgent than everItisclearthatformessagingtobeeffectiveandreachitsintendedaudiencedistributionchannelsshouldincludeFacebookWhatsAppandothersocialmediaplatformsaswellastrustedsourcessuchasmulticulturalhealthworkersmulticulturalservicesandthroughGPsandMedical Centres If mainstream COVID-19 vaccine
19 Op cit
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
32 33
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3534
awareness campaigns are produced in Australia suchashavebeenproducedinNewZealandtheUnitedKingdomandNorthAmericatheyshouldincludehighprofilewell-knowncommunityfig-uresandsportingstarsfromCALDbackgroundsandincludestrategiesspecificallytargetingCALDcommunitiesincludinggroupsidentifiedaspar-ticularlyhigh-risk
It is also important that informationonvaccinesistranslatedintolanguagesfromnewerandemergingcommunitiesOthersuggestionsaroundreachingthesecommunitiesincludeface-to-facemeetingsorganisedbycrossagencypartnershipsandpeer-ledstrategiessuchas mobilising community champions and influenc-ers Messaging needs to be inclusive and framed around the collective values held by commu-n5
It is clear that reinforcing the benefits of being vaccinated at this time rather than dwelling on the risks is more likely to generate behavioural
changeandapositivevaccineresponsefrombothCALDcommunitiesandthegeneralpopulationAppropriately-designedandtargetedCOVID-19vaccinehealthinformationthatiseasytoreadinanylanguagecanbeconveyedbycommunityleadersandcommunitynetworksandpromotesthepositivebenefitsofgettingvaccinatedwouldbevaluableatthistimeBuildingontheworkofpeerchampionssuchastheCOVIDWarriorprogramisalsoasuccessfulmodeltoincreasingCOVID-19vaccinehealthliteracyandinformed decision making
Mostimportantlypositivelymotivatingculturallyandlinguisticallydiversecommunitymemberstolsquogetthejabrsquoespeciallythosewhoareadoptingalsquowaitandseersquoapproachorarevaccinehesitantwould lead to greater vaccine uptake among culturallyandlinguisticallydiversecommunitiesandthereforethecommunityasawhole
Inner West Multicultural Network Addison Road Community Centre DateWednesday12May
A focus group session of members of the Inner WestMulticulturalNetworkpluscustomersoftheFoodPantryatAddisonRoadwasheldattheAddisonRoadCommunityCentreinMarrickvilleon12Mayat200pmThesessionwaspartoftheregularmeetingoftheInnerWestMulticul-turalNetworkTheconsultationinvolvedabout26peopleandwasconductedbyRosannaBarbero
Thegroupbrainstormedresponsestoquestionsaroundvaccinehesitancyinmulticulturalcom-munitiesandmoreeffectivemessagingTheseresponseshavebeenincorporatedinthefindingsof the report
Griffith Women on Fire Focus Group Griffith Community Centre DateFriday14May
This small focus group of women was held at GriffithCommunityCentreonMay14at11amMargCouchSeniorProjectOfficerRegionalDevelopmentAustralia(RDA)-RiverinaandJoanneFitzpatrickSettlementEngagementandTransitionSupport Worker from Centacare Southwest NSW werethekeylinksandnetworkcontactsfortheGriffithcommunityTheWomenonFire(WOF)group was established as part of the Red Cross RuralFireServiceprogramlsquoManyCulturesOneCommunityrsquoInitiallyitwasestablishedtoeducatewomenonemergencypreparednessandtoen-courage NSW Rural Fire Service (RFS) volunteering andnowhastransformedintoacommunityac-tionsupportgroupTheGriffithSoroptimistInter-nationalnowauspicetheirfinancesandsupporttheWOFgroupactivitiesThefocusgroupwasfacilitatedbyCamillaCouchandlocalcommunityvolunteersledbytheGriffithSoroptimistClub
The women in the group were from Pakistan and IndonesiaThegroupweremainlyyoungmotherswithyoungchildrenandtheprogramhadchild-minding arrangements The language level of the womenwaslowandmostwerestudyingESOLat
ATTACHMENTS
ATTACHMENT 1 A Description of the Focus Groups
TAFEThedeliveryoftheinformationwaslimiteddue to language levels and the lack of bilingual interpretersEachparticipantworkedoneononewithavolunteertoslowlyfillinthesurveyandonewomantookthesurveyhometodiscusswithherhusbandThisgroupexperiencehighlightedthe lack of bilingual workers and services in some rural areas
Arabic speaking group Syd West Multicultural Services Mount Druitt Community worker Zaid Naoum Generalist Caseworker SydWest Multicultural Services DateMonday24May
ThefocusgroupfromSydWestMulticulturalSer-viceswasconductedonMonday24May2021atSydWestMulticulturalServicesMountDruittat300pmItwasfacilitatedbyPatriciaMcCormickandsupportedbyZaidNaoumGeneralistCase-workerSydWestMulticulturalServices
Therewere10womenandmenfromSyriainthegroupThegroupweremostlymaturetoolderparticipantsMostparticipantsrequiredassistancewithEnglishandthecaseworkerZaidNaoumhadtranslatedthesurveyintoArabicpriorto the focus group Zaid also translated during the focus group
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Canterbury City Community Centre (4Cs) group The Cottage Lakemba DateTuesday25May
ThefocusgroupfromCanterburyCityCommunityCentre(4Cs)wasconductedonTuesday25MayattheCottageat28CroydonStreetLakembaat10amItwasfacilitatedbyRobinMilesandsup-portedbyRomanaWaseemCommunityWorkerfrom 4Cs
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
34
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3736
The group was comprised of 14 women from PakistanIndiaandSriLankaThewomenrangedinagefrom23to65MostwerefluentEnglishspeakershoweveronewomanrequiredtransla-tionintoUrdufromoneoftheotherwomeninthegrouptoanswerthequestionsdirectly
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
NSW Chaldean League group Community worker Randa Goriya DateTuesday25May
ThefocusgroupfromNSWChaldeanLeagueMountDruittwasconductedonTuesday25May2021 at 1000am at the NSW Chaldean League premisesItwasfacilitatedbyPatriciaMcCormickandsupportedbyRandaGoriyaacommunityworker for the NSW Chaldean League in Mount DruittRandatranslatedtheintroductionandpromptsforthediscussionandhelpedthepartic-ipantstocompletethesurveyMostofthegrouprequiredhelptodothesurvey
ThegroupoftwelveparticipantswereallChaldeanandwerematuretoolderinageTheywereamixed-gendergroup
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Arabic speaking group Red Cross premises Wollongong DateTuesday25May
ThefocusgrouptookplaceonTuesday25Mayat 3pm at the Red Cross premises at Wollongong Therewere22womenandmenparticipatinginthegroupThefocusgroupwasfacilitatedbyCamilla Couch with support from Khalid Zainu-labdeenBilingualSupportWorkerHumanitarianSettlementProgram(ACTampNSW)
There were diverse ages in the group ranging fromyoungpeopletoolderagedMostofthegroupwereyoungerrecently-arrivedrefugeesfrom diverse backgrounds There was also a small-eroldercohortofparticipantswithhigherliteracylevelsandstrongercommunityengagementwith the local services in the area Camilla Couch facilitated the focus group which was conducted inArabicandEnglishwiththeArabictranslationprovidedbyKhalidZainulabdeen
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Work Opportunities for Women group Mt Druitt TAFE DateWednesday26May
TheWorkOpportunitiesforWomen(WOW)focusgroupwasheldonWednesdayMay261100ndash 100pmatMtDruittTAFEItwasfacilitatedbyCamilla Couch and built on the knowledge gainedintheprevioussessiononcriticalandanalyticalthinkingTheWOWgroupisaTAFECertificatelevel course
There were 14 women from diverse cultural backgroundsinthegroupThegroupweremainlyMuslimwomenwithschoolagechildrenandsome were mature aged Due to the learning fo-custhegroupwasfacilitatedasaclasswithguid-eddiscussionontheissuesandcarefulanalysisofthequestionsNotranslationwasneededduetotheeducationalcontextThestudentswereadeptatusingITandcompletedallthesurveysonline
STARTTS Tamil group Toongabbie Community Centre Community worker Sivaharani (Harani) Mayuran DateThursday27May
Thefocusgroupconsistedof18femalepartic-ipantswhowereyoungertomatureagedThefocus group was held at 1000am at Toongabbie CommunityCentreinTargoRdToongabbie
ThefocusgroupwasfacilitatedbyPatriciaMc-CormickandsupportedbyacommunityworkerSivaharani(Harani)MayuranfromtheSTARTTSTamil Group
ThegrouphadmixedlevelsofspokenandwrittenEnglishTheintroductionanddiscussionpromptsweretranslatedbythecommunityworkerSivaha-rani(Harani)Mayuranandsheandthemorepro-ficientstudentssupportedthosewithlowliteracytoanswerthesurveyquestions
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Spanish Speakers Seniors group SydWest Multicultural Services Blacktown DateTuesday1June
TheFocusGrouptookplaceonTuesday1Juneat1100amattheBlacktownShowgroundsandconsistedof16participants(15womenandoneman)AllparticipantswerebornincountriesinSouthAmericaTheirEnglish-fluencylevelsvariedand one of the members of the group translated thesurveyquestionsanddiscussionintoSpanish
ThegrouphadbeenmeetingforseveralyearsThegroupwasfacilitatedbyLindyCassidyandwassupportedbySreeVithyaHarilingamDayRespiteampSocialSupportTeamLeaderatSydWestMulticulturalServicesBlacktownThegroupwerematureagedtoolderparticipants
Thegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyform There was a more focused discussion on somekeyquestionsaftersurveycompletionThetranslatorassistedconsiderablyinthisprocess
Italian Speakers group Warrawong Community Centre DateMonday7June
The focus group of Italian speakers was held on Monday7Juneat1015amattheWarrawongCommunityCentreItwasfacilitatedbyCamillaCouchandsupportedbyJohnPaulTroianiand
SofiaLemafromIllawarraShoalhavenLHDMulti-cultural Health
There were 15 women in the group The group weremostlymaturetoolderparticipantsandwasconductedinItalianandEnglishwithtranslationprovidedbyJohnPaulThisgroupmeetsregularlyandissupportedbyanumberofservicesintheareaespeciallymulticulturalhealth
The group had a general facilitated discussion aboutthequestionsinthesurveyDuetolittleornoliteracytheindividualsurveyresponseswerethencollectedintooneresponseThesesurveyresponses have been included in the general surveyresponses
Mothers Group SydWest Multicultural Services Blacktown DateThursday10June
ThefocusgrouptookplaceonThursday10Juneat1030amandconsistedof14youngwomen13 of whom had a CALD background The focus groupweremainlymothersfromasupportgroupatSydWestMulticulturalServicesinBlacktown
EightofthewomenwereborninIndiatwofromPakistantwofromSriLankaonefromHausaGhana and one was born in Australia (the Austral-ianbornyoungwomanwasasocialworkstudenthelpingwiththegroup)LindyCassidyfacilitatedthe group with support from Wilma Garguath a projectofficerfromSydWestMulticultural Services
The group varied in age One was between 18-24 yearsoldSevenwereagedbetween25-34yearsSixwereagedbetween35=44yearsGiventheirage and circumstances most of the group did not consider themselves eligible at this stage for vac-cinationThiswasanimportantdifferencefromotherfocusgroupsinthattheemphasiswasmoreonwhattheywoulddooncetheybecameeligible
Participantsdidnotrequireassistancewithspo-kenEnglishThegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyformTherewasamorefocuseddiscussiononsomekeyquestions
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3938
ATTACHMENT 2 COVID-19 Vaccine Information in multiple languagesThefollowingsitesappsprovidetranslatedinformationaboutCOVID-19vaccines
Type of information KeyinformationongettingvaccinatedinNew South Wales and on the vaccines available The websiteusesanautomaticservicetotranslate thecontentintodifferentlanguages
Source of information NSW Government website
Link httpswwwnswgovauCOVID-19health-and-wellbeingCOVID-19-vaccina-tion-nswgetting-vaccinated
Type of information COVID-19ResourcessectionontheServiceNSWapp The app has a link to NSW Government websiteinformationonldquoGettingaCOVID-19vaccinationrdquo(seeabove)ItalsoincludesalinktoCOVID-19vaccinationresourcesinotherlan-guages available from the Department of Health
Source of information Service NSW NSW Government
Link Service NSW App
Type of information ArangeoftranslatedresourcesonCOVID-19bytitleincludingafactsheetonCOVID-19VaccineAstraZeneca(ChAdOx1-S)
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCOV-ID-19Pagestranslatedresources-by-titleaspx
Type of information ADigitalCOVID-19resourcelibrarywithtranslated materials
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiouscov-id-19Pagesdigital-resourcesaspx
Type of information AMultilingualCommunityToolkitontheCOVID-19vaccinationprogramtoassist communityworkersprovideseasytoreadresourcesvideosandlinkstokeyservicesandresources
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCovid-19DocumentsNSW-COVID-19-vaccina-tion-program-presentation-20210527pdf
Type of information TheNSWMulticulturalHealthCommunicationServiceoffershealthresourcesandinformationin a wide range of languages It has translated resources on COVID-19 and links to translated resourcesonCOVID-19vaccination
Source of information MulticulturalHealthCommunicationServiceisa New South Wales-wide health service hosted bySouth-easternSydneyLocalHealthDistrict(SESLHD)
Link httpswwwmhcshealthnswgovau
Type of information COVID-19vaccineinformationaddressingkeyquestionsaboutCOVID-19vaccinationandincludesvideosposterstilesfactsheetsandaudio material Translated into 63 languages
Source of information Department of Health Australian Government website
Link httpswwwhealthgovauinitiatives-and-pro-gramsCOVID-19-vaccinesCOVID-19-vaccine-in-formation-in-your-language
Type of information ThisinformationaddressessomecommonmisinformationaboutCOVID-19Translatedintomultiplelanguages
Source of information DepartmentofHomeAffairs Australian Government website
Link httpscovid19inlanguagehomeaffairsgovaumisinformation-and-truths-about-coronavirus
Type of information Australianandinternationalnewsand informationaboutCOVID-19andCOVID-19 vaccinesisavailableontheSBSCoronavirusPortal in more than 60 languages
Source of information SBSwebsite
Link httpswwwsbscomaulanguagecoronavirus
Type of information InformationprovidedaboutCOVID-19vaccinerolloutandsafetyinlanguagesotherthan English
Source of information Department of Health and Human Services Victorian Government
Link httpswwwcoronavirusvicgovautranslat-ed-information-about-COVID-19-vaccines
Type of information HealthTranslationsprovidestranslatedmateri-alsonhealthandwellbeingInformationaboutCOVID-19isregularlyupdatedincludessomeinformationonvaccinationandisavailableinover60communitylanguages
Source of information Victoriangovernmentinitiative
Link httpswwwhealthtranslationsvicgovaubhcv2bhchtnsfPresentEnglishResource-AllOpenampx=amps=Coronavirus
Type of information A one-stop shop for translated materials in multiplelanguagesonCOVID-19
Source of information Ethnolink Language Services
Link httpswwwethnolinkcomauCOVID-19-coro-navirus-translated-resources
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
40
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3332
intodifferentnetworkingspacessuchaswork-placeslocalgymsmothersrsquogroupsandseniorsrsquoclubswithafocusonallagegroupsregardlessofcurrenteligibilityAccordingtoSealethechal-lengeislsquoensuringemerginginformationisadapt-edfortheintendedaudiencersquoShehasalsosaidlsquoThatrsquoswhatIrsquomalittlebitconcernedaboutatthemomenttherersquosalotofresourcesongov-ernmentwebsitesbutthesetermsaroundbloodclottingareverytechnicalWeactuallyneedtomake sure that we are breaking them down in a waythatwillmakeitmeaningfultopeopleThatrsquosnotjustabouttranslatingitrsquosaboutbeingcon-sciousofpeoplersquoshealthliteracyneedstooSomaybegettingsomemorevisualsintomaterialstotryandsupportthatrsquo17
Thereareanumberofmulticulturalhealthresourcesthatusecommunitylanguagetransla-tionsplainEnglishandvideosfromCALDcommu-nityleaderswhichcanbedownloadedandusedbyservicesandindividualsHowevermanyofthewrittenresourcesstillrelyontechnicalandscien-tifictermsthatrequireareasonablyhighlevelofEnglishlanguageliteracyorhighlevelsofliteracyin the translated language to comprehend Host websites can also be hard to navigate making itdifficulttolocateresourcesfromsimplewebsearchesAsummaryofsomeoftheavailableresourcescanbefoundatAttachment2
MulticulturalHealthUnitsinLocalHealthDis-trictshavestaffwhocanworkwithpeoplefromculturallyandlinguisticallydiversecommunitiesatthelocallevelandtranslateandcontextualisethese materials to the needs of the end user These teams respond to local needs and popu-lationdemographicsandareexpertsineffectivehealthliteracyandhealthcommunicationwiththeirlocalcommunitiesTheyworkcloselywithcommunityandvulnerablegroupstobuildhealthliteracyandimprovedhealthoutcomesintheircommunities
Case Study ndash Be a COVID Warrior ndash Responding to COVID-19 in Multicultural Communities InWollongongtheIllawarraShoalhavenLocalHealthDistrict(ISLHD)MulticulturalHealthSer-viceco-designedacommunityengagementandeducationprogramcalledlsquoBeaCOVIDWarriorrsquowhich commenced in 2020 in response to the pandemic This program was designed to respond tothelowlevelsofhealthliteracyaroundCOVID-19potentialexposuretothevirusandaddressfearandstigmainthelocalCALDcommunitiesThelsquoCOVIDWarriorrsquoprogramreachedaround880peopleranginginagefrom14to85years65ofCOVIDWarriorparticipantswerefemaleand35weremaleCOVIDWarriorparticipantsrepresented 21 language groups The outcomes of the program included increased levels of confidenceinapplyinginfectioncontrolmeasuresincreasedliteracyandhealthliteracyandawarenessofhowCOVID-19istransmittedUltimatelyanimprovedawarenessinapplyingCOVIDsafemeasures was also reported
InApril2020theservicecommencedwelfarechecksviaphoneonafortnightlybasistosup-portsocially-isolatedmulticulturalseniorswhoboretheemotionalstressofsocialisolationFrom these calls the ISLHD heard the needs and concernsofseniorsinthecommunityInadditionourexperiencewithCALDcommunitieshighlightedtheimportanceofyoungpeopleasconduitsofessentialinformationtoadultsincommunityandfamilygroupsduetoEnglishlanguageaccessandeducation
InresponsetheISLHDinitiatedthelsquoCOVIDWarri-orrsquoprogramusingbi-culturalhighschoolstudentsthroughthelocalhighschoolsByincreasingthehealthliteracyofstudentsatschooltheselsquocham-pionsrsquocouldtalktotheirfamiliesincludingolderfamilymembersininformalsettingsandthroughsocialmediawiththeirpeersasastrategytoraisethe level of knowledge of COVID-19 trans-mission preventionandtestingTheprogrambecamesopopularthatitwasextendedintomorelocalhighschools and adults accessing the Adult Migrant EnglishProgramTheprogramwassupportedbylocalsettlementservicesprovidedbybothMaxSolutionsandtheRedCrossItwas
17 httpstheconversationcomhow-can-governments-communicate-with-multicultural-australians-about-COVID-19-vaccines-its-not-as-simple-as-having-a-poster-in-their-language-156097
later extendedtoCALDSeniorsthroughtheMulticulturalCommunitiesCouncilIllawarra(MCCI)supportprograms
AkeycomponentoftheprogramwastoprovideparticipantswithlsquoCOVIDWarriorrsquoKitswhichincludedtworeusablemaskshandsanitiserinfographicsaboutCOVID-19symptomsandinfor-mationaboutwheretestingclinicswereavailablelocallyMCCIandRuralAustraliaforRefugeesdonatedreusablemasksforeveryparticipant
AsthelsquoCOVIDWarriorrsquoprogramwasevolvingsowasthenationalvaccinerolloutplanInforma-tionwasthereforeadaptedtomeetthisinfor-mationgapForexampleadultparticipantsandseniors were supported to understand how to accesstheCOVIDvaccinelsquoeligibilitycheckersrsquoandCALD people were shown how to use the NSW HealthwebsiteCOVID-19informationpages18
Decision makingHowpeoplearecurrentlyconsideringtheriskofCOVID-19isinfluencedbyarangeoffactorsincludingratesoftransmissioninthecommunitynumbersofnewcasesreportsinthemediaofrisksandsideeffectsPeopletendtobasetheirassessmentonwhattheyarecurrentlyexperi-encingandthencheckthisagainstwhattheyarehearinginthemediaincludingandespeciallyonsocialmediaandfromfamilyandfriendsMostoftheparticipantsinourstudyspokeclearlyandarticulatelyabouthowtheyweigheduptherisk-benefitofhavingtheCOVID-19vaccineintheir decision making Low case numbers ndash at the timeofconductingtheresearchndashandasensethat Australia was lsquodoing well in safeguarding the communityagainstCOVID-19rsquoweresignificantfactorsinpeoplersquosdecisionnottobevaccinatedortoadoptalsquowaitandseersquoapproachFamilyfriends and social media were reported as having aconsiderableinfluenceondecisionmakingaswerereportsinthemediaofthebloodclottingsideeffectsofAstraZeneca
ThefactthatFacebookwasreportedlythemostpopularsourceofinformationaboutCOVID-19
18httpswwwhealthnswgovauInfectiouscovid-19Pagesdefaultaspx
andtheCOVID-19vaccineforpeopleinthestudyraisesconcernsaboutthepossibledisseminationofmisconceptionsandlsquofakenewsrsquothatmaybespread or compounded via social media Closed social media groups such as WhatsApp and WeChatwithfamilyandfriendsmayalsoleadtopeoplereinforcingtheirpre-existingbiasesThesefactorscoupledwithasensethatAustraliaisfaringwellcomparedtomanycountriesoverseasappear to have resulted in increased vaccine hesi-tancyamongparticipantsofthestudy
Factorsthatwereidentifiedaschangingvaccine-hesitantparticipantsrsquoperceptionswereanincreased risk from COVID-19 and a correspond-ingincreaseinthenumberofinfectionsandonthebenefitsidetheabilitytotraveloverseastovisitfamilyIntherecentresearchfromtheUniversityofNSWcitedaboveSearlearguesthatlsquotheremaybeotherthingsthatweneedtonowstartfocusingonhellipthatwillstarttopromoteandmotivatepeoplesuchasthechancetotravelmorefreelyforexamplersquoThisappearstobeborneoutbyourfocusgroupfindings19
Untilrecentlytherehavebeenverylowcasenumbers and few lockdowns across most of Aus-tralia and NSW The recent outbreak from mid-JuneinGreaterSydneyandintroductionofthehighlyinfectiousDeltavariantinNSWislikelytoimpactonpeoplersquosassessmentsoftherisk-benefitofhavingthevaccineandonewouldassumereducehesitancyrates
GiventheheightenedcommunityanxietycausedbythisrecentCOVID-19outbreaktheproductionofshortsharpandtargetedmessagingtoCALDgroupsincommunitylanguagesthatisaccessibleandmotivationalfeaturescommunityleadershigh-profilecelebritiesandsportsstarsfromCALDbackgroundsandisdirectedatastate-wideandlocal level would appear to be more urgent than everItisclearthatformessagingtobeeffectiveandreachitsintendedaudiencedistributionchannelsshouldincludeFacebookWhatsAppandothersocialmediaplatformsaswellastrustedsourcessuchasmulticulturalhealthworkersmulticulturalservicesandthroughGPsandMedical Centres If mainstream COVID-19 vaccine
19 Op cit
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW DISCUSSION
32 33
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3534
awareness campaigns are produced in Australia suchashavebeenproducedinNewZealandtheUnitedKingdomandNorthAmericatheyshouldincludehighprofilewell-knowncommunityfig-uresandsportingstarsfromCALDbackgroundsandincludestrategiesspecificallytargetingCALDcommunitiesincludinggroupsidentifiedaspar-ticularlyhigh-risk
It is also important that informationonvaccinesistranslatedintolanguagesfromnewerandemergingcommunitiesOthersuggestionsaroundreachingthesecommunitiesincludeface-to-facemeetingsorganisedbycrossagencypartnershipsandpeer-ledstrategiessuchas mobilising community champions and influenc-ers Messaging needs to be inclusive and framed around the collective values held by commu-n5
It is clear that reinforcing the benefits of being vaccinated at this time rather than dwelling on the risks is more likely to generate behavioural
changeandapositivevaccineresponsefrombothCALDcommunitiesandthegeneralpopulationAppropriately-designedandtargetedCOVID-19vaccinehealthinformationthatiseasytoreadinanylanguagecanbeconveyedbycommunityleadersandcommunitynetworksandpromotesthepositivebenefitsofgettingvaccinatedwouldbevaluableatthistimeBuildingontheworkofpeerchampionssuchastheCOVIDWarriorprogramisalsoasuccessfulmodeltoincreasingCOVID-19vaccinehealthliteracyandinformed decision making
Mostimportantlypositivelymotivatingculturallyandlinguisticallydiversecommunitymemberstolsquogetthejabrsquoespeciallythosewhoareadoptingalsquowaitandseersquoapproachorarevaccinehesitantwould lead to greater vaccine uptake among culturallyandlinguisticallydiversecommunitiesandthereforethecommunityasawhole
Inner West Multicultural Network Addison Road Community Centre DateWednesday12May
A focus group session of members of the Inner WestMulticulturalNetworkpluscustomersoftheFoodPantryatAddisonRoadwasheldattheAddisonRoadCommunityCentreinMarrickvilleon12Mayat200pmThesessionwaspartoftheregularmeetingoftheInnerWestMulticul-turalNetworkTheconsultationinvolvedabout26peopleandwasconductedbyRosannaBarbero
Thegroupbrainstormedresponsestoquestionsaroundvaccinehesitancyinmulticulturalcom-munitiesandmoreeffectivemessagingTheseresponseshavebeenincorporatedinthefindingsof the report
Griffith Women on Fire Focus Group Griffith Community Centre DateFriday14May
This small focus group of women was held at GriffithCommunityCentreonMay14at11amMargCouchSeniorProjectOfficerRegionalDevelopmentAustralia(RDA)-RiverinaandJoanneFitzpatrickSettlementEngagementandTransitionSupport Worker from Centacare Southwest NSW werethekeylinksandnetworkcontactsfortheGriffithcommunityTheWomenonFire(WOF)group was established as part of the Red Cross RuralFireServiceprogramlsquoManyCulturesOneCommunityrsquoInitiallyitwasestablishedtoeducatewomenonemergencypreparednessandtoen-courage NSW Rural Fire Service (RFS) volunteering andnowhastransformedintoacommunityac-tionsupportgroupTheGriffithSoroptimistInter-nationalnowauspicetheirfinancesandsupporttheWOFgroupactivitiesThefocusgroupwasfacilitatedbyCamillaCouchandlocalcommunityvolunteersledbytheGriffithSoroptimistClub
The women in the group were from Pakistan and IndonesiaThegroupweremainlyyoungmotherswithyoungchildrenandtheprogramhadchild-minding arrangements The language level of the womenwaslowandmostwerestudyingESOLat
ATTACHMENTS
ATTACHMENT 1 A Description of the Focus Groups
TAFEThedeliveryoftheinformationwaslimiteddue to language levels and the lack of bilingual interpretersEachparticipantworkedoneononewithavolunteertoslowlyfillinthesurveyandonewomantookthesurveyhometodiscusswithherhusbandThisgroupexperiencehighlightedthe lack of bilingual workers and services in some rural areas
Arabic speaking group Syd West Multicultural Services Mount Druitt Community worker Zaid Naoum Generalist Caseworker SydWest Multicultural Services DateMonday24May
ThefocusgroupfromSydWestMulticulturalSer-viceswasconductedonMonday24May2021atSydWestMulticulturalServicesMountDruittat300pmItwasfacilitatedbyPatriciaMcCormickandsupportedbyZaidNaoumGeneralistCase-workerSydWestMulticulturalServices
Therewere10womenandmenfromSyriainthegroupThegroupweremostlymaturetoolderparticipantsMostparticipantsrequiredassistancewithEnglishandthecaseworkerZaidNaoumhadtranslatedthesurveyintoArabicpriorto the focus group Zaid also translated during the focus group
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Canterbury City Community Centre (4Cs) group The Cottage Lakemba DateTuesday25May
ThefocusgroupfromCanterburyCityCommunityCentre(4Cs)wasconductedonTuesday25MayattheCottageat28CroydonStreetLakembaat10amItwasfacilitatedbyRobinMilesandsup-portedbyRomanaWaseemCommunityWorkerfrom 4Cs
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
34
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3736
The group was comprised of 14 women from PakistanIndiaandSriLankaThewomenrangedinagefrom23to65MostwerefluentEnglishspeakershoweveronewomanrequiredtransla-tionintoUrdufromoneoftheotherwomeninthegrouptoanswerthequestionsdirectly
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
NSW Chaldean League group Community worker Randa Goriya DateTuesday25May
ThefocusgroupfromNSWChaldeanLeagueMountDruittwasconductedonTuesday25May2021 at 1000am at the NSW Chaldean League premisesItwasfacilitatedbyPatriciaMcCormickandsupportedbyRandaGoriyaacommunityworker for the NSW Chaldean League in Mount DruittRandatranslatedtheintroductionandpromptsforthediscussionandhelpedthepartic-ipantstocompletethesurveyMostofthegrouprequiredhelptodothesurvey
ThegroupoftwelveparticipantswereallChaldeanandwerematuretoolderinageTheywereamixed-gendergroup
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Arabic speaking group Red Cross premises Wollongong DateTuesday25May
ThefocusgrouptookplaceonTuesday25Mayat 3pm at the Red Cross premises at Wollongong Therewere22womenandmenparticipatinginthegroupThefocusgroupwasfacilitatedbyCamilla Couch with support from Khalid Zainu-labdeenBilingualSupportWorkerHumanitarianSettlementProgram(ACTampNSW)
There were diverse ages in the group ranging fromyoungpeopletoolderagedMostofthegroupwereyoungerrecently-arrivedrefugeesfrom diverse backgrounds There was also a small-eroldercohortofparticipantswithhigherliteracylevelsandstrongercommunityengagementwith the local services in the area Camilla Couch facilitated the focus group which was conducted inArabicandEnglishwiththeArabictranslationprovidedbyKhalidZainulabdeen
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Work Opportunities for Women group Mt Druitt TAFE DateWednesday26May
TheWorkOpportunitiesforWomen(WOW)focusgroupwasheldonWednesdayMay261100ndash 100pmatMtDruittTAFEItwasfacilitatedbyCamilla Couch and built on the knowledge gainedintheprevioussessiononcriticalandanalyticalthinkingTheWOWgroupisaTAFECertificatelevel course
There were 14 women from diverse cultural backgroundsinthegroupThegroupweremainlyMuslimwomenwithschoolagechildrenandsome were mature aged Due to the learning fo-custhegroupwasfacilitatedasaclasswithguid-eddiscussionontheissuesandcarefulanalysisofthequestionsNotranslationwasneededduetotheeducationalcontextThestudentswereadeptatusingITandcompletedallthesurveysonline
STARTTS Tamil group Toongabbie Community Centre Community worker Sivaharani (Harani) Mayuran DateThursday27May
Thefocusgroupconsistedof18femalepartic-ipantswhowereyoungertomatureagedThefocus group was held at 1000am at Toongabbie CommunityCentreinTargoRdToongabbie
ThefocusgroupwasfacilitatedbyPatriciaMc-CormickandsupportedbyacommunityworkerSivaharani(Harani)MayuranfromtheSTARTTSTamil Group
ThegrouphadmixedlevelsofspokenandwrittenEnglishTheintroductionanddiscussionpromptsweretranslatedbythecommunityworkerSivaha-rani(Harani)Mayuranandsheandthemorepro-ficientstudentssupportedthosewithlowliteracytoanswerthesurveyquestions
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Spanish Speakers Seniors group SydWest Multicultural Services Blacktown DateTuesday1June
TheFocusGrouptookplaceonTuesday1Juneat1100amattheBlacktownShowgroundsandconsistedof16participants(15womenandoneman)AllparticipantswerebornincountriesinSouthAmericaTheirEnglish-fluencylevelsvariedand one of the members of the group translated thesurveyquestionsanddiscussionintoSpanish
ThegrouphadbeenmeetingforseveralyearsThegroupwasfacilitatedbyLindyCassidyandwassupportedbySreeVithyaHarilingamDayRespiteampSocialSupportTeamLeaderatSydWestMulticulturalServicesBlacktownThegroupwerematureagedtoolderparticipants
Thegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyform There was a more focused discussion on somekeyquestionsaftersurveycompletionThetranslatorassistedconsiderablyinthisprocess
Italian Speakers group Warrawong Community Centre DateMonday7June
The focus group of Italian speakers was held on Monday7Juneat1015amattheWarrawongCommunityCentreItwasfacilitatedbyCamillaCouchandsupportedbyJohnPaulTroianiand
SofiaLemafromIllawarraShoalhavenLHDMulti-cultural Health
There were 15 women in the group The group weremostlymaturetoolderparticipantsandwasconductedinItalianandEnglishwithtranslationprovidedbyJohnPaulThisgroupmeetsregularlyandissupportedbyanumberofservicesintheareaespeciallymulticulturalhealth
The group had a general facilitated discussion aboutthequestionsinthesurveyDuetolittleornoliteracytheindividualsurveyresponseswerethencollectedintooneresponseThesesurveyresponses have been included in the general surveyresponses
Mothers Group SydWest Multicultural Services Blacktown DateThursday10June
ThefocusgrouptookplaceonThursday10Juneat1030amandconsistedof14youngwomen13 of whom had a CALD background The focus groupweremainlymothersfromasupportgroupatSydWestMulticulturalServicesinBlacktown
EightofthewomenwereborninIndiatwofromPakistantwofromSriLankaonefromHausaGhana and one was born in Australia (the Austral-ianbornyoungwomanwasasocialworkstudenthelpingwiththegroup)LindyCassidyfacilitatedthe group with support from Wilma Garguath a projectofficerfromSydWestMulticultural Services
The group varied in age One was between 18-24 yearsoldSevenwereagedbetween25-34yearsSixwereagedbetween35=44yearsGiventheirage and circumstances most of the group did not consider themselves eligible at this stage for vac-cinationThiswasanimportantdifferencefromotherfocusgroupsinthattheemphasiswasmoreonwhattheywoulddooncetheybecameeligible
Participantsdidnotrequireassistancewithspo-kenEnglishThegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyformTherewasamorefocuseddiscussiononsomekeyquestions
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3938
ATTACHMENT 2 COVID-19 Vaccine Information in multiple languagesThefollowingsitesappsprovidetranslatedinformationaboutCOVID-19vaccines
Type of information KeyinformationongettingvaccinatedinNew South Wales and on the vaccines available The websiteusesanautomaticservicetotranslate thecontentintodifferentlanguages
Source of information NSW Government website
Link httpswwwnswgovauCOVID-19health-and-wellbeingCOVID-19-vaccina-tion-nswgetting-vaccinated
Type of information COVID-19ResourcessectionontheServiceNSWapp The app has a link to NSW Government websiteinformationonldquoGettingaCOVID-19vaccinationrdquo(seeabove)ItalsoincludesalinktoCOVID-19vaccinationresourcesinotherlan-guages available from the Department of Health
Source of information Service NSW NSW Government
Link Service NSW App
Type of information ArangeoftranslatedresourcesonCOVID-19bytitleincludingafactsheetonCOVID-19VaccineAstraZeneca(ChAdOx1-S)
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCOV-ID-19Pagestranslatedresources-by-titleaspx
Type of information ADigitalCOVID-19resourcelibrarywithtranslated materials
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiouscov-id-19Pagesdigital-resourcesaspx
Type of information AMultilingualCommunityToolkitontheCOVID-19vaccinationprogramtoassist communityworkersprovideseasytoreadresourcesvideosandlinkstokeyservicesandresources
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCovid-19DocumentsNSW-COVID-19-vaccina-tion-program-presentation-20210527pdf
Type of information TheNSWMulticulturalHealthCommunicationServiceoffershealthresourcesandinformationin a wide range of languages It has translated resources on COVID-19 and links to translated resourcesonCOVID-19vaccination
Source of information MulticulturalHealthCommunicationServiceisa New South Wales-wide health service hosted bySouth-easternSydneyLocalHealthDistrict(SESLHD)
Link httpswwwmhcshealthnswgovau
Type of information COVID-19vaccineinformationaddressingkeyquestionsaboutCOVID-19vaccinationandincludesvideosposterstilesfactsheetsandaudio material Translated into 63 languages
Source of information Department of Health Australian Government website
Link httpswwwhealthgovauinitiatives-and-pro-gramsCOVID-19-vaccinesCOVID-19-vaccine-in-formation-in-your-language
Type of information ThisinformationaddressessomecommonmisinformationaboutCOVID-19Translatedintomultiplelanguages
Source of information DepartmentofHomeAffairs Australian Government website
Link httpscovid19inlanguagehomeaffairsgovaumisinformation-and-truths-about-coronavirus
Type of information Australianandinternationalnewsand informationaboutCOVID-19andCOVID-19 vaccinesisavailableontheSBSCoronavirusPortal in more than 60 languages
Source of information SBSwebsite
Link httpswwwsbscomaulanguagecoronavirus
Type of information InformationprovidedaboutCOVID-19vaccinerolloutandsafetyinlanguagesotherthan English
Source of information Department of Health and Human Services Victorian Government
Link httpswwwcoronavirusvicgovautranslat-ed-information-about-COVID-19-vaccines
Type of information HealthTranslationsprovidestranslatedmateri-alsonhealthandwellbeingInformationaboutCOVID-19isregularlyupdatedincludessomeinformationonvaccinationandisavailableinover60communitylanguages
Source of information Victoriangovernmentinitiative
Link httpswwwhealthtranslationsvicgovaubhcv2bhchtnsfPresentEnglishResource-AllOpenampx=amps=Coronavirus
Type of information A one-stop shop for translated materials in multiplelanguagesonCOVID-19
Source of information Ethnolink Language Services
Link httpswwwethnolinkcomauCOVID-19-coro-navirus-translated-resources
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
40
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3534
awareness campaigns are produced in Australia suchashavebeenproducedinNewZealandtheUnitedKingdomandNorthAmericatheyshouldincludehighprofilewell-knowncommunityfig-uresandsportingstarsfromCALDbackgroundsandincludestrategiesspecificallytargetingCALDcommunitiesincludinggroupsidentifiedaspar-ticularlyhigh-risk
It is also important that informationonvaccinesistranslatedintolanguagesfromnewerandemergingcommunitiesOthersuggestionsaroundreachingthesecommunitiesincludeface-to-facemeetingsorganisedbycrossagencypartnershipsandpeer-ledstrategiessuchas mobilising community champions and influenc-ers Messaging needs to be inclusive and framed around the collective values held by commu-n5
It is clear that reinforcing the benefits of being vaccinated at this time rather than dwelling on the risks is more likely to generate behavioural
changeandapositivevaccineresponsefrombothCALDcommunitiesandthegeneralpopulationAppropriately-designedandtargetedCOVID-19vaccinehealthinformationthatiseasytoreadinanylanguagecanbeconveyedbycommunityleadersandcommunitynetworksandpromotesthepositivebenefitsofgettingvaccinatedwouldbevaluableatthistimeBuildingontheworkofpeerchampionssuchastheCOVIDWarriorprogramisalsoasuccessfulmodeltoincreasingCOVID-19vaccinehealthliteracyandinformed decision making
Mostimportantlypositivelymotivatingculturallyandlinguisticallydiversecommunitymemberstolsquogetthejabrsquoespeciallythosewhoareadoptingalsquowaitandseersquoapproachorarevaccinehesitantwould lead to greater vaccine uptake among culturallyandlinguisticallydiversecommunitiesandthereforethecommunityasawhole
Inner West Multicultural Network Addison Road Community Centre DateWednesday12May
A focus group session of members of the Inner WestMulticulturalNetworkpluscustomersoftheFoodPantryatAddisonRoadwasheldattheAddisonRoadCommunityCentreinMarrickvilleon12Mayat200pmThesessionwaspartoftheregularmeetingoftheInnerWestMulticul-turalNetworkTheconsultationinvolvedabout26peopleandwasconductedbyRosannaBarbero
Thegroupbrainstormedresponsestoquestionsaroundvaccinehesitancyinmulticulturalcom-munitiesandmoreeffectivemessagingTheseresponseshavebeenincorporatedinthefindingsof the report
Griffith Women on Fire Focus Group Griffith Community Centre DateFriday14May
This small focus group of women was held at GriffithCommunityCentreonMay14at11amMargCouchSeniorProjectOfficerRegionalDevelopmentAustralia(RDA)-RiverinaandJoanneFitzpatrickSettlementEngagementandTransitionSupport Worker from Centacare Southwest NSW werethekeylinksandnetworkcontactsfortheGriffithcommunityTheWomenonFire(WOF)group was established as part of the Red Cross RuralFireServiceprogramlsquoManyCulturesOneCommunityrsquoInitiallyitwasestablishedtoeducatewomenonemergencypreparednessandtoen-courage NSW Rural Fire Service (RFS) volunteering andnowhastransformedintoacommunityac-tionsupportgroupTheGriffithSoroptimistInter-nationalnowauspicetheirfinancesandsupporttheWOFgroupactivitiesThefocusgroupwasfacilitatedbyCamillaCouchandlocalcommunityvolunteersledbytheGriffithSoroptimistClub
The women in the group were from Pakistan and IndonesiaThegroupweremainlyyoungmotherswithyoungchildrenandtheprogramhadchild-minding arrangements The language level of the womenwaslowandmostwerestudyingESOLat
ATTACHMENTS
ATTACHMENT 1 A Description of the Focus Groups
TAFEThedeliveryoftheinformationwaslimiteddue to language levels and the lack of bilingual interpretersEachparticipantworkedoneononewithavolunteertoslowlyfillinthesurveyandonewomantookthesurveyhometodiscusswithherhusbandThisgroupexperiencehighlightedthe lack of bilingual workers and services in some rural areas
Arabic speaking group Syd West Multicultural Services Mount Druitt Community worker Zaid Naoum Generalist Caseworker SydWest Multicultural Services DateMonday24May
ThefocusgroupfromSydWestMulticulturalSer-viceswasconductedonMonday24May2021atSydWestMulticulturalServicesMountDruittat300pmItwasfacilitatedbyPatriciaMcCormickandsupportedbyZaidNaoumGeneralistCase-workerSydWestMulticulturalServices
Therewere10womenandmenfromSyriainthegroupThegroupweremostlymaturetoolderparticipantsMostparticipantsrequiredassistancewithEnglishandthecaseworkerZaidNaoumhadtranslatedthesurveyintoArabicpriorto the focus group Zaid also translated during the focus group
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Canterbury City Community Centre (4Cs) group The Cottage Lakemba DateTuesday25May
ThefocusgroupfromCanterburyCityCommunityCentre(4Cs)wasconductedonTuesday25MayattheCottageat28CroydonStreetLakembaat10amItwasfacilitatedbyRobinMilesandsup-portedbyRomanaWaseemCommunityWorkerfrom 4Cs
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
34
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3736
The group was comprised of 14 women from PakistanIndiaandSriLankaThewomenrangedinagefrom23to65MostwerefluentEnglishspeakershoweveronewomanrequiredtransla-tionintoUrdufromoneoftheotherwomeninthegrouptoanswerthequestionsdirectly
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
NSW Chaldean League group Community worker Randa Goriya DateTuesday25May
ThefocusgroupfromNSWChaldeanLeagueMountDruittwasconductedonTuesday25May2021 at 1000am at the NSW Chaldean League premisesItwasfacilitatedbyPatriciaMcCormickandsupportedbyRandaGoriyaacommunityworker for the NSW Chaldean League in Mount DruittRandatranslatedtheintroductionandpromptsforthediscussionandhelpedthepartic-ipantstocompletethesurveyMostofthegrouprequiredhelptodothesurvey
ThegroupoftwelveparticipantswereallChaldeanandwerematuretoolderinageTheywereamixed-gendergroup
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Arabic speaking group Red Cross premises Wollongong DateTuesday25May
ThefocusgrouptookplaceonTuesday25Mayat 3pm at the Red Cross premises at Wollongong Therewere22womenandmenparticipatinginthegroupThefocusgroupwasfacilitatedbyCamilla Couch with support from Khalid Zainu-labdeenBilingualSupportWorkerHumanitarianSettlementProgram(ACTampNSW)
There were diverse ages in the group ranging fromyoungpeopletoolderagedMostofthegroupwereyoungerrecently-arrivedrefugeesfrom diverse backgrounds There was also a small-eroldercohortofparticipantswithhigherliteracylevelsandstrongercommunityengagementwith the local services in the area Camilla Couch facilitated the focus group which was conducted inArabicandEnglishwiththeArabictranslationprovidedbyKhalidZainulabdeen
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Work Opportunities for Women group Mt Druitt TAFE DateWednesday26May
TheWorkOpportunitiesforWomen(WOW)focusgroupwasheldonWednesdayMay261100ndash 100pmatMtDruittTAFEItwasfacilitatedbyCamilla Couch and built on the knowledge gainedintheprevioussessiononcriticalandanalyticalthinkingTheWOWgroupisaTAFECertificatelevel course
There were 14 women from diverse cultural backgroundsinthegroupThegroupweremainlyMuslimwomenwithschoolagechildrenandsome were mature aged Due to the learning fo-custhegroupwasfacilitatedasaclasswithguid-eddiscussionontheissuesandcarefulanalysisofthequestionsNotranslationwasneededduetotheeducationalcontextThestudentswereadeptatusingITandcompletedallthesurveysonline
STARTTS Tamil group Toongabbie Community Centre Community worker Sivaharani (Harani) Mayuran DateThursday27May
Thefocusgroupconsistedof18femalepartic-ipantswhowereyoungertomatureagedThefocus group was held at 1000am at Toongabbie CommunityCentreinTargoRdToongabbie
ThefocusgroupwasfacilitatedbyPatriciaMc-CormickandsupportedbyacommunityworkerSivaharani(Harani)MayuranfromtheSTARTTSTamil Group
ThegrouphadmixedlevelsofspokenandwrittenEnglishTheintroductionanddiscussionpromptsweretranslatedbythecommunityworkerSivaha-rani(Harani)Mayuranandsheandthemorepro-ficientstudentssupportedthosewithlowliteracytoanswerthesurveyquestions
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Spanish Speakers Seniors group SydWest Multicultural Services Blacktown DateTuesday1June
TheFocusGrouptookplaceonTuesday1Juneat1100amattheBlacktownShowgroundsandconsistedof16participants(15womenandoneman)AllparticipantswerebornincountriesinSouthAmericaTheirEnglish-fluencylevelsvariedand one of the members of the group translated thesurveyquestionsanddiscussionintoSpanish
ThegrouphadbeenmeetingforseveralyearsThegroupwasfacilitatedbyLindyCassidyandwassupportedbySreeVithyaHarilingamDayRespiteampSocialSupportTeamLeaderatSydWestMulticulturalServicesBlacktownThegroupwerematureagedtoolderparticipants
Thegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyform There was a more focused discussion on somekeyquestionsaftersurveycompletionThetranslatorassistedconsiderablyinthisprocess
Italian Speakers group Warrawong Community Centre DateMonday7June
The focus group of Italian speakers was held on Monday7Juneat1015amattheWarrawongCommunityCentreItwasfacilitatedbyCamillaCouchandsupportedbyJohnPaulTroianiand
SofiaLemafromIllawarraShoalhavenLHDMulti-cultural Health
There were 15 women in the group The group weremostlymaturetoolderparticipantsandwasconductedinItalianandEnglishwithtranslationprovidedbyJohnPaulThisgroupmeetsregularlyandissupportedbyanumberofservicesintheareaespeciallymulticulturalhealth
The group had a general facilitated discussion aboutthequestionsinthesurveyDuetolittleornoliteracytheindividualsurveyresponseswerethencollectedintooneresponseThesesurveyresponses have been included in the general surveyresponses
Mothers Group SydWest Multicultural Services Blacktown DateThursday10June
ThefocusgrouptookplaceonThursday10Juneat1030amandconsistedof14youngwomen13 of whom had a CALD background The focus groupweremainlymothersfromasupportgroupatSydWestMulticulturalServicesinBlacktown
EightofthewomenwereborninIndiatwofromPakistantwofromSriLankaonefromHausaGhana and one was born in Australia (the Austral-ianbornyoungwomanwasasocialworkstudenthelpingwiththegroup)LindyCassidyfacilitatedthe group with support from Wilma Garguath a projectofficerfromSydWestMulticultural Services
The group varied in age One was between 18-24 yearsoldSevenwereagedbetween25-34yearsSixwereagedbetween35=44yearsGiventheirage and circumstances most of the group did not consider themselves eligible at this stage for vac-cinationThiswasanimportantdifferencefromotherfocusgroupsinthattheemphasiswasmoreonwhattheywoulddooncetheybecameeligible
Participantsdidnotrequireassistancewithspo-kenEnglishThegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyformTherewasamorefocuseddiscussiononsomekeyquestions
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3938
ATTACHMENT 2 COVID-19 Vaccine Information in multiple languagesThefollowingsitesappsprovidetranslatedinformationaboutCOVID-19vaccines
Type of information KeyinformationongettingvaccinatedinNew South Wales and on the vaccines available The websiteusesanautomaticservicetotranslate thecontentintodifferentlanguages
Source of information NSW Government website
Link httpswwwnswgovauCOVID-19health-and-wellbeingCOVID-19-vaccina-tion-nswgetting-vaccinated
Type of information COVID-19ResourcessectionontheServiceNSWapp The app has a link to NSW Government websiteinformationonldquoGettingaCOVID-19vaccinationrdquo(seeabove)ItalsoincludesalinktoCOVID-19vaccinationresourcesinotherlan-guages available from the Department of Health
Source of information Service NSW NSW Government
Link Service NSW App
Type of information ArangeoftranslatedresourcesonCOVID-19bytitleincludingafactsheetonCOVID-19VaccineAstraZeneca(ChAdOx1-S)
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCOV-ID-19Pagestranslatedresources-by-titleaspx
Type of information ADigitalCOVID-19resourcelibrarywithtranslated materials
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiouscov-id-19Pagesdigital-resourcesaspx
Type of information AMultilingualCommunityToolkitontheCOVID-19vaccinationprogramtoassist communityworkersprovideseasytoreadresourcesvideosandlinkstokeyservicesandresources
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCovid-19DocumentsNSW-COVID-19-vaccina-tion-program-presentation-20210527pdf
Type of information TheNSWMulticulturalHealthCommunicationServiceoffershealthresourcesandinformationin a wide range of languages It has translated resources on COVID-19 and links to translated resourcesonCOVID-19vaccination
Source of information MulticulturalHealthCommunicationServiceisa New South Wales-wide health service hosted bySouth-easternSydneyLocalHealthDistrict(SESLHD)
Link httpswwwmhcshealthnswgovau
Type of information COVID-19vaccineinformationaddressingkeyquestionsaboutCOVID-19vaccinationandincludesvideosposterstilesfactsheetsandaudio material Translated into 63 languages
Source of information Department of Health Australian Government website
Link httpswwwhealthgovauinitiatives-and-pro-gramsCOVID-19-vaccinesCOVID-19-vaccine-in-formation-in-your-language
Type of information ThisinformationaddressessomecommonmisinformationaboutCOVID-19Translatedintomultiplelanguages
Source of information DepartmentofHomeAffairs Australian Government website
Link httpscovid19inlanguagehomeaffairsgovaumisinformation-and-truths-about-coronavirus
Type of information Australianandinternationalnewsand informationaboutCOVID-19andCOVID-19 vaccinesisavailableontheSBSCoronavirusPortal in more than 60 languages
Source of information SBSwebsite
Link httpswwwsbscomaulanguagecoronavirus
Type of information InformationprovidedaboutCOVID-19vaccinerolloutandsafetyinlanguagesotherthan English
Source of information Department of Health and Human Services Victorian Government
Link httpswwwcoronavirusvicgovautranslat-ed-information-about-COVID-19-vaccines
Type of information HealthTranslationsprovidestranslatedmateri-alsonhealthandwellbeingInformationaboutCOVID-19isregularlyupdatedincludessomeinformationonvaccinationandisavailableinover60communitylanguages
Source of information Victoriangovernmentinitiative
Link httpswwwhealthtranslationsvicgovaubhcv2bhchtnsfPresentEnglishResource-AllOpenampx=amps=Coronavirus
Type of information A one-stop shop for translated materials in multiplelanguagesonCOVID-19
Source of information Ethnolink Language Services
Link httpswwwethnolinkcomauCOVID-19-coro-navirus-translated-resources
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
40
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3736
The group was comprised of 14 women from PakistanIndiaandSriLankaThewomenrangedinagefrom23to65MostwerefluentEnglishspeakershoweveronewomanrequiredtransla-tionintoUrdufromoneoftheotherwomeninthegrouptoanswerthequestionsdirectly
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
NSW Chaldean League group Community worker Randa Goriya DateTuesday25May
ThefocusgroupfromNSWChaldeanLeagueMountDruittwasconductedonTuesday25May2021 at 1000am at the NSW Chaldean League premisesItwasfacilitatedbyPatriciaMcCormickandsupportedbyRandaGoriyaacommunityworker for the NSW Chaldean League in Mount DruittRandatranslatedtheintroductionandpromptsforthediscussionandhelpedthepartic-ipantstocompletethesurveyMostofthegrouprequiredhelptodothesurvey
ThegroupoftwelveparticipantswereallChaldeanandwerematuretoolderinageTheywereamixed-gendergroup
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Arabic speaking group Red Cross premises Wollongong DateTuesday25May
ThefocusgrouptookplaceonTuesday25Mayat 3pm at the Red Cross premises at Wollongong Therewere22womenandmenparticipatinginthegroupThefocusgroupwasfacilitatedbyCamilla Couch with support from Khalid Zainu-labdeenBilingualSupportWorkerHumanitarianSettlementProgram(ACTampNSW)
There were diverse ages in the group ranging fromyoungpeopletoolderagedMostofthegroupwereyoungerrecently-arrivedrefugeesfrom diverse backgrounds There was also a small-eroldercohortofparticipantswithhigherliteracylevelsandstrongercommunityengagementwith the local services in the area Camilla Couch facilitated the focus group which was conducted inArabicandEnglishwiththeArabictranslationprovidedbyKhalidZainulabdeen
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Work Opportunities for Women group Mt Druitt TAFE DateWednesday26May
TheWorkOpportunitiesforWomen(WOW)focusgroupwasheldonWednesdayMay261100ndash 100pmatMtDruittTAFEItwasfacilitatedbyCamilla Couch and built on the knowledge gainedintheprevioussessiononcriticalandanalyticalthinkingTheWOWgroupisaTAFECertificatelevel course
There were 14 women from diverse cultural backgroundsinthegroupThegroupweremainlyMuslimwomenwithschoolagechildrenandsome were mature aged Due to the learning fo-custhegroupwasfacilitatedasaclasswithguid-eddiscussionontheissuesandcarefulanalysisofthequestionsNotranslationwasneededduetotheeducationalcontextThestudentswereadeptatusingITandcompletedallthesurveysonline
STARTTS Tamil group Toongabbie Community Centre Community worker Sivaharani (Harani) Mayuran DateThursday27May
Thefocusgroupconsistedof18femalepartic-ipantswhowereyoungertomatureagedThefocus group was held at 1000am at Toongabbie CommunityCentreinTargoRdToongabbie
ThefocusgroupwasfacilitatedbyPatriciaMc-CormickandsupportedbyacommunityworkerSivaharani(Harani)MayuranfromtheSTARTTSTamil Group
ThegrouphadmixedlevelsofspokenandwrittenEnglishTheintroductionanddiscussionpromptsweretranslatedbythecommunityworkerSivaha-rani(Harani)Mayuranandsheandthemorepro-ficientstudentssupportedthosewithlowliteracytoanswerthesurveyquestions
The group had a general facilitated discussion aboutthequestionsinthesurveyandthencom-pletedtheirindividualsurveysattheendofthefocusgroupsessionTheirsurveyresponseshavebeenincludedinthegeneralsurveyresponses
Spanish Speakers Seniors group SydWest Multicultural Services Blacktown DateTuesday1June
TheFocusGrouptookplaceonTuesday1Juneat1100amattheBlacktownShowgroundsandconsistedof16participants(15womenandoneman)AllparticipantswerebornincountriesinSouthAmericaTheirEnglish-fluencylevelsvariedand one of the members of the group translated thesurveyquestionsanddiscussionintoSpanish
ThegrouphadbeenmeetingforseveralyearsThegroupwasfacilitatedbyLindyCassidyandwassupportedbySreeVithyaHarilingamDayRespiteampSocialSupportTeamLeaderatSydWestMulticulturalServicesBlacktownThegroupwerematureagedtoolderparticipants
Thegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyform There was a more focused discussion on somekeyquestionsaftersurveycompletionThetranslatorassistedconsiderablyinthisprocess
Italian Speakers group Warrawong Community Centre DateMonday7June
The focus group of Italian speakers was held on Monday7Juneat1015amattheWarrawongCommunityCentreItwasfacilitatedbyCamillaCouchandsupportedbyJohnPaulTroianiand
SofiaLemafromIllawarraShoalhavenLHDMulti-cultural Health
There were 15 women in the group The group weremostlymaturetoolderparticipantsandwasconductedinItalianandEnglishwithtranslationprovidedbyJohnPaulThisgroupmeetsregularlyandissupportedbyanumberofservicesintheareaespeciallymulticulturalhealth
The group had a general facilitated discussion aboutthequestionsinthesurveyDuetolittleornoliteracytheindividualsurveyresponseswerethencollectedintooneresponseThesesurveyresponses have been included in the general surveyresponses
Mothers Group SydWest Multicultural Services Blacktown DateThursday10June
ThefocusgrouptookplaceonThursday10Juneat1030amandconsistedof14youngwomen13 of whom had a CALD background The focus groupweremainlymothersfromasupportgroupatSydWestMulticulturalServicesinBlacktown
EightofthewomenwereborninIndiatwofromPakistantwofromSriLankaonefromHausaGhana and one was born in Australia (the Austral-ianbornyoungwomanwasasocialworkstudenthelpingwiththegroup)LindyCassidyfacilitatedthe group with support from Wilma Garguath a projectofficerfromSydWestMulticultural Services
The group varied in age One was between 18-24 yearsoldSevenwereagedbetween25-34yearsSixwereagedbetween35=44yearsGiventheirage and circumstances most of the group did not consider themselves eligible at this stage for vac-cinationThiswasanimportantdifferencefromotherfocusgroupsinthattheemphasiswasmoreonwhattheywoulddooncetheybecameeligible
Participantsdidnotrequireassistancewithspo-kenEnglishThegroupwentthroughthesurveyquestionstogetherandindividuallycompletedtheirsurveyformTherewasamorefocuseddiscussiononsomekeyquestions
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3938
ATTACHMENT 2 COVID-19 Vaccine Information in multiple languagesThefollowingsitesappsprovidetranslatedinformationaboutCOVID-19vaccines
Type of information KeyinformationongettingvaccinatedinNew South Wales and on the vaccines available The websiteusesanautomaticservicetotranslate thecontentintodifferentlanguages
Source of information NSW Government website
Link httpswwwnswgovauCOVID-19health-and-wellbeingCOVID-19-vaccina-tion-nswgetting-vaccinated
Type of information COVID-19ResourcessectionontheServiceNSWapp The app has a link to NSW Government websiteinformationonldquoGettingaCOVID-19vaccinationrdquo(seeabove)ItalsoincludesalinktoCOVID-19vaccinationresourcesinotherlan-guages available from the Department of Health
Source of information Service NSW NSW Government
Link Service NSW App
Type of information ArangeoftranslatedresourcesonCOVID-19bytitleincludingafactsheetonCOVID-19VaccineAstraZeneca(ChAdOx1-S)
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCOV-ID-19Pagestranslatedresources-by-titleaspx
Type of information ADigitalCOVID-19resourcelibrarywithtranslated materials
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiouscov-id-19Pagesdigital-resourcesaspx
Type of information AMultilingualCommunityToolkitontheCOVID-19vaccinationprogramtoassist communityworkersprovideseasytoreadresourcesvideosandlinkstokeyservicesandresources
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCovid-19DocumentsNSW-COVID-19-vaccina-tion-program-presentation-20210527pdf
Type of information TheNSWMulticulturalHealthCommunicationServiceoffershealthresourcesandinformationin a wide range of languages It has translated resources on COVID-19 and links to translated resourcesonCOVID-19vaccination
Source of information MulticulturalHealthCommunicationServiceisa New South Wales-wide health service hosted bySouth-easternSydneyLocalHealthDistrict(SESLHD)
Link httpswwwmhcshealthnswgovau
Type of information COVID-19vaccineinformationaddressingkeyquestionsaboutCOVID-19vaccinationandincludesvideosposterstilesfactsheetsandaudio material Translated into 63 languages
Source of information Department of Health Australian Government website
Link httpswwwhealthgovauinitiatives-and-pro-gramsCOVID-19-vaccinesCOVID-19-vaccine-in-formation-in-your-language
Type of information ThisinformationaddressessomecommonmisinformationaboutCOVID-19Translatedintomultiplelanguages
Source of information DepartmentofHomeAffairs Australian Government website
Link httpscovid19inlanguagehomeaffairsgovaumisinformation-and-truths-about-coronavirus
Type of information Australianandinternationalnewsand informationaboutCOVID-19andCOVID-19 vaccinesisavailableontheSBSCoronavirusPortal in more than 60 languages
Source of information SBSwebsite
Link httpswwwsbscomaulanguagecoronavirus
Type of information InformationprovidedaboutCOVID-19vaccinerolloutandsafetyinlanguagesotherthan English
Source of information Department of Health and Human Services Victorian Government
Link httpswwwcoronavirusvicgovautranslat-ed-information-about-COVID-19-vaccines
Type of information HealthTranslationsprovidestranslatedmateri-alsonhealthandwellbeingInformationaboutCOVID-19isregularlyupdatedincludessomeinformationonvaccinationandisavailableinover60communitylanguages
Source of information Victoriangovernmentinitiative
Link httpswwwhealthtranslationsvicgovaubhcv2bhchtnsfPresentEnglishResource-AllOpenampx=amps=Coronavirus
Type of information A one-stop shop for translated materials in multiplelanguagesonCOVID-19
Source of information Ethnolink Language Services
Link httpswwwethnolinkcomauCOVID-19-coro-navirus-translated-resources
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
40
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
3938
ATTACHMENT 2 COVID-19 Vaccine Information in multiple languagesThefollowingsitesappsprovidetranslatedinformationaboutCOVID-19vaccines
Type of information KeyinformationongettingvaccinatedinNew South Wales and on the vaccines available The websiteusesanautomaticservicetotranslate thecontentintodifferentlanguages
Source of information NSW Government website
Link httpswwwnswgovauCOVID-19health-and-wellbeingCOVID-19-vaccina-tion-nswgetting-vaccinated
Type of information COVID-19ResourcessectionontheServiceNSWapp The app has a link to NSW Government websiteinformationonldquoGettingaCOVID-19vaccinationrdquo(seeabove)ItalsoincludesalinktoCOVID-19vaccinationresourcesinotherlan-guages available from the Department of Health
Source of information Service NSW NSW Government
Link Service NSW App
Type of information ArangeoftranslatedresourcesonCOVID-19bytitleincludingafactsheetonCOVID-19VaccineAstraZeneca(ChAdOx1-S)
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCOV-ID-19Pagestranslatedresources-by-titleaspx
Type of information ADigitalCOVID-19resourcelibrarywithtranslated materials
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiouscov-id-19Pagesdigital-resourcesaspx
Type of information AMultilingualCommunityToolkitontheCOVID-19vaccinationprogramtoassist communityworkersprovideseasytoreadresourcesvideosandlinkstokeyservicesandresources
Source of information NSW Health website
Link httpswwwhealthnswgovauInfectiousCovid-19DocumentsNSW-COVID-19-vaccina-tion-program-presentation-20210527pdf
Type of information TheNSWMulticulturalHealthCommunicationServiceoffershealthresourcesandinformationin a wide range of languages It has translated resources on COVID-19 and links to translated resourcesonCOVID-19vaccination
Source of information MulticulturalHealthCommunicationServiceisa New South Wales-wide health service hosted bySouth-easternSydneyLocalHealthDistrict(SESLHD)
Link httpswwwmhcshealthnswgovau
Type of information COVID-19vaccineinformationaddressingkeyquestionsaboutCOVID-19vaccinationandincludesvideosposterstilesfactsheetsandaudio material Translated into 63 languages
Source of information Department of Health Australian Government website
Link httpswwwhealthgovauinitiatives-and-pro-gramsCOVID-19-vaccinesCOVID-19-vaccine-in-formation-in-your-language
Type of information ThisinformationaddressessomecommonmisinformationaboutCOVID-19Translatedintomultiplelanguages
Source of information DepartmentofHomeAffairs Australian Government website
Link httpscovid19inlanguagehomeaffairsgovaumisinformation-and-truths-about-coronavirus
Type of information Australianandinternationalnewsand informationaboutCOVID-19andCOVID-19 vaccinesisavailableontheSBSCoronavirusPortal in more than 60 languages
Source of information SBSwebsite
Link httpswwwsbscomaulanguagecoronavirus
Type of information InformationprovidedaboutCOVID-19vaccinerolloutandsafetyinlanguagesotherthan English
Source of information Department of Health and Human Services Victorian Government
Link httpswwwcoronavirusvicgovautranslat-ed-information-about-COVID-19-vaccines
Type of information HealthTranslationsprovidestranslatedmateri-alsonhealthandwellbeingInformationaboutCOVID-19isregularlyupdatedincludessomeinformationonvaccinationandisavailableinover60communitylanguages
Source of information Victoriangovernmentinitiative
Link httpswwwhealthtranslationsvicgovaubhcv2bhchtnsfPresentEnglishResource-AllOpenampx=amps=Coronavirus
Type of information A one-stop shop for translated materials in multiplelanguagesonCOVID-19
Source of information Ethnolink Language Services
Link httpswwwethnolinkcomauCOVID-19-coro-navirus-translated-resources
ATTACHMENTS
Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
40