Culturally and linguistically diverse (CALD): terminology and standards in reducing healthcare inequalities

Marcus, Kanchan; Balasubramanian, M.; Short, Stephanie; Sohn, Woosung

doi:10.1111/1753-6405.13190

Cited by 19 publications

(16 citation statements)

References 20 publications

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“…3 Further global definitions in research include ethnicity, race, immigration status, ancestry among other variables. 4 Thus, CALD groups are stratified to identify the distribution of health and inequities in populations. Consequently, this in turn helps identify programs and policies to improve population health, as relevant to population needs.…”

Section: Backg Rou N Dmentioning

confidence: 99%

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Barriers and facilitators to dental care among culturally and linguistically diverse carers: A mixed‐methods systematic review

Marcus

Balasubramanian

Short

et al. 2022

Comm Dent Oral Epid

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Objectives Culturally and linguistically diverse (CALD) communities experience widespread inequalities in dental care utilization. While, several studies have reported factors contributing to such inequalities, a synthesis of evidence is lacking for CALD carers. This review examined the barriers and facilitators to dental care utilization among CALD carers. Methods Medline, CINAHL, ProQuest, Scopus and Web of Science were searched for dental utilization and related factors, without geographic limitations. An integrated mixed‐method design was adopted, where both qualitative and quantitative findings were combined into a single synthesis. Critical appraisal was conducted using JBI tools, and a Universal Health Coverage (UHC) framework guided the synthesis approach. Reliability and researcher triangulation occurred throughout the conduct of this review. Results A total of 20 papers were included: qualitative (n = 8), quantitative (n = 8) and mixed method (n = 4). Studies were from Australia, Canada, South Korea, Trinidad and Tobago, United Kingdom and the United States. Three studies insufficiently reported confounding variables and nine qualitative papers lacked philosophical perspectives. Affordability was the foremost barrier at the system level, followed by psychosocial negative provider experiences and language/communication issues at the provider level. Cultural, knowledge, attitudes and beliefs were individual‐family level factors. Utilizing a UHC framework, the barriers and facilitators were aggregated at three levels; financial‐system, provider and individual‐family levels and illustrated in the rainbow model of CALD oral health. Conclusion The review strengthens evidence for multilayered, system‐related policies and culturally sensitive provision of services for reducing oral healthcare inequalities in CALD carers.

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Section: Backg Rou N Dmentioning

confidence: 99%

“…CALD was classified by language, ethnicity or country of birth, which included first-and/or second-generation migrants. 3,4 The population of interest was CALD carers. Parents and carers were included in this search since conception of the study protocol which initially focused upon mothers.…”

Section: Selection Criteriamentioning

confidence: 99%

Barriers and facilitators to dental care among culturally and linguistically diverse carers: A mixed‐methods systematic review

Marcus

Balasubramanian

Short

et al. 2022

Comm Dent Oral Epid

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“…This ‘risk-benefit’ can be viewed in congruence to ‘complacency - competing priorities’ from our study. Parallels are moreover evident in vaccine miscommunication and the lack of accessible trustworthy oral healthcare information, which remains an ongoing challenge to be addressed, particularly for CALD communities [ 23 ]. For instance, one cross sectional study identified disparities in trust pertaining to vaccine hesitancy amongst CALD groups [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

“…Individuals born in non-English speaking countries and those whose first language is not English. Supported by this classification [ 23 ], foreign born mothers from a non-English speaking country, who conversed in a non-English language were recruited. While interpreters were offered, CALD mothers who consented to participate displayed a level of English proficiency and all declined the need for an interpreter.…”

Section: Methodsmentioning

confidence: 99%

Dental hesitancy: a qualitative study of culturally and linguistically diverse mothers

et al. 2022

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Background Oral healthcare is paramount and inextricably linked to well-being. Yet, the evidence indicates that culturally and linguistically diverse (CALD) migrant communities have unequal access to mainstream dental services due to several barriers. The purpose of this study was to investigate the oral healthcare experiences, attitudes and barriers to oral healthcare utilisation in CALD mothers. Methods A qualitative study with semi-structured interviews was conducted within a social constructivism epistemology. CALD mothers who identified as non-English speaking, foreign country born, with a child under 12, were recruited though purposive snowball sampling. Questions probed oral healthcare experiences, barriers, enablers, and attitudes. Verbatim typed transcripts were thematically analysed using grounded methodology. Results Thirty-three CALD mothers participated; twenty from India, five from Fiji, four from China, two from Nepal and one each from Israel and Macedonia. Languages included Cantonese, Fiji-Hindi, Gujrati, Hebrew, Hindi, Kannada, Mandarin, Maharashtrian, Macedonian, Nepalese, Punjabi, Sanskrit, Telegu and Urdu. Cost was the foremost barrier to oral healthcare services, followed by Confidence in quality care for the provision of services and treatment. Confusion in navigating a public and private healthcare system was highlighted and Competing priorities took precedence. Complacency referred to ‘no need’ or lack of urgency in dental care. Subsequently, dental hesitancy (superordinate theme) described the patterning of data as comprising the five ‘C’ factors and was theorised as the dental hesitancy phenomenon to explain the occurrence of delay or avoidance in utilising dental care. Conclusion Findings highlight the utility of the dental hesitancy phenomenon unearthed within this study. CALD mothers explained five ‘C’ dimensions: cost, confidence, confusion, competing priorities and complacency as barriers to accessing timely dental care. Multisectoral collaboration between healthcare systems, universal health coverage and primary sector support is required to address dental hesitancy in CALD mothers. Further, this study contributes to the field of behavioural and social sciences in oral health and augments the literature on dental avoidance.

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“…To explore this gap, we focus on mothers as an influential group for childhood oral health behaviours [30]. In the Australian context, research, policy and government employ 'CALD' terminology to describe ethnic and migrant populations [31]. Noting limitations to this terminology, CALD mothers were included if they were foreign country born, from a non-English speaking country and conversed in a language other than English.…”

Section: Participant Recruitment and Samplingmentioning

confidence: 99%

Dental diaspora: oral health care attitudes and experiences in culturally and linguistically diverse mothers in Australia

Marcus

Balasubramanian

Short

et al. 2022

BMC Health Serv Res

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Background Globally oral health care is unequally accessible or utilised within culturally and linguistically diverse (CALD) migrant communities. Yet much remains unknown about CALD mothers and their oral healthcare experiences in Australia. Hence, this paper explores the oral health care attitudes and experiences of CALD mothers within the Australian context with the broader objective to reduce oral health inequalities. Methods Qualitative semi-structured interviews were conducted from a social constructivism paradigm. Participants were foreign country born, spoke language/s other than English and have a child. Purposive snowball sampling and recruitment was conducted through CALD organisations and social media. Participants were interviewed for their attitudes and experiences to dental care and frequency of utilisation in Australia and the home country. Interviews were transcribed verbatim and grounded analysis (Strauss and Corbin) performed. Researcher bias was reduced through reflexivity and triangulation. Results The participants (n = 33) included 20 CALD mothers born in India and 13 from either China, Fiji, Nepal, Macedonia and Israel. The theme, experiences with health workforce personnel revealed positive attitudes toward CALD providers from similar cultural and/or linguistic backgrounds. We coin these CALD providers as the ‘dental diaspora’. The dental diaspora facilitated CALD mothers through culture and/or language factors, alleviating cost barriers and flexibility in appointments. Dental travel to the home country was affirmed, however family visitation was the foremost reason for travel. Conclusion The findings suggest that the dental diaspora plays a significant role in promoting oral health care utilisation for first generation CALD mothers in Australia. This paper brings to light the phenomenon of the ‘dental diaspora’ as an essential health workforce that contributes to addressing inequities in oral healthcare utilisation within CALD migrant communities. Universal health coverage in oral health is further affirmed, as aligned to the WHO policy context.

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Culturally and linguistically diverse (CALD): terminology and standards in reducing healthcare inequalities

Cited by 19 publications

References 20 publications

Barriers and facilitators to dental care among culturally and linguistically diverse carers: A mixed‐methods systematic review

Barriers and facilitators to dental care among culturally and linguistically diverse carers: A mixed‐methods systematic review

Dental hesitancy: a qualitative study of culturally and linguistically diverse mothers

Dental diaspora: oral health care attitudes and experiences in culturally and linguistically diverse mothers in Australia

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