Knowledge Synthesis: Multicultural Populations

Despite the increasing numbers of multicultural groups in Australia, studies on NCD prevention with CALD and refugee populations are limited to a handful number of qualitative studies, thus making generalisability limited to specific population group(s).

Our research identifies issues relating to the accessibility and comprehensibility of health information available to women from Culturally and Linguistically Diverse (CALD) backgrounds. The lack of accessible and usable health information impacts women’s understanding of the role that health self-management plays in the prevention of Non-communicable diseases (NCDs).  

Healthcare practitioners need to be proactive in initiating conversations with CALD immigrant women relating to the prevention of NCDs and provide relatable and culturally specific practices for health self-management sustainability.  

Findings reveal that immigrant women are ‘shy’, have limited English language proficiency and are unable to access health information because of poor health literacy. Current formats of information availability exclude women from CALD backgrounds and women with low health literacy and literacy.  

Health care practitioners, policymakers both at micro and macro levels and community organisations should be targeted to improve CALD access to health care information in accessible formats to improve understanding and to self-manage health to prevent NCDs. 

Accessing Health Information

A systematic review identified the accessibility of Australian web-based health information for midlife women from culturally and linguistically diverse (CALD) backgrounds or with low health literacy. The level of evidence was assessed using the European Commission’s quality criteria for health websites. Sixteen websites were evaluated, with accessibility scores ranging between 0 and 8. Two websites scored 8 but were ‘difficult to read’ on the readability test. Four websites included written resources in languages other than English, and two had information in audio-visual format in languages other than English [1].  

Managing Gestational Diabetes

An ethnographic qualitative study documented the lived experiences of South Asian women and their understanding and experiences of gestational diabetes mellitus (GDM) diagnosis, self-management, and their healthcare providers’ perspectives of treatment strategies. Face-to-face in-depth interviews with 21 healthcare providers and 23 South Asian women between 24–28 weeks gestation were conducted. Both healthcare providers and the women were dissatisfied with the ‘one size fits all’ care provided in managing their GDM [3].  

Managing Menopause

A systematic review summarised how migrant women perceived and managed their menopausal and postmenopausal health and their experiences with healthcare services; and healthcare providers’ views about delivering menopause-related healthcare to migrant women. Thirty-one papers were identified, of which 23 reported examining migrant women’s perceptions about menopause, their self-care strategies, and their experiences with menopause-related healthcare. Only two reported on healthcare providers’ views about providing menopause-related healthcare to migrant women [2]. 

A qualitative study explored menopause-related health literacy and experiences with menopause-related health care among Vietnamese-born women who migrated as adults. 12 interviews were conducted identifying menopause as a natural event, and menopause-related information obtained from family and friends. Vietnamese-speaking General Practitioners were identified as a reliable source of health information but didn’t initiate menopause-related health conversations. Limited English language proficiency affected women’s capacity to access, understand, evaluate, and use menopause-related health information [4]. 

A qualitative study with 11 women explored menopause-related health literacy and experiences of menopause-related health care with women from the Horn of Africa nations. Women viewed menopause as a normal life phase that did not warrant accessing menopause-related information and care; they preferred healthcare providers who could speak their language but were unhappy with their lack of proactive engagement in providing menopause-related information [5]. 

An anonymous online survey explored 139 primary healthcare providers’ views about the menopause-related care needs of migrant women from low- and middle-income countries and what they perceived as barriers and enablers for providing this. Less than a third routinely offered menopause-related information during consultations. Short appointments, lack of culturally and linguistically appropriate menopause information, and lack of confidence in providing menopause-related care were the main barriers to providing comprehensive menopause-related care to migrant women [6].  

A systematic review of 19 studies on experiences of menopause, self-management strategies for menopausal symptoms and healthcare needs among immigrant women identified 15 studies reporting on symptoms experienced during the menopausal transition, three on self-management strategies and four on perceptions of menopause-specific health care. The heterogeneity of the studies made comparison difficult, but findings were broadly consistent, with immigrant women reporting more vasomotor symptoms and other physical symptoms and poorer mental health than non-immigrant women. Self-management strategies were influenced by culture, and in general, women were dissatisfied with the care they had received [7]. 

The Australian Partnership Prevention Centre 
How can we improve health messaging to reach all Australians https://preventioncentre.org.au/resources/how-can-we-improve-health-messaging-to-reach-all-australians/  

CRE WaND health literacy videos 

Menopause and healthy living https://www.wandcre.org.au/menopause-and-healthy-living/ 

Joint pain – https://www.wandcre.org.au/joint-pain/

1. Bandyopadhyay, M., Stanzel, K., Hammarberg, K., Hickey, M. and Fisher, J. (2022), Accessibility of web-based health information for women in midlife from culturally and linguistically diverse backgrounds or with low health literacy. Australian and New Zealand Journal of Public Health. 46: 269-274. DOI: 10.1111/1753-6405.13192 
2. Stanzel KA, Hammarberg K & Fisher J (2021). Challenges in menopausal care of immigrant women. Maturitas. 150: 49-60 DOI: 10.1016/j.maturitas.2021.05.008 
3. Bandyopadhyay M. (2021) Gestational diabetes mellitus: a qualitative study of lived experiences of South Asian immigrant women and perspectives of their health care providers in Melbourne, Australia. BMC Pregnancy Childbirth. 21, 500. DOI: 10.1186/s12884-021-03981-5 
4. Stanzel K, Hammarberg K, Nguyen T & Fisher J (2020) ‘They should come forward with the information’: menopause‐related health literacy and health care experiences among Vietnamese‐born women in Melbourne, Australia. Ethnicity & Health. 31():1-16. DOI:10.1080/13557858.2020.1740176. 
5. Stanzel K, Hammarberg K & Fisher J (2020) Not everybody is an internet person’: barriers for menopause‐related health literacy among immigrant women from the Horn of Africa nations. Health Promotion Journal of Australia. 32(S1):61-68. DOI:10.1002/hpja.326. 
6. Stanzel K, Hammarberg K & Fisher J (2019) Primary health care providers’ attitudes and beliefs about the menopause‐related health care needs of women who have migrated from low‐ and middle‐income countries to Australia. Australian Journal of Primary Health. 26(1):88-94. DOI:10.1071/PY19132. 
7. Stanzel K, Hammarberg K & Fisher J (2018) Experiences of menopause, self‐management strategies for menopausal symptoms and perceptions of health care among immigrant women: a systematic review. Climacteric. 21(2):101-110. DOI: 10.1080/13697137.2017.1421922.