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Issues, barriers and percepons about the COVID-19 vaccine among culturally and linguiscally diverse communies in NSW

Issues, barriers and perceptions about the COVID-19

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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)

Facebook

WhatsApp

WeChat

Main stream media

Younger group

Instagram

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)

Facebook

WhatsApp

WeChat

Main stream media

Younger group

Instagram

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)

Facebook

WhatsApp

WeChat

Main stream media

Younger group

Instagram

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)

Facebook

WhatsApp

WeChat

Main stream media

Younger group

Instagram

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)

Facebook

WhatsApp

WeChat

Main stream media

Younger group

Instagram

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)

Facebook

WhatsApp

WeChat

Main stream media

Younger group

Instagram

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)

Facebook

WhatsApp

WeChat

Main stream media

Younger group

Instagram

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

Issues barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW

40