Consideration of CALD factors

7.13 Healthcare providers should consider the cultural and linguistic background of the person with aphasia, their family, and their community

Reference: Centeno et al., 2021: Book chapter; Federation of Ethnic Communities’ Councils Australia, 2020: Access and Equity Report; Holland & Penn, 1995: Book chapter; Legg & Penn, 2013: Qualitative study; Siyambalapitiya & Davidson, 2015: Discussion paper; SPA, 2023a: Position statement; WHO, 2001: WHO Framework

NHMRC level of Evidence: Qual.

Rationale: Cultural and linguistic factors that may impact service delivery include language(s) and/or dialect(s) spoken at home or in the community, ethnic background, nationality, dress, traditions, food, societal structures, art, and religious and spiritual beliefs (Ethnic Communities Council of Victoria, 2012). True person-centred care therefore requires a holistic approach, which is considerate of these factors, as well as other factors related to a client’s background or journey, such as their country of birth, path to Australia, socio-political history of their previous country, possible refugee status, the possibility of trauma, and level of acculturation. Another factor is citizenship/residency status, which impacts on access to services such as Medicare and health insurance, as well as contributing to experiences of stress (Federation of Ethnic Communities’ Councils Australia, 2020).

Speech pathologists should also be mindful of social determinants of health (e.g., access to healthcare, education, and social inclusion; WHO, 2001) and how these may affect people with aphasia from CALD backgrounds specifically. This in turn requires speech pathologists to familiarise themselves with a person’s (cultural) norms and background (Centeno et al., 2021), and engage in critical reflection and evaluation of one’s own (un)conscious biases (SPA, 2023a). Attitudes and traditional beliefs towards healthcare, aphasia and the rehabilitation process, may differ both across different cultural or ethnic groups, and also between members of the same cultural or ethnic group, and should therefore be considered on an individual basis (Centeno et al., 2021; Legg & Penn, 2013; Siyambalapitiya & Davidson, 2015). As such, the typical methods and materials used for assessment, intervention, and education may not be suitable for all individuals in a diverse society (Holland & Penn, 1995). 

Healthcare providers should consider the following:

●       Who in the family/community is the decision maker?
●       How do families/communities make decisions on behalf of individual community members?
●       How do individuals/families/communities engage with illness/healthcare?
●       How do individuals/families/communities navigate the healthcare system (which may conflict with their cultural values)?

For reasons of linguistic diversity, assessment norms in one language cannot simply be transferred to a different language/dialect. Cultural diversity may also impact relevance and/or recognition of images and concepts presented in assessments developed in Western contexts. Speech pathologists may therefore need to use their own discretion when interpreting test results in a different language/dialect (Centeno et al., 2021) – see also statements 7.10 and 7.16. Similarly, certain therapy approaches or methods may not align with characteristics and features of a client’s language (e.g., some languages may not use passive constructions to the same extent as English; Centeno et al., 2021). Speech pathologists are encouraged to liaise closely with qualified interpreters – see statements 7.7 and 7.14.

 References:

1. Centeno, J.G., Ghazi-Saidi, L., & Ansaldo, A.I. (2021). Aphasia management in ethnoracially diverse multilingual populations. In I. Papathanasiou & P. Coppens (Eds.), Aphasia and related neurogenic communication disorders (pp 379-402). Jones & Bartlett Learning.

2. Federation of Ethnic Communities’ Councils Australia (2020). Multicultural Access and Equity Report 2020. Retrieved from: https://fecca.org.au/wp-content/uploads/2021/02/FECCA-Access-and-Equity-Report-2020.pdf

3. Holland, A., & Penn, C. (1995). Inventing therapy for aphasia. . In L. K. O. M. O. C. L. Mennm, A. Holland (Ed.), Non-fluent aphasia in a multilingual world (pp. 144-155). Amsterdam: John Benjamins.

4. Legg, C., & Penn, C. (2013). A stroke of misfortune: Cultural interpretations of aphasia in South Africa. Aphasiology, 27(2), 126-144. doi: 10.1080/02687038.2012.684338

5. Siyambalapitiya, S. & Davidson, B. (2015). Managing aphasia in bilingual and culturally and linguistically diverse individuals in an Australian context: Challenges and future directions. Journal of Clinical Practice in Speech-Language Pathology, 17(11).

6. Speech Pathology Australia (2023a). Anti-racism position statement. Retrieved from: https://www.speechpathologyaustralia.org.au/Public/libraryviewer?ResourceID=54

7. World Health Organization. (2001). International Classification of Functioning, Disability and Health (ICF). Geneva: World Health Organization