General description of the good practice:
Australia is one of the most culturally diverse populations in the world with more than one-quarter (26%) of Australians born overseas, and 19% born in countries where English is not the first language (Australian Bureau of Statistics, 2017). There is a disproportionate burden of disease among ethnic groups in Australia with considerable variability depending on country of origin (Anikeeva et al., 2015). Migration from a low-middle income country to an industrialised high-income country has a known detrimental impact on health (Alidu & Grunfeld, 2018). Forced migrants or refugees can experience higher risks of physical and psychological factors that could have negative health impacts (Odone, McKee, & McKee, 2018).
ECCQ’s Healthy Multicultural Lifestyle Program offers group based eight-week health education programs on chronic disease prevention and management using culturally tailored and translated resources. Programs are delivered by trained bilingual multicultural health workers. An independent evaluation concluded the program is effective in improving knowledge, confidence and food and physical activity behaviours among participants.
Main activities of the good practice:
In the 2017/2018 financial year, ECCQ delivered 24 programs reaching a total of 306 participants.
The program was developed using best-practice principles. It incorporated tailored resources developed in partnership with communities around identified topics (healthy eating, physical activity, chronic disease prevention and self-management, alcohol consumption and smoking cessation). The program was delivered by trained Multicultural Health Workers from each community and utilises a self-management framework and adult learning principles to facilitate behaviour-change, and promote health and wellbeing.
Communities targeted in the program included Afghani, Arabic-speaking, Burmese, Pacific and South Sea Islander, Sri Lankan, Sudanese, and Vietnamese. These groups were selected based on identified need and to ensure a mix of established and emerging communities.
Results of the good practice:
A program evaluation conducted by Queensland University of Technology showed:
- Participant knowledge scores increased significantly from 1.7 points at baseline to 5.2 points at week 8.
- Participants’ confidence of reducing their risk of getting a chronic disease with average scores increasing from 5.1 at baseline to 7.4 at week 8.
- Participants’ confidence in managing a chronic condition increased from 5.2 at baseline to 7.5 at week 8.
- The proportion of participants who met the physical activity recommendation of doing at least 150 minutes of moderate to vigorous physical activity per week increased from 58.5% at baseline to 77.8% at week 8.
- Proportion of participants having at least 2 servings of fruit per day increased from 52% to 75.4% at week 8.
- Percentage of participants who increased their vegetable consumption by at least one serving was 63.2% at week 8 and 85% at week 20 compared to baseline.
- At week 8, the decrease on average was 1kg for weight, 0.37 points for BMI, 0.8cm for waist, <0.01 for WHtR, 1.5mmHg and 1.9mmHg for diastolic and systolic blood pressure.
Participants were able to sustain these changes 3 months after completing the program. The program showed to be successful in assisting participants with health lifestyle choices within Australia. Participants are also given assistance with navigating the Australian healthcare system, healthy recipes, buying ingredients, connecting to social and physical activities and general health support.
Challenges in implementing the good practice and how they are being addressed:
Delivering a healthy lifestyle program to culturally and linguistically diverse people is challenging due to the specific disease risks for each group.
Studies have shown that chronic disease risks, particularly cardiometabolic risks are different within and between ethnic groups. The differences in risk between groups are thought to be due to differences in body composition and other genetic factors. Socioeconomic status, unhealthy environments, raised stress levels (including related to bias and racism), consumption of unhealthy diets, low levels of physical activity, smoking, unsafe alcohol consumption, and poor access to health care may explain within and between group differences (Eastwood et al., 2015; El Masri, Kolt, Astell-Burt, & George, 2017; Sanou et al., 2014).
With this in mind, the 8-week program is tailored to fit the needs of each cultural group. It is often delivered in a community language and involves specific food/ingredient choices and social and physical activities. The program is also tailored to the specific needs of current participants. ECCQ is meeting this challenge through a team of trained Multicultural Health Workers who are from the same ethnic background as the participants.