NSW Health aims to provide services that are non-discriminatory and equitable, treating consumers with respect, understanding and compassion.
Healthcare providers should engage in open discussions with consumers about their individual needs and avoid assumptions. When clinically appropriate, a consumer's interest, capacity and access to appropriate devices will determine if virtual care is suitable. Further supports and adjustments may be required for consumers:
- with limited health literacy
- from culturally and linguistically diverse (CALD) backgrounds
- who are isolated, bedbound or homeless
- who are elderly or frail
- living with a disability
- who are post-operative, at risk of falls, have poor or low mobility
- requiring mental health support
- who have complex health needs or challenging behaviours.
Culturally responsive practice
Culturally responsive practice, also known as culturally competent or culturally sensitive practice, refers to an approach in healthcare that acknowledges and respects the cultural beliefs, values, practices, and needs of individuals from diverse backgrounds. It involves tailoring services, communication, and interventions to effectively meet the unique needs of individuals and communities, while promoting equity and reducing disparities.
Culturally responsive practice is essential for providing quality care, improving consumer outcomes, and building trust between healthcare providers and consumers.
A person’s cultural background can affect the way they communicate, make decisions and manage their health. Healthcare professionals must understand how culture impacts the way in which a person understands health, wellbeing, disease and illness.
Cultural responsiveness is important for all priority populations and social and cultural groups, including:
- Aboriginal and Torres Strait Islander peoples
- people from CALD backgrounds
- refugees or displaced migrants
- people at all life stages
- people with different abilities, including intellectual and cognitive disabilities
- lesbian, gay, bisexual, transgender, intersex and queer/questioning (LGBTIQ+) people.
Health staff should regularly review new digital technologies and be aware that not all functionalities will be culturally appropriate, or suitable for the individual. Engage with a cultural advisor or a liaison officer to help you understand if any specific adjustments are required.
Considerations and useful resources
Interpreting services
People who do not speak English as a first language or who are deaf have the right to free, confidential and professional interpreters when they use public health services.
NSW Health Care Interpreting Services provide access to professional interpreting services 24 hours a day, seven days a week. Healthcare interpreters can join consultations in-person or via videoconferencing or telephone. Contact your local Health Care Interpreter Service (HCIS) to book an interpreter.
Translating content
- Incorporating translated materials into healthcare practices is an important step towards achieving health equity, improving consumer outcomes, and fostering a more inclusive healthcare system. A range of translated materials are available on the ACI virtual care web pages.
- The NSW Multicultural Health Communication Service provides an online Appointment Reminder Translation Tool. It allows you to translate appointment details into your consumer's language.
- CALD Assist is an app that supports timely and effective basic care interactions when an interpreter is not available. CALD Assist was designed in collaboration with clinicians, specifically for use by nurses, dietitians, occupational therapists, physiotherapists, podiatrists and speech pathologists. The CALD Assist app is available on the App Store (Apple) or Play Store (Android).
Consumers who are deaf or hard of hearing may use certain tools to help with their communication. Everyone is unique, so ask the consumer how to best communicate with them and avoid making assumptions. This can be done when you:
- face the consumer
- speak clearly
- make and maintain eye contact
- observe body language and be mindful of yours.
A range of techniques and services are available to support the delivery of care for consumers who are deaf or hard of hearing, including:
- AUSLAN interpreters
- lip-reading
- phone-based communication National Relay Service video, chat or sms relay
- voice to text messaging
- smart device applications or phone modifications for accessibility
- the use of transcripts or captions
- written notes.
Relevant online apps are available on the App Store (Apple) or Play Store (Android). Visit the The Deaf Society website for the latest information on the most suitable applications to use.
When caring for Aboriginal people, consider using the ‘Finding your way’ shared decision making model, created with and for mob. It is a holistic, two-way process where Aboriginal people and their healthcare professionals make decisions together.
Below is a summary of key considerations when delivering virtual care to Aboriginal people. These have been adapted from Telehealth Consultations with Aboriginal People for Pain Management.
- Identification: routinely ask whether the person identifies as Aboriginal or Torres Strait Islander. Make a conscious effort to address any barriers that may limit the effectiveness of the consultation.
- Safety: there must be clear and respectful identification of all people involved, and informed consent regarding the intent, process and recommendations.
- Confidentiality: this must be conveyed and assured.
- Respect: address and recognise cultural values and traditions. Use open questions to assess understanding, such as ‘What would improve this for you?’
- Communication: a conversational or ‘yarning’ style may lead to the best outcome.
- Partnerships: recognise and involve appropriate organisations, particularly Aboriginal service providers.
- People and families: a person-centred, and often family-centred, approach will optimise outcomes. Understand the role of community Elders and members.
- Trust and understanding: demonstrate an understanding of racial and economic disadvantage over time that has resulted in mistrust towards government services and systems.
- On Country: if the person is not on Country, this can be a confronting and isolating experience. Effort should be made for care to occur on, or close to, Country.
- Flexibility and timing: offer flexible timings that consider community events and the availability of transport or family and other supports.
- Holistic: health issues should be considered in the broader social, financial, cultural, environmental and emotional context. Spiritual factors are crucial.
People from refugee backgrounds can face multiple challenges in accessing health services, including:
- language and cultural barriers
- lack of familiarity with the Australian healthcare system
- limited trust of health service providers
- limited socioeconomic resources and competing settlement priorities, such as housing, education and employment.
Delivering healthcare to refugee communities in regional NSW is a guide for healthcare workers and their community partners on how to establish trauma-informed and culturally safe health services for refugee communities in regional NSW.
More information is available at NSW Refugee Health Service.
Virtual care has empowered consumers to have more options and choice when it comes to their healthcare experiences.
Inclusive communication with LGBTIQ+ clients provides information and considerations for delivering virtual care.
Trauma-informed services do no harm, i.e. they do not re-traumatise or blame victims for their efforts to manage their traumatic reactions, and they embrace a message of hope and optimism that recovery is possible. In trauma-informed services, trauma survivors are seen as unique individuals who have experienced extremely abnormal situations and have managed as best they could.
Trauma-informed care is based on the understanding that:
- a significant number of people living with mental health conditions have experienced trauma
- trauma may be a factor for people in distress
- the impact of trauma may be lifelong
- trauma can impact the person, their emotions and relationships with others.
Trauma-informed care is an approach to service delivery based on an understanding of the ways trauma affects people’s lives, their service needs and service usage. Adverse childhood experiences, including various forms of child maltreatment, abuse and neglect, have a strong negative impact on health.
NSW Health's What is trauma-informed care? provides key information and resources.
Trauma-informed care and practice in mental health services provides a framework for change, an organisational self-assessment tool and resources to support you to learn more about trauma-informed care.