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
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
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
ACKNOWLEDGEMENTS                                                                                                                  CONTENTS

This research, conducted by Social Equity Works, has
                                                           Rosanna Barbero from Addison Road Community
been commissioned by the New South Wales Council                                                                     iii   ACKNOWLEDGEMENTS
of Social Service (NCOSS) and funded by NSW Ministry       Centre, Marrickville
of Health.                                                 Romana Waseem from Canterbury City
                                                                                                                     1     EXECUTIVE SUMMARY
The research team would like to thank the                  Community Centre (4Cs), Lakemba
following services who helped to set up the focus
groups. The research team is indebted to these ser-        Marg Couch, Senior Project Officer,
                                                           Regional Development Australia (RDA)-Riverina             5     RECOMMENDATIONS
vices, who opened their doors to the research team in
a short time frame between May and June 2021 and,
                                                           Joanne Fitzpatrick from Griffith Women on Fire, Grif-
in particular, collaborated on the facilitation of focus                                                             6     RESEARCH SUMMARY INFOGRAPHIC
                                                           fith Community Centre, Griffith
groups with their community members including sup-
porting the team with spoken and written translation       Randa Goriya from the NSW Chaldean League,
and bilingual facilitation.                                Mt Druitt TAFE Campus, Mt Druitt                          8     INTRODUCTION

                                                           Khalid Zainulabdeen from Red Cross NSW/ACT, Wol-
                                                           longong                                                   9     METHODOLOGY
                                                                                                                           Recruitment for the focus groups 9
                                                           Sivaharani (Harani) Mayuran from STARTTS
                                                           delivered at Toongabbie Community Centre,                       A word about the research design 11
                                                           Toongabbie                                                      Demographics of research participants  11
                                                           Sree VithyaHarilingam, Wilma Garguath and Zaid
                                                           Naoum from SydWest Multicultural                          14    FINDINGS
                                                           Community Services, Mt Druitt and Blacktown
                                                                                                                           Having the vaccine or not 14
                                                           Sofia Lema and John Paul Troiani from Illawarra                 Reasons for having the vaccine 17
                                                           Shoalhaven Local Health District, Wollongong delivered
                                                           at the Warrawong Community Centre                               Reasons for not having the vaccine 18
                                                                                                                           Vaccine refusal 20
                                                           Leissa Pitts Manager, ISLHD Multicultural Health and
                                                           Refugee Health Service                                          Other factors considered 21
                                                                                                                           Knowing someone who has been
                                                           Talei Vulatha Community Resilience Project                      vaccinated 22
                                                           Officer Multicultural Communities Council Illawarra
                                                                                                                           Knowing someone who has had
                                                           We would especially like to thank the 167 people who            COVID-19 23
                                                           participated in our focus groups, all of whom were              Knowing where to get vaccinated 24
                                                           generous with their time and passionate, clear and
                                                           fearless in the feedback they provided to the research-         Sources of information about COVID-19
                                                           ers about the COVID-19 vaccine.                                 and the vaccine 25

                                                                                                                     29    DISCUSSION

AUTHORS NOTE                                               RESEARCH TEAM
                                                                                                                     35    ATTACHMENTS
This report has been written by Robin Miles,               Project Lead
                                                           Robin Miles                                                     ATTACHMENT 1:
Lindy Cassidy, and Audrey Bennett with input to the
                                                           Qualitative Research Team                                       A Description of the Focus Groups  35
content and recommendations from
Dr Camilla Couch and Patricia McCormick.                   Dr Camilla Couch
                                                           Patricia McCormick                                              ATTACHMENT 2:
                                                           Lindy Cassidy                                                   COVID-19 Vaccine Information in multiple
                                                           Expert Multicultural Advisor                                    languages 39
                                                           Paula Abood
                                                           Research Assistant
                                                           Audrey Bennett

                                                           REPORT DESIGN
                                                           Cath Appleton Design
i
Issues, barriers and perceptions about the COVID-19 vaccine among culturally and linguistically diverse communities in NSW
EXECUTIVE SUMMARY

                                                                                             This research was conducted between late April and early June 2021 just prior to the
FIGURES                                       TABLES
                                                                                             most recent outbreak in Sydney of the Delta variant of COVID-19. Many participants
10   Figure 1:                                10   Table 1:
     Country of Birth                              Focus Group Details                       in our study, who were unwilling or hesitant to be vaccinated, expressed the opinion
11   Figure 2:                                15   Table 2:                                  that COVID-19 was not a ‘real and present danger’ in Australia due to the very low
     Language spoken at home                       People in the sample already vaccinated
                                                                                             case numbers active at the time.
12   Figure 3:                                15   Table 3:
     Length of time living in Australia            Vaccine refusal and hesitancy in the
                                                   sample                                    Australia has been very successful in stemming
12   Figure 4:
     Age                                      20   Table 4:                                  the spread of the virus through a combination of
                                                   Vaccine refusal by country of birth and   border closures, quarantine, a first-world health
13   Figure 5:
                                                   language background                       system and expert contact tracing.                        58% of people in our
     Gender
                                              21   Table 5:                                                                                            sample reported that
14   Figure 6:                                                                               It is possible that, were this research conducted         they would be having
                                                   Reasons for not having the vaccine
     Are you going to get the COVID-19                                                       today, this hesitancy would be reduced due to the
     vaccine?                                 22   Table 6:                                                                                            the vaccine.
                                                                                             heightened risk of contracting COVID-19 through
                                                   Who do you know who has been                                                                        This included 13
15   Figure 7:
                                                   vaccinated?                               the more transmissible Delta variant and its pres-
     COVID-19 Vaccine intention of                                                           ence in the community.                                    people (6.4%) who
     respondents by age category                                                                                                                       had already been
                                                                                             Regardless, the need for vaccine take-up among            vaccinated, in most
16   Figure 8:
     Respondents COVID-19 Vaccine intention                                                  CALD communities remains high given they can              cases having had
     by Country of Origin                                                                    be at increased risk due to factors such as in-           their first
17   Figure 9:                                                                               secure high-risk employment and living in high            vaccination only.
     Reasons for getting vaccinated against                                                  density households; and to ensure equitable
     COVID-19                                                                                public health outcomes and social, economic and
18   Figure 10:                                                                              community participation for everyone.
     Reasons for not getting vaccinated                                                      This was a small study of 199 people (our sam-
     against COVID-19
                                                                                             ple), drawn from culturally-diverse communities
22   Figure 11:                                                                              in metropolitan Sydney and two regional NSW lo-
     Do you know someone who has been                                                                                                                  42% reported that
                                                                                             cations. Community members were asked survey
     vaccinated?                                                                                                                                       they were unsure or
                                                                                             questions either online or through focus groups.
23   Figure 12:                                                                                                                                        were not planning to
                                                                                             Separate information was also collected from
     Knowing someone who has had                                                                                                                       have the vaccine.
     COVID-19
                                                                                             intermediary organisations working with CALD
                                                                                             communities (via a second survey).                        Of these, 29% were
24   Figure 13:                                                                                                                                        unsure or hesitant.
     Who do you know who has had                                                             The study’s purpose was to understand issues,
     COVID-19?                                                                               barriers and perceptions in relation to the COV-
25   Figure 14:                                                                              ID-19 vaccine among NSW’s many culturally and
     Where to go to get vaccinated                                                           linguistically diverse (CALD) communities. As
25   Figure 15:                                                                              such, it presents a grassroots perspective. Key
                                                                                                                                                       13% reported that
     Sources of information about COVID-19                                                   findings are presented below.
     and the COVID-19 vaccine                                                                                                                          they would not have
                                                                                                                                                       the vaccine.
27   Figure 16:                                                                              CALD communities have mixed
     Sources of information for respondents
     who were planning to have the vaccine
                                                                                             responses to the vaccine                             This compares closely to recent data published
                                                                                             Like the general population, our study highlights    by The Age and Sydney Morning Herald that sug-
27   Figure 17:
     Sources of information for respondents                                                  that NSW residents from CALD backgrounds are         gests ‘about a third of Australians are hesitant
     who are not planning to have the                                                        mixed in their responses to, and confidence in       about getting a COVID-19 vaccine.’1
     vaccine                                                                                 having, the COVID-19 vaccine.
28   Figure 18:                                                                                                                                   1
                                                                                                                                                   Stephen Duckett. Too many Australians are hesitant to get
     Sources of information for respondents                                                                                                       vaccinated. Here’s how we fix it.  Sydney
     who ‘don’t know’ if they will have the                                                                                                       Morning Herald, May 19, 2021.
     vaccine

                                                                                                                                                                                                               1
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 CALD communities in NSW
                                                                                                                            EXECUTIVE SUMMARY

A range of factors appear to                              ■ Lack of certainty about how the vaccine works       ■ Resources available on websites often rely
influence attitudes                                       ■ Concerns that the vaccine will make you sick          on a high level of English language literacy or
                                                             or change your DNA                                   literacy in a person’s first language
Older people (65+) in the survey sample were the
                                                          ■ Concern that the vaccine is a form of               ■ The importance of tailoring messaging to
age group most likely to report they had had or
                                                             government control                                   those with lower levels of health literacy who
were intending to have the vaccine, while young-
                                                                                                                  are more likely to endorse misinformed beliefs
er people (18-24) were most likely to express             ■ A belief that if you are healthy, it is better to
                                                                                                                  about COVID-19 and vaccination
uncertainty or hesitancy.                                    fight the virus and make yourself and your
                                                             immune system ‘stronger’ as a result.              ■ Mass media campaigns should be utilised,
Country of birth also showed up as a possible                                                                     but supplemented by decentralised
indicator for being ‘positively pre-disposed’ to-         Only a small number of people in the survey
                                                                                                                  communication strategies that tap into local
wards vaccination and would be worthy of further          sample reported that religious or cultural reasons
                                                                                                                  support networks
research.                                                 were a barrier to having the vaccine.
                                                                                                                ■ The need to convey information in a way
Knowing someone who had had the virus or been                                                                     that is meaningful to people, using trusted
vaccinated didn’t appear to make respondents
                                                          Public health information can be
                                                                                                                  community sources and multiple channels to
more likely to get the vaccine themselves.                confusing                                               reinforce messages.
The most frequently cited reasons for getting the         The focus groups highlighted that conflicting
vaccine were a mix of personal safety (‘keeping           pub-lic messaging, overly-complex information         Drawing on motivational factors
family/self-safe’), altruistic reasons (‘for public       (even when translated), or not enough targeted        is key
health’ and ‘it is the right thing to do’), and the       information were factors in vaccine hesitancy,
                                                                                                                On closer inspection, the results of our study
more motivational reason ‘to travel’.                     with comments including:
                                                                                                                suggest that vaccine hesitancy is perhaps better
Across CALD communities there is a good level                                                                   understood as low motivation – or a ‘wait and
of practical knowledge, but still some uncertainty               Nobody knows what                              see’ approach. Many participants said that they
about where to access vaccinations                            to do. My GP doesn’t even                         would consider having the vaccine if there was
                                                                know what I should do,                          ‘more of a reason’ to do so.
Focus group participants generally indicated                       whether I should
familiarity with the 2 types of vaccines available                                                              Reasons given by participants that would moti-
                                                                     have it or not
and the risks associated with each, particularly re-                                                            vate them to get vaccinated included:
garding Astra Zeneca – although this was notably
not the case for a group of newly-arrived
                                                                                     They say one thing            If I was able to
refugees who had little or no knowledge of
                                                                                    and then they tell you        travel to see my
vaccinations for the virus.
                                                                                   something else….it (the              family.
Over 80% of respondents knew where to go to                                           vaccine rollout) is                                    If there was more
get vaccinated including GPs, the vaccination hub                                       so confusing                                       risk from COVID-19 –
for Sydney residents and local hospitals. Howev-                                                                                           another outbreak or
er, a concerning 19% reported that they did not                                                                                                concern about
know where to get vaccinated.                                                                                                                     increased
                                                                                                                                                transmission.
Fears and concerns about vaccinations                                                                              If I had to in order to
remain                                                                                                                   keep my job.
Despite high rates of knowledge about COVID-19
across our study sample, a range of concerns and
                                                                                                                Many participants, even some who were the most
misconceptions – shared with the wider popula-
                                                                                                                vaccine hesitant, said that if being fully vaccinat-
tion – were evident. These included:
                                                                                                                ed meant the difference between being able to
■ Fear about blood clots caused by the Astra                                                                    travel overseas to visit family or not, they would
  Zeneca vaccine                                                                                                definitely roll up their sleeves and get ‘the jab.’
■ Fear about the perceived lack of ‘proper’
  testing of the vaccine prior to rollout

2                                                                                                                                                                  33
Issues, barriers and perceptions about the COVID-19 vaccine among culturally and linguistically diverse communities in NSW
RECOMMENDATIONS
Issues, barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW

                                                          Again, this aligns with other research which         This research is intended to provide a useful,         long-standing trust and strong relationships that
            If I could get home to                        emphasises the importance of building motiva-        grassroots perspective, from a range of CALD           exist between local, place-based services and the
         see my mother, I would get                       tional and ‘pull’ factors into the vaccine rollout   communities across NSW, on issues, barriers and        communities they work with – close connections
               vaccinated today!                          strategy and accompanying messaging, in order        perceptions concerning the COVID-19 vaccine. It        that should be utilised to advance public health
                                                          to increase vaccine uptake among CALD com-           is hoped that these findings contribute to a grow-     outcomes.
                                                          munities. Involving communities in the process,      ing body of knowledge regarding COVID-related
                                                                                                                                                                      In this context, it is recommended that NSW
                                                          understanding concerns and motivational factors,     issues for NSW’s culturally-diverse communities.
                                                                                                                                                                      Health, in partnership with Multicultural NSW,
                                                          building trust and testing messaging have been
                                                                                                               The research has highlighted that reinforcing the      CALD peak bodies and community leaders, use
                                                          identified as key.
                                                                                                               benefits of being vaccinated, rather than dwelling     this research to inform ongoing efforts to encour-
                                                                                                               on the risks, is more likely to generate behavioural   age uptake of the COVID-19 vaccine among CALD
                                                                                                               change and a positive vaccine response from both       communities. The findings indicate that these
                                                                                                               CALD communities and the general population.           efforts could be supported by:
                                                                                                               It also reminds us of the immense value of the

                                                                                                                 1          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

                                                                                                                 2          strategies to ensure community involvement in, and ownership of,
                                                                                                                            any campaigns with trusted sources such as local community leaders
                                                                                                                            and peer champions

                                                                                                                 3          tailored, targeted messaging across multiple platforms and
                                                                                                                            channels, available in easy-to-read format for English and translated
                                                                                                                            versions

                                                                                                                 4          supporting health care professionals in their role as educators and
                                                                                                                            leveraging successful local programs that increase COVID-19 vaccine
                                                                                                                            literacy and informed decision making

                                                                                                                 5          further research to understand concerns, misconceptions and
                                                                                                                            motivations of priority groups.

Mother’s Group at SydWest Multicultural Community Services, Blacktown

4                                                                                                                                                                                                                      55
Issues, barriers and perceptions about the COVID-19 vaccine among culturally and linguistically diverse communities in NSW
2

                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 CALD communities in NSW

           199 s
       participan
                 t                                                                                = 2 people                                                         More          Influence of
            11                                                                                                                                                       likely to     friends and
                  ps
       focus grou                                                                                                                                                   get the       family overseas
                                                                                                                                                                     vaccine       Almost half of the participants
       This small study of 199                                                                                                                                                     knew someone who had
      people from a range of                                                                                                                                       +65 age group   contracted COVID-19 over-
      cultural backgrounds in                                                                                         FEARS &                                                      seas. Many people spoke
   metropolitan Sydney and                                                                             58%           CONCERNS                                                      about the impact of COVID-19
                                                                                                       said yes to                                                                 on their immediate family
        two regional locations                                                                        the vaccine    about the                                                    including some who had lost
  found that the community
                                                                                                       with 6.4%
                                                                                                                       vaccine                                                     loved ones.
    is divided in its response                                                                                                        Fear about
     to both the safety, need                                                                          previously                     blood clots
            and efficacy of the
                                                                                                       vaccinated                   caused by the            HEALTH
                       vaccine.                                                                                                      Astra Zeneca
                                                                                                                                        vaccine              INFO
                                                                                                                       Fear about
                                                                                                                      the perceived
                                                                                                                     lack of ‘proper’
                                                                                                                      testing of the      Lack of
                                                                                                                         vaccine         certainty
                                                                                                      29%
                                                                                                                                        about how
                                                                                                      were
                                                                                                                                        the vaccine
                                                                                                     unsure or                           worked       Health information from
          s not                                                                                       hesitant
   Covid i esent
                                                                                                                           Concerns                    online sources (low use
        d pr                                                                                                          that the vaccine                of government websites)
 real an I would                                                                                                        will make you
        but
danger inated if
                                                                                                                        sick or change                 Facebook
          c                                                                                                                your DNA
  get vac as a                                                                                                                                         WhatsApp
     there w o.                                                                                                                         Concern
              to
      reason
                                                                                                                                    that the vaccine
                                                                                                                                                                                                 ld get
                                                                                                                                                       WeChat
                                                                                                                                      is a form of                                        I co u
                                                                                                      13%                             government                                   ... if        see m
                                                                                                                                                                                                        y
                                                                                                                                                       Main stream media                   e to
                                                                                                      reported                           control                                   hom , I would
                                                                                                                             A belief                                                        er
                                                                                                     that they                                                                      moth cinated
I would get                                                                                           would not
                                                                                                      have the
                                                                                                                        that if you were
                                                                                                                     healthy, it was better
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                                                                                                                                                       Younger group                            c
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                                                                                                                                                                                              tod
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  6                                                                                                                                                                                                         7
Issues, barriers and perceptions about the COVID-19 vaccine among culturally and linguistically diverse communities in NSW
INTRODUCTION                                                                                                                                                                                 METHODOLOGY
Issues, barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW

This research project has been commissioned by the New South Wales Council of                                                     A mixed-method research methodology was used for this project. However, it
Social Service (NCOSS) to look at issues, concerns, attitudes and barriers to receiving                                           was primarily a qualitative approach that aimed to hear directly from people in
the COVID-19 vaccine in culturally and linguistically diverse (CALD) communities in                                               the community from culturally and linguistically diverse (CALD) backgrounds. The
NSW.                                                                                                                              methodology involved:
The research was conducted over two months                        Emerging research indicates that misconceptions
                                                                                                                                  ■ 11 focus groups (including one pilot) involving   ■ A second online survey was designed to elicit
from late April to late June 2021 with data col-                  about COVID-19 in Australia tend to be more
                                                                                                                                    a total of 167 participants from CALD                 the views and experience of the intermediary
lected just prior to the latest COVID-19 outbreak                 common in groups with lower levels of health
                                                                                                                                    backgrounds and 7 locations: Griffith (1),            organisations in their work with CALD
in Sydney. It was undertaken with some urgency                    literacy, including people who speak a language
                                                                                                                                    Wollongong (2), Blacktown (2), Lakemba (1),           communities. It generated eight responses.
given the following factors:                                      other than English. In addition, the varied experi-
                                                                                                                                    Mt Druitt (3), Toongabbie (1) and Marrickville    ■ Two interviews were undertaken with a
                                                                  ence of and information about COVID-19 trans-
■ the lack of data concerning people                                                                                                (1). These supported participants to answer           multicultural health communication expert
                                                                  mission and vaccination in overseas countries
  from culturally and linguistically diverse                                                                                        the survey questions and enabled more                 from the Illawarra Shoalhaven Local Health
                                                                  makes this a particularly interesting issue, given
  backgrounds in larger research studies 2                                                                                          detailed exploration of issues and further            District and an Emergency Department
                                                                  that CALD community members may be having
■ the heightened concern in the community                                                                                           gathering of qualitative information (see Table       medical practitioner.
                                                                  regular discussions with relatives overseas and
  about the potential side effects of, in                                                                                           1 below). Identified multicultural
                                                                  getting information about COVID-19 from over-                                                                       ■ The online survey responses from the
  particular, the Astra Zeneca vaccine which                                                                                        and community service organisations with
                                                                  seas sources.                                                                                                           intermediary organisations and the interviews
  has led to a higher-than-usual rate of vaccine                                                                                    connections to CALD communities in the
                                                                                                                                                                                          with health staff have informed analysis of
  hesitancy in the wider community 3                                                                                                relevant locations acted as ‘intermediaries’ by
                                                                                                                                                                                          data from community members, findings and
■ the need to lift the overall vaccination rate in                                                                                  assisting with organising the focus groups,
                                                                                                                                                                                          recommendations.
  Australia.                                                                                                                        providing bilingual facilitation of discussion
                                                                                                                                    and supporting community members to               In addition, the research has been informed by
                                                                                                                                    undertake the survey. More information            other publicly available research, including find-
                                                                                                                                    on the focus groups and intermediary              ings concerning vaccine hesitancy and uptake4,
                                                                                                                                    organisations can be found at Attachment A.       and a scan of multicultural COVID-19 health
                                                                                                                                                                                      resources available in community languages from
                                                                                                                                  ■ An online survey with the same questions
                                                                                                                                                                                      the Commonwealth, NSW and Victorian Govern-
                                                                                                                                    as those used in the focus groups was made
                                                                                                                                                                                      ments, SBS and Ethnolink (see Attachment 2).
                                                                                                                                    available. This was promoted via NCOSS
                                                                                                                                    networks and the research team’s CALD
                                                                                                                                    connections and completed by 32 people. The       Recruitment for the focus groups
                                                                                                                                    total sample size of this study was therefore     Intermediary organisations and focus group
                                                                                                                                    199 participants, made up of members of           participants were recruited using the research
                                                                                                                                    diverse CALD communities.                         team’s extensive connections with multicultural
                                                                                                                                  ■ A bilingual multicultural community               and community service organisations across NSW
                                                                                                                                    engagement expert was engaged throughout          and drawing on key NCOSS member organisa-
                                                                                                                                    the project to advise the research team,          tions providing support to, and with longstanding
                                                                                                                                    including in relation to the design of the        relationships with, CALD communities. To a large
                                                                                                                                    survey. Bilingual facilitators were used for      extent, the selected locations and the services
                                                                                                                                    focus groups where necessary, and guidance        and supports provided by the intermediary organ-
                                                                                                                                    was provided by intermediary organisation         isations determined the cultural backgrounds that
2
  McCaffery KJ, Dodd RH, et al. Health literacy and disparities   3
                                                                   An online survey conducted by Essential Research (April          representatives as required, and in one           were included in the study.
in COVID-19–related knowledge, attitudes, beliefs and             2021) completed by 1090 people between 21–26 April 2021,          instance the survey was translated into Arabic.
behaviours in Australia. Public Health Res Pract.2020;30(4):      found just 43% of Australians think the rollout is being done     Focus group members were each provided
e30342012. December 2020. First published:5 November              efficiently, down from 68% in March… The slow rollout and
2020. ‘There are several limitations to our study. Although       changes to the roadmap also appear to have given rise to          with a $25 gift card at the end of the session
our recruited sample was large and diverse, it was not            vaccine hesitancy, with one in six people (16%) saying they       and a $50 gift card was donated to the
statistically representative of the Australian population.        will never get vaccinated against COVID-19, up from 12% last      intermediary organisation to provide some
The proportion of Australians from non-English speaking           month, while 42% said they will get vaccinated, but not right
backgrounds was small (6%) since the survey was not               away. The proportion of people who would be willing to get
                                                                                                                                    additional resources to each group.
translated and required sufficient English skills to complete     vaccinated as soon as possible, or are already vaccinated,
the questionnaire in English.’ (p. 7)                             also declined, down from 47% to 42%.’ Essential Report
                                                                  (April 2021)
                                                                                                                                                                                      4
                                                                                                                                                                                          https://www.ncoss.org.au/COVID-19-research/

8                                                                                                                                                                                                                                       9
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 CALD communities in NSW
                                                                                                                                                                                                                                           METHODOLOGY

  Service                                             Location                  Group Composition                               Participant
                                                                                                                                  numbers
  Addison Road Community Centre                       Marrickville              Community leaders: -                                     26      A word about the research design
                                                                                Vietnamese, Chinese, Italian,                                    The research was carefully designed, drawing on
                                                                                Greek, Indonesian, Latin
                                                                                                                                                 expert cultural advice on communication pro-
                                                                                American and Portuguese
                                                                                                                                                 cesses and survey design. Focus groups included
                                                                                speakers
                                                                                                                                                 participant consent forms, incentive vouchers and
  Griffith Community Centre                           Griffith                  Indonesian and Pakistani women                               6
                                                                                                                                                 a one-page introduction to the research for the
  Multicultural Communities                           Wollongong                Arabic-speaking group                                       22
                                                                                                                                                 intermediary organisations. Intermediary organ-
  Council Illawarra
                                                                                                                                                 isations and preferred locations were identified
  Multicultural Communities                           Wollongong                Italian older women’s group                                 15
                                                                                                                                                 and agreed in advance with NCOSS.
  Council Illawarra
  Syd West Multicultural Services                     Mt Druitt                 Arabic-speaking group                                       10   The survey was designed in an easy-to-read
  Syd West Multicultural Services                     Blacktown                 Spanish-speaking seniors’ group                             16   format, using simple English. Feedback from
  Syd West Multicultural Services                     Blacktown                 Mothers’ support group: -                                   14   the Spanish-speaking translator was that it was
                                                                                Indian, Sri Lankan, Pakistani and                                extremely easy to translate and complete. Other
                                                                                Ghanaian                                                         groups commented that they found the survey
  Canterbury City Community                           Lakemba                   Pakistani, Indian and Sri Lankan                            14   easy to complete and most groups displayed a
  Centre (4Cs)                                                                  women                                                            solid level of spoken and written English. The
  Chaldean League and Western                         Mt Druitt                 Chaldean group                                              18   research design and conduct also leant heavily on
  Sydney TAFE                                                                                                                                    the expertise of the facilitators and their exten-
  STARTTS - Toongabbie                                Toongabbie                Tamil-speaking group                                        12   sive networks which made delivery in such a short
  Community Centre                                                                                                                               time frame possible. The positive engagement
  Mt Druitt TAFE – TAFE NSW                           Mt Druitt                 Work Opportunities for Women                                14   and support of the intermediary organisations
                                                                                group (mixed CALD backgrounds)                                   was also a factor contributing to the successful
  TOTAL                                                                                                                                 167      conduct of the research.

Table 1: Focus Group Details
Explanatory note: The focus group at Mt Druitt TAFE - comprised predominantly of CALD women
enrolled in a Certificate II entry level course - was used to pilot and refine the focus group process,
with survey responses generated by the group included in the final survey results.

             35
                                  31
             30
                                                                                                                                                          35                                                                                                     32
             25
                                                                                                                                                          30                                                           27
                                                 20
             20                                                                                                                                           25
                                            17                                                                                                                                          21
                                       16
                                                           15
             15                                                                                                                                           20                   17
     Count

                                                                                                                                                  Count
                                                      12
                                                                                                                                                          15   13                                           12
             10                                                     8                                                                                                     10                     11                         10
                                                                                                              7
                          6                                                 6                                                                             10
                                                                                4
                                                                                        5                                 5                                                                                                                          6
             5                3                                                                     3                                                                                                                                    3 2
                                                                                                                                                          5
                  1 1 1                                         1
                                                                        2
                                                                                    1
                                                                                            2
                                                                                                1       1 1
                                                                                                                  2
                                                                                                                      1       1 1 1 1
                                                                                                                                        2
                                                                                                                                             1                      1 2             2        1        1 1        2 1             1 1 1 1     1 2 1       1 1 1
             0                                                                                                                                            0

                                                                                                                                                                    Chinese…
                             Iran
                             Iraq

                           Egypt
                           China

                          Eritrea
                       Thailand

                       Pakistan

                        Sweden
                    Hong Kong

                        Ukraine

                          Poland
                            Chile

                                                                                                                                                                      Telugu

                                                                                                                                                                        Urdu
                                                                                                                                                                    Spanish

                                                                                                                                                                  Chaldean

                                                                                                                                                                       Polish

                                                                                                                                                                   Multiple
                                                                                                                                                                        Farsi
                                                                                                                                                                       Tamil

                                                                                                                                                                    Gujarati

                                                                                                                                                                   Hazaragi
                                                                                                                                                                      Khmer

                                                                                                                                                                    Tigrinya
                                                                                                                                                                      Arabic
                                                                                                                                                                      Italian

                                                                                                                                                                     Persian

                                                                                                                                                                  Mandarin
                                                                                                                                                                  Spanglish

                                                                                                                                                                        Hindi
                                                                                                                                                                     Punjabi
                      Vietnam

                   El Salvador
                      Australia

                            Italy
                      Sri Lanka

                           Syria
                         Bolivia

                      Malaysia

                    Argentina
                    Cambodia

                        Taiwan

                          Japan
                            Peru

                          Sudan

                  Afghanistan
                    Indonesia

                           India

                         Ghana

                      Uruguay

                          Russia

                         Jordan

                                                                                                                                                                    English

                                                                                                                                                                  Japanese
                                                                                                                                                                      Malay
                                                                                                                                                                      Hausa
                                                                                                                                                               Vietnamese

                                                                                                                                                                    Russian

                                                                                                                                                                    Kurdish

                                                                                                                                                                   Swedish
                                                                                                                                                                Cantonese
                                                                                                                                                                        Thai

Figure 1: Country of Birth
                                                                                                                                                 Figure 2: Language spoken at home
10                                                                                                                                                                                                                                                                11
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 CALD communities in NSW
                                                                                                                                                                  METHODOLOGY

       35.00%                                                                                33.16%          90.00%                        84.30%
       30.00%                                                                                                80.00%
                                                                                                             70.00%
       25.00%
                                                                              20.53%                         60.00%
       20.00%                                                   16.84%                                       50.00%
                                   13.16%        14.21%
       15.00%                                                                                                40.00%
       10.00%                                                                                                30.00%
        5.00%                                                                                                20.00%         14.53%
                      2.11%
                                                                                                             10.00%                                                  1.16%
        0.00%                                                                                                                                         0.00%
                    Lessthat
                   Less   than
                             1 1 1-2 years 22-5
                                 - 2 years   - 5 years 5 5-10  years
                                                         - 10 years           10-20
                                                                              10 - 20       More
                                                                                            More than
                                                                                                  than        0.00%
                      1 year
                      year                                                     years         20 years                       Male           Female   Non-binary   Rather not say

Figure 3: Length of time living in Australia                                                             Figure 5: Gender

     25.00%                                                                                   23.56%
                                                       21.47%
     20.00%
                                           17.28%                               16.75%
     15.00%                                                         13.09%

     10.00%                    7.85%

      5.00%
                  0.00%
      0.00%
                 Under 18      18-24        25-34       35-44        45-54       55-64         65+

Figure 4: Age

                                                                                                         Chaldean Focus Group Feedback Sheet

12                                                                                                                                                                                13
FINDINGS                                                                                                                                                                                                              FINDINGS
Issues, barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW

     Research participants were asked:                                                                       13 people (6.5%) had already been vaccinated                75 (42%) indicated a degree of vaccine hesitancy,
                                                                                                             (at least 1 dose)6 with several commenting that             with 24 participants (13%) reporting that they
     If they were intending to get                                                                           they had chosen or needed to be vaccinated for              were not planning on getting vaccinated, while 53
     vaccinated                                                                                              work-related reasons. Others reported that they             (29%) reported they did not know if they would
                                                                                                             had been vaccinated primarily for health reasons,           get vaccinated.
     The reasons why they would, or                                                                          to stay well and make sure that their families
     would not, choose to get vaccinated                                                                     stayed well. They were also concerned about
                                                                                                             public health and safety. One of the women in the                Response                               Count     Percent
     If they knew anyone who had                                                                             Lakemba groups from Sri Lanka was adamant that                   Not planning to have the vaccine       23        13%
                                                                                                             the benefits outweighed the risks, spoke positive-               Unsure about having the vaccine        52        29%
     already been vaccinated, and if so,                                                                     ly about how easy it had been to get the vaccine                                                        75        42%
     who                                                                                                     from her local medical centre and that she had
                                                                                                             experienced no side effects from the vaccination.           Table 3: Respondents who indicated vaccine
     If they knew anyone who had                                                                                                                                                  refusal or hesitancy
     contracted COVID-19 and if so, who
                                                                                                                 Language          Count               Percent           This level of vaccine hesitancy reflects larger stud-
     If they knew where to go to get                                                                             Urdu              1                                     ies in the Australian community. A survey of over
                                                                                                                 Italian           3                                     1,000 participants from across Australia conduct-
     vaccinated                                                                                                  Arabic            2
                                                                                                                                                                         ed in April 2021 by Essential Research found hes-
                                                                                                                 Tamil             3
     What sources they used to get                                                                               Chaldean          1
                                                                                                                                                                         itancy rates of 42%, including 16% who indicated
                                                                                                                                                                         they were never going to get vaccinated.7
     information about the COVID-19                                                                              Spanish           3
                                                                                                                 Total             13                  6.5% of sample    For our survey, responses indicated that age
     vaccination                                          Having the vaccine or not
                                                                                                                                                                         was a factor, with 85% of respondents aged 65
                                                          Of the 199 participants, 117 (58%) reported that   Table 2: Respondents already vaccinated
     Basic demographic information; age,                                                                                                                                 and over reporting that they would have or had
                                                          they were planning to be, or had already been,
     gender, country of origin, language
                                                          vaccinated, while 78 (42%) reported that they
     spoken at home and length of time                    were not planning to have the vaccine (13%) or
     living in Australia.                                 did not know if they would get vaccinated (29%).                  40
                                                                                                                            35
                                                                                                                            30
                                                                                                                            25

                                                                                                                    Count
      90.00%                                84.30%                                                                          20
      80.00%                                                                                                                15
      70.00%                                                                                                                10
      60.00%                                                                                                                 5
      50.00%                                                                                                                 0
      40.00%                                                                                                                      Under         18-24        25-34      35-44          45-54         55-64          65+
      30.00%                                                                                                                       18
      20.00%           14.53%
      10.00%
                                                                                                                                                   Yes           No     Don’t Know
                                                                   0.00%                1.16%
       0.00%
                                                                                                             Figure 7: COVID-19 Vaccine intention of respondents by age category
                        Male                Female             Non-binary          Rather not say
                                                                                                             6
                                                                                                              The researchers did not distinguish between whether         7
                                                                                                                                                                              Essential Research. The Essential Report, 21 April 2021.
                                                                                                             people had received their first and second doses of the
Figure 6: Are you going to get the COVID-19 vaccine?                                                         vaccine i.e., partially or fully vaccinated.

14                                                                                                                                                                                                                                       15
Issues, barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
                                                                                                                                                                                                            FINDINGS

                                                                                                                                                                                          I’m over 65. I have some
already had the vaccine. Those who indicated that         Country of origin also seemed to play a role in        Reasons for having the vaccine
they would not be having the vaccine were fairly          people’s views about having the vaccine, with                                                                                    health issues. I think it’s
evenly distributed across age groups, with young-         high vaccine pre-disposition reported by                                                                                        [having the vaccine] very
er people aged 18-24 being the age group with             Vietnamese respondents to the online survey                           I don’t                                                         important to
                                                                                                                                                                                                  keep safe.
the highest proportion of participants expressing         and women in the Italian-speaking group. While                        want to
uncertainty about having the vaccine. The age             participants from Iraq recorded the highest ‘yes’
group with the second highest level of hesitancy,         response, this was almost matched by Iraqi                              die.
                                                                                                                                                                                  I want to see my family.
proportionate to other categories, were the 35-44         participants who reported that they were                                                                              I usually go every year but
year olds.                                                ‘unsure’ or ‘did not know’ whether they would                                                                          now I haven’t seen them
                                                          have the vaccine. The relevance of country of          Of the 117 participants who reported that they
                                                                                                                 had either already been vaccinated or were plan-                   because of COVID-19.
                                                          origin in this regard would be worthy of further                                                                           Having it will help.
                                                          research.                                              ning to get vaccinated, ‘keeping my family healthy
                                                                                                                 and well’ (82%) and ‘keeping myself healthy and
                                                                                                                 well’ (81%) were the two most popular reasons
                                                                                                                 for having the vaccine. This was followed by ‘for
          16                                                                                                                                                                              I am well but my parents
                                                                                                                 public health’ (70%), ‘it is the right thing to do’
                                                                                                                                                                                         are older. It is important to
          14                                                                                                     (62%), and in order ‘to travel’ (61%). (See Figure
                                                                                                                                                                                               keep them well.
                                                                                                                 9)
          12
          10
  Count

           8
           6
                                                                                                                    90.00%       80.95%      81.90%
           4
                                                                                                                    80.00%                                70.48%
           2
                                                                                                                    70.00%                                             60.95%                    61.90%
           0
                                                                                                                    60.00%
                                                                                                                    50.00%                                                          45.71%
                          Sr rica

                           Au rica

                                     an
                           Pa ina

                                      n
                             an e
                            Am l y

                           Ea yria
                           Vi Iraq
                                     m

                                      a

                                      n
                            Sw lia
                                     ia

                                    en
                                    ka

                             E n
                          gh p

                                   pa
                          h Ita

                                   di

                                  ta
                         er Ira
                                 As

                       Af uro
                                na

                                 ist
                                 ra
                                an

                               Ch
                               ed
                               In
                                 e

                               Af

                               Ja
                       th S

                              kis

                                                                                                                    40.00%
                              st
                             et

                             st
                             iL

                           n

                                                                                                                    30.00%
                       ut

                      st
                    ou
                    So

                   Ea

                                                                                                                    20.00%
                 rS
              he

                                                                                                                    10.00%
           Ot

                                                                                                                                                                                                                0.95%
                                  Yes intention
Figure 8: Respondents COVID-19 Vaccine    No byDon't know
                                                Country of Origin                                                     0.00%
                                                                                                                                To stay To keep my For public          To travel    To work      It is the Something
                                                                                                                              healthy and family     health                                    right thing else (please
                                                                                                                                 well    healthy and                                               to do tell us what)
The Italian focus group held in Wollongong was an         These women were motivated to stay healthy and                                    well
older women’s social group, with all participants         well, keep their family healthy and well, for public
(15) aged above 65 years. Most in fact were aged          health reasons, to be able to travel, and for gen-
over 75 years, with one participant in her 90s.           eral safety. Members of the group also reported        Figure 9: Reasons for getting vaccinated against COVID-19
87% of the group had either been vaccinated (3)           that they wanted to get vaccinated so that they
or were planning to get vaccinated (10).                  would be able to ‘dance’ and ‘socialise’.              Other reasons that people gave for getting vacci-     All but one of the focus groups were familiar with
                                                                                                                 nated included the need to continue working in        the different vaccines currently available in Aus-
                                                                                                                 essential ‘front line’ employment such as security,   tralia, Astra Zeneca and Pfizer. Most participants
             Of course, I will get
                                                                                                                 cleaning and aged care settings. One woman in         were also aware of blood clots being associated
          vaccinated. It is important
                                                                                                                 the Lakemba focus group who had already had           with the Astra Zeneca vaccine. One group of
          to do this. It is a very bad
                                                                                                                 her first dose of the Astra Zeneca vaccine said       newly-arrived refugees in Griffith had not heard
                   disease.
                                                                                                                 that ‘the benefits outweigh the risks’ and, as an     of either the Astra Zeneca or Pfizer vaccines and
                                                                                                                 older woman, ’I do not want to die.’                  had a more limited understanding of the
                                                                                                                                                                       vaccination program in general.

16                                                                                                                                                                                                                        17
Issues, barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
                                                                                                                                                                                                      FINDINGS

                                                                                                                                                                                           I have heard that the
                                                                                                                                                                                              vaccine changes
Reasons for not having the vaccine                                                                              Issues raised in focus groups as contributing to   Specific comments
                                                                                                                increased hesitancy included:                      included:                     your DNA.

             At the moment the                                                                                  ■ Some GPs being hesitant to recommend
         situation is under control                                                                               vaccination                                         They don’t tell you what
          and don’t feel the need.                                                                              ■ The information being provided is conflicting         chemicals are in the
          Also, I have no plans to                        Of the 42% participants who said that they would                                                                   vaccine.
                                                                                                                ■ The information is overly complex and not
        travel in the near future so                      not have, or were hesitant to have, the vaccine,
                                                                                                                  comprehensible, regardless of whether it has
            I don’t see the need.                         48.65% said that they preferred to ‘wait and see’
                                                                                                                  been translated                                                           I am a mother.
                                                          before getting vaccinated.
                                                                                                                ■ The risk of blood clots                                                I am not sure it [the
                                                                                                                ■ Perceptions that the vaccines are generally                             vaccine] is safe for
                                                                                                                  unsafe                                                                    me when I am
                                                                                                                ■ Concerns that some people are dying after                                 breastfeeding.
                                                                                                                  being vaccinated
  60.00%                                                                                                        ■ Not being sure about the risks associated with
                                                                                            48.65%                                                                        If you are young and
  50.00%                                                                                                          having the vaccine and being pregnant or
              35.14%                                                                                              breastfeeding                                        healthy your body has the
  40.00%                                       32.43%
                                                                                                                ■ The perception that there has been a lack of          energy to fight the virus.
  30.00%                            27.03%
                         21.62%                                                                                   testing of the vaccines prior to rollout             You don’t need to have the
                                                          18.92%
  20.00%                                                                                                                                                               vaccine. You should just let
                                                                     8.11%                           10.81%     ■ A lack of understanding of how vaccines work,
  10.00%                                                                         5.41%                                                                                   your body fight it itself.
                                                                                                                  the composition of the vaccines and what
     0.00%                                                                                                        they would do to the body, including making
                The        The      For      I am I don't like   For              For    I want to Something      changes to a person’s DNA.
             vaccine is vaccine is medical scared to vaccines religious         cultural wait and      else
              not well unsafe reasons have the                 reasons          reasons     see      (please
               tested                       vaccine                                                   tell us
                                                                                                      what)

Figure 10: Reasons for not getting vaccinated against COVID-19

The perceived ‘lack of adequate testing’ of the           The discussion in the focus groups about people’s
vaccine and ‘fear of being vaccinated’ also re-           hesitancy to be vaccinated focused on a number
ceived high response rates, selected by 35.14%            of concerns which reflected:
and 32.43% of participants respectively. Only
                                                          ■ poor communication from a number of
13.55% of respondents cited religious or cultural
                                                            trusted sources including GPs and some media
reasons as being behind their vaccine hesitancy.
                                                            sources
Open-ended responses to this question included:           ■ conflicting information about the vaccine from
                                                            health authorities
                  The vaccine is not 100%                 ■ fears about vaccine safety that are shared by
                  working. It cannot offer                  the general community
                     100% protection.                     ■ misconceptions about the effectiveness of,
                                                            and how the vaccines work.

              I will not have it because
                     make me sick.

                                                                                                                Tamil Focus Group Feedback Sheet
18                                                                                                                                                                                                                 19
Issues, barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
                                                                                                                                                                                                         FINDINGS

Confusion about what to do, where to go and                  One woman whose husband worked for a security                                                            People in this category said that they would ‘wait
the health impacts of the vaccine was a common               firm said that her husband had had to be vacci-                                                          and see’ what happens with the wider rollout be-
thread in the conversations around vaccine hesi-             nated in order to keep his job:                                                                          fore making their final decision. This suggests that
tancy.                                                                                                                                                                a proportion of the ‘no’ group are in fact hesitant
                                                                                                                                                                      rather than outright refusing to have the vaccine.
             Nobody knows what to do.                                                                                                                                 There were also fears expressed by focus group
                                                                            He [husband] had to have it.
             My GP doesn’t even know                                                                                                                                  participants about the dangers of being vacci-
                                                                          He didn’t have a choice. He was
             what I should do, whether                                                                                                                                nated. Participants reported being afraid of the
                                                                          fine [no side effects], but I’m not
              I should have it or not.                                   thinking I will have it. I don’t need                                                        health risks especially from blood clots. Some
                                                                           to. I’m a mum, I’m busy. I have                                                            people distinguished clearly between Astra Zene-
                                                                          to look after my children. I don’t                                                          ca and Pfizer in this regard.  However, for many,
                                                                         know how I feel about it, whether                                                            the distinction between the different vaccines
                       I am not sure what to                                     I’m going to have it.                                                                was lost and they spoke of the vaccines generally
                      do. I have spoken to my                                                                                                                         being unsafe and having a range of unwanted side
                     GP, but they can’t tell me                                                                                                                       effects.
                     whether I should have the
                     vaccine or not while I am               In several focus groups the issue of government             The vaccine has been
                            breastfeeding                    control was also raised. A number of people re-          rushed out. It has not been
                                                             ported strongly that they feared that the vaccine             properly tested.
                                                             was ‘a means that the government was using to
           They say one thing                                control people’.
         and then they tell you                                                                                                                Reason for not having the vaccine                 Percent          Count
        something else… it [the                                                                                                                The vaccine is not well tested                     54.55%              12
          vaccine rollout] is so                                                                                                               I want to wait and see                             54.55%              12
               confusing                                                                                                                       The vaccine is unsafe                              36.36%               8
                                                                                                                                               For medical reasons                                31.82%               7
                                                                                                                                               I am scared to have the vaccine                    31.82%               7
                                                                                                                                               I don't like vaccines                              13.64%               3
Vaccine refusal                                    Country of Birth     Language Background           Count                                    For religious reasons                              13.64%               3
                                                   Pakistan             Urdu                          4                                        For cultural reasons                                9.09%               2
                                                   China, Taiwan        Chinese                       4                                        Something else (please tell us what)                9.09%               2
       I never get sick. It is the                                      (Mandarin/Cantonese)
     same for all my family. We                    Sri Lanka, India     Tamil                         3                                      Table 5: Reasons for not having the vaccine
      have always been strong
                                                   Chile                Spanish and English           2
       and healthy so I will be
                                                   Italy                Italian                       2
      saying no to the vaccine.
                                                   Iraq, Syria          Arabic                        2
                                                   Iraq                 Chaldean                      1          Other factors considered
                                                   Iran                 Farsi                         1
                                                                                                                 In addition to the broader questions of why peo-     ■ Knowing someone who had been
Only a small number of participants (24            Greece               Macedonian                    1
                                                                                                                 ple would or would not choose to get vaccinated,       vaccinated
or 13%), said they would not get vacci-            Poland               Polish                        1          the research team used the focus group discus-       ■ Knowing someone who had contracted
nated. Of this group, 21 were women                Pakistan             Punjabi                       1          sions to explore whether the following factors         COVID-19
and 2 were men8. Respondents were                  Sweden               Swedish                       1          had any impact on a person’s likelihood of being
born in ten different countries with a                                                                                                                                ■ Knowing where to go to get vaccinated
                                                   Vietnam              Vietnamese                    1          vaccine pre-disposed or hesitant:
diverse range of language backgrounds.                                                                                                                                ■ The sources people turn to for information
                                                              Table 4: Vaccine refusal by country of birth and                                                          about COVID-19 and COVID-19 vaccines.
                                                                       language background
8
 This reflects the overall sample bias towards women. The
majority of focus group participants were women X with Y
participants being men.

20                                                                                                                                                                                                                     21
Issues, barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
                                                                                                                                                                                                        FINDINGS

                                                                                                                                                                               My friend works
                                                                                                                                                                            as a COVID-19 cleaner
Knowing someone who has been                                                                                  When this issue was teased out further in focus
                                                                                                                                                                            and they all had to [get
vaccinated                                                                                                    group discussions, a range of reasons were
                                                                                                                                                                                 vaccinated].
                                                                                                              revealed including:
Of those who responded to this question 125 or
70% knew someone who had already had the                                                                                               My husband works in
vaccine.                                                                                                                               security and he had                                      My brother in the UK is a
                                                                                                                                            to get it.                                          doctor and he got it and
                                                                                                                                                                                                        his wife.

                                                                                                                  My family overseas have                                  My son needs to travel for
                                                                                                                  already been vaccinated.                                  work so he is getting it.
         80.00%
                              69.83%
         70.00%
         60.00%
         50.00%
         40.00%                                                                                               Knowing someone who has had
         30.00%                                         25.70%                                                COVID-19
         20.00%                                                                                               Almost half of the participants knew someone
                                                                                                              who had contracted COVID-19 overseas. Some
         10.00%                                                                     4.47%                     reported that all the members of their family or
          0.00%                                                                                               many members of their extended family had
                                                                                                              con-tracted COVID-19. In the older Italian group,
                                Yes                        No                   Don't know                    10 of the 15 women knew someone in Italy who
                                                                                                              had contracted COVID-19.
Figure 11: Do you know someone who has been vaccinated?

Among the 125 participants who knew someone                Who                              Count   Percent
who had already been vaccinated, 100 identified            Other family member              41      31.3%
‘immediate family members’ (parents, children,             Sister                           24      18.32%            50.00%            47.16%                    46.59%
siblings and partners). Some focus group partic-           Community member                 23      17.56%
ipants reported that all of their family members                                                                      40.00%
                                                           Brother                          18      13.74%
overseas had been vaccinated. Others reported
                                                           Father                           17      12.98%
that their relatives had been vaccinated as a                                                                         30.00%
                                                           Mother                           16      12.21%
requirement of their employment.
                                                           Work colleague                   14      10.69%
                                                                                                                      20.00%
                                                           Husband or wife                  11      8.4%
                                                           Son or daughter                  10      7.63%             10.00%                                                              6.25%
                                                           Partner                          4       3.05%
                                                           Someone else                     45      34.35%              0.00%
                                                           Total respondents                131                                           Yes                      No                    Not sure

                                                          Table 6: Who do you know who has been
                                                                   vaccinated?

                                                                                                              Figure 12: Knowing someone who has had COVID-19

22                                                                                                                                                                                                                   23
Issues, barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
                                                                                                                                                                                                                                              FINDINGS

         50.00%
                                                        43.59%
         45.00%
         40.00%
         35.00%
         30.00%                  26.92%                                                                                90.00%            79.58%
         25.00%                                               20.51%                                                   80.00%
         20.00%            15.38%                                              14.10%                                  70.00%
         15.00%                                                     10.26%
                                       6.41% 5.13%                                                                     60.00%
         10.00% 3.85% 3.85%                                               3.85%
          5.00%                                    0.00%
                                                                                                                       50.00%
          0.00%                                                                                                        40.00%                                 29.58%
                                                                                                                       30.00%                                                         22.54%
                         r

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                                                                        be
                     he

                                                                        ne

                                                                        be
                      he

                                                                         te

                                                                        gu
                                                                       ht
                    th

                                                                                                                       20.00%
                                                                       w

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                                                                     Sis

                                                                   sw
                   ot

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                                                                   em
                                                                   em

                                                                      a
                  Fa

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                 Br
               M

                                                                                                                                                                                                                                 5.63%
                                                                 P

                                                                m
                                                                m

                                                              ll u
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                                                                                                                       10.00%                                                                            2.82%

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Figure 13: Who do you know who has had COVID-19?                                                               Figure 14: Where to go to get vaccinated

                                                                                                               From the sample (n=199) GPs were the most                                     Sources of information about COVID-19
                                                                                                               commonly identified place to go to get vaccinat-                              and the vaccine
Four people in the focus groups knew someone              Surprisingly, knowing people who had contracted      ed, followed by the vaccine centre at Homebush
                                                                                                               Bay and then hospitals. Other places identified                               The largest single source of information about
who had died of COVID-19.                                 COVID-19 did not seem to influence focus group
                                                                                                               included medical centres and pharmacies.                                      COVID-19 and the vaccine was Facebook (41.7%).
                                                          participants’ predisposition towards either having
                                                          the vaccine or being vaccine hesitant. However,
                                                                                                                                                                                                                                    Facebook. I get my
                All my family back home                   the older Italian women’s group spoke about the
                                                                                                                                                                                                                                     information from
            [Pakistan] got it [COVID-19] but              impact that COVID-19 had had in Italy in the early
                                                                                                                                                                                                                                 Facebook. But if I want to
     they are all fine now, apart from my father.         stages of the pandemic and how this had affected         45.00%                                                                                    41.71%              check it, I watch the news
      He died. But he was really sick before he           them deeply. 13 of the 15 women in this group            40.00%                                                                                             37.14%
                                                                                                                                       34.86%                                       34.29%                                           on 7 [Channel 7].
     got it. He had lots of underlying conditions.        would have, or had already had, the vaccine.             35.00%                                         30.86%
     Medical conditions, so he was really unwell                                                                   30.00%     27.43%                                       26.86%                                              25.71%
     before he got COVID-19. But everyone else,           Knowing where to get vaccinated                          25.00%                                                                    22.29% 22.86%
        they are fine now. They were sick but                                                                      20.00%
                    they got better…                      115 people (81%) who responded to this question          15.00%                       13.14%
                                                                                                                                                         10.86%                                                                         10.86% 9.71%
              If you are well and healthy                 (n=142) knew where to go to get the vaccine. 34          10.00%
                  you can fight this off.                 people (19%) reported that they did not know.             5.00%
                                                          This included 15 respondents from Iraq, 3 re-             0.00%
                                                          spondents from India, 2 respondents from China,

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                                                                                                               Figure 15: Sources of information about COVID-19 and the COVID-19 vaccine

24                                                                                                                                                                                                                                                     25
Issues, barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW
                                                                                                                                                                                                                                       FINDINGS

The second largest source of information for              Italian radio (3 women) and ABC TV (3 women).
people in the sample was ‘other forms of social           Only two women used the internet and none of              45.00%             41.41%
media’ (37%), followed by SBS television (35%),           the women reported using Facebook or social               40.00%                                                                                  37.37%37.37%
my friends (34%) and other television (31%). Oth-         media as a source of their information. Several           35.00%                                        32.32%
er sources of information people reported that            mentioned that they got their information from            30.00% 26.26%                                          28.28%28.28%                                    28.28%
they used were the NSW Health website, nightly            their GP or specialist doctor and one partici-                                                                                  24.24%
                                                                                                                    25.00%
television news including Channel 7, Channel 9            pant said ’I don’t listen to anyone’. In the Span-        20.00%                                                                         18.18%
and Channel 10 followed by the ABC, the Austral-          ish-speaking focus group a comment was made                                           14.14%
                                                                                                                    15.00%                               11.11%                                                                              12.12%
                                                                                                                                                                                                                                    10.10%
ian government health website, their GP, local            that seemed to reflect many of the other focus            10.00%
Medical Centres and the Red Cross.                        group discussions:                                         5.00%
                                                                                                                     0.00%
In the Lakemba focus group, predominantly made
up of women from Pakistan, there was an ani-                              There is so much confusion

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and news. However, if they wanted to ‘fact check’         the group who said they would have the vaccine

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what they were hearing they would watch the               (n=104), there is a shift from Facebook being the
nightly news on Channel 7 or Channel 9 to verify          preferred source of information to ‘SBS TV’ being    Figure 16: Sources of information for respondents who were planning to have the vaccine9
what they perceived could sometimes be unrelia-           the preferred source.  The ‘vaccine-predisposed’
ble sources.                                              group also had the lowest rate of relying on Face-
In the Mt Druitt focus group several of the wom-          book as a source of information about COVID-19,
                                                                                                                    50.00%
en with well-developed digital literacy and gener-        though it was still high. The graph below high-                                                                       42.86%42.86%            42.86%
                                                                                                                    45.00%
al literacy skills used health and fitness websites       lights how other ‘preferred sources’ play out for                                                                                    38.10%
                                                                                                                    40.00%
and social media sites as their source of infor-          those intending to have, or who have already had,                                                            33.33%
                                                          the vaccine.                                              35.00%
mation about ‘all things health related’, including                                                                 30.00%
                                                                                                                              28.57%                          28.57%
COVID-19. These women also spoke positively               For those participants who indicated that they                               23.81%                                                                    23.81%23.81%
                                                                                                                    25.00%
about the information and support they got from           would not, or were not planning to, have the
                                                                                                                    20.00%
the staff at Canterbury Council Community Centre          vaccine, ‘Facebook’, ‘my friends’ and ‘my family’                                                                                                                     14.29%
                                                                                                                    15.00%
(4Cs) who they could rely on to find out things           were the sources of information about COVID-19                                        9.52% 9.52%                                                                              9.52%
                                                                                                                    10.00%
that they identified they needed to know more             that were equally most frequently cited, followed
                                                                                                                     5.00%
about.                                                    closely by ‘my family overseas’. ‘SBS radio’ and
                                                                                                                     0.00%
In the smaller focus group in Griffith with               ‘SBS TV’ as sources of information received the
                                                          lowest mentions from this group. (See Figure 16)

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ledge about where to go to get vaccinated or find         book’ was followed by ‘other social media’ and

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out more about COVID-19 in general. The                   ‘my friends’ as the next most frequent sources.

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community service staff and volunteers present

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                                                          ‘This community service provider’ (the interme-
at the group were working hard to assist these
                                                          diary organisation where the focus group was
women to improve their English language skills

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                                                          conducted) was identified by 26% of respondents

                                                                                                                         So
and support them with translated information.
                                                          as a source of information regardless of their
                                                                                                               Figure 17: Sources of information for respondents who were not planning to have the vaccine
In the older Italian women focus group in Wollon-         intention to get vaccinated or not. The fact that
gong, participants reported getting their infor-          both the ‘vaccine hesitant’ and those who indi-                                                                            9
                                                                                                                                                                                      This group of the research sample included a small number
mation from slightly different sources – family in        cated they wouldn’t be getting the vaccine sought                                                                          of people who had already been vaccinated.
Australia (10 women), Channel 9 (7 women),                information from this source suggests that rolling

26                                                                                                                                                                                                                                                    27
DISCUSSION
Issues, barriers and perceptions about the COVID-19 vaccine among CALD communities in NSW

     60.00%
                                                                                            49.02%
     50.00%
                                                                 43.14%                              41.18%
     40.00%
               31.37%
     30.00%             25.49%                 25.49%                              23.53%
                                                        21.57%                                                21.57%
     20.00%
                                 9.80% 9.80%                              11.76%                                       9.80%
     10.00%                                                                                                                    3.92%
      0.00%

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Figure 18: Sources of information for respondents who ‘don’t know’ if they will have the vaccine

out positive messaging through trusted
community service organisations could be an
effective way of shifting people from vaccine
hesitancy to deciding to have the vaccine.

28                                                                                                                                              29
Issues, barriers
Issues,  barriers and
                  and perceptions
                      perceptions about
                                  about the
                                        the COVID-19
                                            COVID-19 vaccine
                                                     vaccine among
                                                             among CALD
                                                                   CALD communities
                                                                        communities in
                                                                                     in NSW
                                                                                        NSW                                                                                                      DISCUSSION

translated materials and information about the                                                their circumstances. However, the sources of in-                  The Hub has ‘been working in partnership with
vaccines to be tailored to the needs of people in                                             formation that people most rely upon or trust are                 key stakeholder groups to guide communications
these newly-emerging community groups.                                                        critical to the dissemination of accurate and clear               to meet the health literacy, and culturally and
                                                                                              messaging to dispel the fear surrounding events                   linguistically diverse (CALD) needs of its pop-
It was reported that in Wollongong there can
                                                                                              such as blood clotting and the misconceptions                     ulation. Structured working groups have been
sometimes be four generations of family mem-
                                                                                              raised in the focus groups. With so many partici-                 created to prioritise communications to vulner-
bers from newly-arrived refugee groups living in
                                                                                              pants in this study getting their information from                able youth, CALD groups, the elderly, itinerate
the one house. Most of these family members
                                                                                              Facebook and other social media sites, it is vital                workers, asylum seekers and refugees. The aims
generally have limited English language literacy
                                                                                              that these channels are used to promote simple                    are to test messaging and build trust with priority
which increases their risk of not receiving key
                                                                                              positive messages and for any future community                    populations, to ensure effective communication
health messages and, therefore, increasing the
                                                                                              awareness campaigns.                                              of the need to sustain physical distancing meas-
potential impact of COVID-19 - in particular, the
                                                                                                                                                                ures in the absence of a vaccine. Similar efforts
Delta strain which has proven highly infectious
                                                                                              Effective communication                                           are now needed nationally and should start at the
amongst household members.
                                                                                                                                                                time of disease outbreaks in the future, alongside
                                                                                              Confusion and misconceptions about the vac-                       planned mass media and health communication
Vaccine uptake                                                                                cine’s efficacy, availability and safety were all is-             campaigns.’
                                                                                              sues that were raised in the focus groups. Finding
Not dissimilar to the wider community, more                                                                                                                     In the article by Dodd et al. they reinforce the
                                                                                              ways to effectively communicate with people with
people in our study were planning to have the                                                                                                                   importance of using communication formats
                                                                                              lower English language literacy and health literacy
vaccine than not, and a number had already been                                                                                                                 which are ‘suitable for people with low health
                                                                                              is an important way to address the confusion
vaccinated. In a recent Lancet article (February                                                                                                                literacy and education, and which are appropriate
                                                                                              and misconceptions about the vaccine, as has
2021) 'Concerns and motivations about COVID-19                                                                                                                  for culturally and linguistically diverse groups and
                                                                                              been discussed in a number of recent Australian
vaccination', findings from two surveys from an                                                                                                                 Indigenous populations.’ The article argues that it
                                                                                              studies.
Australian longitudinal study conducted in June                                                                                                                 is important to look at motivations and concerns
and July 2020 included that ‘the top three rea-                                               A study14 by McCaffery et al. (2020) concluded                    about vaccines when shaping messaging. It also
sons for agreeing to vaccinate were ‘to protect                                               that there are ‘important disparities in COVID-19-                points out that primary care doctors are a trust-
themselves and others’ … ‘belief in vaccination                                               related knowledge, attitudes and behaviours                       ed source and as such should be supported in
and science’ …and ‘to help stop the virus spread’.                                            according to people’s health literacy and                         delivering information about the vaccines and ad-
Even among those willing to vaccinate there was                                               language.’ One of the findings was that ‘people                   dressing community concerns. The article states,
some hesitancy about the safety of the vaccine.                                               with lower health literacy were also more likely                  ‘We need to understand and address citizen’s
The Lancet article noted that ‘willingness to                                                 to endorse misinformed beliefs about COVID-19                     concerns that can prevent optimal uptake, build
vaccinate differed by both age and education.’ For                                            and vaccinations (in general) than those with                     motivations into messaging, and prioritise public
those who were indifferent or said they would                                                 adequate health literacy. The same pattern of                     trust by informing and involving the community
not get the vaccine the top reasons across the                                                results was observed among people who primar-                     in the process. Supporting health-care profession-
two surveys were ‘concern about the safety of the                                             ily speak a language other than English at home.’                 als in their role as educators will ensure people
vaccine in its development’ and ‘potential side                                               The McCaffery study highlights the importance                     have adequate and accessible information from
effects’.12                                                                                   of tailoring health messages to those with lower                  a trusted source, to optimise vaccine uptake and
                                                                                              health literacy and culturally and linguistically                 ultimately reduce community transmission of
Older people in our study who comprised 23%
                                                                                              diverse communities. It points out that there are                 COVID-19.’15
of the total sample (n=199) were the group most
                                                                                              examples of effective management of diverse
likely to say that they wanted to get the vaccine.                                                                                                              Recent research by Associate Professor Holly
                                                                                              community needs that use tailored health mes-
85% of those over 65 said they would have, or                                                                                                                   Seale16 with UNSW Medicine’s School of Public
                                                                                              sages and cites the Western Sydney Local Health
had already had, the vaccine. Vaccine predispo-                                                                                                                 Health and Deputy Chair for the Collaboration on
                                                                                              District Health Literacy Hub.
sition was, however, also strong across other age                                                                                                               Social Science and Immunisation found there is a
                                                                                                                                                                need to ‘decentralise’ communications by tapping
                                                                                              13
                                                                                                The Essential Report - an online survey conducted by
12
  R H Dodd, K Pickles, B Nickel, E Cvejic, J Ayre, C Batcup, C                                Essential Research completed by 1090 people
Bonner, T Copp, S Cornell, T Dakin, J Isautier, K J McCaffery                                 between 21–26 April.
Concerns and motivations about COVID-19 vaccination
Sydney Health Literacy Lab, Sydney School of Public Health,
                                                                                              14
                                                                                                McCaffery KJ, Dodd RH, Cvejic E, Ayre J, Batcup C, Isautier
                                                                                              JMJ, Copp T, Bonner C, Pickles K, Nickel B, Dakin T, Cornell S,   15
                                                                                                                                                                     Op cit.
Faculty of Medicine and Health, University of Sydney
                                                                                              Wolf MS. Health literacy and disparities in COVID-19–related      16
                                                                                                                                                                   https://sph.med.unsw.edu.au/sites/default/files/sphcm/
published in the Lancet February 2021 p.162 www.thelancet.
                                                                                              knowledge, attitudes, beliefs and behaviours in Australia.        News/Enhancing-supporting-COVID-19-vaccination-program.
com/infection Vol 21 February 2021
                                                                                              Public Health Res Pract.2020;30(4): e30342012. December           pdf
                                                                                              2020.

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