title: Culturally and Linguistically Diverse Populations in Medical Research: Perceptions and Experiences of Older Italians, Their Families, Ethics Administrators and Researchers.
abstract: BACKGROUND
  Low-participation of culturally and linguistically diverse (CALD) patients in medical research remains a problem in migrant and refugee destination countries such as Australia. The aims of this study were to explore i) CALD persons' perceptions and experiences of the medical system and medical research, in this case, older Italian Australians; and ii) the views of research professionals on CALD patient participation in medical research.
  
  
  METHODS
  A qualitative study was conducted in Melbourne, Australia, in 2015 utilising in-depth interviews and focus groups with four stakeholder groups: older Italian Australians (n=21); adult children of older Italian Australians (n=10); hospital Human Research Ethics Committee administrators (n=4); and clinical researchers (n=4). The data were analysed for content and thematic analysis.
  
  
  RESULTS
  Themes for the CALD and family group were getting by in medical interactions; receptivity to medical research: testing the waters; and, receptivity to technology for support: passive versus active. Themes for the researcher and HREC groups about CALD patient participation in research were: exclusion; cultural factors; and e-consent.
  
  
  CONCLUSIONS
  Our findings from four stakeholder perspectives and experiences confirm that there were considerable cultural, linguistic, and resourcing barriers hindering the participation of older Italian-Australians in medical research. Furthermore, our findings showed that in this study setting there were few enabling strategies in place to address these barriers despite the national ethics guidelines for equitable participation in research. The findings informed the creation of a multimedia tool whose purpose is to address and improve representation of CALD groups in clinical research. Significance for public healthMany people from culturally and linguistically diverse (CALD) backgrounds remain excluded from medical research such as clinical trials due to a range of language and cultural factors that can be amplified when this population is ageing. This exclusion has implications for the ability of CALD populations to benefit from participating in medical research and for applying research findings to CALD populations. It is essential to develop and implement strategies to include CALD communities in medical research and to uphold the ethical obligation of obtaining informed consent to research. The findings of this study have guided the development of a tablet-based resource which can be used in clinical and community contexts to raise awareness about the purpose of medical research. The resource has been carefully designed to be appropriate for participants' cultural background as well as their preferred language and literacy level. Such a resource has potential to address some of the cultural and linguistic barriers to clinical trial participation of CALD populations.
authors.affiliation: University of Melbourne , Australia.
authors.forename: Robyn
authors.initials: R
authors.lastname: Woodward-Kron
authors.affiliation: University of Melbourne , Australia.
authors.forename: Jo-Anne
authors.initials: JA
authors.lastname: Hughson
authors.affiliation: University of Melbourne , Australia.
authors.forename: Anna
authors.initials: A
authors.lastname: Parker
authors.affiliation: University of Melbourne , Australia.
authors.forename: Agnese
authors.initials: A
authors.lastname: Bresin
authors.affiliation: University of Melbourne , Australia.
authors.forename: John
authors.initials: J
authors.lastname: Hajek
authors.affiliation: University of Melbourne , Australia.
authors.forename: Ute
authors.initials: U
authors.lastname: Knoch
authors.affiliation: University of Melbourne, Australia; St. Vincent's Hospital, Melbourne, Australia.
authors.forename: Tuong Dien
authors.initials: TD
authors.lastname: Phan
authors.affiliation: University of Melbourne , Australia.
authors.forename: David
authors.initials: D
authors.lastname: Story
keywords: Culturally and linguistically diverse; informed consent; medical research; migrant health; multimedia