Remote Australia Online

Secondary education access for remote Northern Territory Indigenous Australian students is limited. Although many students attend boarding schools, few complete Year 12. Whole communities rarely engage in their children's boarding school education and boarding schools seldom engage with Elders to support a child's cultural journey. This article presents research findings from interviews conducted with two adults from a very remote Indigenous community and six staff from a partner Western interstate boarding school community. Using a qualitative methodology with phenomenological design, findings show how students achieve Western educational success whilst maintaining their culture and offer implications, including possible model replication, for other communities.

Aims/hypothesis: Women with gestational diabetes mellitus (GDM) and obesity experience lower rates of breastfeeding. Little is known about breastfeeding among mothers with type 2 diabetes. Australian Indigenous women have a high prevalence of type 2 diabetes in pregnancy. We aimed to evaluate the association of hyperglycaemia, including type 2 diabetes, with breastfeeding outcomes. Methods: Indigenous (n = 495) and non-Indigenous (n = 555) participants of the Pregnancy And Neonatal Diabetes Outcomes in Remote Australia (PANDORA) cohort included women without hyperglycaemia in pregnancy (n = 222), with GDM (n = 684) and with type 2 diabetes (n = 144). The associations of hyperglycaemia in pregnancy and breastfeeding at hospital discharge, 6 weeks and 6 months post-partum were evaluated with logistic regression, after adjustment for maternal obesity, ethnicity, maternal and neonatal characteristics. Results: Indigenous women were more likely to predominantly breastfeed at 6 weeks across all levels of hyperglycaemia. Compared with women with no hyperglycaemia in pregnancy, women with type 2 diabetes had lower odds for exclusive breastfeeding at discharge (adjusted OR for exclusive breastfeeding 0.4 [95% CI 0.2, 0.8] p = 0.006). At 6 weeks and 6 months, the relationship between type 2 diabetes and predominant breastfeeding was not statistically significant (6 weeks 0.7 [0.3, 1.6] p = 0.40, 6 months 0.8 [0.4, 1.6] p = 0.60). Women with gestational diabetes were as likely to achieve predominant breastfeeding at 6 weeks and 6 months as women without hyperglycaemia in pregnancy. Conclusions/interpretation: Indigenous women had high rates of breastfeeding. Women with type 2 diabetes had difficulty establishing exclusive breastfeeding at hospital discharge. Further research is needed to assess the impact on long-term breastfeeding outcomes.

Background: Many women with hyperglycaemia in pregnancy do not receive care during and after pregnancy according to standards recommended in international guidelines. The burden of hyperglycaemia in pregnancy falls disproportionately upon Indigenous peoples worldwide, including Aboriginal and Torres Strait Islander women in Australia. The remote and regional Australian context poses additional barriers to delivering healthcare, including high staff turnover and a socially disadvantaged population with a high prevalence of diabetes. Methods: A complex health systems intervention to improve care for women during and after a pregnancy complicated by hyperglycaemia will be implemented in remote and regional Australia (the Northern Territory and Far North Queensland). The Theoretical Domains Framework was used during formative work with stakeholders to identify intervention components: (1) increasing workforce capacity, skills and knowledge and improving health literacy of health professionals and women; (2) improving access to healthcare through culturally and clinically appropriate pathways; (3) improving information management and communication; (4) enhancing policies and guidelines; (5) embedding use of a clinical register as a quality improvement tool. The intervention will be evaluated utilising the RE-AIM framework at two timepoints: firstly, a qualitative interim evaluation involving interviews with stakeholders (health professionals, champions and project implementers); and subsequently a mixed-methods final evaluation of outcomes and processes: interviews with stakeholders; survey of health professionals; an audit of electronic health records and clinical register; and a review of operational documents. Outcome measures include changes between pre- and post-intervention in: proportion of high risk women receiving recommended glucose screening in early pregnancy; diabetes-related birth outcomes; proportion of women receiving recommended postpartum care including glucose testing; health practitioner confidence in providing care, knowledge and use of relevant guidelines and referral pathways, and perception of care coordination and communication systems; changes to health systems including referral pathways and clinical guidelines. Discussion: This study will provide insights into the impact of health systems changes in improving care for women with hyperglycaemia during and after pregnancy in a challenging setting. It will also provide detailed information on process measures in the implementation of such health system changes.

All educational testing is intended to have consequences, which are assumed to be beneficial, but tests may also have unintended, negative consequences (Messick, 1989). The issue is particularly important in the case of large-scale standardized tests, such as Australia's National Assessment Program - Literacy and Numeracy (NAPLAN), the intended benefits of which are increased accountability and improved educational outcomes. The NAPLAN purpose is comparable to that of other state and national 'core skills' testing programs, which evaluate cross-sections of populations in order to compare results between population sub-groupings. Such comparisons underpin 'accountability' in the era of population-level testing. This study investigates the impact of NAPLAN testing on one population grouping that is prominent in the NAPLAN results' comparisons and public reporting: children in remote Indigenous communities. A series of interviews with principals and teachers documents informants' first-hand experiences of the use and effects of NAPLAN in schools. In the views of most participants, the language and content of the test instruments, the nature of the test engagement, and the test washback have negative impacts on students and staff, with little benefit in terms of the usefulness of the test data. The primary issue is the fact that meaningful participation in the tests depends critically on proficiency in Standard Australian English (SAE) as a first language. This study contributes to the broader discussion of how reform-targeted standardized testing for national populations affects sub-groups who are not treated equitably by the test instrument or reporting for accountability purposes. It highlights a conflict between consequential validity and the notion of accountability that drives reform-targeted testing.

In 2018-19, mainstream discussions about unfair financial services centred on the Royal Commission into Misconduct in the Banking, Superannuation and Financial Services Industry ('Banking Royal Commission'). The Australian Securities and Investments Commission ('ASIC') was embroiled in this 'war', waged mainly in Melbourne courtrooms, and banks have incurred over $10 billion in remediation costs.

This article presents a time sensitive critical text analysis of Australian news reporting that has identified, mapped and analysed news reporting about Indigenous education from 2008 to 2018. Three key themes were identified: school attendance; performance as measured by national testing, and boarding school education. A braiding metaphor is introduced to illustrate how the three themes operated independently over time, intersected and together wove a discursive braid steeped in deficit. The analysis is an act of 'unbraiding' that aims to reveal how news media coverage was integral to constructing Indigenous education as an unquestioned problem for society, a policy problem for governments to solve and an intractable pedagogical conundrum.

Background: Allied health services are core to the improvement in health outcomes for remote and rural residents. Substantial infrastructure has been put into place to facilitate rural work-ready allied health practitioners, yet it is difficult to understand or measure how successful this is and how it is facilitated. Methods: A scoping review and thematic synthesis of the literature using program logic was undertaken to identify and describe the contexts, mechanisms and outcomes of successful models of rural clinical placements for allied health students. This involved all empirical literature examining models of regional, rural and remote clinical placements for allied health students between 1995 and 2019. Results: A total of 292 articles were identified; however, after removal of duplicates and article screening, 18 were included in the final synthesis. Australian papers dominated the evidence base (n = 11). Drivers for rural allied health clinical placements include: attracting allied health students to the rural workforce; increasing the number of allied health clinical placements available; exposing students to and providing skills in rural and interprofessional practice; and improving access to allied health services in rural areas. Depending on the placement model, a number of key mechanisms were identified that facilitated realisation of these drivers and therefore the success of the model. These included: support for students; engagement, consultation and partnership with key stakeholders and organisations; and regional coordination, infrastructure and support. Placement success was measured in terms of student, rural, community and/or program outcomes. Although the strength and quality of the evidence was found to be low, there is a trend for placements to be more successful when the driver for the placement is specifically reflected in the structure of the placement model and outcomes measured. This was seen most effectively in placement models that were driven by the need to meet rural community needs and upskill students in interprofessional rural practice. Conclusion: This study identifies the factors that can be manipulated to ensure more successful models of allied health rural clinical placements and provides an evidence based framework for improved planning and evaluation.

Introduction The Top End of Australia has a high proportion of Indigenous people with a high burden of chronic cardiac and pulmonary diseases likely to contribute to pulmonary hypertension (PH). The epidemiology of PH has not been previously studied in this region. Methods Patients with PH were identified from the Northern Territory echocardiography database from January 2010 to December 2015 and followed to the end of 2019 or death. Pulmonary hypertension was defined as a tricuspid regurgitation velocity ≥2.75 m/s measured by Doppler echocardiography. The aetiology of PH, as categorised by published guidelines, was determined by reviewing electronic health records. Results 1,764 patients were identified comprising 49% males and 45% Indigenous people. The prevalence of PH was 955 per 100,000 population (with corresponding prevalence of 1,587 for Indigenous people). Hypertension, atrial fibrillation, diabetes and respiratory disease were present in 85%, 45%, 41% and 39%, respectively. Left heart disease was the leading cause for PH (58%), the majority suffering from valvular disease (predominantly rheumatic). Pulmonary arterial hypertension (PAH), respiratory disease related PH, chronic thromboembolic PH (CTEPH) and unclear multifactorial PH represented 4%, 16%, 2% and 3%, respectively. Underlying causes were not identifiable in 17% of the patients. Only 31% of potentially eligible patients were on PAH-specific therapy. At census, there was 40% mortality, with major predictors being age, ePASP and Indigenous ethnicity. Conclusion Pulmonary hypertension is prevalent in Northern Australia, with a high frequency of modifiable risk factors and other treatable conditions. Whether earlier diagnosis, interpretation and intervention improve outcomes merits further assessment.

In 2020, young people from remote communities in Australia's Northern Territory are required to attend boarding school in order to access a full secondary education. Commissioned by elders in one Northern Territory remote community, this report investigates the intended and unintended consequences of this policy approach at individual and community level. Working with families, researchers tracked the education histories of 100 young people identified as community members and aged 12-21 years. Findings reveal that for this community, the supply of boarding places is not equal to demand, and that families experience difficulties securing secondary pathways for their children. Members of the research cohort had been dispersed among 38 different schools across 16 cities or towns in every state or territory of mainland Australia. A concerning pattern of early disengagement from education and low levels of academic attainment is apparent, with consequences for youth wellbeing and community cohesion. Findings of the study indicate the need for further systems-level research to test the generalisability of findings across other remote communities. They demonstrate that educational determinants in remote contexts (such as the community in this study) including housing, health, justice and employment need to be explicitly understood and quantified in policy discussions concerning educational effectiveness and secondary provision cost. The study has shown a disconnect between local educational aspirations and system-level provision. Policy decisions should seek to identify models which are shown to increase the likelihood of education engagement and attainment in place. The community involved in this study are adamant 'place-based approaches' to educational development must be paramount. This is likely to be generalised to other remote settings.

Processes in child first language acquisition can be a locus of contact-induced language change, yet they have received little attention in the language contact literature. This chapter outlines theories and empirical case studies of children significantly influencing change during the emergence of new languages, specifically creoles and mixed languages. It discusses the role of children in the emergence of new varieties of languages, koines, and multiethnolects. In terms of structure, one way in which multiethnolects diverge from the local standard varieties is through the reduction or simplification of grammatical categories. The chapter presents some examples of child-influenced change where there has not yet been time to see if the changes will consolidate into new ways of speaking, but it is a possibility. The chapter summarizes the types of change significantly influenced by child speakers, and how those speakers’ innovations take hold in a community.

INTRODUCTION: Rural areas depend on a specific evidence base that directly informs their unique health systems and population health context. Developing this evidence base and its translation depends on a trained rural health academic workforce. However, to date, there is limited description of this workforce and the field of rural health research. This study aimed to characterise this field to inform how it can be fostered. METHODS: Qualitative semi-structured interviews of 50-70 minutes duration were conducted with 17 early career rural health researchers based in Australian rural and remote communities, to explore their professional background, training and research experiences. RESULTS: Six key themes emerged: becoming a rural health researcher; place-based research that has meaning; generalist breadth; trusted partnerships; small, multidisciplinary research teams; and distance and travel. The field mostly attracted researchers already living in rural areas. Researchers were strongly inspired by doing research that effected local change and addressed inequalities. Their research required a generalist skill set, applying diverse academic and local contextual knowledge that was broader than their doctoral training. Research problems were complex, diverse and required novel methods. Research occurred within trusted community partnerships spanning wide geographic catchments, stakeholders and organisations. This involved extensive leadership, travel and time for engagement and research co-production. Responding to the community was related to researchers doing multiple projects of limited funding. The field was also depicted by research occurring in small collegial, multidisciplinary teams focused on 'people' and 'place' although researchers experienced geographic and professional isolation with respect to their field and main university campuses. Researchers were required to operationalise all aspects of research processes with limited help. They took available opportunities to build capacity in the face of limited staff and high community demand. CONCLUSION: The findings suggest that rural health research is highly rewarding, distinguished by a generalist scope and basis of 'rural' socially accountable research that is done in small, isolated teams of limited resources. Strategies are needed to grow capacity to a level fit to address the level of community demand but these must embrace development of the rural academic entry pathway, the generalist breadth and social accountability of this field, which underpins the perceived value of rural health research for rural communities.

The current serious threat facing Indigenous communities has led many organisations in northern Australia to take the precaution of sending vulnerable community members back to remote homelands in an effort to physically isolate residents from COVID-19.After many years in which the focus of investment and government policy has moved toward larger communities and towns, the physical and organisational infrastructure supporting many smaller remote communities will likely be tried in new ways, as myriad and cross-cutting issues add complexity and cost to the challenge of remaining healthy on remote communities. Remote communities are likely to be tested disproportionately during the current crisis (Whiting &Handley,2020). In many communities, structural factors such as inadequate and poor-quality housing, fixed high energy use appliances (McKenzie,2013),overcrowded and under-serviced households, and high levels of residential mobility will present immediate challenges to residents, communities, service providers and policymakers over the coming months.

Investment in a more diverse portfolio of housing typologies is vital in remote communities, where single men, in particular, have needs that are not fulfilled by standard public housing. Examples from the Northern Territory, South Australia and Queensland prove that developments can meet complex cultural protocols, while drawing on standard building systems and local skills.

Relational values have recently emerged in the sustainability and ecosystem valuation literature as a way to capture the diversity of human-ecosystem relationships. Relational values have been defined as preferences, principles and virtues about human-nature relationships. We describe participatory action research that aimed to elucidate the values associated with freshwater billabongs by Indigenous people in the Ngukurr community in the South East Arnhem land Indigenous Protected Area, northern Australia. Interviews with senior Indigenous knowledge holders revealed that values were strongly relational, i.e. relationships between people, and between people and Country and the inherent reciprocity of these relationships were important. We developed the “Connection as Country” framework towards conceptualising and understanding the relational values of Country from an Indigenous worldview. The “Connection as Country” framework encompasses four domains: spirituality, reciprocal kinship, knowledge and education and cultural subsistence. Broader and contextualised understandings of reciprocal human-ecosystem relationships is required for greater inclusion of Indigenous values in science-policy processes.

Despite ongoing water resource innovation in Australia, many remote Indigenous communities remain at risk to detrimental water related health impacts. This study draws on a comprehensive review of remote areas research and application to identify the challenges facing sustainable water management on Indigenous homelands. We identify complex intersecting socio-cultural, technical and environmental dimensions that operate at different scales to impede safe water access. We propose a socio-ecological framework that can be used to address these complexities. Drawing on case studies in Cape York, Queensland we demonstrate how this approach can inform implementation outcomes for sustainable water management.

This paper presents an analysis of the longest-running archaeological field school in Australia, the Barunga Community Archaeology Field School, which has been operating annually for over 20 years, since 1998. The overarching aim of this field school is for students to learn about Aboriginal culture from Aboriginal people and to experience the cultural protocols that apply when conducting archaeological research in a remote Aboriginal community. This article frankly identifies the long-term successes, failures, and challenges of this field school. The successes are less in the field of archaeology and more in the areas of growing cross-cultural understandings through the development of relationships between different peoples. The failures are largely to do with the physical challenges of the remote area location of the field school. The challenges are primarily due to understanding and reconciling the differences between Aboriginal and European epistemological and ontological ways of knowing and being.

"First know your students" is a well-known saying in teaching. But do Australian universities really know their students? In this paper we present findings from research conducted in remote and very remote Australia where Aboriginal higher education students and educators were asked about their learning and teaching needs, and their views on things the sector could do to better support them in their journey into and through university. They shared with us experiences and thoughts about their ways of learning in face-to-face and online contexts, in particular the role of cultural security; community partnerships; Aboriginal knowledges; pathways and transitions; and student assessment and support strategies. The depth and richness of the skills, knowledges, and capacities of Aboriginal learners, and indeed of the communities in which they reside and study are vital foundations for participation, retention and completion. However, respondents related that in the main, these attributes are not acknowledged by metropolitan-based course designers nor university administrations. We conclude that learning experiences and university operations that are designed to embrace these students' strengths and to work in and with their communities, are more likely to retain Aboriginal students and facilitate their participation and success, enabling beneficial outcomes for all university students and ultimately society as a whole.

Study Objectives: To compare the use of sleep diagnostic tests, the risks, and cofactors, and outcomes of the care of Indigenous and non-indigenous Australian adults in regional and remote Australia in whom sleep related breathing disorders have been diagnosed. Methods: A retrospective cohort study of 200 adults; 100 Aboriginal and Torres Strait Islander and 100 non-indigenous adults with a confirmed sleep related breathing disorder diagnosed prior to September 2011 at Alice Springs Hospital and Cairns Hospital, Australia. Results: Results showed overall Indigenous Australians were 1.8 times more likely to have a positive diagnostic sleep study performed compared with non-indigenous patients, 1.6 times less likely in central Australia and 3.4 times more likely in far north Queensland. All regional and remote residents accessed diagnostic sleep studies at a rate less than Australia overall (31/100,000/y (95% confidence interval, 21–44) compared with 575/100,000/y). Conclusion: The barriers to diagnosis and ongoing care are likely to relate to remote residence, lower health self-efficacy, the complex nature of the treatment tool, and environmental factors such as electricity and sleeping area. Indigeneity, remote residence, environmental factors, and low awareness of sleep health are likely to affect service accessibility and rate of use and capacity to enhance patient and family education and support following a diagnosis. A greater understanding of enablers and barriers to care and evaluation of interventions to address these are required.

A report by the United Nations (UN) Secretary-General’s Independent Expert Advisory Group on the data revolution for sustainable development suggests: Data are the lifeblood of decision making and the raw material for accountability. Without high-quality data providing the right information on the right trend, at the right time, designing, monitoring and evaluating effective policies becomes almost impossible. (Secretary-General’s IEAG 2014: 2) This report captures the growing preoccupation with and reliance on data and indicators to guide decision-making and to design policies and programs at the international and national levels. Indigenous peoples around the world are not immune from this growing

School-based Filial Therapy (SBFT), a mental health intervention for primary school children living and remote locations. The SBFT pilot was implemented in three rural primary schools in remote and regional New South Wales, Australia, using a pretest-posttest control group design to investigate the impact of 10-sessions of Filial Therapy with a paraprofessional. Target issues were frequency and severity of school behaviour incidents, attendance, academic effort and performance. Participants were 37 children in the experimental group and 22 children in a control group. An independent samples t-test was conducted with bootstrapping. Statistically significant differences were found between the experimental and control groups in the areas of executive managed behaviour (M?=?3.286, SD?=?3.161; t (48)?=??3.5, p?=?.045, two-tailed, BCa 95% CI [?8.529, .642]), student attendance (M?=?92.989, SD?=?6.992; t (26.6)?=?3, p?=?.006, two-tailed, BCa 95% CI [6.839, 22.702]) and academic effort and performance outcomes in science (M?=?2.737, SD?=?.872; t (36)?=??2, p?=?.053, two-tailed, BCa 95% CI [?1.382, .013]); (M?=?2.053, SD?=?.780; t (37)?=??2.7, p?=?.010, two-tailed, BCa 95% CI [-.845, .038]).

The term 'choice-less choice' in education arises from the ethical dilemma where parents are left with no option other than one they do not want to choose. In this article, we draw particularly from David Mander's (2012) use of the term, where he applied it to First Nations students from Western Australia. In Australia, choice-less choice applies to many rural parents where the local school does not offer secondary education options. They must 'choose' a boarding option for their child, or another option such as moving their family to a location where there is a secondary school, or perhaps distance schooling. Other parents have a local secondary option, but this option may not result in Year 12 completion. Based on My School data, this paper uses Google Maps to spatially represent where, in very remote parts of Australia, parents have limited access to local secondary schools or secondary schools that rarely produce completions. The data from My School shows that in very remote areas, this choice-less choice applies to about 6500 students and their families. A further 13000 First Nations students and their families face choice-less choice because even though there is a secondary school in their community, the chances of completing are slim. To explain the latter phenomenon, we draw on Appadurai's (2004) theory of 'capacity to aspire', which suggests that choices are culturally pre-determined and dependent on access to power. Finally, we consider the implications of choice-less choice and suggest how choice-less choice can be removed.

Adoption of agricultural technology such as remote cameras, remote weather stations, bore cameras, and other livestock management systems in the Queensland, Australian beef industry is inconsistent. Marketing of these technologies has previously been aimed solely at men as the decision-makers in rural relationships. Past studies, which are traditionally linked to men’s decision-making, indicate that there are several barriers to technology adoption, such as age, attitude, and education. Barriers may also be attributed to male beef producers’ own perceptions that they do not know how to use technology or that they are not capable of using technology. This perception means technology-based decisions have been falling to rural women who are often identified as invisible farmers and therefore not recognized for their work. By contrast, as technology diffuses into rural settings, it is modifying gender divisions and supporting women as they move from traditional separate roles in decision-making to productive partnerships in farming families. This chapter encourages stakeholders to see women as both decision-makers and community leaders. It highlights the importance of rural women’s use of and role in managing technology and the valuable skills and attributes that rural women bring to decision-making in management and in leadership.

A doctoral study of a program designed to provide access to secondary education for children from a remote Indigenous community was completed in 2014 (Hunter, 2015). This paper reflects on the ongoing commitment of members of this community to a partnership that uses interstate boarding schools as a means of educating their children. It reviews the original longitudinal study that sought the viewpoints of the students, families, community leaders, teachers and schools involved, and uses the resources of spatial theory and place-consciousness to argue the inadequacy of standardised understandings of success that are limited to measurable outcomes within short term policy cycles. Such views of success do not account for the effects of locational difference and disadvantage related to the intersection of health, education, and economic disadvantage that underpins ongoing national efforts to 'close the gap' between schooling outcomes for Indigenous and non-Indigenous Australians. While the experience of boarding schooling raises unique challenges for Indigenous students, as well as for the schools, teachers and non-Indigenous students who are also part of such programs, there is clear evidence that this form of education also presents valuable opportunities 'both ways', and that such partnerships may assist in efforts to decolonialise curriculum and schooling.

Trade-offs involving land use change, cultural values, water resources and jobs are critically important to understand the opportunity cost of resource extraction. Stated preference techniques can be particularly useful in eliciting the non-market values expressed as trade-offs. This study assesses preferences over the management of groundwater released from deep mining operations in Western Australia. A discrete choice experiment is used to investigate the trade-offs Australians are prepared to make for remote economic, ecological and cultural goods against costs. The results suggest that there is heterogeneity of preferences as indicated by a three-class structure of a latent class model. One class supports the use of released groundwater across a range of economic, ecological and cultural uses modelled: extending town water supply, restoring rangeland habitat, creating jobs for Aboriginal Australians and preserving cultural waterholes. The smallest class supports all these uses except job creation and the final class only supports preserving cultural waterholes. These results illustrate public attitudes towards cultural values as well as wider environmental policy tensions between instrumental and intrinsic values.

Background Access to meaningful health information is limited in remote regions of Australia where Indigenous languages and culture are strong but the prevalence of chronic conditions is extremely high. This qualitative study aimed to support and understand the development of an educational approach and resources that evolved in response to an identified need to improve communication in prevention and management of chronic conditions for Yol?u (Aboriginal people of North East Arnhemland). Methods Within a culturally responsive research design, data was gathered through participant observation and semi-structured interviews with both educators and community members. An iterative and continuous process of data collection and inductive analysis, exploring key elements of the process as it evolved, supported the Project Team to modify and refine their approach as the project progressed. Results A high level of community participation and control was a critical element of project. Collaboration between Yol?u educators and community experts, with culturally competent support from other health educators, enabled Yol?u educators to develop the skills and confidence to share health information in ways that could not be achieved by outsiders. Yol?u and biomedical knowledges were integrated to build and share meaningful in-depth (not simplified or directive) oral explanations in local languages using culturally responsive communication processes. The urgent need for ongoing, sufficient and meaningful health education was a consistent and recurring theme in this context where chronic conditions are having a devastating impact. Conclusion Sustained and equitable access to meaningful information, using a culturally responsive approach led by community educators, is crucial to improve health literacy and to enable genuinely informed decisions in prevention and management of chronic conditions. Long-term funding and culturally responsive support are also needed to improve equity of access to health information for those who do not share the language and culture of the majority population.