Barriers to accessing official information about COVID-19 vaccines among migrants were related to unmet language needs, modes of dissemination, and mistrust in official sources. Providing timely language support, improving the modes of dissemination, communicating uncertainty, and building a broader foundation of trust were suggested by participants to overcome the reported barriers.
Official sources of information should be the main sources that people use to make an informed decision about COVID-19 vaccines. In a survey on the same population, 17% reported that official sources were not their main sources of receiving information about COVID-19 vaccines and more than 80% reported that one of their main source of information was unofficial sources such as social media, family and friends (16). When official sources are not accessible, people may turn to unofficial sources to find answers to their questions. These sources are more likely to contain misinformation which can contribute to vaccine hesitancy (2).
The Australian health system requires individuals to have adequate health literacy and health system literacy in order to use the available services appropriately to protect their health (17). Health information is typically provided in a written form in English and disseminated digitally and individuals are responsible to access and interpret information and take appropriate actions for their health. This approach excludes people who may not have that level of English language and digital literacy. Approximately 14% of Australians can only read English at a primary school equivalent level with about 4% at pre-primary school level (18); 28% are highly excluded or excluded digitally (19) and 21% use languages other than English at home (20).
In communicating public health information, a community engagement approach needs to be used. This is especially important at the time of a health crisis such as COVID-19 when providing timely information is crucial (21). Using a community engagement approach, the health information needs of the population should be understood and appropriate modes and formats used to reach all members of society (22). There is no doubt that in a multicultural society such as Australia, information about COVID-19 vaccines should be available in people’s languages. To improve the acceptability of official sources of information, it is important that professional translation services are in place to provide information in different languages at the same time as the English version (23).
Prominent and trusted members of communities should be engaged to give advice about appropriate modes of providing information. These individuals have knowledge about their communities and established trust networks (24). In most Australian states and territories, there are community specific organisations that provide social support for their communities and try to improve the connection among community members and their integration within Australian society. There are also religion-specific organisations that provide religious and social support for their members. These organisations can be approached to find appropriate methods of providing health information for different communities. Engagement of these members of communities should not be seen as a one fits all model as migrant communities are diverse even migrants from the same country (25).
Engagement of younger members of migrant communities can help with the distribution of information about COVID-19 vaccines. Young members of migrant communities usually have better access to health information as they experience fewer language barriers and have higher digital literacy (26). However, as reported in this study, the structure of the family in different migrant communities should be considered. Previous studies showed the importance of engagement of young migrants in the prevention of the spread of misinformation in a multicultural society (26).
Health inequity can be seen in COVID-19 cases due to a range of reasons, including being disproportionally affected by misinformation. In the context of the newness of COVID-19 and its vaccines, clear communication of uncertainties is necessary to help people understand what is known and unknown about COVID-19 vaccines in different stages of the vaccination program, and what actions are undertaken to have more and better quality information (27). This communication should also provide opportunities for people to communicate their concerns about vaccines and create two-way communication. If uncertainty is not appropriately communicated this can affect individuals’ trust in official information (28).
There is no doubt that people do not access the information if the provider of the information is not trusted. As reported in this study mistrust in officials among migrants prevented people from accessing official information. There are many factors that contribute to the development of mistrust in officials. These factors may differ for migrants in Australia. Generally, non-English speaking migrants have higher trust in the Australian government compared to other Australians (29). However, negative experiences with the government in their home countries and the Australian government and experience of racism, exclusion and alienation from Australian society were reported as contributing factors (30). Experiences of racism, exclusion, and discrimination are commonly reported by migrants living in Australia. A recent survey in 2021 has shown that a high percentage of Australians has negative views about migrants from some of the Eastern Mediterranean Region countries (more than 40%) and Muslim Australian (32%). It also reported that 34% of people born in non-English speaking countries experienced discrimination because of their skin colour, ethnic origin or religion (29). It is important that migrants’ experiences with the government, the health system and the general public are considered in health communications. Although engagement of trusted community members can help to provide information for migrants who may not trust officials, it is important that steps are taken to build the foundations of trust with migrants through engagement with migrant communities and recognising migrants' potential and existing contribution to society.
Strengths and limitations:
Diversity among participants of this study enabled us to explore the experiences of a diverse group of individuals and communities. Participants of this study included individuals born in 11 different countries and health professionals and members of communities who actively supported their communities during COVID-19 pandemic. However, the requirement to speak English during the interview might have limited the ability to hear from some groups of the targeted population. But the inclusion of participants who identified themselves as a community leader and could speak on behalf of their community might have reduced this limitation. Using qualitative methods, we were able to explore people's experiences and viewpoints. The qualitative nature of the study may limit the applicability of findings in other contexts.