COVID-19 and vaccine health promotion resources in Aboriginal and Torres Strait Islander languages

ABSTRACT

Risk communication during a public health crisis necessitates the provision of accessible, timely and accurate health information to the public. The aim of this research project was to explore the availability and characteristics of COVID-19 and vaccine health promotional materials published in Aboriginal and Torres Strait Islander languages. We aimed to identify the strategies used by Aboriginal-led organizations and Departments of Health to improve communication about COVID-19 and vaccination. Health promotion resources published online between January 2020 and December 2021 were identified by means of a desktop scan and a content analysis was subsequently conducted. We also interviewed five Aboriginal-led organizations and interview data were analyzed thematically. Findings illustrate the vital role of Aboriginal and Torres Strait Islander languages in high stakes information transfer and, in particular, the push by Departments of Health and language groups to create and disseminate important messaging in Aboriginal and Torres Strait Islander languages. This is best achieved by utilizing local knowledge, existing relationships and local connections. Finally, a multimodal approach to the production and dissemination of pandemic health information better caters for the diverse specific needs of these communities.

KEYWORDS:

• COVID-19
• intercultural communication
• mediated communication
• First Nations
• pandemic
• public health communication
• qualitative research

1. Introduction

Health communication plays a vital role during crisis situations, as has been the case since 11 March 2020, when the World Health Organization (WHO) declared COVID-19 (SARS-CoV-2) a global pandemic (Crooks et al., 2020). Given that health communication is an essential tool for meeting public health objectives and ensuring that the behaviour of the public aligns with government health policy recommendations (Finset et al., 2020; Freimuth & Quinn, 2004; Wild et al., 2021), the objective of this paper is to explore the availability and characteristics of COVID-19 and vaccine health promotional materials published in Aboriginal and Torres Strait Islander languages. We also aimed to identify the strategies used in Australia by Aboriginal-led organizations and various Departments of Health to improve communication about COVID-19 and vaccination.

The Australian government and State and Territory governments’ initial response to the COVID-19 emergency was to introduce recommendations that aimed to reduce the transmission of the virus, and later, to impose restrictions including lockdowns, school closures and ultimately mass vaccination. More targeted responses were subsequently developed to protect vulnerable communities encountering higher risks, such as people with low immunity, the elderly, migrants, refugees and First Nations peoples (Wild et al., 2021).

First Nations peoples are at increased risk from COVID-19 due to a “range of factors associated with higher rates of non-communicable diseases and a lack of access to health services in remote communities” (Finlay & Wenitong, 2020, p. 251). There are also socio-cultural factors such as high mobility for family or cultural reasons. Dudgeon et al. (2020) emphasize the role of “social determinants” and, in particular, “the interrelationship between health outcomes and the living and working conditions that define the social environment” (p. 5).

Any health communication campaign designed for First Nations peoples needs to consider the complex linguistic ecology in Australia. First Nations peoples’ “linguistic repertoires are typically complex, often including traditional languages and English alongside contact varieties, combined in diverse patterns of multilingualism which are responsive to shifts in domain, interlocutor and other sociocultural factors” (Vaughan & Loakes, 2020, p. 717). Rodríguez Louro and Collard (2021a) discuss varieties of English, such as Australian Aboriginal English (AAE) that have a surface similarity with Standard Australian English and critique the often ill-formed assumption that “mainstream English media should work well for the almost 80% of Indigenous people in Australia for whom Australian Aboriginal English is their first language”. In fact, there are multiple varieties of Australian Aboriginal English (AAE), some being acrolectal (light) or basilectal (heavy) and the “unique communication styles embedded in AAE may be misinterpreted or misunderstood” as has been the case in legal (Eades, 2013; Rodríguez Louro & Collard, 2021b; Rodríguez Louro et al., 2023) and healthcare settings (Karidakis, 2021). Such misapprehensions highlight the need for healthcare messaging to be tailored to the linguistic needs of the communities in question in order to be “meaningful and accessible” (Rodríguez Louro & Collard, 2021b). An indicative example includes the video resource “Get a heart check” fully scripted and produced in AAE and presented as a yarn, i.e. in story-like fashion (https://youtu.be/op1dNfMiz9s; Rodríguez Louro & Collard, 2021a). Producing the video resource in AAE allowed the communities “to relate to media directly and to feel the messaging [was] intended for them” (Rodríguez Louro & Collard, 2021a).

Lessons learnt from the H1N1 pandemic, also known as the 2009 Swine Flu pandemic, highlight that “a one-size fits all approach to infectious disease emergencies” is unlikely to work, particularly following the omission of First Nations peoples from Australia’s 2009 National Action Plan for Human Influenza Pandemic (Miller & Durrheim, 2010, p. 151). This omission not only disadvantaged those who most needed protection but also failed to identify this segment of the population as being a high-risk population group, resulting in First Nations peoples experiencing hospitalization rates higher than those reported elsewhere in Australia and higher than those reported for First Nations people overseas (Flint et al., 2010; Miller & Durrheim, 2010). Following the 2009 H1N1 pandemic, health researchers proposed that risk management strategies needed to be tailored to First Nations communities by adopting a cooperative approach between governments and communities (Massey et al., 2009).

With these challenges in mind, the Aboriginal and Torres Strait Islander language Advisory Group on COVID-19 was established in May 2020 to develop and deliver the Australian Health Sector Emergency Response Plan for Novel Coronavirus (COVID-19) (Australian Government Department of Health, 2020). One of the priorities of this emergency response plan was to produce and disseminate information that was tailored to key audiences using media outlets approachable by First Nations peoples. The Aboriginal and Torres Strait Islander language clinical advisory group was also brought together to ensure that “local culture, language and understandings shape local health messaging” (Australian Government Department of Health, 2020, p. 21).

When considering the role of Indigenous language and culture in maintaining and improving the health of First Nations peoples, emerging evidence has shown that they are a contributing factor to lowering suicide rates in Canadian First Nations communities (McIvor et al., 2013) and lessening the burden of type 2 diabetes in Alberta First Nations peoples (Oster et al., 2014). In Australia, “language maintenance and revitalization efforts have positive effects on physical and communal health among Indigenous populations” and speaking an Aboriginal and Torres Strait Islander language has been found to reduce several health risk factors such as “excessive alcohol consumption (8% vs. 18% for English monolinguals), illicit drug use (16% vs. 26%), and violence victimisation (25% vs. 37%)” (Australian Institute of Aboriginal and Torres Strait Aboriginal and Torres Strait Islander language Studies (AIATSIS), 2020, p. 3; Whalen et al., 2016, p. 4).

The role of self-determination in the COVID-19 pandemic response in Australia has been instrumental in safeguarding the lives of First Nations peoples. As of January 2022, 2,639 deaths were registered, where people died with or from COVID-19, 40 of which were among First Nations peoples (ABS, 2022a). This was largely achieved through active community controls and engagement. These early calls for self-determination privileged “First Nations voices, within a culturally appropriate governance structure, to develop and implement planning, response and management protocols” (Crooks et al., 2020, p. 152).

2. Literature review

2.1 Public health risk communication and communication strategies

So-called risk communication and community engagement (RCCE) readiness in the wake of any public health event is integral to the success of responses to health emergencies (WHO, 2020). Risk communication principles established in response to public health and environmental disaster response in the late twentieth century may offer important insight into public health responses to the risks posed by COVID-19 (Eisenman et al., 2007; Glik, 2007; Sandman, 1988, 1989; Slovic, 1987).

Risk communication, as defined by the World Health Organization, is “the exchange of real-time information, advice and opinions between experts and people facing threats to their health, economic or social well-being” (WHO, 2020, p. 42). The underlying goal is that populations at risk are able to “take informed decisions to mitigate the effects of a disease outbreak and take protective and preventive action” (WHO, 2020, p. 42). CE, or Community Engagement, is “the process of developing relationships and structures that engage communities as equal partners in the creation of emergency response solutions that are acceptable and workable for those they impact” (WHO, 2020, p. 42). Beyond this, emergency response solutions need to be culturally safe, taking into account “processes of culture and identity formation in order to understand how the effects of colonialism manifest in the health system” (Downing & Kowal, 2011, p. 7). Embedding emergency responses in cultural safe principles raises awareness of social, cultural and historical factors applying to First Nations peoples and has the potential to lead to “changes in health and wellbeing that follow from improved knowledge, attitudes and/or skills” (Downing et al., 2011, p. 254).

This study adopts a social constructionist approach which sees risk as being interrelated with its socio-cultural context and is concerned with explaining the process by which social actors come to describe the crisis. The social constructionist approach allows for an examination of how risk is perceived by the individual and society as well as “how populations develop defence mechanisms to control their anxiety” (Smith, 2006, p. 3114).

Thus, risk communication is a two-way exchange of information between “those with technical risk knowledge and information and an individual, group, or community in order to exchange information about, knowledge of, and experiences with a risk or risk situation” (Kain & Jardine, 2020, p. 101). This public health information needs to be given in a timely manner, and it needs to be accurate and appropriate for the targeted population, in order to engender trust in the general public (Seeger, 2006). It is often assumed, however, that behaviour change and compliance will seamlessly ensue from the provision of information and explanations of why people should adopt a particular behaviour (Kelly & Barker, 2016). This is not the case as it is very difficult to predict “with any certainty how individual people will behave in any given situation … as there is a great deal of variance in individual behavioural outcomes” (Kelly & Barker, 2016, p. 113). Another consideration is the variable levels of trust and different types of trust that people may have in the health messaging they receive. Hwahng et al. (2021) identify “thick” and “thin” approaches to trust. “Thick” trust is the trust that people have with their family members, relatives and close friends and is premised on similarity and the building of strong interpersonal relationships with others over time. “Thin” trust on the other hand is the kind that exists when investing trust in abstract systems, such as, for instance, in government, health systems and institutionalized media. This trust is based on “a position of relative unfamiliarity” because it is a trust in their official status (Pym et al., 2022, p. 111).

Ensuring compliance and effecting behavioural change thus form a complex and multi-faceted process as can be seen through the recent experience of racial and ethnic minority communities in Australia and abroad. Recent research suggests that such groups in the UK, the United States and Australia have borne a disproportionate burden of COVID-19 related outcomes (Gruer et al., 2021; Hayward et al., 2021; Karidakis, 2021; Njoku et al., 2021). Racial and ethnic minorities are at risk of poorer health outcomes due to structural inequities such as lower levels of literacy (including digital literacy), poorer socio-economic conditions, language barriers and a general mistrust in the authorities (Truong et al., 2022). While First Nations peoples face similar structural inequities as other racial and ethnic minorities, their health needs are unique due to the impact of “colonization, dispossession, genocide, and forced removal from lands” (Truong et al., 2022, p. 971). It is widely accepted therefore that failure to communicate effectively may lead to “a loss of trust and reputation, economic impacts, and – in worst case – loss of lives” (WHO, 2020, p. 1).

Gaborit et al. (2022) describe the availability and characteristics of COVID-19 and maternal health promotion resources in Aboriginal and Torres Strait Islander languages in Australia. This initial work highlights the increase in resources, capacity and strategies used for creating and disseminating COVID-19 and maternal health promotion resources incorporating Indigenous languages.

The current study proposes to extend this research by making use of an extended data set that covers the first two years in full of the pandemic from January 2020 to December 2021 and provides an evidence-based response to two research questions:

1. What are the availability and characteristics of COVID-19 and vaccine health promotional materials in Aboriginal and Torres Strait Islander languages?

2. What strategies are used by health departments, Aboriginal community-controlled organizations and Aboriginal-led organizations to reach their communities about COVID-19 and vaccine health promotional information?

3. Methodology

3.1 Study design

This study adopted a mixed methods design (Schoonenboom & Johnson, 2017) by combining two research approaches. Firstly, it incorporated a descriptive quantitative research design to obtain and quantify primary data from COVID-19 and vaccine health promotion resources published online from January 2020 to December 2021 on Australian Federal, State and Territory Government Health Department websites and key Aboriginal-led organization websites, including Aboriginal Community Controlled Health Organisations (ACCHOs). This data set was then supplemented with semi-structured interviews to collect qualitative data to support the collection of richer and more context-specific data (Bell et al., 2022).

We drew on the WHO definition of health promotion to guide our data collection. Health promotion is defined as

the process of enabling people to increase control over, and to improve, their health. … [I]t supports governments, communities and individuals to cope with and address health challenges. This is accomplished by building healthy public policies, creating supportive environments, and strengthening community action and personal skills. (WHO, 1986, p. 2)

COVID-19 and vaccine health promotion resources included information sheets and brochures, audio and video files, animations, posters, cards and banners designed to inform First Nations peoples of resources targeting the spread of the COVID-19 virus, COVID-19-safe behaviours, government regulations, local restrictions and vaccine campaigns.

3.2 Study setting – overview of the Australian jurisdictional context

Australia has a federal system of governance, and as a result, the responsibilities for the pandemic response were split between Commonwealth, State and Territory governments. The primary coordination of COVID-19 and vaccine health promotion communication was assigned to the State and Territory level of government. In response, each State and Territory (henceforth State) disseminated COVID- and vaccine-related information via their respective government websites and, also for a significant period of time, media conferences by the State and Territory leaders. There were also extensive efforts to translate COVID- and vaccine-related information into migrant community languages and these efforts were instrumental in the success of the pandemic health communication campaign more widely due to “public trust not just in the governments’ official messaging itself but in various kinds of translations of those messages” (Pym et al., 2022, p. 110).

3.3 Quantitative data

3.3.1 Data collection

COVID-19 and vaccine health promotion resources were identified by means of a desktop scan that collected information from secondary sources located through online searching. The following information sources were searched online via their respective websites: The Australian Government Department of Health and Aged Care (AUS Health) and the eight State and Territory health departments – The Australian Capital Territory (ACT), New South Wales (NSW), the Northern Territory (NT), Queensland (QLD), South Australia (SA), Tasmania (TAS), Victoria (VIC) and Western Australia (WA). While other departments published COVID-19 and vaccine health communication resources, these are beyond the scope of this study, particularly as the latter resources were typically published after December 2021.

In addition, key Aboriginal-led organization websites, and Aboriginal Community Controlled Health Organisations (ACCHOs) were searched as well. The search terms used included: “Indigenous language” AND “COVID-19”, OR “Coronavirus”, OR “vaccine”, OR “COVID-19 vaccine”, OR “Aboriginal and Torres Strait Islander”, OR “First Nations peoples” OR “Aboriginal Peak bodies”, OR “Aboriginal and Torres Strait Islander people-led organisations”, OR “health department”.

The following are quality inclusion criteria used to identify appropriate resources:

1. the resource was openly available online;

2. the resource was specifically designed for Australian First Nations peoples;

3. the resource was published between January 2020 and December 2021;

4. the resource was published in English or an Aboriginal and Torres Strait Islander language; and

5. the resource aimed to promote Covid-19 and vaccine health education.

Following a detailed analysis of these websites, it was found that most State and Territory health departments included a very large number of links to resources located in the Australian Government Department of Health and Aged Care website. Health departments of the different States and Territories also collaborated with Aboriginal-led organizations or, as noted above, with ACCHOs for the design of a significant amount of COVID-19 and vaccine health promotion materials.

A very long list of key Aboriginal-led communication and health organizations which were identifiable online was drafted with the purpose of collecting the largest possible number of materials available on the web and to offer a rigorous and nuanced analysis of the different types of messages related to COVID-19 health promotion. This list, however, is by no means exhaustive.

When coding the resources that were in Aboriginal and Torres Strait Islander languages, we encountered different labelling for several languages. In an attempt to code languages consistently across departments and organizations, we drew on the AIATSIS (Australian Institute of Aboriginal and Torres Strait Islander Studies) classification of Aboriginal and Torres Strait Islander languages. This is the case for:

1. Yolngu Matha which includes resources classified as Yolngu Matha and Yolŋu and all its variants such as Dhuwaya, Djambarrpuyngu, Djapu, Djinang, Galpu, Gumatj, Gupapuyngu and Rirratjingu (The Northern Territory Government website);

2. Pintupi-Luritjia which comprises resources labelled as in Pintupi-Luritjia, Luritjia and Pintupi;

3. Pitjantjatjara which encompasses materials in Pitjantjatjara, Pitja and Iwiri;

4. Torres Strait Creole – Yumplatok which in some cases was also referred to as Torres Strait Islander Kriol; and

5. Central and Eastern Arrernte coded oftentimes as Central and Eastern Arrernte, Central Arrernte and Eastern Arrernte.

3.4 Qualitative data

3.4.1 Participants

For the purposes of collecting interview data, we used a purposive sampling approach to recruit key members of Aboriginal-led health and communication organizations from five research sites across three states/territories (see Figure 1). We sought to recruit participants from organizations that provided either health or communication services. This included broadcasting, media and communication organizations, Aboriginal community-controlled health services and language centres. Although the participants were concentrated in three states, the five organizations which were represented produced COVID-19 and vaccine health promotion resources largely for and about First Nations people.

Figure 1 Five research sites across three states/territories

There were five participants in total: four were female and one was male. All participants were adults aged over 18 and were primarily English speaking. Two participants were bilingual. Table 1 provides an overview of the organizations the participants represented.

Table 1 Profiles of participants’ organization, location, gender and language

Type of organization	State/Territory	Gender	Language	Identifier
Broadcasting, media and communications organization	Northern Territory & Victoria	Female	English	BMC170821
Aboriginal Community-Controlled Health Service	Northern Territory	Female	English	HS300821
Aboriginal language centre	Northern Territory	Female	Gunwinggu, English	ALC050921
Aboriginal media organization	New South Wales	Female	English	MO2150921
Aboriginal broadcasting service	New South Wales	Male	English, French	ABS220821

3.4.2 Data collection

Data collection was scheduled in line with the availability of the participants and took place online between June 2021 and October 2021. We conducted five semi-structured interviews lasting between 30 and 60 min. Interview participants were invited to discuss their experiences of COVID-19 and vaccine health information mediation and dissemination. The main points for discussion related to: (a) the organization’s role in the provision of pandemic health information; (b) mediation and dissemination strategies used; and (c) whether information was translated or adapted for their respective audiences.

All interviews were conducted by the research members online via Zoom. Consent for recording was sought beforehand. The audio-recorded data were transcribed using Sonix Transcription, which is an automated speech-to-text transcribing platform. A research member checked the accuracy of the transcripts and made necessary amendments. The transcripts were de-identified and organization names were replaced with generic descriptions to ensure anonymity.

We acknowledge that being non-Indigenous researchers has its limitations (see Puch-Bouwman, 2014). However, the approach to the research followed Indigenous guidelines for ethical conduct in research with First Nations peoples and communities (NHMRC, 2018) and the research was reflective of community priorities and was perceived to be of benefit to the communities.

3.5 Data analysis

3.5.1 Quantitative data

The materials found in the online search were coded inductively to include the provider, link, content description, publishing date, last review or update (when available), type of resource, language and location (see Ditlmann & Kopf-Beck, 2019, on the inductive approach to content coding). An indicative example from the NT Department of Health and an Aboriginal-led organization in the Northern Territory is provided in Table 2.

Table 2 Coding categories used to categorize COVID-19 and vaccine-related resources

Provider	Link	Content on COVID-19	Publishing date	Type	Language	Location
NT Health department	https://www.youtube.com/watch?v=h3N_9G1tfXY&list=PLvzNtphHxtRwgyiz1zQf7AZibMGOMJb6x&index=27	General information on COVID-safe practices	May-20	Video	Alyawarr	NT
Northern Land Council	https://www.youtube.com/watch?v=0eYhYgNQEwI	Nakangila Neville Namarnyilk – “Get jabbed”	Sep-21	Video	Kunwinjku	NT

The specification of the provider became crucial as the same resource often appeared on multiple websites. In order to avoid repetition when quantifying materials, each item was counted once under the principal organization or health department which created the resource. When resources were designed by multiple organizations and health departments jointly, only the first named organization was noted. If a source was translated into more than one Aboriginal and Torres Strait Islander language, this was counted for as many languages as it was translated into. In line with previous studies (see Gaborit et al., 2022; McCalman et al., 2014), webpages and social media home pages were not considered for analysis.

3.5.2 Qualitative data

Drawing on Braun and Clarke (2006) and Nowell et al. (2017), a rigorous thematic analysis was adopted in order to examine the participants’ experiences of COVID-19 and vaccine-related health communication. This enabled identifying, organizing, analyzing, describing and reporting themes in the interview data set (Braun & Clarke, 2006). NVivo 12 software was used to sort and organize the data and initial codes were generated inductively to identify meanings and patterns. Once all data had been initially coded and a list of the different codes identified across the data set, the following phase involved sorting the coded data extracts into themes. The next phase involved peer-reviewing the coded data to ensure whether the themes coded were an accurate reflection of the meanings evident in the data set (Braun & Clarke, 2006). Peer debriefing was undertaken with three separate researchers, which helped to clarify different interpretations that arose during the data coding process, and in doing so enhanced the credibility and rigour of the research findings (Cutcliffe & McKenna, 1999).

3.6 Ethics

This study was reviewed and approved by the University of Melbourne Humanities and Applied Sciences Human Ethics Sub-Committee (21033.3.6). Written informed consent was obtained from all participants. Participants were assured that the privacy and confidentiality of the collected information would be maintained at all times. The resources analyzed for this study were openly available to the public.

4. Results

4.1 A quantitative exploration of materials

4.1.1 Health promotion resources published by key Aboriginal-led organizations and Federal, State and Territory Departments of Health

This section presents the main outcomes of the analysis of COVID-19 and vaccine-related materials published online by Aboriginal and Torres Strait Islander people-led organizations and Federal, State and Territory Departments of Health.

Targeted communication resources for First Nations peoples have been developed or freely disseminated by key Aboriginal-led organizations and health departments to help inform and educate First Nations peoples. These include video and audio files, posters, banners and cards, and information sheets and brochures. These resources have either been created in Standard Australian English and later translated into a selection of Aboriginal and Torres Strait Islander languages or produced directly in an Aboriginal and Torres Strait Islander language depending on the dominant language existing in the area where the organization or health department was located. As can be seen in Table 3, overall, 60% of health promotion resources have been published in English compared to 40% in Aboriginal and Torres Strait Islander languages. When examining each source separately, the Departments of Health of the various states and territories have published 67.2% of sources in English and 32.8% in Aboriginal and Torres Strait Islander languages. During the same time period, key Aboriginal-led organizations and ACCHOs have published 54.3% of health promotion materials in English and 45.7% in Aboriginal and Torres Strait Islander languages.

Table 3 Health promotion resources in English and Aboriginal and Torres Strait Islander languages by health departments of the Federal, State and Territory governments and key Aboriginal-led organizations, including ACCHOs, from January 2020 to December 2021

Source	Materials in English	% of materials in English	Materials in language	% of materials in Aboriginal & Torres Strait Islander languages	Total	% total by State/Territory
Departments of Health	447	67.2	218	32.8	665	44.0
Key Aboriginal-led organizations	459	54.3	386	45.7	845	56.0
Total	906	60.0	604	40.0	1,510

4.1.2 Health promotion materials published by key Aboriginal-led organizations and ACCHOs

This section examines health promotion resources published in English and Aboriginal and Torres Strait Islander languages across Australia by key Aboriginal-led organizations and Aboriginal Community Controlled Health Organisations (ACCHOs).

As can be seen in Table 4, the greatest proportion of COVID-19 and vaccine-related materials published in English and Aboriginal and Torres Strait Islander languages has been disseminated by organizations in the Northern Territory (NT) (54.3%). Of these materials, 77.5% have been published in Aboriginal and Torres Strait Islander languages and 34.9% have been published in English. Organizations in Western Australia (WA) have published the second highest number of resources in English and Aboriginal and Torres Strait Islander languages (16.7%). Of this percentage, 21.8% appear in Aboriginal and Torres Strait Islander languages and 12.2% appear in English. In Tasmania, 0.8% of materials have been disseminated in Aboriginal and Torres Strait Islander languages spoken in the region. In other states, Aboriginal-led organizations and ACCHOs have published materials exclusively in English and this is the case for organizations in QLD (15.9%), NSW (12.2%), SA (9.4%), ACT (7.4%) and VIC (3.7%). However, resources in languages such as Yumplatok, Pitjantjatjara and Kala Lagaw Ya have been created by AUS Health, often in collaboration with organizations and this is why there is potential undercounting in Table 4.

Table 4 Materials published by key Aboriginal and Torres Strait Aboriginal and Torres Strait Islander language people-led organizations, including ACCHOs, in the different States and Territories from January 2020 to December 2021

Aboriginal-led organizations	Materials in English	% of resources in English	Materials in Aboriginal languages	% of materials in Aboriginal & Torres Strait Islander languages	Total	% Total by State/Territory
NT	160	34.9	299	77.5	459	54.3
WA	56	12.2	84	21.8	141	16.7
QLD	73	15.9	0^a	0.0	73	8.6
NSW	56	12.2	0	0.0	56	6.6
SA	43	9.4	0^b	0.0	43	5.1
ACT	34	7.4	0	0.0	34	4.0
FEDERAL	20	4.4	0	0.0	20	2.4
VIC	17	3.7	0	0.0	16	1.9
TAS	0	0.0	3	0.8	3	0.4
TOTAL	459	54.3	386	45.7	845

Notes: ^a,b Resources in languages such as Yumplatok, Pitjantjatjara, Kala Lagaw Ya have been created by AUS Health, see text above about potential undercounting in the table.

It is not surprising that the bulk of health resources has been created or disseminated by Aboriginal-led organizations and ACCHOs in the NT and WA, due to the number and diversity of Aboriginal and Torres Strait Islander languages spoken in these two regions, in addition to high speaker numbers. According to the 2021 Census of Population and Housing, 45.9% of First Nations people in the NT and 14.6% in WA reported speaking an Australian Indigenous language at home (ABS, 2022b). These states are also home to state-wide interpreting services, including Aboriginal Interpreter Service (AIS) and Aboriginal Interpreting WA (AIWA) which have played an instrumental role in the creation of COVID-19 and vaccine health promotion materials. The only other state where any materials have been provided by community organizations is Tasmania.

4.1.3 Health promotion materials published by State and Federal Departments of Health

This section examines COVID-19 and vaccine health promotion resources published in English and Aboriginal and Torres Strait Islander languages across States and Territories by State and Federal Departments of Health from January 2020 to December 2021, as well as the type of resources published. As can be seen in Table 5, AUS Health has published 32.3% of health promotion resources in English and Aboriginal and Torres Strait Islander languages. This was followed by NT Health (19.7%), SA Health (16.8%), NSW Health (13.1%) and WA Health (11.3%). The remaining states have published less than 3.5% of the total resources identified. There may be instances of undercounting for some states’ Departments of Health (see Queensland) because in order to avoid repetition when quantifying materials, each item was counted once under the health department which created the resource, i.e. AUS Health.

Table 5 COVID-19-related materials published by health departments of the Federal, State and Territory governments from January 2020 to December 2021

Source	Types of materials in English	N^o of materials in English	% of materials in English	Types of materials in Aboriginal & Torres Strait Islander languages	N^o of materials in Aboriginal & Torres Strait Islander languages	% of materials in Aboriginal & Torres Strait Islander languages	Total	% total by jurisdiction
AUS Health	96 video files; 12 audio files; 4 info sheets & brochures; 38 posters, banners & cards	150	33.6	11 video files; 54 audio files	65	29.8	215	32.3
NT Health	9 video files; 1 info sheet & brochure; 1 poster, banner & card	11	2.5	30 video files; 80 audio files; 11 posters, banners & cards	121	55.5	131	19.7
SA Health	10 video files; 7 info sheets & brochures; 69 posters, banners & cards	86	19.2	5 video files; 1 audio file; 1 info sheet & brochure; 19 posters, banners & cards	26	11.9	112	16.8
NSW Health	25 video files; 3 info sheet & brochure; 59 posters, banners & cards	87	19.5		0	0.0	87	13.1
WA Health	14 video files; 1 audio file; 31 info sheets & brochures; 23 posters, banners & cards	69	15.4	6 audio files	6^a	2.8	75	11.3
VIC Health	6 video files; 17 info sheets & brochures	23	5.1		0	0.0	23	3.5
ACT Health	4 video files; 8 info sheets & brochures	12	2.7		0	0.0	12	1.8
QLD Health	1 video file; 8 info sheets & brochures	9	2.0		0^b	0.0	9	1.4
TAS Health		0	0.0		0	0.0	0	0.0
TOTAL		447	67.2		218	32.8	665

Notes: ¹ It must be noted, that all of the Departments of Health provided links to the AUS Health resources that were created in Aboriginal and Torres Strait languages and these, as mentioned in the methodology, have not been counted twice).

^aThis may be a potential undercounting as resources have also been created in collaboration with language service providers, i.e. Aboriginal Interpreting WA.

^bResources created in Yumplatok have been created by AUS Health.

As was the case for Aboriginal-led organizations, the NT is confirmed to be the geo-political area with the largest number of resources published in Aboriginal and Torres Strait Islander languages (55.5%). A smaller proportion have been published by SA Health (11.9%) and WA Health (2.8%). Health departments at the Federal, State and Territory level published 67.3% of all materials identified in English and 32.8% were published in an Aboriginal and Torres Strait Islander language. As discussed earlier, there might be cases of undercounting as resources were often created in collaboration with language service providers, Aboriginal-led organizations and ACCHOs (Kerrigan et al., 2023).

4.1.4 Examples of key Aboriginal-led organizations creating or disseminating health promotion materials

As can be seen in Table 6, the most prolific organizations creating or disseminating health promotion resources appear to be broadcasting, media and communication organizations, Aboriginal peak bodies, Aboriginal Interpreting Services, Aboriginal land councils, Aboriginal language centres and medical research institutes.

Table 6 Examples of key Aboriginal-led organizations, including ACCHOs, creating or disseminating health promotion materials in English and Aboriginal and Torres Strait Islander languages, categorized by State and Territory from January 2020 to December 2021

State or Territory	Key Aboriginal-led organizations identifiable online	Types of materials in English	N^o	Type of materials in Aboriginal & Torres Strait Islander Languages	N^o	Total
NT	Aboriginal Medical Services Alliance Northern Territory (AMSANT)	5 info sheets & brochures; 2 video files	7	5 video files; 18 posters, banners & cards	23	30
	ARDS – Yolŋu Radio		0	7 video files; 70 audio files	77	77
	Groote Eylandt Language Centre & Broadcasting	1 video file	1	32 video files	32	33
	Menzies Health	17 video files	17	27 video files	27	44
	Northern Land Council	13 video files	13	23 video files	23	36
	Why Warriors Ltd		0	30 video files	30	30
	Ngurratjuta Aboriginal Corporation		0	22 audio files	22	22
	Anindilyakwa Land Council		0	3 video files; 16 audio files	19	19
	Bininj Kunwok Regional Language Centre		0	17 video files; 1 posters, banners & cards	18	18
	First Nations Media	29 video files; 22 audio files; 12 info sheets & brochures; 44 posters, banners & cards	107	9 audio files	9	116
	Central Australian Aboriginal Congress	6 video files	6	6 video files	6	12
	Central Australian Aboriginal Media Association (CAAMA)	3 audio files	3	3 audio files	3	6
	PAW Media	1 video file	1	2 video files	2	3
	Numbulwar Culture & Media		0	2 video files	2	2
	Secure NT		0	2 video files	2	2
	Laynhapuy Homelands Aboriginal Corporation	2 info sheets and brochure	2	1 video file	1	3
	Ngukurr Language Centre		0	1 video file	1	1
	Kalkaringi School		0	1 video file	1	1
	Central Land Aboriginal Council	1 video file	1		0	1
	Red Dust	1 video file	1		0	1
	Gapuwiyak Notice Board	1 video file	1		0	1
WA	Aboriginal Health Council of Western Australia (AHCWA)	3 audio files; 6 video files; 8 info sheets and brochures	17	1 audio file; 2 posters, banners & cards	3	20
	Aboriginal Interpreting Services WA	11 audio files	11	60 audio files; 7 video files	67	78
	Nganampa Health Council	1 poster, banner & card	1	6 posters, banners & cards	6	7
	Kimberley Aboriginal Medical Services	9 video files; 2 posters, banners & cards; 3 info sheets and brochures	14	5 video files	5	19
	Western Desert Lands Aboriginal Corporation		0	2 video files	2	2
	Mirima Dawang Woorlab-gerring – Language and culture centre		0	1 poster, banner & card	1	1
	Geraldton Regional Aboriginal Medical Service	5 posters, banners & cards	5		0	5
	Southwest Aboriginal Medical Service	1 video file; 4 posters, banners & cards	5		0	5
	Nindilingarry Cultural Health Services	2 posters, banners & cards	2		0	2
	Nirrumbuk Environmental Health and Services	1 video file	1		0	1
	Tjukurla Remote School – Ngaanyatjarra Lands		0	1 poster, banner & card	1	1
NSW	The Aboriginal Health and Medical Research Council of NSW (AH&MRC)	11 video files; 33 posters, banners & cards	44		0	44
	First peoples’ disability network Australia	6 video files; 1 info sheet and brochure	7		0	7
	Walgett Aboriginal Medical Service	2 video files; 3 info sheets and brochures	5		0	5
ACT	Winnunga Nimmityjah Aboriginal Health and Community Services		0		0	0
	Gayaa Dhuwi (proud spirit) Australia	21 posters, banners & cards	21		0	21
	Indigenous Allied Health Australia	5 info sheets and brochures; 1 poster, banner & card	6		0	6
	Australian Indigenous Doctors’ Association	5 video files	5		0	5
	National Association of Aboriginal and Torres Strait Aboriginal and Torres Strait Islander language Health Workers and Practitioners	2 info sheets and brochures	2		0	2
SA	Aboriginal Health Council of South Australia (AHCSA)	6 video files	6		0	6
	Nunyara Aboriginal Health Service Incorporated	36 posters, banners & cards	36		0	36
	Port Lincoln Aboriginal Health Service	1 info sheet and brochure	1		0	1
QLD	Queensland Aboriginal and Aboriginal and Torres Strait Islander language Health Council (QAIHC)	1 video file; 19 posters, banners & cards; 8 info sheets and brochures	28		0	28
	Apunipima Cape York Health Council (Apunipima)	16 video files	16		0	16
	ATSiCHS Brisbane	6 info sheets and brochures	6		0	6
	Brisbane South PHN	1 video file	1		0	1
	Institute for Urban Indigenous Health (IUIH) Brisbane	1 video file; 6 info sheets and brochures	7		0	7
	Deadly choices	10 video files; 5 info sheets and brochures	15		0	15
VIC	Victorian Aboriginal Community Controlled Health Organisation (VACCHO)	6 video files	6		0	6
	3KND Radio	6 audio files	6		0	6
	Gippsland & East Gippsland Aboriginal Co-operative	4 posters, banners & cards	4		0	4
	Aboriginal Community Elders Services Incorporated	1 video file	1		0	1
TAS	Tasmanian Aboriginal Centre (TAC)		0	3 video files	3	3
FEDERAL	National Aboriginal Community Controlled Health Organisation (NACCHO)	1 video file; 15 posters, banners & cards; 4 info sheets and brochures	20		0	20
TOTAL			459		386	845

4.1.5 Types of health promotion resources in English and Aboriginal and Torres Strait Islander languages

Table 7 depicts the types of resources created in English and Aboriginal and Torres Strait Islander languages. Video and audio files featured amongst the highest proportions of resources created by Departments of Health (English = 39.8; Aboriginal & Torres Strait Islander languages = 85.8%) and Aboriginal-led organizations (English = 43.8%; Aboriginal & Torres Strait Islander languages = 92.5%). This was followed by posters, banners and cards and finally information sheets and brochures.

Table 7 Types of health promotion resources in English and Aboriginal and Torres Strait Islander languages by health departments of the Federal, State and Territory governments and key Aboriginal-led organizations, including ACCHOs, from January 2020 to December 2021

Type of resource	Departments of Health		Key Aboriginal-led organizations
	% of materials in English	% of materials in Aboriginal & Torres Strait Islander languages	% of materials in English	% of materials in Aboriginal & Torres Strait Islander languages
Information sheets and brochures	17.7	0.5	15.5	0
Video files	36.9	21.1	34.0	51.3
Audio files	2.9	64.7	9.8	41.2
Posters, banners and cards	42.5	13.7	40.7	7.5

4.1.6 Distribution of Aboriginal and Torres Strait Islander languages in COVID-19 and vaccine health communication resources

Use of 37 Aboriginal and Torres Strait Islander languages featured among a sample of 604 COVID-19 and vaccine-related resources. As can be seen in Table 8, the top 10 languages in which health promotion materials have been published include, far ahead of other languages, Yolŋu Matha (N = 132) spoken in NT. This was followed in second position by Anindilyakwa (N = 61), and in third position by Pitjantjatjara (N = 48), Although Kriol (on its own) is fourth most commonly used, if all varieties of Kriol listed in the table (i.e. Kriol, Kimberley Kriol, Eastside Kriol, Westside Kriol, Northern Kriol and Yumplatok) are tallied, the ranking ordering changes so that all Kriols together rise to second position (N = 80). The remaining rank ordering of the top 10 languages most featured in the table, is as follows: Kunwinjku (N = 35), Warlpiri (N = 33), Martu (N = 27), Pintupi-Luritja (N = 22), Ngaanyatjarra (N = 21) and Western Arrernte (N = 17).

Table 8 Aboriginal and Torres Strait Islander languages used in a sample of 604 COVID-19 and vaccine health promotion resources in Aboriginal and Torres Strait Islander languages

Ranking	Resources produced in Aboriginal and Torres Strait Islander languages	Created by organization and/or health department	No of resources
1	Yolŋu Matha^a	ORG & HD	132
2	Anindilyakwa	ORG & HD	61
3	Pitjantjatjara	ORG & HD	48
4	Kriol	ORG & HD	45
5	Kunwinjku	ORG & HD	35
6	Warlpiri	ORG & HD	33
7	Martu	ORG & HD	27
8	Pintupi-Luritja	ORG & HD	22
9	Ngaanyatjarra	ORG & HD	21
10	Western Arrarnta	ORG & HD	17
11	Murrinhpatha	ORG & HD	13
12	Tiwi	ORG & HD	12
13	Burarra	ORG & HD	12
14	Arrernte	ORG & HD	11
15	Kimberley Kriol	ORG & HD	11
16	Yanyuwa	ORG	9
17	Alyawarr	ORG & HD	8
18	Eastside Kriol	ORG & HD	8
19	Westside Kriol	ORG & HD	8
20	Anmatjere	ORG & HD	7
21	Western Arrernte	ORG & HD	6
22	Torres Strait Creole – Yumplatok	ORG & HD	7
23	Maung	ORG & HD	7
24	Warumungu	ORG & HD	7
25	Central/Eastern Arrernte^b	ORG & HD	9
26	Ngarinyman	ORG & HD	5
27	Meriam Mer	ORG & HD	4
28	Kala Lagaw Ya	HD	3
29	Ngan'gikurunggurr	ORG	3
30	Palawa Kani	ORG	3
31	Mudburra	HD	2
32	Pertame	HD	2
33	Walmajarri	ORG	2
34	Arrarnta	HD	1
35	Jingulu	ORG	1
36	Northern Kriol	HD	1
37	Wubuy	ORG	1
	Total		604

Notes: ^aYolŋu Matha includes different variants such as Dhuwaya, Djambarrpuyngu, Djapu, Djinang, Galpu, Gumatj, Gupapuyngu and Rirratjingu as mentioned above.

^b Central/Eastern Arrernte appear as separate languages in the resources.

In summary, a large number of pandemic health resources have been published in English and Aboriginal and Torres Strait Islander languages. The expansion of health communication resources produced in English and Aboriginal and Torres Strait Islander languages also showcases the collaborative efforts of health departments and Aboriginal-led organizations to keep communities safe.

4.2 A qualitative exploration of COVID-19 and vaccine health communication

This section presents the main outcomes of a thematic analysis of interview data with five Aboriginal-led organizations who were invited to discuss their experiences and perspectives of the processes of COVID-19 and vaccine information-related mediation and dissemination. The organizations which were interviewed discussed strategies they used to reach and inform their communities about COVID-19 and vaccination health communication, challenges for risk communication and finally recommendations for health emergencies.

4.2.1 Dissemination of pandemic health information

Participating media and communication organizations and Aboriginal community-controlled health services reported using multi-platform distribution methods. They made use of print materials such as booklets and posters as well as audio-visual materials in the form of audio recordings or videos. One organization discussed the need for the dissemination of print material due to internet accessibility issues faced by community members in remote communities, but also by Elders or people of lower socio-economic status in urban centres (Extract 1). One of the health services helped produce video content as it was perceived to be more accessible to the community (Extract 2).

Extract 1: I think there’s a misunderstanding that it’s just remote communities, but it’s not. Even elders or lower socio-economic people in urban areas don’t have access to the internet or computer or data. (MO1170821)

Extract 2: We worked on a lot of video content because it was kind of a lot more accessible for a lot of people. (HS300821)

Media and communication organizations and Aboriginal language centres were also active in the provision of pandemic health information on social media platforms such as Facebook and YouTube (Extracts 3 and 4). Such social media channels were deemed to be easily accessible and afforded the opportunity for the information to be shared across communities (Extract 5). It also enabled communities to determine what kinds of health communication resources worked and they subsequently adapted the materials for their own communities (Extract 6).

Extract 3: Social media is a very big communication channel and very important for getting information out about COVID and to overcome misinformation, so arming people with the right information to share. (BMC170821)

Extract 4: Oh, well, we put it into Facebook or YouTube. (ALC05091)

Extract 5: We tried to post it mostly through the “keepourmobsafe” hashtag. So, we very quickly kind of saw that, you know, there was a lot of information coming out and we tried to put it all into a way that if you have information, you could share it, but also if you didn’t have information that you could access. (MO2150921)

Extract 6: Yeah, they were producing their own videos and then  …  communities said: “that worked really well”, and they tried to adapt and do their own. (BMC170821)

Some organizations provided pandemic health information primarily in English and this was due to the variable needs of the States and Territories, particularly as they were not facing the same set of challenges or experiencing the same levels of transmission at a given time.

Extract 7: We went with mostly English, and the States and Territories did a lot of the adaptation in language. But the rest was top-tailored by the States and Territories and in a way, rightfully so, because they were then able to give that second tier of information that communities needed. (MO2150921)

4.2.2 Mediation strategies

Many participants acknowledged the need to go beyond the simple dissemination of information from official sources to providing mediated health information about COVID-19 and vaccination. Mediation strategies involved drawing on religious leaders, Elders, health professionals and media personalities in the community as spokespeople in order to help build trust in the message that was being disseminated. The focus was on creating a groundswell of awareness and growing support in COVID-19 and vaccine health promotion messaging by having community members talking to community.

Extract 8: We developed a range of community voices to share their thoughts. We covered about 30 or 40 community leaders, leaders in their own right, I should say, not necessarily full cultural authorities, but members of the community, ranging from people like Tom Calma  …  so Aboriginal Torres Strait Islander language health professionals through to kind of media personalities like Sean Choolburra  … . (MO2150921)

One participant from an Aboriginal Language Centre discussed adopting a supporting role and highlighted the need to listen to the community’s concerns regarding incoming COVID-19 and vaccine health messaging and respond to these concerns (Extract 9). Another participant from a media organization reported giving the community a platform to ask questions (Extract 10).

Extract 9: Um  …  at the moment myself and others who work in XXX Language Centre, we just stop and watch people – what they’re doing, and hear them – what they speak, and we are still there to help them with their concerns. (ALC050921)

Extract 10: Community members generally will come to  …  media organizations with questions that help them understand the information and language that they can relate to, whether that’s in English or whether that’s in an Indigenous language. (MO31650921)

A participant from an Aboriginal community-controlled health service reported participating in direct engagement programmes with certain vulnerable groups of the community, such as rough sleepers and transient people, who were a segment of the population that had been overlooked in the governmental pandemic health response.

Extract 11: But we got some funding  …  to do engagement with the rough sleepers and transient people who have to be in and out of Darwin different communities and things like that. They were a group of people that we were quite worried about, particularly in lockdown – but the government hadn’t really planned for it very much. (HS300821)

This direct engagement with community members allowed for interpersonal connections to develop as existing barriers regarding conversations around the COVID-19 vaccine were gradually removed.

Extract 12: They go out and talk to people and try to have that conversation about the vaccine and then just bring them to the van and just kind of remove as many of those barriers as possible, and that’s been going really well. And I think it’s just that person-to-person conversation. That’s more important. (HS300821)

4.2.3 Translation or adaptation of materials

Key members of the Aboriginal-led community organizations described their role within the process of information brokering. In line with general community translation protocols, this involved an activity chain from the original preparation of information in English to multilingual translations in select Aboriginal and Torres Strait Islander languages and then distribution to and by Aboriginal-led community organizations. Some media organizations (Extract 13) and an Aboriginal language centre (Extract 14) reported dedicating time towards reworking COVID-19 and vaccine health messaging to ensure that the information was relatable by commissioning First Nations actors, celebrities and sports personalities to deliver it. Efforts were also made to make translations locally relevant and meaningful to communities. This was particularly the case when community members were faced with terminology which they were unfamiliar with. This had to be dealt with by explanations that were articulated in a way that was of local relevance to the community, or in a language they could understand better (Extract 15).

Extract 13: The adaptation is mainly to put some of the language in language that’s easily understandable and that’s relatable. That’s where we use like community actors, celebrities, sports personalities. They come in and give the message and that’s really more targeted. So, it’s the same wording, but expressed in a different manner that’s actually easily accessible to the audiences. That’s the kind of adaptation. (ABS220821)

Extract 14: In terms of terminology, they’re looking for explanation that they can connect with. They’re looking for explanation that they can put into terms that has local relevance to them. (MO1150921)

Extract 15: We helped them to translate it from English into Kunwinjku. So, you know, people can really understand something they don’t understand. (ALC050921)

One of the participants outlined reasons why COVID-19 and vaccine health promotion material required adaptation. Firstly, health messaging for First Nations peoples needs to move beyond the inclusion of cursory greetings at the start of an announcement, as this did not necessarily make the message locally relevant (Extract 16). Secondly, the wording of translations can be challenging particularly when it comes to the translation of action verbs or directives due to the sensitivity around the use of the imperative (see Rodríguez Louro and Collard, 2021c), especially when there are external pressures to take up vaccination (Extract 17).

Extract 16: It’s not as simple as saying: “Hey, you mob!” at the start of an announcement. It can be understood in the non-Indigenous space about the difference between states and the way terminology is used, where you know someone says a particular word or refers to a certain football code where you go: “Okay, well, this tells me something about where that person’s coming from”. That is the same, but probably more pronounced, I guess, with Aboriginal and Torres Strait Islander communities just in terms of locally relevant terminology. (MO1150921)

Extract 17: There are some things that are kind of  …  in terms of straight translations, that can be tricky, but there are other things in terms of wording  …  just mainly action words, I suppose, you know, in trying to encourage people to take action. There are different ways that that can be expressed, I suppose, rather than being a directive, more of an encouragement, so that kind of thing. (MO1150921)

Motivations for deciding to become vaccinated may also differ in Aboriginal communities where the driving force may not necessarily be individual preservation but stems instead from a sense of community and cultural responsibility where protecting family and the broader community is of a higher priority. Therefore, it is important that the adaptation of COVID-19 and vaccine health promotion materials aligns with the community’s cultural values.

Extract 18: So, for example, you know, the sense of community responsibility and culturally, I guess, people protecting family and the broader community being larger than an individual. The motivations for people to get vaccinated and things can be a little bit different. It’s not necessarily about self-preservation, you know, it’s in terms of what motivates people to take action. (MO1150921)

Participating media organizations reported scrutinizing generic population messaging they received from official sources to determine whether it was appropriate for their audiences:

Extract 19: That’s done differently depending on where they are because there are members in urban, regional and remote locations. So, the way that the messaging is adapted by urban stations might be quite different to the way that it can be interpreted or translated in language in remote communities for example. (MO1150921)

In the context of providing information to cater for the needs of remote communities the organization needed to determine whether the information was relevant or whether it had to be tailored to the specific context. One indicative example offered was the case of the broad “stay at home” directive, issued in response to a positive COVID-19 test result:

Extract 20: So, we focused a lot on remote communities. “How would that broad message best resonate in a remote community setting?” For example, “stay at home” might not be the safest place for you to be, if at home is a dwelling with 20/30 people. (BMC170821)

4.2.4 Challenges for risk and crisis communication and ways to move forward

The onset and the unprecedented rapid spread of the virus meant that relevant organizations responded to the crisis by preparing, adapting and disseminating information in English and Aboriginal and Torres Strait Islander languages in a very short time frame. During the implementation of this health communications response, Aboriginal-led organizations reported many barriers to the provision of COVID-19 and vaccine health promotion information to their communities. One media organization reported that the recording and distribution of COVID-19 and vaccine health messaging were hampered by community closures (Extract 21), funding issues (Extract 22), staff shortages as many interpreters were unable to work due to COVID-19 “stay at home” mandates and having to respond to COVID-19-related emergencies alongside other emergency situations they had to deal with all year round (Extract 23).

Extract 21: Many communities are still closed, you know – so the physicality of actually recording some of the messaging has slowed down a little bit as compared to non-pandemic times. (MO1150921)

Extract 22: Our programmes are kind of patchworked together from various federal and state funding. But it’s always kind of patchworked together and it is always falling short. But even the funding that is available, it’s never for coms, it’s for programmes. (HS300821)

Extract 23: There’s a significant challenge to personnel. They’re well-trained. They have capacity to actually do the work in terms of production work, but it’s whether they can do the production work all at once in an unexpected way, in the emergency situation, where they’re also dealing with the other emergencies that they deal with year around anyway – cyclones, floods, fires. All these kind of things, that those individuals have to respond to as the frontline of information on those kinds of emergency services. (MO1150921)

A final challenge was connected to the stream of constant and changing information from multiple sources that organizations were trying to process and translate into Aboriginal and Torres Strait Islander languages. As can be seen in Extract 24, often the option to translate was not viable given that commissioning translations was often a lengthy process and by the time a translation was completed, the information might have already been out of date:

Extract 24: So, by the time you get something translated, it may well be out of date and that’s kind of why the only thing that exists is that really, really basic messaging of “Covid is bad, vaccine is good”. (HS300821)

As a response to these challenges, members of participating organizations offered some recommendations that could be beneficial in planning risk and crisis communication strategies more broadly. The media organization and Aboriginal Community Controlled Health Service staff that we interviewed unanimously recommended utilizing ongoing local knowledge and local connections, providing information that is locally relevant to communities (Extract 25) and drawing on existing relationships with medical staff and Aboriginal health workers (Extract 26). In this way the organizations were able to empower their communities by building trust in the messages that were communicated.

Extract 25: Well, I think it’s an ongoing local knowledge, really. That’s the benefit of having a localized media service. It’s got cultural layers to it as well. People want information that’s locally relevant to them. So that is an ongoing way of building trust of having that local knowledge and having those local connections and the only way that you can really do that is to be embedded in that local community and known within the local community. It’s sort of a long-term peace rather than an action that someone takes, you know? (MO1150921)

Extract 26: So, I think just having particularly trusted relationships with our staff who have been doing this for a long time, and they already have that relationship, but also the Aboriginal health workers would just be there and continue to be super important. So, yeah, even with our vaccination-related service, most of them, most of the people working in that programme are Aboriginal. Yeah! And it just makes such a difference. (HS300821)

Finally, it was concluded that by facilitating and promoting grassroots communications, the governance of what happens in Aboriginal communities lies with the communities themselves rather than with any external bodies:

Extract 27: I’m optimistic that, as I said at the very top, this has been a real break in the cycle of how things usually roll out. And our opportunity now is to say: “actually this is in the hands of community. This is what happened”. (MO1150921)

5. Discussion

Our findings suggest that the provision of mediated COVID-19 and vaccine health information by Aboriginal-led organizations, ACCHOs and Departments of Health has played an important role in efforts to reduce vulnerability and cater for the needs of very diverse First Nations communities across States and Territories in Australia.

5.1 COVID-19 and vaccine health promotion materials

The coordination of key messaging between the health sector and other sectors is necessary in pandemic responses (Smith & Judd, 2020). Aboriginal and Torres Strait Islander peoples in Australia have experienced lower rates of infection and death in contrast to other First Nations peoples across the globe (Dudgeon et al., 2020; Mallard et al., 2021; Power et al., 2020; Wiemers et al., 2020; Yashadhana et al., 2020). This is primarily because Departments of Health and key Aboriginal-led organizations have worked collaboratively, to create and disseminate health promotion resources to communities. “Inclusiveness of Indigenous people and Indigenous institutions to lead the way in pandemic planning, response and management has been at the heart of the COVID-19 response” (Choiseul et al., 2021, p. 600) and is a crucial factor driving the large expansion of pandemic health communication resources produced in English and Aboriginal and Torres Strait Islander languages.

The format of the communication can also have an impact on its effectiveness. Video and audio files featured amongst the highest proportions of resources created by Departments of Health and Aboriginal-led organizations and previous research has highlighted that this format allows for information to be “meaningful, relevant and culturally appropriate” while at the same time fostering trust between healthcare providers and First Nations peoples (Kerrigan et al., 2021, p. 10).

There is a large body of evidence that suggests that health promotion messaging needs to be tailored for the linguistic and cultural needs of First Nations peoples in Australia (Australian Government Department of Health, 2021; Poder et al., 2020). Aboriginal Community Controlled Health Organisations alongside Aboriginal-led organizations have been forerunners in creating culturally centred health promotion material and social marketing campaigns in the context of smoking cessation, chronic disease management, suicide prevention and more recently, COVID-19 (Arabena et al., 2014; Poder et al., 2020; Wise et al., 2012; Wyndow et al., 2018). It is not surprising therefore, that these organizations have published a large proportion of COVID-19 and vaccine health promotion materials in Aboriginal and Torres Strait Islander languages.

The pandemic has brought to light the importance of multilingual messaging to facilitate compliance with public health directives and effect behaviour change in an effort to stem the spread of the virus (Ahmad, 2020; Arora & Grey, 2020; Piller et al., 2020). It was generally acknowledged that as the pandemic progressed, State, Territory and Federal governments invested in the translation of COVID-19 and vaccine health-related information in Aboriginal and Torres Strait Islander languages and language service providers were integral in ensuring that the messaging was meaningful and accessible.

O’Brien et al. (2018, p. 628) suggest that the quality of multilingual crisis communication can be evaluated along the following four dimensions:

1. Availability: ensuring translated information is made available; is it recognized as an essential product and service?

2. Accessibility: if translation is “available”, is it accessible, i.e. free, delivered on multiple platforms, in multiple modes, in all relevant languages?

3. Acceptability: ensuring that the provision of translation is acceptable, i.e. are provisions put in place to ensure accuracy and appropriateness of information?

4. Adaptability: can the provision of translation be adapted to different scenarios, for example, fluid language requirements, literacies, technological demands, new modes of delivery, diverse hazards and movement of peoples?

5.1.1 Availability

With respect to the availability of language resources, this study found that during the period extending from January 2020 to December 2021 there were translations of COVID-19 and vaccine-related information in 37 Aboriginal and Torres Strait Islander languages. Lack of resources and funding to support local initiatives to commission translations in additional Aboriginal and Torres Strait Islander languages was raised as an issue by participating organizations. As has been argued for culturally and linguistically diverse communities (Hajek et al., 2022; Seale et al., 2022), increased funding needs to be available to First Nations broadcasting, media and communications organizations, language service providers to meet workload demands and, finally, funding would also facilitate bilingual education and interpreter training.

5.1.2 Accessibility

When considering accessibility, it is necessary to improve the reach of health messaging by distributing translated information more widely across different settings and by engaging the local community. Much of the COVID-19 public health information is available online on government health departments websites and on digital media platforms and social media, as reported in the previous section. However, as we and others have noted, technology may constitute a barrier to information access and exacerbate existing inequalities for vulnerable groups (Knights et al., 2021). COVID-19 health information is also often disseminated in ways that requires community members to have specific resources or skills such as language, health literacy and technology literacy (Aylsworth et al., 2022). Aylsworth et al. (2022) discuss the challenges of reaching First Nations people residing in remote communities in Cananda or who may have low English literacy, low digital health literacy levels or difficulties with internet accessibility. Government health departments and key Aboriginal-led organizations have produced or disseminated large numbers of materials in audio-visual formats as well as print materials in the form of booklets and posters to help mitigate technology and language access issues. In line with findings from previous epidemics (Ebola, Zika and yellow fever) this reflects effective modes of communication, which “vary by location and population, as what works best for one population may work poorly for another” (Toppenberg-Pejcic et al., 2019, p. 442). Additionally, in a bid to reinforce trust in the health messaging, information was often conveyed by prominent Indigenous people and/or Elders and community leaders instead of Anglo-Australian characters to reduce the distance between speakers and receivers (Kerrigan et al., 2021). This practice aligns with the principles of culturally safe health (Mithen et al., 2021; Tremblay et al., 2021), in particular by engaging local people “as community liaisons, cultural brokers and clinical assistants; and Indigenous artworks are commonly used in health promotional material” (Vass et al., 2011, p. 36).

5.1.3 Acceptability and adaptability

In the context of crisis communication and community engagement, creating and disseminating health messaging in a language that the targeted population understands and identifies with goes beyond the translation of the information from the source language (Di Carlo et al., 2022; Wild et al., 2021). As the well-known linguist Nicholas Evans notes:

rather than just translating words and phrases, it’s about taking apart a complex concept and rebuilding it using existing aspects of your language to convey the message and its importance. That takes real skill and intimate knowledge of a language and its speakers. (ANU Communications & Engagement, 2020)

Understanding and acknowledging the different cultural beliefs around illness and COVID-19 are deemed critical components of developing resources while a collaborative approach, engaging a broad range of stakeholders to tailor materials, facilitates the communities’ sense of inclusiveness (Seale et al., 2022). Collaborations with language service providers are pivotal in this effort as evidenced by the swift response of Aboriginal Interpreter Service (AIS) in “helping to get this information out to our mob” (NLC, 2020; https://www.nlc.org.au/media-publications/nlcs-aboriginal-language-videos-about-coronavirus) and by Aboriginal Interpreting Western Australia (AIWA) which advocated for translations to go beyond the written mode to include audio formats, animations and Plain English versions “to ensure that the context and concepts were conducive to Aboriginal people’s way of hearing English, and that the target audience was reached” (Lightfoot, 2020, p. 9).

An additional challenge identified in this study relates to difficulties faced by the public with respect to the readability, understandability and language accessibility of COVID-19 – and vaccine-related translated information. This resonates with findings regarding difficult text comprehension in migrant and ethnic languages (Georgsson & Carlsson, 2022). It is also in line with studies of readability of official public health information in English, where it has been consistently found that public health information is pitched at too high a level exceeding the American Medical Association’s (AMA), National Institutes of Health’s (NIH), and Centers for Disease Control and Prevention’s (CDC) recommendation that medical information for the public be written at no higher than an eighth-grade reading level (Badarudeen & Sabharwal, 2010; Basch et al., 2020; Khan et al., 2021; Valizadeh-Haghi et al., 2021; Worrall et al., 2020; Wrigley Kelly et al., 2021).

Prior to engaging with some considerations for future decision making in the context of risk communication in emergency situations, it is important to note that this study has some limitations. Firstly, with respect to the quantitative data set, the findings in this study only relate to information sourced between January 2020 and December 2021. The search does not capture resources that were not publicly available online and as such the number of resources and the number of Aboriginal-led organizations listed is not exhaustive. In terms of the qualitative data, we acknowledge that only the perspectives of producers of language materials are presented. Future studies could source information about the efficacy of COVID-19 and vaccine health messaging from a broader range of stakeholders. These could be representatives from government health departments and from community members themselves who are recipients of targeted messaging.

5.2 Recommendations and conclusions

This study showcases the effectiveness of having a collaborative approach on two levels: (a) on the ground; and (b) at the peak level of government policymaking (Spence & Sekercioglu, 2022). The findings highlight the vital role of Aboriginal and Torres Strait Islander languages in high stakes information transfer and in particular, the push by Departments of Health and language groups to create and disseminate important messaging in Aboriginal and Torres Strait Islander languages. Participating Aboriginal-led organizations made the following recommendations, during the course of data collection, to facilitate crisis communication for First Nations peoples:

1. community-led initiatives for current and future crisis communication should be supported to help optimize health care for First Nations peoples, drive innovation and create change;

2. health public messaging across First Nations groups needs to be locally relevant to communities;

3. public health messaging should be tested in sample First Nations communities to ensure it is understandable to the targeted populations;

4. strategies should be in place to be able to deal with the constant and changing information received;

5. ongoing local knowledge, existing relationships and local connections need to be utilized in emergency response campaigns;

6. a multimodal approach to the production and dissemination of pandemic health information better caters for the diverse needs of First Nations communities; and

7. building capacity in language service providers will facilitate the translation process and help fund translation and interpreter training.

These recommendations are in line with the National Agreement on Closing the Gap (Australia, Coalition of Aboriginal and Torres Strait Islander Language Organisations, 2020), the National Indigenous Languages Report (Australian Institute of Aboriginal and Torres Strait Aboriginal and Torres Strait Islander language Studies (AIATSIS), 2020), and the National Aboriginal and Torres Strait Aboriginal and Torres Strait Islander Language Health Workforce Strategic Framework and Implementation Plan 2021–2031 (National Workforce Plan Project Reference Group, 2022) which actively recognize the vital role of Aboriginal and Torres Strait Islander languages in high stakes information transfer. This study also highlights the role of the Aboriginal community-controlled sector in the provision of culturally safe care and information and the importance of strengths-based and rights-based approaches to health. Finally, having a bottom-up and top-down response to COVID-19 may provide learning lessons and policy direction for health emergencies. Embedding the social and cultural determinants of health for First Nations peoples into a national health policy ensures it is anchored in First Nations peoples’ “ways of knowing, being and doing, and encompasses a holistic understanding of health and wellbeing” (Lowitja Institute, 2022, p. 15).

Acknowledgements

We would like to acknowledge and dedicate this paper to the late Associate Professor Barbara Kelly, whose insights into this research were invaluable.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

The data that support the findings of this study are available on request from the corresponding author, MK. The data are not publicly available due to restrictions, e.g. their containing information that could compromise the privacy of research participants.

Additional information

Funding

This work was supported by Melbourne University under Grant [2021ECR167].

Notes on contributors

Maria Karidakis

Maria Karidakis is a Lecturer at the School of Languages and Linguistics at the University of Melbourne. Her current research focuses on medical interpreting for Aboriginal and Torres Strait Islander peoples, and narrative analysis and narrative identity construction and positioning in small stories told by interpreters. Other research interests are language maintenance and shifts in migrant community languages and Indigenous languages and socio-economic variation in the use of these languages.

Giuseppe D’Orazzi

Giuseppe D’Orazzi is a Lecturer in ESL and Applied Linguistics at the University of Melbourne whose primary research interests are in motivation and demotivation in learning second languages as well as research into multilingualism and health communication with CALD and Aboriginal and Torres Strait Islander peoples.

John Hajek

John Hajek is Professor of Italian Studies and director of the Research Centre for Multilingualism and Cross-Cultural Communication at the University of Melbourne. A trained linguist, he completed his university studies in Australia, Italy and the United Kingdom. He has a broad range of research interests, with a particular focus on understanding multilingualism and addressing the needs of culturally and linguistically diverse communities in Australia, including during the COVID-19 pandemic.