
Zeinab Fakih (left) on a recent trip to Broome with Specsavers and The Fred Hollows Foundation.
Australia is home to a vibrant multicultural population. Boasting one of the largest immigrant populations in the world,1 the nation’s cultural tapestry is enriched by the presence and contribution of migrants who have settled in towns and cities across the country.
This article delves into the experiences of four Specsavers optometrists who demonstrate cultural responsiveness in their practices. Through their insightful reflections and effective strategies, they ensure eye exams are safe and accessible for all patients.
As of 2023, nearly a third of Australians (8.2 million) were born overseas,2 the highest number of foreign-born residents in over 130 years. In addition, almost threequarters of recent migrants3 and 22.3% of the general population speak a language other than English at home.4 These factors have influenced a need for health practitioners to take a more culturally and linguistically diverse (CALD) approach to patient care.5
THE IMPORTANCE OF CULTURALLY AND LINGUISTICALLY DIVERSE CARE
There are a number of challenges optometrists may encounter when providing eye care services to patients from varied backgrounds. Language barriers and cultural differences can make communication difficult, which can lead to misunderstandings or, in the worst case, a lack of trust.
However, the diversity within Australia’s population reflects not only the demographic of patients but also the optometry workforce itself. A significant proportion of practitioners were born overseas or have parents who were born overseas.6 Positively, these optometry professionals bring a fresh perspective to patient care and impart a wealth of cultural sensitivity, understanding, and language skills to their roles as healthcare providers.
In doing so, they can break down barriers and improve access to essential optometry services for CALD patients. This enhanced approachability not only helps individuals see clearly through vision-corrective glasses and treatments, but also enriches patients’ overall quality of life.
NAVIGATING LANGUAGE BARRIERS
Zeinab Fakih sees a high volume of patients from various cultural backgrounds at Specsavers Eastgardens in Sydney’s south. Describing herself as a visibly Muslim woman, she often finds her ethnicity puts patients from similar backgrounds at ease and makes them feel more comfortable in the test room.
“I’ve had a lot of patients express their anxiety about not understanding English well. In these instances, I adapt my communication style; I slow down, reassure them, repeat myself, speak calmly and clearly, and touch base with them throughout the test to make sure they have understood everything we have gone through,” she explained.
Acknowledging the pivotal role technology plays in bridging communication gaps, Ms Fakih often relies on tools like Google Translate to ensure comprehension and, where possible, involves family members or team members who can translate for the patient.
“There have been multiple instances where I’ve completed entire eye tests via Google Translate as patients have spoken little to no English. I recently had a patient who needed to be referred for an eye condition. Something like this is difficult enough to explain to someone who does speak English, let alone someone who doesn’t. We went back and forth on Google Translate for a while until the patient was satisfied and understood the care plan. While this takes more time, it’s the right thing to do for the patient to ensure they have a grasp of their eye health,” she said.
“It’s also important to be mindful of any religious or cultural implications of treatment. For instance, when caring for Muslim patients during Ramadan; when fasting, sometimes they are hesitant to use eye drops because they may flow through tear ducts into their throat and break their fast.
“Of course, adhering to eye drops is especially relevant for glaucoma patients who need drops daily to avoid vision loss. Understanding the patient’s hesitation, explaining the importance of using the drops, and teaching them a method of application where they can pinch the corners of their eyes to avoid liquid going down their throat, all contribute to culturally sensitive patient care.”
VARYING COMMUNICATION STRATEGIES
Specsavers optometrist Selinda Lai leverages her ability to converse in Mandarin and Hakka dialects to connect with Chinesespeaking patients who attend her practice in Narellan, New South Wales. To make the eye exam experience easier for CALD patients, she incorporates a variety of communication strategies to engage with them and confirm their understanding.
“I can speak Mandarin and Hakka Chinese dialects but mostly at a conversational level, so doing an eye test and explaining eye conditions can be challenging, especially when I only know the term in English.
“It’s important to let patients know they can bring an interpreter or a trusted family member to their appointment if they’re not comfortable with their level of English. If this is not possible, I offer to translate medical terms and management to patients using Google Translate to ensure they understand, or source online resources that are available in the language they need. There have been times when I pull up online images to help convey a condition and management options.”
Ms Lai also recommended being mindful of the patient’s preference for a gender-specific optometrist, as this may be another factor in their level of comfort in the test room.
FOSTERING CONNECTIONS THROUGH CULTURAL SENSITIVITY
For Nithiya Vijayakumar, establishing a connection with the patient beyond verbal communication is an essential element of effective and quality CALD care. She provides optometry services to a culturally diverse community in Caroline Springs, Victoria, and said it has been a deeply enriching experience to be able to conduct eye examinations in her native language of Tamil.
“Over the past three years, I’ve encountered hundreds of patients who spoke the same language as me. Initially, it was difficult to communicate complex terminology that lacked direct translation, but I developed strategies over time, such as using simple descriptive words in Tamil to effectively communicate.
“I do what I can to deconstruct language barriers. For patients who are unable to read English alphabets, I use the number chart for visual acuity assessment. I also take note of non-verbal cues, like nods of reassurance or simple gestures like thumbs up or down during the eye examination to ensure understanding,” she explained.
In addition to her range of communication techniques in the test room, Ms Vijayakumar expressed the value diverse staff representation can bring to an optometry practice. A multicultural team can be an excellent way to enhance the customer experience and better cater to the local demographic.
“Bilingual staff can help breakdown communication barriers with CALD patients. At our Specsavers practice, we boast a culturally diverse team with varied backgrounds and language abilities. This helps to create a seamless and comfortable experience when patients visit.”
ENGAGING WITH COMPASSION
Safana Al Dajon practises within a culturally rich community in Merrylands, New South Wales. She approaches CALD patient care by being respectful and receptive towards the patients’ past experiences, and takes the time to fully understand the cultural and religious sensitivities of the people she’s caring for.
“I once had an Arabic-speaking patient, with whom I was able to converse in her native tongue, express how much easier it was to receive healthcare from me because she was able to use her own words to describe her own concerns.
“In turn, I felt confident I could understand her. She told me that having someone translate was helpful, but it sometimes left her feeling uncertain; she was unsure whether the clinician truly understood the experience of her presenting concerns. That made me realise how important it is to maintain a high level of engagement with the patient, even in the presence of interpreters, and make sure they feel included in the discussion.
“Communicating with non-verbal cues, such as eye contact, a friendly smile, and nodding in understanding, are all subtle ways a practitioner may convey their receptiveness.”
Ms Al Dajon often sees patients who have recently immigrated or sought asylum in Australia and are shy or embarrassed about their English language skills. When caring for refugee patients, she stressed the importance of cultural sensitivity when addressing health literacy and trauma.
“These people may adhere to differing cultural norms and perceptions, may be facing challenges with resettlement, or perhaps have never had access to the level of healthcare available in Australia.”
She said extra steps must be taken to ensure a warm and welcoming environment in these situations, encouraging patients to use simple comparisons to explain their symptoms.
“Create a safe space to invite patients to freely communicate – no matter how ‘imperfect’ this may be. Patients may use varying phrases or comparisons to convey their point; I once had a patient use ‘rain’ to tell me that they had watery eyes, and ‘fire’ to tell me their eyes were burning.”
PATIENCE, EMPATHY, AND CONTINUOUS LEARNING
The experiences of these four Specsavers optometrists illustrate the critical role optometry has in making eye exams, vision correction, and treatments more accessible to more Australians. As the nation continues to embrace its multicultural identity, there are a variety of simple, yet effective strategies practitioners can employ.
Culturally sensitive healthcare is good healthcare, and these stories offer valuable lessons for all optometrists to ensure patients feel heard, respected, and cared for, and importantly, are able to be involved in and understand their eye health.
Cindy Nguyen is the Head of Professional Development at Specsavers Australia/New Zealand, where she oversees optometry development, training, and career strategy. Ms Nguyen graduated with a Bachelor of Applied Science (Optometry) (Hons) from Queensland University of Technology (QUT) in 2011. She is a therapeutics-endorsed optometrist and has previously worked as a clinical optometrist, and clinical supervisor for fourth- and fifth-year optometry students at QUT.
References
- Dyvik EH, Countries with largest immigrant populations worldwide 2020 (webpage, 4 July 2024) available at statista.com/statistics/1378084/migrants-stock-worldhighest- population/ [accessed July 2024].
- Australian Bureau of Statistics. Australia’s population by country of birth. Statistics on Australia’s estimated resident population by country of birth. Canberra: Australian Government; 2023. Available at abs.gov.au/statistics/ people/population/australias-population-country-birth/jun- 2023 [accessed June 2024].
- Australian Bureau of Statistics. Permanent migrants in Australia. Characteristics of permanent migrants who arrived in Australia between 1 January 2000 and 10 August 2021. Canberra: Australian Government; 2023. Available at abs.gov.au/statistics/people/people-and-communities/ permanent-migrants-australia/2021 [accessed June 2024].
- Australia: Language used at home. Available at profile. id.com.au [accessed June 2024].
- Australian Bureau of Statistics. Religious affiliation (RELP) 2021 Census of population and housing: Census dictionary. History and changes. Available at abs.gov. au/census/guide-census-data/census-dictionary/2021/ variables-topic/cultural-diversity/religious-affiliation-relp [accessed June 2024].
- Optometry Australia. Cultural responsiveness framework for optometrists 2021. Available at optometry.org.au/wpcontent/ uploads/OA-CALD-Framework_designed-v5.pdf [accessed June 2024].
Tips for Culturally Responsive Clinical Care
- Speak slowly and simply.
- Be respectful and sensitive about a patient’s past experiences and any emotions they may feel in the test room.
- Use non-verbal communication, such as nods and hand gestures, to help convey messages and engage the patient in the conversation.
- Use visuals and diagrams to demonstrate your points.
- Invite the patient to bring an interpreter or family member to the appointment to help with comfort and communication.
- Utilise language translator tools like Google Translate to interact directly with the patient and ensure you understand each other.
- Use non-subjective methods to help determine the patient’s glasses prescription.
- If making a referral, be sure to include whether an interpreter is required for the appointment.
- Encourage diversity in the staff employed at your practice to help create a safe and welcoming environment for patients from different backgrounds.
- Speak to people from different cultures to gain a better understanding of their cultural and religious nuances and needs.