The COVID-19 pandemic disproportionately affected culturally and linguistically diverse (CaLD) communities globally, including in Australia. Factors such as occupation, housing arrangements, and cultural practices contributed to increased risk. Concerns arose about the lack of meaningful inclusion of CaLD communities in public health planning. While traditional approaches like translated materials proved insufficient, research indicates that CaLD communities rely heavily on interpersonal communication and trust individuals within their social networks. This study investigated the perceptions of those working with CaLD communities in Australia regarding the role and impact of community leaders and other information intermediaries in disseminating COVID-19 public health information. Understanding their role is crucial for effective pandemic communication and equitable health outcomes. The study aimed to address a gap in the literature by investigating the experiences and perspectives of those directly engaged in supporting CaLD communities during the pandemic, focusing specifically on the efficacy and challenges of using community leaders and other information intermediaries as crucial links to public health messaging.

Existing literature highlights the unequal burden of COVID-19 on minority ethnic groups due to a complex interplay of factors. Communication barriers hinder access to healthcare for CaLD populations, as translated resources alone do not guarantee understanding or reach. Research consistently shows the preference for information from trusted sources within social networks, emphasizing the role of interpersonal communication, particularly in collectivist cultures. The 'gatekeeper' model, though previously focused on non-professionals, provides a framework for understanding the role of individuals who facilitate information flow. This study adapts the term to 'information intermediaries' to encompass a broader range of individuals, including community leaders, faith leaders, bilingual workers, and other influential figures within CaLD communities. The Australian Government's COVID-19 vaccination plan acknowledges community leaders' crucial role in information dissemination. However, this study focuses on exploring whether this acknowledged role was effectively realised and how it can be further optimized.

This qualitative study employed semi-structured, in-depth telephone interviews conducted between January and April 2021. Forty-six interviews were conducted with key informants and stakeholders actively delivering services to CaLD communities in Australia. Informants included those working in migrant resource centers, refugee health services, settlement services, community-based organizations, and primary care settings. Stakeholders included those involved in multicultural health and diversity through advocacy, policy, or research, representing government agencies or CaLD peak bodies. Recruitment utilized a mixed approach: online searches, referrals from participants, and direct contact with researchers' networks. A multi-stage thematic analysis using NVivo software was used to identify recurring themes and codes. The researchers followed a constant comparative approach ensuring rigor by comparing themes and addressing any disagreements through team discussion. The study adhered to ethical guidelines, obtaining verbal informed consent from all participants and having the research approved by the Human Research Ethics Advisory Panel at the University of New South Wales (HC200776). No identifiable personal information was collected.

Four key themes emerged from the interviews. First, participants consistently highlighted the essential role of information intermediaries in bridging communication gaps within CaLD communities. These intermediaries included community and religious leaders, bilingual workers, and even individuals with health backgrounds who weren't licensed to practice in Australia. Their understanding of community dynamics and networks was deemed crucial for effective information dissemination. However, some participants questioned the intermediaries' reach and understanding, raising concerns about potential misinterpretations or information filtering. Second, strong criticism was leveled at government agencies for their late recognition of the importance of these intermediaries and their insufficient resources and support in the early stages of the pandemic. While consultation improved later, concerns remained about whether governments genuinely engaged these leaders or simply extracted information without reciprocal feedback or acknowledgement of their contributions. This lack of meaningful engagement was seen as a long-standing issue rather than a pandemic-specific problem. Third, several concerns were expressed regarding the lack of sufficient training, support, and resources provided to the information intermediaries. Participants raised concerns about the lack of clear guidance, inconsistent or insufficient briefings, and the assumption that intermediaries were adequately prepared for their roles. The lack of support was particularly pronounced in regional and remote areas, highlighting the geographical disparities in resource allocation. Fourth, significant concerns were raised about the risk of burnout among information intermediaries, particularly due to the unpaid nature of their work, the heavy emotional burden, and the lack of recognition for their considerable efforts. Participants suggested that compensation, public acknowledgment, and adequate training could mitigate burnout, although the feasibility of funding was debated. This was seen as particularly crucial for sustainability beyond the immediate crisis and for effective response in future emergencies.

The findings address the research question by highlighting the crucial yet often overlooked role of information intermediaries in effectively communicating public health messages within CaLD communities. The study's significance lies in demonstrating the critical need for proactive government engagement, resource allocation, and ongoing support for these intermediaries. The results contribute to the field by offering actionable recommendations for improving public health communication strategies, particularly in diverse and marginalized communities. The findings highlight the limitations of traditional top-down approaches and underscore the necessity of collaborative and community-centered strategies. The study's emphasis on recognizing and supporting community-based efforts is essential for building trust and promoting health equity. The findings contribute significantly to understanding how information flows within CaLD communities, highlighting the need for strategies that leverage existing social networks and trusted individuals. This nuanced understanding is particularly important during health crises like pandemics.

This study underscores the critical need for recognizing and resourcing community leaders and other information intermediaries in responding to pandemics and other disasters. Future pandemic plans must incorporate communication strategies that leverage diverse channels and actors, potentially providing a cost-effective approach. Researchers and policymakers should collaborate with these intermediaries to improve information access and develop effective policies for the communities they serve. Future research should explore the cost-benefit analysis of investing in intermediary support versus relying on traditional communication pathways, and should examine the effectiveness of different training models and compensation strategies.

The study acknowledges the heterogeneity of CaLD communities, and although efforts were made to recruit participants from a range of backgrounds, limitations remain in representing all groups. The relatively small sample size and reliance on snowball sampling may limit the generalizability of findings. Furthermore, the lack of detailed information about participants’ roles could have influenced the results. The qualitative nature of the study limits the ability to make broad quantitative generalizations.