The influence of cultural factors on outcomes following traumatic brain injury.

Abstract

BACKGROUND AND AIMS: Most traumatic brain injury (TBI) outcome studies focus on white, English-speaking patients who identify with the dominant health care system. Little is known of the experience of TBI individuals from Culturally and Linguistically Diverse (CALD) backgrounds. The present study compared outcomes following TBI in individuals from English-Speaking Backgrounds (ESB) with those from CALD backgrounds. METHOD: 103 ESB and 99 CALD participants with TBI (whom were treated at Epworth) were assessed an average 22.3 months post-injury on the Brief Acculturation Scale, Craig Handicap Assessment and Reporting Technique (CHART), Activities of Daily Living scale, Coping Scale for Adults, and Hospital Anxiety and Depression Scale. RESULTS: Results showed no significant group differences in most demographic and injury-related variables, although CALD participants showed lower pre-injury employment. There was no significant difference between groups in therapy costs. At post-injury follow-up, CALD participants were significantly less independent than the ESB group in light domestic duties, shopping and financial management, and reported lower cognitive independence, mobility and participation in occupational and social activities on the CHART after controlling for pre-injury employment. CALD participants reported heightened awareness of post-injury deficits relative to ESB participants, and held different beliefs regarding injury consequences and factors that would aid their recovery. The CALD groups also reported greater anxiety symptoms and less problem-focused coping than the ESB group. There was, however, significant variability in responses to injury across different geocultural regions. Hierarchical regression analyses showed that higher CHART total scores were associated with having a value system that is Australian, being younger in age, having more education, and spending less time as an inpatient. CONCLUSIONS: Poorer outcomes in CALD individuals with TBI are not simply reflective of socio-demographic factors. TBI clinicians needs to consider their differing beliefs about injury and recovery in order to maximize outcomes in CALD individuals.