What are we trying to measure when we create a variable based on CALDness? — The Association Specialists
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  3. What are we trying to measure when we create a variable based on CALDness?

What are we trying to measure when we create a variable based on CALDness? (23917)

Davoud Pourmarzi 1 , John Noel Viana 2 3 , Tehzeeb Zulfiqar 1 , Linda Murray 4 , Anna Olsen 5 , Guddu Kaur 1 , Sadia Hossain 6 7
  1. National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
  2. Justice and Technoscience Laboratory, School of Regulation and Global Governance, College of Law, Governance, and Policy, The Australian National University, Canberra, ACT, Australia
  3. Sydney Health Ethics, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
  4. College of Health, Massey University, Wellington, New Zealand
  5. School of Medicine and Psychology, Australian National University, Canberra, Australia
  6. Discipline of Public Health, School of Medicine, Faculty of Health, Western Sydney University, Campbelltown, New South Wales, Australia
  7. Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, New South Wales, Australia

Background: Despite being a poorly defined term, “culturally and linguistically diverse” or CALD is commonly used as an independent variable in health research. This study critically examines the variables that Australian health research used CALD as a proxy for.

Methods: We conducted a scoping review of quantitative health research conducted in Australia that defined “culturally and linguistically diverse” as an independent variable. PubMed and Scopus-indexed peer-reviewed articles published up to January 2026 were searched. We employed a content analysis method to identify variables for which CALD was used as a proxy, based on how researchers rationalised the relevance of the study for CALD populations in the Introduction and Discussion sections.

Results: 121 articles were included. Seven (5.8%) were interventional studies. The aim of 71 (58.7%) studies included comparison between CALD and other group/s. In most studies, country of birth was used as an indicator of CALD. In 79 (68%) studies, the comparison group was labelled as non-CALD. We categorised the identified variables in personal capacities (language proficiency, literacy and digital literacy, health literacy, genetics and biology, and awareness about services); sociocultural (culture, ethnicity, religion, taboos and shame, social support and norms, health beliefs, migration experience, exposure to risk factors and healthcare-seeking behaviour) and system-related (socio-economic status, experiences of racism and discrimination, belonging to a minority group, stigma, trust, and access to health and other services) categories.

Conclusion: Australian health studies assume that the study population can be categorised as CALD and other, and CALD can be used as a variable that would impact health-related outcomes, and as a proxy for a variety of variables. Health researchers should directly measure specific variables of interest using valid and reliable methods rather than using the proxy CALD. This would enable a more accurate understanding of factors affecting the health status of Australia’s population.