New Australian study identifies key barriers to COVID-19 testing and vaccination

In 2021, mass vaccination against the coronavirus disease 2019 (COVID-19) became the primary management strategy that helped to ease restrictions, open up the economy, as well as protect those who were most vulnerable to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 vaccine rollout began in February 2021 and is continuing in most countries.

Testing for COVID-19 symptoms during vaccination was considered another major management strategy. Additionally, testing and contract tracing helped to provide essential data on when, where, and how the virus was spreading.

Study: COVID-19 testing and vaccine willingness: Cross-sectional survey in a culturally diverse community in Sydney, Australia. Image Credit: /


COVID-19 vaccination has been declared mandatory by the Australian government. The vaccine rollout in Australia is state-based and phased, where priority is given to frontline healthcare workers, older people, Aboriginal and Torres Strait Islander people, and people with specific underlying medical conditions.

Two COVID-19 vaccines including the Pfizer (Comirnaty) and AstraZeneca (Vaxzevria) vaccines were available during the current study. However, AstraZeneca was found to be less effective and pose certain risks as compared to Pfizer. Therefore, Pfizer became the preferred vaccine in Australia. This shift slowed down the rollout, as few community members refused to get vaccinated with AstraZeneca during the first half of 2021.

A recent survey indicated that the percentage of Australians who agreed to get vaccinated fluctuated from February to June of this year. A previous survey, when vaccines were not available, suggested that the main concerns to COVID-19 vaccination included vaccine safety, the need for more information, and distrust of the government or vaccine.

A survey on COVID-19 testing indicated that a small percentage of Australians were willing to get tested if they had mild symptoms. The most common barriers to testing were having symptoms but not believing it to be COVID-19, concerns regarding the test being painful, preferring to self-isolate, and feeling that symptoms were not severe enough. However, these surveys did not include culturally and linguistically diverse communities of Australia.

A new study published on the medRxiv* preprint server aimed to bridge the research gap that existed in a culturally and linguistically diverse population concerning COVID-19 testing intentions and vaccine willingness in Sydney, Australia between March 21, 2021, and July 9, 2021.

About the study

The current study involved 708 participants who were recruited through bilingual Multicultural Health staff and Health Care Interpreter Service staff. The recruited participants had to be 18 years of age and speak either of the following languages: Arabic, Assyrian, Croatian, Dari, Dinka, Hindi, Khmer, Chinese, Samoan/Tongan (combined as one language ‘group’), or Spanish.

The participants had two means of taking part in the study, either by completing the survey themselves online or completing the study with the help of bilingual staff or an interpreter. The participants had to undergo demographic questions, questions related to COVID-19 testing intentions, and questions related to vaccine willingness.

Finally, logistic regression models were used for determining the factors that were associated with both vaccine willingness and testing intentions. Free-text responses were also analyzed with the help of content analysis.

Study findings

The results of the study indicated that the mean age of the participants was 45.4 years, with 51% of the participants being female. Most of the participants recruited in the study were not born in Australia.

Taken together, 31% of the participants did not speak English well or at all, while 70% had no tertiary qualifications. Additionally, inadequate health literacy was reported in 41% of the participants.

The results reported that three-quarters of the participants, ranging from 58.7% for Croatian speakers to 99.4% for Hindi speakers, responded that they would ‘get tested no matter what’ on the development of COVID-19 symptoms. Furthermore, 72.7% of participants with inadequate health literacy responded that they would ‘get tested no matter what,’ as compared to 80.3% of people with adequate health literacy. The intention to get tested for COVID-19 was found to be associated with age and varied significantly across language groups.

The most common barriers to testing, as identified by the participants, were concerns regarding testing being painful, the belief that if they already had a negative test report they did not require another one, and concerns regarding getting infected at the testing center.

The findings of the current study also indicated that most of the participants were willing to get vaccinated for COVID-19, while about 20% of the participants were unwilling while the rest remained unsure. Vaccine willingness was found to be greater in males as compared to females. The vaccine acceptance was highest in Khmer speakers, whereas the ‘not sure’ response was highest in Dari and Samoan/Tongan speakers, and the ‘no’ response was highest for Arabic and Assyrian speakers.

The main barriers to vaccination were side effects and safety concerns regarding the vaccine, a need for more information, and distrust in the government.

Study takeaways

Overall, the results of the current study showed higher testing intentions as compared to national Australian estimates during the same period. However, the study also demonstrated lower COVID-19 vaccine willingness in comparison to national Australian estimates.

The current study involving culturally and linguistically diverse communities showed that the different community members had serious concerns regarding COVID-19 testing and vaccination. Thus, different language groups have different needs that must be met through local targeted communication strategies.

Although the Australian federal government provided a policy in November 2020 regarding the need for translated and simple English communication about the vaccines to cater to all communities, this policy was not implemented while the current study was conducted. Therefore, public health entities must work collaboratively to provide specific approaches to people belonging to different communities to encourage them to participate in COVID-19 testing and vaccination.


Although the current study was able to indicate the concerns regarding COVID-19 testing and vaccination for different communities in Australia, it had certain limitations. First, the study included only ten specific language groups that did not represent all the cultural and language groups of Australia.

Second, this study did not ask the participants whether they had been vaccinated. Lastly, the study was unable to incorporate specific items about the Astrazeneca vaccine, since recruitment began before the news regarding its side effects hit mainstream media outlets.

*Important notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:
Suchandrima Bhowmik

Written by

Suchandrima Bhowmik

Suchandrima has a Bachelor of Science (B.Sc.) degree in Microbiology and a Master of Science (M.Sc.) degree in Microbiology from the University of Calcutta, India. The study of health and diseases was always very important to her. In addition to Microbiology, she also gained extensive knowledge in Biochemistry, Immunology, Medical Microbiology, Metabolism, and Biotechnology as part of her master's degree.


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