Confident
Communities
A guide to working
together with African
communities to reduce
alcohol-related harms
2
Help us keep this toolkit relevant and up to date
People who have migrated to Australia from a wide range of African countries
possess a rich diversity of languages, cultural values and practices, identities,
experiences, personal and community resources.
The Hunter Multicultural Community Drug Action Team’s toolkit is intended to be a
“living” document, driven by knowledge exchange, research developments and
evolving community and generational needs.
Whilst the research and community consultation underpinning this toolkit have
focused on African communities, some of the topics and strategies discussed may
also be of use to those working with other community groups to address a range of
alcohol and other drug issues.
We have created a Facebook page https://www.facebook.com/ConfidentCommunities
for community members and those working with them to share learnings about the
building of community, family and individual resilience to alcohol and other drug
related harms. You can also email feedback and suggestions for toolkit improvement
to info@damec.org.au
Tony Brown
Chairperson
Hunter Multicultural CDAT
Newcastle NSW
March 2015
Suggested citation: Hunter Multicultural Community Drug Action Team and Drug and Alcohol Multicultural Education
Centre. Confident Communities: A guide to working together with African communities to reduce alcohol-related harms.
Sydney: Drug and Alcohol Multicultural Education Centre; 2015.
The Licensed Material being used is for illustrative purposes only; any person depicted in the Licensed Material is a model.
3
Acknowledgements
The creation of this toolkit was overseen by a steering committee from the Hunter
Multicultural Community Drug Action Team (CDAT). The Hunter Multicultural CDAT is
made of up interested members of the community and representatives from Government
and Non-Government Organisations. Its role is to identify drug and alcohol issues among
culturally and linguistically diverse communities in Newcastle and surrounding regions
and respond through effective and culturally sensitive prevention and health promotion
strategies.
In particular, the contribution of the following people/organisations was crucial in the
production of this toolkit:

Members of various African communities who participated in our consultations and
provided general advice for the project

Community and health workers who provided feedback on the toolkit drafts

Tony Brown, Chairperson, Hunter Multicultural Community Drug Action Team

Catherine Norman, Area Manager, Multicultural Health Service, Hunter New England
Local Health District

Helena Hodgson, Senior Community Development Officer (CEAP), Australian Drug
Foundation

Kiri Hata, Team Leader, Refugee Issues and Advocacy, Penola House

Alison Jaworski, Project Officer, Drug and Alcohol Multicultural Education Centre

Linda Stewart, Alcohol and other Drug Counsellor, McAuley Outreach Service

Mark Toohey, former Community Focus Manager, Ethnic Communities Council
Newcastle & Hunter Inc.

Miza Torlakovic, Family Worker, Northern Settlement Services Ltd

Dubravka Vasiljevic, Multicultural Health Liaison Officer for Mental Health and Drug
and Alcohol Services, Hunter New England Local Health District

Jean-Paul Birama who provided some of the photos used in this toolkit
This work was supported by the Foundation for Alcohol Research and
Education, an independent, charitable organisation working to prevent the
harmful use of alcohol in Australia www.fare.org.au
4
Contents
Introduction ....................................................................................................................................................... 5
How this toolkit was developed .................................................................................................................. 5
Who is this toolkit for? ................................................................................................................................. 6
How to use this toolkit.................................................................................................................................. 6
Alcohol use amongst African communities .................................................................................................... 9
Preparation ....................................................................................................................................................... 12
Build your own capacity to work in a culturally competent way.......................................................... 12
Learn about the group you want to work with ................................................................................... 13
Preparing to Act: SWOT Analysis .............................................................................................................. 16
Engagement ..................................................................................................................................................... 19
Identify Gatekeepers .................................................................................................................................. 19
Build a relationship of trust with the community ................................................................................... 21
Alcohol use and stigma .............................................................................................................................. 22
Case Study 1: Hunter Multicultural Community Drug Action Team Consultations ................................ 24
Strategies ......................................................................................................................................................... 27
Be guided by the results of the consultation .......................................................................................... 27
What existing evidence is there? .............................................................................................................. 28
Take a holistic approach ............................................................................................................................ 30
Factors Influencing alcohol-related harms .......................................................................................... 31
Case Study 2: Educational workshops with a community sports group ................................................. 33
Evaluation ......................................................................................................................................................... 35
Support and guidance for alcohol-related issues ....................................................................................... 38
Alcohol and drug telephone information services in each State/Territory: ........................................ 38
References........................................................................................................................................................ 40
5
Introduction
How this toolkit was developed
Several strategies were used to create this toolkit:
a) A review of existing academic and grey literature to identify:
(i) Best practices in culturally sensitive engagement strategies, and
(ii) The contents of alcohol harm prevention measures that are likely to be the most effective
and applicable to African communities living in Australia.
b) Preliminary meetings between CDAT members and key community representatives working
with African communities in the Hunter area of NSW.
c) Consultations with African community members living in the CDAT area. A total of 48 men and
women from six communities were consulted from October to December 2013.
d) Incorporation of practice wisdom reflecting on findings from the literature review and
consultations.
e) Review of the final draft with local health/community workers and community members.
In this toolkit “African communities”
refers to people from an increasing
diversity of African countries who
have migrated to Australia since the
early 1990s. The term includes new
and emerging communities who
have migrated to Australia for a
range of reasons, such as refugees,
students or those joining family
members.
6
Who is this toolkit for?
This toolkit is designed to help community groups and workers engage with African communities to
prevent alcohol-related harms. Those that might find this toolkit useful include:

Community Drug Action Teams (CDATs)

Government-funded health services

Migrant and settlement organisations

Local Councils

Community Development Workers

Health Promotion Workers
How to use this toolkit
Africa is a huge continent with a vast range of different cultures and traditions. There is no ‘one size
fits all’ approach to supporting African communities tackle alcohol-related harms. This toolkit aims
to provide you with guidance on important issues to consider, however you will need to tailor
engagement and intervention strategies to the particular needs of the group you are working with.
No previous experience in working with African or culturally diverse communities is assumed;
readers with more familiarity with African communities may wish to proceed to Engagement and
Strategies and only review the first sections briefly.
Throughout the toolkit key
principles are highlighted.
Community groups are
encouraged to use these
in the development of
their own projects
Whilst the toolkit concentrates on alcohol-related harms, many of the issues discussed are relevant
for a range of substance use issues.
Introduction
7
This toolkit takes a Participatory Action Research approach. Participatory Action Research is a
combination of community participation and research that involves community participants as
partners in the project; sharing decision making, planning, responsibilities and tasks. By creating
opportunities for learning and empowering participants through their involvement in project
activities, the aim is to create broader social change.1, 2
Participatory Action Research Cycle
Participatory action research involves an iterative reflective cycle of data collection, reflection and
action in a ‘corkscrew’ movement.3 Groups focus on research that aims to determine the action that
should follow, the effectiveness of this action is then reflected upon, and further research may be
necessary such as to understand any other issues noticed or to identify ways to improve the
response, upon which the process begins again.2, 3
Introduction
Introduction
8
Engaging with African communities to address alcohol-related harms is a long term commitment,
not a one-off project. It may take some time to build trusting relationships needed for meaningful
engagement with community members.4 Sustaining partnerships beyond a single consultation or
project also helps maintain accountability and increases the chances for enduring positive results.5, 6

Introduction
Introduction
At the end of each section there are links to
additional resources that explore the issues
discussed in more detail.
9
Alcohol use amongst African communities
At the 2011 Census 337,823 Australian residents were born in Africa.7 Since the 1980s there
has been a growth in the number of refugees arriving from Africa, as well as an increasing
diversity of birthplaces among African migrants.8 Ethiopia, the Democratic Republic of
Congo, Eritrea and Egypt have recently been major sources of humanitarian entrants to
Australia.9 People born in Sudan remain a significant proportion of Australia’s African-born
population7 due to past migration policies. Whilst many migrants from Africa settle in capital
cities, regional areas are also important settlement destinations.10
There are no population-wide studies that have recorded rates of alcohol-related harms
across African communities living in Australia. Research in Australia and overseas suggests
there may be lower rates of drinking among some African communities compared to the
general population; although within communities there is diversity in consumption patterns,
attitudes and knowledge of effects.11- 13
Alcohol consumption among African communities living in Australia is influenced by various
religious, socioeconomic, cultural and individual factors. Alcohol is used for a range of
reasons, including as a status symbol, to represent seniority, or as a way of socialising and
expressing inclusion.14
10
Some of the factors that protect against alcohol harms in African communities are common
to other communities: healthy social networks, religious practices, social inclusion and
connection with a supportive family. 15, 16 As with the general population, numerous harm
reduction strategies are practiced by members of African communities.13
Nevertheless, alcohol-related harms are an issue of concern in some African communities.
Research has identified that alcohol is used to cope with settlement stresses, for instance:

Not being able to find work and particularly for men, losing their traditional role as
head of the family;

Young people experiencing difficulties with schooling, due to lack of access to or
disrupted education prior to arriving in Australia, and becoming disengaged from
education and employment.13, 17

Mental distress and anxiety due to these and other experiences including loneliness,
social exclusion, discrimination, loss of identity. For those with refugee-like
experiences, alcohol has been reported to be used as self-medication for the
symptoms of post-traumatic stress disorder.11, 18
Alcohol related harms may also occur as communities are exposed to Australian cultural
practices, such as young people drinking in order to ‘fit in’ at parties. Differences in
acculturation, where young people are often reported as more quickly adapting to Australian
culture, legal and social systems compared to their parents, leading to intergenerational
conflicts, frustration, and young people’s disconnection from their family/community is also
linked to alcohol consumption problems.16-18 For instance when problems arise, parents may
be uncertain how to discipline other than by using methods from their home countries,
however feel that this conflicts with Australian child protection laws. Such experiences are
not only disempowering for parents but also leave the young person without adequate
boundaries around alcohol use.13, 17
It has been noted that existing services may also not be able to meet the long-term and
complex needs of those disconnected from family, community and vocational pathways,
leading to lack of trust and hopelessness and consequently to ongoing problems with alcohol
and drug use.4, 19
Alcohol use amongst African communities
11

African Alcohol Awareness (AAA) Study: An
exploratory pilot study in partnership with Ethnic
Communities Council of Queensland, Queensland
Health, Griffith University, DRUG ARM Australasia
and Queensland African Communities Council.
http://www.eccq.com.au/publications/africanalcohol-awareness-report/

Department of Immigration and Border Protection,
Settlement Reporting Facility.
http://www.immi.gov.au/settlement/

The Link Youth Health Service, Fun and forgetting:
Alcohol and other drug use by African young
people in Hobart.
http://www.dhhs.tas.gov.au/__data/assets/pdf_file
/0016/60028/Fun_Forgetting.pdf
Alcohol use amongst African communities
12
Preparation
Build your own capacity to work in a culturally
competent way
Culture is a ‘lens’ that shapes what and how we see the world and how we understand our
experiences. It influences the opportunities available to us, our behaviour and how we
interact with others.20
An inability to recognise and work with different interpersonal styles, values, lifestyles and
viewpoints leads to poor relationships, and a failure to understand and address the needs of
diverse groups.
Cultural competence is a set of behaviours, attitudes, and policies that enable people,
organisations and systems to work effectively in cross-cultural situations.21
Cultural Competence for Individuals 5, 20, 22-24
Knowledge
Skills
 Value for diversity
 Capacity to demonstrate
empathy, tolerance and respect
when interacting with people
from other cultures
 Recognition that issues that
arise are likely the result of
misunderstandings, rather than
rushing to make judgments
 Ability to privilege the
community’s perspectives about
how they define their own
needs and problems
Attitudes
 Awareness of one’s own
attitudes and values, and the
use of self-reflection to explore
the influence of cultural identity
on one’s own behaviour and
beliefs
 Understanding of appropriate
ways of communicating (both
verbal and non-verbal)
 Knowledge of how cultures
differ on key dimensions:
o
individualism/ collectivism,
o
hierarchy and power
relations,
o
tolerance of uncertainty and
ambiguity,
o
masculinity/ femininity
13
Individual cultural competence also needs to be supported by organisational cultural
competence, such as:





An organisational commitment to recognising diversity;
Support for skills development (such as staff training);
Policies and procedures for culturally competent service delivery (for instance
access to and use of interpreters);
Flexibility of service rules that allow for investing a longer time for engagement and
outreach to build trust;
Planning documents that incorporate cultural competence issues.4, 25, 26
Cultural competence is best thought of as an ongoing developmental process and a goal for
people, organisations and systems to aim for. 21, 27
Learn about the group you want to
work with
Cultural competence requires knowledge about the
community/communities you want to work with (target
community), their needs, attitudes and expectations.
Gathering some of this information (by speaking to service
providers, local schools, community groups, religious
organisations and by spending time with members of the
community) prior to developing engagements strategies
will also help you to plan your approach more effectively.
Preparation
14
Some questions to ask about the community you want to work with include:
Demographics
Social/Cultural
•
How big is the group/ community?
•
•
Who are the community leaders or
prominent community members?
What have been the community’s
migration and settlement experiences?
•
•
What different groups make up the
community? Are there any divisions
within the community (e.g. between
religious or ethnic groups)?
What image does the community have
of itself? What image does it want to
project onto the wider community?
•
What are the historical, social, religious
and political influences on the
community?
•
Where does the community live/work/go
to school?
•
What are moral values and beliefs that
community members hold?
•
What is the community’s English
language proficiency, literacy (in English
and first languages), and levels of
acculturation (adaptation to Australian
culture)? How do these vary between
groups in the community?
•
What is the role that family, social
networks and systems play in
supporting community members?
•
What issues does the community see as
problems?
•
Who do members relate to outside of
their community? Who is the community
prepared to work with?
•
What are the strengths of the
community? How can these be drawn
on?
Background to the issue
•
What are the norms, beliefs and
attitudes (including stigma) about
alcohol use in the community?
•
Have there been any incidents linked to
alcohol misuse that have affected the
community? (e.g. drink driving, physical
or verbal abuse against community
members)
•
Have community members sought help
from government and non-government
agencies on any alcohol-related
concerns? Where have they sought help
and what has been their experience?
Preparation
15
Identify ways of
meaningfully including
community partners
Build relationships
with stakeholders
Working in partnership allows access
to a variety of knowledge, skills,
expertise and resources that
individuals or single organisations are
usually not able to obtain on their
own.
It is useful to connect to a range of people with:

Relevant skills (e.g. local knowledge and experience) and interest in preventing alcoholrelated harms; 28

Good leadership capabilities, who are able to co-ordinate planning, undertake strategic
work and bring people together; and

Connections to key decision-makers and those who create/enforce policies.
29
This includes bicultural workers, interested community organisations already working with
the target group and representatives from local communities. These partners can act as a
‘bridge’ to the target community, are already likely to have credibility with and the trust of
community members, and can encourage community participation.5, 23 They can also help
address language and cultural barriers. For example, communities that have experienced
oppressive government rule may have negative perceptions about public services or
research, however interacting with workers with shared background and experiences may
help address these concerns.30
It may also be helpful to connect with
workers from other state or national
areas with experience in working with
African communities, who could provide
advice or mentoring for your group.
Preparation
16
Preparing to Act: SWOT Analysis
One example of a tool to guide you in planning your project is a SWOT
(strengths, weaknesses, opportunities, threats) analysis. 31, 32 This is a simple
way of exploring internal and external factors that could affect what you
want to achieve. The SWOT tool is used to map out what are the strengths
and weaknesses of your situation, organisation or project and what are the
opportunities and threats facing it. A SWOT analysis can be used at any
stage of an initiative. It can help with making decisions about the area you
wish to target and should prepare you to act more effectively.
WEAKNESSES
Internal
STRENGTHS
Internal factors to consider include:
Preparation

Human resources: staff, volunteers, board members, target
population

Physical resources: location, building, equipment, technology

Financial: grants, funding agencies, other sources of income (e.g.
donations)

Activities and processes: the programs you run, the systems you
use

Your reputation with the target community
17
THREATS
External
OPPORTUNITIES
External factors to consider include:

Existing efforts, programs and policies that address this issue (or
similar)

Community and community leaders’ attitudes and priorities

Funding sources

The target community’s needs and service demands

The physical environment, such as accessible transport
After brainstorming and recording ideas, working through the following
questions may help turn these ideas into a plan to guide your actions:

How can we use our strengths to take advantage of the
opportunities?

How can we use our strengths to overcome the threats?

What do we need to do to overcome the weaknesses before we
can take advantage of the opportunities?

How should we minimise our weaknesses to ward off the threats?
Conducting a SWOT analysis in collaboration with a variety of stakeholders
can challenge assumptions, give a broader picture of the situation and
deepen understandings of issues and problems to target. For example you
may wish to explore:


Preparation
Do differences in age, English-language ability, education, stage of
settlement and family situation between community members affect
readiness to engage with alcohol harm prevention projects?
How might the community’s experiences with similar organisations
before arriving in Australia affect perceptions of your project? 23
18

Centre for Culture, Ethnicity & Health, Cultural
competence series.
http://ceh.org.au/culturalcompetence

Community Toolbox, SWOT analysis: Strengths,
weaknesses, opportunities, and threats
http://ctb.ku.edu/en/table-ofcontents/assessment/assessing-community-needsand-resources/swot-analysis/main

Waitemata District Health Board, Toolkit for staff
working in a culturally and linguistically diverse
health environment.
http://www.caldresources.org.nz/info/info/CALDToolkit_WDHB.pdf

United Nations Office on Drugs and Crime, Drug
abuse prevention among youth from ethnic and
Indigenous minorities.
http://www.unodc.org/pdf/youthnet/handbook_eth
nic_english.pdf
Preparation
Preparation
19
Engagement
One of the most common ways to engage with community members in order to identify
their views about and visions for alcohol harm prevention activities is through a community
consultation. Planning for this should begin at an early stage, as the process of identifying
and engaging with community members may take a considerable amount of time,
particularly if you are not familiar with community structures.33
Identify Gatekeepers
If your group has little prior involvement with African communities, it is likely that you will
need to seek the assistance of community leaders or gatekeepers. Approaching bicultural/
bilingual workers and organisations with firsthand experience engaging with the community
could help with identifying community leaders. These persons may also be able assist with
setting up meetings with community leaders to explain what the group wants to achieve.
Examples of issues you may want to explore with community leaders or gatekeepers could
include:

Common languages spoken by community members and whether interpreters will
be necessary

The issues you would like to discuss with community members;

Whether separate consultations should be held for different groups across and
within communities (e.g. different religious or language groups);

The appropriateness of using a particular research method or asking particular
questions;34

Facilities where the community are accustomed to gathering and the best time(s) to
hold consultations;23

Any assistance they could offer with community engagement;

The likely level of attendance from the community; and

How to evaluate the process.35
20
It is important that consultations be broadened beyond community leaders. Only consulting
with community leaders may mean that you do not get information about the range of
experiences and views of a community (for instance if community leaders are all male) or
may mean that you only receive an ‘official version’ of events.36 Some community leaders
may not be aware of problems amongst groups that are less visibly experiencing difficulties.4
Consultation participation should try to capture the diversity of the community. Strategies to
enhance the accessibility of consultations to typically under-represented groups (such as
women, young people, people with a health condition or mental illness) include:

Choose familiar venues that people are comfortable with. Ideally these should be
linked to public transport and be disability accessible;

Convening gender and/or age based small groups;

Provision of childcare;23, 35

Appropriate timing of events e.g. after-school hours or at a time of day that does
not create additional safety concerns (especially for female participants);22

Allow plenty of time for advertising the consultation and identifying interested
participants. For instance, cultural customs may require some women to include the
male head of the household in decision making about their involvement.34 Parents
may require reassurance about supervision or mixed gender activities;22

Some groups are less likely to have attended school compared to the community as
a whole; 37 therefore when giving explanations and seeking feedback use methods
that do not require a high degree of literacy (in both English and the person's first
language).
Tailor strategies to
encourage
participation from
harder-to-reach
groups
Engagement
21
Build a relationship of trust with the community
Relationships of trust with community leaders and the broader target community are
crucial in fostering and sustaining engagement. Particular efforts to build trust may be
needed if community members are not familiar or comfortable with organisations asking
for their opinion or involvement; or some may be reluctant to engage with groups if
they have not seen any changes or benefits from previous involvement with services/
projects.4, 22 Steps to build trust include:
Communication
•
Being clear at the outset about the
goals of a project and the likely
outcomes of participants’
involvement. For instance, you could
describe outcomes of similar projects,
discuss realistic timeframes for
systemic changes, and explain what
will happen with any information
people provide.38
•
Having open and clear
communication channels among
those involved, developing a shared
language, understanding and vision
for what aims to be achieved.28
•
Keeping community partners
informed of project development
issues (such as via meeting minutes
and reports).
•
Providing opportunities for
participants to give feedback on the
outcomes of any activities.23
Sensitivity
•
Being aware of the power imbalance
that can exist between mainstream
organisations and smaller
ethnic/religious/ community
agencies. Make efforts to involve
these groups as equal partners, such
as by learning about and adapting to
their level of resources available and
ways of working, asking agencies to
be responsible for informationgathering activities (with appropriate
training provided), or looking for
ways to incorporate the project into
the current work of partner
agencies.23
•
Be conscious that trauma-related
issues are likely to come up in
discussions and will need to be
addressed sensitively. You may wish
to source additional training to
enhance your understanding of and
ability to respond to issues around
torture and trauma, or seek support
from agencies with expertise in
working with torture and trauma
survivors.
•
One project used an ‘ethical auditor’
who was not involved in the project,
but whose role was to ask questions
about the ethical implications of
actions/decisions made as the project
progressed.6
Reliability
•
Demonstrating integrity of conduct,
for instance by spending time and
working with the target community in
a culturally sensitive and inclusive
way.2
•
Following through on actions that
have been agreed to so that people
can see the outcomes from their
participation. 38
Engagement
22
Alcohol use and stigma
Part of your preparation should help give you an idea of the likely level of difficulty you
may encounter when exploring alcohol-related issues and how this may vary within the
community.
An ability to address issues relating to alcohol use sensitively may be required.
Particularly in communities that traditionally have had low levels of alcohol consumption,
drinking may be viewed as a ‘shameful activity’, or there may be a lack of willingness to
engage with those affected by alcohol misuse.15, 17
Consider how to enhance the environment in which consultations are conducted to
make discussing sensitive issues more comfortable. For instance, you could give
participants a choice of facilitator from within or outside the community, or provide
options for taking notes of conversations (other than electronic recording).23
Giving people the opportunity to share their concerns and have their questions
addressed is also likely to be perceived positively by community members39, and groups
could consider options to raise questions anonymously.
In addition, referring to the prevention evidence base (even if little has been done
directly with the community you are targeting), can be useful to:
Engagement

Help with explaining the rationale underpinning potentially controversial issues,
such as harm minimisation interventions;

Allay concerns about the effectiveness of an initiative people are unfamiliar with
or do not feel would succeed;40

Diffuse tensions around culturally sensitive topics.4
23

Centre for Addiction and Mental Health, Culture
counts: A roadmap to health promotion.
http://www.camh.ca/en/hospital/about_camh/heal
th_promotion/culture_counts/Pages/culture_counts
_roadmap_health_promotion.aspx

Centre for Multicultural Youth, Considering
consulting? A guide to meaningful consultation
with young people from refugee and migrant
backgrounds.
http://cmy.net.au/publications/consideringconsulting-0

NSW Service for the Treatment and Rehabilitation
of Torture and Trauma Survivors, Guidelines for
working with interpreters – for counselling and
health care staff working with refugees.
http://www.startts.org.au/media/InterpreterGuidelines-Jan-11.pdf.
Engagement
24
Case Study 1: Hunter Multicultural
Community Drug Action Team Consultations
In 2013 Hunter Multicultural Community Drug Action Team (CDAT) held a series of
group consultations with local African communities to explore how they understood
alcohol related harms in their community and if/how communities wanted help to
address any issues identified.
At the start of the project, the CDAT agreed on a uniform strategy to be implemented
by the different members involved in the various consultations. Services that had a long
history of supporting local African communities were chosen as locations for
consultations. Consultations were held on weekends and at other times that would not
clash with potential participants’ work or educational/TAFE commitments.
Invitations were issued through local service providers and community leaders. It was
expected that different communities would have differing perspectives on alcoholrelated harms and issues of concern; therefore each community (grouped by nationality)
was allocated their own consultation time. For communities where there were sufficient
numbers, separate consultations were held for men and women.
Meeting format
At each meeting written consent to participate was obtained from each person. Basic
demographic information including country of birth, language spoken and length of time
residing in Australia was also collected for each person through a questionnaire. Even
though attempts were made to phrase these questions in a way that did not require a
high level of English literacy, some participants still required support to complete their
answers.
Each consultation was facilitated by one member of the CDAT, with another member
taking notes during the session. Key community members also assisted with facilitation
where available. A qualified and accredited interpreter was used at each consultation.
At the start of each consultation the facilitator discussed the purpose of the meeting;
explained that the answers would be recorded; reiterated to participants the confidential
nature of the consultation; and assured participants that further activities would depend
on what communities would like to see happen.
Engagement
25
Questions for group discussion
1. Do you see harm to yourself, your family, or your community from alcohol? How?
2. What do you, your family and your community do to keep safe [from alcoholrelated harms]?
3. What would help you, your family and your community to manage these issues?
Feedback to the group
Before finishing, a list of the main discussion points was fed back to the group for
verification. If there was agreement on future strategies within a group, commitment to
working with the community on these issues was confirmed by CDAT members.
Participants
48 people from six different countries participated in the consultations. The number of
female participants was almost one-and-a-half times that of men. A quarter of those
consulted were aged between 17-24 years. The majority of participants had lived in
Australia more than three years. Approximately three-quarters of participants were
currently studying or working.
Engagement
26
Results
Each group (different cultural communities, as well as male and female groups within
communities) had a different perception of the harms relating to alcohol use in their
community, although most groups stated that alcohol misuse was not a common
problem. Some issues appeared to be particularly important to certain groups, such as
unemployment, needs when adjusting to a new society, or child protection issues.
Education was commonly mentioned as a way to help communities, although there were
many differing perspectives as to what education should be provided and how it should
be delivered. Several groups also described families, friends and the community as key
for supporting people who have used alcohol in a harmful way.
Uniformity of needs and
preferences among
African communities
should not be assumed
Engagement
Strategies
Consultation
Evidence
Holistic
Approach
Strategies
Be guided by the results of the consultation
Community needs and priorities identified through your consultation should guide where
to target your efforts. Acting on participant feedback also demonstrates to those
involved that their contribution is respected and helps with the development of trusting
relationships.
Continuing to ensure that community members are involved in all levels of the project
(including planning, developing and implementing the intervention, monitoring and
evaluating the results of the project) will help make sure the project is meeting the
needs of the local community and can enhance a sense of ownership in the project.2 For
example, community members could produce ‘storyboards’ depicting the community’s
ideas about solutions to local problems at a meeting with key stakeholders.36 Or,
culturally adapted program materials could be tested with representatives from the
intended audience to make sure the final product incorporates the norms and beliefs of
the community.23
28
What existing evidence is there?
Substance misuse prevention programs should be based on sound evidence on what
works.2 Results from the small amount of existing evidence that is available from African
communities, as well as from broader research into substance-use prevention with
diverse cultural groups, suggests the following strategies could be useful:
i.
Family based interventions that teach parenting skills and work to improve family
functioning may help to address important risk factors. 41 There is evidence from
systematic review of family prevention programs that they can be effective across a
range of diverse communities.42
ii.
Research has shown that alcohol health promotion campaigns that reflect the
dominant culture are often not directly transferable to communities with different
cultural norms.15 ‘Culturally adapting’ programs to the needs of the target
community/communities aims to improve the comprehension, acceptance and
impact of interventions.43
Cultural adaptation is more than using people,
language, music, locations and other items
familiar to/preferred by the target audience in
program messages and materials. It also
involves incorporating the cultural, social,
psychological, environmental and historical
factors that influence health behaviours in
different cultural communities. This could
include understanding how members of the
target community perceive the cause, course,
and treatment of health problems; and taking
into account how religion, family, society, the
economy and the government influence the
community’s behaviour.43
Strategies
29
Evidence also suggests the following aspects are important when culturally adapting
programs:
a. Community participation in the creation of the program’s messages;44
b. Being faithful to the core components of any existing, evidence-based
programs used;45
c. Considering how different cultural values/elements combine together to
affect alcohol use;46
d. Ensuring interventions are of a sufficient intensity to create behaviour change
e. Targeting multiple levels for cultural adaptation (i.e. individual and family)47
iii.
There is strong evidence that regulatory and economic strategies targeting the
environment and systems that influence drinking behaviour are effective in reducing
alcohol consumption and related harms.48 Further consultation with African
communities could identify how these strategies could be used to best address
community needs.
As relatively little research has been done into what are effective alcohol prevention
measures with African communities living in Australia, local groups may need to think
creatively about actions to implement. The knowledge and experience of community
representatives, bicultural workers, or agencies already working with the target group
can also support you in determining strategies.
Strategies
Strategies
30
Take a holistic approach
Harmful alcohol consumption is influenced by complex relationships between individual
risk and protective factors, as well as environmental and societal factors that affect
health more broadly.49, 50 A single intervention or single sector will only have a limited
impact on preventing alcohol-related harms.49 Community groups will need to consider
strategies across a range of different domains: individual, interpersonal, community,
macro.
Alcohol misuse is also linked to a range of other health and risky health behaviours (for
instance mental illness, early school leaving) with many common social origins (such as
social exclusion, family relationship problems). 49, 50 Community groups should
collaborate across a range of sectors, such as education, public health, vocational
services, criminal justice, child welfare and mental health to create a comprehensive and
sustained response.49
Use multiple strategies
that can complement and
reinforce each other
Strategies
31
Factors Influencing alcohol-related harms12, 18, 41,
Individual
Attitudes
Human
development
experiences
that influence
well-being,
behaviour and
skills
Mental Health
Issues/ Trauma
Acculturation
Interpersonal
Community
48-50
Macro
Parenting
Community
cohesion and
social capital
Education and
employment
policies/
systems
Family harmony
Social and
cultural values
Institutionalised
racism
Friend/peer
culture
Religious
practices
Housing
policies
Health system
Laws,
regulations
(e.g. drink
driving, alcohol
availability)
Alcohol pricing
policies
Media/
Advertising
Strategies
32
Build the community’s
capacity to tackle the
issues it defines as
important
Strategies
Projects should focus on building
strengths and capacity in the
community to enhance protective
factors against alcohol misuse.
Some suggestions for
incorporating these activities into
projects include:

Consultations could identify the resources that already exist in the target
community to address alcohol-related harms.

Supporting trained peer educators to develop the skills of community members.2

One Australian project established a youth advisory group consisting of youth
leaders and disengaged young people, which was a successful forum for
discussing issues of social exclusion, alcohol and drugs and refugee experiences.4

Working in partnership to build the capacity of local services to work with African
communities.4 For example, fostering conversations between community members
and local police to improve information sharing and understanding around issues
such as alcohol, parenting and the law.

Employing community members as researchers to
determine the impact of a new policy or initiative.
Community researchers should be appropriately
supported (such as by providing education in
substance-use awareness and research
techniques).30

Community information/education sessions could
include opportunities for members to practice
exercising their rights in order to resolve
difficulties.39

English language classes can be used to teach
community health issues and students could
produce health promotion materials as part of class
exercises.23
33
Case Study 2: Educational workshops with a
community sports group
Health workers were finding it extremely difficult to involve young male migrants in
healthy living programs, and noticed that this group tended to have little contact with
health professionals. A community sports club whose membership was mostly made up
of young men from African communities needed financial support to participate in the
regional soccer competition. When this club approached a local NGO for assistance, the
organisation accepted on the condition that the team agreed to participate in an
education program.
Drug and alcohol and mental health workers from the Hunter New England Local Health
District presented six interactive education sessions with the group on weeknights when
training was held.
Participants expressed appreciation at being able to meet professionals in a more
relaxed and friendlier environment (outside of school or health care settings), and felt
comfortable in asking questions about a range of issues that concerned them. A
coordinator noticed players switched from bringing alcohol to bringing soft drinks to
enjoy after the game.
Strategies
34

Australian Drug Foundation, Preventing alcohol
and drug problems in your community.
http://www.druginfo.adf.org.au/reports/prcommunities

Centre for Addiction and Mental Health, Culture
counts: Best practices in community education in
mental health and addiction with
ethnoracial/ethnocultural communities: Phase one
report.
http://www.camh.ca/en/education/Documents/ww
w.camh.net/education/Resources_communities_or
ganizations/culture_counts_jan05.pdf

Drug and Alcohol Multicultural Education Centre,
The African companions project: A guide for
practitioners.
http://www.damec.org.au/resources/damecpublications/workforce-developmentresources/the-african-companions-project-a-guidefor-practitioners

The Victorian Foundation for Survivors of Torture
Inc & Centre for Multicultural Youth, Responding
to challenges of misuse of alcohol and other drugs
by young people of refugee backgrounds:
Reflections from two projects.
http://library.bsl.org.au/jspui/handle/1/4132
Strategies
35
Evaluation
Build the knowledge base about effective alcohol-harm prevention campaigns with
African communities by evaluating your project. Evaluation should be part of your
overall strategy development and is not an afterthought at the end of a project. Care
should be taken to use methods that are appropriate for literacy levels and community
preferences. For instance newly arrived refugees may be reluctant to use paper-based
evaluation.22
Two types of evaluation that you may wish to consider are:
Process Evaluation
This is part of good reflective practice. It involves assessing what worked, what needed
improvement and why.51 Whilst results can tell you how satisfied participants are with
the strategy, this may not give an accurate indication of how effective the project was at
meeting its objectives.41
Outcome evaluation
Outcome evaluation assesses what changes have occurred in the community and
whether the project has achieved what it set out to do.51 For example, measuring levels
of awareness, attitudes, intention or behaviour before and after implementing a project
to identify any changes. Partnering with a university or other research organisation may
provide you with expertise and resources to conduct a high quality outcome evaluation.
36
Make evaluation relevant for your target community
Evaluation provides an opportunity to explore how well the preferences and needs
expressed by the target community were responded to. For instance, a process
evaluation could explore what alterations needed to be made to the project to respond
to disclosure of other issues as trust is built, or to unexpected events impacting on the
community. The indicators and statistics chosen in an outcome evaluation should
measure what progress has been made towards the goals the community wants to
achieve (e.g. skills-building, increased community strengths).
Make sure results and lessons learnt from undertaking the project are available to
others, including community members themselves. For example, results could be
translated into community languages or community partners could present the results
orally at a community meeting.23
Evaluation
37

Lobo R, Petrich M, Burns SK. Supporting health
promotion practitioners to undertake evaluation for
program development. BMC Public Health
2014;14(1):1315
http://www.biomedcentral.com/14712458/14/1315/abstract

NSW Service for the Treatment and Rehabilitation of
Torture and Trauma Survivors, Community
Development Evaluation Manual
http://www.startts.org.au/communityservices/evaluation/
Strategies
Evaluation
38
Support and guidance for alcohol-related
issues
The Australian Guidelines to Reduce Health Risks from Drinking Alcohol published by the
National Health and Medical Research Council recommends:

For healthy men and women, drinking no more than two standard drinks on any day
reduces the lifetime risk of harm from alcohol-related disease or injury.

For healthy men and women, drinking no more than four standard drinks on a single
occasion reduces the risk of alcohol-related injury arising from that occasion.

For children and young people under 18 years of age, not drinking alcohol is the
safest option.

For women who are planning a pregnancy, are pregnant or breastfeeding, not
drinking alcohol is the safest option.
Alcohol and drug telephone information services in each
State/Territory:
ACT
(02) 6207 9977
NSW
(02) 9361 8000 (Sydney)
1800 422 599 (NSW country)
NT
(08) 8922 8399 (Darwin)
(08) 8951 7580 (Central Australia)
1800 131 350 (Territory-wide)
QLD
1800 177 833
SA
1300 131 340
TAS
1800 811 994
VIC
1800 888 236
WA
(08) 9442 5000 (Perth)
1800 198 024 (WA country)
39

Australian Government Department of Health
www.alcohol.gov.au

Australian Guidelines to Reduce Health Risks from
Drinking Alcohol
http://www.nhmrc.gov.au/your-health/alcoholguidelines

Standard drinks chart
http://www.nhmrc.gov.au/_files_nhmrc/file/your_h
ealth/healthy/alcohol/std-drinks.pdf
Support and guidance
40
References
1. van der Velde J, Williamson DL, Ogilvie LD. Participatory action research: Practical
strategies for actively engaging and maintaining participation in immigrant and
refugee communities. Qualitative Health Research 2009; 19(9): 1293-1302.
2. United Nations Office on Drugs and Crime. Drug abuse prevention among youth
from ethnic and Indigenous minorities. Vienna: United Nations Publications, 2004.
3. Baum F, MacDougall C, Smith D. Participatory action research. Journal of
Epidemiology and Community Health 2006; 60(10): 854-857.
4. The Victorian Foundation for Survivors of Torture Inc and Centre for Multicultural
Youth. Responding to challenges of misuse of alcohol and other drugs by young
people of refugee backgrounds: Reflections from two projects. Melbourne: The
Victorian Foundation for Survivors of Torture Inc, 2013.
5. Fedorova O. Transcultural drug work: Handbook for practitioners working with drug
users from different ethnic and cultural backgrounds. Strasbourg: Council of
Europe, Pompidou Group, 2012.
6. Hugman R, Bartolomei L, Pittaway E. Human agency and the meaning of informed
consent: reflections on research with refugees. Journal of Refugee Studies 2011;
24(4): 655-671.
7. Australian Bureau of Statistics. Table generated 14 January 2014 using ABS
TableBuilder, 2011 Census of Population and Housing, Database 2011 Census Cultural and Language Diversity, Counting: Persons, Place of Usual Residence,
http://www.abs.gov.au/websitedbs/censushome.nsf/home/tablebuilder?opendocum
ent&navpos=240.
8. Hugo G. Migration between Africa and Australia: A demographic perspective, 2009.
Viewed 9 January 2014, https://www.humanrights.gov.au/publications/africanaustralians-project-migration-between-africa-and-australia-demographic.
9. Department of Immigration and Citizenship. Australia’s migration trends 2011–12.
Canberra: Department of Immigration and Citizenship, 2013.
10. Department of Immigration and Border Protection. Settlement Reporting Facility,
nd. Viewed 21 July 2014, http://www.immi.gov.au/living-in-australia/deliveringassistance/settlement-reporting-facility/.
11. Gibson M, Mario-Ring A, Belay D, Nyiransabimana I, Otto J, Bangura J, Robe Z. Fun
and forgetting: Alcohol and other drug use by African young people in Hobart.
Hobart: The Link Youth Health Service, 2005.
12. Hurcombe R, Bayley M, Goodman A. Ethnicity and alcohol: A review of the UK
literature. York: Joseph Rowntree Foundation, 2010. Viewed 30 September 2013,
http://www.jrf.org.uk/publications/ethnicity-alcohol-review.
13. Ethnic Communities Council of Queensland. African Alcohol Awareness (AAA) study:
An exploratory pilot study in partnership with Ethnic Communities Council of
Queensland, Queensland Health, Griffith University, DRUG ARM Australasia and
Queensland African Communities Council. Brisbane: Ethnic Communities Council of
Queensland, 2012.
41
14. Khawar L, Rowe R. Substance use issues and support needs among CALD
communities in NSW: Report from DAMEC research strategy consultation. Sydney:
Drug and Alcohol Multicultural Education Centre, 2013.
15. Agic B. Culture counts: Best practices in community education in mental health and
addiction with ethnoracial/ethnocultural communities: Phase one report. Toronto:
Centre for Addiction and Mental Health, 2004.
16. Goren N. Newly arrived refugees and drug prevention. Prevention Research
Quarterly. Melbourne: Australian Drug Foundation, 2006. Prevention Research
Evaluation Report No.: 18. Viewed 18 September 2013,
www.druginfo.adf.org.au/attachments/351_PRQJune06_final.pdf.
17. Awet MD. NSW Southern Sudanese youth drug and alcohol issues report. Sydney:
Bahr El Ghazal Youth Union Inc, 2007.
18. Posselt M, Galletly C, de Crespigny C, Procter N. Mental health and drug and alcohol
comorbidity in young people of refugee background: a review of the literature.
Mental Health and Substance Use 2014; 7(1): 19-30.
19. Turnbull M, Stokes H. Evaluation of the Brimbank young men’s project: final report.
Melbourne: Youth Research Centre, University of Melbourne, 2011. Viewed 29
November 2013, http://www.cmy.net.au/sites/default/files/publicationdocuments/Brimbank%20Young%20Men%E2%80%99s%20Project%202011.pdf.
20. Waitemata District Health Board. Toolkit for staff working in a culturally and
linguistically diverse health environment. Aukland: Waitemata District Health Board
and Counties Manukau District Health Board, 2010.
21. Cross TL, Bazmn BJ, Dennis KW, Isaacs MR. Towards a culturally competent system
of care, 1989. Viewed 6 May 2014,
http://www.mhsoac.ca.gov/meetings/docs/Meetings/2010/June/CLCC_Tab_4_Towa
rds_Culturally_Competent_System.pdf .
22. Centre for Multicultural Youth. Considering consulting? A guide to meaningful
consultation with young people from refugee and migrant backgrounds. Melbourne:
Centre for Multicultural Youth, 2007.
23. Kobus-Matthews M, Agic B, Tate M. Culture counts: A roadmap to health promotion.
Toronto: Centre for Addiction and Mental Health, 2012.
24. Westoby P. Developing a community-development approach through engaging
resettling Southern Sudanese refugees within Australia. Community Development
Journal 2008; 43(4): 483-495.
25. Fountain J. Issues surrounding drug use and drug services among the Black African
communities in England. London and Preston: NHS National Treatment Agency for
Substance Misuse, 2009.
26. Centre for Culture, Ethnicity and Health. Cultural competence series, 2010. Viewed
13 January 2014, http://ceh.org.au/culturalcompetence.
27. Center for Substance Abuse Treatment. Substance abuse: Administrative issues in
outpatient treatment. Treatment Improvement Protocol (TIP) Series 46, DHHS
Publication no. (SMA) 06-4151. Rockville, MD: Substance Abuse and Mental Health
Services Administration, 2006.
28. Dibley G. Resource guide for planning effective community drug prevention.
Melbourne: Victorian Government Department of Human Services, 2009.
42
29. Mastache C, Mistral W, Velleman R, Templeton L. Partnership working in community
alcohol prevention programmes. Drugs: Education, Prevention, and Policy 2008;
15(S1): 4-14.
30. Smith J, Field-Thorne J, Kumbin C, Elmi M, Didar M, Ali F, et al. Community
engagement project: Report of the drugs misuse needs assessment carried out by
Nilaari Agency and Black Orchid amongst the Somali community in Bristol, UK,
2001. Viewed 1 November 2013,
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
http://repository.forcedmigration.org/show_metadata.jsp?pid=fmo:5164.
Community Toolbox, SWOT analysis: Strengths, weaknesses, opportunities, and
threats, nd. Viewed 7 May 2014, http://ctb.dept.ku.edu/en/table-ofcontents/assessment/assessing-community-needs-and-resources/swotanalysis/main.
ourcommunity.com.au, Undertaking a SWOT analysis, nd. Viewed 7 May 2014,
https://www.ourcommunity.com.au/boards/boards_article.jsp?articleId=1369.
Sowey S. The African companions project: A guide for practitioners. Sydney: Drug
and Alcohol Multicultural Education Centre, 2007.
Goodkind JR, Deacon Z. Methodological issues in conducting research with refugee
women: Principles for recognizing and re‐centering the multiply marginalized.
Journal of Community Psychology 2004; 32(6): 721-739.
NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors.
STARTTS community consultations manual. Sydney: NSW Service for the Treatment
and Rehabilitation of Torture and Trauma Survivors, 2006.
Pittaway E, Bartolomei L, Hugman R. ‘Stop stealing our stories’: The ethics of
research with vulnerable groups. Journal of Human Rights Practice 2010; 2(2): 229251.
U.S. Committee for Refugees and Immigrants. Resource guide for serving refugees
with disabilities, 2007. Viewed 30 January 2014,
http://www.refugees.org/resources/for-service-providers/resource-guide-forserving.html.
Refugee Council of Australia. Amplifying the voices of young refugees, 2009.
Viewed 19 September 2013, http://www.refugeecouncil.org.au/r/rpt/2009Youth.pdf .
Ekblad S, Linander A, Maria Asplund M. An exploration of the connection between
two meaning perspectives: An evidence-based approach to health information
delivery to vulnerable groups of Arabic- and Somali-speaking asylum seekers in a
Swedish context. Global Health Promotion 2012; 19(3): 21-31.
Kennedy V, Goren N. Culturally and linguistically diverse communities and drug
prevention. Prevention Research Quarterly. Melbourne: Australian Drug Foundation,
2007. Issues Paper No.: 1. Viewed 18 September 2013,
www.druginfo.adf.org.au/attachments/349_PRQ01Jun07_FINAL.pdf.
Browne JL, Renzaho AMN. Prevention of alcohol and other drug problems in
culturally and linguistically diverse communities. Prevention Research Quarterly.
Melbourne: Australian Drug Foundation, 2010. Issues Paper No.: 13. Viewed 24
October 2013,
www.druginfo.adf.org.au/attachments/175_ADFPRQJune10_final.pdf.
43
42. Foxcroft DR, Tsertsvadze A. Universal family-based prevention programs for alcohol
misuse in young people. Cochrane Database of Systematic Reviews 2011, Issue 9.
43. Resnicow K, Soler R, Braithwaite RL, Ahluwalia JS, Butler J. Cultural sensitivity in
substance use prevention. Journal of Community Psychology 2000; 28(3): 271-290.
44. Hecht ML, Raup Krieger JL. The principle of cultural grounding in school-based
substance abuse prevention: The drug resistance strategies project. Journal of
Language and Social Psychology 2006; 25(3): 301-319.
45. Kumpfer KL, Alvarado R, Smith P, Bellamy N. Cultural sensitivity and adaptation in
family-based prevention interventions. Prevention Science 2002; 3(3): 241-246.
46. Castro FG, Hernández Alarcón E. Integrating cultural variables into drug abuse
prevention and treatment with racial/ethnic minorities. Journal of Drug Issues 2002;
32(3): 783-810.
47. Nierkens V, Hartman MA, Nicolaou M, Vissenberg C, Beune EJ, Hosper K, et al.
Effectiveness of cultural adaptations of interventions aimed at smoking cessation,
diet, and/or physical activity in ethnic minorities. A systematic review. PloS one
2013; 8(10): e73373.
48. Anderson P, Chisholm D, Fuhr DC. Effectiveness and cost-effectiveness of policies
and programmes to reduce the harm caused by alcohol. The Lancet 2009;
373(9682): 2234-2246.
49. Spooner C, Hetherington K. Social determinants of drug use. Technical Report
Number 228. Sydney: National Drug and Alcohol Research Centre; 2004.
50. Loxley W, Toumbourou JW, Stockwell T, Haines B, Scott K, Godfrey C, et al. The
prevention of substance use, risk and harm in Australia: A review of the evidence.
Canberra: Commonwealth of Australia, 2004.
51. The Forum of Australian Services for Survivors of Torture and Trauma. A framework
for evaluating community development projects in agencies working with survivors
of torture and trauma: Stage one. Melbourne: Forum of Australian Services for
Survivors of Torture and Trauma, 2007.