African-Caribbean Community Research Articles

Exploring barriers to accessing mental health services within minoritised communities in Nottingham City, UK - a creative participatory approach to service improvement

ObjectivesWe use an art-based approach to engage and involve members of African, African Caribbean and Muslim communities’ in exploring barriers to accessing and using mental health services in the co creation and co-production of mental health communication material. Study designA creative practice approach underpinned by the principles of participatory action research was used. MethodsSeven community-based interactive workshops were held between February and June 2022 at three community centres in Nottingham, UK Attendees were invited to take part in open discussions around the conceptualisations of mental health, well-being and emotional health and to draw or describe their experiences of accessing mental health services. ResultsAttendance was higher than anticipated, with 72 individuals from African, African Caribbean and Pakistan communities taking part in the workshops. What emerged was the low level of understanding of the services available in addressing mental health. In addition, it was felt that health professionals in the National Health Service (NHS) do not sufficiently acknowledge or consider the ethnic, social, cultural and economic factors influencing the mental health and emotional well-being of minoritised communities. Attendees critiqued and provided feedback on service providers’ posters and leaflets. They commented on the lack of key information provided, the inclusion of what was viewed as irrelevant content and the use of unfamiliar terminology. Some attendees created mock-ups of what they believed a good poster should look like. ConclusionA creative practice approach that follows the principles of participatory action research can play an important role in engaging members of minoritised communities in the co-production and co-design of services. This approach highlighted the need to establish trust and shared ownership among marginalized communities affected by inequities of mental health service provision.

Left ventricular hypertrophy and mortality in ethnic minority groups in the UK: e-ECHOES study.

Hypertension is the key modifiable cardiovascular risk factor but is underdiagnosed, and its scale in South Asian and African-Caribbean communities is unknown. Left ventricular hypertrophy (LVH) is a measure of target organ damage in uncontrolled hypertension. The study assesses LVH prevalence in South Asian and African-Caribbean communities and its impact on mortality. This study is based on the large prospective UK community Ethnic-Echocardiographic Heart of England Screening Study (E-ECHOES, age ≥45 years). Left ventricular mass index (LVMI) was calculated using echocardiography to establish LVH. The predictive value of LVH all-cause and cardiovascular mortality was assessed using Cox regression. The study included 3200 South Asians (age 59 ± 10 years, 52% women, 45% had a history of hypertension, 5.8 ± 1.0-year follow-up). LVH was found in 1568 (49%), of whom 45% did not have hypertension diagnosis. On Cox regression, LVH was independently associated with all-cause mortality [hazard ratio 1.38, 95% confidence interval (95% CI) 1.01-1.88], cardiovascular mortality (hazard ratio 2.64, 95% CI 1.21-3.73). The projected overall hypertension prevalence was 82%, undiagnosed hypertension prevalence 37%. The study included 1858 African-Caribbeans (age 62 ± 12, 45% women, 45% had history of hypertension, 5.1 ± 0.9-year follow-up). LVH was found in 1186 (64%), of whom 32% did not have hypertension diagnosis. LVH was borderline associated with all-cause mortality (hazard ratio 1.57, 95% CI 1.01-2.44), but not cardiovascular mortality (hazard ratio 1.82, 95% CI 0.80-4.16). The projected overall hypertension prevalence was 78.5%, and undiagnosed hypertension prevalence was 20.8%. UK South Asians and African-Caribbeans have a high prevalence of hypertension, which is often underdiagnosed and poorly controlled.

CO-DESIGNING ACCEPTABLE AND INCLUSIVE APPROACHES TO PUBLIC INVOLVEMENT OF ETHNIC MINORITY COMMUNITIES IN ORTHOPAEDIC RESEARCH

AbstractIntroductionPeople from ethnic minority backgrounds are underserved in healthcare and research. We co-developed a checklist to promote good practice for inclusive community patient and public involvement (PPI).MethodsWe worked with three community groups in Bristol to develop the checklist – Dhek Bhal (South Asian community), Malcolm X Elders (African Caribbean community) and My Friday Coffee Morning (predominantly Somali women). We worked with group leaders to better understand the needs of the groups. We visited each group at least three times and used informal and open discussions tailored to how each group preferred to work. We paid for community leaders’ time, interpretation and transport where needed, as well as contributing towards activities and catering as suggested by group leaders.ResultsThe checklist covers 4 broad themes:Link building – understand the community, gauge interest in topic, build trust and relationships, visit regularly and return to updatePracticalities – visit the communities in their usual space, understand most appropriate meeting formats, consider translation and transport3. During the meeting – avoid jargon, be informal and flexible, build in social time, provide culturally preferred food4. Giving back – acknowledge the value of people's time, identify preferences for reimbursement, look for opportunities to give backTo complement the checklist, we produced a visual output in the form of an illustration created by a local artist.DiscussionWe hope this checklist will facilitate meaningful involvement of people from underserved communities in all stages of research, including identifying research priorities, co-design, research management and dissemination.

Engagement with a local African-Caribbean community to explore perspectives and research priorities among Black men for prostate cancer using a co-participatory approach.

Prostate cancer (PCa) is the most common cancer in the UK, with 1 in 8 affected in their lifetime. However, there are significant race disparities that Black men are more negatively impacted than any other races with their increased risks and worse outcomes. However, they are under-represented in research, and often labelled as 'hard to reach' population. The aim of this study was to reach out to a local Black male community using a co-participatory approach, to build up trust and explore their understandings and concerns of the disease. We recruited 2 community researchers (CRs) from SACMHA (Sheffield African-Caribbean Mental Health Association). Using a co-participatory approach, we worked together throughout the project, including recruitment, planning and facilitating workshops, analysing and presenting data. Two workshops were organised. We introduced an overview of PCa followed by open discussion in several small groups. A rapid qualitative analysis was used to identify key points. The engagement was fantastic. We recruited over 30 participants from the Black male community for the first workshop within 4 weeks. A range of topics were raised which were summarised as a Black men's journey of PCa. The participants were very keen to receive information and have their voice heard. These are facilitating factors in engagement. The males showed concern about their lack of awareness of their high risks of PCa. Personal experiences have also been emphasised throughout the disease journey. Using a co-participatory approach in community research engagement was successful. We shared our knowledge, built trust, and identified research priorities.

To Live and Die in Hip-Hop

Hip-hop began in the Bronx, New York City as a ­­relatively obscure cultural movement during the 1970s. New York’s African American and Caribbean communities pioneered and incubated break ­­dancing (B-boying), graffiti art, disc jockeying (affectionately known as turntablism), and MCing (rapping). In time, the culture spread like wildfire—first to other Black communities and then out of American cities altogether. The suburbanization and globalization of hip-hop during the 1990s eventually transformed the culture into a worldwide billion-dollar industry. Hip-hop struggled to come to terms with its own growth—popularity and authenticity are not always compatible. The late bell hooks argued in We Real Cool: Black Men and Masculinity (2003), “While the patriarchal boys in hip-hop crew may talk about keeping it real, there has been no musical culture with black men at the forefront of its creation that has been steeped in the politics of fantasy and denial as the more popular...

FROM CRIME FIGHTING TO COUNTERINSURGENCY: The Transformation of London’s Special Patrol Group in the 1970s

ABSTRACT The Special Patrol Group (SPG) of the London Metropolitan Police was formed as a crime-fighting unit in 1965. Beginning in the early 1970s, however, it underwent a transformation of ‘colonial counterinsurgenization’. The SPG shifted its initial role and increasingly took on the characteristics of a colonial counterinsurgency police force operating in the metropolis. The change is seen in the SPG’s approach to public order policing and crime prevention, especially in London’s African-Caribbean communities. The new counterinsurgency tactics of the SPG in those communities in turn generated the conditions for the very sorts of metropolitan uprisings the SPG had sought to subdue.

Joint allies: Benefits and tensions of co-producing a prostate cancer app for, and with, the Black British African-Caribbean community

ABSTRACT In this paper we use a case study, the co-production of a prostate cancer app with, and for, Black British African-Caribbean communities, to discuss benefits and tensions of inclusive practice and allyship. We view our collaborators as joint partners, and joint allies, for the Black British African-Caribbean community. Here, we document the research process and highlight successful aspects of our collaboration such as mentoring, recruitment, ideas on the format and presentation of the app, supportive data collection practices, useful community feedback and promotion of the app. We also highlight points in the research process that in hindsight needed more discussion and careful negotiation. We end with some recommendations based on our experience.

Let's Talk: African Caribbean Women, Mothering Motherhood, and Well-Being.

In the UK, African Caribbean women's experiences of mothering and motherhood are often studied in isolation from how “race” structures and shapes their lives and everyday health and well-being. This failure to connect women's wellbeing and racialized injustices also occurs in debates around “gangs” and “urban gun crime” (UGC). The women's experiences and the effects on their health and well-being are absented from the discussions. This paper, based on my doctoral research, uses an intersectional analysis to explore the views of mothers engaged in community activities to limit “urban gun crime.” Like me, they defined themselves as of Black Caribbean heritage and we created “spaces” where we could “reason,” share experiences of womanhood, motherhood and mothering in a racist society and centre what is habitually ignored. They highlight the importance of getting mothering “right” with the stress and anxiety about the dire consequences of getting it “wrong.” They show their love, commitment and aspirations for their child/ren and the emotional and intellectual labor needed in their daily strategies to keep them from harm caused by state institutions and life “on road.” The research confirms the impact of “race,” racialization and racism to our lives and experiences of health and well-being and raises critical questions for the dominant and normative views of mothering and/ or motherhood that underpin UK policy and practice.

A Qualitative Study to Identify Perceptual Barriers to Antiretroviral Therapy (ART) Uptake and Adherence in HIV Positive People from UK Black African and Caribbean Communities

To inform the development of interventions to increase uptake and adherence to antiretroviral therapy (ART), we explored perceptions of ART in semi-structured interviews with 52 men and women from UK black African and black Caribbean communities. Verbatim transcripts were analyzed using framework analysis. Perceptions of ART could be grouped into two categories: doubts about the personal necessity for ART and concerns about potential adverse effects. Doubts about necessity stemmed from feeling well, doubts about the efficacy of ART, religious beliefs and the belief that treatment was futile because it could not cure HIV. Concerns about adverse effects included the fear that attending HIV services and taking treatment would lead to disclosure of HIV, feeling overwhelmed at the prospect of starting treatment soon after diagnosis, fears about side effects and potential long-term effects, and physical repulsion. The findings will facilitate the development of interventions to increase uptake and adherence to ART.

Ethnic differences in psychosis-Lay epidemiology explanations.

BackgroundMuch research attention has been given to the high rates of psychosis diagnosed in the Black community. However, little has been heard about possible reasons for this from Black African and Caribbean mental health service users themselves.AimsTo determine how Black African and Caribbean service users perceive and explain these apparent differences.MethodsWe conducted four focus groups between 2014 and 2015 with 35 participants from the Black African and Black Caribbean community in Lambeth and Southwark, South East London, diagnosed with a psychotic illness. Recruitment was through a local voluntary sector organization and other community contacts.ResultsEach group described an elevated risk of psychosis in their community and explanations followed the following themes, with increased rates due to: (a) an accumulation of stressors due to disadvantaged ethnic minority status, (b) further disadvantage due to inequitable experiences of mental health services, (c) an absence of community support and (d) a double stigma: as a result of external discrimination, due to ethnicity, and internal stigma about mental illness from within the Black community itself.ConclusionsBlack mental health service users attributed an elevated risk of psychosis in their community to an accumulation of stressors directly related to ethnic minority status.

Co-production and evaluation of an e-learning resource to improve African-Caribbean families\u2019 knowledge about schizophrenia and engagement with services: a pilot randomised controlled trial protocol

BackgroundA higher proportion of African-Caribbean people in the UK are diagnosed with schizophrenia spectrum disorders than other ethnic groups. High levels of shame and stigma at individual and community levels contribute to delayed access to care, potentially increasing the duration of untreated psychosis and so worsening outcomes. Inferior access, more coercive care, and worse outcomes have created a ‘circle of fear’ of mental health services within African-Caribbean communities. This further discourages early engagement with statutory services and increases the burden of care for families living with schizophrenia.Providing tailored and relevant information about psychosis (psychoeducation) has the potential for improving outcomes for patients and families. However, there are no culturally appropriate psychoeducation programmes for African-Caribbeans in the UK. We aim to determine whether an e-learning resource, co-produced with African-Caribbean stakeholders to improve knowledge about psychoses, would be culturally acceptable and accessible to members of this population.MethodsA pilot randomised controlled trial of the feasibility of co-producing and testing a novel e-learning resource to improve knowledge about and attitudes towards schizophrenia in African-Caribbean families. We will seek to recruit 40 participants, aged ≥ 16 years, either to receive the intervention or as controls. They will self-refer or be referred via inpatient and wellbeing services, family and carers’ forums, statutory community mental health teams, and voluntary sector/non-governmental agencies (NGOs). Participants will complete the Ca-KAP, ASMI, and SF-12. Acceptability will be explored qualitatively via focus groups and individual semi-structured interviews.DiscussionThe proposed trial will demonstrate the feasibility of conducting a fully powered RCT to evaluate the efficacy of an e-learning resource about schizophrenia with African-Caribbean families. Qualitative work will explore the intervention’s accessibility and barriers/facilitators to participation, including attitudes to randomisation. These data will facilitate further refinement of the intervention.Trial registrationISRCTN11394005, retrospectively registered 20/03/2018.

A grounded theory analysis of the experiences of carers for people living with dementia from three BAME communities: Balancing the need for support against fears of being diminished.

An estimated 25,000 people of Black, Asian and other Minority Ethnic (BAME) origins live with dementia in UK - a number which is expected to increase sevenfold by 2051. People from many BAME communities experience dementia in a markedly different way to their white British counterparts. For instance diagnosis is more likely to occur at an advanced stage of the illness, while there is a lower take-up of mainstream dementia services. This research study focused on the experiences of caregivers for family and friends living with dementia from South Asian, African Caribbean and Chinese communities in Bristol. Data were collected through interviews with 27 participants and 8 focus groups attended by 76 participants. Additionally, interviews were carried out with 16 paid staff and volunteers working for Voluntary and Community Sector Organisations (VCSOs) that provided services for older people from these three communities. As concepts emerged during data analysis, so these were checked with each community. The grounded theory, 'fear of diminishment' was present across all communities: participants both needed and wanted support, but they were reluctant to accept this if it came at the cost of being diminished as a person. To resolve this dilemma, informants turned to BAME-led VCSOs, which provided ongoing support and advocated on behalf of their members. However, the services provided by these VCSOs varied and reflected differences in the ways in which communities enacted the theory. Given the increasing importance of cultural diversity within dementia care, this study has important implications for communities across the UK and elsewhere, and points towards the need for sustainable and equitable resourcing of dementia care within BAME-led VCSOs.

Police Stop and Search Within British Muslim Communities: Evidence From the Crime Survey 2006–11

Abstract This article discusses police stop and search within British Muslim communities and reports the analysis of statistical data collected by the Crime Survey of England and Wales between 2006 and 2011. The primary aim of the article is to determine the extent to which Crime Survey data support or challenge allegations of police discrimination against British Muslim communities. The context for the study is provided by criminological literature related to the policing of British African Caribbean and British Muslim communities. The article engages with the concept of ‘institutional Islamophobia’ and represents the first known study to model large-scale police stop and search data from British Muslim communities. Overall, the findings reveal a more complex picture of police stop and search practices within these communities than might be assumed from an uncritical reading of the literature.

Raising awareness about Vascular Dementia in the African-Caribbean community in London

London, the UK capital is home to 58% of all those who identified themselves as African-Caribbean in the UK 2011 National Census. Demographically due to the age profile, the UK African-Caribbean population has the highest proportion of older people than any other Black populations in the Census categories as result of the history of the migration of African-Caribbean peoples into the UK. This saw a significant increase in migration of working age adults in the period from 1940 to 1960, encouraged by the UK government in World War II and the post war UK economic policy. Many of these expected to return to the Caribbean on retirement. At that time, the average life span in the Caribbean was 51.5 years . Subsequently the increasing life expectancy has risen to 74 in the Caribbean and 81 in the UK today. People have put down family roots in the UK and also the poor experience of many pensioner retirees and concerns about the limitations of older peoples services in the Caribbean have led to a high proportion of the African- Caribbean community spending their last years in the UK. However, the UK African- Caribbean community has a proportionally higher rate of dementia than the White UK majority and a higher proportion of people under 65 developing young onset dementia. A number of researchers have speculated that this may be due to the increased risk factors of diabetes and high blood pressure in the African- Caribbean community creating a higher risk of stroke related vascular dementia , but supporting research for this hypothesis is limited and it would be more accurate to say the causal factors are unknown.

Appeal launched as rate of sickle cell disease rises.

More people from the African-Caribbean community are needed to donate blood due to growing rates of sickle cell disease.

?We All Black Innit??: Analysing Relations between African and African-Caribbean Groups in Britain

‘We all Black innit?’ examines relationships between African and African-Caribbean communities in Britain. Historically, these groups have formed coalitions, especially in times of difficulty, for example in resistances against racism. Yet media coverage and academic research studies have highlighted ‘tensions’ between African and Caribbean migrants, especially those arriving from the latter stages of World War 2 and during the 1960s (Mwakigale 2007, Benson 1981). However, this research is limited and focuses specifically on the views and experiences of that particular generation. Very little, if any academic research considers the views and perceptions of second and third generation British born people of African and African-Caribbean descent, although plays, books and, more recently films have begun to explore this issue (see for example, Femi Oguns, Torn (2008) and Bola Agbaje's Gone Too Far (2013). Therefore, the following research draws on interviews with second and third generation British African and African Caribbean people to assess whether tensions still exist between the two groups, and if so, the potential causes, and if they replicate those of previous generations. Conversely it may be that there has been reconcilement between them, and establishment of new ‘race based coalitions’ (Rogers 2004). Again, the research considers the factors which may have contributed to this.

Support and its Impact on the Lived Experiences of African Caribbean Nurses as Students and Practitioners in the British National Health Service (NHS)

Current participation by the children of immigrants in UK nursing education is very low. There are implications for culturally sensitive care delivery and the increasing demographic shift towards an ageing population. Those who arrived during the HMS Windrush period immediately after World War 2 are now beginning to use NHS services more frequently. This paper will provide insights into Black British African Caribbean nurses’ perceptions of support as students and clinical practitioners. It draws on original research, which explored factors, that impact on participation of British African Caribbean people in careers in nursing. The paper is specifically concerned with support which was one of four key findings from the research. UK policy requires that all services, including health services, should reflect the diversity of the communities they serve. This presents opportunities and challenges that need to be explored and addressed, as the UK grapples with increased nursing shortages and low retention rates of qualified staff. The British National Health Service (NHS) has benefited from major contributions of African Caribbean communities who were specifically invited and recruited to help to rebuild the economy and the infrastructure. There is some evidence that Children of the post Windrush era, who were born here, may choose not to participate in nursing as a career because of the experiences of discrimination suffered by their parents and grandparents in the NHS. This paper explores the views of British African Caribbean nursing participants as students and workers, in their own voices. It specifically highlights the role of support in their experiences and its direct impact on their decision making and success with regards to career choices in nursing. It will consider the role that bespoke support can play in enabling successful participation, career building and the implications for nursing education.

Co-design of a culturally-tailored diet & lifestyle intervention for diabetes management in the UK African-Caribbean community

Co-design of a culturally-tailored diet & lifestyle intervention for diabetes management in the UK African-Caribbean community

PROCEE: a PROstate Cancer Evaluation and Education serious game for African Caribbean men

Purpose Prostate cancer is the most common cancer diagnosed in men in the UK. Black men are in a higher prostate cancer risk group possibly due to inherent genetic factors. The purpose of this paper is to introduce PROstate Cancer Evaluation and Education (PROCEE), an innovative serious game aimed at providing prostate cancer information and risk evaluation to black African-Caribbean men. Design/methodology/approach PROCEE has been carefully co-designed with prostate cancer experts, prostate cancer patients and members of the black African-Caribbean community in order to ensure that it meets the real needs and expectations of the target audience. Findings During the co-design process, the users defined an easy to use and entertaining game which can effectively raise awareness, inform users about prostate cancer and their risk, and encourage symptomatic men to seek medical attention in a timely manner. Originality/value During focus group evaluations, users embraced the game and emphasised that it can potentially have a positive impact on changing user behaviour among high risk men who are experiencing symptoms and who are reluctant to visit their doctor.

Engaging African-Caribbean, Asian, and Latino community leaders to address HIV stigma in Toronto

Purpose Racialized minority and newcomer communities are over-represented in positive HIV cases in Canada. Stigma has been identified as one of the barriers to HIV prevention, testing, and treatment. Faith, media, and social justice sectors have historically served a vital role in promoting health issues in these communities. However, they have been relatively inactive in addressing HIV-related issues. The purpose of this paper is to report on the results of an exploratory study that engaged faith, media, and social justice leaders in the African-Caribbean, Asian, and Latino communities in Toronto. Design/methodology/approach This study used a qualitative interpretive design and focus groups to explore the challenges and opportunities in addressing HIV stigma. A total of 23 people living with HIV and 22 community leaders took part in seven focus groups. Intersectionality was used as an analytical lens to examine the social processes that perpetuate HIV stigma. Findings This paper focuses on the perspectives of community leaders. Five themes were identified: misconception of HIV as a gay disease; moralistic religious discourses perpetuate HIV stigma; invisibility of HIV reinforces community denial; need to promote awareness and compassion for people with HIV; and the power of collective community efforts within and across different sectors. Originality/value Although affected communities are faced with many challenges related to HIV stigma, effective change may be possible through concerted efforts championed by people living with HIV and community leaders. One important strategy identified by the participants is to build strategic alliances among the HIV, media, faith, social justice, and other sectors. Such alliances can develop public education and HIV champion activities to promote public awareness and positive emotional connections with HIV issues, challenge HIV stigma and related systems of oppression, and engage young people in HIV championship.