British Asian Research Articles

COVID-19 vaccine hesitancy or refusal: the challenges for healthcare staff

The article discusses the challenges faced by healthcare staff in Great Britain in addressing the hesitancy or refusal of citizens to be vaccinated against COVID-19 amidst the anti-vaccination campaigns by powerful individuals in various countries

Accessing Mental Health Services: a Systematic Review and Meta-ethnography of the Experiences of South Asian Service Users in the UK

BackgroundDespite calls to address ethnic inequalities to accessing mental health services in the UK, governmental initiatives have had limited impact. Studies indicate that South Asian communities underutilise mental health services. Previous reviews have identified cultural and institutional factors that may influence service use, but these are mostly narrative and limited in their scope.MethodA systematic literature search resulted in fifteen studies exploring the experiences of seeking help and barriers to accessing and using services from the perspective of British South Asian service users.FindingsQualitative data was synthesised through meta-ethnography, and three themes emerged: Distanced from Services, Dilemma of Trust and Threat to Cultural Identity. South Asian service users were positioned at a distance from being able to access services and stuck in a dilemma of mistrusting White and Asian professionals. They constructed their cultural identity through a set of important values which were neglected by mental health services. Service users, therefore, appeared to engage in an ongoing evaluation of the potential benefits of accessing services against the risks of threat to their personal and cultural identities. The findings are discussed in relation to Eurocentric models of care and community engagement approaches.ConclusionThe review argues that institutional racism and cultural dissonance marginalise South Asian service users from access to quality and effective mental healthcare. It is recommended that services acknowledge the impact of alienation and powerlessness and advance their practices to establish trust and cultural safety for South Asian service users in the UK.

COVID-19: The disease of loneliness and solitary demise

The birth of the COVID-19 pandemic has transformed working lives of British Asian general practitioners (GPs), such as one of the authors. The effects of the national lockdown and the subsequent loneliness have impacted every aspect of our lives and increased mental health problems. The added social isolation of local lockdowns, such as in Leicester, will undoubtedly exacerbate some health problems due to a lack of patient willingness to attend healthcare services and the postponement of some appointments. The lack of culturally competent support is likely to add to the isolation in non-English-speaking people. Thus, we should pre-empt these issues in a culturally effective manner. To prepare for subsequent waves, GPs are risk-stratifying patients for COVID-19 and have commenced ReSPECT care-plan conversations with higher-risk patients. But with the increased risk from COVID-19 to Black, Asian and minority ethnic patients, should this and other groups of patients also have a ReSPECT care plan? Is now the time to consider community-hospice settings for our palliative COVID-19 patients? This pandemic has uncovered a training need for healthcare professionals to feel more comfortable in discussing end of life as an integral consultation component. We should focus our efforts in alleviating suffering by achieving 'shared understanding' and 'negotiating management' of our ReSPECT conversations.

Does negative contact undermine attempts to improve intergroup relations? Deepening the understanding of negative contact and its consequences for intergroup contact research and interventions

AbstractIntergroup contact is an established pathway to improve intergroup relations. Research has long focused on mainly positive intergroup contact and its capability to improve intergroup relations. Yet, if members of different groups meet, they will not only make positive, but possibly also negative intergroup contact experiences. Recent research considering both positive as well as negative intergroup contact has raised concerns about potentially stronger effects of negative compared to positive contact. These new insights and the increasing awareness of potentially detrimental effects of contact could lead to doubts about whether it is always sensible to bring individuals from different groups together. Our article first updates the latest review on joint effects of positive and negative intergroup contact. We find that there is no clear tendency for either positive or negative intergroup contact to yield stronger effects on intergroup relations, and we portray factors that might influence these effects. Such factors—for example an individual's prior experiences—could play a crucial role in defining the relevance of negative contact in everyday settings. We continue by answering calls to increase a more qualitative understanding of what kinds of experiences are seen to be intergroup contact, and where intergroup contact in everyday life is experienced from a lay understanding, with new qualitative data from British White and British Asian individuals. Our results demonstrate that positive as well as negative contact is often rather casual and happens in public spaces and at work. Interventions explicitly addressing these spaces may help to reach more people. We also demonstrate that positive contact is much more frequent than negative contact. This finding is confirmed in the third section, which reviews the relative frequency of positive and negative intergroup contact. Last but not least, we discuss the implications of our review for practitioners and researchers alike.

Identity Threat and Coping Among British South Asian Gay Men During the COVID-19 Lockdown

This study focuses on the impact of the COVID-19 lockdown on identity, relationships and psychological wellbeing among British South Asian gay men (BSAGM). Interview data from 15 BSAGM were analyzed using qualitative thematic analysis and identity process theory. The analysis yielded the following three themes: (1) Fear of involuntary disclosure of gay identity; (2) Anxiety about relationships; and (3) Coping and casual sexual encounters. BSAGM who returned to the family home during the lockdown reported fear of involuntary disclosure of their sexual identity, exposure to stigma in relation to their sexuality, and anxiety about their relationships with significant others. In order to cope with the resultant threats to identity, some individuals concealed their sexual identity, which could undermine their sense of identity authenticity, and some reported engaging in casual sexual encounters as a means of coping with identity threat. BSAGM may be at high risk of identity threat during the COVID-19 outbreak with limited access to social and psychological support in relation to their sexuality. This in turn may lead to a reliance on ineffective coping strategies, such as sexual risk-taking.

The dietary practices and beliefs of British South Asian people living with inflammatory bowel disease: a multicenter study from the United Kingdom

Background/AimsEpidemiological associations have implicated factors associated with Westernization, including the Western diet, in the development of inflammatory bowel disease (IBD). The role of diet in IBD etiopathogenesis, disease control and symptom management remains incompletely understood. Few studies have collected data on the dietary habits of immigrant populations living with IBD. Our aim was to describe the dietary practices and beliefs of British South Asians with IBD.MethodsA 30-item questionnaire was developed and consecutively administered to 255 British South Asians with IBD attending gastroenterology clinics in the United Kingdom.ResultsFifty-one percent of participants believed diet was the initiating factor for their IBD and 63% felt diet had previously triggered disease relapse. Eighty-nine percent avoided certain dietary items in the belief that this would prevent relapse. The most commonly avoided foods and drinks were spicy and fatty foods, carbonated drinks, milk products, alcohol, coffee, and red meat. A third of patients had tried a whole food exclusion diet, most commonly lactose- or gluten-free, and this was most frequently reported amongst those with clinically active IBD (P = 0.02). Almost 60% of participants avoided eating the same menu as their family, or eating out, at least sometimes, to prevent IBD relapse.ConclusionsBritish South Asians with IBD demonstrate significant dietary beliefs and food avoidance behaviors with increased frequency compared to those reported in Caucasian IBD populations. Studies in immigrant populations may offer valuable insights into the interaction between diet, Westernization and cultural drift in IBD pathogenesis and symptomatology.

Discrimination and mental health outcomes in British Black and South Asian people during the COVID-19 outbreak in the UK

ABSTRACT This study focuses on the impact of the COVID-19 outbreak on mental health outcomes in Black and South Asian people in the United Kingdom. A sample of 226 participants completed a survey consisting of measures of ethnic identification, religiosity, British national identification, perceived discrimination, fear of COVID-19, generalised anxiety, depression and life satisfaction. Black participants reported more frequent ethnic discrimination than South Asians who, conversely, reported more religious discrimination. Structural equation modelling showed that discrimination had a direct impact on fear of COVID-19 and an indirect impact through decreased British national identification and life satisfaction. Religiosity and ethnic identification appeared to be protective against fear of COVID-19. Fear of COVID-19 was in turn associated with increased depression and generalised anxiety and decreased life satisfaction. The results suggest that some minority groups may be facing poorer mental health outcomes due to discrimination and minority stress.

Flexible Bodies: British South Asian Dancers In An Age Of Neoliberalism by Anusha Kedhar

Flexible Bodies: British South Asian Dancers In An Age Of Neoliberalism by Anusha Kedhar

Examining BSA Muslim women’s everyday experiences of veiling through concepts of ‘the veil’ and ‘double consciousness’

ABSTRACT In The Souls of Black Folk W.E.B Du Bois conceptualised arguably two of the most significant and powerful theories of race and racism, that of ‘the Veil’ and ‘double consciousness’. This paper utilises the concept of the veil both literally, in the case of non/veiling acts of British South Asian (BSA) Muslim women living in Oldham, but also metaphorically, through the Veil, as a form of social and cultural exclusion of Muslim women in everyday interactions. The paper argues that the use of the Veil and double consciousness, is able to highlight the extent to which Muslim women actively reflect upon hegemonic discourses of the veil as oppression and veil as respectability which shape understandings of them. The paper contends that an analytical use of ‘double consciousness’ in particular, can highlight the nuanced experiences of BSA Muslim women’s everyday lives.

Prostate cancer in the British Asian population: A case-control study

Objectives: To study demographic and disease variables at presentation, diagnosis and treatment of prostate cancer in British South Asian (SA) men and compare with their Caucasian counterparts. Methods: A retrospective review of prostate cancer cases between 2010 and 2015 identified patients of SA descent who were matched for age, residential location and year of diagnosis with two Caucasian patients. Disease characteristics, treatment and short-term outcomes were recorded and compared. Results: A total of 1274 patients were diagnosed, of which 50 (3.9%) were SA. SA patients had less screen-detected prostate cancer (12% versus 31%, p=0.02), more co-morbidity and more high-risk disease (57% versus 37%, p=0.03). Active surveillance was the preferred treatment option (32%) with 2% having surgery compared with 22% ( p=0.003) from the Caucasian cohort. Logistic regression showed these disparities to be related to the different presentations. Conclusion: SA men with prostate cancer are less likely to be diagnosed following asymptomatic screening and the majority have high-risk disease at presentation. These differences lead to SA men preferring active surveillance to radical surgery. Given the increasing British Asian population, the findings demonstrate a need for research and public health interventions to better understand and address the differences noted between these groups.

Investigating Ethnic Disparity in Living-Donor Kidney Transplantation in the UK: Patient-Identified Reasons for Non-Donation among Family Members.

There is ethnic inequity in access to living-donor kidney transplants in the UK. This study asked kidney patients from Black, Asian and minority ethnic groups why members of their family were not able to be living kidney donors. Responses were compared with responses from White individuals. This questionnaire-based mixed-methods study included adults transplanted between 1/4/13–31/3/17 at 14 UK hospitals. Participants were asked to indicate why relatives could not donate, selecting all options applicable from: Age; Health; Weight; Location; Financial/Cost; Job; Blood group; No-one to care for them after donation. A box entitled ‘Other—please give details’ was provided for free-text entries. Multivariable logistic regression was used to analyse the association between the likelihood of selecting each reason for non-donation and the participant’s self-reported ethnicity. Qualitative responses were analysed using inductive thematic analysis. In total, 1240 questionnaires were returned (40% response). There was strong evidence that Black, Asian and minority ethnic group individuals were more likely than White people to indicate that family members lived too far away to donate (adjusted odds ratio (aOR) = 3.25, 95% Confidence Interval (CI) 2.30–4.58), were prevented from donating by financial concerns (aOR = 2.95, 95% CI 2.02–4.29), were unable to take time off work (aOR = 1.88, 95% CI 1.18–3.02), were “not the right blood group” (aOR = 1.65, 95% CI 1.35–2.01), or had no-one to care for them post-donation (aOR = 3.73, 95% CI 2.60–5.35). Four qualitative themes were identified from responses from Black, Asian and minority ethnic group participants: ‘Burden of disease within the family’; ‘Differing religious interpretations’; ‘Geographical concerns’; and ‘A culture of silence’. Patients perceive barriers to living kidney donation in the UK Black, Asian and minority ethnic population. If confirmed, these could be targeted by interventions to redress the observed ethnic inequity.

Care and Resistance

SummaryI consider the ways in which acts of kinship among British South Asians such as the suitable arrangement of a child’s marriage can be rejected by the child as an act of care and reframed as acts of force. Drawing on ethnographic research with people who have experienced “forced marriage,” I examine the processes through which they come to re‐examine the meanings of kinship and care from their own perspective and through their own life course. I argue that acts of care are not stable givens but rather constitute a constantly shifting set of configurations evolving through changing life experiences.

A British South Asian Muslim relational negotiation of divorce: uncoupling beyond the couple

Through analysis of the narratives of one British South Asian Muslim woman contemplating divorce, this article explores how the termination of marriage is negotiated within families. The article charts the involvement and emotional implication of multiple family members in the decision at multiple levels: the interpersonal, via their involvement as sounding boards, advisers and mediators, and the intersubjective, as people’s sense of their own internal will or resolve to divorce is dialogical and unstably tied to others’ expressed views. The negotiation of divorce is an agentic intervention in the reordering of relationships and sheds light on wider processes linking agency, culture and belief. While these multiple levels of the relational negotiation of divorce may be particularly piqued in South Asian contexts, there are wider implications for sociology as, in contrast with individualisation theory, uncoupling is shown to involve more than the feelings and choices of just the husband and wife.

Developing and implementing guidelines on culturally adapting the Addenbrooke\u2019s cognitive examination version III (ACE-III): a qualitative illustration

BackgroundCognitive tests currently used in healthcare and research settings do not account for bias in performance that arises due to cultural context. At present there are no universally accepted steps or minimum criteria for culturally adapting cognitive tests. We propose a methodology for developing specific guidelines to culturally adapt a specific cognitive test and used this to develop guidelines for the ACE-III. We then demonstrated their implementation by using them to produce an ACE-III Urdu for a British South Asian population.MethodsThis was a several stage qualitative study. We combined information from our systematic review on the translation and cultural adaptation of the ACE-III with feedback from previous ACE-III adaptors. This identified steps for cultural adaptation. We formatted these into question-by-question guidelines. These guidelines, along with feedback from focus groups with potential users were used to develop ACE-III Urdu questions. Clinical experts reviewed these questions to finalise an ACE-III Urdu.ResultsOur systematic review found 32 adaptations and we received feedback from seven adaptors to develop the guidelines. With these guidelines and two focus groups with 12 participants a sample ACE-III Urdu was developed. A consensus meeting of two psychiatrists with a South Asian background and familiarity with cognitive tests and cultural adaptation finalised the ACE-III Urdu.ConclusionsWe developed a set of guidelines for culturally adapting the ACE-III that can be used by future adaptors for their own language or cultural context. We demonstrated how guidelines on cultural adaptation can be developed for any cognitive test and how they can be used to adapt it.

Antenatal depression and anxiety and early pregnancy BMI among White British and South Asian women: retrospective analysis of data from the Born in Bradford cohort

BackgroundMaternal obesity has severe physical impacts such as increased chances of pre-eclampsia and gestational diabetes. However, mental health impacts are given less attention within antenatal care. Evidence suggests that women with obesity carry increased risk of maternal depression and anxiety, however, this association is not well researched amongst South Asian women in the UK who are vulnerable to both. The aim of this study was to investigate the association between antenatal depression and anxiety and early pregnancy BMI, within and between White British and South Asian women, using data from the Born in Bradford cohort.MethodsDepression and anxiety were assessed using the General Health Questionnaire (GHQ); a GHQ score of > 0 for the depression subscale and > 6 for anxiety. Mother’s BMI was stratified into six World Health Organisation BMI categories (underweight, recommended, overweight or obese class 1–3). To determine associations, univariate and multivariate logistic regression models (adjusting for maternal age, education, deprivation and smoking) were used.ResultsThere were 7824 women included (3514 White British and 4310 South Asian). South Asian women were more likely to have depression than White British (43.3% vs 36.1% p < 0.0001) and less likely to have anxiety (45.3% vs 48.4% p < 0.01). There were no significant associations between BMI and depression or anxiety in South Asian women. White British women with an overweight BMI had higher odds of anxiety compared with women with a recommended BMI (Adjusted Odds Ratio 1.25, 95% Confidence Interval 1.05–1.47). No significant associations were observed for other BMI categories. Smoking was a risk factor for antenatal depression (AOR 1.32, 95% CI 1.12–1.56; AOR 2.08, 95% CI 1.49–2.91) and anxiety (AOR 1.34, 95% CI 1.14–1.57; (AOR 2.87, 95% CI 2.02–4.07) in both White British and South Asian women, respectively.ConclusionsAlthough South Asian women have a higher prevalence of depression than White women in this cohort, the known associations between maternal obesity and anxiety do not appear to be present. More studies are needed using validated depression tools for South Asian pregnant women. Mental health screening during antenatal care is important for South Asian women, with factors such as smoking considered.

Racism and Discrimination: Let's practice what we preach

With the world in turmoil, an unexpected and tragic consequence of the SARS-CoV-2 pandemic has been its disproportionate impact on the British Asian and Minority Ethnic (BAME) communities. The pandemic led to an excessive number of deaths in these populations and revealed long-standing inequalities that began many years ago. This indictment raises questions about the extent to which racism and discrimination remain deeply rooted in British society. Have the diverse groups that together constitute the rich fabric of British society not heard, or do they choose to be deaf and blind to the suffering caused by racism and discrimination?

Study dissecting COVID‐19 related mortality in people with Type 1 and Type 2 diabetes

Studies using univariate analysis from China, Italy and the USA, as well as multivariate analysis from USA and UK have shown that people with diabetes have a higher risk of more adverse outcomes from COVID-19 compared with people without diabetes. However, the differential risks between type 1 versus type 2 diabetes remains unreported. Using data from the COVID patient notification system, UK investigators have studied the relative and absolute risk of in-hospital related death with COVID-19 in people with type 1 and type 2 diabetes. There were 23,804 hospital deaths with COVID-19 in England reported to 11th May 2020. Overall, one third of these deaths occurred in people with diabetes. Adjusted for age, sex, deprivation, ethnicity and geographical regions, people with type 1 and type 2 diabetes had 3.5 and 2.03 times the relative risk of dying in hospital from COVID-19 compared to those without diabetes. To put this into context however, age appears to be a major factor for people with diabetes at risk of death with COVID-19. Mean age of death in type 1 diabetes was 72 years and type 2 diabetes was 77.9 years. Moreover, the odd ratio for death in people <40 years was 0.01, whereas for people >80 years was 9.14 (both relative to reference age group of 60-69 years. Additional important risk factors which adjusted and increases the risk of in-patient death with COVID-19 in people with type 1 and type 2 diabetes are social deprivation, British Asian Minority ethnic (BAME) group and presence of comorbidities such as coronary heart disease, cerebrovascular disease and heart failure.

Living Suspiciously: Contingent Belonging in British South Asian Theater

This article investigates representations of national belonging in British South Asian theater productions after the 2005 London bombings. It identifies a significant yet hitherto underresearched corpus of plays that show the formation of the UK “home front” in the war on terror from the perspective of postcolonial subjects who are deemed threatening rather than worthy of protection. After discussing the construction of British South Asian citizens as suspicious subjects, the article analyzes two plays that offer an extensive consideration of the contingencies of national belonging. It argues that True Brits by Vinay Patel and Harlesden High Street by Abhishek Majumdar dramatize strategies for building, making, or keeping a home in London in spite of the strictures of suspectification and securitization.

Social representations of Britishness among British South Asian gay men

ABSTRACT Nationhood can be conceptualised in many different ways and these conceptualisations determine the level of access that ethnic minorities have to a national identity. This study focuses on social representations of Britishness among British South Asian gay men and their impact for constructing and managing national, ethnic and sexual identities. Fifteen individuals were interviewed using a semi-structured interview schedule and the data were analysed using thematic analysis and social representations theory. The analysis yielded three themes focusing on the racial representation of Britishness, which emphasised the centrality of race and was perceived to be exclusionary; the multicultural representation, which facilitated both ethnic and British national identification but did not address homophobia in the ethnic ingroup; and the civic/ instrumental representation, which facilitated a sense of belonging in spite of their multiple identities. A civic/ instrumental representation of Britishness appears to be inclusive and may have far-reaching social and psychological benefits.

The Relations and Role of Social Competencies and Belonging with Math and Science Interest and Efficacy for Adolescents in Informal STEM Programs

Adolescence represents a developmental period of waning academic motivation, particularly in STEM domains. To combat this, better understanding the factors that might foster STEM motivation and interest is of importance. Social factors like social competencies and feelings of belonging become increasingly important in adolescence. The current study investigated structural relations between social competencies, feelings of belonging to an informal STEM learning program, math and science efficacy and interest in a sample of 268 adolescents (Mage = 15.25; 66.8% girls; 42.5% White British or European American, 25.7% South Asian British or Asian American, 15.7% Afro-Caribbean Black British or African American 5.6% Bi-racial, and 3.0% other). Adolescents were recruited from six different informal learning sites (e.g., science museums, zoos, or aquariums) in the United States (n = 147) and the United Kingdom (n = 121). The results revealed positive relations between social competencies and belonging, and between belonging and math and science efficacy and interest. Further, the results also indicated a positive indirect effect of social competencies on efficacy and interest, via belonging. These findings have implications for guiding informal STEM programming in ways that can enhance STEM motivation and interest.