Deprived London Borough Research Articles

N18 Exploring the experiences of UK-dwelling Bangladeshi native language-speaking patients with Inflammatory Bowel Disease: preliminary findings from a qualitative study

Abstract Background Native language-speaking patients with IBD may be underserved by an Anglo-centric delivery of healthcare in multicultural communities. We explored experiences of IBD Bangladeshi patients living in the UK whose preferred languages were Bengali or Sylheti. Methods Bangladeshi patients aged 18 years+, with confirmed diagnosis of Crohn’s disease, or ulcerative colitis, who fully or mostly spoke Bengali or Sylheti, were recruited from IBD infusion clinics. Semi-structured individual phone interviews with a bilingual researcher (captured February-May 2021) were audio-recorded, translated and transcribed professionally, and analysed thematically. Results The eight participants were aged 34-52 years; 4 (50%) females; with Crohn’s disease (n=3), ulcerative colitis (n=5). They spoke no English (n=2), Standard Bengali (n=8), and/or Sylheti (n=6); they could read Bengali and some English (n=5), Bengali only (n=2), or neither (n=1). Four early themes emerged: The impact of socioeconomic factors: Health inequalities pervaded participants’ experiences. They lived in a deprived London borough in multiple occupancy and/or multi-generational households, often with just one toilet. Those on low incomes had limited access to health-maintaining resources such as diet and medications. The importance of understanding and being understood in their native language: Issues with translation of health information and interpretation in health settings were reported. Participants struggled to explain their experiences of and concerns about IBD to clinicians; having a clinician who understood their position enabled needs and concerns to be better addressed. Understanding the condition and its chronic nature: Few participants had a good lay understanding of IBD and did not comprehend why it was only ‘being managed rather than cured’ by clinicians. Some distrusted Western medicine, believing that treatment would be better, and curative, in their native country. Family, friends, and the wider Bangladeshi community did not understand IBD and its effects. Day-to-day self-management experienced as a burden: Self-management tasks impinged on day-to-day activities, disrupting cultural and religious pursuits. Toileting, food practices and medication management all impacted negatively on personal and family social relationships and events, and on the ability to work. Conclusion Wider socioeconomic factors preceded and affected participant’s resources and ability to self-manage their condition. Language barriers fostered poor understanding of IBD and its chronic nature. Improved translation and interpretation assistance, alongside community-based initiatives to ameliorate health inequalities and improve access to health resources, would benefit this community.

Reducing childhood obesity: evaluation of an Early Years Nutrition programme in a deprived London borough

Background:Childhood obesity is a growing global health concern, with far-reaching implications on health in childhood and in later life. Early intervention strategies are key to reducing childhood obesity. This study aims to evaluate the implementation of an Early Years Nutrition programme in the London Borough of Newham’s children’s centres.Methods:A service evaluation of the Early Years Nutrition programme was conducted at children’s centres within the borough. Information was collected on the sessions provided to parents by staff, breastfeeding promotion and nutritional topics the centres were displaying. Nutritional activities in each centre were assessed for compliance with the National Institute for Health and Care Excellence (NICE) guidelines.Results: Eight out of eleven (72.7%) centres participated. Parent sessions focused mostly on oral health (n=4/8, 50.0%). Display board topics most commonly related to generic health and wellbeing (n=4/8, 50.0%). All centres displayed the UNICEF breastfeeding logo and complied with the NICE guidelines for nutritional activities.Conclusions:The programme is consistent with NICE guidelines in the centres evaluated; however, further acquisition of data on obesity-associated factors specific to communities and preventive measures for reducing childhood obesity, such as increased parental and community engagement, promotion of breastfeeding and improved staff training, will help tailor similar programmes elsewhere with higher social and cultural acceptance.

Can a Community-Led Intervention Offering Social Support and Health Education Improve Maternal Health? A Repeated Measures Evaluation of the PACT Project Run in a Socially Deprived London Borough.

Social adversity can significantly influence the wellbeing of mothers and their children. Maternal health may be improved through strengthened support networks and better health literacy. Health improvement at the population level requires optimizing of the collaboration between statutory health services, civic organizations (e.g., churches, schools), as well as community groups and parents. Two key elements in improving community engagement are co-production and community control. This study evaluated a co-produced and community-led project, PACT (Parents and Communities Together), for mothers in a deprived south London borough. The project offered social support and health education. Intended effects were improvements in mental health, health literacy, and social support, assessed by standardized measures in a pre-post design. Sixty-one mothers consented to take part in the evaluation. Significant improvements were found in mental health measures, in health literacy, for those with low literacy at baseline, and in overall and some specific aspects of social support. Satisfaction with the project was high. We found that the project engaged local populations that access statutory health services relatively less. We conclude that community-organized and community-led interventions in collaboration with statutory health services can increase accessibility and can improve mothers’ mental health and other health-related outcomes.

The burden of poverty in children with haemoglobinopathies presenting to a London tertiary referral centre

Background The burden of poverty and its impact on children with sickle cell disease has been documented in the United States of America where healthcare is accessed via health insurance programs. In the UK, there are few references in the literature to the impact of poverty on sickle cell disease or the extent of poverty within the sickle cell population. However, there has been media coverage of children with sickle cell disease, entering the country illegally, being deported to countries with inadequate healthcare provisions. Objectives We aim to show the demographics of children attending a tertiary haemoglobinopathy referral centre, and the locations of their respective domiciles to examine the burden of poverty and deprivation within the areas of residence. Methods The postcodes of 256 paediatric haemoglobinopathy patients were plotted on a map of the boroughs served by the hospital. The deprivation and poverty indices of each borough were then analysed. The highest areas of poverty within each borough were located and compared to where the children were resident. Results 49% of children attending the hospital lived in the borough of Enfield, ranked 15th highest out of 32 London boroughs for child poverty. Enfield is ranked as the 74th most deprived borough in the country out of 354 boroughs. 35% of children lived in the borough of Haringey ranked as the 5th most deprived London borough with the 4th highest level of child poverty in London. Haringey is the 18th most deprived borough in England. The children from both Enfield and Haringey lived in the most deprived areas of those boroughs. Conclusions There is a strong link between poverty and haemoglobinopathies based on the findings from this study. 84% of the children with a haemoglobinopathy lived in two of the most deprived boroughs in the country with high levels of child poverty. 3% of the children were on a child protection plan and many more had social problems including problems with immigration. The impact of this poverty to their health is yet undetermined but further studies are planned by the authors of this paper.

Storylines of Self-Management: Narratives of People with Diabetes from a Multiethnic Inner City Population

to analyse the narratives of people with diabetes to inform the design of culturally congruent self-management education programmes. the study was based on quasi-naturalistic story-gathering; i.e. making real-time field notes of stories shared spontaneously in diabetes self-management education groups in a socioeconomically deprived London borough. Eighty-two adults aged 25-86, from six minority ethnic groups who were in the intervention arm of a randomized controlled trial of story-sharing, participated. Stories were translated in real time by the facilitator or group members. Ethnographic field notes were transcribed, and analysed thematically (to identify self-management domains raised by participants) and interpretively for over-arching storylines (i.e. considering how self-management domains were contextualized and made meaningful in personal narratives). Analysis was informed by both biomedical and sociological theories of self-management. people with diabetes identified seven self-management domains: knowledge; diet; exercise; medication; foot care; self-monitoring; and attending check-ups. Interpretive analysis revealed eight illness storylines within which these practical issues acquired social meaning and moral worth: becoming sick; rebuilding spoiled identity; becoming a practitioner of self-management; living a disciplined and balanced life; mobilizing a care network; navigating and negotiating in the health care system; managing the micro-morality of self-management 'choices'; and taking collective action. living with diabetes involves both medically recommended behaviours and complex biographical work to make sense of and cope with illness. Self-management education programmes should take closer account of over-arching storylines that pattern experience of chronic illness and recognize that some elements of self-management knowledge cannot be pre-specified in a structured curriculum.

Prevention of type 2 diabetes in British Bangladeshis: qualitative study of community, religious, and professional perspectives

Objective To understand lay beliefs and attitudes, religious teachings, and professional perceptions in relation to diabetes prevention in the Bangladeshi community.Design Qualitative study (focus groups and semistructured interviews).Setting Tower Hamlets,...