Minority Ethnic Service Users Research Articles

The power of the lived experience: improving awareness of cardiovascular care for minority ethnic service users

In this month's BANCC column, Lorna Jones, head of nursing in urgent and emergency care at George Eliot Hospital NHS Trust, reflects on her talk at the BANCC study day about her experience as a Black minority ethnic nurse in leadership.

Differences in Remote Mental Healthcare: Minority Ethnic Service User Experiences and Perceptions During COVID-19

AimsCOVID-19 has resurfaced health inequalities but also provides new opportunities for remote healthcare. Minority ethnic service users (SUs) are substantially under-represented in secondary mental health services due to gaps in understanding needs of this priority group. We aimed to assess and identify any differences in characteristics and acceptability, with a focus on minority ethnic mental health SUs.MethodsA prospective, online feedback questionnaire was developed with the help of SUs. This was built into video consultations (VCs), using the secure Attend Anywhere platform through a survey link. We present results between July 2020 and January 2022, during which, a total of 2,565 SUs completed the online questionnaire after VCs. SPSS (version 27) was used for descriptive statistical analysis. Chi-squared test, using 5% level of significance, was conducted to test differences between the two (minority Vs majority ethnic) SU groups.ResultsOf 2,565 SUs, 119 (4.6%) were from minority ethnic groups (Asian British, Mixed/multiple, Black British, and Other), 2,398 (93.5%) were White British, and 48 (1.9%) preferred not to disclose. A higher percentage of SUs were females from both minority (55.6%) and White British (66.1%) ethnic groups (ϰ2=5.476, p < 0.05). By age group, almost half (48.7%) of minority ethnic SUs were less than 25 years old, compared with those from White British ethnicity (29.2%). In contrast, only 2.5% minority ethnic SUs were aged ≥65 years with none ≥80 years old (ϰ2 Likelihood Ratio = 27.11, p < 0.001).No significant differences were found for video technical quality, such as waiting area, joining the video call, sound, and video quality. Similar findings were observed for video care delivery aspects with no significant differences between (minority ethnic and White British) SUs. Overall, both groups felt comfortable during the video call (ϰ2=0.137, p > 0.05), their needs were met (ϰ2=0.384, p > 0.05) and felt supported (ϰ2=0.164, p > 0.05). However, according to care team, a significantly higher percentage of minority ethnic SUs (43%) had remotely consulted Specialist (Eating disorders, Well-being/IAPT) services compared with those of majority ethnicity (29%) (ϰ2 Likelihood Ratio = 21.936, p < 0.05).ConclusionBoth minority ethnic and White British SUs found video care to be acceptable, with positive experiences. A significantly high proportion of minority ethnic SUs was younger and had remotely consulted Specialist services, with none in the 80-plus age group. These findings highlight priority areas to address among this massively underrepresented group in mental healthcare services.

Barriers in access to dementia care in minority ethnic groups in Denmark: a qualitative study

Objectives To explore barriers in access to dementia care in Turkish, Pakistani and Arabic speaking minority ethnic groups in Denmark. Method Semi-structured qualitative individual- and group interviews with minority ethnic family carers, primary care dementia coordinators, staff in elderly daycare, and multicultural link workers. Hermeneutic phenomenology was used as theoretical framework. Results A total of 21 individual- and 6 group interviews were conducted, including a total of 35 participants. On the service user side, barriers in access to dementia care were related to lacking language proficiency and strong cultural norms, including familial responsibility for the care of older family members and stigma associated with mental illness and dementia. On the care provider side, the available formal services were rarely tailored to the specific needs of minority ethnic service users and were often considered inadequate or unacceptable. Conclusion Care practices and perceived consequences of dementia in minority ethnic communities were heavily influenced by cultural factors leading to a number of persisting barriers to accessing dementia care services. There is a simultaneous need to raise awareness about dementia and the existence of dementia care services in minority ethnic groups, to reduce stigma, and to develop culturally appropriate dementia care options.

Co-production for service improvement: Developing a training programme for mental health professionals to enhance medication adherence in Black, Asian and Minority Ethnic Service Users.

AimTo co‐produce consensus on the key issues important in educating mental health‐care professionals to optimize mental health medication adherence in Black, Asian and Minority Ethnic (BAME) groups.ObjectivesTo identify perceptions of factors enabling or disabling medication adherence. To achieve consensus on content and delivery of an educational intervention for mental health‐care professionals.MethodsData were collected from 2016 to 2018. Using individual interviews and a consensus workshop with carers and service users (SUs treated under the 1983 Mental Health Act 1983/revised 2007 for England and Wales), the experience of taking prescribed mental health medication and perspectives on adherence were explored. Data were analysed using 2‐stage qualitative coding via the software tool NVivo version 11 to analyse transcribed data and to produce the main explanatory categories.ResultsSU and carer participants' perspectives substantially altered the original research design. The need to educate students rather than trained professionals was emphasized, and they suggested that educational content should be packaged in a contemporary manner (a virtual reality experience). Findings indicated that education should focus upon understanding the impact of taking prescribed antipsychotic medication on both SUs and carers.DiscussionThe importance of effective communication between health professionals, SUs and carers and a willingness to learn about and appreciate how BAME culture influences perception of mental illness and mental well‐being were highlighted.ConclusionIn working co‐productively, researchers need to be flexible and adaptable to change.

Barriers to post-diagnostic care and support in minority ethnic communities: A survey of Danish primary care dementia coordinators.

BackgroundPeople from minority ethnic groups are under-represented in dementia diagnosis, treatment, and care. The aim of this study was to examine barriers to accessing post-diagnostic care and support in minority ethnic communities from the perspective of primary care dementia coordinators in Denmark.MethodA survey questionnaire investigating issues related to provision of care and support services in minority ethnic communities was conducted among 41 primary care dementia coordinators representing all Danish geographic regions. Responses were primarily based on five-point Likert scales. Results from geographic regions with different rates of people from minority ethnic communities with dementia were compared.ResultsAmong the surveyed dementia coordinators, 95% generally thought that providing dementia care and support services to minority ethnic service users was challenging. Strategies for overcoming cultural and linguistic barriers were generally sparse. Uptake of most post-diagnostic services was perceived to be influenced by service users’ minority ethnic background. Communication difficulties, poor knowledge about dementia among minority ethnic service users, inadequate cultural sensitivity of care workers, and a lack of suitable dementia services for minority ethnic communities were highlighted as some of the main barriers. Not surprisingly, 97% generally found minority ethnic families to be more involved in provision of personal care and support compared to ethnic Danish families.ConclusionThere is a need to develop methods and models for post-diagnostic care and support that include cultural awareness and diversity for interacting with different cultural communities.

Understanding Black and Minority Ethnic service user's experience of racism as part of the assessment, formulation and treatment of mental health problems in cognitive behaviour therapy

AbstractExperiences of racism can be a cumulative risk factor for developing mental health problems. Cognitive Behaviour Therapists working with Black and Minority Ethnic (BME) service users should be confident in their ability to establish the necessary rapport to ask about these experiences and be able to incorporate this information into longitudinal formulations and as part of maintenance cycles. This paper sets out guidelines as to how to do this as part of a wider engagement process.

Perceived barriers to accessing mental health services among black and minority ethnic communities: a qualitative study in southeast England

BackgroundIn most developed countries, substantial disparities exist in access to mental health services for black and minority ethnic populations. We sought to determine perceived barriers to accessing mental health services among people from these backgrounds to inform the development of effective and culturally acceptable services to improve equity in health care. MethodsIn this qualitative study in southeast England, 26 adults (13 men, 13 women; aged >18 years) from black and minority ethnic backgrounds were recruited to two focus groups. Participants were identified through the registers of the Black and Minority Ethnic Community Partnership centre and by visits to local community gatherings, and were invited to take part by community development workers. Thematic analysis was conducted to identify key themes about perceived barriers to accessing mental health services. FindingsParticipants identified two broad themes that influenced access to mental health services. First, personal and environmental factors included inability to recognise and accept mental health problems, positive impact of social networks, reluctance to discuss psychological distress and seek help among men, cultural identity, negative perception of and social stigma against mental health, and financial factors. Second, factors affecting the relationship between service user and health-care provider included the impact of long waiting times for initial assessment, language barriers, poor communication between service users and providers, inadequate recognition or response to mental health needs, imbalance of power and authority between service users and providers, cultural naivety, insensitivity, and discrimination towards the needs of black and minority ethnic service users, and lack of awareness of different services among service users and providers. InterpretationPeople from black and minority ethnic backgrounds require considerable mental health literacy and practical support to raise awareness of mental health conditions and combat stigma. There is a need for improving information about services and access pathways. Health-care providers need relevant training and support in developing effective communication strategies to deliver individually tailored and culturally sensitive care. Improved engagement with people from black and minority ethnic backgrounds in the development and delivery of culturally appropriate mental health services could facilitate better understanding of mental health conditions and improve access. FundingPublic Health Directorate NHS Brighton and Hove, Sussex Partnership NHS Foundation Trust, Black and Minority Ethnic Community Partnership, Brighton and Sussex Medical School.

Co-production as an approach to developing stakeholder partnerships to reduce mental health inequalities: an evaluation of a pilot service.

Black and minority ethnic communities continue to face inequalities in mental health service access and provision. They are under-represented in low-level interventions as they are less likely to be referred, and more likely to disengage from mainstream mental health services. Effective models that lead to improved access and better outcomes are yet to be established. It has long been recognised that to be effective, services need to be more culturally competent, which may be achieved through a co-production approach. This study aimed to evaluate the role of co-production in the development of a novel community mental health service for black and minority ethnic service users. Qualitative research methods, including semi-structured interviews and focus groups, were used to collect data to examine the use of co-production methods in designing and delivering an improved mental health service. Findings Twenty-five patients enrolled into the study; of these, 10 were signposted for more intensive psychological support. A 75% retention rate was recorded (higher than is generally the case for black and minority ethnic service users). Early indications are that the project has helped overcome barriers to accessing mental health services. Although small scale, this study highlights an alternative model that, if explored and developed further, could lead to delivery of patient-centred services to improve access and patient experience within mental health services, particularly for black and minority ethnic communities.

Satisfaction with social care services among South Asian and White British older people: the need to understand the system

ABSTRACTNational surveys show that people from minority ethnic groups tend to be less satisfied with social care services compared with the white population, but do not show why. Research indicates that barriers to accessing services include lack of information, perceptions of cultural inappropriateness and normative expectations of care. Less research has examined the experience of minority ethnic service users after they access services. This study conducted in-depth interviews with 82 South Asian and White British service users and family carers, the majority of whom were older people. Thematic analysis was used. The key theme was understanding the social care system. Participants with a good understanding of the system were more able to adapt and achieve control over their care. Participants with a poor understanding were uncertain about how to access further care, or why a service had been refused. More White British than South Asian participants had a good understanding of the system. There was more in common between the South Asian and White British participants' experiences than might have been expected. Language was an important facilitator of care for South Asian participants, but ethnic matching with staff was less important. Recommendations include better communication throughout the care process to ensure service users and carers have a clear understanding of social care services and hence a better experience.

Reaching the ‘hard to reach’: strategies to recruit black and minority ethnic service users with rare long-term neurological conditions

Little is known about health and social care experiences of patients with rare long-term neurological conditions. Furthermore, black and minority ethnic (BME) service users are often perceived to be under-represented in health services research. BME service users have been described as ‘hard to reach’ in the past. However, evidence suggests that a variety of recruitment methods need to be used in order to increase recruitment. We employed a range of recruitment strategies shown to be effective in recruiting BME patients, to recruit patients to participate in one-to-one interviews to establish experiences of health and social care. Strategies included community and clinically based strategies. In total we recruited 15 participants through these recruitment methods, with all recruits ultimately coming from neurology clinics and disease-specific charities. Despite community-based strategies generating interest and a willingness to be involved, the rare nature of these conditions resulted in a lack of recruits from these strategies. Consequently we conclude that researchers need to plan and prioritise strategies carefully in order to maximise recruitment and utilise resources efficiently dependent on the nature of the research.

Black and minority ethnic service users: getting a raw deal

Black and minority ethnic service users: getting a raw deal

Culturally determined care goals and the efficacy of statutory services

This article describes the culturally determined understandings of good mental health and distress of older Pakistani- Punjabi immigrants in Britain, and of how these beliefs may determine specific goals and needs during the help-seeking process for distressed minority ethnic service users. This includes a discussion of how these beliefs determine the perceptions of appropriateness and efficacy of statutory treatment options. The data is drawn from a qualitative, largely interview-based study of Pakistani immigrants, statutory healthcare service providers, and traditional Pakistani healers in Northern England. The study aimed to assess the reasons for the low uptake and apparently poor efficacy of statutory services provided to the immigrant group, despite a high prevalence of distress in this group. The study found that interaction (usually surgery consultation) between service users and providers was unsatisfactory for both parties. The unsatisfactory results of service use for both providers and users appeared to be rooted primarily in cultural misunderstandings that led to divergent goals, and thus divergent approaches to service use/provision behaviour. It is hoped that this article may serve as a guideline for the development of more appropriate and effective services for similar groups. Key words: Transcultural, worldview, mental healthcare services, British-Pakistani, south Asian, mental health

Culturally determined care goals and the efficacy of statutory services

This article describes the culturally determined understandings of good mental health and distress of older Pakistani-Punjabi immigrants in Britain, and of how these beliefs may determine specific goals and needs during the help-seeking process for distressed minority ethnic service users. This includes a discussion of how these beliefs determine the perceptions of appropriateness and efficacy of statutory treatment options. The data is drawn from a qualitative, largely interview-based study of Pakistani immigrants, statutory healthcare service providers, and traditional Pakistani healers in Northern England. The study aimed to assess the reasons for the low uptake and apparently poor efficacy of statutory services provided to the immigrant group, despite a high prevalence of distress in this group. The study found that interaction (usually surgery consultation) between service users and providers was unsatisfactory for both parties. The unsatisfactory results of service use for both providers and users appeared to be rooted primarily in cultural misunderstandings that led to divergent goals, and thus divergent approaches to service use/provision behaviour. It is hoped that this article may serve as a guideline for the development of more appropriate and effective services for similar groups.

Book reviews

Book reviews

An investigation into minority ethnic prisoners' knowledge and perceptions of the Probation and Prison Service in the east of England

This article presents the key findings of an investigation into minority ethnic prisoners' knowledge and perceptions of the Probation and Prison Services in the east of England. The first part of the article puts this study into disciplinary context by examining relevant and topical research and debate about minority ethnic service users' experiences and treatment within the criminal justice system. Most notably perceptions and opinions of minority ethnic service users are limited. However accounts of discrimination and racism within elements of the criminal justice system provide a useful springboard to understand and collect much awaited data in this area. The final part of the article summarises the key findings of this investigation and goes on to make useful recommendations to the service providers in terms of developing and establishing effective race relations in the shape of policy development, consequent action and for further investigative studies of this nature.

Therapists’ Experiences of Working with Language Interpreters

While practitioners working in the mental health care context are making greater use of interpreters, there remains a paucity of literature that is informed by a critiqued theoretical, clinical, empirical, and research grounding. This study employed a qualitative methodology and used Interpretative Phenomenological Analysis (IPA) to elicit an in-depth understanding of child and adolescent mental health practitioners’ experiences in carrying out assessments and therapeutic work with the help of an interpreter. Participants spoke about their reliance on language, and how the process of communication lost important attributes through translation. A striking quality about this work was related to the difficulties the participants experienced in being able to establish a constructive working alliance with an interpreter. This in turn had a negative effect on being able to establish a working alliance with families. The interventions offered by practitioners tended to become simplified. Such findings lead to a closer questioning of why these difficulties occur. It is suggested that addressing structural inequalities and training issues, and incorporating good practice guidelines can go a long way toward ensuring improved clinical services for many minority ethnic service users needing the help of interpreters during mental health consultations.