A qualitative study exploring the parceived impact of race on leprosy-affected persons' experiences of diagnosis and treatment of leprosy in Southeast Brazil

Leprosy is a chronic, yet curable, infectious disease that causes severe morbidity in Brazil with an annual incidence of 33,000 new cases. Recent studies in Brazil showed a correlation between leprosy and the percentage of non-whites affected. Racial discrimination has been documented as a barrier to accessing healthcare. This study seeks to explore whether patients perceive race to have impacted on their leprosy care. A qualitative study was undertaken. 20 semi-structured interviews were conducted with patients' at Instituto Lauro de Souza Lima (ILSL), Brazil. Thematic analysis was used to analyse the data. 4 main themes were generated: racism is part of Brazilian culture, difficulties associated with the diagnosis of Leprosy, barriers to accessing treatment, and a lack of health education. Participants felt that racism infiltrates all aspects of Brazilian society, with isolated incidents in healthcare settings. Racism is known to be associated with socioeconomic inequalities. Leprosy control continues to be hindered by various social determinants of health. This, in turn, affects patients' access to leprosy treatment and care. This study may inform the continuing development of equitable leprosy control strategies in Brazil.

Perceptions and experiences regarding the impact of race on the quality of healthcare in Southeast Brazil: a qualitative study.

Objective: To explore the impact of race on the quality of healthcare received by patients attending a primary care centre in Brazil.Design: This was a qualitative study consisting of 19 semi-structured interviews conducted on patients from six racial groups (as defined in Brazil as white, yellow, brown, black and indigenous and one self-identified 'other' group). The interviews were analysed using thematic analysis.Results: Four main themes were identified during analysis; factors affecting the access to healthcare, experiences regarding quality of healthcare, discrimination in healthcare and deep-rooted societal discrimination, which were categorised into a number of sub-themes. Within these themes, interviewees reported (1) experiences of racism in society towards the black racial group, (2) one personal perception and two observations of racial discrimination in healthcare, (3) perceived racial discrimination due to healthcare professional behaviour and (4) other factors, such as delays in appointments and long waiting times in health facilities were felt to impact access to care.Conclusion: The findings suggest that racial discrimination exists in Brazilian society but its direct impact on healthcare access was felt to be less obvious. Instead, organisational level factors were felt to contribute to difficulty accessing care. Interviewees perceived that racial discrimination may affect the quality of care, particularly for those designated as 'black'. Socio-economic factors were felt to influence discrimination in healthcare. The findings can help inform further studies and educational initiatives to help address discrimination and access to healthcare in Brazil.

Managing hypertension in people of African origin with diabetes: Evaluation of adherence to NICE Guidelines.

BACKGROUND: The pathophysiology of hypertension in people of African origin differs from other ethnicities. This effect may be exacerbated in people with type 2 diabetes mellitus (T2DM), hence control of hypertension is particularly important in this population. AIMS: The primary aim was to evaluate the adherence to National Institute of Clinical Excellence (NICE) guidance (National Guidelines NG28) for hypertension management in African origin patients with T2DM. METHODS: This study was done using electronic health records at a large primary care centre based in Birmingham, UK. Strict exclusion criteria were applied to identify individuals with T2DM, African origin patients and a diagnosis of hypertension. Retrospectively participants were identified, and NICE guideline adherence was assessed using descriptive statistics. RESULTS: 78 patients were included in the study of which 28 (36%) were on the NICE recommended combination of antihypertensives, suggesting poor adherence to the guidance in primary care prescribing. The blood pressure control of 35 (44.9%) patients was suboptimal, although this group received more frequent blood pressure monitoring. Microalbuminuria remains a problem in the suboptimal group. CONCLUSION: This study provides insight into adherence to NICE guidance for managing hypertension in African origin patients with diabetes. Further work should be done to explore the effects of hypertension in this ethnic group and if there is a need for a more refined management guideline.

Perceptions and experiences regarding the impact of race on the quality of healthcare in Southeast Brazil: a qualitative study

OBJECTIVE: To explore the impact of race on the quality of healthcare received by patients attending a primary care centre in Brazil. DESIGN: This was a qualitative study consisting of 19 semi-structured interviews conducted on patients from six racial groups (as defined in Brazil as white, yellow, brown, black and indigenous and one self-identified 'other' group). The interviews were analysed using thematic analysis. RESULTS: Four main themes were identified during analysis; factors affecting the access to healthcare, experiences regarding quality of healthcare, discrimination in healthcare and deep-rooted societal discrimination, which were categorised into a number of sub-themes. Within these themes, interviewees reported (1) experiences of racism in society towards the black racial group, (2) one personal perception and two observations of racial discrimination in healthcare, (3) perceived racial discrimination due to healthcare professional behaviour and (4) other factors, such as delays in appointments and long waiting times in health facilities were felt to impact access to care. CONCLUSION: The findings suggest that racial discrimination exists in Brazilian society but its direct impact on healthcare access was felt to be less obvious. Instead, organisational level factors were felt to contribute to difficulty accessing care. Interviewees perceived that racial discrimination may affect the quality of care, particularly for those designated as 'black'. Socio-economic factors were felt to influence discrimination in healthcare. The findings can help inform further studies and educational initiatives to help address discrimination and access to healthcare in Brazil.