Evaluation of the Call for a Kit intervention to increase bowel cancer screening uptake in Lancashire, England.

OBJECTIVE: To evaluate the 'Call for a Kit' health promotion intervention that was initiated in Lancashire, England to improve bowel cancer screening uptake. METHODS: Within the intervention, screening non-responders are called and invited to attend a consultation with a health promotion team member at their primary care practice. In this audit, we analysed the proportion of those contacted who attended the in-person clinic versus those who received a phone consultation, the number returning a test kit from in-person versus phone consultations, and the extent to which test kit return was moderated by sociodemographic characteristics. RESULTS: In 2019, 68 practices participated in the intervention which led to 10,772 individuals being contacted; 2464 accepted the invitation to an in-person consultation, of whom 1943 attended. A further 1065 agreed to and attended a consultation over the phone. The 3008 consultations resulted in 2890 test kits being ordered, of which 1608 (55.6%) were returned. The intervention therefore yielded a 14.9% response rate in the total cohort; 71.5% of test kits came from individuals attending the in-person consultation. Women and those registered with a practice in socioeconomically deprived areas were less likely to return the test kit. Individuals with a black, mixed or a non-Indian/Pakistani Asian ethnic background were significantly more likely to accept the offer of an in-person consultation and return the test kit. CONCLUSION: Our analysis demonstrated the strong likelihood of people returning a test kit after an in-person appointment but also the usefulness of using phone consultations as a safety net for people unable or unwilling to attend in-person clinics.

Exploring the relationship between stigma and help-seeking for mental illness in African-descended faith communities in the UK.

BACKGROUND: Stigma related to mental illness affects all ethnic groups, contributing to the production and maintenance of mental illness and restricting access to care and support. However, stigma is especially prevalent in minority communities, thus potentially increasing ethnically based disparities. Little is known of the links between stigma and help-seeking for mental illness in African-descended populations in the UK. OBJECTIVE AND STUDY DESIGN: Building on the evidence that faith-based organizations (FBOs) can aid the development of effective public health strategies, this qualitative study used semi-structured interviews with faith groups to explore the complex ways in which stigma influences help-seeking for mental illness in African-descended communities. A thematic approach to data analysis was applied to the entire data set. SETTING AND PARTICIPANTS: Twenty-six men and women who had varying levels of involvement with Christian FBOs in south London were interviewed (e.g. six faith leaders, thirteen 'active members' and seven 'regular attendees'). RESULTS: Key factors influencing help-seeking behaviour were as follows: beliefs about the causes of mental illness; 'silencing' of mental illness resulting from heightened levels of ideological stigma; and stigma (re)production and maintenance at community level. Individuals with a diagnosis of mental illness were likely to experience a triple jeopardy in terms of stigma. DISCUSSION AND CONCLUSION: 'One-size-fits-all' approaches cannot effectively meet the needs of diverse populations. To ensure that services are more congruent with their needs, health and care organizations should enable service users, families and community members to become active creators of interventions to remove barriers to help-seeking for mental illness.

Assessing satisfaction with social care services among black and minority ethnic and white British carers of stroke survivors in England.

Overall satisfaction levels with social care are usually high but lower levels have been reported among black and minority ethnic (BME) service users in England. Reasons for this are poorly understood. This qualitative study therefore explored satisfaction with services among informal carer participants from five different ethnic groups. Fifty-seven carers (black Caribbean, black African, Asian Indian, Asian Pakistani and white British) were recruited from voluntary sector organisations and a local hospital in England, and took part in semi-structured interviews using cognitive interviewing and the critical incident technique. Interviews took place from summer 2013 to spring 2014. Thematic analysis of the interviews showed that participants often struggled to identify specific 'incidents', especially satisfactory ones. When describing satisfactory services, participants talked mostly about specific individuals and relationships. Unsatisfactory experiences centred on services overall. When rating services using cognitive interviewing, explicit comparisons with expectations or experiences with other services were common. Highest satisfaction ratings tended to be justified by positive personal characteristics among practitioners, trust and relationships. Lower level ratings were mostly explained by inconsistency in services, insufficient or poor care. Lowest level ratings were rare. Overall, few differences between ethnic groups were identified, although white British participants rated services higher overall giving more top ratings. White British participants also frequently took a more overall view of services, highlighting some concerns but still giving top ratings, while South Asian carers in particular focused on negative aspects of services. Together these methods provide insight into what participants mean by satisfactory and unsatisfactory services. Cognitive interviewing was more challenging for some BME participants, possibly a reflection of the meaningfulness of the concept of service satisfaction to them. Future research should include comparisons between BME and white participants' understanding of the most positive parts of satisfaction scales and should focus on dissatisfied participants.

End-of-life care in advanced kidney disease: ethical and legal issues and key challenges for black and minority ethnic groups.

Advances in modern medical technology have gone so far that it is now possible for machinery to keep people alive. To some extent this has led to a misperception in society that death can almost always be postponed because life-sustaining extracorporeal machinery of some sort or another, for example a dialysis machine, can prevent it. However, for some, being kept alive connected to a dialysis machine for four hours three times a week does not represent or even come close to an existence or quality of life they consider valuable. It may even cause unnecessary distress. This may be because they have reached a point at the end of their lives where they would like the focus of their treatment or care to become that which enables them to live as well as possible until they die. In these circumstances treatment and care should properly be that which enables the supportive and palliative care needs of both patient and family to be identified and met throughout the last phase of life and into bereavement. Identifying and acknowledging the importance of such a paradigm shift in the delivery of healthcare, and above all facilitating it, includes taking on the responsibility, incumbent upon us all, to address the ethical issues that are brought into focus. In this paper, I examine some of these issues. I consider the ways in which underlying theoretical ethical principles have informed the development of professional guidance and highlight the dynamic relationship this guidance has with the law. Finally, I demonstrate the ways in which it can be usefully applied to inform and assist clinical decision-making. Key challenges for BAME groups are addressed.

Improving access to primary mental health services: are link workers the answer?

Background The incidences of common mental disorders such as anxiety, depression and low-level post-traumatic stress are associated with deprivation. Since 2007, the Improving Access to Psychological Therapy (IAPT) programme in Ealing has made it easier for primary care practitioners to refer patients with common mental disorders for treatment. However, fewer patients of a black and minority ethnic (BME) background were referred than expected. Setting Southall, Ealing, is a diverse ethnic community; over 70% of the population is classified as having a BME background. Aim To evaluate the effect of locating mental health link workers in general practitioners' (GP) surgeries on referral of BME patients to IAPT services. Methods In 2009, an initiative in Southall helped practitioners and managers that served geographic areas to work with many different agencies to improve whole systems of care. One strand of this work led to mental health link workers being placed in 6 of the 23 GP practices. They provided psychological therapy and raised awareness of common mental disorders in BME groups and what mental health services can do to improve these. Referrals to the service were monitored and assessed using statistical process control. Results The mean referral rate of BME patients for GP practices without a link worker was 0.35 per week per 10 000 patients and was unchanged throughout the period of the study. The referral rates for the six practices with a link worker increased from 0.65 to 1.37 referrals per week per 10 000 patients. Conclusions Link workers located in GP practices, as part of a collaborative network of healthcare, show promise as one way to improve the care of patients with anxiety and depression from BME communities.

Tackling fuel poverty through facilitating energy tariff switching: a participatory action research study in vulnerable groups.

OBJECTIVES: A fifth of UK households live in fuel poverty, with significant health risks. Recent government strategy integrates public health with local government. This study examined barriers to switching energy tariffs and the impact of an energy tariff switching 'intervention' on vulnerable peoples' likelihood to, success in, switching tariffs. STUDY DESIGN: Participatory Action Research (PAR), conducted in West London. METHODS: Community researchers from three voluntary/community organisations (VCOs) collaborated in recruitment, study design, data collection and analysis. VCOs recruited 151 participants from existing service users in three groups: Black and Minority Ethnic (BME) communities, older people (>75 yrs) and families with young children. Researchers conducted two semi-structured interviews with each participant, a week apart. The first interview asked about demographics, current energy supplier, financial situation, previous experience of tariff-switching and barriers to switching. Researchers then provided the 'intervention' - advice on tariff-switching, printed materials, access to websites. The second interview explored usefulness of the 'intervention', other information used, remaining barriers and information needs. Researchers kept case notes and a reflective log. Data was analysed thematically and collaboratively between the research coordinator and researchers. Quantitative data was analysed using SPSS, with descriptive statistics and Chi-squared tests. A total of 151 people were interviewed: 47 older people over 75 years, 51 families with young children, 51 BME (two were missing demographics). RESULTS: The majority were not White British or UK-born. Average household weekly income was £230. Around half described 'difficult' financial situations, 94% were receiving state benefits and 62% were in debt. Less than a third had tried to find a better energy deal; knowledge was the main barrier. After the intervention 19 people tried to switch, 13 did. Young families were most likely to switch, older people least. The main reasons for not switching were apathy ('can't be bothered'), lack of time, fear or scepticism and loyalty. Older people were particularly affected by apathy and scepticism. The personalized advice and help with websites was especially valued. CONCLUSIONS: Low-income consumers appear to have considerable apathy to switching energy tariffs, despite potential savings and health benefits, in part due to their complex lives in which switching is not a priority. An independent, one-on-one, personalized 'intervention' encouraged switching, particularly for young families. However, older people still experience significant barriers to switching with specific interventions needed, which take account of their status quo bias, energy use habits and scepticism. The recent integration of public health and local government in the UK may provide the ideal environment for providing similar services which are desperately needed to reduce fuel poverty in these groups in line with the new Public Health Strategy.

'Oh my gosh I'm going to have to undress': potential barriers to greater ethnic diversity in the physiotherapy profession in the United Kingdom.

OBJECTIVE: To explore the views and experiences of South Asian participants in relation to the potential barriers to increasing ethnic diversity of the physiotherapy profession. DESIGN: A qualitative research design was utilised, drawing on ethnographic traditions and including ethnographic interviews. The interviews were transcribed and the data were analysed using thematic analysis. SETTING: A venue of the participant's own choosing in the North west of England. PARTICIPANTS FINDINGS: From analysis of the data generated, three subthemes emerged in relation to the overarching theme; potential barriers: decreased knowledge of physiotherapy; issue of status; tension between cultures. CONCLUSIONS: It appears that a lack of knowledge may impact negatively on BME potential students considering physiotherapy as a possible career. The status of the profession was found to be an important factor in career choice. However, a lack of knowledge led many to consider physiotherapy to be less prestigious than other healthcare professions. Finally, a lack of sensitivity with the information given during the selection process caused some participants anxiety and to question physiotherapy as a career choice. Due consideration should be given to these potential barriers to address the underrepresentation of BME groups in physiotherapy.

'Isn't it all Whites?' Ethnic diversity and the physiotherapy profession.

AIM: To explore physiotherapists' perceptions, views and experiences of ethnic diversity in relation to the physiotherapy profession. DESIGN: Qualitative research study, drawing on ethnographic traditions and including ethnographic interviews. The interviews were transcribed verbatim and the data were analysed using thematic analysis. Several verification procedures were incorporated into the design to ensure quality. SETTING: Venues chosen by the participants in North West England. PARTICIPANTS: A purposive sample of 22 physiotherapists (five students, seven clinicians and 10 academics) with a range of ethnicities. FINDINGS: Most participants' experiences and perceptions were of a lack of ethnic diversity within the profession. Further findings related to the impact of this included: the perception that physiotherapy is a White profession; some Black and Minority Ethnic (BME) physiotherapists felt 'out of place' on occasions; and failure to meet patients' needs. The potential benefits of increased ethnic diversity and the possible risks of valuing BME staff solely in terms of their ethnicity were also illuminated by the findings. CONCLUSIONS: This study of the perceptions and experiences of physiotherapists identified a lack of ethnic diversity within the profession. It is argued that a lack of ethnic diversity may result in a failure to meet patients' needs. A workforce that is reflective of the population it serves can have greater cultural knowledge, and is more likely to understand and respond to patients' needs.