Ethnic inequalities among NHS staff in England: workplace experiences during the COVID-19 pandemic.

OBJECTIVES: This study aims to determine how workplace experiences of National Health Service (NHS) staff varied by ethnicity during the COVID-19 pandemic and how these experiences are associated with mental and physical health at the time of the study. METHODS: An online Inequalities Survey was conducted by the Tackling Inequalities and Discrimination Experiences in Health Services study in collaboration with NHS CHECK. This Inequalities Survey collected measures relating to workplace experiences (such as personal protective equipment (PPE), risk assessments, redeployments and discrimination) as well as mental health (Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder 7 (GAD-7)), and physical health (PHQ-15) from NHS staff working in the 18 trusts participating with the NHS CHECK study between February and October 2021 (N=4622). RESULTS: Regression analysis of this cross-sectional data revealed that staff from black and mixed/other ethnic groups had greater odds of experiencing workplace harassment (adjusted OR (AOR) 2.43 (95% CI 1.56 to 3.78) and 2.38 (95% CI 1.12 to 5.07), respectively) and discrimination (AOR 4.36 (95% CI 2.73 to 6.96) and 3.94 (95% CI 1.67 to 9.33), respectively) compared with white British staff. Staff from black ethnic groups also had greater odds than white British staff of reporting PPE unavailability (AOR 2.16 (95% CI 1.16 to 4.00)). Such workplace experiences were associated with negative physical and mental health outcomes, though this association varied by ethnicity. Conversely, understanding employment rights around redeployment, being informed about and having the ability to inform redeployment decisions were associated with lower odds of poor physical and mental health. CONCLUSIONS: Structural changes to the way staff from ethnically minoritised groups are supported, and how their complaints are addressed by leaders within the NHS are urgently required.

Negotiating access to community-based participatory research.

PURPOSE: Community-based participatory research (CBPR) that improves social capital can be a powerful tool for promoting mental health and well-being. This work explores what gaining, maintaining, and losing access to this type of CBPR looks like from a reflexive research perspective. METHOD: I describe and reflect on my experiences conducting a mixed-methods study of an existing CBPR to increase social capital in Switzerland. I draw on ethnographic observations, field notes, and reflexive memos collected during fieldwork between 2016 and 2020. RESULTS: I negotiated access to the CBPR across three levels: (1) formal organizational with intervention leaders, (2) implementational with facilitators, and (3) the community/group level with participants. Intervention leaders let me conduct research if they benefitted from my work in a timely and reinforcing way, facilitators granted access if I made myself helpful and supported their work, and community members accepted me if I participated in their community meaningfully. I lost access when my findings posed a potential risk to the intervention funding. CONCLUSION: I highlight how access is a fluid and complex process that can change throughout CBPR. I show the importance of reflexive analysis to understand how access is negotiated in diverse settings, what sources of social capital are needed to engage in these negotiations, and how positionality and power play a role in this process.

Ethnic inequalities during clinical placement: A qualitative study of student nurses' experiences within the London National Health Service.

AIM: To understand how student nurse experiences on clinical placement, within National Health Service (NHS) hospitals, differ for ethnic minority and White British groups. DESIGN: A qualitative thematic analysis with an inductive approach. METHODS: Data from semi-structured interviews with 21 London (United Kingdom) hospital-based student nurses were examined using thematic analysis. Participants were interviewed as part of the Tackling Inequalities and Discrimination Experiences in Health Services (TIDES) study and asked about their experiences during clinical placement. RESULTS: Five main themes were identified: (1) Role of mentors, (2) Discrimination and unfair treatment, (3) Speaking up/out, (4) Career progression, and (5) Consequences of adverse experiences. All themes were linked, with the social dynamics and workplace environment (referred to as "ward culture") providing a context that normalizes mistreatment experienced by nursing students. Students from ethnic minority backgrounds reported racism as well as cultural and/or religious microaggressions. While being valued for their race and ethnicity, White British students also experienced discrimination and inequity due to their age, sex, gender, and sexual orientation. Students from both White British and ethnic minority groups acknowledged that being treated badly was a barrier to career progression. Ethnic minority students also noted the lack of diverse representation within senior nursing positions discouraged career progression within the UK NHS. CONCLUSION: These initial experiences of inequality and discrimination are liable to shape a student's perspective of their profession and ability to progress within nursing. The NHS is responsible for ensuring that student nurses' developmental opportunities are equal, irrespective of ethnicity. IMPACT: Ward culture is perpetuated by others who normalize mistreatment and concurrently disadvantage ethnic minority students, making them feel unvalued. This in turn impacts both staff retention and career progression within the NHS. Training assessors should be aware of the existing culture of discrimination within clinical placements and work to eradicate it.

Online peer mentorship programmes for children and adolescents with neurodevelopmental disabilities: A systematic review.

BACKGROUND: Children and adolescents with neurodevelopmental disabilities may be less well integrated into their community than their peers. Online groups can be particularly accessible for individuals with neurodevelopmental disabilities, as individuals may be able to connect with a larger network than they would in their local community. This systematic review aimed at estimating the effectiveness of online peer mentorship programmes on children and adolescent's participation in life situations. METHODS: A systematic review was conducted to search Medline, PsycINFO, Embase, CINAHL, and Education Research Complete (ERIC) electronic databases. Thematic analysis was done for studies that used qualitative methodology. RESULTS: Eleven articles were included, and they examined the influences of five different structured online peer mentorship intervention programmes and six different online support groups. The disabilities included cerebral palsy (n = 3), autism spectrum disorder (n = 3), spina bifida (n = 2), attention deficit hyperactivity disorder (n = 2), and other neurodevelopmental disorders. The mentors included in the studies were caregivers of children with disabilities, youth and adults with disabilities, and a virtual peer actor. The mentees included in the studies were youth with disabilities (age 10-19 years) and their families. Intervention characteristics varied across the studies but consistently showed a unique potential to facilitate social networking and support. Intervention programmes with specific content and structure showed better participation outcomes than unstructured interventions. Presence of a moderator and participant characteristics (age and sociocultural background) was suggested to influence the outcomes of interventions. CONCLUSIONS: Online peer mentorship programmes appear to have positive influence on social engagement and participation in life situation for children and adolescents with disabilities. This paper discusses several areas that should be considered in future research studies to improve potential effectiveness and use of study designs that help to establish not only if interventions work but also for whom they work best and why.

Reducing loneliness in older adults: looking at locals and migrants in a Swiss case study.

Older adults are at a high risk for loneliness, and community-based interventions can help reduce loneliness for all older adults in a community, regardless of their migration status. However, little research has investigated how older adults, including locals and migrants (in this case, internal newcomers and international expats) participate in these interventions. The "Neighbourhoods in Solidarity" (NS) are a series of community-based interventions that aim to increase social connectedness and reduce loneliness in older adults (55+) in the canton of Vaud, Switzerland. This longitudinal embedded mixed-methods study aimed to understand whether older adults (distinguishing between locals, newcomers, and expats) were aware of and participated in the NS, to assess whether participation was associated with changes in loneliness, and to identify relevant processes that could explain a reduction in loneliness. We combined a longitudinal pre/post survey (235 respondents) with ethnographic observations and informal interviews. Quantitative findings showed that individuals who participated in the NS did not have significant changes in loneliness. Qualitative findings showed that perceived migration played an important role in who participated, and that the community distinguished between two types of migrants: newcomers who spoke French fluently, and expats who did not. Individuals were only 'local' if they had ancestors from the town. Some newcomers and some locals used the NS as a platform to build a new sense of community within the NS, whereas expats rarely participated. This was due to linguistic and cultural determinants, institutional constraints, interpersonal relationships, and personal preferences.

Place, social capital, and mental health: A mixed-methods case study of a community-based intervention.

This study collaborated with the "Neighbourhoods in Solidarity" (NS) action research intervention to understand place, social capital, and mental health for older adults in one Swiss town. It used a longitudinal mixed-methods design, combing a pre/post survey with ethnographic observations. It found that place was a recurring theme throughout the NS intervention and how the NS were able to build social capital. Older adults who participated in the NS experienced an increase in structural social capital, but many participants already had high levels of structural social capital before the intervention. Participants did not experience a significant change in cognitive social capital, but this may have been due to a general decline in cognitive social capital in the area. Neither changes in cognitive nor structural social capital predicted depressive symptoms after one year.

Social capital and health: A systematic review of systematic reviews.

There are many systematic reviews on social capital (SC) and various health outcomes, but each of these reviews shows one piece of the larger SC and health puzzle. The aim of this research was to systematically review systematic reviews on SC and health, in order to provide an overview of existing evidence and to identify strategies for future research. Nine databases were searched for key words that could fall under the broad umbrella of SC and health outcomes. We screened 4941 titles and abstracts and read 187 reviews before retaining 20 of them. A critical appraisal of each review was conducted. The reviews show there is good evidence to suggest that SC predicts better mental and physical health, and indicators of SC are protective against mortality. At the same time, many reviews also found numerous non-significant and negative relationships that are important to consider. It was unclear whether SC interventions for health were really improving SC, or other aspects of the social environment. Overall, this research shows that evidence on how various aspects of SC affect different health outcomes for different actors remains unclear. Intergroup and lifecourse perspectives could help clarify this link. Future research could benefit from conceptualizing the link between SC and health in a what, who, where, when, why and how framework.

Progress and gaps in Quebec's autism policy: a comprehensive review and thematic analysis.

OBJECTIVE: Consistent with a national and global trend, prevalence estimates of autism have risen steadily in Quebec, causing concerns regarding quality and availability of diagnostic and intervention services as well as policies guiding service delivery and their efficacy. We conducted an analysis of Quebec's autism policies to determine recent advances, challenges and gaps in the planning and delivery of provincial autism services. METHODS: We identify autism policy priorities in Quebec through a comprehensive review and a thematic analysis of past and present policies, consider their compliance with national and international human rights and health frameworks and identify policy gaps. RESULTS: Autism policies articulated at a provincial level in Quebec are comprehensive, well grounded in international and national frameworks and considerate of existing barriers in the systems. Quebec policies reflect long-standing recognition of many barriers affecting service utilization and quality. Root cause of challenges currently confronting the policy environment in Quebec includes limitations in: specific measures to enhance a person-centred approach across the lifespan, evaluation of economic costs associated with autism, utilization of research evidence, and enactment of policies. CONCLUSION: Early intervention services, building capacity in existing resources through training programs, and integrating research through research translation initiatives can help the Québec government improve the quality and efficacy of services while reducing long-term costs to the systems and promoting quality of life for individuals with autism and their families.

Social capital and common mental disorder: a systematic review.

OBJECTIVE: This study aims to systematically review all published quantitative studies examining the direct association between social capital and common mental disorders (CMD). Social capital has potential value for the promotion and prevention of CMD. The association between different types of social capital (individual cognitive and structural, and ecological cognitive and structural) and CMD must be explored to obtain conclusive evidence regarding the association, and to ascertain a direction of causality. DESIGN: 10 electronic databases were searched to find studies examining the association between social capital and CMD published before July 2014. The effect estimates and sample sizes for each type of social capital were separately analysed for cross-sectional and cohort studies. From 1857 studies retrieved, 39 were selected for inclusion: 31 cross-sectional and 8 cohort studies. 39 effect estimates were found for individual level cognitive, 31 for individual level structural, 9 for ecological level cognitive and 11 for ecological level structural social capital. MAIN RESULTS: This review provides evidence that individual cognitive social capital is protective against developing CMD. Ecological cognitive social capital is also associated with reduced risk of CMD, though the included studies were cross-sectional. For structural social capital there was overall no association at either the individual or ecological levels. Two cross-sectional studies found that in low-income settings, a mother's participation in civic activities is associated with an increased risk of CMD. CONCLUSIONS: There is now sufficient evidence to design and evaluate individual and ecological cognitive social capital interventions to promote mental well-being and prevent CMD.

Association between orthodontic treatment need and masticatory performance.

AIM: This retrospective cohort study assessed the differences between the masticatory performance of individuals with and without orthodontic treatment need. METHODS: Masticatory performances of 120 participants with equal numbers of males and females (n = 60 each) with and without treatment need (n = 60 each, determined using the index of the complexity, outcome, and need [ICON]) matched by age and sex were assessed. Participants chewed on test foods at sequences of 20, 30, 40, 40, 30, and 20 masticatory cycles. After sieving the chewed particles, the masticatory parameters (median particle size [MPS], masticatory frequency [MF], and broadness of particle distribution [BPD]) were calculated. The associations between treatment need and the MPS with age, weight, and stature, as well as the relationship between sex and MPS and MF, were assessed. RESULTS: According to the independent samples t test, MPS of subjects with and without treatment need differed significantly (P < .05) while MF did not. The differences between BPD values reached the level of significance only after 40 cycles of mastication (P < .05). Females showed significantly greater MPS values. Only at the 40-cycle sequence did females in need of treatment chew significantly slower. According to the repeated-measures ANOVA, no significant differences existed (P > .05) between each of the MPS, MF, and BPD values measured at different sequences. No significant correlations were found between MPS and age, sex, or stature (P > .05 [Spearman correlation coefficient]). CONCLUSION: The masticatory performance of individuals with and without treatment need differed for MPS and BPD (at the 40-cycle sequence). Age, weight, and stature did not affect the treatment need and MPS. Females showed poorer results regarding MPS--only at the 40-cycle sequence did females with malocclusion chew significantly slower.