systematic review: the barriers and facilitators for minority ethnic groups in accessing urgent and...
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Systematic review: the barriers and facilitators for minority ethnic groups in accessing urgent and
prehospital care
Lincolnshire Community Health Services Research Forum, 12 March 2014
Viet-Hai Phung1 Karen Windle1 Marishona Ortega 1 Nadya Essam2 Mukesh Barot2 Joe Kai3 Mark Johnson4 Niro Siriwardena1 2
1 University of Lincoln 2 East Midlands Ambulance Service 3
University of Nottingham 4 De Montfort University
Introduction• Research addressing inequalities has
focused predominantly on primary care; less so on prehospital care.
• Variable uptake and use of health services by minority ethnic groups.
• Systematic review to identify barriers or facilitators experienced by minority ethnic patients in accessing pre-hospital care.
Aims of the review
• Exploring and understanding the barriers and facilitators to delivering high quality ambulance service care to patients from minority ethnic communities; and
• Exploring the causes and consequences of those differences in delivery to minority ethnic groups.
Methods• Agreed inclusion and exclusion
criteria.• Search terms finalised and
applied to 16 databases.• Data extraction tool designed.• Variant of Moffat Scale to
assess representation of minority ethnic groups.
• Data synthesis.
Data extraction processDesign data extraction tool
Search 14 databases using terms in data extraction tool
442 publications selected for analysis
24 studies included 8 full-text articles filtered out after analysis
181 studies included overall
418 articles screened out
16 studies included overall
ResultsThe main emergent themes from the analysis were:
– Cultural competency;– Knowledge of healthcare
systems;– Language and communication;
and– Evidence of poorer health
outcomes
Discussion
• Causes and consequences of:–Cultural competency –Knowledge of healthcare system–Language & communication–Evidence of poorer health
outcomes • Socioeconomic factors.
Strengths and limitations
• Strong evidence of ethnic health inequalities in both UK and US.
• Dearth of UK prehospital literature and ethnicity data means reliance on predominantly US literature – not always transferable.
Implications for future research
• Language and culture interconnected factors of disadvantage.
• Limited evidence of evaluation, but certain interventions can address specific problems among particular ethnic groups / in particular locations.
RecommendationsIncreasing ethnic diversity requires:
• More complete ethnicity data used appropriately by providers.
• Cultural competency training to address stereotypical behaviour among providers.
• More interpreting and translation services.
• Greater workforce diversity so providers reflect the population they serve.
Conclusion • Clear evidence that some minority ethnic groups
more disadvantaged than others.• Disparities in ethnic health outcomes.• Limited availability and application of ethnicity
data underestimates scale of the problem for service providers.
• Further studies to investigate UK differences in prehospital care and outcomes for minority ethnic groups, followed by qualitative approaches to understand barriers and enablers to equitable access.
Diversity is critical to innovation and change“The most basic not-so-secret formula for building an innovation culture is pretty simple – embrace diversity and start to attract, retain and promote a diverse workforce that looks differently, works differently, dress differently, speaks differently and is inclusive of the full spectrum of human sexual orientation and gender identities. Do this before you start hiring consultants and re-thinking your innovation process, there is no process that works without true diversity.” Idris Moore
