Barriers and Facilitators in Accessing Prehospital Care for Minority Ethnic Groups

1. 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 Essam2Mukesh 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

2. CaHRU@lincoln.ac.uk 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.

3. CaHRU@lincoln.ac.uk 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.

4. CaHRU@lincoln.ac.uk 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.

5. CaHRU@lincoln.ac.uk Data extraction process

6. Results The main emergent themes from the analysis were: Cultural competency; Knowledge of healthcare systems; Language and communication; and Evidence of poorer health outcomes CaHRU@lincoln.ac.uk

7. CaHRU@lincoln.ac.uk Discussion • Causes and consequences of: • Cultural competency • Knowledge of healthcare system • Language & communication • Evidence of poorer health outcomes • Socioeconomic factors.

8. CaHRU@lincoln.ac.uk 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.

9. CaHRU@lincoln.ac.uk 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.

10. CaHRU@lincoln.ac.uk Recommendations Increasing 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.

11. CaHRU@lincoln.ac.uk 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.

12. CaHRU@lincoln.ac.uk 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

13. CaHRU@lincoln.ac.uk Thank you