Tackling health inequality in ethnic minority communities

Targeted health information, in the right language, and applicable to the cultural practices of those to whom it is aimed, should be a key part of future public health campaigns. We are all aware of the tragic statistics around the disparity of infections and deaths among ethnic minority populations with COVID-19, and research funded by the Applied Research Collaborative Kent Surrey & Sussex, explored the COVID-19 health information needs in minority populations.

These are the findings of the research  led by Dr Priya Paudyal from Brighton & Sussex Medical School,  supported by Kent Surry Sussex Academic Health Science Network (KSS AHSN), and published in the British Medical Journal in June 2022.

Dr Priya Paudyal from Brighton & Sussex Medical School

Early in the COVID-19 pandemic, Public Health England published a report that showed deaths from COVID-19 among people from minority ethnic groups were two to four times greater than those among the white population in England. A raft of similar statistics emerged, together with reasons why this might be the case, broadly encompassing socioeconomic inequalities and systemic racism.

Dr Paudyal and her research team explored what could be done to mitigate these adverse impacts, in the immediate short term, to influence broader COVID-19 response. Research commissioned by ARC KSS led to the publication of leaflets in Hindi and Nepalese, targeting COVID-19 information specifically for Nepali and Hindi-speaking communities in the UK, giving vital information around COVID-19.

Researchers connected with the Nepalese and Indian communities, and healthcare professionals (HCPs) within those communities. They looked at the health information needs of those populations, interviewing older adults and their family members, and HCPs, and where those needs were being met – if at all. Participants had the option of being interviewed in their native language and dialect.

Issues that emerged from the conversations included the lack of information in the person’s primary language, reliance on own-language information sources from their country of origin which might not be applicable in the UK setting, and preference for traditional ayurverdic medicines. The research also highlighted how government guidance did not represent cultural difference, for example, around multi-generational homes or shared accommodation.

The research culminated in the publication of leaflets in January 2021, after consultation with community members and health professionals, covering the basic information on COVID-19 at that time: What it is, symptoms, spread, prevention and protection, self-isolation, treatment, contacting health services, and testing.

The recommendations for practice that have been shared following the research include:

• Providing health information in clear, simple formats, and a variety of media, (audio, visual, written), and a wide variety of ethnic languages – which should be checked by native speakers for cultural nuances.
• Cultural practices should be addressed, and their benefits acknowledged as well as challenges addressed.
• An understanding of which information sources and organisations were trusted by those in minority communities needs to be developed, so that these channels can be better harnessed in future, to share information, and discredit mis-information.
• Health information should be co-produced with a representative sample of the community, including faith leaders, older adults, family members, and healthcare professionals.
• Relationships between HCPs and communities need to be built, over time, so that the trust is there, and community spaces, such as religious sites, should be utilised to help build trust.

The full research paper has been published in the British Medical Journal, and examples of the leaflets can be found on the KSS AHSN website. For more information about the project, contact Becky Sharp on rebecca.sharp4@nhs.net. You can see the entire project, and download the leaflets (although they pre-date COVID-19 vaccinations) on the Brighton and Sussex Medical School website. The project there is called Co-REM – (Co-producing COVID-19 Resources with Ethnic Minorities).