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Patel T, Umeh K, Poole H, Vaja I, Ramtoola S, Newson L. Health professionals interface with cultural conflict in the delivery of type 2 diabetes care. Psychol Health 2023; 38:230-248. [PMID: 34351821 DOI: 10.1080/08870446.2021.1960346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study explored the knowledge and experiences of health professionals (HPs) caring for South Asian patients with type 2 diabetes (T2D). DESIGN Fourteen HPs, who supported patients with T2D, were interviewed. The recruitment strategy employed purposeful and theoretical sampling methods to recruit HPs who worked across primary and secondary care settings. MAIN OUTCOME MEASURES Grounded Theory (GT) methodology and analysis generated a theoretical framework that explored HP's perceptions and experiences of providing diabetes care for South Asian patients. RESULTS A GT, presenting a core category of Cultural Conflict in T2D care, explores the influences of HP's interactions and delivery of care for South Asian patients. This analysis is informed by four categories: (1) Patient Comparisons: South Asian vs White; (2) Recognising the Heterogeneous Nature of South Asian Patients; (3) Language and Communication; (4) HPs' Training and Experience. CONCLUSIONS The findings consider how the role of social comparison, social norms, and diminished responsibility in patient self-management behaviours influence HPs' perceptions, implicit and explicit bias towards the delivery of care for South Asian patients. There was a clear call for further support and training to help HPs recognise the cultural-ethnic needs of their patients.
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Affiliation(s)
- Tasneem Patel
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Kanayo Umeh
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Helen Poole
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Ishfaq Vaja
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK.,Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Shenaz Ramtoola
- Endocrinology and Metabolic Medicine, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Blackburn, UK
| | - Lisa Newson
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
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Wilson T, Temple J, Brijnath B, Utomo A, McDonald P. The ageing of Asian migrant populations in Australia: projections and implications for aged care services. ASIAN POPULATION STUDIES 2021. [DOI: 10.1080/17441730.2021.1953689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Tom Wilson
- Demography and Ageing Unit, Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Jeromey Temple
- Demography and Ageing Unit, Melbourne School of Population and Global Health, University of Melbourne, Australia
| | | | - Ariane Utomo
- School of Geography, Earth and Atmospheric Sciences, University of Melbourne, Australia
| | - Peter McDonald
- Demography and Ageing Unit, Melbourne School of Population and Global Health, University of Melbourne, Australia
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McDonald K, Ding T, Ker H, Dliwayo TR, Osborn DP, Wohland P, Coid JW, French P, Jones PB, Baio G, Kirkbride JB. Using epidemiological evidence to forecast population need for early treatment programmes in mental health: a generalisable Bayesian prediction methodology applied to and validated for first-episode psychosis in England. Br J Psychiatry 2021; 219:383-391. [PMID: 34475575 PMCID: PMC7611597 DOI: 10.1192/bjp.2021.18] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Mental health policy makers require evidence-based information to optimise effective care provision based on local need, but tools are unavailable. AIMS To develop and validate a population-level prediction model for need for early intervention in psychosis (EIP) care for first-episode psychosis (FEP) in England up to 2025, based on epidemiological evidence and demographic projections. METHOD We used Bayesian Poisson regression to model small-area-level variation in FEP incidence for people aged 16-64 years. We compared six candidate models, validated against observed National Health Service FEP data in 2017. Our best-fitting model predicted annual incidence case-loads for EIP services in England up to 2025, for probable FEP, treatment in EIP services, initial assessment by EIP services and referral to EIP services for 'suspected psychosis'. Forecasts were stratified by gender, age and ethnicity, at national and Clinical Commissioning Group levels. RESULTS A model with age, gender, ethnicity, small-area-level deprivation, social fragmentation and regional cannabis use provided best fit to observed new FEP cases at national and Clinical Commissioning Group levels in 2017 (predicted 8112, 95% CI 7623-8597; observed 8038, difference of 74 [0.92%]). By 2025, the model forecasted 11 067 new treated cases per annum (95% CI 10383-11740). For every 10 new treated cases, 21 and 23 people would be assessed by and referred to EIP services for suspected psychosis, respectively. CONCLUSIONS Our evidence-based methodology provides an accurate, validated tool to inform clinical provision of EIP services about future population need for care, based on local variation of major social determinants of psychosis.
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Affiliation(s)
| | - Tao Ding
- Department of Statistical Sciences, University College London, UK
| | - Hannah Ker
- Division of Psychiatry, University College London, UK
| | | | | | - Pia Wohland
- School of Earth and Environmental Sciences, University of Queensland, Australia; Hull-York Medical School, University of Hull, UK
| | - Jeremy W. Coid
- Mental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, China
| | - Paul French
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, UK
| | | | - Gianluca Baio
- Department of Statistical Sciences, University College London, UK
| | - James B. Kirkbride
- Division of Psychiatry, University College London, UK,Correspondence: James B. Kirkbride.
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Midwives' insights in relation to the common barriers in providing effective perinatal care to women from ethnic minority groups with 'high risk' pregnancies: A qualitative study. Women Birth 2021; 35:152-159. [PMID: 34074625 DOI: 10.1016/j.wombi.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
PROBLEM Childbearing women from ethnic minority groups in the United Kingdom (UK) have significantly poorer perinatal outcomes overall. BACKGROUND Childbearing women from ethnic minority groups report having poorer experiences and outcomes in perinatal care, and health professionals report having difficulty in providing effective care to them. Yet barriers in relation to providing such care remain underreported. AIM The aim of this study was to elicit midwives' insights in relation to the common barriers in providing effective perinatal care to women from ethnic minority groups with 'high risk' pregnancies and how to overcome these barriers. METHODS A qualitative study was undertaken in a single obstetric led unit in London, UK. A thematic analysis was undertaken to identify themes from the data. FINDINGS A total of 20 midwives participated. They self-identified as White British (n=7), Black African (n=7), Black Caribbean (n=3) and Asian (n=3). Most (n=12) had more than 10 years' experience practising as a registered midwife (range 2 - 35 years). Four themes were identified: 1) Communication, 2) Continuity of carer, 3) Policy and 4) Social determinants. Racism and unconscious bias underpin many of the findings presented. DISCUSSION Co-created community hubs may improve access to more effective care for childbearing women from ethnic minority groups. A focus on robust anti-racism interventions, continuity of carer, staff wellbeing and education along with the provision of orientation and bespoke translation services are also suggested for the reduction of poorer outcomes and experiences. CONCLUSION Along with policies designed to promote equality and irradicate racism, there is a need for co-created community hubs and continuity of carer in perinatal services. Further research is also required to develop and evaluate culturally safe, and evidence-based interventions designed to address the current disparities apparent.
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Patel T, Umeh K, Poole H, Vaja I, Newson L. Cultural Identity Conflict Informs Engagement with Self-Management Behaviours for South Asian Patients Living with Type-2 Diabetes: A Critical Interpretative Synthesis of Qualitative Research Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2641. [PMID: 33807965 PMCID: PMC7967381 DOI: 10.3390/ijerph18052641] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 02/07/2023]
Abstract
The prevalence of type-2 diabetes (T2D) is increasing, particularly among South Asian (SA) communities. Previous research has highlighted the heterogeneous nature of SA ethnicity and the need to consider culture in SA patients' self-management of T2D. We conducted a critical interpretative synthesis (CIS) which aimed to a) develop a new and comprehensive insight into the psychology which underpins SA patients' T2D self-management behaviours and b) present a conceptual model to inform future T2D interventions. A systematic search of the literature retrieved 19 articles, including 536 participants. These were reviewed using established CIS procedures. Analysis identified seven constructs, from which an overarching synthesizing argument 'Cultural Conflict' was derived. Our findings suggest that patients reconstruct knowledge to manage their psychological, behavioural, and cultural conflicts, impacting decisional conflicts associated with T2D self-management and health professional advice (un)consciously. Those unable to resolve this conflict were more likely to default towards cultural identity, continue to align with cultural preferences rather than health professional guidance, and reduce engagement with self-management. Our synthesis and supporting model promote novel ideas for self-management of T2D care for SA patients. Specifically, health professionals should be trained and supported to explore and mitigate negative health beliefs to enable patients to manage social-cultural influences that impact their self-management behaviours.
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Affiliation(s)
- Tasneem Patel
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool L69 3BX, UK;
- Faculty of Health, School of Psychology, Liverpool John Moores University, Liverpool L3 3AF, UK; (K.U.); (H.P.); (I.V.)
| | - Kanayo Umeh
- Faculty of Health, School of Psychology, Liverpool John Moores University, Liverpool L3 3AF, UK; (K.U.); (H.P.); (I.V.)
| | - Helen Poole
- Faculty of Health, School of Psychology, Liverpool John Moores University, Liverpool L3 3AF, UK; (K.U.); (H.P.); (I.V.)
| | - Ishfaq Vaja
- Faculty of Health, School of Psychology, Liverpool John Moores University, Liverpool L3 3AF, UK; (K.U.); (H.P.); (I.V.)
- NHS Bradford Teaching Hospital, Bradford BD9 6RJ, UK
| | - Lisa Newson
- Faculty of Health, School of Psychology, Liverpool John Moores University, Liverpool L3 3AF, UK; (K.U.); (H.P.); (I.V.)
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Vaja I, Umeh KF, Abayomi JC, Patel T, Newson L. A grounded theory of type 2 diabetes prevention and risk perception. Br J Health Psychol 2021; 26:789-806. [PMID: 33448543 DOI: 10.1111/bjhp.12503] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 11/26/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Type 2 diabetes (T2D) prevention programmes should target high-risk groups. Previous research has highlighted minimal engagement in such services from South Asian (SA) people. Given SA's elevated risk of T2D, there is a need to understand their perceptions, risks, and beliefs about T2D. DESIGN This study aimed to assess T2D risk perception within a community sample of SA people using Grounded Theory methodology. Specifically, health beliefs were assessed, and we explored how these beliefs affected their T2D risk perceptions. METHOD Twenty SA participants (mean age = 38 years) without a diagnosis of T2D were recruited from community and religious settings across the North West of England. In line with grounded theory (Strauss & Corbin, 1990, Basics of qualitative research: Grounded theory procedures and techniques. Newbury Park: Sage Publications), data collection and analysis coincided. RESULTS The superordinate category of Culturally Situated Risk Perception incorporated a complex psychological understanding of the formation of T2D risk perception, which takes into account the social, cultural, and community-based environmental factors. This superordinate category was explained via two core categories (1) Diminished Responsibility, informed by sub-categories of Destiny and Heredity, and (2) Influencing Healthy Lifestyle Behaviours, informed by sub-categories of Socio-cultural and Environmental. CONCLUSION This study investigated risk perception of T2D within the SA community. When considering health prevention in the context of an individual's culture, we need to consider the social context in which they live. Failure to acknowledge the cultural-situated T2D risk perception relevant to health promotion and illness messages may account for the issues identified with health care engagement in the SA population.
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Affiliation(s)
- Ishfaq Vaja
- School of Psychology, Faculty of Health, Liverpool John Moores University, UK
| | - Kanayo F Umeh
- School of Psychology, Faculty of Health, Liverpool John Moores University, UK
| | - Julie C Abayomi
- Faculty of Health and Social Care, Edgehill University, Liverpool, UK
| | - Tasneem Patel
- Department of Primary Care and Mental Health, University of Liverpool, UK
| | - Lisa Newson
- School of Psychology, Faculty of Health, Liverpool John Moores University, UK
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Wilson T, McDonald P, Temple J, Brijnath B, Utomo A. Past and projected growth of Australia's older migrant populations. GENUS 2020; 76:20. [PMID: 32834077 PMCID: PMC7403568 DOI: 10.1186/s41118-020-00091-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/20/2020] [Indexed: 01/05/2023] Open
Abstract
In recent years, Australia’s older population (aged 65 and over) has been growing rapidly, accompanied by a shift in its country of birth composition. Although a great deal of research has been undertaken on past and current aspects of Australia’s migrant groups, little attention has been paid to future demographic trends in older populations. The aim of this paper is to examine recent and possible future demographic trends of Australia’s migrant populations at the older ages. We present population estimates by country and broad global region of birth from 1996 to 2016, and then new birthplace-specific population projections for the 2016 to 2056 period. Our findings show that substantial growth of the 65+ population will occur in the coming decades, and that the overseas-born will shift from a Europe-born dominance to an Asia-born dominance. Cohort flow (the effect of varying sizes of cohorts moving into the 65+ age group over time) will be the main driver of growth for most older birthplace populations. The shifting demography of Australia’s older population signals many policy, planning, service delivery and funding challenges for government and private sector providers. We discuss those related to aged care, health care, language services, the aged care workforce, regulatory frameworks and future research needs in demography and gerontology.
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Affiliation(s)
- Tom Wilson
- Demography and Ageing Unit, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie St, Melbourne, Victoria 3010 Australia
| | - Peter McDonald
- Demography and Ageing Unit, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie St, Melbourne, Victoria 3010 Australia
| | - Jeromey Temple
- Demography and Ageing Unit, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie St, Melbourne, Victoria 3010 Australia
| | - Bianca Brijnath
- National Ageing Research Institute (NARI), Parkville, Australia
| | - Ariane Utomo
- School of Geography, University of Melbourne, Melbourne, Australia
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Buchan JC, Norman P, Shickle D, Cassels-Brown A, MacEwen C. Failing to plan and planning to fail. Can we predict the future growth of demand on UK Eye Care Services? Eye (Lond) 2019; 33:1029-1031. [PMID: 30814654 DOI: 10.1038/s41433-019-0383-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 02/06/2019] [Accepted: 02/13/2019] [Indexed: 01/15/2023] Open
Affiliation(s)
- John Cameron Buchan
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Paul Norman
- School of Geography, University of Leeds, Leeds, UK
| | - Darren Shickle
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Carrie MacEwen
- Department of Ophthalmology, Ninewells Hospital, University of Dundee, Dundee, UK
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