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Deshmukh A, Roberts L, Adebajo A, Kamal A, Armitage CJ, Evison F, Bunting H, Dubey S, Moorthy A, Reehal J, Dogra N, Kumar K. Development and testing of a bespoke cultural intervention to support healthcare professionals with patients from a diverse background. Rheumatology (Oxford) 2024; 63:1352-1358. [PMID: 37505459 PMCID: PMC11065443 DOI: 10.1093/rheumatology/kead383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/19/2023] [Accepted: 07/02/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE Development and test of a culturally sensitive intervention for rheumatology healthcare professionals (HCPs). METHODS Using a before and after study design, 15 HCPs were recruited to undertake the bespoke intervention from four National Health Service sites across England, in areas serving a diverse population. The intervention was evaluated using two validated outcomes: (i) Patient Reported Physician Cultural Competency (PRPCC); and (ii) Patient Enablement Instrument (PEI), measuring patients' perceptions of their overall healthcare delivery. Additionally, HCPs completed the COM-B questionnaire for capability (C), opportunity (O) and motivation (M) to perform behaviour (B), measuring behaviour change. RESULTS Two hundred patients were recruited before HCPs undertook the intervention (cohort 1), and 200 were recruited after (cohort 2) from 15 HCPs; after exclusions 178 patients remained in cohort 1 and 186 in cohort 2. Sixty percent of patients identified as white in both recruited cohorts, compared with 29% and 33% of patients (cohorts 1 and 2, respectively) who identified as being of South Asian origin. After the intervention, the COM-B scores indicated that HCPs felt more skilled and equipped for consultations. No significant differences were noted in the average overall cultural competency score between the two cohorts in white patients (57.3 vs 56.8, P = 0.8), however in the South Asian cohort there was a statistically significant improvement in mean scores (64.1 vs 56.7, P = 0.014). Overall, the enablement score also showed a statistically significant improvement following intervention (7.3 vs 4.3, P < 0.001) in the white patients and in the South Asian patients (8.0 vs 2.2, P < 0.001). CONCLUSION This novel study provides evidence for improving cultural competency and patient enablement in rheumatology settings.
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Affiliation(s)
- Ashwini Deshmukh
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Lisa Roberts
- School of Health Sciences, University of Southampton, Southampton, UK
- Therapy Services, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Adewale Adebajo
- School of Health Sciences, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK
| | - Atiya Kamal
- School of Social Sciences, Birmingham City University, Birmingham, UK
| | - Christopher J Armitage
- Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, UK
- Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Felicity Evison
- Department of Health Informatics, The University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Helen Bunting
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Shirish Dubey
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Arumugam Moorthy
- Department of Rheumatology, University Hospitals of Leicester NHS Trust, Leicester, UK
- College of Life Sciences, University of Leicester, Leicester, UK
| | - Joti Reehal
- National Rheumatoid Arthritis Society, Maidenhead, UK
| | - Nisha Dogra
- Medical School, University of Leicester, Leicester, UK
| | - Kanta Kumar
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Department of Rheumatology, Royal Wolverhampton NHS Trust, Wolverhampton, UK
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Sharma-Oates A, Zemedikun DT, Kumar K, Reynolds JA, Jain A, Raza K, Williams JA, Bravo L, Cardoso VR, Gkoutos G, Nirantharakumar K, Lord JM. Early onset of immune-mediated diseases in minority ethnic groups in the UK. BMC Med 2022; 20:346. [PMID: 36224602 PMCID: PMC9558944 DOI: 10.1186/s12916-022-02544-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 09/01/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The prevalence of some immune-mediated diseases (IMDs) shows distinct differences between populations of different ethnicities. The aim of this study was to determine if the age at diagnosis of common IMDs also differed between different ethnic groups in the UK, suggestive of distinct influences of ethnicity on disease pathogenesis. METHODS This was a population-based retrospective primary care study. Linear regression provided unadjusted and adjusted estimates of age at diagnosis for common IMDs within the following ethnic groups: White, South Asian, African-Caribbean and Mixed-race/Other. Potential disease risk confounders in the association between ethnicity and diagnosis age including sex, smoking, body mass index and social deprivation (Townsend quintiles) were adjusted for. The analysis was replicated using data from UK Biobank (UKB). RESULTS After adjusting for risk confounders, we observed that individuals from South Asian, African-Caribbean and Mixed-race/Other ethnicities were diagnosed with IMDs at a significantly younger age than their White counterparts for almost all IMDs. The difference in the diagnosis age (ranging from 2 to 30 years earlier) varied for each disease and by ethnicity. For example, rheumatoid arthritis was diagnosed at age 49, 48 and 47 years in individuals of African-Caribbean, South Asian and Mixed-race/Other ethnicities respectively, compared to 56 years in White ethnicities. The earlier diagnosis of most IMDs observed was validated in UKB although with a smaller effect size. CONCLUSION Individuals from non-White ethnic groups in the UK had an earlier age at diagnosis for several IMDs than White adults.
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Affiliation(s)
- Archana Sharma-Oates
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK. .,School of Biosciences, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Dawit T Zemedikun
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Kanta Kumar
- Institute of Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - John A Reynolds
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK.,Department of Rheumatology, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | | | - Karim Raza
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK.,Department of Rheumatology, Sandwell and West Birmingham NHS Trust, Birmingham, UK.,MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, B15 2TT, UK.,NIHR Birmingham Biomedical Research Centre, University Hospital Birmingham and University of Birmingham, Birmingham, UK
| | - John A Williams
- Department of Rheumatology, Sandwell and West Birmingham NHS Trust, Birmingham, UK.,Health Data Research UK, Midlands Site, Birmingham, B15 2TT, UK
| | - Laura Bravo
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Victor Roth Cardoso
- Health Data Research UK, Midlands Site, Birmingham, B15 2TT, UK.,Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Georgios Gkoutos
- Health Data Research UK, Midlands Site, Birmingham, B15 2TT, UK.,Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.,Health Data Research UK, Midlands Site, Birmingham, B15 2TT, UK
| | - Janet M Lord
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK.,MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, B15 2TT, UK.,NIHR Birmingham Biomedical Research Centre, University Hospital Birmingham and University of Birmingham, Birmingham, UK
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Dubey S, Adebajo AO. Crying out for equity: outcomes of rheumatic diseases confounded by ethnicity. Clin Rheumatol 2022; 41:2621-2624. [PMID: 35854167 PMCID: PMC9296010 DOI: 10.1007/s10067-022-06296-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/07/2022] [Accepted: 07/10/2022] [Indexed: 12/19/2022]
Affiliation(s)
- Shirish Dubey
- Department of Rheumatology, Oxford University Hospitals NHS FT, Windmill Road, OX3 7LD, Oxford, UK.
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, OX3 7HE, UK.
| | - Adewale O Adebajo
- Faculty of Medicine, Dentistry and Health, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX, UK
- Barnsley Hospital NHS Foundation Trust, Gawber Road, Barnsley, S75 2EP, South Yorkshire, UK
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Adas MA, Norton S, Balachandran S, Alveyn E, Russell MD, Esterine T, Amlani-Hatcher P, Oyebanjo S, Lempp H, Ledingham J, Kumar K, Galloway JB, Dubey S. Worse outcomes linked to ethnicity for early inflammatory arthritis in England and Wales: a national cohort study. Rheumatology (Oxford) 2022; 62:169-180. [PMID: 35536178 PMCID: PMC9788810 DOI: 10.1093/rheumatology/keac266] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/01/2022] [Accepted: 04/19/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To assess variability in care quality and treatment outcomes across ethnicities in early inflammatory arthritis (EIA). METHODS We conducted an observational cohort study in England and Wales from May 2018 to March 2020, including patients with a suspected/confirmed EIA diagnosis. Care quality was assessed against six metrics defined by national guidelines. Clinical outcomes were measured using DAS28. Outcomes between ethnic groups ('White', 'Black', 'Asian', 'Mixed', 'Other') were compared, and adjusted for confounders. RESULTS A total of 35 807 eligible patients were analysed. Of those, 30 643 (85.6%) were White and 5164 (14.6%) were from ethnic minorities: 1035 (2.8%) Black; 2617 (7.3%) Asian; 238 (0.6%) Mixed; 1274 (3.5%) Other. In total, 12 955 patients had confirmed EIA, of whom 11 315 were White and 1640 were from ethnic minorities: 314 (2.4%) Black; 927 (7.1%) Asian; 70 (0.5%) Mixed; 329 (2.5%) Other. A total of 14 803 patients were assessed by rheumatology within three weeks, and 5642 started treatment within six weeks of referral. There were no significant differences by ethnicity. Ethnic minority patients had lower odds of disease remission at three months [adjusted odds ratio 0.79 (95% CI: 0.65, 0.96)] relative to White patients. Ethnic minorities were significantly less likely to receive initial treatment withMTX[0.68 (0.52, 0.90)] or with glucocorticoids [0.63 (0.49, 0.80)]. CONCLUSION We demonstrate that some ethnic minorities are less likely to achieve disease remission in three months following EIA diagnosis. This is not explained by delays in referral or time to treatment. Our data highlight the need for investigation into the possible drivers of these inequitable outcomes and reappraisal of EIA management pathways.
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Affiliation(s)
| | | | | | - Edward Alveyn
- Centre for Rheumatic Disease, Department of Inflammatory Biology
| | - Mark D Russell
- Centre for Rheumatic Disease, Department of Inflammatory Biology
| | | | | | | | - Heidi Lempp
- Centre for Rheumatic Disease, Department of Inflammatory Biology
| | - Joanna Ledingham
- Rheumatology Department, Portsmouth Hospitals University NHS Trust, Portsmouth
| | - Kanta Kumar
- Institute of Clinical Sciences, University of Birmingham, Birmingham
| | - James B Galloway
- Correspondence to: James Galloway, Weston Education Centre, 10 Cutcombe Road, SE5 9RJ London, UK. E-mail:
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Bosworth A, Dubey S, Adebajo A, Moorthy A, Arora S, Salim A, Reehal J, Paudyal V, Gupta M, Kumar K. Patient Empowerment: Apni Jung (Our Fight) against Rheumatoid Arthritis for South Asian Population. Mediterr J Rheumatol 2021; 32:93-95. [PMID: 34447903 PMCID: PMC8369277 DOI: 10.31138/mjr.32.2.93] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/26/2021] [Accepted: 04/30/2021] [Indexed: 12/19/2022] Open
Abstract
Covid-19 has affected many populations in the UK, and ethnic minority communities in particular. People from ethnic minority communities living with long-term chronic diseases have shown to be less engaging with self-management and report having poor medication adherence. The main reason to this problem is the way information is delivered to non-English speaking patients. This editorial discusses an innovation to over this barriers in rheumatology practice.
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Affiliation(s)
- Ailsa Bosworth
- National Rheumatoid Arthritis Society, Maidenhead, United Kingdom
| | - Shirish Dubey
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Headington, United Kingdom
| | - Ade Adebajo
- Faculty of Medicine, Dentistry and Health, University of Sheffield, United Kingdom
| | - Arumugam Moorthy
- Department of Rheumatology, University Hospitals of Leicester, Leicestershire, United Kingdom
| | - Shivam Arora
- National Rheumatoid Arthritis Society, Maidenhead, United Kingdom
| | - Afshan Salim
- Bellevue Medical Centre, Birmingham, United Kingdom
| | - Joti Reehal
- National Rheumatoid Arthritis Society, Maidenhead, United Kingdom
| | - Vibhu Paudyal
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Monica Gupta
- Gartnavel General Hospital and Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Kanta Kumar
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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Kumar K, Bradbury-Jones C, Armitage CJ, Peters S, Raizada S, Wong P. Comparing reactions to written leaflets, online information and real-time Doppler images among South Asian patients with rheumatoid arthritis. Rheumatol Adv Pract 2020; 4:rkaa009. [PMID: 32551414 PMCID: PMC7293862 DOI: 10.1093/rap/rkaa009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 03/06/2020] [Indexed: 12/31/2022] Open
Abstract
Objective There is poor adherence to medication in patients of South Asian origin with RA. There are limited numbers of interventions to improve patient engagement. The objective of this study was to explore how patients of South Asian origin make sense of their disease after receiving written leaflets compared with online information or visualizing real-time Doppler US images of their inflamed joints. Methods Patients of South Asian origin with RA were recruited from two National Health Service hospitals in the West Midlands, UK. In-depth semi-structured interviews were undertaken after exposure to vignettes designed to elicit patients’ perspectives on: written leaflets; online information to complement face-to-face interaction with health-care professionals; and Doppler US during the early stages of the disease journey. Data were analysed thematically until data saturation was reached in 20 individuals. Results The responses to vignette scenarios were described by the patients. Overall, patients found real-time Doppler US more valuable in understanding RA and RA medications compared with other methods. Patients reported that Doppler US reduced anxiety and helped to address misconceptions about the long-term disease and its ability to be controlled. Conclusion We have developed new understanding regarding the educational utility of a Doppler US session in patients of South Asian origin and how these sessions can be optimized to increase patient engagement and adherence to medication.
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Affiliation(s)
- Kanta Kumar
- Insitute of Clinical Sciences, University of Birmingham, Birmingham
| | | | - Christopher J Armitage
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester.,Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester
| | - Sarah Peters
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester
| | - Sabrina Raizada
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trusts, Wolverhampton, UK
| | - Peter Wong
- Department of Rheumatology, Westmead Hospital, Westmead, NSW, Australia
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Landgren E, Bremander A, Lindqvist E, Nylander M, Van der Elst K, Larsson I. "Mastering a New Life Situation" - Patients' Preferences of Treatment Outcomes in Early Rheumatoid Arthritis - A Longitudinal Qualitative Study. Patient Prefer Adherence 2020; 14:1421-1433. [PMID: 32884244 PMCID: PMC7431595 DOI: 10.2147/ppa.s253507] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/03/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To explore patients' preferred treatment outcomes during their first two years with rheumatoid arthritis (RA). PATIENTS AND METHODS A qualitative, longitudinal, multicenter study with interviews at two time points was performed in Sweden. Individual interviews were conducted at time point 1 with 31 patients with RA, defined as disease duration of ≤1 year and treatment for 3-7 months. Seven focus group interviews and five individual interviews were conducted at time point 2 with 22 patients 12-20 months after treatment initiation. The interviews were analyzed using the Qualitative Analysis Guide of Leuven. A core category with four related concepts emerged. RESULTS The core finding of patient-preferred treatment outcomes was "mastering a new life situation". Patients preferred to experience control of the disease by controlling the symptoms and by experiencing absence of disease. To experience autonomy by regaining former activity level, experiencing independence, and being empowered was another preferred outcome. Patients preferred to regain identity through being able to participate, experience well-being, and regain former self-image. To experience joy in everyday life through vitality and believing in the future was another preferred outcome. Patients' preferences developed over time from the acute phase of controlling the symptoms and wanting to return to the life they lived prior to diagnosis, to a more preventive way of self-management and empowerment to master the new life situation. CONCLUSION The patients' preferred treatment outcomes during the first two years with RA were to master their new life situation and changed from a preference to return to a life lived prior disease onset, to a preference of living with quality of life, despite RA. This study increases the understanding of patients' preferred treatment outcomes in the early disease course and can be a foundation for tailoring interventions to be more person-centered and to improve long-term treatment outcomes.
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Affiliation(s)
- Ellen Landgren
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden
- Department of Rheumatology, Skåne University Hospital, Lund, Sweden
- Spenshult Research and Development Centre, Halmstad, Sweden
| | - Ann Bremander
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden
- Spenshult Research and Development Centre, Halmstad, Sweden
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sonderborg, Denmark
| | - Elisabet Lindqvist
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden
- Department of Rheumatology, Skåne University Hospital, Lund, Sweden
| | - Maria Nylander
- Spenshult Research and Development Centre, Halmstad, Sweden
- Swedish Rheumatism Association, Stockholm, Sweden
| | | | - Ingrid Larsson
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden
- Spenshult Research and Development Centre, Halmstad, Sweden
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Correspondence: Ingrid Larsson School of Health and Welfare, Halmstad University, PO Box 823, HalmstadS-30118, SwedenTel +46 35 167965 Email
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Kumar K, Stack RJ, Adebajo A, Adams J. Health-care professionals' perceptions of interacting with patients of South Asian origin attending early inflammatory arthritis clinics. Rheumatol Adv Pract 2019; 3:rkz042. [PMID: 31768498 PMCID: PMC6862933 DOI: 10.1093/rap/rkz042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/06/2019] [Indexed: 11/13/2022] Open
Abstract
Objective The aim was to explore the perceptions of rheumatology health-care professionals (HCPs) of interacting with patients of South Asian origin attending early inflammatory arthritis clinics. Methods We used face-to-face semi-structured interviews, designed in partnership with a clinician partner, to interview 10 HCPs involved in the running of early inflammatory arthritis clinics across seven centres in the UK. Data were recorded, transcribed by an independent company and analysed using inductive thematic analysis. Results Three emerging themes were identified that characterized consulting experiences of HCPs: varied approaches were used in early inflammatory arthritis clinic; the challenges for rheumatology HCPs in managing and delivering information to patients of South Asian origin in early inflammatory arthritis clinics; and moving towards good practice, the views on managing future patients of South Asian origin in early inflammatory arthritis clinics. Overall, HCPs found that they required additional skills to support the engagement and management for patients of South Asian origin living with inflammatory arthritis. The HCPs felt that they were less effective in addressing self-management issues for this patient group, and they found it difficult to determine adherence to medication. In such consultations, HCPs perceived that their own limitation of inadequate training contributed towards poor consultations. Conclusion For the first time, our data demonstrate that the management of patients of South Asian origin in early inflammatory arthritis clinics is under-served. To address this, HCPs have identified training needs to improve knowledge and skills in engaging with and supporting patients of South Asian origin. These findings provide a good direction for future research.
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Affiliation(s)
- Kanta Kumar
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham
| | - Rebecca J Stack
- Department of Psychology, Nottingham Trent University, Nottingham
| | - Ade Adebajo
- Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield
| | - Jo Adams
- School of Health Sciences, Faculty of Environment and Life Sciences, University of Southampton, Southampton, UK
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