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How to engage with Black, Asian and minority ethnic communities most at risk during the pandemic

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Brunel University London’s Prof Jane Hendy was invited by the government’s Cabinet Office to present findings alongside her research partners on why Black, Asian and minority ethnic (BAME) communities may be disproportionately affected by Covid-19 – and how targeted health messaging could help mitigate that impact.

The Dean of the Brunel Business School was joined by Dr Tushna Vandrevala of Kingston University and Prof Aftab Ala of the University of Surrey, Royal Surrey NHS Foundation Trust and King’s College Hospital NHS Foundation Trust, for the presentation to 140 Cabinet Office civil servants last month.

The pandemic has brought into focus long-standing health inequalities affecting BAME groups in the UK, with a recent report by Public Health England confirming deaths from Covid-19 are higher among BAME populations. Individuals of Black African or Black Caribbean ethnicity may be at greatest risk of catching and dying from the virus, early evidence suggests.

Dr Vandrevala, whose research focuses on health promotion and risk prevention in vulnerable and hard to reach populations, believes the reasons behind this are much more social-cultural than to do with pre-existing or genetic conditions.

“We know that Covid-19 is disproportionately represented in minority groups. The recent figures show that even when socio-economic deprivation is taken into account, Black and South Asian people who live in the UK are more likely to die from Covid-19, and that is a really serious issue,” Dr Vandrevala said.

Possible explanations are complex and multifactorial, Prof Ala explained, and can include people from BAME communities being more likely to live with extended family in multi-generational households, increasing the risk of cross-infection, and some cultural practices making social distancing challenging. “These factors can be compounded by an increased number of individuals working in key and frontline jobs, poor transportation, language proficiency and a distrust of the healthcare system – preventing BAME groups from seeking prompt treatment,” he added.

The presentation by the researchers was based on lessons learned from a previous study investigating the barriers to viral hepatitis screenings in South Asian communities and how these communities could be reached. “One of the findings from our previous work suggest that South Asian communities delay in seeking help because there’s a real mistrust in health services – and other services – so we need to make sure they feel welcome and not alienated,” Dr Vandrevala said.

At the presentation, the research team suggested that the government needs to have engagement strategies for building trust and that BAME communities should feel Covid-19-related messages are for them and about them.

“Our research with first-generation migrants suggests they question whether they have an equal place in society and can feel powerless and uneasy about how to voice needing help,” Prof Hendy said. “Many of those in BAME communities feel ‘outside’ or ‘othered’ – that they won’t be understood or welcome when they engage with health services.”

Dr Vandrevala warned that existing public health messages around Covid-19 do not always resonate with Black and Asian communities, whom for many the understanding of risk was much more about collective, family risk, rather than individual risk. “One of the questions asked was, how do we change our messaging to make ethnic minorities included? We recommended that they really look at how to protect rather than alienate – ‘stay at home to protect your family and community’ is much more powerful than messaging around self-isolation, which exacerbates issues around isolation and stigma.

“Covid-19 might be stigmatised in their family and community which can be a barrier to people seeking healthcare outside of their familiar groups. Unless we try and make sure they understand that they are entitled to and worthy of treatment, it’s unlikely they will seek help.”

Other advice included making safeguarding behaviours, such as social distancing, more culturally compatible, giving representation and voice to BAME groups, and working with respected community leaders to help promote important public health messages that are relatable.

During the viral hepatitis case finding research study, which was funded by the National Institute for Health Research, the researchers successfully engaged South Asian participants by working with faith, community leaders and NHS medical professionals from within their own communities. “They were mistrustful of people from outside, so we had to build trust in the study from an insider perspective,” Dr Vandrevala said.

“In our work we have shown that it is possible to build on a trusting relationship with communities and it is important for us to not only engage with members of the community to develop culturally relevant messaging, but also ensure that the messages are communicated in safe spaces. In this context, this might be mosques and temples, rather than asking them to visit hospitals and GP surgeries where they might feel alienated,” she added.

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