Systematic review: the barriers and facilitators for ethnic minority groups in accessing urgent and prehospital care Trent Regional SAPC, University of Lincoln, 25 March 2014 Viet-Hai Phung 1 Karen Windle 1 Zahid Asghar 1 Marishona Ortega 1 Nadya Essam 2 Mukesh Barot 2 Joe Kai 3 Mark Johnson 4 Niro Siriwardena University of Lincoln 2 East Midlands Ambulance Service 3 University of Nottingham 4 De Montfort University

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.

Aims of the review Exploring and understanding the deficiencies, barriers and facilitators to delivering high quality urgent and ambulance service care to patients from minority ethnic communities; Exploring the causes and consequences of those differences in delivery to minority ethnic groups.

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.

Data extraction process Design data extraction tool Search 14 databases using terms in data extraction tool 432 publications selected for analysis 24 studies included 8 full-text articles filtered out after analysis 181 studies included overall 408 articles screened out 16 studies included overall

Results The main emergent themes from the analysis were: –Cultural competency; –Knowledge of healthcare systems; –Language and communication; and –Evidence of poorer health outcomes

Discussion Causes and consequences of: –Cultural competency; stereotypical provider behaviour can deter minority ethnic groups from subsequently using prehospital care when necessary. –Knowledge of healthcare system –Language & communication –Evidence of poorer health outcomes: minority ethnic patients can delay seeking treatment due to discriminatory past experiences, which can lead to poorer outcomes. Socioeconomic factors

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.

Implications for future research Limited evidence of evaluation, but certain interventions can address specific problems among particular ethnic groups / in particular locations. In depth qualitative research needed to investigate barriers and facilitators in the 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.

Conclusion Barriers to accessing prehospital care included: –language difficulties; and –cultural misconceptions among clinical staff. Facilitators included interpreting services and staff education. Effective ethnicity data monitoring central to narrowing mismatch between service provision and target populations.

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Thank you