Understanding clinician barriers to providing equitable healthcare for ethnic minority populations

Abstract Background It has long been recognised that ethnic minority groups have worse health outcomes in the UK. Social determinants of health (SDH) contribute significantly to these inequalities. However, inequalities persist, even after controlling for these determinants. As well as being less likely to engage with healthcare services, ethnic minority groups are more likely to report poor experiences. The majority of healthcare in the UK is delivered through patient: clinician interactions (PCI), therefore a good working relationship with patients is paramount. Recent focus has been placed on ensuring “cultural competence”. Whilst this is important, we suggest also examining the culture within healthcare itself. Healthcare professionals are not immune to bias, preconceptions and the stresses of work and this must be taken into account. A seminal piece of work on this is the “culture of medicine” framework proposed by Boutin-Foster et al, which examines the impact of these factors. Aims and Methodology This paper aims to examine barriers within PCI that impact healthcare for ethnic minorities. A formal literature review was conducted and 131 relevant studies were identified. Grounded theory was used for analysis and data was categorised into themes with Boutin-Foster’s framework used as a structure. Results The review found that the concept of implicit bias was paramount in PCI. Three major barriers resulting from this bias are suggested: its impact on clinical decision making, the impact on clinician-patient communication and finally the resultant lack of trust in clinicians and poor perceived quality of care by ethnic minority groups. Conclusions Clinician implicit bias is a major barrier to equitable healthcare for ethnic minority populations. A solution we propose is to acknowledge our own preconceptions. Awareness of our own culture, preconceptions and the pressures around us will allow us to find solutions to these barriers, including further research and education. Key messages • Clinician implicit bias within the “Culture of Medicine” is a barrier to equitable healthcare for ethnic minority populations. • Awareness of our own culture and preconceptions is paramount to addressing these barriers.


Background:
The death toll of the COVID-19 pandemic has been hugely downsized by the advent of the currently available vaccines, at least in high-income countries. Nevertheless, there is a huge gap between countries and within countries with respect to vaccination access and coverage. In June 2021, several nongovernmental non-profit organizations responded to a call issued by Regione Lazio to help organize and enrol for vaccination vulnerable people such as irregular migrants and migrants living in temporary or informal settlements. Through a huge effort, non-profit voluntary organizations Nonna Roma and Intersos enabled the vaccination of thousands of immigrants from different countries, age and residence status.

Methods:
We obtained a dataset regarding part of the people these NGOs facilitated in accessing the vaccination booking. We had information regarding age, sex, country of origin, nationality and type of document. Results: These populations were from different ethnic backgrounds, in majority males and below 50 years old on average. We found an association between the continent of origin and holding any document and between age and holding any document, both at a significant level (p < 0.05). Coming from Asia, as opposed to coming to any other continent, and being younger, i.e. under 25 years of age, were associated with holding any type of document.

Conclusions:
We reflect on the need of rethinking the services for this population, having in mind article 25 of the Universal Declaration of Human Rights, but also, more practically, that often these people work in our elderly homes as caregivers or as cleaners in our offices. Therefore, making it easier to access health services would be in any country's interest, especially during a pandemic. Policy efforts directed at facilitating migrant access to health services would ultimately help create a safer community for both migrants and residents, for whom migrants often work as strategic employees.

Background:
It has long been recognised that ethnic minority groups have worse health outcomes in the UK. Social determinants of health (SDH) contribute significantly to these inequalities. However, inequalities persist, even after controlling for these determinants. As well as being less likely to engage with healthcare services, ethnic minority groups are more likely to report poor experiences. The majority of healthcare in the UK is delivered through patient: clinician interactions (PCI), therefore a good working relationship with patients is paramount. Recent focus has been placed on ensuring ''cultural competence''. Whilst this is important, we suggest also examining the culture within healthcare itself. Healthcare professionals are not immune to bias, preconceptions and the stresses of work and this must be taken into account. A seminal piece of work on this is the ''culture of medicine'' framework proposed by Boutin-Foster et al, which examines the impact of these factors.

Aims and Methodology:
This paper aims to examine barriers within PCI that impact healthcare for ethnic minorities. A formal literature review was conducted and 131 relevant studies were identified. Grounded theory was used for analysis and data was categorised into themes with Boutin-Foster's framework used as a structure.

Results:
The review found that the concept of implicit bias was paramount in PCI. Three major barriers resulting from this bias are suggested: its impact on clinical decision making, the impact on clinician-patient communication and finally the resultant lack of trust in clinicians and poor perceived quality of care by ethnic minority groups.

Conclusions:
Clinician implicit bias is a major barrier to equitable healthcare for ethnic minority populations. A solution we propose is to acknowledge our own preconceptions. Awareness of our own culture, preconceptions and the pressures around us will allow us to find solutions to these barriers, including further research and education. Key messages: Clinician implicit bias within the ''Culture of Medicine'' is a barrier to equitable healthcare for ethnic minority populations. Awareness of our own culture and preconceptions is paramount to addressing these barriers.