Clinical Research Directory

Ethnic Minorities Experiences of Healthcare Intervention

As ethnic diversity in Britain continues to grow, so do the health needs in a society with many different ethnic backgrounds, including the need for personalised healthcare. Studies show that people from ethnic minority groups are at a higher risk of illness and death compared to white people with the same health issues. For example, ethnic minority individuals have strokes five years earlier than white people and are at greater risk of serious problems, including an increased risk of falling. These differences are made worse because people from ethnic minority communities are less likely to use or engage with healthcare interventions delivered in the community, which increases health inequalities. Ethnic minorities have a greater susceptibility to falls because they are likely to have underlying health issues, such as high blood pressure and diabetes. We do not have enough evidence on what treatment can stop these falls. Older adults who fall can get hurt and may even die from their falls. Research hasn't found the best ways to prevent falls for ethnic minorities, because often, they are underrepresented in the study. The NHS wants to transform care delivery by providing more care in the community rather than in hospitals, by using more digital tools instead of paper methods and focusing more on keeping people healthy rather than just treating sickness. This means healthcare services need to be designed to meet the specific needs of different ethnic groups when they are provided at home or in community centres. This qualitative study is classified into two phases. The purpose of Phase 1 of the study is to understand how people from ethnic minority backgrounds feel about accessing healthcare delivered to them at home or in community centres, with the view to identifying how to help them participate in these services. Semi-structured interviews, focus groups or informal conversations will be conducted with adults from Asian, Black African, Black Caribbean, or Mixed ethnic backgrounds. The study aims to find out what changes can be made to better meet their needs. Phase 1 will explore broad areas of health due to health inequalities in diagnosis and treatment outcomes for the ethnic minority population. This will help understand the relevant factors to consider when delivering interventions. Phase 2 of the study will focus on falls prevention intervention due to the greater susceptibility to falls among ethnic minorities. A range of people deliver falls prevention in the community, for example, exercise instructors, personal trainers, support workers, nurses, AHPs, falls leads, community groups coordinators, etc. A semi-structured interview will be conducted with people delivering falls prevention interventions in the community to explore their experiences of providing tailored treatment to ethnic minorities.

Family Bridge Program

Pediatric healthcare disparities in the United States (US) remain persistent and pervasive. Suboptimal patient-provider communication plays an important role in creating and maintaining disparate outcomes; this is compounded by mismatches between a family's skills and resources and the complexity of the health system (such as health literacy and system navigation). Few interventions exist to address disparities related to communication and system navigation in the inpatient setting; given the established links between these and disparate clinical outcomes, such interventions are needed. To address this gap, the study team collaborated with parents/caregivers, staff, and providers to develop and pilot-test a novel program to improve navigation ability, communication, and hospital-to-home transition for a diverse population of children and their families, The Family Bridge Program (FBP). The FBP combines principles of effective patient navigation and communication coaching interventions into a brief and targeted inpatient program. It is designed for a broad population of low-income children, is not disease-specific, is not limited to English proficient families, and is less time-intensive than traditional navigation, to enable provision of support to more families. The FBP, delivered in-person by a trained lay navigator, includes: (1) hospital orientation; (2) unmet social needs screening (e.g., food insecurity); (3) parent communication and cultural preference assessment, relayed to the medical team; (4) communication coaching for parents; (5) emotional support; (6) assistance with care coordination and logistics; and (7) a phone call 2 days post-discharge. Program elements are flexibly delivered based on parent need and interest. In pilot testing, the program was feasible to deliver, acceptable to parents and providers, and significantly improved parent-reported system navigation ability. The current R01 proposes a two-site randomized controlled trial (RCT) of the effectiveness of FBP among 728 families of low-income children from families who identify as Hispanic, Black, Asian, Native American/Alaska Native, or Pacific Islander. Enrolled families will be randomized 1:1 (stratified by site and language) to FBP or usual care plus written resources. The specific aims of this clinical trial are to (1) Test the effect of the FBP on parent-reported system navigation ability, quality of hospital-to-home transition, diagnosis comprehension, observed communication quality, perceived stress and revisits; (2) Examine whether changes in parent-reported barriers and needs mediate program effects; and (3) Identify subgroups of parents among whom the FBP is more effective. The proposed RCT will use a rigorous design to test a feasible, innovative program to address a critical national problem. If effective, the Family Bridge Program would provide a scalable model for improving health care experiences and outcomes for families of low-income children at risk for disparities, including those who prefer a language other than English for their medical care.