Accessing primary health care: a meta-ethnography of the experiences of British South Asian patients with diabetes,coronary heart disease or a mental health problem
Restricted accessResearch articleFirst published online June, 2012
Accessing primary health care: a meta-ethnography of the experiences of British South Asian patients with diabetes,coronary heart disease or a mental health problem
Objectives: To develop an explanatory framework of the problems accessing primary care health services experienced by British South Asian patients with a long-term condition or mental health problem.
Methods: This study used meta-ethnographic methods. Published qualitative studies were identified from a structured search of six databases and themes synthesized across studies to develop a new explanatory framework.
Results: Initial searches identified 951 potentially relevant records from which a total of 27 articles were identified that met inclusion and exclusion criteria. Twelve of these articles were chosen on the basis of their quality and relevance. These 12 articles described themes relating to the cultural, spatial and temporal dimensions of patient experiences of accessing and using health care. Our interpretive synthesis showed that access to primary care among British South Asians with diabetes, coronary heart disease and psychological health problems is co-constructed and negotiated over time and space along the key domains of the candidacy model of access: from help-seeking to interactions at the interface to following treatment advice. In the case of each condition, British South Asians’ claims to candidacy were constrained where their individual as well as broader social and cultural characteristics lacked fit with professionals’ ways of working and cultural typifications.
Conclusion: Interventions that positively affect professionals’ capacity to support patient claims to candidacy are likely to help support British South Asians overcome a broad range of barriers to care for physical and mental health problems.
GilbodySWhittyP. Improving the recognition and management of depression in primary care. Effect Health Care2002; 7: 1–12.
3.
McCronePDhanasiriSPatelA. Paying the price: the cost of mental health care in England to 2026London: King’s Fund, 2008.
4.
AndrewsG. Should depression be managed as a chronic disease?BMJ2001; 322: 419–421.
5.
RichardsRALovellKGilbodyS. Collaborative care for depression in UK primary care: a randomized controlled trial. Psychol Med2008; 38: 279–287.
6.
ChisholmDDiehrPKnappM. Depression status, medical comorbidity and resource costs: Evidence from an international study of major depression in primary care (LIDO). Br J of Psychiatr2003; 183: 121–131.
7.
Office for National Statistics Census. General Report for England and WalesBasingstoke: Palgrave Macmillan, 2005.
LantingLCYongIMAMackenbachJP. Ethnic differences in mortality, end-stage complications, and quality of care among diabetic patients: a review. Diabetes Care2005; 28: 2228–2280.
10.
BhopalRFischbacherCVartiainenE. Predicted and observed cardiovascular disease in British South Asians: FINRISK, Framlingham and SCORE models to Newcastle Heart Project data. J Publ Health2005; 27: 93–100.
11.
HussainFCochraneR. Depression in South Asian women living in the UK: A review of the literature with implications for service provision. Transcult Psychiatr2004; 41: 253–270.
12.
BhuiKDineshBGoldbergD. Assessing the prevalence of depression in Punjabi and somatic symptoms. Transcult Psychiatr2004; 41: 307–307.
13.
GaterRTomensonBPercivalC. Persistent depressive disorders and social stress in people of Pakistani origin and white Europeans in the UK. Soc Psychiatry Psychiatr Epidemiol2009; 44: 198–207.
14.
WeichSNazrooJYSprostonK. Common mental disorders and ethnicity in England: the EMPIRIC study. Psychol Med2004; 34: 1543–1551.
15.
Davey-SmithGChatuvediNHardingS. Ethnic inequalities in health: a review of UK epidemiological literature. Crit Publ Health2000; 10: 375–408.
16.
BhuiKBhugraDGoldbergD. Cultural influences on the prevalence of common mental disorder, general practitioners' assessments and help-seeking among Punjabi and English people visiting their general practitioner. Psychol Med2001; 31: 815–825.
17.
NazrooJYFalaschettiEPierceM. Ethnic inequalities in access to and outcomes of healthcare: analysis of the Health Survey for England. J Epidemiol Commun Health2009; 63: 1002–1027.
18.
GaldasPCheaterFMarshallP. What is the role of masculinity in white and South Asian men’s decisions to seek medical help for cardiac chest pain?J Health Serv Res Pol2007; 12: 223–229.
19.
ShaukatNde BonoDPCruickshankJK. Clinical features, risk factors, and referral delay in British patients of Indian and European origin with angina matched for age and extent of coronary atheroma. BMJ1993; 307: 717–718.
20.
MindellJKlodawskiEFitzpatrickJ. Using routine data to measure ethnic differentials in access to coronary revascularization. J Publ Health2008; 30: 45–53.
21.
VermaABirgerRBhattH. Ethnic disparities in diabetes management: a 10-year population-based repeated cross-sectional study in UK primary care. J Publ Health2010; 32: 250–258.
22.
GoddardMSmithP. Equity of access to health care services: Theory and evidence from the UK. Social Sci Med2001; 53: 1149–1162.
23.
PenchanskyRThomasJW. The concept of access: definition and relationship to consumer satisfaction. Med Care1981; 19: 127–140.
24.
CampbellSMRolandMOBuetowSA. Defining quality of care. Social Sci Med2000; 51: 1611–1625.
25.
Dixon-Woods M, Cavers D and Agarwal S. Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups. BMC Med Res Methodol 2006; 6: 35.
26.
Worth A, Irshad T, Bhopal R, et al. Vulnerability and access to care for South Asian Sikh and Muslim patients with life limiting illness in Scotland: prospective longitudinal qualitative study. BMJ 2010; 338: b183.
27.
Finfgeld-ConnettD. Generalizability and transferability of meta-synthesis research findings. J Adv Nursing2010; 66: 246–254.
28.
MalpassAShawASharpD. “Medication career” or “moral career”? The two sides of managing antidepressants: A meta-ethnography of patient’s experience of antidepressants. Social Sci Med2009; 51: 1087–1110.
Atkins S, Lewin S, Smith H, et al. Conducting a meta-ethnography of qualitative literature: Lessons learnt. BMC Med Res Methodol 2008; 8: 8.
31.
BrittenNCampbellRPopeC. Using meta-ethnography to synthesise qualitative research: a worked example. J Health Serv Res Pol2002; 7: 209–215.
32.
Office for National Statistics Census. General Report for England and WalesBasingstoke: Palgrave Macmillan, 2005.
33.
Dixon-WoodsMSuttonAShawR. Appraising qualitative research for inclusion in systematic reviews: a quantitative and qualitative comparison of three methods. J Health Serv Res Pol2007; 12: 42–47.
RitchieJSpencerL. Qualitative data analysis for applied policy research. In: BrymanABurgessRG (eds). Analyzing qualitative dataLondon: Routledge, 1994, 173–194.
36.
Barnett-PageEThomasJ. Methods for the synthesis of qualitative research: a critical review. BMC Med Res Methodol2009; 9: 59–59.
37.
GreenhalghTHelmanCChowdhuryAM. Health beliefs and folk models of diabetes in British Bangladeshis: a qualitative study. BMJ1998; 316: 978–983.
38.
StoneMPoundEPancholiA. Empowering patients with diabetes: a qualitative primary care study focusing on British South Asians in Leicester, UK. Family Pract2005; 22: 647–652.
39.
Lawton J, Ahmad N, Hallowell N, et al. Perceptions and experiences of taking oral hypoglycaemic agents among people of Pakistani and Indian origin: qualitative study. BMJ Online 2005; 330(7502): 1247.
40.
LawtonJAhmadNHannaL. ‘I can’t do any serious exercise’: barriers to physical activity amongst people of Pakistani and Indian origin with type 2 diabetes. Health Educat Res2006; 21: 43–54.
41.
LawtonJAhmadNHannaL. Diabetes service provision: a qualitative study of the experiences and view of Pakistani and Indian patients with Type 2 diabetes. Diabetic Med2006; 23: 1003–1007.
42.
DarrAAstinFAtkinK. Causal attributions, lifestyle change, and coronary heart disease: Illness beliefs of patients of South Asian and European origin living in the United Kingdom. Heart Lung2008; 37: 91–104.
43.
SriskantharajahJKaiJ. Promoting physical activity among South Asian women with coronary heart disease and diabetes: what might help?Family Pract2006; 24: 71–76.
44.
KaiJHedgesC. Minority ethnic community participation in needs assessment and service development in primary care: perceptions of Pakistani and Bangladeshi people about psychological distress. Health Expectations1999; 2: 7–20.
45.
Chew-GrahamCBashirCChantlerK. South Asian women, psychological distress and self-harm: lessons for primary care trusts. Health Social Care Commun2002; 10: 339–347.
46.
HussainFACochraneR. Depression in South Asian women: Asian women’s beliefs on causes and cures. Ment Health Relig Cult2002; 5: 285–311.
47.
HussainFACochraneR. Living with depression: Coping strategies used by South Asian women, living in the UK, suffering from depression. Ment Health Relig Cult2003; 6: 21–44.
48.
LawrenceVBanerjeeSBhugraD. Coping with depression in later life: a qualitative study of help-seeking in three ethnic groups. Psychol Med2006; 36: 1375–1383.
KovandžićMChew-GrahamCReeveJ. Access to primary mental health care for hard-to-reach groups: from 'silent suffering' to 'making it work'. Social Sci Med2011; 72: 763–772.
51.
GatelyCRogersASandersC. Re-thinking the relationship between long-term condition self-management education and the utilisation of health services. Social Sci Med2007; 65: 934–945.
52.
ThompsonAG. The meaning of patient involvement and participation in health care consultations: a taxonomy. Social Sci Med2007; 64: 1297–1310.
53.
CoyleJ. Exploring the meaning of ‘dissatisfaction’ with health care: The importance of ‘personal identity threat’. Sociol Health Illness1999; 21: 95–123.
54.
SuchmanL. Plans and situated actionsCambridge: Cambridge University Press, 1987.
55.
AdayLAAndersenRM. Access to medical care in the US: Realized and potential. Med Care1978; 16: 533–546.
56.
AndersenRMMcCutcheonAAdayLA. Exploring the dimensions of access to medical care. Health Serv Res1983; 18: 49–74.
57.
WerlenB. Society, action and space. An alternative human geographyLondon: Routledge, 1993.
58.
GiddensA. The constitution of society. Outline of the theory of structurationCambridge: Polity, 1984.
59.
Gill PS, Shankar A, Quirke T, et al. Access to interpreting services in England: secondary analysis of regional data. BMC Publ Health 2009; 9: 12.
60.
RhodesPNoconA. A problem of communication? Diabetes care among Bangladeshi people in Bradford. Health Social Care Commun2003; 11: 45–54.
61.
Coventry PA, Hays R, Dickens C, et al. Talking about depression: a qualitative study of barriers to managing depression in people with long term conditions in primary care. BMC Fam Pract 2011; 12: 10.
62.
Lamb JD, Bower P, Rogers A, et al. Access to mental health in primary care: a qualitative meta-synthesis of evidence from the experience of people from 'Hard to Reach' Groups. Health 2012.
63.
ProtheroeJNutbeamDRowlandsG. Health literacy: a necessity for increasing participation in health care. Br J Gen Pract2009; 59: 721–723.
64.
Dowrick C, Gask L, Edwards S, et al. Researching the mental health needs of hard-to-reach groups: managing multiple sources of evidence. BMC Health Serv Res 2009; 9: 226.
65.
HeymanB. Reflecting on a meta-synthesis of qualitative papers concerned with pregnant women’s decision-making about prenatal screening for Down syndrome: A commentary on Reid, Sinclair, Barr, Dobbs and Crealey. Social Sci Med2009; 69: 1574–1576.
66.
Finfgeld-ConnettD. Generalizability and transferability of meta-synthesis research findings. J Adv Nurs2010; 66: 246–254.
