Title: BE SURE - Building an understanding of Ethnic minority people's Service Use Relating to Emergency care for injuries
Funder: Health and Care Research Wales (Welsh Government)

Abstract: Background: Injuries are a major public health problem which can lead to disability or death. There are differences in how people from ethnic minority groups living in the UK contact emergency services such as the ambulance service or emergency departments with injury, compared to White British people. They may not have the same experience of care or recover as well as White British people._x000D_ _x000D_ Study aim: We will describe differences in how people from ethnic minority groups who have an injury contact emergency ambulance services and emergency departments and what happens to them, compared to White British people._x000D_ _x000D_ Methods: We will study injuries caused by accidents, assaults and when people harm themselves. We will study the experiences of asylum seekers and refugees as well as ethnic minority groups._x000D_ _x000D_ To understand what is already known about ethnic minority groups’ experiences of emergency health services, we will look at previous research findings which describe people’s injuries and how these were treated. We will use information which is routinely collected in the National Health Service (NHS) to study the experiences of people from ethnic minority groups and White British people. We will compare: the type and seriousness of their injuries; the care they receive; what happens to them over the following six months. We will use data collected between 2016 and 2021 to do this. We will also check how people’s ethnic background is listed in these records._x000D_ _x000D_ We will survey 800 people who have contacted the ambulance service or an emergency department in four regions in England and Scotland during 2021. Half will be people from ethnic minority groups and half from a White British background. The survey, translated into several languages, will be administered by ethnic minority researchers, paramedics or nurses. We will link their responses to their routinely collected NHS information (unless people opt out). To better understand individual experiences, we will interview 40 people from an ethnic minority background about accessing and receiving emergency healthcare. We will hold group interviews with 24 asylum seekers and refugees to collect their stories too. We will also interview NHS emergency care staff to explore their experiences of providing care to people from ethnic minority groups who are injured. We will pull together all our results to produce a report which can help policy makers ensure people from ethnic minorities have good access to emergency care for injuries. Our findings will help to address disadvantages faced by ethnic minorities when they seek care for injury._x000D_ _x000D_ Public Involvement: Two people from ethnic minority groups are research team members. They have been actively involved in planning this research and will be involved at all stages of delivering the study. Both have worked with us on previous studies and will be offered further research training. We will recruit and train 12 peer researchers from ethnic minority communities. Our stakeholder event will have places for eight more public contributors to be involved in interpreting study findings._x000D_ _x000D_ Impact: We will engage with people who plan and run health services; those who work in ambulance services and emergency departments; and Third Sector organisations who support ethnic minority groups to present findings. We will publish findings in journals read by policy makers, service managers, clinicians and researchers.

Lay abstract: Research question_x000D_ What differences are there in how people from ethnic minority groups present to emergency ambulance services and Emergency Departments (EDs) with injuries; the care they receive and outcomes compared to White British people?_x000D_ _x000D_ Objectives: to_x000D_ - Describe what is known about ethnic minority people's use of emergency health services for injury, care received and outcomes_x000D_ - Describe the quality of ethnicity data in NHS injury datasets_x000D_ - Compare injury type and severity; and processes and outcomes of care for people in ethnic minorities with White British people when they make contact with emergency health services_x000D_ - Explore with people from ethnic minorities, including asylum seekers and refugees: knowledge of service availability; factors which deter or encourage them to seek help; experiences of and beliefs about emergency healthcare for injuries_x000D_ - Explore emergency healthcare providers’ experiences of delivering care to people in ethnic minority groups for injury_x000D_ - Produce findings to improve emergency care for injuries for people in ethnic minority groups_x000D_ _x000D_ Methods_x000D_ For accidental and non-accidental injuries, including assault and self-harm we will:_x000D_ - Carry out scoping review of the literature to describe what has been published about how ethnic minority people present to emergency health services, the care they receive and outcomes_x000D_ - Analyse quality of data on ethnicity in routine emergency care datasets_x000D_ - Analyse routine data (2016-2021) from 4 regions in England and Scotland to compare type and severity of injury, care delivered and 6 month outcomes between ethnic minority and White British populations who presented to the ambulance service or ED for care_x000D_ - Conduct survey to compare experiences, views and health status of 400 ethnic minority and 400 White British people who have contacted the ambulance service or ED in the participating regions of England and Scotland during 2021. The survey will be translated, piloted and administered by peer researchers and research paramedics or nurses. We will link completed questionnaire responses to routine NHS datasets_x000D_ - Conduct interviews and focus groups with asylum seekers and refugees to understand their experiences of accessing and receiving care following injury; and with NHS staff to explore their experiences of providing care to ethnic minorities_x000D_ - Synthesise quantitative and qualitative findings to:_x000D_ * help develop and implement interventions to promote accessibility of services for injury in ethnic minority populations_x000D_ * enable ambulance services and EDs to improve care and outcomes for people in these populations with injuries_x000D_ * inform injury surveillance resources where they exist, to include ethnicity_x000D_ _x000D_ Timelines for delivery_x000D_ Months 1-3: Study set up; research permissions; begin scoping review; pilot routine data collection and linkage_x000D_ Months 4-7: Hold Stakeholder Event 1; recruit and train research paramedics and nurses; recruit and train peer researchers; conduct survey; complete scoping review, _x000D_ Months 8-12: Collate emergency service data to link to existing datasets;link questionnaire data; retrieve 6 month outcomes_x000D_ Months 13-15: Carry out interviews and focus groups_x000D_ Months 16-20: Synthesise data, hold Stakeholder Event 2_x000D_ Months 21-24: Submit final report, prepare materials for dissemination_x000D_ _x000D_ Impact and dissemination_x000D_ We will engage with and present findings to policy makers; care providers in ambulance services and EDs; and Third Sector organisations who support ethnic minority groups. We will publish findings in scientific journals and professional publications in order to maximise impact.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: INJURIES AND ACCIDENTS