The Missing Voices, an exploration of what healthcare-related research would matter to Global Ethnic Majority Women in Aberdeenshire, Scotland
Authors: Kerr A , Dube B , Neshat-Mokadem L , Singh G 
Published: November 2024

Abstract

Introduction
In multicultural communities, such as the UK, published evidence has indicated that patients from marginalised backgrounds experience healthcare inequality and inequity with regards to accessibility and safety.1 The lack of appropriate ethnic representation in healthcare-related research, has been identified as a potential causation of some of these disparities and poorer health outcomes.2,3 The focus of this project was the marginalised communities identified by the NIHR to have poorer health outcomes, such as Global Ethnic Majority (GEM) women.

Aim
To explore what healthcare research matters to marginalised communities with a focus on lived and perceived experiences on access to healthcare for GEM women in Aberdeen city and Aberdeenshire, Scotland.

Methods
This pilot project captured real world data through an inclusive community engagement approach of reaching within rather than reaching out. A framework of 5Cs (Connect, Collaborate, Consult, Co-create and Circulate) was used to establish a diverse panel of ten GEM women. All panel members had a passion for equality and wellbeing as well as diverse lived experiences. The method used to establish the panel is presented elsewhere. Based on a review of literature, open-ended, flexible, thought-provoking questions for the discussions were developed and circulated to all panel members for approval. These questions were used to guide both in-person and virtual open discussions with aforementioned stakeholders to capture narratives and perspectives around barriers and facilitators to equitable healthcare access in the area. As the public members were research partners and not participants, no ethical approval was required as advised by a professor of pharmacy research and the school’s ethics convenor. The project had three main objectives. This submission will only report on objective three that aimed to Identify and prioritise research questions relating to equitable access to healthcare and the needs of marginalised minority ethnic communities.

Results
The objective was met. A list of emergent themes from the pre-panel questions and a list of panel-approved research questions were devised with a focus on access to healthcare. The emergent themes were around accessibility and equity of maternal/reproductive healthcare, lack of early screening for high-risk GEM groups and culturally appropriate approaches to mental healthcare. Solution focused recommendations included the design of an inclusive healthcare curriculum, compulsory EDI and cultural competency training for healthcare professionals who practice in diverse communities, additional screening programmes tailored to specific GEM groups based on prevalence and risk factors and the development of localised culturally appropriate and inclusive community programmes, especially for those who support new immigrants. Mistrust and lack of inclusive language were mentioned as potential barriers to participating in research.

Discussion / Conclusion
This pilot offered the historically under-represented and usually silent communities an equal voice within a trusting and collaborative environment. Over ten years after the enaction of the UK Equality Act (2010) inequity in healthcare access and poor outcomes are still evident. The outcomes of this small pilot study highlight that GEM-specific projects should be driven by that community.

References
1. Chauhan, A., Walton, M., Manias, E., Walpola, R. L., Seale, H., Latanik, M., Leone, D., Mears, S., & Harrison, R. The safety of health care for ethnic minority patients: a systematic review. IJEH, 2020, 19(1), 118-143
2. Faluyi, D., Ovseiko, P.V., Dziedzic, K. et al. NIHR Race Equality Framework: development of a tool for addressing racial equality in public involvement. Res Involv Engagem, 2024, 10, 44-58.
3. Shea L,et al. Improving diversity in study participation: Patient perspectives on barriers, racial differences and the role of communities. Health Expect. 2022,25(4):1979-1987