Barriers And Enablers To Adult Ethnic Minority Patients' Participation In Healthcare Interventions Delivered In The Community In The UK: A Qualitative Systematic Review

INTRODUCTION: The NHS 10-year plan ethos is providing care that is fit for the future. Healthcare interventions delivered in the community offer an opportunity for health equity that can lead to sustainable social change, delivering an outward-facing approach and community-centred care. More work is needed to develop tailored healthcare interventions suitable for ethnic minorities to effectively address their needs. This review is component one of a wider PhD study that aimed to develop and establish principles for delivering health interventions to ethnic minorities in the community using Action Falls as a case study. Action Falls is an evidence-based, cost-effective falls management tool that reduced falls in care home residents by 43%.
  

METHODS: We undertook a qualitative systematic review to identify barriers and enablers to adult ethnic minority patients' participation in healthcare interventions delivered in the community. Protocol published in PROSPERO (https://www.crd.york.ac.uk/PROSPERO/view/CRD420251003414). Peer-reviewed and grey literature were searched using MEDLINE, CINAHL, Web of Science, Embase, PsycINFO, HMIC database and ProQuest. A bibliographic specialist was consulted to review and refine the search strategy. The PhD supervisory team and project PPIE members provided expert advice. Studies included in the review were independently assessed and quality appraised by two reviewers using JBI-QARI. Credibility level was checked using JBI-SUMARI. Contextual-level and individual-level barriers and enablers to participation in healthcare interventions delivered in the community were mapped to CFIR and TDF constructs. Studies included in the review underwent narrative synthesis.

RESULTS: Two reviewers screened 2523 titles and abstracts, with conflicts resolved by a third reviewer. 78 studies were screened full text. 9 studies included in the final analysis consist of falls prevention (3), mental health (1), physical activity and exercise (3), diet programme (1), and cardiac rehabilitation (1).  68 findings were derived from the 9 studies included. This was further aggregated into 3 synthesised findings: individual and psychological factors, social and cultural factors and environmental and structural factors.

CONCLUSIONS: Study results indicate that people’s perceptions, in addition to social, cultural, and environmental influences, can either impede or facilitate their decision to engage in healthcare interventions, including falls prevention interventions in the community. This study also finds that the characteristics of the intervention, context, benefit and enjoyability are crucial to adherence.