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“You don't know what you are saying ‘Yes’ and what you are saying ‘No’ to”: hospital experiences of older people from minority ethnic communities

Published online by Cambridge University Press:  26 September 2014

ICF International, Birmingham, UK.
Health Services Management Centre, University of Birmingham, UK.
Address for correspondence: Jo Ellins, Senior Management Consultant, ICF International, 30 St Pauls Square, Birmingham B3 1QZ, UK. E-mail:


Improving responsiveness to the needs of older people from minority ethnic communities has been emphasised as a goal in England since the publication of the National Service Framework for Older People in 2001. Despite this, people from minority ethnic groups consistently give poorer ratings of their health services than ‘majority’ populations, both in England and across many other health-care systems. Language barriers have been shown to play a particularly important role, and appear to be a stronger predictor of perceived quality of care than ethnic origin per se. This paper reports findings from a larger study exploring older people's experiences of care transitions, focusing on the findings from one case study area which explored the hospital and discharge experiences of older people from minority ethnic communities. A participatory approach was adopted, with older people from the local area collaborating in the design, delivery and analysis of the research as ‘co-researchers’. Twenty-four in-depth narrative interviews were carried out with people who had experienced a recent hospital stay as a patient or a family member providing care and support. Our findings show that many aspects of the hospital experience, including the desire for personalised and humanistic approaches to care, are important to older people irrespective of ethnic background. However, older people from minority ethnic communities can also face language and cultural barriers which negatively affect the quality and experience of care. People who had limited English proficiency struggled to understand, communicate and participate in their care. Where professional services were not available or requested, interpreting was provided informally by other patients, family members, hospital staff in clinical and domestic roles, or not at all. We conclude that targeted strategies are required to ensure appropriate and effective hospital services for a multicultural population.

Copyright © Cambridge University Press 2014 

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Alexander, C., Edwards, R., Temple, B., Kanani, U., Zhuang, L., Mohib, M. and Sam, A. 2004. Access to Services with Interpreters. Joseph Rowntree Foundation, York, UK.Google Scholar
Amado, G. and Ambrose, A. 2001. The Transitional Approach to Change. Karnac Books, London.Google Scholar
Anderson, L., Scrimshaw, S., Fullilove, M., Fielding, J. and Normand, J. 2003. Culturally competent healthcare systems. A systematic review. American Journal of Preventive Medicine, 24, 3supplement, 6879.Google Scholar
Audit Commission 2004. Older People – Independence and Wellbeing. The Challenge for Public Services. Audit Commission, London.Google Scholar
Bastiaens, H., Van, R., Pavlic, D., Raposo, V. and Baker, R. 2007. Older people's preferences for involvement in their own care: a qualitative study in primary health care in 11 European countries. Patient Education and Counseling, 68, 1, 3342.Google Scholar
Bate, P. and Robert, G. 2006. Experience-based design: from redesigning the system around the patient to co-designing services with the patient. Quality and Safety in Health Care, 15, 5, 307–10.Google Scholar
Bridges, J., Flatley, M. and Meyer, J. 2010. Older people's and relatives’ experiences in acute care settings: systematic review and synthesis of qualitative studies. International Journal of Nursing Studies, 47, 1, 89107.Google Scholar
Campbell, J., Ramsay, J. and Green, J. 2001. Age, gender, socioeconomic, and ethnic differences in patients’ assessments of primary health care. Quality in Health Care, 10, 2, 90–5.Google Scholar
Carrasquillo, O., Orav, E., Brennan, T. and Burstin, H. 1999. Impact of language barriers on patient satisfaction in an emergency department. Journal of General Internal Medicine, 14, 2, 82–7.Google Scholar
Clough, R., Gree, B., Hawkes, B., Raymond, G. and Bright, L. 2006. Older People as Researchers: Evaluating a Participative Project. Joseph Rowntree Foundation, York, UK.Google Scholar
Cornwall, A. and Jewkes, R. 1995. What is participatory research? Social Science and Medicine, 41, 12, 1667–76.Google Scholar
Department of Health 2009. Report on the Self Reported Experience of Patients from Black and Minority Ethnic Groups. Department of Health, London.Google Scholar
Department of Health 2010 a. Equity and Excellence: Liberating the NHS. Department of Health, London.Google Scholar
Department of Health 2010 b. Ready to Go? Planning the Discharge and Transfer of Patients from Hospital and Intermediate Care. Department of Health, London.Google Scholar
Dewing, J. 2002. From ritual to relationship: a person-centred approach to consent in qualitative research with older people who have a dementia. Dementia, 1, 2, 157–71.Google Scholar
Ellins, J., Glasby, J., Tanner, D., McIver, S., Davidson, D., Littlechild, R., Snelling, I., Miller, R., Hall, K., Spence, K. and The Care Transitions Project Co-Researchers 2012. Understanding and improving transitions of older people: a user and carer centred approach. Final report. National Institute for Health Research Service Delivery and Organisation Programme, Southampton, UK.Google Scholar
Feldman, S., Radermacher, H., Browning, C., Bird, S. and Thomas, S. 2008. Challenges of recruitment and retention of older people from culturally diverse communities in research. Ageing & Society, 28, 4, 473–93.Google Scholar
Flores, G. 2005. The impact of medical interpreter services on the quality of health care: a systematic review. Medical Care Research and Review, 62, 3, 255–99.Google Scholar
Goodrich, J. 2009. Exploring the wide range of terminology used to describe care that is patient-centred. Nursing Times, 105, 20, 1417.Google Scholar
Harmsen, J., Bernsen, R., Bruijnzeels, M. and Meeuwesen, L. 2008. Patients’ evaluation of quality of care in general practice: what are the cultural and linguistic barriers? Patient Education and Counseling, 72, 1, 155–62.Google Scholar
Heine, C. and Browning, C. 2002. Communication and psychosocial consequences of sensory loss in older adults: overview and rehabilitation directions. Disability and Rehabilitation, 24, 15, 763–73.Google Scholar
Heron, J. 1996. Cooperative Inquiry: Research into the Human Condition. Sage, London.Google Scholar
Karliner, L., Jacobs, E., Chen, A. and Mutha, S. 2007. Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Services Research, 42, 2, 727–54.Google Scholar
Kelly, F. 2010. Recognising and supporting self in dementia: a new way to facilitate a person-centred approach to dementia care. Ageing & Society, 30, 1, 103–24.Google Scholar
Leamy, M. and Clough, R. 2006. How Older People Became Researchers: Training, Guidance and Practice in Action. Joseph Rowntree Foundation, York, UK.Google Scholar
Levenson, R. 2007. The challenge of dignity in care. Upholding the rights of the individual. Help the Aged, London.Google Scholar
Lurie, N., Zhan, C., Sangl, J., Bierman, A. and Sekscenski, E. 2003. Variation in racial and ethnic differences in consumer assessments of health care. American Journal of Managed Care, 9, 7, 502–9.Google Scholar
Manthorpe, J., Iliffe, S., Moriarty, J., Cornes, M., Clough, R., Bright, L. and Rapaport, J. 2009. ‘We are not blaming anyone, but if we don't know about amenities, we cannot seek them out’: black and minority older people's views on the quality of life, health and personal social services in England. Ageing & Society, 29, 1, 93113.Google Scholar
Manthorpe, J., Samsi, K., Campbell, S., Abley, C., Keady, J., Bond, J., Watts, S., Robinson, L., Gemski, A., Warner, J., Goodman, C., Drennan, V. and Iliffe, S. 2011. The transition from cognitive impairment to dementia: older people's experiences. National Institute for Health Research Service Delivery and Organisation Programme, Southampton, UK.Google Scholar
McFadden, A., Renfrew, M. and Atkin, K. 2013. Does cultural context make a difference to women's experiences of maternity care? A qualitative study comparing the perspectives of breast-feeding women of Bangladeshi origin and health practitioners. Health Expectations, 16, 4, 124–35.Google Scholar
McLaughlin, H. 2009. Service User Research in Health and Social Care. Sage, London.Google Scholar
Mead, N. and Roland, M. 2009. Understanding why some ethnic minority patients evaluate medical care more negatively than white patients: a cross sectional analysis of a routine patient survey in English general practices. British Medical Journal, 339, b3450.Google Scholar
Miller, E., Cook, A., Alexander, H., Cooper, S.-A., Hubbard, G., Morrison, J. and Petch, A. 2006. Challenges and strategies in collaborative working with service user researchers: reflections from the academic researcher. Research Policy and Planning, 24, 3, 198208.Google Scholar
Molyneaux, V., Butchard, S., Simpson, J. and Murray, C. 2011. Reconsidering the term ‘carer’: a critique of the universal adoption of the term ‘carer’. Ageing & Society, 31, 3, 422–37.Google Scholar
Murray-Garcia, J., Selby, J., Schmittdiel, J., Grumbach, K. and Quesenberry, C. 2000. Racial and ethnic differences in a patient survey: patients’ values, ratings, and reports regarding physician primary care performance in a large health maintenance organization. Medical Care, 38, 3, 300–10.Google Scholar
O'Halloran, R., Worrall, L. and Hickson, L. 2012. Stroke patients communicating their healthcare needs in hospital: a study within the ICF framework. International Journal of Language and Communication Disorders, 47, 2, 130–43.Google Scholar
Ong, L., de Haes, J., Hoos, A. and Lammes, F. 1995. Doctor–patient communication: a review of the literature. Social Science and Medicine, 40, 7, 903–18.Google Scholar
Policy Research Institute on Ageing and Ethnicity (PRIAE) and Help the Aged 2001. Dignity on the ward: towards dignity. Acting on the lessons from hospital experiences of black and minority ethnic older people. Help the Aged, London.Google Scholar
Puthussery, S., Twamley, K., Macfarlane, A., Harding, S. and Baron, M. 2010. ‘You need that loving tender care’: maternity care experiences and expectations of ethnic minority women born in the United Kingdom. Journal of Health Services Research and Policy, 15, 3, 156–62.Google Scholar
Raleigh, V., Irons, R., Hawe, E., Scobie, S., Cook, A., Reeves, R., Petruckevitch, A. and Harrison, J. 2007. Ethnic variations in the experiences of mental health service users in England: results of a national patient survey programme. British Journal of Psychiatry, 191, 4, 304–12.Google Scholar
Ramirez, D., Engel, K. and Tang, T. 2008. Language interpreter utilization in the emergency department setting: a clinical review. Journal of Health Care for the Poor and Underserved, 19, 2, 352–62.Google Scholar
Ray, M. 2007. Redressing the balance? The participation of older people in research. In Bernard, M. and Sharf, T. (eds), Critical Perspectives on Ageing Societies. The Policy Press, Bristol, UK, 7387.Google Scholar
Repper, J., Grant, G., Curran, M. and Nolan, M. 2007. Carers of people with mental health problems as co-researchers: reflections on the partnerships in Carer Assessment project (PICAP). In Nolan, M., Hanson, E., Grant, G. and Keady, J. (eds), User Participation in Health and social Care Research: Voices, Values and Evaluation. Open University Press, Maidenhead, UK, 134–50.Google Scholar
Ritchie, J. and Spencer, L. 1994. Qualitative data analysis for applied policy research. In Bryman, A. and Burgess, R. (eds), Analyzing Qualitative Data. Routledge, Abingdon, UK, 173–94.Google Scholar
Schnittker, J. and Bhatt, M. 2008. The role of income and race/ethnicity in experiences with medical care in the United States and United Kingdom. International Journal of Health Services, 38, 4, 671–95.Google Scholar
Simmons-Mackie, N., Kagan, A., Christie, C., Huijbregts, M., McEwen, S. and Willems, J. 2007. Communicative access and decision making for people with aphasia: implementing sustainable healthcare systems change. Aphasiology, 21, 1, 3966.Google Scholar
Taira, D., Safran, D., Seto, T., Rogers, W., Inui, T., Montgomery, J. and Tarlov, A. 2001. Do patient assessments of primary care differ by patient ethnicity? Health Services Research, 36, 6, 1059–71.Google Scholar
Vydelingum, V. 2000. South Asian patients’ lived experience of acute care in an English hospital: a phenomenological study. Journal of Advanced Nursing, 32, 1, 100–7.Google Scholar
Ward, L., Barnes, M. and Gahagan, B. 2012. Wellbeing in old age: findings from participatory research. University of Brighton and Age Concern Brighton, Brighton and Hove, UK.Google Scholar
Warren, L. and Cook, J. 2005. Working with older women in research: benefits and challenges. In Lowes, L. and Hulatt, I. (eds), Involving Service Users in Health and Social Care Research. Routledge, Abingdon, UK, 171–89.Google Scholar
Weech-Maldonado, R., Morales, L., Elliott, M., Spritzer, K., Marshall, G. and Hays, R. 2003. Race/ethnicity, language, and patients’ assessments of care in Medicaid managed care. Health Services Research, 38, 3, 789808.Google Scholar
Yeo, S. 2004. Language barriers and access to care. Annual Review of Nursing Research, 22, 5973.Google Scholar