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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

  • JO ELLINS (a1) and JON GLASBY (a2)

Abstract

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

Corresponding author

Address for correspondence: Jo Ellins, Senior Management Consultant, ICF International, 30 St Pauls Square, Birmingham B3 1QZ, UK. E-mail: jo.ellins@icfi.com

References

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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.
Amado, G. and Ambrose, A. 2001. The Transitional Approach to Change. Karnac Books, London.
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.
Audit Commission 2004. Older People – Independence and Wellbeing. The Challenge for Public Services. Audit Commission, London.
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.
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.
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.
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.
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.
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.
Cornwall, A. and Jewkes, R. 1995. What is participatory research? Social Science and Medicine, 41, 12, 1667–76.
Department of Health 2009. Report on the Self Reported Experience of Patients from Black and Minority Ethnic Groups. Department of Health, London.
Department of Health 2010 a. Equity and Excellence: Liberating the NHS. Department of Health, London.
Department of Health 2010 b. Ready to Go? Planning the Discharge and Transfer of Patients from Hospital and Intermediate Care. Department of Health, London.
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.
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.
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.
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.
Goodrich, J. 2009. Exploring the wide range of terminology used to describe care that is patient-centred. Nursing Times, 105, 20, 1417.
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.
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.
Heron, J. 1996. Cooperative Inquiry: Research into the Human Condition. Sage, London.
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.
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.
Leamy, M. and Clough, R. 2006. How Older People Became Researchers: Training, Guidance and Practice in Action. Joseph Rowntree Foundation, York, UK.
Levenson, R. 2007. The challenge of dignity in care. Upholding the rights of the individual. Help the Aged, London.
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.
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.
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.
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.
McLaughlin, H. 2009. Service User Research in Health and Social Care. Sage, London.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Yeo, S. 2004. Language barriers and access to care. Annual Review of Nursing Research, 22, 5973.

Keywords

“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

  • JO ELLINS (a1) and JON GLASBY (a2)

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