Evidence of On-Going Disparate Levels of Care for South Asian Patients with Inflammatory Bowel Disease in the United Kingdom during the Quinquennium 2015–2019

Over the last decade, there have been a number of studies which have documented disparate levels of care in the management of inflammatory bowel disease amongst various minority communities in the UK. Similar findings had previously been described in the USA, where access to biologics has been an issue. In this study, data on admissions to hospital of South Asian and White British patients with inflammatory bowel disease between 2015 and 2019 were collected from 12 National Health Service (NHS) trusts in England, three Health Boards in Wales and two Scottish health organizations using Freedom of Information requests. The analyses of data were based on the assumption that inflammatory bowel disease (IBD) has the same prevalence in the South Asian community and the White British community in the UK. Comparisons were made between the proportion of hospitalised patients who were South Asian and the proportion who were White British in the local community using a z statistic. In Leicester, Bradford, Croydon and Lothian, the proportion of patients from the South Asian community admitted to hospital was significantly greater than the proportion from the local White British community, which is consistent with the greater frequency and severity of the disease in the South Asian community in the UK. However, in Coventry, Wolverhampton, Walsall, Acute Pennine Trust in the north-west of England, Barking, Havering and Redbridge and Glasgow, South Asian patients were significantly under-represented, indicating significant issues with access to hospital-based healthcare for inflammatory bowel disease. This study provides evidence of on-going evidence of disparate levels of care for patients from a South Asian background, with inflammatory bowel disease being underserved by a number of NHS Trusts, Health Boards and comparable organisations. When there is on-going failure to achieve the objectives of the NHS of achieving equality in the delivery of care, it is critical to introduce effective policies which will alter the in-built inertia to change within such organisations.

Barriers and Facilitators to Accessing Digital Health Tools Faced by South Asian Canadians in Surrey, British Columbia: Community-Based Participatory Action Exploration Using Photovoice

Background South Asian community members in Canada experience a higher burden of chronic disease than the general population. Digital health innovations provide a significant opportunity to address various health care challenges such as supporting patients in their disease self-management. However, South Asian community members are less likely to use digital tools for their health and face significant barriers in accessing them because of language or cultural factors. Objective The aim of this study is to understand the barriers to and facilitators of digital health tool uptake experienced by South Asian community members residing in Canada. Methods This study used a qualitative community-based participatory action research approach. Residents from Surrey, British Columbia, Canada, who spoke 1 of 4 South Asian languages (Hindi, Punjabi, Urdu, or Tamil) were invited to participate in focus group discussions. A subsample of the participants were invited to use photovoice methods in greater depth to explore the research topics. Results A total of 197 participants consented to the focus group discussions, with 12 (6.1%) participating in the photovoice phase. The findings revealed several key obstacles (older age, lack of education, and poor digital health literacy) and facilitators (social support from family or community members and positive attitudes toward technology) to using digital health tools. Conclusions The results support the value of using a community-based participatory action research approach and photovoice methods to engage the South Asian community in Canada to better understand digital health competencies and needs. There were several important implications for policy makers and future research, such as continued engagement of community leaders by health care providers and administrators to learn about attitudes and preferences.

Knowledge of osteopathic manipulative medicine and osteopathic physicians in a New York South Asian community

Context Research regarding patient awareness of osteopathic manipulative medicine (OMM) can help identify barriers and factors limiting patient knowledge. Levels of knowledge about OMM and osteopathic physicians have been studied in New York’s Chinese and Korean populations, but have not previously been investigated in the South Asian population. Objectives To assess the knowledge of OMM and osteopathic physicians within a South Asian community of New York. Methods A cross-sectional study was designed in which a culturally appropriate survey, provided in both English and Hindi, was administered to study participants in order to measure knowledge of osteopathic medicine. The study utilized convenience sampling and distributed surveys to individuals who identified themselves of South Asian descent at high traffic sites in Hicksville, New York. The survey contained 10 questions, assessing the individual’s knowledge of osteopathic medicine. The Kruskal–Wallis and Chi-Square tests were employed to determine statistical significance of the data obtained from the surveys. Results The survey was conducted on 100 participants in Hicksville, New York. The respondent demographics included 53 males and 47 females with an average age of 41.2 ± 16.3 years old. There were 34 (34%) participants who had heard of osteopathic manipulative medicine (OMM) and 26 (26%) participants who had knowledge of doctor of osteopathic medicine (DO) physicians. Respondents were found more likely to have knowledge of DOs if they were born in the United States (US) vs. other countries (US, 8 of 14 [57.1%] vs. others, 18 of 86 [20.9%]; p=0.006) or lived longer in the US (11 of 26 [42.3%], p=0.039). Participants who spoke a non-English primary language were also found less likely to have knowledge of DOs as they made up 46 of the 58 respondents who indicated no knowledge (79.3%, p=0.042). Conclusions A general lack of knowledge of DOs and OMM exists within the South Asian community of Hicksville, New York and lower levels of awareness were found among participants who were male, born outside the US, had a language other than English as their primary language, and had spent less time in the US. Additional educational resources may be implemented to increase awareness of DOs and OMM among this and similar communities.

Mitigating the identity and health threat of COVID-19: Perspectives of middle-class South Asians living in the UK

The recognition and representation of BAME community as ‘high risk’ of Covid-19 in the UK presents both a health and an identity threat to this ethnic group. This study employed thematic analysis to explore response to these threats as related by a sample of 13 middle class members of the South Asian community. This work advances both health and identity psychological theory by recognising the affinity between expressions of health efficacy and identity. Our findings identify South Asian intragroup stigmatisation and commonalities that have implications for the promotion of health behaviour and health communications for minority groups.

South Asian immigrant women & abuse : identifying intersecting issues and culturally appropriate solutions

The current discourse and media portrayal of abused South Asian women is largely around depicting a pathological community, placing the blame of domestic violence within the South Asian community as an inherent result of South Asian culture. This paper aims moves [sic] away from a simplistic cultural interpretation of violence and utilizes an intersectional perspective for understanding multiple oppressions faced by abused South Asian women. Mapping key intersecting issues and analysis of gaps in the service provision in the domestic violence sector are undertaken through an in-depth literature review. An exploratory and descriptive case study method is adopted to explore a community-based organization's approach to culturally appropriate domestic violence intervention in the South Asian community. Case study findings recommend utilizing a culturally appropriate approach for understanding, engaging and intervening in domestic violence cases in the South Asian community. Community development, strengthening the family and a non-blame approach to addressing violence is recommended through the case study.

South Asian immigrant women & abuse : identifying intersecting issues and culturally appropriate solutions

The current discourse and media portrayal of abused South Asian women is largely around depicting a pathological community, placing the blame of domestic violence within the South Asian community as an inherent result of South Asian culture. This paper aims moves [sic] away from a simplistic cultural interpretation of violence and utilizes an intersectional perspective for understanding multiple oppressions faced by abused South Asian women. Mapping key intersecting issues and analysis of gaps in the service provision in the domestic violence sector are undertaken through an in-depth literature review. An exploratory and descriptive case study method is adopted to explore a community-based organization's approach to culturally appropriate domestic violence intervention in the South Asian community. Case study findings recommend utilizing a culturally appropriate approach for understanding, engaging and intervening in domestic violence cases in the South Asian community. Community development, strengthening the family and a non-blame approach to addressing violence is recommended through the case study.

Diffusion of Responsibility: A Discourse Analysis of The Toronto Star’s Protrayal of Domestic Violence in the South Asian Community

Literature on domestic violence in the South Asian community demonstrates that there is an over emphasis on dismissing violence as a ‘cultural’ phenomenon. Likewise, literature on media’s portrayal of violence against women tends to reinforce patriarchal ideologies by blaming the victim, excusing the perpetrator, and reporting violence as a private, individual matter rather than a larger, social problem. Using discourse analysis, my findings illustrate that the portrayal of domestic violence in The Toronto Star reinforces racism and sexism when framing the problem. In doing so, responsibility is diffused and therefore the solution to violence against women becomes limited, if not non-existent.

Diffusion of Responsibility: A Discourse Analysis of The Toronto Star’s Protrayal of Domestic Violence in the South Asian Community

Literature on domestic violence in the South Asian community demonstrates that there is an over emphasis on dismissing violence as a ‘cultural’ phenomenon. Likewise, literature on media’s portrayal of violence against women tends to reinforce patriarchal ideologies by blaming the victim, excusing the perpetrator, and reporting violence as a private, individual matter rather than a larger, social problem. Using discourse analysis, my findings illustrate that the portrayal of domestic violence in The Toronto Star reinforces racism and sexism when framing the problem. In doing so, responsibility is diffused and therefore the solution to violence against women becomes limited, if not non-existent.