Ethnic differences in barriers to symptomatic presentation in primary care: A survey of women in England

Abstract

Objective The majority of cancers are diagnosed following a decision to access medical help for symptoms. People from ethnic minority backgrounds have longer patient intervals following identification of cancer symptoms. This study quantified ethnic differences in barriers to symptomatic presentation including culturally specific barriers. Correlates of barriers (eg, migration status, health literacy, and fatalism) were also explored. Methods A cross‐sectional survey of 720 White British, Caribbean, African, Indian, Pakistani, and Bangladeshi women aged 30 to 60 (n = 120/group) was carried out in England. Barrier items were taken from the widely used cancer awareness measure; additional culturally specific barriers to symptomatic presentation were included following qualitative work (11 barriers in total). Migration status, health literacy, and fatalism were included as correlates to help‐seeking barriers. Results Ethnic minority women reported a higher number of barriers (P < .001, 2.6‐3.8 more than White British women). Emotional barriers were particularly prominent. Women from ethnic minority groups were more likely to report “praying about a symptom” (P < .001, except Bangladeshi women) and “using traditional remedies” (P < .001, except Caribbean women). Among ethnic minority women, adult migration to the United Kingdom, low health literacy, and high fatalistic beliefs increased likelihood of reporting barriers to symptomatic presentation. For example, women who migrated as adults were more likely to be embarrassed (OR = 1.83; CI, 1.06‐3.15), worry what the GP might find (OR = 1.91; CI, 1.12‐3.26), and be low on body vigilance (OR = 4.44; CI, 2.72‐7.23). Conclusions Campaigns addressing barriers to symptomatic presentation among ethnic minority women should be designed to reach low health literacy populations and include messages challenging fatalistic views. These would be valuable for reducing ethnic inequalities in cancer outcomes.

Building the case for the use of gut feelings in cancer referrals: perspectives of patients referred to a non-specific symptoms pathway

“… 17 Other studies have suggested a connection between ethnic group and fatalism, and, for some groups, body vigilance. 18 , 19 Furthermore, if the patient’s preferred language is not the same as the GP’s, difficulties in explaining symptoms or a gut feeling, which is difficult to describe even in the informant’s native language, 2 may harm the development and use of gut feeling. As such, it is conceivable that ethnic background may influence the GP’s use of the ‘short cut’ to investigations that gut feelings provide, the patients’ experience of being taken seriously by their GP, and their views on gut feelings, but this is beyond the scope of this study.…”

“…While no research has examined how ethnicity may affect the expression or use of gut-feelings for serious illness either from the perspective of the patient or the GP, a patient's ethnicity has been associated with increased consultations, with patients of Black, Asian, and Mixed ethnicity having a greater chance of attending their GP three or more times before hospital referral than White patients (17). Other studies have suggested a connection between ethnic group and fatalism and, for some groups, body vigilance (18,19). Furthermore, if the patient's preferred language is not the same as the GP's difficulties in explaining symptoms or a gut-feeling, which is difficult to describe even in the informant's native language (2), may harm the development and use of gut-feeling.…”

Exploring the lived experience of Long Covid in black and minority ethnic groups in the UK: Protocol for qualitative interviews and art-based methods

“…Specialist post-COVID-19 clinics for support from multidisciplinary teams and individualised rehabilitation plans are accessed via primary care services [25]. Minority groups may experience additional barriers to accessing support for their symptoms, such as, lack of trust in professionals, feelings of embarrassment and fear, fatalistic beliefs (shaped by religion/culture) and alternative understandings of causes, symptoms and treatments, lower language proficiency, not presenting to healthcare for certain symptoms and not having culturally-relevant terms to describe medicalised conditions or terms [26][27][28][29][30][31][32][33][34].…”

Insights Into Conducting Audiological Research With Clinical Databases

“…In order for an event to occur, the patient must first seek medical care. The extent to which care is sought for symptoms varies not only by symptom knowledge, interpretation, and beliefs (Petrova et al, 2019), but also by ethnicity (Williams et al, 2019), socioeconomic status (McCutchan et al, 2015, and gender (Magaard et al, 2017). Second, the presence or absence of an event is subject to the clinical judgment of a provider.…”