People from ethnic minorities seeking help for long COVID: a qualitative study

Smyth, Nina; Ridge, Damien; Kingstone, Tom; Gopal, Dipesh P; Alwan, Nisreen A; Wright, Alexa; Chaudhry, Ashish; Clark, Sophie; Band, Rebecca; Chew-Graham, Carolyn A

doi:10.3399/bjgp.2023.0631

Cited by 6 publications

References 58 publications

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Using General Practice Patient Survey data to explore prevalence and patient uncertainty about Long Covid

Woodrow,

Ziauddeen,

Smith

et al. 2024

Preprint

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Background: The high global burden of Long Covid (LC) has significant implications for population wellbeing, healthcare, social care and national economies. Aim: To explore associations between patient sociodemographic and health characteristics with two outcomes: reporting having LC and expressing uncertainty about having LC, as described by general practice (GP) survey respondents. Design and setting: Analysis of GP Patient Survey (England), a random sample of 759,149 patients aged 16yrs+ registered with a GP in England (2023). Method: Multivariable logistic regression modelling comparing those with and without LC, and those who were unsure in relation to patient characteristics. Results: 4.8% of respondents reported having LC, and 9.1% were unsure. Significant adjusted associations indicating higher risk of LC included age (highest odds 35-54yrs), sex (females), ethnicity (White Gypsy/Irish Traveller, mixed/multiple ethnic groups), sexual orientation (gay/lesbian or bisexual), living in a deprived area, being a carer or a parent and having a long-term condition (LTC). Those aged 25yrs and under, males, non-binary, heterosexual, not parents or carers, from other white, Indian, Bangladeshi, Chinese, Black or Arab backgrounds, former and current smokers, and with no defined LTC were more likely to be unsure about having LC compared to answering "yes". Conclusion: There is an unequal distribution of LC in England, with the condition being more prevalent in minoritised and disadvantaged groups. There are also high levels of uncertainty about having LC. Improved awareness is needed amongst the general population and healthcare professionals to ensure those most vulnerable in society are identified and provided with care and support.

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Using General Practice Patient Survey data to explore prevalence and patient uncertainty about Long Covid

Woodrow,

Ziauddeen,

Smith

et al. 2024

Preprint

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A mixed-methods analysis of the implementation of a new community long-COVID service during the 2020 pandemic: learning from practice

Williams,

Beadle,

Williams

et al. 2024

Preprint

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Introduction: The rapidly increasing prevalence of long-COVID (LC), the multisystem complexity of the condition and high patient symptom burden, necessitated an immediate need to develop new clinics for assessment and management. This article reports on the rapid implementation of a reactive and responsive LC care pathway. We mapped patients’ journey through this pathway, identifying the services that were activated according to prevalent symptoms, and assessed the barriers and facilitators to its implementation and delivery, from the perspective of health care professionals (HCPs) and LC patients using the Theoretical Domains Framework (TDF). Methods: Mixed methods study, including retrospective quantitative cross-sectional analysis of patient data and semi-structured qualitative interviews. One hundred and sixteen patients who attended long-COVID clinic in Hertfordshire, UK, in the first 5 months of its existence, consented for their data to be analysed for the quantitative study. Six HCPs and five patients participated in semi-structured interviews. Results: Patients were referred into the service an average of 5.75 months post initial COVID-19 infection. 82% of patients required onward referral to other HCPs, most commonly pulmonary rehabilitation, chronic fatigue specialists, and the specialist COVID-19 Rehab general practitioner embedded within the service. Patients reported having rehabilitation needs, moderate depression and anxiety, and difficulties performing usual activities of daily living at point of care. The TDF domains most relevant to the implementation of the LC pathway were beliefs about capabilities, environmental context and resources, knowledge, and reinforcement. Discussion: Our study provides novel insight into the development of a reactive multidisciplinary care pathway. Key drivers for successful implementation of LC services were identified, such as leadership, multidisciplinary teamwork, transferable skills, and knowledge exchange. Barriers to rapid set up of the service included funding constraints and the rapid evolution of an emergency context.

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Exploring the help-seeking journeys for Long Covid from a health inequalities perspective: a qualitative study in England

Clutterbuck,

Ramasawmy,

Pantelic

et al. 2024

Preprint

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Background and aimLong Covid is a health condition that continues to be challenging in terms of obtaining care and support, even in the fourth year following its emergence. This study, which forms part of the STIMULATE-ICP study in England, explores the barriers and facilitators people with Long Covid face when trying to access care, as well as experiences in relation to stigma, discrimination, and inequitable treatment.MethodsThe study was co-designed with people with lived experience of Long Covid. People attending three post-covid services in England were invited to participate by clinic staff. Twenty-three participants were interviewed about their experiences in relation to barriers and facilitators of accessing adequate care, including experiences of being treated unfairly. Interviews were analysed thematically.FindingsParticipants experienced difficulties in accessing and receiving appropriate support from primary and secondary care but generally care and support improved once participants were under the care of a Long Covid service. Positive interactions with clinicians who were knowledgeable and supportive helped to foster good patient experiences when accessing Long Covid care. Inequalities in accessing care were reported in the form of experiences of gender and race discrimination. People with previous and existing conditions reported further stigmatisation. Financial barriers to care existed and there were also difficulties faced by those who got infected with COVID-19 early in the pandemic. The impact of Long Covid on mental health was evident, as was the stigma related to mental health and the inadequacy of mental health service provision for people with Long Covid. Some participants who worked within the National Health Service (NHS) perceived their professional position as a facilitator to accessing Long Covid care. However, some NHS employees also reported the negative impact of Long Covid on their work, the lack of employment support available, mistreatment from colleagues, and dismissal of professional knowledge.ConclusionOur findings highlight a range of barriers to accessing adequate Long Covid care, with women, ethnic minorities and people with co-occurring conditions experiencing intersectional stigma. We recommend a move towards a healthcare system that is sensitive to intersectional disparities in access to care and is mindful of how stigma can reinforce these inequalities. This would speak to removing barriers to care and foster a more positive experience for people living with Long Covid already disadvantaged by structural and systemic discrimination.

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People from ethnic minorities seeking help for long COVID: a qualitative study

Cited by 6 publications

References 58 publications

Using General Practice Patient Survey data to explore prevalence and patient uncertainty about Long Covid

Using General Practice Patient Survey data to explore prevalence and patient uncertainty about Long Covid

A mixed-methods analysis of the implementation of a new community long-COVID service during the 2020 pandemic: learning from practice

Exploring the help-seeking journeys for Long Covid from a health inequalities perspective: a qualitative study in England

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