Improving healthcare for BME groups in Birmingham

Angela Knight Jackson, Health Visitor, Heart of Birmingham Teaching PCT
Leading Practice Through Research
Angela Knight Jackson
Angela Knight Jackson, Heart of Birmingham Teaching PCT

Across the UK, black and minority ethnic groups experience more poor health, premature deaths and chronic ill-health than the rest of the population. In some areas these inequalities are widening, which presents a challenge to the quality and delivery of healthcare through the NHS.

Furthermore, the country is more ethnically diverse than ever before – almost 10 per cent of the population are of BME origin and ethnic minorities are expected to account for 73 per cent of population growth. So any improvement in the quality of care for BME groups has the potential to have a positive impact on a large, and growing, proportion of the population.

Angela Knight Jackson, health visitor at Heart of Birmingham Teaching Primary Care Trust, is working on a project that aims to improve healthcare for BME groups in Birmingham. She was supported by The Health Foundation, through our Leading Practice Through Research leadership scheme. This scheme enabled mid-career professionals from a wide range of backgrounds to take time out from their daily responsibilities and undertake research projects to improve the quality of patient care or the health of the population.

Tackling discrimination

“It’s recognised that there is poor health among BME communities in the UK,” Angela comments. “They suffer from higher rates of stroke, coronary heart disease and infant mortality. Research suggests that access to healthcare services is difficult for these groups due to institutional racism, negative experiences and lack of information. I believe that it’s time for mainstream health services to address these issues and deliver change.”

To tackle the problem, Angela has commissioned experts in the field of transcultural nursing to train community public health nurses in Birmingham in cultural competence. “The training allows the practitioners to take an inward look at themselves, their value and belief systems and the way they practice,” she explains. “We look at how their own value systems affect how they care for, and even provide services for, other groups.”

“I think the participants are realising that their own viewpoints have been inhibiting them from seeing the patient’s viewpoint and the culture they come from,” she continues. “It’s about fostering a tolerance for other people’s beliefs and looking at how you can combine the UK’s system with the health beliefs and behaviours of other cultures, in order to bring out the best of each.”

Angela hopes that practitioners who have been on the training course will be more likely to challenge any inequalities and injustice that they encounter in the future. “Rather than sitting back and allowing it to happen, they will recognise the importance of challenging services and systems that prevent disenfranchised communities from accessing healthcare services,” she explains.

“With religious groups, for example, they might make sure that home, clinic and hospital visits don’t correspond with times of religious observence and that they provide a more flexible service.”

"Mainstream health services need to address poor health in BME communities in the UK"
Angela Knight JacksonHealth Visitor, Heart of Birmingham Teaching PCT

Testing it out

Angela used both quantitative and qualitative research methods to assess whether the training could help provide a more culturally sensitive service. “I pre-tested the participants before the training and then post-tested them at three and six months, using an experimental and a control group,” she says.

“The idea was to ascertain whether there was any change in knowledge, attitudes and practice,” Angela continues. “The results do show improvements in all these areas but they also show that we could have done with a larger sample, as some of the results were inconclusive because of the small sample size. However, the quantitative data indicates that things have improved and the qualitative data backs this up in terms of participants’ experiences during the training.

“I also measured levels of competence, so you can see that people have moved to different levels, from culturally incompetent, through culturally aware and culturally safe, to culturally competent.”

Spreading the word

Initially, Angela viewed the project just in terms of its local impact but she now thinks it could have national and even international implications. “There are a lot of theoretical models out there on the subject of transcultural nursing and cultural competence, mainly from the US and more recently from the UK, but very few have been put into practice,” she says. “As far as I know, this is the first study with community public health nurses which has been empirically tested in practice. So I’ve disseminated the results and learning at local, national and international conferences.”

However, she warns that the biggest challenge – of making this common practice in the NHS – is yet to come. “You can do a wonderful project at the local level but the idea at the end of it is to integrate into the mainstream of the NHS,” she says. “I must admit I’m finding that hard with the financial situation as it is at the moment. When you want to actually adopt some of these approaches, the inevitable question is ‘where’s the funding?’”

Despite this, Angela is pressing ahead and doing what she can to spread best practice. “I’ve had articles published in Nursing Standard and Community Practitioner and will be presenting a paper to our local Trust board,” she says. “I hope to run some dissemination events and we’ll be launching a website in June, which will be a practical tool that practitioners can use to help them in developing cultural competence.”

The Health Foundation is also launching a new leadership scheme aimed specifically at improving the healthcare of BME groups.

13 March 2007

See also

External sites