Transcript Slide 1

NHS VULNERABLE GROUPS
HEALTH CHECK
Date
22RD APRIL
Job Number:
1271
Prepared for:
NHS Leeds
Prepared by:
Kath Rhodes
Caroline Snell
1
BACKGROUND
2
BACKGROUND
• NHS Leeds is committed to reducing health
inequalities
• With this in mind it has put in place a systematic
process for delivering health checks to ‘at risk’ men
and women in more deprived areas of Leeds aged
40-74 through their GPs
• However there are key vulnerable groups that may
not be reached by these measures – these are:
–
–
–
–
–
3
Homeless
Gypsies and Travellers
Asylum Seekers
Those with learning disabilities
Those with mental health problems
BACKGROUND
• Equally key groups from ethnic minority
backgrounds may not be reached through the
current health check offer
• So, research was also needed to understand how to
target and deliver the health check for men and
women aged 40-74 from the following ethnic
groups:
– South Asians
– African Caribbeans
– Africans
• Overall the project was designed to understand how
to deliver health checks most effectively to these
specific target groups
4
RESEARCH OBJECTIVES
• To understand general attitudes to health and the
priority that these groups place on health within
their lifestyles and those of their families
• To gauge initial reactions to the invitation to attend
an NHS Health Check (Vascular Risk Assessment) and
motivators to attend
• To determine their understanding of health risks
generally and Vascular Risk specifically, and its
perceived relevance to them.
• To explore their expectations of what this
assessment would involve and what follow-up they
might expect.
5
RESEARCH OBJECTIVES
• To identify in detail, the main barriers to attending
for this group and gain insight into what factors may
motivate them to attend
• To gain feedback on the current invitation letter
(and the DH letter) and provide guidance on how to
optimise, where appropriate.
• To understand the potential role of community
groups, community leaders, religious groups etc in
influencing attitudes and attendance rates
6
RESEARCH METHOD
A mix of depth interviews, group discussions with
the key target groups and depth interviews were
carried out for each target group. Specific
details are listed in the main body of the
document. (The only exception to this is with
respondents with mental health issues, who were
represented across all our other target groups –
here we also interviewed a support worker).
Fieldwork was carried out in March and April 2010
by Kath Rhodes and Caroline Snell for Claro
7
MAIN FINDINGS
8
SHARED THEMES
9
SPECTRUM OF NEEDS
Across each target group there is a spectrum of
needs and attitudes
People who will easily
access the letter and
leaflet
People who easily
understand the
benefits of health
check and find it
appealing
People who have
more barriers to
understanding
People who are
less connected
into the system
10
Within each
vulnerable group
there are easier and
harder to reach
individuals
ADDITIONAL SUPPORT REQUIRED
For all those with more barriers to understanding
and access the leaflet and letter is not enough on
its own. Greater support is required to
encourage participation.
Support to access
the information
Via support
workers or a
support group
11
Via community
leaders
Support to
understand/believe
the benefits
Via GP
Via appropriate
materials
/translations
SHARED ATTITUDES: AGE
Some common themes emerge across the target
groups
The impact of age
• Midlife crisis – 40 -55 can be a time when people’s
attitude to their health changes
– From confidence/ oblivious to awareness/concern
• This leads to a receptive attitude to a health check
‘to know where you stand’
12
SHARED ATTITUDES: AGE
The impact of age: attitudes of 60+ can be more
varied
13
Already in contact
with GP
Head in the sand
I don’t want to know
It will only be bad
news
Keen to get
additional
Information.
Willing to attend
health check
A minority (?)
but harder to access
SHARED ATTITUDES: GENDER
Male / female split
• Women are often more open to
health checks than men
• Women often have a proactive
attitude to health care
– Don’t view selves as healthy and
fit
There are of course exceptions to this
14
• Male self image and
family/provider/ breadwinner
role can create more barriers to
attending a health check
–
–
–
–
Won’t go until their leg falls off
Only react to health problem
No time to stop
Want to see themselves as
healthy and fit
– Don’t want to miss work
SHARED ATTITUDES: ATTITUDE TO GP
Negative experience of the GP is common
• Doesn’t listen
• Doesn’t look at or touch me
• Doesn’t ask questions
• Is keen to get me in and out in as quickly as possible
• Just wants to look at one particular problem and not all
of me
• Just wants to write a prescription
• Doesn’t explain things to me
There can be a large gap between how the patient
expects to be treated and their experience
15
SHARED ATTITUDES: MENTAL HEALTH
In all target groups mental health issues and
related barriers emerge
• Mental health, specifically depression and psychoses
can be significant barriers to attending a health
check
• When in a positive phase attending a health check is
more likely
• When in a negative phase attending a health check
can seem an impossible ask
16
SHARED ATTITUDES: EXPECTATION OF
WHAT THE ASSESSMENT WILL INVOLVE
• When the letter is understood there is a clear
understanding of the tests that will be carried out in
the Health Check
– Weight, height, BP, family history, blood test etc
• However many expect the health check to cover
more than cardio vascular health (and mentally add
on other elements)
– Mental health
– Cancer screening
– Full body scan
17
SHARED ATTITUDES: EXPECTATION OF
FOLLOW UP
Many do not think as far as the follow up, but when
questioned further..
• Expect to either get the ‘all clear’, or a lecture on
lifestyle
• Most do not think as far or expect medication to be
a benefit
18
SHARED ATTITUDES: EXPECTATION OF
OUTCOMES
Many take a passive approach to the health check
and any outcomes
• Most imagine if they were prescribed medication
they would comply
• But many feel they would struggle to make strong
lifestyle changes
– Some asylum seekers and less medically knowledgeable
Africans may be an exception as they have a stronger
desire to adapt to the ‘rules’ of their new country
19
SHARED ATTITUDES
Overall, when it is understood, a cardio
vascular health check is perceived to be
positive and desirable service
Good for future health
20
FEEDBACK ON LETTER AND
LEAFLET
21
BALANCE OF ATTENTION
Of the two elements, the letter is the most influential
The leaflet gives additional
information and detail but is
only read once the reader
has already decided to
attend
Decision to attend
(or not) is taken
based on the
letter
22
INVITATION LETTER
23
QUESTIONS ASKED AS LETTER READ
What is this about?
Is it relevant to me?
24
An appointment/a
health check
Yes …my age, my
name, from my GP
QUESTIONS ASKED AS LETTER READ
Yes, it’s a good idea.
Do I
want to
attend a
health
check?
25
Yes but …my life, my
circumstance issues
READ LEAFLET
DON’T READ
LEAFLET
No, its not important.
DON’T READ
LEAFLET
No, I don’t want to
think about my
health.
DON’T READ
LEAFLET
TAKE OUT FROM LETTER
Overall the letter is clear but there are different
levels of take out dependant on mental capacity,
reading ability, interest, standard of translation
performed
 Some no understanding
 Some understand NHS logo
 It is a doctors appointment
 For a health check
 For people 40 – 74
 It takes 20 – 30 minutes
26
Learning disabilities
and illiterate
Basic reading skills,
‘lazy’ translators,
less interested
skimmers
TAKE OUT FROM LETTER
 You can change it if it not
convenient
 For these specific illnesses
 To help prevent or spot these
illnesses early
 This is what will happen in it
 Look at the leaflet for more
information
Only the word cholesterol can be difficult
but meaning not required for good
understanding of letter.
27
Higher level of
reading skills, more
time, more interest,
more commitment
to health
LETTER DEVELOPMENTS
• Also include GPs address at
top of page
• Some don’t see this as an
appointment, which
diminishes importance.
• GPs could increase take up
in vulnerable groups where
they know or suspect
reading skills are low by
including a filled out
appointment card in the
envelope
28
LEAFLET
Level of attention given varies
Some don’t read, just look
At the front cover
-Too onerous
- Not interested in detail
until just before appointment
-have already decided if
they will attend or not
29
Others read in detail
When there is lots of
new news for them
When they have lots
of free time
When particularly interested
in free services
When trying to be diligent
COVER
• Cover take out varies according to
literacy skill
• The illiterate can interpret the cogs as
different parts of the body – brain,
mouth, throat. Which gives no
understanding of CVD
• Some focus on ‘free’ and ‘health
check’, then see the visuals as
illustrating different part of the body
and the illnesses they can have
• A few understand the front cover
entirely and the interconnectivity of
CVD
30
LEAFLET COVER
• We recommend adding 40 – 74 on front cover to
reinforce relevance
31
LEAFLET
• For those who have the literacy skills and engage
with the leaflet its meaning is clear.
• Others can view it as the unnecessary extra – ‘the
glossy marketing bit’
• The leaflet’s role as influencer is limited, as most
have decided to attend before they have read the
leaflet
• The most significant influences of whether a person
will or will not attend are down to overcoming the
barriers in their own lives, attitudes and needs and
not the written communication.
32
LEAFLET
• Identifies risk
• Identifies benefit
• But already assumed by
most who read
33
LEAFLET
• Interesting new news
for some. Makes the
leaflet feel worth
reading.
• ‘Type 2 diabetes’ can
be an unfamiliar term
for many
• Confirms attitudes that
it is worth attending
34
LEAFLET
• Some don’t get this far
• See this as a reiteration
of the letter
• Most focus on the check
rather than what
happens afterwards.
Can be surprised when
they consider it might
require a second
appointment
35
LEAFLET
• Least read section
• In our sample all who
read this far did not
need these questions.
Already knew they
would attend.
• Request from support
workers for clear
direction to
translations on the
back page
36
DEVELOPMENTS
• Important to have translation of letters
• Have clear direction for support workers /family
carers to translation
• Consider an audio version of the translation – basic
points only like the letter for non readers
– In English
– In Bengali, Urdu, Hindi, Gujarati, Punjabi
• Put the age range on front page to reinforce sense
of relevancy
37
LANGUAGES
• Translations are also requested in the following
languages:
–
–
–
–
–
–
–
38
Kurdish
Tigrinya (Eritrean language)
Amharic (Ethiopia/Eritrea)
Farsi
Czech
Hungarian
Bulgarian
THE LETTER AND LEAFLET
When they are engaged with, read and understood
the letter and leaflet are effective at
encouraging attendance.
However, amongst these vulnerable groups more
support is required.
39
NEEDS OF SPECIFIC GROUPS
40
GYPSY AND TRAVELLERS
41
GYPSIES AND TRAVELLERS
Sample
• 4 women from the Cottingley Site in Leeds
• 1 ‘roadside’ man
• 2 women living in houses
• 1 GATE support worker – health visitor
42
ATTITUDE TO HEALTH
• Health not top of mind for men and many women
• Women focus on kids health
• Women more aware of and interested in health
• Men do not think about health until ill
• None aware that they are a community more at risk of
CVD than broader population
– Risks resonates once explained – lots of family history
43
ACCESS TO GPS
• Feel excluded and self exclude from health services
• Can feel GPs don’t want them and don’t like the way
they are treated
– Think GPs and their HCPs see them and their children as
‘trouble makers’
– Can prefer to access emergency out of hours treatment to
avoid GPs
• Some, particularly roadside, are not registered
• Some are registered in different cities
– Hang on to a sympathetic GP
• Some are registered
– Set up systems with local pharmacist to receive mail (and
repeat prescriptions) from doctor. Pharmacist rings when
new post has arrives and reads it to patient.
44
GYPSY AND TRAVELLERS KEY
BARRIERS
Illiteracy
Awareness of
CVD risks
Attitude to GP
Attitude to
prevention
in health
Transport
Access to post
45
GYPSIES AND TRAVELLERS - BARRIERS
• All able to collect mail, either because live on static
site or house or have made an arrangement with a
friend or pharmacist (when need repeat
prescription)
• Some 40+ illiterate
– ‘scholar’ e.g.. child, friend, support worker or even
pharmacist asked to read it (probably letter only for gist)
• Needs to feel important enough to get someone to
read
– Recognise NHS logo
– Communication of age on leaflet would help relevance
46
GYPSIES & TRAVELLERS - BARRIERS
• Once content of letter understood…..
NOT INTERESTED
INTERESTED
• Practical Barriers
– Too far/difficult to
travel to GP on bus
– May have to take
children
• Men:
–
–
–
–
Not a priority
See self as fit
Don’t go to doctor unless ill
See health check as indulgent See
self as too busy
– Don’t value preventative health
• Can expect health
check to have broader
• Both men and women:
remit
– Don’t see as particularly relevant
to themselves
47
GYPSIES AND TRAVELLERS
They just plain simple they do not care about us, they
are doing what Hitler done, shoot all the bloody
gypsies, that’s what it is (laughter) F61
Travelling people is not like ordinary people, they’ve got
their own way of living. If they get a cold they won’t bother
with the doctors, because they know it’s not really bad. It’s
got to be bad before they go and do something about it,….
especially men. Men don’t like going to doctors, I wouldn’t
go myself except I’ve got to. They don’t worry about it.
Until they are poorly and when they feel ill and they’ve got
to go they go. M 60s
48
GYPSIES AND TRAVELLERS - SOLUTIONS
For the health check to seem worthwhile and
increase chance of attendance additional
communication is required
• Aural communication days through trusted
spokespeople
– E.g. GATE
– Use word of mouth to spread message
– Explain potential problems more than in current leaflet, what
could having a stroke mean for their lives
– Give more time to sessions to allow their style of
communication
• Place health checks away from the GP (for some)
– With gender specific HCPs if possible
49
GYPSIES AND TRAVELLERS - SOLUTIONS
• Have a system that can react to the arrival of
roadside camps
– different times of year
• Also use pharmacists and trusted GPs to
communicate importance of Health check
• Use text messaging – e.g. your GP wants you to
come for a health check (for all people 40 – 75) next
time you are in the area ring for an appointment.
• Ring (mobile) to invite
50
ASYLUM SEEKERS AND REFUGEES
51
ASYLUM SEEKERS AND
REFUGEES
SAMPLE
• All interviewed via SOLACE
• 2 Kurdish men
• 1 Nigerian woman
• 3 Iranians men
• 1 Ugandan woman
• 1 Eritrean woman
• 1 Support worker
52
ATTITUDE TO HEALTH
• Expect themselves to have poor health
– Because of trauma of life so far
– View own life as unhealthy, with lots of stress
– Poor health may also be a reason to be allowed to stay in UK
•
•
•
•
•
All have very positive attitude to a health check
Have time to attend (if not working)
Worried about own health
See access to free NHS as a major benefit
Expect to be denied / rejected so delighted to be
included
• Have less knowledge of CVD and their own risks, eager
to gain knowledge
53
ACCESS TO GPS
Relatively easy to access GP services.
• Once registered as asylum seeker, taken to NAS
accommodation. When taken to accommodation shown
local facilities including the local GP.
– Can have short gaps in GP registration when move NAS
accommodation
• Failed asylum seekers may be nervous to register
because fear deportation if they give an address. But in
reality GPs do not check asylum status.
• 3 in sample had recently been invited to NHS health
check
54
ASYLUM SEEKERS AND REFUGEES KEY
MOTIVATIONS TO ATTEND
Fear around
health
Want to conform
to GP request
Want to access
benefits of the UK
55
Lots of free time
Want
to learn more
about health
ASYLUM SEEKERS AND REFUGEES KEY
BARRIERS
56
Language
English Literacy
Time off work
Health
connected
to spirituality
for some
Africans
ASYLUM SEEKERS AND REFUGEES
I would do as I am
instructed to improve
my health (m)
The best form of
health prevention is
praying and reading
the bible… living your
life under the will of
god. (f)
There is no reason not
to go unless I am a
mad person (m)
58
(if I am depressed) I leave it, I don’t care
about my life any more. (m)
Would she attend? Yeah she
don’t joke about that. She says
no one pays for this and this is for
free so if I am getting this
because people are thinking for
my health I should get up and get
help, it’s not a big deal for me to
go there, where ever it is (f)
ASYLUM SEEKERS AND REFUGEES KEY
SOLUTIONS
• Provide clearer access to translation help
• Increase number of languages
• Provide a translation of the letter too
• Engage support organisations to promote health
checks (Solace, Pafras, BHI, Refugee council)
– Provide clarification as to who is and isn’t eligible
59
PEOPLE WITH MENTAL HEALTH
PROBLEMS
60
MENTAL HEALTH
SAMPLE
• We interviewed people with mental health problems
across almost all target groups - homeless, asylum
seekers, African Caribbean, Gypsies, Learning
Difficulties (8 in total)
• 2 support workers – 1 working with homeless and 1
from a Community Psychiatric Support Team
61
MENTAL HEALTH SUFFERERS
Attitude to health in this group is completely
dependant on their state of mind
• When feeling positive and in
control, looking after your
health and attending a
health check can feel
entirely possible
62
• When feeling vulnerable or
depressed it can seem an
impossible and pointless
task
MENTAL HEALTH SUFFERERS
Additionally there are those within the system and
those outside it
Currently under medical care
• Regularly see GP for
prescriptions
• Psychiatrist and psychiatric
support teams more aware of
physical health impact of antipsychotics (particularly
diabetes)
• Likely to already be monitored
for CVD
63
Not under any medical
care/not a service user
• Life likely to be far to
chaotic to turn up for a
health check
• Can have negative
relationship to GP
• Can feel suspicious
• Requires GP to identify
mental health need
MENTAL HEALTH SUFFERERS KEY
BARRIERS
Depression and
Psychosis
Attitude to
longevity
Attitude to GP
64
Transport
Literacy
MENTAL HEALTH SUFFERERS KEY
MOTIVATIONS TO ATTEND
Worry about own
health
Want to discuss
mental health
probs
65
MENTAL HEALTH SUFFERERS
This is the 49% 51% thing… With my depression they obviously talk
about suicide and its like 49% yes I will do it and 51% is no I won’t.
If, I wouldn’t sit plan to go and hang myself or take an overdose
because I am a coward, pain eughh, but the other 51% which is the
side that says no you ain’t gonna do it sort of says well why don’t
you get cancer cos that would be alright because you would die. Just
get a terminal disease like aids or cancer or a brain haemorrhage
and just be dead, that would be better because you wouldn’t have
to kill yourself. So yes I think it’s good but 51% thinks I’m not really
bothered if I drop dead. The way I am feeling at the moment with
life I wouldn’t really mind if I had a stoke or a brain haemorrhage.
But then there is another part of me if it were a good day I would
be like yeah lets go and do it. And there is a family history of things
like strokes.
66
MENTAL HEALTH SUFFERERS SOLUTIONS
• Engage community psychiatric teams with promoting
the Health Checks
• Ensure all more general support services for
vulnerable groups are aware of the increased risk
those using anti-psychotics have of developing CVD
and diabetes and encourage attendance
• Encourage GPs to promote health check to those
with mental health needs
67
HOMELESS
68
HOMELESS
• Sample
• 1 group (including a woman)
• 6 depth interviews
• 2 support workers – 1 at St Anne’s, 1 at St George’s
Crypt
• More men than women are homeless in Leeds and
most are under 40
69
ATTITUDE TO HEALTH
Attitudes to health can be split
according to current outlook on life
• Health is very important • Health is a low priority
• ‘It is all I have’/’ I need • Hard to focus on the
it to survive’
future/live day to day
• Can be easy to eat
• When in a self
healthily and get
destructive phase can be
exercise
disinterested in own
• Especially when in a
health and resistant to
phase where want to
change
change
70
ACCESS TO HEALTHCARE
• Long term homeless can be most informed about the
system and where to access support
• More recently homeless have more problems accessing
healthcare
• However as soon as in contact with a support
organisation access to healthcare and information is
much easier
– Leeds Street Team and St George’s Crypt directs the newly
homeless there to NFA team/ St Anne’s
– Delivers a respectful and well regarded service
• St Anne’s can be used as a ‘care of’ address
– But this facility only kept open for 2 weeks if person does not
pick up their post
71
HOMELESS KEY BARRIERS
Lack of
desire to look
after self
Not telling GP so
post never reaches
Focus on
day to day
survival
Language
New to
homelessness
72
Drug and Alcohol
addiction
Mental health
HOMELESS KEY MOTIVATIONS TO ATTEND
73
Have time to
attend
Have time to
read literature
Want personal
attention
Worry about own
health
HOMELESS
I’ll be honest, what would
attract me is that I’m the star
in my own movie (m)
There are times when it (a
health check) just wouldn’t
be on your radar (m)
If they find anything wrong with
me they can fix it (m)
(Sigh) No important in the
past, no important in the
future, just now. OK (m)
I think the reason it being done here (St Anne’s) you get
respect from the doctors and nurses.. They don’t talk
down to you. They respect you. They realise that because
there are problems you are not half baked (m)
74
HOMELESS SOLUTIONS
• Hold health checks in a trusted place e.g.. St Anne’s
• Encourage support services to direct homeless people
to health checks
• Have posters at all services and shelters and ads in
the Big Issue
• Have print outs of leaflet in many languages available
in shelters and services.
• Include maps of how to get to the place carrying out
the checks
• Communicate age on front cover of leaflet
• Consider text invite from GP
• Free phone number on letter
75
PEOPLE WITH LEARNING
DISABILITIES
76
LEARNING DISABILITIES
• Sample
• 2 x women with learning difficulties
• 1 support worker (PIA)
• 1 home carer
77
ATTITUDE TO HEALTH
• Short term attitude to health
– E.g. being overweight is bad for your knees and makes it
difficult to walk
• Difficulty understanding prevention, risk and
consequences
• Care of their health integrated into their lives by
state and carers
78
ACCESS TO HEALTHCARE
• Those with more severe learning disabilities very
connected into NHS support
– However easy read materials can be hard to access
• Some with much milder learning disabilities may be
outside the system
– See own health as low priority
– Only driven to act by an immediate problem
– Chaotic life can make it hard to attend appointments
79
LEARNING DISABILITIES KEY BARRIERS
Understanding
prevention and
risk
Organisational
skills
Depression
Literacy/
understanding
80
Seeing Health Check
Simply as a lecture
LEARNING DISABILITIES KEY MOTIVATIONS
TO ATTEND
Told to attend,
happy to follow
instruction
81
Want to be
healthy
LEARNING DISABILITIES – SOLUTIONS
• Engage NHS Leeds carers to encourage attendance
– Help carers access easy read version
• Shorten easy read version to cover:
– State the purpose as to help you be healthy/keep your
heart healthy
– List what happens in the check
– Explain meet again for results and advice
• Use support organisations to engage harder to reach
people
• (GPs and or social workers required to identify who
might need more help in wider community)
82
AFRICAN CARIBBEAN COMMUNITY
83
AFRICAN CARIBBEAN
SAMPLE
• 2 support/community workers
• 6 men
• 2 women
84
ATTITUDE TO HEALTH
• On the whole this community do not hold particularly
different in attitudes to mainstream population
• Good awareness that heart disease, stroke and diabetes
is prevalent in their community
– via prominent young deaths and health care education
– aware a traditional diet can have negative health implications
• Men less likely to consider their health until they are ill
• 65 – 74 year olds (if not already in GPs care) thought to
be a particularly hard target to engage
– Prefer traditional herbal approach to health
85
ACCESS TO HEALTHCARE
• All likely to be registered with GP
• Some do not like their GP and therefore avoid going
– Do not feel listened to or given enough time
86
AFRICAN CARIBBEANS KEY BARRIERS
Male attitude
to health
Time off work
Culture of privacy
Traditional herbal
practices
87
Low sense of
importance
AFRICAN CARIBBEAN MOTIVATIONS TO
ATTEND
Desire to look
after long term
health
Knowledge allows
prevention
and treatment
Know CVD relevant
to their community
88
AFRICAN CARIBBEANS
It’s conducive to my
health to go and my
health is my wealth (F)
We have no
community leader,
the community
leader is a waste of
time (m)
89
You tend to think, it
doesn’t matter, I’ll ride
this out (m)
I’d read and act.. To
ensure I remain healthy,
prevention is better than
cure..it’s better to deal
with things before they are
full blown (f)
AFRICAN CARIBBEAN SOLUTIONS
• Use community/support groups to emphasise
significance and potential impact on their lives and that
this is preventable
– diabetes might lead to amputation or erectile dysfunction
– stroke might lead to not being able to walk
• Use community groups to access hard to reach older
traditionalists (hold additional clinics away from GP)
• Also engage church leaders
• Distribute posters in local male frequented cafes e.g..
‘Dutch Pot’, ‘Cabin’ ‘Counter fish and chip shop’
• Encourage GP to include a filled out appointment card
with letter to make appointment feel more fixed and
pressing
90
AFRICANS
91
AFRICAN SAMPLE
• 4 support workers (2 x BHI, 1 St George’s Crypt, 1
Solace)
• 5 women
• 2 men
92
ATTITUDES TO HEALTH
• Gender divide:
– Women more motivated than men to look after their health
– Men prefer to ignore health unless feel ill
• Can feel the UK is a sick place, feel more unhealthy here
• Can feel that looking after your body is part of their
religion (both Christianity and Islam)
• Less knowledgeable of health and illness, than other
groups
– Keen to get more information on health
– Don’t see selves as a vulnerable group re CVD
• Value free healthcare and respect the doctor (likely to
do what he/she wants of them)
93
ACCESS TO HEALTH CARE
• Good access to healthcare, quickly registered
94
AFRICAN KEY BARRIERS
Male attitude
to health
Time off work
Sense of
importance
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AFRICAN MOTIVATIONS TO ATTEND
Value free
healthcare
Desire to look
after long term
health
Respect GPs
request
96
Religion
encourages
looking after your
body
Good health allows
you to look after
family better
AFRICAN
We would always think
health checks, its for
aristocrats… a luxury
Where we grew
up, having medical
check up is a rich
thing.. aristocrats,
yeah its like a
luxury
I am a little concerned about
my health when I am getting
ill, but when I am fine I don’t
think about my health (m)
You should get the pastor to
tell everyone to go (f)
It’s the women who will get
the men to go (f)
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AFRICAN - SOLUTIONS
• Make sure the letter is clearly from GP – respect own
doctor and more likely to attend
• Include a appointment card to make it seem more fixed
• Engage Imam (or assistant) and Pastor to communicate
importance of looking after your body for god (as part of
notices not just leafleting)
– Even going as far as to quote from the scripture/Koran
– To encourage men and women to prioritise attending
• Use community groups to communicate – e.g.. Nigerian
community in Leeds
– Express particularly vulnerability of this target group
98
SOUTH ASIANS
99
SOUTH ASIANS
• Sample
• 1 x family session
• 1 x support worker
• 1 x mini group of older women (all who had CVD
issues)
• 1 x male depth interview
• 1 x female depth interview
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SOUTH ASIANS –
ATTITUDE TO HEALTH
• Women can be highly engaged:
– Carers for the whole family – so concerned about how
everyone in the family is doing
– As the care-giver need to remain in good health
– Recognise the importance of health
• Men are less interested in their health status:
–
–
–
–
Whilst care of the body is integral to Muslim faith..
… so is fatalism
Men see selves as too busy to attend doctors
Men’s health is to some degree controlled by external
forces – sedentary work/ diet controlled by women
– Low overall engagement with health risks (smoking; diet;
exercise)
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SOUTH ASIANS –
ATTITUDE TO HEALTH
… reactive – they’re not proactive. Unless they’ve had
a medical diagnosis they won’t act on it until after
they’ve had it. We know loads of taxi drivers, they’re
obese, they eat all the junk food, the hours of work...
the messages are there – unless you have a reaction
something that stops them, they’ll carry on. They will
associate religion.. They might not associate it
outwardly but they’ll say, whatever is written for you
is written for you (religion).
(Health support worker)
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SOUTH ASIANS –
ATTITUDE TO HEALTH
Overall there is some awareness that S Asian (men)
in particular are at risk from CVD… several
examples of young deaths (under 40) through
heart attack
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3
SOUTH ASIANS –
ACCESS TO HEALTHCARE
• Access to GPs for women can be complicated:
–
–
–
–
–
Many don’t speak English with any degree of fluency
Many are illiterate in any language
Need an interpreter to go with them to the doctor’s
Rely on family members to go with them to the doctors
Rely on family members to read letters/ communications –
tend only to get ‘topline’ information from family members
• Men can be dismissive of GP service:
– Don’t have time to visit the GP
– Feel the GP doesn’t give them full attention/ highest
quality medication
– More trust of the pharmacist (local community)
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SOUTH ASIANS – BARRIERS
TO HEALTH CHECK
Illiteracy/ ltd info
from letter
Awareness of
CVD risks
Attitude to GP
Attitude to
prevention
in health
Co-ordinating
family members
Language barriers
(women)
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SOUTH ASIANS –
KEY BARRIERS
• Women:
– Family members who act as gatekeepers may not endorse
the health check or be available for the appointment
– Women may not be able to engage with the health check
messages (without the help of translators)
– Expectations of the health check can be high (getting the
full well woman treatment)
• Men:
– Low degree of interest in attendance
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SOUTH ASIANS –
SOLUTIONS
• Wave one: letters inviting the householder to attend
with the offer of interpreter service at the GPs
• Wave two: health check days promoted at local
community centres where interpreters are available
• Within wave two:
– Social element
– Education element – as a group learn what you can do to
improve your cardio vascular health
• Specifically for men: health check to be promoted
through local mosques. End of Friday prayer notices
– Linked to insight around caring for your body..
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SOUTH ASIANS –
SOLUTIONS
• Wave one: letters inviting the householder to attend
with the offer of interpreter service at the GPs
• Wave two: health check days promoted at local
community centres where interpreters are available
• Within wave two:
– Social element
– Education element – as a group learn what you can do to
improve your cardio vascular health
• Specifically for men: health check to be promoted
through local mosques. End of Friday prayer notices
– Linked to insight around caring for your body..
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CONCLUSIONS
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CONCLUSIONS
• When understood the letter and leaflet are clear and
make it easier for those who are keen on the idea of
a health check to attend by giving them all the
information they need.
– Only main development for the leaflet is to communicate the
age range on the front cover.
• However, to reach people in these vulnerable groups
more effectively further support is required. Both to
make sure people can understand the information and
to convinced them that a health check is worthwhile.
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0
CONCLUSIONS
• Additional support to understanding of the letter and
leaflet should be provided by:
– Translating the leaflet and the letter into more languages
– Making it clearer how to access the translations and easy
read version
– Shortening the easy read version
– Having shortened audio versions in different languages
available online
• Additional support to communicating you have an
appointment for a health check
– Adding an doctors appointment card to the letter sent out
– Using text messaging and voice messaging to mobiles
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CONCLUSIONS
• Raising awareness of availability of a health check by
putting up poster and leaving leaflet in appropriate
venues, community centres, shelters and cafes.
• Making the health check feel accessible by holding
them away from mainstream GPs surgeries
– For Homeless - NFA/St Anne’s
– For Gypsies and Travellers - GATE
– For African Caribbean community
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CONCLUSIONS
• Additional support to communicate the benefits and
importance of attending by engaging appropriate
community/support/religious groups
– Engaging the community
– Highlighting the specific relevance to them as a community
(higher risks)
– Explaining more directly what the implications of getting these
problems might mean to their life
– Communicating the importance of health as part of faith
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CONCLUSIONS
• Additional support through NHS services
– GPs raising awareness and persuading patients to attend
– Carers bringing it to the attention of the people they look after
– Community Psychiatric Services also communicating it to the
service users
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CONCLUSIONS
• Once a person has attended their attitude to the
information received is likely to be quite passive
• Most are likely to comply if asked to take medication
but lifestyle changes will be harder for people to take
on board.
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Claro
71a Walmgate
York
YO1 9TZ
01904 673114
Email:- [email protected]
www.claro-research.com
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