What does relationship-based, holistic care look like for South Asian men with long-term conditions experiencing emotional distress?

Problem

People with long-term conditions (LTCs) are twice as likely to suffer from depression than the general population. People with physical-mental comorbidity have a poorer quality of life, worse clinical outcomes and increased mortality than those with physical conditions alone. South Asians (SAs) are the largest minority group in the UK, and are more likely to have certain LTCs such as diabetes and heart disease. Asians are less likely to recognise symptoms which may represent mental health problems and perceive a need for support. Furthermore, people from ethnic minorities are an under-served group within healthcare services, manifested for example with reduced access and uptake of mental health services. There is limited research on the experiences of men of SA origin with comorbid physical and mental health problems in primary care.

Approach

A qualitative study explored the perspectives of men of SA origin with diabetes and/or heart disease and GPs working in areas with higher densities of SAs. Recruitment for SAs was from community settings and GPs working in practices serving catchment areas with higher proportions of SAs. Semi-structured interviews took place online and were digitally recorded with consent. Thematic analysis was conducted concurrently and informed iterative modifications of the topic guide. Topics explored in interviews included: understanding, experiences and help-seeking behaviour for emotional distress, support received and gaps in services. GPs were also asked about barriers and facilitators to care.

An ethnically appropriate PPIE group was convened and inputted throughout all stages of research.

Findings

Seventeen SA males (from India, Pakistan and Bangladesh) with LTCs and 18 GPs were interviewed. SAs described a lack of trust in GPs due to different health beliefs and unacceptability of treatments offered. GPs related this to poor concordance based on reduced health literacy. The social determinants of distress were described as fundamental to creating inequalities, which were exacerbated by the covid pandemic due to access and language barriers. Relationship-based care was felt to build trusting relationships between GPs and SAs with LTCs experiencing emotional distress by understanding patients holistically within their life circumstances and co-navigating cultural health beliefs. SAs and GPs described the need to build cultural capital within the SA community by culturally-sensitive care and services and partaking in community outreach and engagement programs.

Consequences

The findings provide a greater understanding of what relationship-based and holistic care mean for SAs with LTCs experiencing emotional distress. This should inform its recognition and management, and can be used to overcome barriers to care and create a shared understanding between SAs and GPs.

The research has the potential to influence policy-makers and commissioners about service provision, given the need described by both GPs and SAs with LTCs for culturally-sensitive services and developing cultural capital are a means of building trust.