Significant and persistent challenges to accessing healthcare, throughout the pandemic and beyond, have perpetuated inequities amongst minoritised communities living with chronic conditions and disabilities: qualitative findings from the CICADA study

Problem

Those living with chronic conditions and disabilities and those from minoritised ethnicities suffered a disproportionate burden during the COVID-19 pandemic both in terms of infection rates, risk and challenges with access to care (1, 2). The CICADA study is a national, mixed methods study, which has explored the intersectional impact of ethnicity, migration and chronic conditions on health and social care during the COVID-19 pandemic and beyond (3). The study aimed to both explore lived experiences and to identify assets and coping strategies which may be leveraged to improve health outcomes in future. In this analysis we have focused on the qualitative data concerning healthcare access. 1. Núñez A, et al., Int. J of environmental research and public health. 2021;18(6):2980.2. White C, et al., ONS, UK Gov, 2020.3. Rivas C, et al., JMIR research protocols. 2022;11(7)

Approach

The research team worked in partnership with a network of UK migrant charities, to conduct semi-structured interviews. We also conducted 4 community workshops at 2 subsequent time points. We aimed to capture the voices of those who may not normally access the research process, including undocumented migrants. The conversations were audio recorded and professionally transcribed. They were analysed using a framework approach to identify key themes.

Findings

228 interviews were analysed (South Asian (40%), Arab/N.African (26%), Black African (13%), Central/Eastern European (11%), White British (10%)). Participants had a range of conditions including sensory disability, amputations, neurological, mental health, cardiovascular and pulmonary conditions. Overall, health status was considered to have deteriorated for most during the pandemic. Access to healthcare presented a significant challenge. Key themes identified were difficulties accessing appointments; reduced rapport with and support from healthcare teams; specific challenges with physical and mental therapy being given online; language, cultural and digital access barriers; increasing use of alternatives to primary care (including escalation to accident and emergency and turning to private community doctors and unregulated support groups); and specific access barriers associated with hybrid care for certain disabilities and conditions.

Consequences

In moves towards establishing a hybrid healthcare system for primary care, consideration needs to be given to those living with disability and chronic conditions and from minoritised ethnic groups, to ensure their needs are met.