This commissioning brief is intended to form the first of a series of briefs that address the topic of health inequalities experienced by disadvantaged/underserved groups in the UK. This brief focuses on improving access, experience, and uptake of services in groups from ethnic minority backgrounds. The Health and Social Care Delivery Research Programme intends to advertise further briefs that will focus on disadvantaged/underserved groups and improving the organisation and delivery of services, including tackling health inequalities experienced by these groups.
Scope
The Health and Social Care Delivery Research (HSDR) Programme wishes to commission research on a series of challenges that face individuals from groups who experience disadvantage in service access, service experience, and outcomes. Disadvantaged groups are those that include a higher proportion of individuals and groups experiencing one or more factors among poverty, social exclusion, discrimination, or violence than the general population. These groups are typically those affected by structural or systemic barriers and include, but are not limited to, individuals from ethnic minority backgrounds, migrants, disabled people, and those with impairments and isolated elderly people. The ways in which different disadvantages interact and affect experiences of health and care within and between different groups are also of interest, recognising the heterogeneity within groups.
In this first call of the series, the HSDR Programme invites research applications focused on improving service access, uptake and experience of health and social care services and outcomes in people from ethnic minority backgrounds. These challenges are multifaceted and broad including the intersection with socioeconomic disadvantage, structural racism, and discrimination that increases health inequalities. Researchers may wish to focus on particular groups or services but should make the case for transferable learning on equity across health and care systems. Researchers should not only consider evaluating new interventions or services, but also existing interventions or services that are or could be modified and culturally adapted or specifically designed for groups from ethnic minority backgrounds.
For the purpose of this call, groups from ethnic minority backgrounds are defined as those who are not White British or White Irish. Ethnic groups meeting this definition (with reference to ONS Census categories) include: Asian or Asian British; Black, Black British, Caribbean or African; Mixed or Multiple ethnic groups; and Other ethnic groups. People who identify as white but not as White British or White Irish – this might include Gypsy, Roma, or Irish Traveller populations – are considered in scope for this call. It is acknowledged that classifications of ethnicity may vary, and potential applicants with queries about remit are encouraged to contact the HSDR Programme to discuss. Researchers may wish to refer to the UK government guidance on writing about ethnicity.
Reducing health inequalities is a priority in the NHS and for research. NIHR has also stated its ambition to enhance the diversity of its research portfolio.
Identified research need
Poorer and otherwise more socially disadvantaged people who face particular barriers to accessing preventive care (for example, screening or health check-ups), are less likely to be referred for specific specialist investigations and more likely to experience worse outcomes. The NHS Race and Health Observatory’s recent rapid review highlighted patterns of inequality, particularly in areas such as mental healthcare. Access and uptake of services in relation to ethnicity are affected by factors such as availability and accessibility of health information, interaction and communication with professionals, cultural beliefs, language barriers and geographical location and timing of services (Baird 2021, Rivas, Ongoing).
Areas of interest
The HSDR Programme is looking to fund ambitious projects to design and evaluate complex interventions which will improve access to and experience of health and social care services, consequently improving health and care outcomes for people from ethnic minority backgrounds. Studies should be theoretically informed and use robust methodology to evaluate promising interventions, considering national learning and transferability while paying attention to context. This will include issues of organisational culture, power relations and structural influences on practice and experience.
Research projects should include thoughtful and embedded engagement with underserved populations throughout the study. Effective use of relevant national routine data should be considered, while being mindful of challenges in quality and completeness of data on ethnicity and how these might be addressed in the data collection and analysis. Innovations in methodology for complex systems research will be welcome but must be carefully described and justified.
Examples in the HSDR portfolio of high quality studies in related areas include:
- Mixed methods evaluation of a Culturally adapted Family Intervention (CaFI) co-created with African-Caribbean people diagnosed with schizophrenia and their families (Edge 2018);
- Mixed methods study of intersectional impact of ethnicity and other dimensions in experiences of the COVID pandemic (Rivas, Ongoing);
- Evaluation of a tailored asthma management programme for children from ethnic minority backgrounds (Lakhanpaul 2014);
- Evidence synthesis of interventions to improve therapeutic communications between Black and other groups from ethnic minority backgrounds who come in contact with specialist mental health services and the staff providing these services (Bhui 2015).
Research areas of interest for this call could include (but are not limited to) evaluation of interventions that:
- Seek to improve awareness of access to health and social care services for groups from ethnic minority background/s, from peer advocacy or navigation/link workers to use of outreach and other service changes.
- Are aimed at improving and increasing uptake of health and social care services including early intervention and screening services for groups from ethnic minority background/s.
- Seek to enhance communication between health and social care professionals and groups from ethnic minority background/s, including accessibility of information, language translation and health literacy considerations.
- Are tailored or culturally adapted or specifically designed interventions to improve the experiences of health and social care services for groups from ethnic minority background/s, including models of service provision.
- Improve cultural competency and capability of the health and social care workforce.
Successful applications must clearly demonstrate the following:
- An engagement and inclusion plan agreed with the relevant groups from ethnic minority background/s of interest at every stage of the application
- An impact pathway that engages services users, service providers and those who are likely to use the outputs from the research
- A dissemination plan to maximize the benefits of the outputs of the research.
Applicants may find the toolkit (output of the NIHR-funded CICADA study) on general considerations for research with minoritised ethnic groups with chronic conditions and disabilities, a useful resource when planning their application
Research Inclusion
The NIHR is committed to creating a diverse and inclusive culture, as outlined in our Equality, Diversity and Inclusion strategy 2022-2027. We therefore encourage applications from people from all backgrounds and communities. We are committed to having leadership and teams that contain diverse skills and experiences.
All NIHR research proposals need to demonstrate that they have met the requirements of the Equality Act (2010). Researchers should consider being diverse and inclusive in the design, planning, conduct, impact, and dissemination of their research study.
NIHR also welcomes partnerships between research active and other less active institutions and those located in geographical areas of deprivation. Applicants are also expected to pay attention to populations that have been underserved, to conduct research in locations where the need is greatest.
General guidance
The HSDR Programme supports applied research with the aim of improving both health and social care services across the nation and is open to any appropriate methodological approaches to answer the proposed research question(s). The approach must be fully explained and justified.
To enhance the success of a research proposal, a clear theory of change and pathway to impact, with links into the NHS and social care services delivery, is suggested. It is useful to consider in the research study design how outcomes could be scaled up to maximise impact and value for money across the NHS and social care services – the focus is on applied research with tangible impacts that improve the quality and organisation of health and social care services. This includes stakeholder engagement and the development of processes, tools, and guidelines to strengthen workforce capacity. Please see the HSDR Programme for further general information.
Research proposals should be co-produced with national organisations, professional bodies, health and social care service professionals, and service users. Links with health and social care planners and professional bodies are required to ensure impact and scaling up of research findings to benefit the wider health and social care system.
The COVID-19 pandemic is having a significant impact across the health and social care system. As this research may be conducted during the COVID-19 response and recovery period, applicants should consider how the impact of the COVID-19 response and recovery may affect the deliverability of their research.