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Kingston University psychologist presents to Cabinet Office on how to engage with Black, Asian and minority ethnic communities most at risk from COVID-19

Kingston University's Dr Tushna Vandrevala presented to 140 civil servants on health messaging for Covid-19

The Cabinet Office has invited a health psychologist from Kingston University and her research partners to present their findings outlining why BAME communities may be disproportionately affected by Covid-19 and how targeted health messaging could help mitigate its impact.

Dr Tushna Vandrevala was joined by Professor Jane Hendy of Brunel University London and Professor Aftab Ala of the University of Surrey, Royal Surrey NHS Foundation Trust and King's College Hospital NHS Foundation Trust for the presentation to 140 Cabinet Office civil servants.

The pandemic has brought into focus longstanding health inequalities affecting BAME groups in the United Kingdom, with a recent report by Public Health England confirming deaths from Covid-19 are higher among BAME populations. Individuals of Black African or Black Caribbean ethnicity may be at greatest risk of catching and dying from the virus, early evidence suggests.

Dr Vandrevala, whose research focuses on health promotion and risk prevention in vulnerable and hard to reach populations, believes the reasons behind this are much more social-cultural than to do with pre-existing or genetic conditions.

"We know that Covid-19 is disproportionately represented in minority groups. The recent figures show that even when socio-economic deprivation is taken into account, Black and South Asian people who live in the United Kingdom are more likely to die from Covid-19 and that is a really serious issue," Dr Vandrevala said.

Possible explanations are complex and many factored, Professor Ala, from the University of Surrey, explained, and can include people from BAME communities being more likely to live with extended family in multi-generational households, increasing the risk of cross-infection, and some cultural practices making social distancing challenging. "These factors can be compounded by an increased number of individuals working in key and frontline jobs, poor transportation, language proficiency and a distrust of the healthcare system preventing BAME groups from seeking prompt treatment," Professor Ala said.

The presentation by Dr Vandrevala, of Kingston University's Faculty of Business and Social Sciences, and her colleagues was based on lessons learned from a previous study investigating the barriers to viral hepatitis screenings in South Asian communities and how these communities could be reached. "One of the findings from our previous work suggests that South Asian communities delay seeking help because there's a real mistrust in health services and other services, so we need to make sure they feel welcome and not alienated," Dr Vandrevala said.

During the presentation, the research team suggested that the government needed to have engagement strategies for building trust and that BAME communities should feel Covid-19 related messages were for them and about them.

"Our research with first generation migrants suggests they question whether they have an equal place in society and can feel powerless and uneasy about how to voice needing help," Professor Jane Hendy, from Brunel University, said. "Many of those in BAME communities feel ‘outside' or ‘othered' - that they won't be understood or welcome when they engage with health services."

Dr Vandrevala warned that existing public health messages around Covid-19 do not always resonate with Black and Asian communities, whom for many the understanding of risk was much more about collective, family risk rather than individual risk. "One of the questions asked was, how do we change our messaging to make ethnic minorities included? We recommended that they really looked at how to protect rather than alienate – stay at home to protect your family and community is much more powerful than messaging around self-isolation, which exacerbates issues around isolation and stigma," Dr Vandrevala said.

"Covid-19 might be stigmatised in their family and community which can be a barrier to people seeking healthcare outside of their familiar groups. Unless we try and make sure they understand that they are entitled to and worthy of treatment it's unlikely they will seek help," she added.

Other advice included making safeguarding behaviours, such as social distancing, more culturally compatible, giving representation and voice to BAME groups, and working with respected community leaders to help promote important public health messages that were relatable.

During the viral hepatitis case research study, which was funded by the National Institute for Health Research, the researchers successfully engaged South Asian participants by working with faith, community leaders and NHS medical professionals from within their own communities. "They were mistrustful of people from outside, so we had to build trust in the study from an insider perspective," Dr Vandrevala said.

"In our work we have shown that it is possible to build on a trusting relationship with communities and it is important for us to not only engage with members of the community to develop culturally relevant messaging, but also ensure that the messages are communicated in safe spaces. In this context, this might be mosques and temples, rather than asking them to visit hospitals and GP surgeries where they might feel alienated," she added.