Barriers to access and minority ethnic carers' satisfaction with social care services in the community: a systematic review of qualitative and quantitative literature.

As populations age, the numbers of carers overall and numbers of carers from minority ethnic groups in particular are rising. Evidence suggests that carers from all sections of the community and particularly carers from minority groups often fail to access care services. This may relate to barriers in accessing services and service dissatisfaction. The aim of this systematic review was to identify and summarise minority ethnic carers' perceptions of barriers to accessing community social care services and their satisfaction with these services if accessed. The following databases were searched from their start until July 2013: Social Care Online, Social Policy and Research, Scopus, PsychINFO, HMIC, ASSIA, MEDLINE, Embase, CINAHL Plus and AMED. Thirteen studies met the inclusion criteria. Most investigated either barriers to access or satisfaction levels, although three explored both. Only 4 studies investigated minority ethnic carers' satisfaction with social care, although 12 studies reported perceived barriers to accessing services. Few studies compared minority ethnic carers' perceptions with majority ethnic groups, making it difficult to identify issues specific to minority groups. Most barriers described were potentially relevant to all carers, irrespective of ethnic group. They included attitudinal barriers such as not wanting to involve outsiders or not seeing the need for services and practical barriers such as low awareness of services and service availability. Issues specific to minority ethnic groups included language barriers and concerns about services' cultural or religious appropriateness. Studies investigating satisfaction with services reported a mixture of satisfaction and dissatisfaction. Barriers common to all groups should not be underestimated and a better understanding of the relationship between perceived barriers to accessing services and dissatisfaction with services is needed before the experiences of all carers can be improved

Assessing satisfaction with social care services among black and minority ethnic and white British carers of stroke survivors in England.

Overall satisfaction levels with social care are usually high but lower levels have been reported among black and minority ethnic (BME) service users in England. Reasons for this are poorly understood. This qualitative study therefore explored satisfaction with services among informal carer participants from five different ethnic groups. Fifty-seven carers (black Caribbean, black African, Asian Indian, Asian Pakistani and white British) were recruited from voluntary sector organisations and a local hospital in England, and took part in semi-structured interviews using cognitive interviewing and the critical incident technique. Interviews took place from summer 2013 to spring 2014. Thematic analysis of the interviews showed that participants often struggled to identify specific 'incidents', especially satisfactory ones. When describing satisfactory services, participants talked mostly about specific individuals and relationships. Unsatisfactory experiences centred on services overall. When rating services using cognitive interviewing, explicit comparisons with expectations or experiences with other services were common. Highest satisfaction ratings tended to be justified by positive personal characteristics among practitioners, trust and relationships. Lower level ratings were mostly explained by inconsistency in services, insufficient or poor care. Lowest level ratings were rare. Overall, few differences between ethnic groups were identified, although white British participants rated services higher overall giving more top ratings. White British participants also frequently took a more overall view of services, highlighting some concerns but still giving top ratings, while South Asian carers in particular focused on negative aspects of services. Together these methods provide insight into what participants mean by satisfactory and unsatisfactory services. Cognitive interviewing was more challenging for some BME participants, possibly a reflection of the meaningfulness of the concept of service satisfaction to them. Future research should include comparisons between BME and white participants' understanding of the most positive parts of satisfaction scales and should focus on dissatisfied participants

A qualitative study exploring the experiences of African-Caribbean informal stroke carers in the UK

Objective: To explore the experiences of African-Caribbean informal stroke carers in the UK. Design: Qualitative methodology. Setting: Three urban locations in southern England. Participants: Nine African-Caribbean informal stroke carers providing support to a relative with stroke for at least six months. Method: Semi-structured interviews were used to explore both predetermined and unexpected topics relating to any aspects of the carers’ experiences. Interview transcriptions were analysed using inductive thematic analysis. Results: Several themes resembled those identified in previous qualitative studies with informal stroke carers from other ethnic backgrounds. However, new themes emerged which were related to the carers’ ethnicity and cultural values. These themes were ‘understanding of individual needs’, ‘battle’, ‘independence from services’, ‘faith in God’, ‘family ties’ and ‘avoiding institutionalised care.’ Conclusions: This small-scale study provides an insight into African-Caribbean stroke carers’ own perspectives. These have much in common with those of other ethnicities, but also exhibit important areas of difference. Several themes indicate issues with existing service provision. Stereotypical assumptions about informal stroke carers based on ethnicity appear to be unwarranted; there is diversity within ethnic groups. Individual contexts of ethnicity, culture and religious beliefs shape expectations and perceptions. Several themes signpost service attributes that are perceived as relevant to acceptability by African-Caribbean stroke carers. Recruitment challenges could be addressed in future projects with ethnic minority carers by collaborative planning and the development of individual relationships with key informants