Pain management programmes for non-English-speaking black and minority ethnic groups with long-term or chronic pain

Increasing ethnic diversity in the UK means that there is a growing need for National Health Service care to be delivered to non-English-speaking patients. The aims of the present systematic review were to: (1) better understand the outcomes of chronic pain management programmes (PMPs) for ethnic minority and non-English-speaking patients and (2) explore the perspectives on and experiences of chronic pain for these groups. A systematic review identified 26 papers meeting the inclusion criteria; no papers reported on the outcomes of PMPs delivered in the UK. Of the papers obtained, four reported on PMPs conducted outside the UK; eight reported on ethnic differences in patients seeking support from pain management services in America; and the remaining papers included literature reviews, an experimental pain study, a collaborative enquiry, and a survey of patient and clinician ratings of pain. The findings indicate a lack of research into UK-based pain management for ethnic minorities and non-English-speaking patients. The literature suggests that effective PMPs must be tailored to meet cultural experiences of pain and beliefs about pain management. There is a need for further research to explore these cultural beliefs in non-English-speaking groups in the UK. Culturally sensitive evaluations of interpreted PMPs with long-term follow-up are needed to assess the effectiveness of current provision. Copyright © 2015 John Wiley & Sons, Ltd.

Black and minority ethnic graduate entrepreneurs: motivations, characteristics and access to finance

This paper draws upon four case studies to examine characteristics, entrepreneurial motivations and access to finance of black and minority ethnic (BME) graduates in the UK. We find that BME graduates starting a business are motivated by a desire to “do better”, and rely heavily on personal savings and family sources for start-up capital. In addition: • There is no conclusive evidence that suggests in this study that BME graduates entered entrepreneurship because of unemployment; with the exception of a few, all had jobs prior to entering self employment. • “Glass ceilings” were often cited by participants of the case studies as a kind of barrier, but there was reluctance to specify exactly what that meant. • Also, lack of satisfaction from working for others is considered to be a strong motivator for entering self-employment but other reasons, to be one’s own boss and the prospect of higher earnings, are also strong motivators. There is, therefore, a need for support agencies and universities to recognise the distinctive nature of BME graduate enterprise in order to provide effective solutions for different groups. This might include a) work experience, b) advice on an adequate capital structure at start up, c) adequate funding and training, and d) appropriate training for all graduates in basic business education.

Ethnic groups as market segments: implications of the demand structure

Ethnic market potential in Britain has not yet been thoroughly researched. Important recent trends have focused mainly on the affective and emotional aspects of ethnicity, and included deliberations on the emergence of a revitalised neo-ethnic consciousness; its identification; politicisation, and the impact on it; of a rising third-world consciousness. This investigation attempts to take cognizance of the consuner demand of the ethnic Asian and West Indian groups, as specific market segments. It discusses the rationale for ethnic segmentation on the underlying premise, that the starting point for all product marketing is a response to perceived market opportunities. On the basis of this approach, the UK laundry detergent and automobile markets were investigated; as being representative of product categories constitutirg extremes along the purchase-search-time continuun in consuner decision-making. Ethnic groups were further analysed for their retail patronage patterns; media usage, and the differential effectiveness of alternative advertisirg strategies. The basic technique of marketing research namely the sample survey, was used with the aim of applying scientific techniques in obtaining information on ethnic groups. The integrated marketirg framework utilised allowed, moreover, for the collection of market research data on the specific issues of ethnic product penetration dealing with retailing, advertising and product promotion. The evidence highlights the fact that the cultural orientations of ethnic groups are instrunental in providing for differential demand structures. It points to the answer that ethnicity is an anchor not only for a deeper sense of identity; but also serves as a focus for the economic interests of ethnic groups. On this basis it is argued here, that since cultural levelling would eventually produce stagnation; current marketing strategies should utilise ethnic diversity as an econanic artifact; which; per se is necessary for profitability and growth; especially in innovative product design and development.

Evaluation of the Heart of Birmingham teaching Primary Care Trust (HoBtPCT): My Choice Weight Management Programme:report commissioned by Heart of Birmingham teaching Primary Care Trust

This report details an evaluation of the My Choice Weight Management Programme undertaken by a research team from the School of Pharmacy at Aston University. The My Choice Weight Management Programme is delivered through community pharmacies and general practitioners (GPs) contracted to provide services by the Heart of Birmingham teaching Primary Care Trust. It is designed to support individuals who are ‘ready to change’ by enabling the individual to work with a trained healthcare worker (for example, a healthcare assistant, practice nurse or pharmacy assistant) to develop a care plan designed to enable the individual to lose 5-10% of their current weight. The Programme aims to reduce adult obesity levels; improve access to overweight and obesity management services in primary care; improve diet and nutrition; promote healthy weight and increased levels of physical activity in overweight or obese patients; and support patients to make lifestyle changes to enable them to lose weight. The Programme is available for obese patients over 18 years old who have a Body Mass Index (BMI) greater than 30 kg/m2 (greater than 25 kg/m2 in Asian patients) or greater than 28 kg/m2 (greater than 23.5 kg/m2 in Asian patients) in patients with co-morbidities (diabetes, high blood pressure, cardiovascular disease). Each participant attends weekly consultations over a twelve session period (the final iteration of these weekly sessions is referred to as ‘session twelve’ in this report). They are then offered up to three follow up appointments for up to six months at two monthly intervals (the final of these follow ups, taking place at approximately nine months post recruitment, is referred to as ‘session fifteen’ in this report). A review of the literature highlights the dearth of published research on the effectiveness of primary care- or community-based weight management interventions. This report may help to address this knowledge deficit. A total of 451 individuals were recruited on to the My Choice Weight Management Programme. More participants were recruited at GP surgeries (n=268) than at community pharmacies (n=183). In total, 204 participants (GP n=102; pharmacy n=102) attended session twelve and 82 participants (GP n=22; pharmacy 60) attended session fifteen. The unique demographic characteristics of My Choice Weight Management Programme participants – participants were recruited from areas with high levels of socioeconomic deprivation and over four-fifths of participants were from Black and Minority Ethnic groups; populations which are traditionally underserved by healthcare interventions – make the achievements of the Programme particularly notable. The mean weight loss at session 12 was 3.8 kg (equivalent to a reduction of 4.0% of initial weight) among GP surgery participants and 2.4 kg (2.8%) among pharmacy participants. At session 15 mean weight loss was 2.3 kg (2.2%) among GP surgery participants and 3.4 kg (4.0%) among pharmacy participants. The My Choice Weight Management Programme improved the general health status of participants between recruitment and session twelve as measured by the validated SF-12 questionnaire. While cost data is presented in this report, it is unclear which provider type delivered the Programme more cost-effectively. Attendance rates on the Programme were consistently better among pharmacy participants than among GP participants. The opinions of programme participants (both those who attended regularly and those who failed to attend as expected) and programme providers were explored via semi-structured interviews and, in the case of the participants, a selfcompletion postal questionnaire. These data suggest that the Programme was almost uniformly popular with both the deliverers of the Programme and participants on the Programme with 83% of questionnaire respondents indicating that they would be happy to recommend the Programme to other people looking to lose weight. Our recommendations, based on the evidence provided in this report, include: a. Any consideration of an extension to the study also giving comparable consideration to an extension of the Programme evaluation. The feasibility of assigning participants to a pharmacy provider or a GP provider via a central allocation system should also be examined. This would address imbalances in participant recruitment levels between provider type and allow for more accurate comparison of the effectiveness in the delivery of the Programme between GP surgeries and community pharmacies by increasing the homogeneity of participants at each type of site and increasing the number of Programme participants overall. b. Widespread dissemination of the findings from this review of the My Choice Weight Management Project should be undertaken through a variety of channels. c. Consideration of the inclusion of the following key aspects of the My Choice Weight Management Project in any extension to the Programme: i. The provision of training to staff in GP surgeries and community pharmacies responsible for delivery of the Programme prior to patient recruitment. ii. Maintaining the level of healthcare staff input to the Programme. iii. The regular schedule of appointments with Programme participants. iv. The provision of an increased variety of printed material. d. A simplification of the data collection method used by the Programme commissioners at the individual Programme delivery sites.

Place, ethnicity and poverty in England’

Examination of the relationship between ethnicity, poverty and place has tended to focus on the spatial distribution of minority ethnic groups. This summary paper reviews some key themes in this literature, in order to review the following key questions: •Where are different ethnic groups located, and how does this location relate to their experience of poverty? •Is clustering a good or bad thing, and what is the role of location – regardless of concentration – in terms of impacts on access to housing, employment, and other resources? However, it is notable that existing research in this area continues to present ethnicity as a factor that shapes outcomes only for minority ethnic groups. A wider discussion increasingly recognises the working of ethnicity in the lives of majority communities. Some of the most consistently impoverished areas in Britain, for example, are in regions with relatively small minority ethnic communities. For example, examinations of poverty in Cornwall (Cemlyn, et al., 2002) and Wales (Kenway and Palmer, 2007) identify longstanding concentrations of poverty and social exclusion among relatively static populations. Instead of assuming that ethnic identity influences propensity to poverty when concentrated in particular places, the experiences of Cornwall and Wales encourage us to consider the manner in which places of poverty also have an ethnic character and the impact of this in the wider experience of poverty. In what follows, and in order to reflect the existing literature, we review key points in the debate about the spatial concentration of minority ethnic groups and the impact of this concentration on experiences of poverty. Where possible, we seek to extend these ideas to consider possible implications for spaces of poverty characterised by concentrations of majority ethnic groups.

The Aston Medication Adherence Study:mapping the adherence patterns of an inner-city population

Background: The Aston Medication Adherence Study was designed to examine non-adherence to prescribed medicines within an inner-city population using general practice (GP) prescribing data. Objective: To examine non-adherence patterns to prescribed oralmedications within three chronic disease states and to compare differences in adherence levels between various patient groups to assist the routine identification of low adherence amongst patients within the Heart of Birmingham teaching Primary Care Trust (HoBtPCT). Setting: Patients within the area covered by HoBtPCT (England) prescribed medication for dyslipidaemia, type-2 diabetes and hypothyroidism, between 2000 and 2010 inclusively. HoBtPCT's population was disproportionately young,with seventy per cent of residents fromBlack and Minority Ethnic groups. Method: Systematic computational analysis of all medication issue data from 76 GP surgeries dichotomised patients into two groups (adherent and non-adherent) for each pharmacotherapeutic agent within the treatment groups. Dichotomised groupings were further analysed by recorded patient demographics to identify predictors of lower adherence levels. Results were compared to an analysis of a self-reportmeasure of adherence [using the Modified Morisky Scale© (MMAS-8)] and clinical value data (cholesterol values) from GP surgery records. Main outcome: Adherence levels for different patient demographics, for patients within specific longterm treatment groups. Results: Analysis within all three groups showed that for patients with the following characteristics, adherence levels were statistically lower than for others; patients: younger than 60 years of age; whose religion is coded as "Islam"; whose ethnicity is coded as one of the Asian groupings or as "Caribbean", "Other Black" and "African"; whose primary language is coded as "Urdu" or "Bengali"; and whose postcodes indicate that they live within the most socioeconomically deprived areas of HoBtPCT. Statistically significant correlations between adherence status and results from the selfreport measure of adherence and of clinical value data analysis were found. Conclusion: Using data fromGP prescribing systems, a computerised tool to calculate individual adherence levels for oral pharmacotherapy for the treatment of diabetes, dyslipidaemia and hypothyroidism has been developed.The tool has been used to establish nonadherence levels within the three treatment groups and the demographic characteristics indicative of lower adherence levels, which in turn will enable the targeting of interventional support within HoBtPCT. © Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2013.

A comparison of the provision of the My Choice Weight Management Programme via general practitioner practices and community pharmacies in the United Kingdom

This study aimed to assess the effectiveness of a novel, community-based weight management programme delivered through general practitioner (GP) practices and community pharmacies in one city in the United Kingdom. This study used a non-randomized, retrospective, observational comparison of clinical data collected by participating GP practices and community pharmacies. Subjects were 451 overweight or obese men and women resident in areas of high socioeconomic deprivation (82% from black and minority ethnic groups, 86% women, mean age: 41.1 years, mean body mass index [BMI]: 34.5 kg m−2). Weight, waist circumference and BMI at baseline, after 12 weeks and after 9 months were measured. Costs of delivery were also analysed. Sixty-four per cent of participants lost weight after the first 12 weeks of the My Choice Weight Management Programme. There was considerable dropout. Mean percentage weight loss (last observation carried forward) was 1.9% at 12 weeks and 1.9% at final follow-up (9 months). There was no significant difference in weight loss between participants attending GP practices and those attending pharmacies at both 12 weeks and at final follow-up. Costs per participant were higher via community pharmacy which was attributable to better attendance at sessions among community pharmacy participants than among GP participants. The My Choice Weight Management Programme produced modest reductions in weight at 12 weeks and 9 months. Such programmes may not be sufficient to tackle the obesity epidemic.

Access to start up finance for ethnic minority graduate entrepreneurs in the West Midlands: a gendered perspective

This aim of this paper, from a study funded by the National Council for Graduate Entrepreneurship (NCGE), is to explore access to finance for ethnic minority graduate entrepreneurs (EMGEs) with a particular focus on comparisons between different ethnic groups, and men and women. The authors interviewed selected individuals based upon a review of literature on finance for ethnic minority enterprise. A number of key results from the survey, in that EMGEs: • use external finance significantly (more so than non graduates) and encounter barriers in accessing finance at start-up, in particular those belonging to poor families. • rely excessively on personal savings and family finance, at the start-up and long after the start-up stage, that has implications for the optimal capital structure. • start up businesses that are, on average, larger than non-graduate enterprises and have the potential to reduce economic inactivity amongst the ethnic population. • have, in contrast to general graduate start-ups, a high level of unemployment, take a longer period of time to enter employment and there is a higher level of dissatisfaction with career progression. These findings raise the question whether the right financial advice is taken and whether this behaviour constrains EMGEs' expansion.

Within-country ethnic differences and product positioning:a comparison of the perceptions of two British sub-cultures

While cross-cultural consumer behaviour and its impact on marketing strategies has received considerable interest within the marketing literature, differences between ethnic groups within countries have received significantly less attention. This study examines the effect of within-country ethnic differences on brand positioning, using the UK automobile industry as a context. Both qualitative and quantitative research is used to identify the perceptions of two sub-cultural groups: British of Indian extraction, and Caucasian British. It was found that these two groups display appreciably different values, and also place different levels of importance on different product attributes when evaluating brands. Furthermore, the two groups exhibited different perceptions of the same set of brands. The results suggest that, to position brands effectively, marketers should take account of cultural diversity within countries as well as between them.

The representation of majorities and minorities in the British Press:a content analytic approach

A content analysis examined the way majorities and minorities are represented in the British press. An analysis of the headlines of five British newspapers, over a period of five years, revealed that the words ‘majority’ and ‘minority’ appeared 658 times. Majority headlines were most frequent (66% ), more likely to emphasize the numerical size of the majority, to link majority status with political groups, to be described with positive evaluations, and to cover political issues. By contrast, minority headlines were less frequent (34%), more likely to link minority status with ethnic groups and to other social issues, and less likely to be described with positive evaluations. The implications of examining how real-life majorities and minorities are represented for our understanding of experimental research are discussed.

Involving the family in higher education:do they really matter?

In an ever-changing higher education (HE) environment, institutions are seeing the involvement of parents in students' education increasing. This may partly be due to tuition fees and the introduction of deferred variable tuition fees ("top-up fees") from 2006, and also because of the increased number of students choosing to remain in the family home for the duration of their studies. Many students see their families as the most important source of motivation and advice right through from school age to when they make decisions about HE. In the light of this increase in involvement, institutions need to provide information about, and access to, university to ensure that families are fully prepared and able to support their children throughout the university experience. In recognition of the vital role parents play, the Involving the Family project focuses on parents or key family members from groups currently under-represented in HE in order to increase their awareness and understanding of HE. This article evaluates research undertaken to investigate the views, perceptions and key concerns held by minority ethnic parents with regards to their children and participation in HE. The article then details how these results were utilised in the development of the Involving the Family project.

Uncovering the root cause of ethnic difference in ability testing:differential test functioning, test familiarity and trait optimism as explanations of ethnic group differences

The present research represents a coherent approach to understanding the root causes of ethnic group differences in ability test performance. Two studies were conducted, each of which was designed to address a key knowledge gap in the ethnic bias literature. In Study 1, both the LR Method of Differential Item Functioning (DIF) detection and Mixture Latent Variable Modelling were used to investigate the degree to which Differential Test Functioning (DTF) could explain ethnic group test performance differences in a large, previously unpublished dataset. Though mean test score differences were observed between a number of ethnic groups, neither technique was able to identify ethnic DTF. This calls into question the practical application of DTF to understanding these group differences. Study 2 investigated whether a number of non-cognitive factors might explain ethnic group test performance differences on a variety of ability tests. Two factors – test familiarity and trait optimism – were able to explain a large proportion of ethnic group test score differences. Furthermore, test familiarity was found to mediate the relationship between socio-economic factors – particularly participant educational level and familial social status – and test performance, suggesting that test familiarity develops over time through the mechanism of exposure to ability testing in other contexts. These findings represent a substantial contribution to the field’s understanding of two key issues surrounding ethnic test performance differences. The author calls for a new line of research into these performance facilitating and debilitating factors, before recommendations are offered for practitioners to ensure fairer deployment of ability testing in high-stakes selection processes.