Health service access for ethnically underrepresented communities: A scoping review of complex interventions

BACKGROUND: The aim of this scoping review is to systematically map the existing evidence of complex interventions used to improve access and/or engagement of ethnically underrepresented communities with healthcare services in the UK, and explore equity factors of the evidence. METHODS: The review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews Checklist. Six databases were searched. Analysis was completed using reflexive and thematic content analysis. Interventions were mapped against the five domains of the Patient-centred access framework and the PROGRESS-Plus equity framework. RESULTS: A total of 35 studies met the inclusion criteria. Of these studies 63% were completed in primary care, 31% in mental health, 3% in maternity services and 3% in dental care. Several communities were represented, including Gypsy, Roma and Travellers, African Caribbeans, Jewish communities, as well as broader groups such as South Asians, migrants and Muslims. Complex interventions were spread across the five domains of the patient centred access framework and included strategies such as outreach workers, using community settings such as places of worship, cultural adaptations and cultural training for healthcare staff. Effectiveness of interventions was assessed in a third of studies. PROGRESS-Plus analysis identified exclusion criteria including age groups (e.g., below 18 years), ethnic groups (e.g., not first-generation migrants), disabilities (e.g., severe mental health problems) and plus (e.g., language proficiency). CONCLUSIONS: All domains of the patient centred access framework were represented with approachability and acceptability being the most common. Effectiveness assessment was not included in two thirds of studies however, complex interventions show promise to improve equity in ethnically underrepresented communities. Future research should endeavour to assess effectiveness and the translation of interventions in healthcare contexts outside of primary care and mental health. Future policy and research should consider how to increase transparency of power and build strong collaborations with underrepresented communities.