Proposed barriers and facilitators for engaging with neuropsychological services by Black and South Asian populations in the UK: A qualitative systematic review of ethnic minority access of neurological services.

Abstract

Objectives: British ethnic minorities are underrepresented in neuropsychological services for conditions such as stroke and epilepsy, despite being disproportionately at risk. However, there is little data on why and how to improve this. Given the absence of studies examining the provision of neuropsychological services we aimed to systematically review qualitative studies and synthesise data on British ethnic minorities access of neurological services and propose barriers and facilitators they may face when engaging with neuropsychological services. Method: Our search strategy for six databases located qualitative studies investigating British ethnic minorities' views and experiences of neurological services. Studies were eligible if they included ethnic minority patients with a neurological condition or their caregiver, or staff in a neurological service. Studies described at least one barrier or facilitator to accessing and engaging with neurological services. This data was extracted and thematically synthesised. Results: 2,001 studies were identified and 16 included after screening, which focused primarily on Black and South Asian populations. We synthesised data into five overarching themes: "information gap", 'beliefs and experiences', 'diagnostic assessment', 'treatment measures', and 'communication issues'. Barriers within these include misunderstanding around neurological conditions and their management, language issues, being dismissed or neglected, and assumptions made about ethnicity. Facilitators include timely and accurate provision of information and a person-centered approach to care by accommodating for cultural needs while also understanding patients as individuals beyond their ethnicity. Conclusions: Themes highlighted gaps across the overall service pathway and at individual stages, from initial access to diagnosis to treatment. They also have the potential to influence each other. Themes indicate what current clinical service provision should address and what future research should focus on.