Intersecting factors of disadvantage and discrimination and their effect on daily life during the coronavirus pandemic: the CICADA-ME mixed-methods study.

Background: The COVID-19 pandemic exacerbated pre-existing societal inequities. Our study addresses the dearth of studies on how intersecting factors of disadvantage and discrimination affected pandemic daily life for disabled people from minoritised ethnic groups, aiming to improve their experiences and social, health and well-being outcomes.

Objectives: Through an intersectionality lens, to: explore and compare, by location and time, survey and qualitative data on changing needs for social, health and well-being outcomes relate coping strategies/solutions to these explore formal and informal network issues/affordances gain insights from synthesising our data contextualise and explore transferability of findings co-create outputs with stakeholders.

Design: Mixed-methods, asset-based, underpinned by embodiment disability models and intersectionality, integrating three strands: (secondary): analysis of existing cohort/panel data, literature review (primary: quantitative): new survey (n = 4326), three times over 18 months (primary: qualitative): semistructured interviews (n = 271), interviewee co-create workshops (n = 104) 5 and 10 months later, mixed stakeholder co-design workshops (n = 30) for rapid-impact solutions to issues, key informant interviews (n = 4).

Setting: United Kingdom and Republic of Ireland.

Participants: Strand 2: community-dwelling migrants, White British comparators, with/without disability. Strand 3: focus on Arab, South Asian, African, Central/East European, or White British heritage with/without disability.

Results: We found strong adherence to pandemic restrictions (where accommodation, economic situations and disability allowed) due to COVID-19 vulnerabilities. High vaccine hesitancy (despite eventual uptake) resulted from side-effect concerns and (mis)trust in the government. Many relied on food banks, local organisations, communities and informal networks. Pandemic-related income loss was common, particularly affecting undocumented migrants. Participants reported a crisis in mental health care, non-holistic social and housing care, and inaccessible, poor-quality and discriminatory remote health/social care. They preferred private care (which they could not easily afford), community or self-help online support. Lower socioeconomic status, mental health and mobility issues reduced well-being. Individual and community assets and coping strategies mitigated some issues, adapted over different pandemic phases, and focused on empowerment, self-reflection, self-care and social connectivity. Technology needs cut across these.

Limitations: We could not explore area-level social distancing and infection rates. Data collection was largely online, possibly excluding some older, digitally deprived or more disabled participants. Participants engaged differently in online and face-to-face co-create workshops. Our qualitative data over-represent England and South Asian people and use contestable categories.

Conclusions: Different intersecting factors led to different experiences, with low socioeconomic status particularly significant. Overall, disability and minoritised ethnic identities led to worse pandemic experiences. Our co-design work shows how to build on the assets and strengths; simple changes in professional communication and understanding should improve experience. Minoritised groups can easily be involved in policy and practice decision-making, reducing marginalisation, with better сare and outcomes.

Future work: More research is needed on: (1) the impact of the post-pandemic economic situation and migration policies on migrant mental health/well-being; (2) supporting empowerment strategies across disadvantaged intersecting identities; and (3) technological deprivation and the cultural and disability-relevant acceptability of remote consultations. We found some differences in the devolved nations, which need elucidation.

Study registration: This study is registered as ISRCTN40370, PROSPERO CRD42021262590 and CRD42022355254.

Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR132914) and is published in full in Health and Social Care Delivery Research; Vol. 13, No. 2. See the NIHR Funding and Awards website for further award information.