Cultural Sensitivity in IAPT Services for Ethnic Minorities

Abstract

Abstract: A thesis submitted by Kanza Khan for the degree of Master of Philosophy in the Faculty of Biology, Medicine and Health at The University of Manchester. Cultural Sensitivity in IAPT for Ethnic Minorities. Submitted 2017. Introduction: Cultural sensitivity is traditionally viewed as the awareness and facilitation of ethnic minority needs. The optimum delivery of psychological therapy for ethnic minority patients is through ensuring high levels of cultural sensitivity within services. Exploring the levels of cultural sensitivity within the Improving Access to Psychological Therapies (IAPT) services is relevant to this field due to the under-utilisation of treatment in this population where prevalence of anxiety and depressive disorders is primarily high. The aim of this research was to explore contributing barriers to accessing psychological therapy for ethnic minorities and levels of cultural sensitivity within IAPT services in the North West of England. Methods: A systematic review was conducted to capture barriers to accessing psychological therapy for ethnic minorities residing in western countries. Qualitative methods were employed to explore a patients journey through the IAPT patient pathway and IAPT staff roles. Semi-structured discussions with an IAPT North West of England Training Commissioner were used to confirm findings and facilitate the recruitment of IAPT staff members for focus groups. A focus group to capture staff perspectives of barriers to accessing IAPT for ethnic minority patients was conducted. Discussions with experts were used to capture opinions for the development of a cultural sensitivity audit tool (TULIP). The next phase aimed to develop TULIP for IAPT services and guidelines for completion. A mixed methods design aimed to conduct the first TULIP audit of IAPT services. Finally, we aimed to capture feedback for TULIP and the TULIP: Guidelines from IAPT services managers completing the audit at each service. Results: The key findings from the research project include the capturing of barriers experienced by ethnic minorities to western countries accessing IAPT services. The systematic review results found 5 key barrier themes (comprising of 21 sub-themes): Patient related barriers, Community related barrier, Family related barriers, Health service related barriers and Practical issues related barriers. We thoroughly looked into the IAPT patient pathway, qualitatively interviewed staff and an IAPT commissioner, gaining an understanding of the barriers to accessing IAPT for ethnic minorities. We presented the findings to a meeting of experts and developed the final audit tool. The collective stages of the project led to the penultimate development of TULIP: cultural sensitivity audit tool for IAPT services and TULIP: Guidelines. Finally, the researchers conducted a TULIP: audit of 11 IAPT services in the North West of England. Key audit findings revealed that only 9% of IAPT services facilitated culturally adapted written materials. A specific policy for working with ethnic minority patients was only available at 18% of services and no services had culturally adapted workbooks or manuals. Conclusions: Key findings highlight barriers experienced by ethnic minorities accessing psychological therapy services in western countries and more specifically in accessing the IAPT services for ethnic minority patients residing in the United Kingdom. The final results of our nine studies led to the development and implementation of the first cultural sensitivity audit tool for IAPT services, capturing areas of decreased levels of cultural sensitivity within and across services included in the audit.

Date of Award	1 Aug 2017
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Waquas Waheed (Supervisor) & Maria Panagioti (Supervisor)