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Religious and Cultural Barriers in Health Care Systems

Learn more about religious, cultural and other barriers in health care systems.
Religion Race Culture And Vaccines
© BSAC

The COVID-19 Pandemic and our way out of it – vaccination – has brought into sharp focus just how an individual’s concerns and reaction to treatment are shaped by their culture, ethnicity, religion, socioeconomic status and the sources of information they have access to.

All these factors have the potential of positively impacting an individual’s health, wellbeing and treatment but can also make them more vulnerable.

We don’t need to look far to see the impact of this in action. From the outset, the evidence was clear Black, Asian and minority ethnic groups had and still have higher rates of infection, serious disease, and deaths from COVID-19 and yet we hear reports everyday that the uptake of vaccines in these communities is low.

Examples of the concerns raised about the vaccines by these communities range from whether the vaccines are permissible for Muslims (a major concern being whether receiving a vaccine was interfering in God’s will) through to whether the vaccines are halal, or if they affect fertility or have an impact on our DNA. For some, the answers to these questions provided the clarity they needed and resulted in them accepting vaccination but for others, the responses provided were not enough and has led to an ever stronger reluctance not to be vaccinated.

What has become apparent is that the outward concerns about the vaccines are masking something much deeper. Scratching beneath the surface, what we have found is that the concerns from these communities are not necessarily about the vaccines themselves but a long-standing mistrust of public services. A mistrust fuelled by a history of marginalisation, structural racism and systematic discrimination going back decades.

In addition to all this within these communities, the amount of misinformation fuelled by an outspoken minority of anti-vaxxers cannot be understated. These groups capitalise on these examples of previous bad practice towards Black and Asian Minority Ethnic communities to feed an existing suspicion that these communities will be less favourably treated. Their campaigns, which began at the start of the pandemic, have led many from these communities not to get involved in research and to question the notion of having a vaccine.

It is therefore vital that as health care professionals we are aware of both the wider context of communities that patients are a part of, as well as the background of the patients themselves to understand what motivates patients to refuse or receive treatment and the information that they have access to which may be influencing their decisions. It is also important to think about how health messages are conveyed and by whom.

Here are a few simple points to consider (this is not an exhaustive list). These have been divided up into organisational and individual staff level but it is important to note that neither are mutually exclusive.

Organisational Level

The Pandemic has highlighted the need for public organisations like the NHS to actively engage with the communities to become culturally competent and learn how to serve their communities better.

Here are some ways in which organisations can achieve this:

How organisations can increase their cultural competence and serve their communities better: appoint community engagement leads; provide regular programmes of cultural awareness training sessions; develop a guideline to accompany a training programme that lists key contacts for different communities; provide easily accessible face to face interpreter services; provide information in a culturally relevant and sensitive manner and in different formats; develop a repository of supporting information and resources; make a concerted effort to recruit staff from communities into different roles

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Individual Staff Level

How individuals can increase their cultural competence and serve their communities better: ask patients about their religious, cultural, social and familial background and general lifestyle; talk about your own background and upbringing if appropriate; encourage patients to talk about their treatment options with relatives, ensuring that they are not a source of influence; it may be helpful to ask a colleague with the same background as the patient to attend an appointment to help convey information in a culturally sensitive manner (obtain patient's permission); provide information in an appropriate language or format; attend any cultural awareness training provided by your organisation

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Particularly when trying to counteract any inaccurate information, try to avoid saying that something is a fact – use instead ‘the evidence suggests’ – this way you are helping patients weigh up benefits and risks and are facilitating them to make informed choices based on accurate, evidenced and balanced information.

If you would like to look into this topic further, please take a look at the CCDH website and the Antivax playbook report.

© BSAC
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