Barriers and facilitators for people from minority ethnic groups accessing prehospital care: a systematic review

ABSTRACT Background Despite its increasing importance, equity remains an unrealised aspiration in healthcare. People from minority ethnic groups are proportionately less likely to access emergency and hospital services than the majority White population, despite higher levels of need. Our systematic literature review and narrative synthesis aimed to identify the barriers or facilitators to accessing ambulance and paramedic care for minority ethnic patients. In doing so, the review explored the causes and consequences of any differences in care delivery. Methods We designed a data extraction tool to elicit the required information. Studies were included if they referenced minority ethnic groups, the ambulance service, barriers and facilitators, etc. Included studies also had to be: published in English, from 2003-2013, based in North America, Europe or Australasia. We applied the same combination of search terms across 14 electronic databases. Results Barriers to accessing care included: communication difficulties; limited knowledge of the healthcare system and staff cultural stereotyping. There were ethnic disparities in mortality and survival rates, reflecting differences in condition severity, delays in seeking treatment, etc. Such delays were due to limited knowledge of symptoms and previous discriminatory experiences. Conclusion Little quality evidence exists on improving minority ethnic access to ambulance and paramedic care, which is compounded by challenges in generalising findings from the US to the UK. The identified barriers may be mitigated by interpreting services and staff cultural competency education. Each requires more robust patient ethnicity and language data. Having identified some of the barriers and facilitators, further qualitative research is needed to explore why they exist. This supplementary research could then inform strategies to provide more equitable prehospital ambulance care for minority ethnic groups