Tackling ethnic disparities in orthopaedic healthcare: intervention development using co-production methods

Motif

Supervisors

  • Dr Vikki Wylde – Associate Professor in Musculoskeletal Health, Bristol Medical School with expertise in health services research
  • Dr Katie Whale – Research Fellow in Qualitative Health Research, Bristol Medical School with expertise in health psychology, intervention development and qualitative methods
  • Catherine Jameson – Senior Research Associate, Bristol Medical School with expertise in patient and public involvement

Theme

Surgical and orthopaedic innovation  

Keywords

Intervention development, qualitative methods, underserved communities  

Background

We know that people from minority ethnic backgrounds are underserved in healthcare and research. Within orthopaedics, there are widespread inequalities in healthcare, with people from minority ethnic backgrounds less likely to receive joint replacement than white people [1-3]. There are also ethnic disparities in outcomes after joint replacement, with people from minority ethnic groups experiencing greater post-operative pain and disability, higher rates of complication and increased mortality [2-4]. These inequalities are likely to be exacerbated by the COVID-19 pandemic, which disproportionately affected people from minority ethnic backgrounds [5]. There is a clear need to address these inequalities and ensure that people traditionally underserved in research are involved in the design of new healthcare interventions.  

We are currently working in partnership with community organisations in Bristol to identify orthopaedic research priorities for people from minority ethnic backgrounds. These organisations include Dhek Bhal (South Asian), Malcolm X Elders (African Caribbean) and My Friday Coffee Morning – Barton Hill (women resident in Barton Hill with a high Somali population). This project will address one of these research priorities (priorities will be finalised by summer 2023), by developing an accessible and inclusive intervention to address unmet orthopaedic healthcare needs, optimise patient care and improve health and wellbeing. 

Aims and objectives

The aim of this project is to work in partnership with community organisations to develop a new intervention to address unmet orthopaedic healthcare needs of people from minority ethnic backgrounds. Co-production methods will be used, which involves different groups of people (in this case, community organisations, patients, healthcare professionals and researchers) working together on an equal basis to make important decisions about the research.  The specific focus of the project will be informed by the research priorities that we are currently developing, and there will be scope for the student to decide which research priority to focus on, in collaboration with the project supervisors. 

Specific objectives are to: 

  1. Learn principles of community engagement, foster strong relationships and liaise with members of underserved groups to facilitate co-production between members of the public, academics and clinicians 
  2. Understand the problem to be addressed and its causes 
  3. Identify modifiable factors that contribute to the problem that could be targeted with a new intervention 
  4. Design an intervention that could modify these factors and benefit patients 
  5. Decide how this intervention could be delivered in NHS healthcare 

Methods

The project will use qualitative and quantitative methods to design a new intervention that aims to improve orthopaedic health for people from minority ethnic backgrounds. The first step is to work with the supervisors to review the research priorities that have been developed with the community organisations and choose one to address within this project. The exact methods to be used will be tailored depending on the research priority that is being addressed. However, the methods are likely to include:  

  1. Qualitative interviews and/or focus groups with patients to understand needs and experiences  
  2. Systematic review of relevant literature to evaluate existing evidence  
  3. Survey of current practice to understand clinical context in which the intervention would be implemented  
  4. Develop an initial intervention design using relevant theory e.g. health psychology, behaviour change, sociology, and implementation science
  5. Qualitative work with healthcare professionals to understand how the intervention could be delivered in NHS practice
  6. Consensus methods to finalise the intervention content and methods of delivery  

The student will be responsible for primary data collection. The research will be overseen by a co-production group including community organisations, patients, healthcare professionals and researchers, who will meet regularly to make decisions about project design and conduct. The approach to co-production will be flexible and designed with community organisations to ensure processes are inclusive and all members are equal partners.  

Expected knowledge, skills and attitudes to be gained

This project provides the opportunity to gain a strong multifaceted skillset in qualitative and quantitative methods applied to healthcare intervention development. The student will gain knowledge and experience of protocol writing, preparation of study documents, and gaining relevant governance approvals. Qualitative research methodology skills that will be gained include designing and conducting in-depth interviews and/or focus groups with different stakeholder groups, coding and analysing data, and applying the findings to inform intervention design. Quantitative skills may be developed in evidence synthesis through the conduct of systematic reviews, including designing literature searches, screening records, extracting data from articles and performing narrative synthesis or meta-analysis. Surveys of practice would provide the opportunity to develop skills in questionnaire design, data cleaning and descriptive quantitative data analysis. The student will develop knowledge of how to apply theory to intervention design and support behaviour change. 

Skills will also be gained in co-production which will include understanding the requirements and needs of different groups of people; the ability to describe and present findings from the primary data collection in clear and accessible formats, tailored to different stakeholder groups; and facilitation of discussions and the reaching of consensus on decisions regarding intervention design.  

This project would suit students with a social science or health science undergraduate degree and/or some experience of qualitative research.  

Project references

  1. Smith MC, Ben-Shlomo Y, Dieppe P, Beswick AD, Adebajo AO, Wilkinson JM, et al. Rates of hip and knee joint replacement amongst different ethnic groups in England: an analysis of National Joint Registry data. Osteoarthritis Cartilage 2017;25(4):448-54.
  2. Ryan-Ndegwa S, Zamani R, Akrami M. Assessing demographic access to hip replacement surgery in the United Kingdom: a systematic review. Int J Equity Health 2021;20(1):224.
  3. Zhang W, Lyman S, Boutin-Foster C, Parks ML, Pan TJ, Lan A, et al. Racial and Ethnic Disparities in Utilization Rate, Hospital Volume, and Perioperative Outcomes After Total Knee Arthroplasty. J Bone Joint Surg Am 2016;98(15):1243-52.
  4. Klemt C, Walker P, Padmanabha A, Tirumala V, Xiong L, Kwon YM. Minority Race and Ethnicity is Associated With Higher Complication Rates After Revision Surgery for Failed Total Hip and Knee Joint Arthroplasty. J Arthroplasty 2021;36(4):1393-400.
  5. Raifman MA, Raifman JR. Disparities in the Population at Risk of Severe Illness From COVID-19 by Race/Ethnicity and Income. Am J Prev Med 2020;59(1):137-9.