Background Awareness of, and access to, social care services within UK is uneven. Two groups that exhibit low uptake of services are Black Asian and Minority Ethnic (BAME) people and Lesbian Gay Bisexual and Transgender plus (LGBT+) people. Some members of BAME groups may be unfamiliar with social care provision in general or specific social services. Other members of BAME groups and LGBT+ people may share a common perception that the service is not for people like us or they may delay uptake of services until precipitated by a crisis. Objectives The aim of this review is to identify and understand the contexts that affect access to social care services for Black Asian and Minority Ethnic (BAME) people and Lesbian Gay Bisexual and Transgender plus (LGBT+) people in the United Kingdom. Methods For the scoping search, we searched Ovid MEDLINE and Google for key evidence and reviews. Studies included in the scoping search helped to inform the sampling frame for the subsequent realist synthesis. We also engaged with the wider evidence base through supplementary searching. Data extraction forms were developed structured around five programme theory components advanced by the review team. Following identification of initial programme theories (from the theoretical literature, empirical studies and insights from the PPI group) the review team extracted data into evidence tables. The resultant hypotheses functioned as synthesised statements around which we developed an explanatory narrative referenced to the underpinning evidence base. An overarching social care pathway was generated and used to explore contexts, causal mechanisms and outcomes. Additional searches for mid-range and overarching theories were performed using Google Scholar. Results A total of 52 publications were included in the scoping search. These publications were used to generate 11 candidate programme theory components. Five of these programme theory components were prioritised for testing following consultation with the Department of Health and Social Care (DHSC), For the testing of programme theories 60 publications were included from an initial 76 items tagged as include or query. All items, with the exception of works contributing to theory originated from the UK. The majority were qualitative in design and presented data by BAME (e.g. South Asians) or LGBT+ (e.g. older Gay people) population subgroup. From these studies, a social care pathway was generated which included 7 steps (Recognition of Need; Decision to Seek Support; Identification of Social Care as a source of support; First Contact; Continuation of Contact; Ongoing social care relationship and Appropriate fulfilment of Needs). Important contexts were awareness of services, access to social care (information, contacts, referral and services), acceptance of social care as an appropriate source of support, communication, trust, and informal/family support. Prominent causal mechanisms were navigation, recognition of the caregiver role, and responsiveness to emergent needs. Limitations The research was conducted by a small team, according to a rapid realist methodology, and time and resources limited our ability to consult with diverse stakeholders. Conclusions Although studies of the experience of BAME populations in accessing social care services were relatively plentiful, studies were unequally distributed across BAME subgroups. In particular newer concentrations of migrants were poorly represented (e.g. from the Balkans and the Horn of Africa). In comparison the experiences of LGBT+ populations were poorly represented overall. Studies of transgender experiences in accessing services were poorly represented. Data suggest that differences within both these two larger groupings and their constituent populations are likely to be as important as between group differences. Findings consistently affirmed the value of a person-centred approach to social care. Future work Research should focus on understanding how different subpopulations respond to personcentred care, its costs and potential measurable benefits. In addition, the evidence for matching care providers and service users according to racial or ethnic characteristics is, at best equivocal, and, as revealed by this review may result in many unintended consequences. The value of this strategy compared with, or combined with organisation-wide approaches to training in cultural awareness requires further exploration. Funding The Sheffield Evidence Synthesis Centre is funded by NIHR's Health Services and Delivery Research programme, reference 16/47/17. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.
CORE (COnnecting REpositories)
CORE (COnnecting REpositories)
