Engaging the multiply marginalised in Primary Care Research. Reflections on Involvement and Engagement activities within the homeless Central and Eastern European Community in Greater Manchester

Problem

The UK-Central and Eastern European community (UK-CEE) totals around 2 million people. A range of barriers to effective community engagement within UK primary care services exist, with resultant service dissatisfaction. Such barriers are greater for multiply marginalised ‘minorities within the minority’, such as the UK-CEE homeless. Despite having significant unmet physical and mental health needs, UK-CEE homeless individuals are routinely absent from demographic data and health services research. Little exploration of their health beliefs and concepts for health utilisation has taken place. Furthermore, the relevance of routine Public and Patient Involvement (PPI) strategies to this population is unclear.

Approach

A series of community stakeholder, individual and group PPI meetings are currently being undertaken with UK-CEE homeless individuals within the Booth Centre, Manchester. Meetings are semi-structured and in line with UK Standards for Public Involvement in Research and INVOLVE PPI guidance. Field notes are recorded with participant permission. Discussion topics include: perspectives on UK primary care; practicalities of study recruitment, design, and ongoing participation; and the perceived viability of different methods of PPI and study/intervention co-design.

Findings

Meetings are ongoing with completion due by June 2020. Identified themes and their potential implications for primary care research among the multiply marginalised will be presented. Direct comparison will be made with PPI and engagement activities undertaken within the wider UK-CEE and other UK based ethnic minority communities. Outcomes will inform subsequent qualitative study recruitment/engagement strategies in addition to co-design of primary care service guidance.

Consequences

Engaging the multiply marginalised in primary care research is key to overcoming health inequalities and achieving community empowerment. Clear guidance on developing sustainable PPI and co-design strategies within the UK-CEE homeless population will support development of engagement strategies for other multiply marginalised communities.