Living well with multimorbidity: a qualitative study exploring perspectives of emotional distress in men of south Asian origin

Problem

People with long-term conditions (LTCs) are twice as likely to suffer from depression than the general population. People with physical-mental comorbidity have a poorer quality of life, worse clinical outcomes and increased mortality than those with physical conditions alone.

People from some ethnic groups are less likely to recognise symptoms which may represent mental health problems and perceive a need for support. Furthermore, people from ethnic minorities are an under-served group within healthcare services. South Asians (SAs) are the largest minority group in the UK, and are more likely to have certain LTCs such as diabetes and heart disease. There is limited published research on the experiences of men of SA origin with comorbid physical and mental health problems in primary care. The term emotional distress has been chosen for this study as it encompasses distress which can cause significant suffering, yet may not be diagnosed.

The qualitative study is informed by our systematic review, which synthesised existing qualitative research on understanding, experiencing and help-seeking for emotional distress in people of SA origin with LTCs.

Approach

A qualitative study is being undertaken to explore the perspectives of men of SA origin with LTCs, on the experiences and help-seeking, for emotional distress. Recruitment from community settings is ongoing. Semi-structured interviews are taking place by telephone or using an online platform, with concurrent coding of transcripts, thematic analysis and iterative modification of the topic guide. Topics explored include personal experiences of emotional distress, understanding of the nature, causes and cures of emotional distress, help-seeking behaviour and healthcare accessed, and support received for emotional distress and their long-term physical condition; impact of COVID-19 restrictions; gaps in services and what support is most wanted.

An ethnically appropriate PPIE group has been convened and is working according to the INVOLVE principles. The PPIE group has reviewed and inputted throughout all stages of research, including the overall research question, recruitment ideas, public-facing documents and topic guides.

Findings

Initial analysis suggests the following themes are important: distress within physical illness, living between two cultures, concepts of black magic, and prejudice locally and globally. Participants reported strength in faith, a lack of trust of medical professionals and the need for culturally appropriate community-based services.

Consequences

This study will support greater awareness of emotional distress, which should inform the recognition and management of emotional distress in men of SA origin with LTCs, thus improving quality of live. The research has the potential to influence policy-makers and commissioners about service provision for this patient group. As well as academic routes of dissemination, learning will be shared with the SA community via a community event, written resources and an animation video.