Learning from covid-19 to improve health information for South Asian communities

Covid-19 has had a disproportionate impact on ethnic minority populations, including South Asian communities in the UK, and highlighted the urgent need for culturally appropriate health information. Written and multimedia information was produced at pace during the pandemic, amid an absence of guidance on optimal ways of developing culturally sensitive health messaging for covid-19. Short videos in a range of South Asian languages were produced on numerous topics and disseminated on social media, on WhatsApp, and via community organisations. Much of this work was led by South Asian healthcare professionals and organisations. We must learn from this and develop culturally relevant health information for all conditions that disproportionately affect South Asians, including hypertension, type 2 diabetes, asthma, and depression. This would help reduce inequalities in health outcomes seen before the pandemic and exacerbated during it. 

Lessons from covid-19 health messaging

Research into the best ways of developing culturally relevant health information resources is lacking. Recommendations for developing a tailored health communication strategy for ethnic minority communities during the pandemic included co-producing and pre-testing health messages that personalise experiences and target specific community beliefs; delivering messages by credible, trusted sources; and using language that retains cultural context and meaning to increase understanding. Recommendations also included using community engagement to understand the needs of the target community. Guidance specifically about covid-19 vaccine uptake highlighted the importance of multilingual, non-stigmatising communications with ethnic minority communities, and using educational videos in multiple languages to increase awareness, sharing these with individuals within family and community networks. Misinformation can cause anxiety, highlighting the need for clear, honest, and sensitive information. Lack of culturally appropriate information can result in fear of Western medications, leading patients to seek advice on traditional medicines.

Recommendations from previous research   

Before the pandemic, research focusing on South Asian communities emphasised the need for health information to be made available mainly via video, rather than leaflets, to overcome potential problems with literacy. Culturally sensitive educational videos for South Asian communities have been produced on biologic medications in rheumatoid arthritis, coronary artery disease (aimed at Bangladeshi women), and insulin treatment for South Asian patients with type 2 diabetes. When evaluated, these resources showed statistically significant improvement in knowledge, changes in patients’ attitudes and understanding, and an improvement in consultations between patients and health professionals.

Developing health information for South Asian groups 

The July 2020 Scientific Advisory Group for Emergencies report on public health messaging for ethnic minority communities recommended qualitative engagement work with minority groups to understand how government messages regarding covid-19 were received and what their impacts were. Learning from, and building on, the substantial financial and community initiatives taken/started during the pandemic is vital to improving health inequalities. We conducted five online community engagement workshops with British South Asian communities to learn about views and experiences of covid-19 health messaging, and lessons for developing health information resources for South Asian groups after covid. Fifty patient and public contributors took part in the workshops held in February-March 2021. Key learning from these discussions is set out below [see full report].  

  1. Health information in a range of formats (written, audio, video) can be helpful in urgent situations such as the covid-19 pandemic. For long term conditions, participants prefer multilingual educational videos  to written information because videos can be understood by community members regardless of their education and literacy levels.  
  2. Educational videos aimed at South Asian communities need to be co-designed and co-produced with patients, health professionals, and researchers to ensure relevance and acceptability.
  3. People value having evidence based information from healthcare professionals, examples of patients’ experiences, information about the mental health impacts of a long term condition, and sources of support. Evidence based medical information communicated by healthcare professionals needs to be simple, clear, and consistent. Examples of patients’ experiences need to include a wide range of perspectives reflecting the diversity within and across communities (such as age, education, religion, migration history).   
  4. Evaluating co-produced educational resources with patients, healthcare professionals, and other stakeholders can help ensure that the content included is accurate, sensitive, appropriate, and unlikely to cause fear or anxiety.  
  5. Educational resources for South Asian communities need to be disseminated through as wide a range of credible sources as is practical. Dissemination through healthcare settings includes showing educational videos in clinic waiting areas, referring patients to resources aimed at South Asian communities, and having posters advertising these resources in GP surgeries and community pharmacies.   

Dedicated funding is needed to co-produce high quality resources based on rigorous research and conducted in a range of languages. Working with local communities and partners can help ensure that resources reach those that need them most. These communities are not “hard to reach and need not be “underserved.” 

Suman Prinjha, senior qualitative researcher, University of Oxford. Twitter @SumanPrinjha

Nasima Miah, community engagement officer, University of Leicester.

Andrew Farmer, professor of primary care, University of Oxford. 

Kamlesh Khunti, professor of primary care diabetes and vascular medicine, University of Leicester. Twitter @kamleshkhunti 

Competing interests: We have read and understood the BMJ policy on declaration of interests and have no relevant interests to declare. KK is a member of SAGE, Chair of Ethnicity subgroup of SAGE, Director of the Centre for Ethnic Health Research, University of Leicester, and a trustee of the charity South Asian Health Foundation. KK and NM are supported by the NIHR Collaboration for Leadership in Applied Health Research and Care East Midlands (CLAHRC EM). KK and AF are NIHR Senior Investigators and AF receives funding from the NIHR Biomedical Research Centre.

Acknowledgements: We would like to thank all the people who took part in our workshops, and University of Oxford for funding this work.