Walsall Equal Access Survey

WALSALL HEALTH
Report Of Les Crosthwaite, Contracts Manager to The Equal Access Committee 18/11/1994

INTRODUCTION

The decision to undertake a survey of Asian and African Caribbean people was taken by Walsall Health Authority as part of the process of consultation with the Asian and African Caribbean Working Group. From discussions with the Group, and with individual representatives Of Muslim, Hindu, Sikh and African Caribbean communities, a questionnaire was formulated which sought to obtain information on a variety of issues highlighted by the discussions as factors which affected the access of Asian and African Caribbean people to health services.
A market research firm was commissioned to produce a questionnaire and to undertake a survey by structured interview. Volunteers were sought from the communities to act as interviewers and after training they carried out the survey. The aim was to interview 30 male and 30 female people from each of the following communities: Muslim, Hindu, Sikh and African Caribbean. This process was not without problems and as a consequence it took considerably longer to plan, prepare and carry out the survey than had been anticipated. This was also compounded by problems of analysis. It had originally been hoped to have a report to inform the contracts for 1994/95, but this did not prove possible. Clauses were, however, included in the contracts for 1994/95 highlighting the issues raised by the representatives of the Asian and African Caribbean communities and identifying the need to make progress on issues related to cultural and religious needs. The results of the survey, which are detailed below, confirm the view as presented by the community representatives and give credence to the measures adopted in the contract. These facts have already been shared with the Equal Access Committee-, the Asian and African Caribbean Working Group and the Providers.

THE SURVEY

As indicated earlier, the intention was to interview 30 male and 30 females from each community. In the event, there were 57 Sikh, 52 Muslim, 51 Hindu and 42 African Caribbean people interviewed. This is a very small sample and as not all respondents had experience of all the health facilities referred to in the questionnaire, i.e. GPs, Hospital in-patients-, Hospital out-patients and Community Clinics, the number of respondents to some questions were as few as 4 people.
The tables provide a response to questions expressed as a percentage of the number of people answering that question. Those marked * show a reduced sample size of about 1-5 respondents and those marked ** show an even smaller sample size and should either be ignored or treated with extreme caution.
The market research company advise that there is a significant margin of error with the size of sample that we had in the survey, but that we can be 95% sure that the "true" answer lies between a range of percentage points. This is expressed as follows:-

Sample size	Percentage Response	Range of Error
10	20% or 80%	+- 25%
	40% or 60%	+- 30%
25	20% or 80%	+- 15%
	40% or 60%	+- 19%
50	20% or 80%	+- 11%
	40% or 60%	+- 13%

It is important to note, therefore, that an analysis of the tables cannot be guaranteed to give an accurate picture of the views of all the people in the Asian and African Caribbean communities, but the figures can only be used as indicators of opinion. They do, however, reflect the views presented by the community representatives of the Asian and African Caribbean Working, Group and therefore should be taken account of in service provision.

FINDINGS

Understanding of Needs

The table shows the perception that people have of the extent to which Doctors and Nurses understand their needs. Generally, it would appear that GPs are perceived to understand the needs of the Asian communities, but there is a mixed perception with regard to the understanding of Doctors and Nurses at the hospital.
DO DOCTORS AND NURSES UNDERSTAND YOUR NEEDS ?

		Muslim	Hindu	Sikh	Afric,Carib
		%	%	%	%
GP	Yes	94	84	81	53*
	No	6	16	19	47*
Hospital	Yes	68*	53*	67*	67**
	No	32*	47*	33*	33**
Outpatient	Yes	70*	70*	56*	41 *
	No	30*	30*	44*	59*
Clinic	Yes	83**	100**	67**	29**
	No	17**		33**	71**

Interpreter Services

The first table shows that some people needed an interpreter when visiting their GP and that the number increases for people attending the hospital. The reason for this is shown in the next table, where it can be seen that in a significant number of cases the GP speaks the same language as the patient.
DID YOU NEED AN INTERPRETER ON YOUR LAST VISIT?

		Muslim	Hindu	Sikh	Afric,Carib
		%	%	%	%
GP	Yes	12	4	1	3*
	No	88	96	83	97*
Hospital	Yes	42*	27*	44*	11**
	No	58*	73*	57*	89**
Outpatient	Yes	27*	27*	26*
	No	73*	73*	74*	100*
Clinic	Yes	33**	0**	67**
	No	67**	100**	33**	100**

IF NOT WHY NOT?

		Muslim	Hindu	Sikh	Afric,Carib
		%	%	%	%
GP	Speak English	56	74	56	100**
	Dr speaks language	44	26	44
Hospital	Speak English	94*	80	90**	100**
	Dr speaks language	6*	20	10**
Outpatient	Speak English	80*	92	100**	100*
	Dr speaks language	20*	8
Clinic	Speak English	75**	100**	100**	100*
	Dr speaks language	25**

In most cases, where an interpreter is required, a relative or friend interpreted for the patient and in some cases the patient attempted to speak English themselves.
The third table shows the response to the question "If you, or a member of your family, had to go to the GP/Hospital/Clinic (again) how important do you think interpreters employed by the GP/Hospital/Clinic to help you talk with the doctors and the nurses would be?" The answers clearly show the importance of this issue.

		Muslim	Hindu	Sikh	Afric,Carib
		%	%	%	%
GP	Very	76	61	63	19*
	Quite	10	24	19	21 *
	Not	16	14	18	60*
Hospital	Very	87	84	75	32*
	Quite	8	14	14	17*
	Not	6	2	9	51*
Outpatient	Very	84	84	74	19*
	Quite	12	12	21	21 *
	Not	4	4	5	60*
Clinic	Very	82	84	70	29*
	Quite	14	10	23	19*
	Not	4	6	4	52*

Worship Facilities

The next tables relate to worship facilities at the Manor Hospital. There are Chaplains of all faiths at the hospital, but a significant number of a small sample did not have access to one. The reason for this is not known. A larger number of people responded to questions about the importance of chaplaincy services and worship facilities on their next in-patient stay, with the greatest need being identified by the Muslims.

WAS A CHAPLAIN AVAILABLE ON YOUR LAST VISIT?

	Muslim	Hindu	Sikh	Afric,Carib
	%	%	%	%
Yes	17*	13*	6	56**
No	70*	40*	77	33**
Don't Know	13*	47*	18	11**

HOW IMPORTANT WOULD A CHAPLAIN BE ON YOUR NEXT VISIT?

	Muslim	Hindu	Sikh	Afric,Carib
	%	%	%	%
Very	85	41	56	36
Quite	10	31	19	26
Not	6	28	25	38

HOW IMPORTANT WOULD WORSHIP FACILITIES BE ON YOUR NEXT VISIT?

	Muslim	Hindu	Sikh	Afric,Carib
	%	%	%	%
Very	90	47	61	45
Quite	6	33	26	29
Not	4	20	12	26

Food

The first table shows the responses of a small sample. Other questions revealed that a few people were unaware of the availability of Halal/Indian food. The second table shows the importance that the Asian communities would attach to this issue if they, or a member of their family, were to be admitted to hospital in the future.
WHEN YOU WERE IN HOSPITAL WHICH OF THESE DID YOU EAT?

	Muslim	Hindu	Sikh	Afric,Carib
	%	%	%	%
Halal /Ind/AC	63*	50*	65*	0
English Veg	57*	71 *	47*	0
English Meat	0*	21*	24*	78**
Family food	27*	29*	24*	22**

HOW IMPORTANT WOULD ASIAN/AFRICAN CARIBBEAN MEALS BE NEXT TIME ?

	Muslim	Hindu	Sikh	Afric,Carib
	%	%	%	%
Very	92	69	70	54*
Quite	8	18	14	19*
Not	0	10	14	26*

Female Staff

These tables show the strong feeling amongst the Asian communities for female Doctors and Nurses to attend to female patients.
HOW IMPORTANT WOULD IT BE TO HAVE A FEMALE DOCTOR NEXT TIME?

		Muslim	Hindu	Sikh	Afric,Carib
		%	%	%	%
GP	Very	80	67	75	41
	Quite	12	22	14	26*
	Not	8	12	9	33*
Hospital	Very	86	74	77	31 *
	Quite	8	22	16	36*
	Not	6	4	7	33*
Outpatient	Very	88	69	79	33*
	Quite	6	24	16	21*
	Not	6	8	5	45*
Clinic	Very	84	80	72	36*
	Quite	14	18	23	24*
	Not	2	2	4	40*

HOW IMPORTANT WOULD IT BE TO HAVE A FEMALE NURSE NEXT TIME?

		Muslim	Hindu	Sikh	Afric,Carib
		%	%	%	%
GP	Very	88	69	75	38*
	Quite	8	25	14	26*
	Not	4	6	9	36*
Hospital	Very	85	73	79	36*
	Quite	10	22	12	26*
	Not	6	6	9	38*
Outpatient	Very	86	59	67	31*
	Quite	10	22	19	19*
	Not	4	20	14	50*
Clinic	Very	84	76	65	36*
	Quite	12	16	19	26*
	Not	4	8	14	38*

Information in own Language

Asian people were asked about the need for leaflets/posters and signposts/directions to
be available in their own language in Hospitals and Clinics and the results are shown below. Information in Asian Languages would obviously be valued.

HOW IMPORTANT WOULD IT BE TO HAVE LEAFLETS/ POSTERS IN OWN LANGUAGE NEXT TIME ?

		Muslim	Hindu	Sikh
		%	%	%
Hospital	Very	73	61	68
	Quite	14	31	25
	Not	13	8	7
Outpatient	Very	71	69	79
	Quite	17	23	16
	Not	12	8	6
Clinic	Very	78	70	73
	Quite	12	22	23
	Not	4	8	4

HOW IMPORTANT WOULD IT BE TO HAVE SIGNPOSTS/DIRECTIONS IN OWN LANGUAGE NEXT TIME?

		Muslim	Hindu	Sikh
		%	%	%
Hospital	Very	69	61	60
	Quite	15	23	23
	Not	15	16	17
Outpatient	Very	77	59	67
	Quite	10	22	19
	Not	13	20	14
Clinic	Very	76	62	66
	Quite	10	18	20
	Not	14	20	14

Finding out about Health Services

This table shows that videos and leaflets in Asian Languages, together with health professionals visiting places of worship and community centres, would be valued as a means of finding out about health services.

USEFUL WAYS OF FINDING OUT AB0UT HEALTH SERVICES

	Muslim	Hindu	Sikh	Afric,Carib
	%	%	%	%
Cassettes English	31	58	32	33
Cassettes Other Lang	42	75	67
Video English	37	60	46	48
Video other Lang	81	84	83
Video represent Asian	92	85	86	83
Leaflets English	45	67	47	81
Leaflets other Lang	78	78	75
Leaflets represent Asian	90	85	77	93
Visits place of Worship	89	88	86	52
Visits Community Centre	88	90	80	93
Interpreters	87	75	74	38

RECOMMENDATIONS

Even allowing for the possible margins of error on the small samples, the results of the survey support the views expressed by the community representatives that issues related to interpreting facilities-, information in Asian languages, availability of appropriate meals, female staff, and to some extent worship and chaplaincy facilities, are important to people from the Asian and African Caribbean communities, especially the Asian Communities.
Walsall Health Authority needs to continue to work together with health service providers, the Community Health Council and people from the communities to develop services and facilities for Asian and African Caribbean people and ensure that services are provided in a Culturally acceptable way.

This report was kindly provided by Walsall Health Authority and has been slightly adapted.

Resources about Race and Ethnicity in the Health Service