Appendix 2 - Thematic analysis of qualitative evidence submitted to RHIC Call for Evidence, Sept 2020
In addition to reports and quantitative data from formal engagement exercises or research, a number of local partners and stakeholders submitted qualitative responses to the call for evidence These included civic, academic and voluntary & community sector organisations,112 reflecting insights from community engagement as part of their regular practice
A thematic analysis was carried out to identify key themes relating to experiences of COVID-19 and its impact on communities, and the challenges, barriers and support needs identified in improving accessibility This is summarised in Table A.
Table A: Thematic analysis of qualitative evidence submitted
Experiences of COVID-19 and impact on communities
Theme 1: Exacerbation of existing inequalities
Exacerbation of existing health and social inequalities was a consistent theme, with responses identifying impacts relating to people (i e protected and marginalised groups), and places (i e wider determinants of health)
Impact on protected and marginalised groups
BAME communities, women, asylum seekers and rough sleepers (including those with substance use issues) were highlighted as key groups affected by both long-standing inequalities and COVID-19 Impacts cited included those on mental health and wellbeing (e g through anxiety and bereavement due to COVID-19) and not just the physical consequences of infection This sub-theme intersects across other thematic areas, with these groups identified as being disproportionately affected by the health and economic impacts of control measures Underlying health conditions were also cited as a factor in existing and exacerbated inequalities
Wider determinants of health
This sub-theme is divided into impacts of wider determinants on individuals and communities, and impacts on environments and places The former highlights the two-way relationship between COVID-19 and health inequalities: while the disproportionate effects on people living in deprived areas and the increased risk of transmission in certain sectors are recognised, impacts on wider determinants are also cited as consequences of the pandemic (e g increasing homelessness) However, a number of positive environmental impacts were also identified, namely improved air quality, reduced carbon emissions and reduced noise A reduction in road traffic accidents was also noted
Theme 2: Impacts of control measures
This theme relates specifically to the impact of measures taken to control the spread of COVID-19 rather than the effects of the virus itself These are split broadly into impacts on health and wellbeing, and those on the economy – however, the two are closely linked and intersect with the exacerbation of existing inequalities
Health and wellbeing impacts
Health and wellbeing impacts cover direct and indirect impacts on mental health and wellbeing, as well as psychological and social impacts These included isolation and loneliness through lockdown and shielding; anxiety, frustration and bereavement; uncertainty around employment or immigration status; and the impact of loss of income Disproportionate impacts on BAME communities and asylum seekers/refugees were again emphasised, e g women asylum seekers reported an exacerbation in loneliness
Economic impacts
This subtheme concerns the impact on the economy and employment sectors as well as on individuals and families Small businesses and the faith sector were highlighted as bearing major impacts of loss of income – particularly small businesses that did not operate online and were therefore unaware of or unable to access Government funding, or where employment type was not covered by the furlough scheme
Theme 3: Culture and behaviour
While this theme overlaps with other thematic areas, it was clearly a theme in its own right, with two distinct sub-themes: the general shifts in culture and behaviour that have occurred as a result of the pandemic and control measures (linking with Theme 2), and where specific cultural characteristics have interacted with these measures to impact disproportionately on certain groups (linking with Theme 1)
Shifts in culture and behaviour
This subtheme was predominantly concerned with changes in transport use and physical activity – specifically, decreases in transport use and increases in walking and cycling, which relates to the environmental impacts noted in 2
Relationship between culture and COVID-19 impacts
This sub-theme included increased risks presented by culture- specific behaviours (e g increased risk of transmission due to cohabitation with elders; traditional Bangladeshi diet increasing risks of obesity) and the impacts on way of life (e g enforced restrictions on places of worship that are central to way of life, such as Sikh Gurdwaras However, an increased appreciation of the role of faith and faith communities was also noted, suggesting that culture may play a protective role in maintaining wellbeing during the crisis.
Theme 4: Safety
This is again a theme that overlaps across a number of areas, but was prominent enough to be a theme in itself. The theme is divided into concerns relating to the risk of infection, and those relating to unintended consequences of lockdown (see Theme 3)
Fear of infection
Direct concerns about infection risk focused mainly on a lack of confidence in social distancing measures, either because it was felt other people were not respecting these measures, or because circumstances and/or environments made it difficult to follow guidance, e g using public transport, attending school, or using narrow high streets) Women asylum
seekers reported feeling unsafe in their accommodation as other residents were not respecting self-isolation and social distance rules
Unintended consequences of lockdown
Concerns around indirect impacts on safety included victims of domestic violence being isolated with their abusers, and reduced access to services (see Theme 5)
Challenges, barriers and needs
Theme 5: Access to services
Access to services was a prominent theme in responses relating to community challenges, barriers and needs during the pandemic, with the disproportionate impacts on BAME and marginalised groups evident in both subthemes: the availability and distribution of health and care resources, and experiences of these services
Availability and distribution of resources
This sub-theme picked up issues around accessing specific services and/or resources, and wider issues around recovery funding Reduced capacity and contact was noted both generally (e g lack of access to first responders and GP appointments; increased waiting times) and in relation to issues affecting specific groups (e g women’s reproductive health & care including lack of access to contraception, abortion & maternity care) Scarcity and unreliability of PPE sources for frontline staff/key workers was a key concern in relation to increasing risk among BAME workers (see Theme 1) A lack of funding and staffing overall was highlighted, as well as inequitable distribution of these resources: white-led organisations and a lack of trust established in local communities were cited as reasons why residents from BAME communities were not benefitting from available funding in some areas.
Experiences of care
Overall, this sub-theme reflects poorer experiences of care for people from BAME groups and women, linking to the disproportionate impacts on these groups outlined in Theme 1 1 Language barriers and challenges with using online or telephone services were cited as a key issue, particularly for women asylum seekers who were unable to use remote services with no interpreters available Women who were alone while giving birth were cited as particularly vulnerable, particularly where their babies required special care or they had interpretation needs
Theme 6: Stigma and trust
In addition to the practical barriers identified in 5 1, which related predominantly to service provision not being appropriate to community needs, there were also factors which made people unwilling to seek help Stigma around help-seeking was identified as being a particular issue in refugee and migrant communities; there was also a lack of trust in services and the government, with misinformation and a lack of clarity cited as an issue
Theme 7: Information
This theme relates to information provided to individuals and communities during the pandemic, and information gathered by health and other public services
Communication and messaging
Uncertainty and inadequate communication was a key concern among service users and communities, both generally around risk (e g why BAME communities are more affected) and specifically within services (see 5 3) This sub- theme is strongly linked to lack of trust (Theme 6)
Lack of data and visibility
The lack of data on ethnicity and faith was highlighted as a general concern However, even where data are available, the categories are broad and some communities are consistently ‘invisible’ (e g the Sikh community)