Developing New Strategies to Tackle Health Inequalities in the UK - Research Paper Example

? Research Proposal: Factors that of Decreasing Smoking Rate Introduction Within the context of the current concerns for the health inequalities among those considered the minority ethnic groups in the United Kingdom, there are various perceptions concerning the counseling services among the members of the Afro-Caribbean Community. It is worth noting that efforts geared towards reducing inequalities in health should always take into account factors that are deemed to hinder achieving equality, and this can be achieved through collecting various views of the members of the local community as pertains the sources of those inequalities, as well as on the local health services. Statistical existence of the inequalities in counseling, in treatment, as well as in diagnosis of the African-Caribbean group in the UK is well documented alongside the sociological explanations following those inequalities which happen to be centered on social exclusion in various forms. The reason behind inequalities in health service provision with a focus on counseling services which in essence, entails social exclusion is the conceptual ground of the proposed research. Following the publication of the 1979 Black report (Townsend and Davidson, 1982), inequalities in health have more often than not been a major concern of most of the UK health researchers. Moreover, the wide spread existence of inequalities in health among the ethnic groups in the UK is also well documented Smaje and Grand, 1997). However, the mental and physical outcomes as outlined in these studies appear to vary with ethnicity (NHS Executive Mental Health Task force, 1992). However, what remains ill understood pertains to the precise mechanisms through which those inequalities are practiced, as well as factors that supersede those inequalities. The specific inequality in health that this proposed research seeks to address is the counseling experienced by the members of the Afro-Caribbean community living in the UK. According to Bhui (1998), under-utilization of the support services seem to be an essential contributor to low health outcomes observed among the Afro-Caribbean community. While there are various notable factors that work to contribute to health inequalities, this suggested research focuses on the factors that hinder the Afro-Caribbean from accessing the counseling services in the UK. The policy environment of such health services often target eliminating any role health services might have in generating health inequalities. Arguably, equal opportunities legislation often makes explicit treatment inequalities by the practitioners a malpractice. The existing government policies, as well promote partnership with members of the disadvantaged communities at grassroots with a view to ensuring accessibility and appropriateness of services, alongside fostering some sense of public accountability (McLeod, 2003). When patients are addressed as consumers, deinstitutionalization of health services, as well as the rising counseling users has provided room for active involvement of the interested groups in treatment and health services. Clearly, this research proposal would take place within the national policy efforts in order to achieve inclusion of the marginalized groups in delivery and design of the health services. In micro-level interactions that take place between members and the health services inclusion and exclusion in services is often experienced and understanding the relationship existing between health inequalities and the social exclusion. As can be inferred from the body of literature preceding this section, detailed studies on factors hindering Afro-Caribbean people in accessing health services and in particular counseling has received less attention. This paper seeks to propose a study on factors that hinder the Afro-Caribbean people from accessing counseling in the UK. Research Objectives This study has three key objectives that play the central focus of this paper. The first objective entails providing qualitative answers to the factors that hinder the Afro-Caribbean people from accessing counseling in the UK and, secondly, the study seeks to illustrate the importance of counseling services in its totality, as well as to the Afro-Caribbean people in the UK. Thirdly the proposed research seeks to find attributes that the world and in particular the UK ought to embody in order to achieve equality delivering health services. Purpose of the research The overarching purpose for this research would be establishing the factors hindering the Afro-Caribbean people from accessing counseling services in the UK. The topic to be examined shall, therefore, be factors hindering the Afro-Caribbean people from accessing counseling services in the UK. Research Questions There are three essential questions considered in this study. These questions can support research in its objective of achieving the possible answer to the thesis. • Who are the Afro-Caribbean people? • What is the perception of the Afro-Caribbean people living in the UK concerning provision of health services by the government and how are they affected by the limited counseling services they receive? • What are the factors that hinder the Afro-Caribbean people in the UK from accessing counseling services? • Other than the counseling services, what other health services are the Afro-Caribbean people in the UK denied right to access? • Of these factors, what are the most prominent ones that impact negatively to their day to day living? Methodology This aspect of the research shall be dedicated to knowing the step by step approach to be used by the researcher to arrive at data collected. It is also for a reflection on the major steps taken to achieve the purposes set for this research work in the early chapters of the research report. To this end, the following components have been discussed. Research Design Saunders et al (2003) outline six major research designs that can be used by researchers. Among these, the researcher shall settle with the use of survey research design. Generally, surveys entail a representative research whereby data collected from a group of people is generalized for a wider population base (Ogus, 2002). For this research, therefore, the researcher shall use the data to be collected from the sample size to represent the wider idea as it exists among the none-experienced, as well as the experienced principals within the surrounding area of the research and beyond. Because conclusions from surveys are generalized, it is always important to ensure that the selection procedure for the sample size is very fair and well represented (Etherington, 2004). It is for this reason that the surveying sampling procedure shall be used by the researcher. Again, it is important to make the scope of population wide in ensuring there is a variety in variables. It is for this reason that the researcher shall use as many as sixty participants including thirty the Afro-Caribbean people and thirty none Afro-Caribbean people. Even more, the conclusions from a survey can well be considered representative if the sample size is large enough. To this effect, the researcher shall use all Afro-Caribbean and none Caribbean people from each district in the UK. Instrumentation The instrumentation simply refers to the mechanism of data collection. In all, the researcher shall make use of two major research instruments. These are the interview, and questionnaire. It must be emphasized that the selection of these three research instruments are based on the need to get both qualitative and quantitative data for research. However, the two named research instruments shall best help in the collection of quantitative data (Moustakas, 1994). This is because they all deal with data that can be quantified on a given scale. For instance, if respondents answer ‘yes’ or ‘no’ on a questionnaire, the data can easily be quantified into x number of yes and y number of no. The same is true for the other research instruments selected. One other important consideration also is that three different orientations of research instruments have been selected in order that kind of data to be collected will vary. Seeing that there are outlined purposes of this research, it is just appropriate that the means of data collection become wide and varied. This research instruments are considered very appropriate for the sample size as they were all in a position to write, understand the questions and answer them appropriately. As a way of ensuring ethical compliance to anonymity and confidentiality, the respondents will not write their names on the forms. The use of questionnaire shall be necessitated for the collection of other forms of questions related to the health inequalities, their personality, lifestyle, and how they combat stress given that they have limited access to counseling services. The questionnaire shall actually be used to cover a wider range of questions and shall not be restrictive on particular tone of questionnaires (McLeod, 2005). The questionnaire shall be attended to by respondents through writing. The questionnaire shall contain both open ended and close ended questions. Due to the size of the sample size, however, a lot of the questions shall be closed ended to enable easier analysis and handling of the data. Close ended questions do not demand that respondents give answers from their own discretion (McLeod, 2005). Rather, respondents are supposed to answer questions by choosing from among suggested options of answers. Examples of closed ended answers are ‘yes’, ‘no’ ‘agree’, disagree’, ‘always’, ‘often’ and so on. The questionnaires shall be given to the respondents with a deadline, by which time they are to submit the questionnaires. This means that the respondents shall be at liberty to answer questions at their own free will. The questions shall be answered anonymously. They shall, however, be expected to produce a 4-figure ode like ‘2572’ that must be used on all three instruments. This code is necessary to ensure that instruments can be well compared to each other. Each of the two instruments shall contain some facts that deal with personal data of respondents. These personal data are simply data on the personality of the respondents. Some of these shall include age race, gender, highest educational status earned and administrative achievement. These personal variables shall be necessary for establishing links between how each of the variables affect or influence the issue of stress. Indeed, it must be mentioned that these variables shall be collected from the primary data collection procedure, and it shall serve as a very good avenue for testing the data from the secondary sources. For instance, if the secondary sources allude that age has nothing to do with risk factors in stress and levels of stress for a person, this data shall be compared with the personal data to be collected in relation to the causes and levels of stress that cause them to seek counseling services. This means that the personal data have very important roles to play as far as the research topic and outlined research purposes are concerned. On the questionnaire, the personal data; thus data on age, gender, race, educational qualification and educational experience shall be under a section to be known as demographic data. Due to the fact that the whole research shall be anonymous, it can be trusted that these demographic data can be collected confidentially. Occupational data shall also be collected. The occupational data are those data types that relate to the environment. It will be noted that the research topic has to do with the Afro-Caribbean people. This means that their environment cannot be eliminated. This, thus, means that the environment which covers their niches and the wider UK and data on the environment are very important for this research work. Among data to be collected under this component are a number of hours, they get access to counseling services, and the number of hours they get informed concerning the need to access counseling services. It is expected that these data on the number of hours in a given year they access counseling services should go a long way to influence the findings pertaining to the factors influencing the Afro-Caribbean people from receiving counseling services in the UK. This also underscores the fact that most of the occupational data shall be found on the administrative stress index rather than the questionnaire. This notwithstanding questions on the questionnaire that shall reflect the other variables. Literature review The literature on factors that hinder Afro-Caribbean people in accessing counseling in the UK, contains results of many research projects that were contacted over a period of time. It is evident that the total number of such publications is quite overwhelming, although this does not mean that all the pertinent publication were reviewed, though none of those that were applicable and useful to this work were excluded intentionally. Difficulties that were encountered in review of literature are an attempt to find studies that clearly highlight factors that hinder Afro-Caribbean people in accessing counseling in UK. Initially there has been an attempt to quantify the existing association between counseling in the UK and the Afro-Caribbean people by a wide range of researchers. Some studies like those of Cambell and Mclean (1998) showed that Afro-Caribbean population like any other minority community is a heterogeneous population and draws on various islands, religious and the social-economic identities. Epidemiological analysis, based upon clients affected with schizophrenia diagnosis, indicate that there is a disproportionate representation of the Afro-Caribbean among patients who were diagnosed as being schizophrenic detained under the Mental Health Act (Dunn & Fahy, 1990; Littlewood, 1986; Thorncroft, Dunn, Leese, Higginbotham & Phelan, 1996; Croudace, Singh, Harrison & Beck, 1998). According to the study by Littlewood (1986), the Afro-Caribbean people suffer high rates of the involuntary detainment in the secure psychiatric settings and the involvement of the police in the sectioning process. Littlewood (1998) have shown that the minority ethnic communities like the Afro-Caribbeans are much less likely to being offered talking therapies such as the more offered chemotherapy, counseling, and seem to be prescribed somewhat higher drug dosage than the white counterparts. Littlewood (1998) noted that the pervasive cultural stereotypes do permeate the manner in which the Afro-Caribbean patients are viewed as being dangerous, irrational, and threatening as compared to their white counterparts. The low utilizing of the support services according to Bhui, Bhugra & Christie (1998) along with the less desirable route that is taken through the psychiatric services (Sashidharan, wildsmith, Commander, Cochrane, 1999) are some of the features of minority ethnic usage of the mental health services. Failing to access the support services at some early stage has been linked to the worsening mental health outcome, as well as the greater likelihood of the involuntary admission. The insufficient accessibility of services might increase following the repeated contact with the mental health services for some substantial amount of time which suggest that negative experiences of the health services by the ethnic minorities contributing to their under-utilization of the health services (Sashidharan, wildsmith, Commander & Cochrane, 1999). Other studies that asked the clients of mental health services concerning their satisfaction with services found a significantly somewhat lower satisfaction scores among the black users compared to the white British users (Bhugra, Bhui, Christine, 1998; Thornicroft, Parkman, Leese, Davies & Phelan, 1997). These studies seem to suggest that problems associated with the health services, in particular the counseling services in interaction between the Afro-Caribbean contribute immensely to the relatively poor counseling services of the Afro-Caribbean population. Clearly, there is lacking evidential study that has so far been conducted on factors affecting the Afro-Caribbean people in the UK from accessing counseling. Research ethics applied Researchers are made to go through an array of ethical requirements. There is the need to meet professional, institutional, as well as standards for conducting any research related to human participants. In helping steer clear any ethical quandaries, this research would consider a number of research ethics. First, it would frankly discuss with participants the intellectual property. More often than not, academic competitive leads to trouble depending on who should be credited for authorship. The best way the researcher would consider in order avoiding disagreements about who to be credited, and using which order, the researcher would talk about the issues at the start of the working relationship with participants and ensure they are put in writing. This will act as a tool to help discus and evaluate the contributions during the research process. Secondly, the researchers would be conscious of professionalism of participants by selecting professional participants who have are rich in knowledge, and practice in the field. This could be achieved by avoiding relationships that might tend to impair the researchers’ professional performances or could cause harm to others. However, they will have to take note that many multiple relationships between the researcher and participants are not ethical especially if they are not to have adverse effects. When recruiting the patients as participants in this study, the researchers would have to think carefully before joining the multiple relationships with other participants. In this case, the researcher would act as lab supervisor, as well as a mentor and make sure he or she does not abuse the power to differentiate him or herself with participants. The researcher would make sure he/she outlines the nature and structure of mentoring before mentoring begins. The third code of ethics to be upheld during the study would be to make sure the informed-consent rules are strictly followed. Doing this properly, the consent process would ensure that the participants voluntarily participate in the research when fully informed of the relevant benefits and risks. Fourthly, the researcher would have to consider respecting the confidentiality and privacy of the participants. In this respect, the researcher would be keen not to question about any personal issues like family, origin or politics. Respecting individual rights to confidentiality, as well as privacy is a key tenet for every researcher. The researcher will, therefore, have to discus confidentiality limits giving participants information about how their data will be put into use and also know the law of the state, as well as taking practical security measures. Last but not least, the researcher would stare clear of restrictions about age, gender, ethnics or believes. This would ensure reduced biasness in the final outcome. Participants The sample shall be a handy percentage out of the total population size to be built. The population, on the other hand, refers to all people who have some level of possibility of becoming part of the sample size. In common terms, the sample size is referred to as respondents (Mok, Lee, &Kam-yuet, 2002). This means that they are people from whom the researcher shall collect data directly shall be composed of thirty Afro-Caribbean and thirty none Afro-Caribbean. It is always important to build a sample size for data collection when there is a very large population to deal with. It would be seen that this population presents a very large number  of participants whom the researcher will have to deal with. With the sample size, the researcher will now be dealing with a number that is quite manageable and not out of the control of the researcher. Using a large sample size ensures very high level of fairness in the representation of people in the sample size. Again, it is important to make the scope of population wide so that there will be a variety in variables. It is for this reason that the researcher shall use a large sample. Even more, the conclusions from a survey can well be considered representative if the sample size is large enough. This would help reduce bias as well as reducing on variability, which in turn will make it appropriate for generalization of the results and their application in practice. Conclusion and Recommendations Successful completion of this research work will come with a lot of significance to many people, especially to the minority ethnic group in the UK. First, data, results and conclusions from this research shall serve as updated literature coping mechanism among the Afro-Caribbean people within the population size targeted for this research work. To a large extent, this research shall help in coming out with new strategies on how to address inequalities in health services in the UK. The new trend of knowledge to be acquired shall indeed lead to a new paradigm shift whereby the knowledge shall be adapted for use and implementation by present and future governments. This is to say that the findings and conclusions from this research work will go a long way to shape the lifestyle, working habit and social lives of the Afro-Caribbean people, as well as those living in the UK. This means that the Afro-Caribbean and all other people in the UK who come across this document will have a renewed commitment towards the handling of inequalities in health in the UK. In particular, the Afro-Caribbean people will reap a lot of benefits from this research given that it seeks to inform them about how they are left behind in terms of accessing counseling services. This in effect would go along way streamlining the provision of services to those living in the UK. The majority group, on the other hand, would not fail to reap these benefits. This study is inclusive in its objective and would, therefore, explore other strategies of dealing with the inequalities in health, which would go a long way in boosting their knowledge of dealing with inequalities in the society. Finally, this research work is going to be a very useful medium for stakeholders in the health sector to take very tangible decisions and come out with practical policies on ways of helping the Afro-Caribbean, feel free while living in the UK. Some of these practical policies may include the conduct coming up with working measures that would see to it that the issue under discussion is addressed amicably. References Barker,C., Pistrang, N., R, Elliot (2002). Research methods in clinical psychology; an introduction for students and practitioners, 2nd ed. Publisher: John Wiley & Sons ltd. Bhui, K., Christine, Y. & Bhugra, D. (1995). The essential elements of culturally sensitive psychiatric services. International journal of Social Psychiatry 41 (4): 244-257. Bont,T (2000). standards and ethics for counselling in action. 2nd ed,Sage publication Campbell, C. & Mclean, C. (1998). Ethnic identities, Social capital and health inequalities: Factors shaping African-Caribbean participation in local community networks. Social science and medicine. Sashidharan, S., wildsmith, E., Commander & Cochrane, M.(1999). Mental health care for Asian, black and white patients with non-affective psychoses. 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