CICADA-ME: Coronavirus Intersectionalities: Chronic Conditions and Disabilities And Migrants and other Ethnic minorities

Two groups that experience similar societal inequities (expanded by the COVID-19 pandemic), including in social and health care, are people with chronic conditions/disabilities (PwCD) and ethnic minorities. The worst affected are both ethnic minority AND with chronic conditions/disabilities, a common group, as COVID-19 mortality statistics show. There is a largely unmet expressed need to explore this combined group'Äôs pandemic experiences with new or worsening conditions/disabilities including post-Covid syndrome in relation to reduced services, inequalities, lifestyle changes or health neglect and vaccine uptake. We aim to contribute and inform evidence-based formal and informal strategies, guidelines, recommendations and easily adopted interventions for pandemic-related and future health and social care policy and practice, to mitigate inequities and improve the experiences, health and wellbeing outcomes of minority ethnic groups at the intersection with chronic conditions/disabilities. To do so, we will develop a rich intersectional understanding of their mental and physical health, coping, access to resources, and informal and formal social and health care support experiences, and relevant assets and strengths, longitudinally over 18 months using mixed methods. Our 4 work packages involve a new UK survey in 3 waves, parallel qualitative insights, secondary analyses of other surveys, rapid review, and outputs for immediate use developed with participatory methods, with co-create workshops involving our PPI team and other stakeholders throughout. Our survey (n=5000) samples for 1st and 2nd generation community-dwelling minority ethnic groups and white British comparators, all with/without chronic conditions/disabilities, across the UK'Äôs 4 nations, to determine relationships between measured variables and their trajectories. After Survey Wave 1 we will interview 1st and 2nd generation ethnic minorities from Poland, India and Pakistan, sub-Saharan Africa, and the Middle East, and white British comparisons, all with and without chronic conditions/disabilities, about their pandemic experiences at 5 diverse sites in England, supporting transferability. Interviews (n=210) informed by survey analyses will include social network analysis, photovoice. We will train local lay people to help undertake these remotely; a transformative community migrant-majority research-active group will be our main London co-researcher. This group and a main co-applicant are members of an existing UKRI consortium and have undertaken complementary work at two of our sites, demonstrating the feasibility of our plans. At Waves 2 and 3 research workshops with interviewees will use video vignettes built from earlier study findings. Key informant interviews and co-create workshops will consider implementation. We will synthesise Keyword frequency analysis, Framework, discourse and narrative analyses, Latent Growth Modelling, Structural Equation Modelling, and social network analyses using tabulated evidence to decision methods, with interim findings reported at each wave for early delivery of benefits. Respondent and national UK demographic data will be compared for representativeness, and transferability explored at each stage. Data will be presented separately and combined for ethnic minorities and PwCD. We expect rapid impact from our strong networks and Co-A and collaborator existing strong pathways to influence in health and social policy and clinical practice.