Exploring alcohol, ethnicity and COVID-19
Research type
Research Study
Full title
Exploring ethnic differences in alcohol trends, explanatory models, and attitudes to alcohol consumption and intervention in a British South Asian population during COVID-19.
IRAS ID
273216
Contact name
Stacey Jennings
Contact email
Sponsor organisation
Queen Mary University London
Duration of Study in the UK
1 years, 2 months, 30 days
Research summary
Alcohol is a leading risk factor for global disease burden and is estimated to cost the NHS approximately £3.5 billion annually. Rates of alcohol-related admissions have continued to rise whilst numbers accessing standard treatment decline, with ethnic minorities least likely to enter treatment. South Asians comprise the largest UK ethnic minority group, yet subgroups are often categorised as a homogenous entity which can obscure important heterogeneity. Despite reporting lower consumption in survey data, certain South Asian subgroups are overrepresented in alcohol-related harms. Given the disproportionate impact of COVID-19 on UK South Asian groups across multiple health outcomes and mortality rates, research is urgently needed to better understand drinking behaviours and help-seeking to adequately support those affected.
This qualitative project will explore ethnic differences in alcohol trends, explanatory models, and attitudes to alcohol consumption and intervention in a British South Asian population. It will also explore the impact of COVID-19 on shaping alcohol patterns, treatment seeking and the feasibility of using remote research methodologies for this group. The study will involve four sample groups: 1) alcohol consumers 2) health professionals 3) lay individuals, and 4) religious leaders. Eligible participants will live, work, or receive care within Barts Hepatitis C Operational Delivery Network. Alcohol consumers will be recruited from hospital, addiction and community services within the study area. Purposive sampling will be used to maximise key characteristics including ethnicity, religion, age, gender, service use, and occupation. Participants will take part in one semi-structured interview or focus group. A culturally sensitive vignette task will be administered to triangulate qualitative methods and increase validity. Validated questionnaires assessing alcohol consumption levels and common mental health symptomatology will be administered. Surveys exploring acceptability of interview methods and COVID-19 impact will also be administered. Qualitative data will undergo thematic analysis and relevant main themes presented.
Thank you to all health professionals and service users who took part in this study.
Study title: Exploring ethnic differences in alcohol trends, explanatory models, and attitudes to alcohol consumption and intervention in a British South Asian population during COVID-19.
Who carried out the research?
This research was carried out as part of a PhD qualification. It was sponsored by Queen Mary University of London and funded by Barts Health Charity.
What public involvement was there in the study?
Two East London based PPI groups with relevant addiction and/or mental health lived experience assisted with the development of the study aims and materials. These groups included individuals from a South Asian background who had either personally experienced or cared for a loved one with alcohol problems. Staff from inpatient and community addiction services also provided feedback on the study aims and materials.
Where did the study take place?
This study took place from 2021-2023 across inpatient and community alcohol services within the Barts Hepatitis Operational Delivery Network (HCV ODN). This covered the East London boroughs of Havering and Redbridge, Tower Hamlets, Newham, Waltham Forest, and Hackney and Barking.
Why was the research needed?
This research was needed to help better understand the factors influencing excess alcohol consumption and help seeking in British South Asian communities. The main research questions studied were:
1) What are staff perspectives and experiences on barriers and facilitators to alcohol interventions for South Asian communities?
2) What are service user perspectives and experiences on barriers and facilitators to alcohol interventions for South Asian communities?
Who participated in the study?
10 multidisciplinary staff members and 11 current service users participated in the study.
What happened in the study?
Participants underwent a one-to-one qualitative interview in which they were asked about their experiences with alcohol misuse and support, relevant barriers and facilitators (including religious, psychological, socio-cultural, and economic), and the impact of COVID-19. Staff were also asked about any training or support needs.
What were the results of the study?
Staff and service users identified different barriers and facilitators across macro (structural), meso (societal) and micro (individual) levels of influence.
Staff
Staff identified three main barriers at the macro level: funding, service structure and COVID-19. Lack of funding created gaps in service provision and restricted the ability for services to build sustainable collaborations with the communities they serve. Alcohol services were seen as operating on a “West Centric†model that reduced specialist treatment options that may be more aligned with South Asian preferences. Adapting to remote working approaches during COVID-19 was also perceived to have multiple challenges and benefits.
At the meso level staff identified four main barriers. Firstly, staff highlighted cultural competence and offered nuanced, and often conflicting, descriptions of what this should look like. Ethnic matching of staff and service user was not accepted as a default preference. Instead, having a deep understanding of wider historical and sociocultural contexts of minority groups, whilst not making assumptions the individual. Staff also stressed that certain barriers were shared cross culturally (e.g. widespread accessibility of alcohol undermining harms).
Secondly, staff described how the sociocultural traditions held by South Asian families enhanced stigma surrounding alcohol, resulting in concealment of drinking within the family and community. This contributed to limited alcohol-related knowledge and communication tools, as well as delayed treatment seeking. South Asian women were described as having unique sociocultural barriers in accessing alcohol support due to gendered traditional roles. Suboptimal and uninformed service responses to women were also regarded as potentially dangerous.The acceptability of alcohol use in South Asian communities was seen as falling within religio-cultural boundaries, further intersecting with gender. Successful collaborations with places of worship to promote alcohol support within communities, with encouragement of compassion rather than judgement seen as a particularly effective strategy.
At the micro level, staff perceived that communities tended to mistakenly frame alcohol-related problems as a lifestyle choice that could be “just stoppedâ€. Increased education around the nature of addiction could reduce attributions of blame and responsibility.
Service users
At macro level, the widespread availability of alcohol was seen as a significant factor in the initiation and development of drinking problems. The steep financial cost of private treatment also restricted accessibility to those in need. COVID-19 had significant detrimental impacts on service user drinking behaviours and mental health, amplified by loss of employment, relationship breakdown, or domestic violence during the pandemic period. Participants displayed a clear preference for face-to-face treatment due to inadequacies in connection and accountability with an remote approaches.
At the meso level, service users differentiated family responses from that of the wider community, which was seen as judgemental and stigmatising. Only males experienced supportive family responses, whereas women reported being ostracized by families, which perpetuated alcohol misuse and discouraged help seeking. Unlike males, all women located the root of their alcohol misuse within the context of family conflict. Family educational strategies identified by females were centred around psychological impacts of family on the development of alcohol problems, whereas males suggested strategies around the hidden consequences of consumption.
Service users identified a sense of shared understanding as a key facilitator of cultural competence. Peer support was seen as a valuable aid in recovery, particularly when focused on the same substance (i.e., alcohol specific groups). Most service users strongly expressed a preference for someone not of the same background. Increased service discretion was also viewed as important to negate the prominence of alcohol services within South Asian communities. Many participants believed mental and physical conditions should be given equal weighting during the recovery process, as comorbidity could significantly delay receiving appropriate treatment.
At the micro level, normalisation of male social drinking contributed to a lack of internal acceptance that their drinking was a problem. For men and women, reaching rock bottom (severe physical, social or financial harms) served as a trigger for help seeking and recovery.How has this study helped patients and researchers?
This study has identified specific barriers and facilitators to alcohol treatment from both patient and staff perspectives that will inform service engagement and intervention design. It has also demonstrated how adopting an intersectionality-informed approach can help uncover a deeper insight into the experiences of ethnic minorities.
This study has shown that alcohol misuse and help seeking experiences within South Asian groups are rooted in stigma from intersecting religious, cultural and gender norms. Alcohol interventions and policy should be tailored to these unique needs. Central considerations include tackling the ‘culture of concealment’ and taking into account the unique presentations and needs of South Asian women. To be culturally competent, services must have the flexibility to sensitively cater to both individual and group identities and preferences, and concurrently treat both mental health and alcohol problems. Psychoeducational strategies should be informed by intersectionality and focus on expanding alcohol knowledge beyond physical health impacts, as well as expanding the audience to lay community members.Details of any further research planned
The lead researcher is currently developing grant applications to further explore alcohol misuse in minority communities with an intersectional lens.Where can I learn more about this study?
To learn more about the study please contact the lead researcher Dr Stacey Jennings at s.jennings@qmul.ac.ukREC name
London - Camden & Kings Cross Research Ethics Committee
REC reference
21/LO/0337
Date of REC Opinion
10 Jun 2021
REC opinion
Further Information Favourable Opinion