Patient engagement: What are the barriers to direct care in ethnic minority/patients of ethnic origins? A systematic review.

Background: Patient engagement (PE) in healthcare operates at different levels, with direct care PE being the most common in everyday healthcare. Engagement at this level involves activities like medication adherence, attending appointments, and managing own health through proactive behaviours such as seeking information. Despite its importance, ethnic minority (EM) patients may face barriers to direct care PE and the reasons for this are unclear. Studies have shown that increased direct care PE is linked to better health outcomes, highlighting the need to identify the barriers that exist to direct care patient engagement in ethnic minority patients/patients of ethnic origin. Methods: A systematic review (SR) was conducted with thematic analysis to elicit the barriers. It was conducted following the guidance of Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 checklist. A comprehensive search was conducted on Embase, MEDLINE, Web of Science and Cochrane from 2004 to 2024 to obtain studies identifying barriers in direct care patient engagement in ethnic minorities. The included studies underwent quality assessment, after which thematic analysis was utilised to identify the barriers. Ethics approval was not required for this systematic review. Results: 3034 articles were initially identified from the appropriate database searches. After the removal of duplicates, 2197 articles were sourced and subjected to a review of their titles and abstracts. Subsequently, 24 relevant full text articles were retrieved for eligibility screening, of which 3 met the inclusion criteria and were included in this study. Additionally, 4 articles were identified through reference searching and subjected to title and abstract screening, with 1 article meeting the inclusion criteria and thus included in this study. Eventually, a total of 4 articles were included in this study: 3 articles from database search and 1 article from reference search. Barriers reported were based on patients’ perceptions and were thematically grouped. Racial and ethnic discrimination emerged as the dominant barrier, while other significant barriers included language proficiency and culture. Health literacy and education were also reported as barriers. Conclusions: Barriers identified in this review impeded direct care patient engagement in ethnic minority/patients of ethnic origin. Language proficiency and culture contributed to the racial and ethnic discrimination reported by participants. Awareness of these barriers is crucial for improving the poorer health outcomes already experienced by ethnic minority/patients of ethnic origin. Further research collecting primary data would be ideal for additional evidence of the barriers affecting direct care patient engagement and their impact on health outcomes. The role of artificial intelligence can also be explored further to mitigate language proficiency as a barrier.