Co-navigating care for emotional distress in South Asian men with long-term conditions: a qualitative study of patient and GP perspectives in UK primary care

Abstract Background Men of South Asian (SA) origin in the UK have increased rates of long-term conditions (LTCs) and mental health problems, yet are less likely to seek help from NHS services, and Pakistani men in particular report the lowest recovery rates in NHS Talking Therapies. Co-occurring physical and mental health problems are associated with poorer outcomes. Research examining help-seeking in SA men with LTCs experiencing emotional distress is limited. Understanding this is essential to addressing inequalities in access to, experience of, and outcomes from primary care mental health support. Methods This qualitative study used online semi-structured interviews analysed through reflexive thematic analysis, underpinned by a critical realist epistemology. Participants were SA men with diabetes or coronary heart disease ( n = 17) and general practitioners (GPs) working in practices serving higher density SA populations ( n = 18), across three UK regions. Most patient participants were Muslim and first generation. Participants were recruited through community and faith centres, social media, and snowball sampling. A Patient Advisory Group of SA men was involved throughout. Results Two overarching themes were developed: (1) trust and mistrust, in primary care and in culturally-based support, and (2) co-navigating care, negotiating health beliefs between GPs and patients. SA men in our study described avoiding NHS services for emotional distress because of perceived over-medicalisation, experiences of discrimination, and divergent health beliefs, turning instead to faith-based support, family, and self-management. Both patients and GPs described the need for care that engages with patients’ cultural and religious health beliefs, built through relational continuity. Co-navigating care recognises that patients and GPs may bring distinct beliefs to the consultation which require mutual negotiation. Integrating findings with PAG input and prior work, we present the 3Cs framework (Contextualising distress, Conceptualising distress, Co-navigating care) for general practice consultations. Conclusions SA men with LTCs in our study described limited engagement with primary care for emotional distress. The 3Cs framework may support GPs to engage through co-navigating care. Embedding community and faith organisations as partners in primary care, consistent with the 10 Year Health Plan shifts toward community-based care and prevention, could contribute to more equitable service delivery.