Ethnicity and paediatric healthcare utilisation: Improving the quality of quantitative research

Abstract Background The COVID-19 pandemic highlighted the stark health inequities affecting minority ethnic populations in Europe. However, research on ethnic inequities and healthcare utilisation in children has seldom entered the policy discourse. A scoping review was conducted in the UK, summarising and appraising the quantitative evidence on ethnic differences (unequal) and inequities (unequal and unfair or disproportionate to healthcare needs) in paediatric healthcare utilisation. Methods Embase, Medline and grey literature sources were searched for studies published 2001-2021. Studies that found differences and inequities were mapped by ethnic group and healthcare utilisation outcome. They were appraised using the National Institute for Health and Care Excellence appraisal checklists. The distribution of studies was described across various methodological parameters. Results Of the 61 included studies, most found evidence of ethnic variations in healthcare utilisation (n = 54, 89%). Less than half attempted to distinguish between ethnic differences and inequities (n = 27, 44%). Studies were concentrated on primary and preventive care and hospitalisation, with minimal evidence on emergency and outpatient care. The quality of studies was often limited by a lack of theory underpinning analytical decisions, resulting in conflation of difference and inequity, and heterogeneity in ethnic classification. The majority of studies examined children's ethnicity but overlooked parent/caregiver ethnicity, and also didn't investigate patterns across age, year or location. Conclusions To improve the validity, generalisability and comparability of research on ethnicity and paediatric healthcare utilisation, findings from this scoping review were used to develop recommendations for future research. These lessons could be applied more broadly across the European context to improve evidence generation and evidence-based policy-making to reduce inequities in healthcare. Key messages • Quantitative studies of ethnicity and paediatric healthcare utilisation in the UK lack the use of sound theoretical frameworks, and often do not distinguish between ethnic differences and inequities. • The quality of future studies can be improved with greater attention to how ethnicity is classified and analysed, alongside specific considerations for examining healthcare utilisation in children.


Background:
The adjuvanted recombinant zoster vaccine (RZV), first approved in 2017, has high, long-lasting efficacy against herpes zoster (HZ) and a clinically acceptable safety profile. In addition to the prevention of HZ in adults aged !50 years, the non-live RZV can be used from age 18 years in individuals with immunocompromised (IC) conditions. We reviewed the evolving landscape of national recommendations for RZV use. Methods: National health authority and vaccination committee websites of countries where RZV is approved were searched in March 2022.

Results:
Of 41 countries where RZV is licensed, 14 (Australia, Austria, Canada, Czech Republic, Germany, Ireland, Italy, Netherlands, New Zealand, Saudi Arabia, Spain, Switzerland, UK, US) provide national recommendations related to RZV; the majority are preferential to RZV or only recommend RZV. Overall, seven and seven countries recommend immunisation from age 50 years or 60/65 years, respectively. Of the seven countries that recommend immunisation from age 60/65 years, five recommend immunisation in individuals from age 50 years with comorbidities/IC conditions. Five countries recommend immunisation from age 18/19 years in individuals at increased risk of HZ due to immunosuppressive disease/ treatment. In addition, six national recommendations refer to RZV safety and nine address prior HZ vaccination and/or infection. All recommendations outlined the RZV administration schedule.

Conclusions:
Although national recommendations can inform decision making in clinical practice, RZV recommendations are not available in all licensed countries. The recommendations highlight a trend in favour of the use of RZV for the prevention of HZ in older individuals and those with IC conditions. Main messages: An increasing number of countries are providing recommendations for the use of RZV for the prevention of HZ in older individuals and those with IC conditions. Key messages: An increasing number of countries are providing recommendations for the use of RZV for the prevention of HZ in older individuals. An increasing number of countries are providing recommendations for the use of RZV for the prevention of HZ in IC conditions.

Background:
The COVID-19 pandemic highlighted the stark health inequities affecting minority ethnic populations in Europe.
15th European Public Health Conference 2022 However, research on ethnic inequities and healthcare utilisation in children has seldom entered the policy discourse. A scoping review was conducted in the UK, summarising and appraising the quantitative evidence on ethnic differences (unequal) and inequities (unequal and unfair or disproportionate to healthcare needs) in paediatric healthcare utilisation.

Methods:
Embase, Medline and grey literature sources were searched for studies published 2001-2021. Studies that found differences and inequities were mapped by ethnic group and healthcare utilisation outcome. They were appraised using the National Institute for Health and Care Excellence appraisal checklists. The distribution of studies was described across various methodological parameters.

Results:
Of the 61 included studies, most found evidence of ethnic variations in healthcare utilisation (n = 54, 89%). Less than half attempted to distinguish between ethnic differences and inequities (n = 27, 44%). Studies were concentrated on primary and preventive care and hospitalisation, with minimal evidence on emergency and outpatient care. The quality of studies was often limited by a lack of theory underpinning analytical decisions, resulting in conflation of difference and inequity, and heterogeneity in ethnic classification. The majority of studies examined children's ethnicity but overlooked parent/caregiver ethnicity, and also didn't investigate patterns across age, year or location.

Conclusions:
To improve the validity, generalisability and comparability of research on ethnicity and paediatric healthcare utilisation, findings from this scoping review were used to develop recommendations for future research. These lessons could be applied more broadly across the European context to improve evidence generation and evidence-based policy-making to reduce inequities in healthcare.

Key messages:
Quantitative studies of ethnicity and paediatric healthcare utilisation in the UK lack the use of sound theoretical frameworks, and often do not distinguish between ethnic differences and inequities. The quality of future studies can be improved with greater attention to how ethnicity is classified and analysed, alongside specific considerations for examining healthcare utilisation in children. . Internationally, racism is recognized as a determinant of health and there is a discourse that it must be addressed in order to achieve health equity (Weil 2022). This qualitative secondary data analysis focuses on racially discriminatory experiences among older chronically ill people of Turkish origin in the context of medical and drug care in Germany. Methods: 11 expert interviews and 11 problem-centred interviews with chronically ill people of Turkish origin and their relatives in Germany were conducted in the MedikaMig-Project with regard to care practices, continuity of drug care and polypharmacy and analysed with structuring qualitative content analysis (Mayring 2015).

Results:
The analysis yielded 7 superordinate categories and 27 subcategories, identifying racial discrimination in access to care, the treatment situation and communication, and in the consideration of transnational lifestyles. Patients are often helpless, sometimes trying to put their experiences into perspective or to be treated by Turkish doctors in order to avoid these discriminatory experiences.

Conclusions:
Racial discrimination is pervasive in health care and should not be hidden behind other terms that mask discrimination. An intersectional approach allows us to understand which individuals are particularly affected and what they need to be protected from racism in health care. Key messages: Structural racism in health care needs to be clearly named and examined from an intersectional perspective in further research projects. Elderly patients with Turkish origin need empowerment and contact persons after racist experiences to find ways to deal with discriminating experiences that are sometimes perceived as traumatic.
Abstract citation ID: ckac129.731 Diversity competence: what should be prioritised in an online course? An adapted delphi study

Background:
Population diversity is a reality in our societies and requires health systems and health professionals to adapt to the needs of diverse patient groups, including migrants and ethnic minorities. This study aims to investigate topics and methods that should be prioritised in an online course on diversity competence in healthcare delivery to improve health care encounters and provide health services that meet the unique needs of all patients in order to reduce health disparities.

Methods:
The study uses an adapted Delphi method including two rounds, combining some open-ended questions with predefined items, asking 31 European academic experts and health professionals within the field of migrant health to rate training content and teaching methods. Consensus for training topics was set to 80% and for teaching methods 70%.

Results:
The only item reaching 100% consensus as being important or very important to include was 'health effects of migration (pre-, mid-and post-migration risk factors)'. Other highscoring items were 'social determinants of health' (97%) and 'discrimination within the healthcare sector' (also 97%). A general trend was to focus more on reflective practice since almost all items in the reflection section reached consensus. 'Reflection on own stereotypes and prejudices' reached the highest consensus in this section (97%).

Conclusions:
Experts' prioritisations of teaching content and methods for diversity training can help the design of short online trainings for health professionals and reduce extensive course content, thereby fostering professional development and enabling diversity competence trainings to be implemented in cases of scarce resources.