Factors influencing the mental health of an ethnically diverse healthcare workforce during COVID-19: a qualitative study in the United Kingdom

Figures & data

Table 1. Demographic characteristics of participants.

Characteristics	Sample (n = 61)	% of Sample
Male	26	43
Female	35	57
Other	0	0
Age, median (IQR)	46 (22–69)
Asian	22	36
Black	15	25
Mixed	6	10
White	17	28
Other	1	1
Doctors	13	21
Nurses & Midwives	12	20
Allied Health Professionals*	15	25
Ancillary Health Workers**	21	34
England	52	85
Scotland	1	1
Wales	0	0
Northern Ireland	5	8
Unknown	3	6

*Also Includes dentists, pharmacists, healthcare scientists, ambulance workers and those in optical roles.

** Includes those in administrative, or other non-clinical roles (e.g housekeeping/security/maintenance etc).

Figure 1. Factors influencing the mental health of all healthcare workers.

Table 2. Participant based recommendations.

Participant narrative	Suggested policy recommendation
“I think the only thing from my side would be communication … .The communication has been very confusing and, you know, lack of the right communication … . Right now the communication from the government, from the NHS, from everywhere, from your company, it’s very confusing and very little.” (FG5, F3, Ancillary Health Worker)	Clearer, quicker and consistent communication (including policy guidance) with all staff via regular briefings utilising various media including newsletters, online/face to face, email alerts and social media
“And for kind of future situations … .healthcare staff, especially from BAME (Black, Asian and minority ethnic) backgrounds, can be included as part of those conversations and protected because there is a risk there.” (FG7, F, Allied Health Professional)	Inclusion of all minoritised staff groups in regular dialogue within senior management forums in order to hear their voice in relation to perceived risks and concerns
“Yeah, so I’d like to take the flexibility forward and the inter-disciplinary working. I think it seems more levels at the moment than it has done in the past. It would be great to take that forward. More remote working and I think the advances we’ve made in technology over the past year are phenomenal when you think what the NHS hasn’t done over the past century or so”. (FG6, F2, Allied Health Professional)	Further utilisation of new technologies to continue flexible working arrangements including remote working where possible
“But the mental health hubs are a great idea I think. We have quite a lot of health and wellbeing at our workplace. There’s a big health and wellbeing department and they give ideas and vouchers for food and all sorts of things like that.” (FG6, F1, Doctor)	Sustainable staff wellbeing initiatives including rewards schemes with local and national businesses, sustained access to talking therapy provision, counselling and in-house staff resources such as spaces for staff to focus on wellbeing and take self-care
“Rather than clumping us all into one, you know, there could be some nuances between different cultures, different religions, different countries and so on.” (FG7, M, Allied Health Professional)	More nuanced approaches to assessing staff needs, including the development and use of intersectional frameworks for risk assessments.
“What they could do is, and I don’t know how many employees would be willing to do it, so in the pharmacy job that I’ve got in hospital, what they’ve done is with the two dispensers, they’ve split them up. It’s a financial thing for the employer. Again, it’s about capital versus, you know, livelihood versus life, where they have one dispenser coming in three days of the week one week and two days the following week, so she’s only doing five days over ten days. But she’s getting paid full time in case the other one goes down. So they never work together.” FG1, F2, Allied Health Professional	Easing workload intensity and exposure to the virus by dividing Full Time Equivalent roles across HCWs, enabling them to work differing work patterns, potentially in different settings

Figure 2. Cumulative effect on ethnic minority healthcare workers. Contributary factors highlighted in green may be applicable to most HCWs; factors in amber apply to ethnic minority staff; those in red are long standing factors impacting on ethnic minority HCWs. The cumulative impact of all factors can lead to an increased mistrust in employer and sense of betrayal resulting in increased psychological burden for ethnic minority HCWs.

Table

OBJECTIVES • To gather reflections on participants’ views and experiences as clinical and non-clinical healthcare workers during the COVID-19 pandemic; • To explore what factors healthcare staff feel have put them or other healthcare staff at risk; • To examine fears or concerns healthcare staff have experienced both in and outside of work; • To discuss challenges healthcare staff have experienced in accessing the information they need for protecting themselves; • To identify things that have been helpful in their workplace or community in supporting healthcare staff or protecting their health.

Table

Heading	Examples of subject matter
Introduction	Project overview, consent information etc
Participant background information	Biographical data
Fears, concerns and perceived risk factors	Individual level factors
Challenges relating to accessing information or ability to protect yourself	Experiences in accessing information
Support and facilitators	Coping mechanisms
Cultural, ethnic and migration related factors	Influence of culture
Stigma and discrimination	Impact of stigma
Protection and promotion	Recommendations for the future
Closing	Thanks and final opportunity to contribute any more thoughts/comments/suggestions

Data availability

To access data or samples produced by the UK-REACH study, the working group representative must first submit a request to the Core Management Group by contacting the UK-REACH Project Manager in the first instance. For ancillary studies outside of the core deliverables, the Steering Committee will make final decisions once they have been approved by the Core Management Group. Decisions on granting the access to data/materials will be made within eight weeks. Third party requests from outside the Project will require explicit approval of the Steering Committee once approved by the Core Management Group. Note that should there be significant numbers of requests to access data and/or samples then a separate Data Access Committee will be convened to appraise requests in the first instance.