TIDES Phase 1

Overview of Data

To capture inequalities in mental and physical health and service use, we will be examining national population data from the 2007 and 2014 Adult Psychiatric Morbidity Survey (APMS); local data from the South East London Community Health (SELCoH) study provides local prospective population data from 1698 adults residing in 1075 randomly selected households (2008 to 2015); clinical data from Lambeth DataNet (LDN; 2004 onwards), a primary care database system containing clinical records on approximately 360,000 service users from all 52 GP practices in the southeast London Borough; and the Clinical Record Interactive Search (CRIS; 2007 onwards) system at the South London and Maudsley NHS Foundation Trust representing the largest mental health clinical informatics database.

Publications

Gazard, B., Chui, Z., Harber-Aschan, L., MacCrimmon, S., Bakolis, I., Rimes, K., Hotopf, M. & Hatch, S. L. (2018). Barrier or stressor? The role of discrimination experiences in health service use. BMC public health, 18(1) 1354.

Chui, Z., Gazard, B., MacCrimmon, S., Harwood, H., Downs, J., Bakolis, I., Polling, C., Rhead, R. & Hatch, S. (2020). Inequalities in referral pathways for young people accessing secondary mental health services in south east London. European Child & Adolescent Psychiatry, 1-16.

What Was the Survey About?

What was the survey about? This survey aimed to examine inequalities and discrimination experiences in healthcare settings. Topics included: Sociodemographics, Orientation and Internalised Homophobia, Relationship Status and Social Support, Ethnicity, Cultural Identity and Racial Identity, Feelings Towards Others and Comparison of Self to Others, Work Environment, Diversity and Inclusion, Work Attitudes, Unfair Treatment in the Workplace, Life Events, Discrimination, Explicit Bias, Health Outcomes, Health Service Use and Social Desirability

What is the TIDES interview study?

The qualitative study interviewed TIDES survey particpants to further explore survey results. Nurses and healthcare assistants were selected for interview due to higher reported levels of experiencing and witnessing discrimination and bullying. The topic guide included questions about: Their work environment, Witnessing and experiencing discrimination, Reporting discrimination, The impact of discrimination on health service use and Training available on discrimination and bullying

Who took part in the survey?

Over 900 healthcare practitioners working across London NHS Trusts took part in the survey in 2018-19.

HCA= healthcare assistant; AHP = allied health professional

Virtual Reality

The TIDES Virtual Reality (VR) study uses innovative VR methods to examine how bias and discrimination influences clinical decision making. This will enable us to tackle inequalities and discrimination experiences in health services.

What has happened so far?

A novel VR simulation was developed to investigate the role of bias and discrimination in clinical decision making. An iterative and collaborative process was used to build and refine the content of the VR simulation based on input from the core TIDES team, clinical experts and the KCL Virtual Reality Research Lab. In our simulation, we were able to manipulate various sociodemographic characteristics of the virtual patients (e.g., gender, race and migration status) to investigate bias and discrimination in clinical decision making from an intersectional perspective. Thirty-five healthcare practitioners were recruited to the study between January 2020 and September 2022.

The participant’s task was to conduct a 10-minute consultation with each virtual patient to determine their health problem and provide a treatment recommendation. After each consultation with the virtual patients, participants were asked to complete a short survey to provide ratings of the virtual patients’ personality characteristics, probable behaviour and social roles, and overall health.

What Next?

We are currently analysing both quantitative and qualitative data from the study which will be published shortly.

Data Collection

We completed data collection for our healthcare practitioner sample in February 2020; a total of 48 interviews were conducted with student and qualified nurses, healthcare assistants and nursing associates.

Thank you to everyone who participated and took the time to share their experiences with us.

We also interviewed senior staff to gain multiple perspectives across healthcare. A total of 24 interviews were completed between January 2021 and March 2021.

Analysis

Existing interview data are being analysed using thematic analysis. Here is information about the first of a series of papers involving these data.