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Health expectations : an international journal of public participation in health care and health policy
Par Taylor F, Vandrevala T, Zschomler S et 7 autres.
Contenu en anglais
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Underserved communities including ethnic minorities, refugees and migrants, experience higher mental health needs than the general population, yet engage less with cultural and green community assets (CGCAs) that could support wellbeing. While access barriers are known, less is understood about the cultural meanings and processes underpinning inequalities shaping engagement. This study examined the cultural drivers and mechanisms of these inequalities and how they might be addressed to improve mental health.
A multi-site qualitative study in England with community voice champions (CVCs) recruited through five underserved community organisations. A lived experience storytelling methodology with thematic analysis was used, informed by a theoretical model of cultural processes and causal pathways to inequality. Twelve workshops were held, following which CVCs collected community stories.
Twenty-seven CVCs participated and collected 147 stories. Symbolic, place-based and material inequalities emerged across three themes: cultural influences on mental health; unknown spaces and unfriendly environments; and creating spaces of safety and belonging. Even when CGCAs were available and known, racial stigmatisation and cultural dissonance reinforced exclusion. Community-led initiatives, facilitation and peer support helped make CGCAs safer and more welcoming.
Engagement with CGCAs is not only about access, but a negotiated process shaped by intertwined inequalities. Nevertheless, these inequalities are not fixed. Community-led activities grounded in trust and collective action can transform exclusionary environments into inclusive ones to support mental health. Patient or public contribution: Community organisation leads contributed to study design, participant recruitment and support, data interpretation, and are co-authors. CVCs participated in workshops, collected and interpreted data, and validated findings.
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