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Introduction: The under-representationo f minority ethnic staff groups within the clinical psychology profession has been a serious area of concern for some time. Central to these concerns has been the questionable ability of the profession to adequately address, provide for and meet the needs of an increasingly diverse multi-racial and multi-ethnic society, for whom the utilisation of clinical psychology services are extremely poor. Literature review: The literature review indicated that minority ethnic groups were generally marginalized and excluded from clinical psychology services on a number of different levels, due to a combination of referral conventions, professional misunderstandings of psychological distress, the limitations of conceptual frameworks and cultural factors. Research report: Given the profession's lack of success in attracting and recruiting staff from minority ethnic groups, this thesis was undertaken to: (a) explore the perceptions of clinical psychology held by different ethnic groups, using psychology undergraduates as the target population and (b) investigated their intention or otherwise to pursue a future career in clinical psychology, using the Theory of Planned Behaviour (TPB) as a model. The results showed the TPB to be predictive of intention in all cases. However, for the minority ethnic groups, there were significantly more perceptions of disadvantage in pursing clinical psychology, as there were the factors that would deter them from entering the profession. Methodological limitations of the study, practical implications and directions for future research are discussed. Critical appraisal: An appraisal of the research process is presented, concluding with salient learning points for the future.

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Aim: To systematically review lifestyle interventions to treat and prevent obesity in adults, children and vulnerable subgroups. Methods: Cochrane methodology and a "best available evidence‟ approach were adopted to produce a series of published systematic reviews. Results: Adults: diets alone and with exercise and/or behaviour therapy compared with control significantly reduced weight for up to three years (weighted mean difference weight change 4 to 13 kg at one year) and prevented weight gain for up to seven years. Exercise as an adjunct to diet and also meal replacements may be effective in the long-term maintenance of weight loss. 600 kcal/day deficit or low-fat diet; diet and exercise with/without behaviour therapy; significantly reduced the risk of hypertension, type 2 diabetes and metabolic syndrome compared with control. School-children: 39% of school-based interventions significantly improved mean body-mass index compared with control. Combined diet and physical activity interventions were most effective. It is unclear what elements of interventions are consistently effective in preventing excessive weight gain. There can be significant prevention of weight gain in children from interventions not conceptualized as obesity prevention interventions. Vulnerable subgroups: lifestyle interventions can prevent excessive weight gain in pregnancy and help weight-concerned women stop smoking. Diet and exercise can reduce weight in postmenopausal women. There is insufficient evidence to inform how interventions need to be modified to meet the needs of pre-school children or ethnic minority groups within the UK. Conclusions: This evidence underpins national guidance, informs government policy and influences clinical practice. Population-wide recommendations may be effective in preventing a population increase in prevalence of obesity only as part of a government strategy that includes environmental change and is coupled with targeted interventions to reduce the prevalence of obesity caused at least in part by social inequalities.

No / Background/Aims This article investigates the representation of black, Asian and minority ethnic staff in NHS disciplinary proceedings. Methods The study involved an in-depth knowledge review and analysis of literature on the representation of black, Asian and minority ethnic staff in NHS disciplinary proceedings from 2008 to 2017, as well as semi-structured interviews with 15 key stakeholders. Participants were stakeholders from both primary and secondary care and included equality and diversity leads, human resource professionals, NHS service managers, representatives of trade unions and health professional regulatory council representatives. Findings The knowledge review indicates that to date, black, Asian and minority ethnic staff are disproportionately represented in NHS disciplinary proceedings. Evidence gathered demonstrates the continuation of inappropriate individual disciplinary action and failure to address organisational shortcomings against black, Asian and minority ethnic members of staff. Conclusions Overall, six factors were identified as underpinning the disproportionate representation of black minority ethnic staff in disciplinaries: closed culture and climate; subjective attitudes and behaviour; inconclusive disciplinary data; unfair decision making; poor disciplinary support; and disciplinary policy misapplication.

Yes / The increasing heterogeneity of the population of older people is reflected in an increasing number of people with dementia and carers drawn from minority ethnic groups. Data from the IDEAL study are used to compare indices of 'living well' among people with dementia and carers from ethnic minority groups with matched white peers. We used an exploratory cross-sectional case-control design to compare 'living well' for people with dementia and carers from minority ethnic and white groups. Measures for both groups were quality of life, life satisfaction, wellbeing, loneliness, and social isolation and, for carers, stress, relationship quality, role captivity and caring competence. The sample of people with dementia consisted of 20 minority ethnic and 60 white participants and for carers 15 and 45 respectively. People with dementia from minority ethnic groups had poorer quality of life (-4.74, 95% CI: -7.98 to -1.50) and higher loneliness (1.72, 95% CI: 0.78-2.66) whilst minority ethnic carers had higher stress (8.17, 95% CI: 1.72-14.63) and role captivity (2.00, 95% CI: 0.43-3.57) and lower relationship quality (-9.86, 95% CI: -14.24 to -5.48) than their white peers. Our exploratory study suggests that people with dementia from minority ethnic groups experience lower quality of life and carers experience higher stress and role captivity and lower relationship quality than their white peers. Confirmatory research with larger samples is required to facilitate analysis of the experiences of specific minority ethnic groups and examine the factors contributing to these disadvantages. / Economic and Social Research Council. National Institute for Health and Care Research. Grant Number: ES/L001853/2

Evidence has shown that Multisystemic Therapy (MST) an intensive family- and community-based intervention has been particularly effective in the treatment of youth with antisocial behaviour from ethnically diverse backgrounds. Although the process of change within MST has been explored, there is a dearth of research in looking at this for families from ethnic minority backgrounds. The current research aimed to address this gap by exploring the experiences of a sample of London based caregivers who had completed an MST intervention. A qualitative approach was adopted, using grounded theory methodology to explore ethnic minority caregiver experiences of MST and generate a model of the processes of engagement and change based on participants' accounts. Seven semi-structured interviews were carried out with caregivers from two London sites. The emergent model consisted of seven interacting theoretical codes. Three of these codes were organised around the process of engagement; deciding to engage with MST, becoming therapeutically aligned and considering cultural difference, and four related to the process of change; working within a safe and trusting relationship, therapist acting as cultural broker, empowering the parent and increased communication within and outside the family. The author makes novel suggestions relating to the specific mechanisms that are thought to underlie the process of engaging with MST, and highlights the importance of considering cultural difference in the initial stages of the MST intervention.

This thesis addresses the question ‘how can breastfeeding support services best meet the needs of women of Bangladeshi origin living in the UK?’ Breastfeeding is important for health, potentially contributing to reducing health inequalities. National surveys show that women of Bangladeshi origin have high initiation rates but low rates of continuation and exclusive breastfeeding. An initial literature review revealed that existing research relating to breastfeeding and the Bangladeshi community was descriptive and essentialist representing ethnic groups as homogenous and failing to recognise the influence of structural factors. Quantitative analysis of 357 Bangladeshi women in the Millennium Cohort Study (MCS) provided a more detailed national context for the qualitative research.A cumulative qualitative design underpinned by reflexivity was used comprising focus groups and interviews with grandmothers, fathers, mothers and health practitioners. Sampling was purposive for the family and practitioner phases and theoretically-informed for the mothers’ interviews. Analysis used ethnographic and narrative approaches to make sense of individual experiences within social context.The main finding was that the breastfeeding support needs of women of Bangladeshi origin were generally similar to the majority population. However to improve breastfeeding support practitioners need to understand where cultural context makes a difference. Practitioners misrecognised diversity of the Bangladeshi population in the UK including how ethno-religious identities as a minority group within a hostile majority were constituted and impacted on women’s lives. The family context of breastfeeding, including living arrangements, household responsibilities and family relationships mediated women’s access to time and space for breastfeeding. While practitioners recognised these pressures on women, they were used to affirm stereotypes of women as passive. This combined with lack of confidence and organisational constraints led to practitioners feeling powerless to support breastfeeding. Alongside implementing good practice for breastfeeding and culturally competent care, health services could engage with families, provide bilingual advocacy workers and involve women in designing accessible breastfeeding support services.

No / This paper examines the current circumstances of minority ethnic media production. It particularly addresses the tensions that may exist for minority ethnic media workers between their commitment to a professional identity and status, and their negotiation of their own ethnic identity. Through employing a specific model of communities of practice this paper provides an analytic frame which illuminates some of the challenges which may be particularly present in the institutional dynamics and identity politics operating within minority ethnic media enterprises. In noting the synergy between the minority ethnic media activities and the media systems of the dominant ethnic communities this paper argues for a recognition of the role of minority ethnic media in shaping a vigorous public sphere, and advocates a more extensive commitment of research resources to the analysis of their role in the multi-ethnic nation-state and transnationally.

No / Palliative care for minority ethnic groups remains a poorly accessed and limited area in district nursing. This article outlines a hospice apprentice programme that aims to promote and expand the use of specialist palliative and end of life care services for a South Asian community through increasing access and referrals, improving services by making them more culturally appropriate for black and minority ethnic (BME) people, involving BME people in the delivery of services, and creating better relationships between BME communities and providers