Authors' objectives: The COVID-19 pandemic exacerbated pre-existing societal inequities. Our study addresses the dearth of studies on how intersecting factors of disadvantage and discrimination affected pandemic daily life for disabled people from minoritised ethnic groups, aiming to improve their experiences and social, health and well-being outcomes. Through an intersectionality lens, to: explore and compare, by location and time, survey and qualitative data on changing needs for social, health and well-being outcomes relate coping strategies/solutions to these explore formal and informal network issues/affordances gain insights from synthesising our data contextualise and explore transferability of findings co-create outputs with stakeholders. Our aim was to address the gaps by contributing and informing evidence-based formal and informal strategies, guidelines, recommendations and interventions for health and social care policy and practice, to mitigate inequities and improve the experiences and social, health and well-being outcomes of minoritised ethnic groups at the intersection with disabling chronic conditions or impairments. This necessitated in-depth understanding of relevant influences on mental and physical health, coping, access to resources, and informal and formal social and healthcare support from different intersecting combinations of disability and ethnicity. Citizenship status is also critical; many recent refugees and undocumented migrants will have ‘no recourse’ to support. Though the study centres on these intersections, we necessarily also explore other categories of societal difference (e.g. age, gender) that interact with them under institutional and structural conditions to create specific health outcomes and experiences. We included comparison with people self-identifying as of White British heritage, with/without disability, and non-disabled people from minoritised ethnic groups to help unpack intersectional patterns. Our objectives, using an intersectionality lens, were to: explore and compare, by location and time, survey and qualitative data on changing need for social, health and well-being outcomes relate pandemic coping strategies/solutions to objective 1 findings, including what worked well or less well, and touchpoints (where experiences might best be improved) explore formal and informal network issues/affordances in health and social care solutions gain insights from convergence synthesis of our mixed-methods data contextualise and explore transferability of findings co-create with stakeholders identified strategies and interventions, and plans for rapid pathways to impact.

Authors' results and conclusions: We found strong adherence to pandemic restrictions (where accommodation, economic situations and disability allowed) due to COVID-19 vulnerabilities. High vaccine hesitancy (despite eventual uptake) resulted from side-effect concerns and (mis)trust in the government. Many relied on food banks, local organisations, communities and informal networks. Pandemic-related income loss was common, particularly affecting undocumented migrants. Participants reported a crisis in mental health care, non-holistic social and housing care, and inaccessible, poor-quality and discriminatory remote health/social care. They preferred private care (which they could not easily afford), community or self-help online support. Lower socioeconomic status, mental health and mobility issues reduced well-being. Individual and community assets and coping strategies mitigated some issues, adapted over different pandemic phases, and focused on empowerment, self-reflection, self-care and social connectivity. Technology needs cut across these. Different intersecting factors led to different experiences, with low socioeconomic status particularly significant. Overall, disability and minoritised ethnic identities led to worse pandemic experiences. Our co-design work shows how to build on the assets and strengths; simple changes in professional communication and understanding should improve experience. Minoritised groups can easily be involved in policy and practice decision-making, reducing marginalisation, with better сare and outcomes. We showed that structural adversities cut across minoritised groups, including those often viewed as ‘white’. There is a need to look at intersecting factors, specific contexts and individual and community strengths and assets, rather than considering some groups as inherently more disadvantaged. We also showed that low socioeconomic status is a problematic product of racial and disability discrimination that cuts across experiences and groups. Synthesising our qualitative and survey data revealed an intersection for people of all ethnicities of lower socioeconomic status, mental health, hand loss and mobility issues, lack of outdoor spaces, cramped accommodation or dependency on others to get outside leading to poor psychological and mental well-being. Participants generally mistrusted NHS and social care, preferring informal networks and private care despite the cost. While these challenges have a structural basis, our work shows that relatively simple changes supporting empowerment, social connectivity, self-care, communication and understanding would rapidly improve the lives of disabled people from minoritised ethnic groups. We are developing some ideas for local and regional implementation. We have shown that with appropriate approaches, minoritised groups, including undocumented migrants, can easily be involved in policy and practice decision-making. This would reduce structural barriers and marginalisation, with better сare and outcomes for all.

Authors' methods: Mixed-methods, asset-based, underpinned by embodiment disability models and intersectionality, integrating three strands: (secondary): analysis of existing cohort/panel data, literature review (primary: quantitative): new survey (n = 4326), three times over 18 months (primary: qualitative): semistructured interviews (n = 271), interviewee co-create workshops (n = 104) 5 and 10 months later, mixed stakeholder co-design workshops (n = 30) for rapid-impact solutions to issues, key informant interviews (n = 4). United Kingdom and Republic of Ireland. Strand 2: community-dwelling migrants, White British comparators, with/without disability. Strand 3: focus on Arab, South Asian, African, Central/East European, or White British heritage with/without disability. We could not explore area-level social distancing and infection rates. Data collection was largely online, possibly excluding some older, digitally deprived or more disabled participants. Participants engaged differently in online and face-to-face co-create workshops. Our qualitative data over-represent England and South Asian people and use contestable categories. We used a transformative, convergent parallel mixed-methods design integrating three strands – quantitative, qualitative and a secondary data strand – across three phases over 18 months, to answer the study objectives. Strands 2 and 3 involved concurrent primary data collection, with repeated measures in three ‘waves’ over 18 months. This allowed us to explore experiences and attitudes within changing pandemic contexts, relations between these, intersectional identities and health and well-being, and enhanced the ecological validity of our work. Our data synthesis followed a triangulation design; qualitative data were merged and compared with quantitative data. Strand 1: secondary data analyses We analysed existing cohort and panel data and undertook a scoping literature review, and fed these into the other strands, though they were not dependent on this.

Project Status: Completed

URL for project: https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/NIHR132914

Year Published: 2025

URL for published report: https://www.journalslibrary.nihr.ac.uk/hsdr/KYTF4381

URL for additional information: English

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: England, United Kingdom

DOI: 10.3310/KYTF4381

Organisation Name: NIHR Health Services and Delivery Research programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk