Greater Manchester has one of the highest rates of cardiovascular disease (CVD) in England, contributing to the deaths of more than 1 in 4 people.

However, increased CVD mortality also correlates with areas of higher deprivation.

Rochdale, among other areas in GM, is one of the most income deprived local authorities in England, and citizens of differing ethnicity who live in these areas also experience increased CVD mortality.

What can be done to address the significant and unfair health inequalities in these communities?

Supported by Health Innovation Manchester and NHS Greater Manchester, local VCSE organisations are working collaboratively with the South Asian community in Rochdale and the Black Caribbean community in Manchester to improve engagement and access to services for CVD prevention, and make a real impact in reducing CVD mortality in underserved communities.

We shine a spotlight on work in Rochdale, where community engagement falls at the heart of understanding the reasons behind higher CVD mortality in the South Asian community.

Learning how to engage with a disengaged community

How do we engage with a community that feels distanced from the local healthcare system?

Sanya and Mo are community fieldworkers for Living Well Rochdale, working to increase awareness of CVD. They reflect on how they have been able to increase engagement within their community.

Connections: Crucially, Sanya and Mo are part of the South Asian community, and using their knowledge, networks and experiences they have been given the freedom to organise events and develop resources that resonate with their target audience.

“I knew all these people, and I knew that they belonged to various groups, so I was like, can we borrow your group for a session, and they were really welcoming, they really appreciated it.” – Sanya

“We both have raised cholesterol levels, and we can talk about our experiences in the community because we are comfortable doing that, we can get our message across better and people relate to that. It’s all about having that experience and being able to talk about it.” – Mo

Culture: Many resources that are designed to increase awareness and understanding of CVD are not suitable or accessible for a South Asian population. It has therefore been important that any resources developed are culturally relevant, including language, images, content and case studies.

“Information needs to be culturally appropriate and relevant to South Asian people. In our presentation to raise awareness of cholesterol, we have encouraged them from a religious perspective as well by adding hadiths and sunnahs (sayings and practices of our Prophet (PBUH)). We have been encouraging healthy lifestyle changes by highlighting that looking after the body is an obligation, and eating prophetic foods such as dates, honey, cucumber and watermelon – to increase intake of fruit and vegetables.” – Mo.

“We’ve had a lot of debate around food, where people say back home they would eat ghee, and we have to say well back at home it’s hot, you were moving around a lot more, and you were eating lots more organic food. Here you’re not going out and moving about as much, and there’s also lot more processed food with additives.”  – Sanya

Language: A significant proportion of the South Asian community cannot speak or read English, therefore it has been crucial that presentations, resources and conversations have been available in a variety of other languages, including Urdu, Bengali, Mirpuri.

Location: The location of organised events and focus groups has been crucial to ensuring high attendance and engagement from across the community. As well as attending various established community groups across the community, Sanya and Mo have been engaging with local mosques to raise awareness and increase engagement, with the aim of holding events there that target a greater population of males.

Channel: In addition to raising awareness through more traditional channels, Sanya and Mo have utilised local channels with success, including community WhatsApp groups, community newsletters, and the local radio station Crescent Community Radio.

Co-design: Over time, Sanya and Mo have been able to develop resources that are increasingly engaging and relevant. They have realised it’s not just about their primary objective of raising awareness of cholesterol – it’s about listening to the concerns and questions of their communities, and being able to provide wider support and guidance to educate and encourage healthy lifestyle changes.

“At the start people were literally falling asleep listening to us! Now we have to rush through to the end of our presentation because we’re having these awesome quality discussions, and even now the community groups are asking us to come back. No session is the same, and as well as talking about cholesterol we can talk about other areas like hypertension, smoking, cancer screening, the NHS app, Pharmacy First… we are working as a wider team to educate our communities on a range of areas.” – Sanya

Reducing the barriers to accessing healthcare

Whilst the first step has been to increase awareness and understanding of CVD and associated risk factors, the next step is to encourage individuals to follow up with their local healthcare providers.

Access barriers: A common perception amongst the community is that it can be incredibly difficult –impossible even – to get an appointment, so why would they try? Consequently, many individuals have not contacted their GP surgery in years, even if they are concerned or have a health issue. Sanya and Mo have been focused on providing reassurance and solutions to address this issue:

“A lot of people say they can’t get appointments so they don’t try, and haven’t tried for years. They say if they get really sick they’ll go to A&E, and that’s what we want them not to do. We tell them they can use the NHS app, or they can go to the community pharmacist for advice and medication, or if their GP can’t see them, they can go to another GP practice.” – Sanya

Language barriers: For those members of the South Asian community who are less fluent in English, or where English is not their first language, this can present a huge challenge when trying to organise an appointment or explain a health issue to their healthcare provider. Sanya and Mo, who are both multi-lingual, have been able to properly communicate the possible solutions to address the language barriers, including the development of multi-language cards to use at appointments, and raising awareness that they can request an interpreter at appointments:

“Some people are just thankful for that opportunity to be able to express their needs, their difficulties in their own language and I think that’s been a massive success that we speak the language and we’re from their community.” – Sanya.

Empowering GP practices: In addition to encouraging communities to reach out to their healthcare providers, the wider team have been looking to support and empower healthcare providers to better understand and engage with the South Asian community.

As part of the wider project, an Outreach Worker has been recruited to support primary care practices with the delivery of clinical activity and engagement with communities, acting as a liaison between the community fieldworkers and healthcare professionals.

In addition, the team at Health Innovation Manchester has been utilising insights from the GM Care Record to help identify those with higher risk of CVD, so targeted approaches can be put in place by GP practices to ensure their patients receive the best care to reduce their risk of CVD.

“It’s not just empowering individuals and community groups, it’s about empowering the GP practices to better understand their South Asian patients, the language they speak, why their health outcomes are poorer. GPs want to find out this information, but they have had no means of finding this out.” – Sanya

Ensuring Sustainability

Reducing risk of CVD is a long-term goal, and therefore it is crucial that awareness and education of CVD are not dependent on the engagement activities run by Sanya, Mo, and the wider team. A priority is to train community champions to ensure this work is sustainable.

“How can we help our community to be empowered, enabled, and motivated to look after themselves? We could see people only a couple of times and then that’s it. But there are community leaders who are seeing these people on regular basis, and it’s about empowering them and giving them the right tools to continue to inform and educate our community.” – Sanya

 “I hope that people after our project will feel empowered and feel motivated to look after themselves, to have a healthier diet, to keep physically active. It’s not just about lowering cholesterol, it’s about living better and being more healthy.” – Sanya

 “Hopefully if we get the ball rolling maybe in the next decade or two we’ll have lower numbers of CVD in the area compared to what it is now.” – Mo

Reflecting, learning and sharing

Learnings and feedback from the project are being captured through an established feedback loop, and a key output of the project will be to develop a toolkit that other teams and organisations can apply learnings to similar projects across different communities and disease areas to maximise success.

Through this project, Sanya and Mo have been given the freedom to do what they think is best for their communities. Using their knowledge, their own connections within the South Asian community, they have been able to get rich insight and engagement with community groups that would not have otherwise been possible. This is a key learning to share with other projects aiming to engage with other underserved communities.

“It’s kind of been a learning curve, the project was given to us and we had to create and design and implement things ourselves. It’s been an amazing journey”. – Mo

“And I just think the fact that we’re making a change in the Community and to these grassroot organizations, I think it’s amazing.” – Sanya

System Transformation Fund – Lipid Management

The System Transformation Fund (STF) is an award that supports local lipid pathway transformation across integrated care systems. Read more about the project here: https://healthinnovationmanchester.com/our-work/system-transformation-fund-lipid-management/

Novartis Pharmaceuticals UK Limited (“Novartis”) has provided the funding for the creation of the System Transformation Fund (“STF”) as part of a collaborative working project between NHS England and Novartis. Novartis has had (i) no input into the delivery or execution of the STF and (ii) no involvement in the identification and/or selection of the recipients of the STF. Ownership of the web copy is the responsibility of NHS GM. The content of this web copy has not been checked or reviewed by Novartis.