title: Diagnosis and management of chronic fatigue syndrome/myalgic encephalitis in black and minority ethnic people: a qualitative study.
abstract: OBJECTIVE
  This study aims to explore the possible reasons for the lower levels of diagnosis of chronic fatigue syndrome/myalgic encephalitis (CFS/ME) in the black and minority ethnic (BME) population, and the implications for management.
  
  
  BACKGROUND
  Population studies suggest CFS/ME is more common in people from BME communities compared with the White British population. However, the diagnosis is made less frequently in BME groups.
  
  
  METHODS
  Semi-structured qualitative interviews were conducted with 35 key stakeholders in NW England. Interviews were analysed using open explorative thematic coding.
  
  
  RESULTS
  There are barriers at every stage to the diagnosis and management of CFS/ME in people from BME groups. This begins with a lack of awareness of CFS/ME among BME respondents. Religious beliefs and the expectation of roles in the family and community mean that some people in BME groups may choose to manage their symptoms outside primary care using alternative therapies, prayer or spiritual healing. When accessing primary care, all participants recognised the possible influence of language barriers in reducing the likelihood of a diagnosis of CFS/ME. Stereotypical beliefs, including labels such as 'lazy' or 'work shy' were also believed to act as a barrier to diagnosis. Patients highlighted the importance of an on-going relationship with the general practitioner (GP), but perceived a high turnover of GPs in inner city practices, which undermined the holistic approach necessary to achieve a diagnosis.
  
  
  CONCLUSIONS
  Training is required for health professionals to challenge inaccurate assumptions about CFS/ME in BME groups. The focus on the individual in UK primary care may not be appropriate for this group due to the role played by the family and community in how symptoms can be presented and managed. Culturally sensitive, educational resources for patients are also needed to explain symptoms and legitimise consultation.
authors.affiliation: 1Research Associate, Institute of Population Health, University of Manchester, Manchester, UK.
authors.forename: Kerin
authors.initials: K
authors.lastname: Bayliss
authors.affiliation: 2Research Fellow, Institute of Population Health, University of Manchester, Manchester, UK.
authors.forename: Lisa
authors.initials: L
authors.lastname: Riste
authors.affiliation: 3Academic Clinical Fellow, National School for Primary Care Research, University of Manchester, UK.
authors.forename: Louise
authors.initials: L
authors.lastname: Fisher
authors.affiliation: 4Professor of Health Psychology, School of Psychological Sciences, University of Manchester, Manchester, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Wearden
authors.affiliation: 5Senior Lecturer in Psychology, School of Psychological Sciences, University of Manchester, Manchester, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Peters
authors.affiliation: 6Professor of Mental Health, School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
authors.forename: Karina
authors.initials: K
authors.lastname: Lovell
authors.affiliation: 7Professor of Primary Care, Primary Care and Health Sciences and National School for Primary Care Research, Keele University, UK.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Chew-Graham
mesh_terms: D044383:Black People; D003144:Communication Barriers; D003469:Culture; D004739:England; D015673:Fatigue Syndrome, Chronic / Q000175:diagnosis / Q000208:ethnology* / Q000628:therapy; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008913:Minority Groups; D011320:Primary Health Care; D036301:Qualitative Research; D063505:Racism; D012068:Religion and Medicine