Who uses NHS Direct? Investigating the impact of ethnicity on the uptake of telephone based healthcare.
BACKGROUND
NHS Direct, a leading telephone healthcare provider worldwide, provided 24/7 health care advice and information to the public in England and Wales (1998-2014). The fundamental aim of this service was to increase accessibility, however, research has suggested a disparity in the utilisation of this service related to ethnicity. This research presents the first national study to determine how the diverse population in England have engaged with this service.


METHODS
NHS Direct call data from the combined months of July, 2010 October, 2010, January 2011 and April, 2011 was analysed (N = 1,342, 245) for all 0845 4647 NHS Direct core service calls in England. Expected usage of NHS Direct was determined for each ethnic group of the population by age and gender and compared by actual usage using Chi-square analysis. A one-way analysis of variance (ANOVA) was used to determine variations of uptake by ethnic group and Index for Multiple Deprivation (IMD) 2010 rank.


RESULTS
Results confirmed that all mixed ethnic groups (White and Black Caribbean, White and Black African, White and Asian) had a higher than expected uptake of NHS Direct which held consistent across all age groups. Lower than expected uptake was found for Black (African/Caribbean) and Asian (Bangladeshi/Indian/Chinese) ethnic group which held consistent by age and gender. For the Pakistani ethnic group usage was higher than expected in adults aged 40 years and older although was lower than expected in younger age groups (0-39).


CONCLUSIONS
Findings support previous research suggesting a variation in usage of NHS Direct influenced by ethnicity, which is evidenced on a national level. Further research is now required to examine the underlying barriers that contribute to the ethnic variation in uptake of this service.
Department of Psychology, University of Bedfordshire, Park Square, Luton, UK. erica.cook@beds.ac.uk.
Erica J
EJ
Cook
Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, UK. gurch.randhawa@beds.ac.uk.
Gurch
G
Randhawa
NHS England, Horley, Surrey, UK. shirley.large2@nhs.net.
Shirley
S
Large
Department of Psychology, University of Bedfordshire, Park Square, Luton, UK. andy.guppy@beds.ac.uk.
Andy
A
Guppy
UCL School of Pharmacy, BMA House, Tavistock Square, London, UK. a.chater@ucl.ac.uk.
Angel M
AM
Chater
Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, UK. dong.pang@beds.ac.uk.
Dong
D
Pang
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D044466:Asian People / Q000706:statistics & numerical data; D044383:Black People / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D004739:England; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D044469:Racial Groups / Q000706:statistics & numerical data*; D012737:Sex Factors; D012959:Socioeconomic Factors; D013222:State Medicine / Q000706:statistics & numerical data*; D017216:Telemedicine / Q000706:statistics & numerical data*; D013689:Telephone; D014852:Wales; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult