King's College London

The Tackling Inequalities and Discrimination Experiences in health services (TIDES) study aims to understand how discrimination witnessed and experienced by healthcare practitioners is related to work and health outcomes, and how this may contribute to inequalities in health service use. TIDES phase 1 was funded by the Wellcome Trust.

TIDES phase 2 was funded by the ESRC as part of UK Research and Innovation’s rapid response to COVID-19 and aims to understand how discrimination contributes to inequalities in health and health services, and aims to continue this work by examining the impact of COVID-19 on inequalities experience by ethnic minority people working in health and social care.

TIDES Phase 1 involves four interrelated projects:

• Project 1 uses survey data and electronic health records to investigate inequalities in health service use.
• Project 2 uses the findings from Project 1 to inform a quantitative survey and facilitate qualitative interviews with healthcare practitioners about both experiencing and witnessing discrimination to see what impact these experiences have on inequalities in health service use.
• Project 3 builds on the findings from the first two projects to look at how healthcare practitioners interact with patients in virtual reality environments.
• Project 4 involves talking to a range of stakeholders including carers, service users, healthcare practitioners, community members and policy makers about the findings from Projects 1-3. Stakeholders will review evidence, set priorities and develop guidance for an intervention framework to tackle discrimination experiences and inequalities in health service use.

TIDES Phase 2 aims:

• Identify ethnic inequalities in mental health and occupational outcomes amongst NHS health and social care workers, how COVID-19 exacerbates such inequalities, and the processes through which inequalities are produced, maintained and resisted.
• Develop a Race Equality Assessment toolkit, to help ensure ethnic minority perspectives are prioritised in research and education for all NHS staff.
• Develop education and training resources targeted at improving ethnic minority health and social care worker experiences, job retention and relevant NHS policies.

An ethnicity module was incorporated into an ongoing national longitudinal study of NHS staff (NHS CHECK, www.nhscheck.org) to assess health and work outcomes by ethnicity over an 18-month period. The survey captured existing and emerging ethnic inequalities in mental and occupational outcomes between White British and ethnic minority staff during and after COVID-19.

Interviews were also carried out with ethnic minority staff with three samples:

1. NHS CHECK sample of ethnic minority health and social care staff recruited from NHS CHECK Trusts across the UK.
2. Pre/post COVID-19 TIDES sample of London-based nurses and healthcare assistants who have previously completed interviews as part of the TIDES Phase 1.
3. TIDES senior management sample.

The interviews explored how COVID-19 affected mental and physical health and occupational outcomes, the impact of COVID-19 on experiences of discrimination, bullying and harassment during and post COVID-19, and the structural factors underpinning elevated adversity for ethnic minority staff during COVID-19.

For more information, please visit tidesstudy.com