Black African and Caribbean communities’ experiences of accessing NHS care for long-term health conditions: a systematic review and thematic synthesis and “a journey without an end": a constructivist grounded theory of black british women’s lived experiences with dermatological conditions

Puckerin, Ciara 2025. Black African and Caribbean communities’ experiences of accessing NHS care for long-term health conditions: a systematic review and thematic synthesis and “a journey without an end": a constructivist grounded theory of black british women’s lived experiences with dermatological conditions. ClinPsy Thesis, Cardiff University. Item availability restricted.

	PDF (DClinPsy Thesis) - Accepted Post-Print Version Restricted to Repository staff only until 25 September 2026 due to copyright restrictions. Download (3MB) | Request a copy
	PDF (Cardiff University Electronic Publication Form) - Supplemental Material Restricted to Repository staff only Download (937kB) | Request a copy

Abstract

Persistent ethnic health inequalities in the UK continue to disproportionately affect Black African and Caribbean communities, particularly in the context of long-term conditions. While growing attention has been paid to these disparities, research often groups ethnically diverse populations under broad categories such as ‘BAME’, overlooking the specific structural, historical, and cultural factors that shape healthcare experiences for Black individuals. Paper 1 is systematic review that was undertaken in response to the need for more nuanced, disaggregated, and critically engaged accounts of healthcare access and quality for Black African and Caribbean populations. Using a thematic synthesis approach, across a range of long-term conditions, this review seeks to centre the lived experiences of Black patients and explore how these are shaped by intersecting factors, including race, migration history, culture, and systemic bias. The review applies Andersens Behavioural Model of Health Service Utilisation as a conceptual framework to examine not only individual-level health-seeking behaviours, but also the broader structural and institutional contexts within which healthcare is navigated. In doing so, it contributes to a growing literature that looks to understand the various determinants of health inequity. A commitment to health equity, reflexivity, and the critical examination of power within health systems underpins this work. It aims to support the development of culturally safe, responsive services and to inform policy and practice by articulating the systemic barriers that many Black patients face in accessing care. It is hoped that this review will serve as a resource for scholars, practitioners, and policymakers engaged in tackling racial inequities in health, and as a prompt for further research that meaningfully includes and reflects the voices of Black communities. Paper 2 was undertaken in response to the systemic underrepresentation of Black women’s dermatological health experiences within both clinical practice and psychological research. Informed by a constructivist grounded theory approach, the research sought to develop a conceptual framework grounded in the lived experiences of Black British women who navigate visible dermatological conditions. The project was motivated by a commitment to health equity, cultural specificity, and participant-led knowledge production. The resulting conceptual framework is structured around five interrelated categories: Where I Stand (exploring family and community influences), How I Am Viewed (focusing on medical marginalisation and healthcare navigation), How I Adapt and Grow (capturing coping strategies and psychological adjustment), Who I Am (reflecting shifts in identity and acceptance) and Seeing a Difference (encompassing participants’ visions for systemic and community change). These categories are not linear stages but intersecting processes within a dynamic and ongoing journey; what one participant described as “a journey without an end.” Within these categories, key subthemes include family support and stigma, cultural pressures around skin and hair, diagnostic delay, distrust in healthcare, therapeutic and informal coping strategies, the emotional loss of self, and the evolving process of self-acceptance. Notably, the final category articulates participants’ hopes for improved representation and advocacy, both within healthcare systems and Black communities themselves. As a researcher who shares aspects of cultural identity with participants, I approached the work with reflexivity and care, striving to honour the complexity of their experiences while maintaining critical analytic rigour. This study does not presume to speak for all Black women, Still, it offers a grounded, theory-informed contribution that highlights both the structural exclusions and the personal resilience shaping dermatological experiences. In centring participants’ narratives and mapping their strategies of resistance, adaptation, and redefinition, the research aims to inform more inclusive models of dermatological care, psychosocial support, and health communication tailored to the realities of minoritized populations.

Item Type:	Thesis (DClinPsy)
Date Type:	Completion
Status:	Unpublished
Schools:	Schools > Psychology
Subjects:	B Philosophy. Psychology. Religion > BF Psychology
Date of First Compliant Deposit:	25 September 2025
Last Modified:	25 Sep 2025 15:42
URI:	https://orca.cardiff.ac.uk/id/eprint/181341

Actions (repository staff only)

Edit Item