Public Engagement

WINNER- MVLS Engagement Awards 2021

High blood pressure is a silent disease affecting 1.2 million individuals in Scotland. MVLS College is recognised internationally as a leading centre of cardiovascular and blood pressure research.  

Participants in our healthcare research need to be representative of the diverse populations being studied to produce meaningful results that will benefit all. The Glasgow BP Clinic (GBPC) undertakes major hypertension trials but had noticed a lack of ethnic minority participation – surprising for a city as diverse as Glasgow.  

The team had a well-established public engagement programme that sought to raise awareness of hypertension and encourage participation in their trials. Realising that these engagements were not reaching everyone, the team consulted different ethnic groups across Glasgow and co-developed a new bespoke public engagement model which they implemented in 2019.  

Led by Dr Stefanie Lip, Clinical Research Fellow working together with colleagues from ICAMS University of Glasgow and the Queen Elizabeth University Hospital including: Dr Katriona Brooksbank, Hayley King, Ammani Brown, Dr Linsay McCallum and Professor Sandosh Padmanabhan. With support from Dr Sahil Jain, Georgia Dempster, Dr Nazim Ghouri. 

The team worked hard to find appropriate lay ethnic minority partners and were delighted to develop activities with leaders representing communities attending:  

• Glasgow Central Mosque
• Glasgow Gurdwara (South and West)
• Calabash African Restaurant
• Hindu Old Age Pensioners Club
• Hindu Temple (West) 
• Scottish Health Council, Glasgow. 

Ethnic minorities, despite having higher cardiovascular risk with poor health outcomes, are consistently underrepresented in clinical research. This issue is well-recognised, and the reasons are complex including historic mistrust, social perceptions, and communication barriers.  

The Glasgow BP Clinic (GBPC) team have been conducting large-scale public engagement events annually since 2012. These events offered free blood pressure measurements along with health education and information on current research to visitors at a variety of public venues including bingo halls, community centres, Costco, IKEA, police stations, our university, and hospitals.  

In 2019, when a funded trial, which specifically targeted ethnic minorities, was flagged at high-risk of failure because of poor ethnic recruitment they undertook a review. This confirmed the near total absence of ethnic minority representation in all research trials and the need for a major and rapid intervention by the team.  

Dr Lip and the team held focus groups, approached colleagues and friends, and sought minority ethnic community contacts, to help devise a new engagement strategy.  

The solution, co-developed with lay members and the GBPC team, was to move their engagement activities to places and existing events where these communities already gathered, including places of worship and social spaces. They also sought to ensure they   provided any additional health related activities and information that the individual community groups felt were important.  

To support these new engagements Dr Lip organised a large team of volunteers comprising students (medical, nursing, PhD, MSc), doctors (trainees, GPs, consultants), pharmacists, nurses, and researchers.  

Between August and December 2019, they held 11 public events offering blood pressure measurements, diabetes screening, health education and clinical research advocacy to public audiences attending mosques, temples, gurdwaras and an African community centre in Glasgow.  

They worked with colleagues, friends, and patients from the South Asian and African communities ensuring good consultation and co-development with the different stakeholders. The Glasgow Central Mosque (the largest in Europe) offered the Team access to their community halls for clinical trial recruitment, preventing the need for participants to attend hospital. The team were also allowed access to community halls in the two large Glasgow gurdwaras and a Hindu temple. To promote engagement with an East African community a local restaurant provided event space over a weekend.  

From our large-scale public engagement events, the impact was immediate and measurable across many levels. We were engaging directly with our target audiences in high numbers.  

We conducted almost 800 blood pressure tests and identified 262 individuals with undiagnosed high blood pressure. These individuals were referred to primary care who took action to reduce their risk of stroke and heart attacks. The majority of those newly diagnosed with hypertension were female mosque attendees who had never visited a GP. We obtained consents to contact their GPs and inform them of the screening results. 

All event attendees had access to cardiovascular specialists within a familiar local community venue - removing the need for them to attend clinics or hospitals. During this period recruitment of ethnic minorities into trials increased dramatically - almost a 50% up lift. This helped transform Glasgow into one of the largest recruiting sites globally. In turn this improved our reputation and attracted further research trials to Glasgow.   

The team worked closely with community leaders to design a survey to understand both perceived and actual barriers that prevent ethnic minorities from engaging with clinical research. Over 200 individuals responded to the survey and a paper highlighting these insights is being prepared for publication.  

We have shared our work with other clinical researchers to help tackle underrepresentation of ethnic minorities in medical research. Our volunteers have been able to develop their understanding of the different cultures and apply this learning to their own clinical practice and research.  

During the early stages of the pandemic, it became apparent that people with hypertension and those from ethnic minorities faced a greater risk from COVID-19. The team were able to provide advice to the different communities at both Glasgow Gurdwara and the Glasgow Central Mosque.  

These established community links have also allowed these once excluded communities to participate as part of Public and Patient Involvement (PPI) groups providing input into future research grant applications.  

The COVID pandemic interrupted further progress; however, the team are planning to reactivate these links and seek support to scale up and continue this activity. 

Language barriers 

We expected language barriers to be a major challenge. However, thanks to the enthusiasm of our volunteers and partners it was in fact one of the least challenging aspects of this project.  Our healthcare volunteers and lay-organisers were ready and eager to help with the translation and distribution of surveys. Our survey and patient information leaflets were translated into Urdu, Hindi, and Arabic. 

COVID 

The COVID-19 pandemic was an unanticipated challenge, which had an immediate and dramatic effect suspending our planned engagement activities. However, the links we had already established allowed us to provide advice to these communities during the initial lock-down. This strengthened relationships and resulted in research grant applications to study COVID-19 amongst ethnic minorities.  

Local events and correct social etiquette  

Crucial to our success were the briefing meetings held before each event. These ensured that all volunteers were well versed on the social etiquettes and cultural significance of the people and places we visited. Especially important when attending places of worship, and a central adaptation of our engagement model.   

We also worked closely with the community organisers to identify local events that we could attend. Being part of established community events helped to strengthen our mandate and gave us greater access to our target audiences but did require a more flexible approach with evening and weekend working.  

Glasgow City Council has recognised the wider benefits of our new public engagement model. They have offered the use of their local facilities and staff to help upscale this work for the benefit of all underserved communities.  

The Glasgow BP Clinic team (GBPC) served as clinical advisors to the 2019 Scottish Government cross-party inquiry into hypertension. A task force, established to develop a strategy to act on the recommendations of the cross-party report Beating High Blood Pressure: Scotland’s Silent Killer   recognised the value of the GBPC team’s public engagement model and encouraged its adoption in future screening efforts across Scotland.  

Stefanie.Lip@glasgow.ac.uk