A co-production film project with the older South Asian community to promote inclusive involvement in health research

A photo of a South Asian man discussing with a white man on a roof top in front of a camera on a tripod.

1 January 2024

How can health researchers, film researchers, charity organisers, and the south Asian community work together to promote inclusion of marginalised communities in healthcare research by using co-creation methods and visual media?

Seedcorn 2023/2024

Previous research has shown that ethnic minority communities are marginalised in healthcare and research, leading to problematic under-representation in involvement in health research design, research priority setting, research participation, and knowledge mobilisation. Within orthopaedics, there are ethnic disparities in those who receive joint replacement, and in outcomes after joint replacement, with these patients experiencing greater post-operative pain, disability, complications and mortality. These inequalities are likely exacerbated by the COVID-19 pandemic, which disproportionately affected people from minority ethnic backgrounds. In research, ethnic minority communities are marginalised, in all stages of research, from early work to identify research questions of relevance and importance to patients and the public, through to the conduct of research and the healthcare services that follow from implementation of the research findings.

What will the project involve?

This project intends to support, empower and facilitate the Dhek Bhal community to explore the film making process and to co-create a short film with support of the Department of Film and TV. Dhek Bhal are a charity providing carers’ respite breaks, domiciliary and day care, self-help and advocacy activities for the older South Asian Community in Bristol and South Gloucestershire. The team hope that this filmmaking process will help to bridge the gaps between healthcare research and communities that remain marginalised in health research. During discussions with Dhek Bhal and other marginalised communities, it was shared that people from ethnic minority communities have been excluded from opportunities throughout their lives and therefore don’t perceive that research opportunities are open to them, or that research results are applicable to them. The team hope that the video will promote inclusion of the older South Asian community in health research. They also hope that their work together will offer an example of a process that can be used by others to reach and empower other marginalised communities.

The direct aim of the project is to co-create a short film to promote the importance of PPIE and how communities and researchers can work together to make health research better. During this process the researchers hope to achieve the following objectives:

To support, empower and facilitate members of Dhek Bhal to explore film as a medium.
To work with Dhek Bhal to use film as a medium to share information within the community.
To reflect the needs of people within the community who are housebound and in receipt of care within the home.
To co-create resources with Dhek Bhal using the above methods, with the support of the Department of Film and TV and communication experts.
To explore the best channels to share these outputs to reach members of similar communities.
To promote further inclusion of marginalised communities in healthcare research by using co-creation methods and visual media.
To explore how the resources and practices could be embedded in University of Bristol research practices, e.g., inclusion into inductions for postgraduate researchers and into short courses.
To share recommendations and reflections for future collaborations and other co-production research groups to draw upon.

To achieve this the researchers will continue their previously established working practice with Dhek Bhal. This involves a tailored approach for involvement of this community; visiting the community during their days where the men’s and women’s groups meet for the daycentre, using an open and informal discussion process, supported by community group leaders and interpreters.

Supported by the University of Bristol Department of Film and TV, the project will first run relaxed sessions where they will assist both the men’s and women’s groups to play with equipment and video each other to explore film as a medium. They will then work with the groups to form the creative brief and decide on roles, through open discussion. Although the researchers envisage capturing conversations or casual interviews amongst the community members, they are keen not to prescribe and will listen to the group on how they would like the video to look. Film students identified with help from Rayna Denison and Jimmy Hay from the Department of Film and TV will then work with the group to make a plan for editing of the footage into a cohesive short film. The project will hold a final ‘premiere’ showing of the video at a community meeting before dissemination through channels suggested by the community and the team.

The project will also seek to understand how to involve people who are mainly housebound and in receipt of care packages, who are likely the most underserved at the intersection of language, disability, digital exclusion and social isolation.

Based on early discussions with community leaders, the team know that visual methods of sharing information are preferred. Video allows for preferred languages to be used, which is important to this particular community who speak a number of languages, the top two being Punjabi and Urdu. The researchers will seek to record people in their preferred language and produce (English) subtitles with the assistance of the community leaders.

Who are the team and what do they bring?

Catherine Jameson (Health Sciences, University of Bristol) is a works in Patient and Community Involvement and Engagement in the Bristol Medical School and is Co-Lead for PPIE within the Surgical and Orthopaedic Innovation Theme in the Bristol Biomedical Research Centre (BRC). Over the last year, Catherine has established relationships with Dhek Bhal and carried out a parcel of work funded by the Elizabeth Blackwell Institute and Wellcome Trust to understand how to achieve fair, accessible and fulfilling involvement of communities in the design of conduct of health research.
Vikki Wylde (Health Sciences, University of Bristol) is a researcher of Musculoskeletal Health at the University of Bristol, Theme Co-Lead and PPIE Co-Lead for the Surgical and Orthopaedic Innovation Theme in the Bristol NIHR BRC, and lead for PPIE in the Musculoskeletal Research Unit. Vikki works across many different programmes of research which aims to improve the health and wellbeing of people living with chronic musculoskeletal conditions.
Wendy Bertram (Health Sciences, University of Bristol) is a researcher of Musculoskeletal Health Services Research within the Bristol BRC, with an interest in developing and evaluating novel interventions to improve outcomes after interventions for musculoskeletal conditions.
Joanna McLaughlin (Health Sciences, University of Bristol) is a public health doctor and National Institute for Health and Care Research (NIHR) Doctoral Fellow in the Musculoskeletal Research Unit, University of Bristol, using mixed methodology research to investigate the health inequalities linked to weight loss and smoking cessation rules for referral to surgery.
Zoe Trinder Widdess (Health Sciences, University of Bristol) is a science communicator specialising in health research communication. She leads communications and marketing in the NIHR Applied Research Collaboration West and is Head of Communications for the Bristol NIHR BRC and is NIHR Regional Communications Link for the West of England.
Rayna Denison (Film and Television, University of Bristol) is Head of Film and Television at the University of Bristol and a researcher on transcultural media flows, especially animation.
Jimmy Hay (Film and Television, University of Bristol) is a filmmaker and lecturer with experience of UK-wide cinematic release. He brings his expertise in the fusion of theory and practice with audio-visual interrogation of cognition and emotion in filmmaking. Jimmy leads the Medical Humanities Cluster’s ‘Grief’ research strand.
Alisa Cameron (Policy Studies, University of Bristol) n is a social scientist in the School for Policy Studies at the University of Bristol. She has a particular interest in social care and older people.
Zehra Haq (Dhek Bhal) is the CEO of Dhek Bhal. Tariq Khan (Dhek Bhal) is Chair and a facilitator for the men’s group at Dhek Bhal. Dhek Bhal is a Bristol-based charity providing care, social support, as well as assistance with mental health to elderly South Asian people over 50 from diverse backgrounds. It provides an opportunity for isolated, frail, disabled men and women to meet within a culturally appropriate setting for friendship, mutual support, to access information in their language of choice. Dhek Bhal also offers a range of activities to maintain physical, social and mental wellbeing and has previously worked with community artists and identified art and craft activities.

What is to come?

Through exploration of film, co-creation of a creative brief and supported filming of the community by the community, the project will create a short film on the importance of community involvement in health research and how communities and researchers can work together to make health research better.

The team intend to utilise accessory methods for sharing and raising the awareness of the outputs, for example face to face at community groups and events, community radio, social media/WhatsApp groups, newsletters and word of mouth (eg via family members and carers). This combined approach will help to raise awareness of health research and to reach more members of the community via family members, friends and professionals in the care industry. They will draw everyone's reflections and learning together after the experience to feed into recommendations for future use of this film co-production technique.