Shared learning database

Bradford Teaching Hospitals NHS Foundation Trust / InHealth Pain Management Solutions
Published date:
May 2018

The creation of a tailored language specific and culturally adapted pain management programme, which was in line with the beliefs, attitudes and understanding of a group of South Asian patients.

The programme demonstrates how quality statements 1 and 2 in the NICE Quality Standard 167 for Promoting health and preventing premature mortality in black, Asian and other minority ethnic groups can be used in practice.

Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

This project meets the aims of standard 1 and 2 of the NICE Quality Standard in development 'Black, Asian and other minority ethnic groups: promoting health and preventing premature mortality'

Some patients are unable to sufficiently comprehend the Pain Management Programme (PMP) in English, not only due to language, but cultural differences.

The multi-disciplinary team consisted of a pain specialist physiotherapist, clinical psychologist, a GP with special interest in pain management. Crucially, for the first time in pain management in the UK, a chaplain (Muslim) was incorporated into the team. All team members were tri-lingual in English, Punjabi and Urdu. Thus, reducing the requirement to spend on interpreters.

Reasons for implementing your project

Before the project, patients who did not speak sufficient English, were excluded from attending the pain management programme (PMP), which was a total contact time of 26 hours.

One fifth of Bradford's population is of Pakistani ethnicity, for whom English is not the first language. Patients who do not speak English, had to be seen on a one to one basis with an interpreter. This led to meaning being lost through translation, but also, increased clinician demand.

The Bradford City CCG were consulted and agreed to the pilot, which ran successfully. The team drew upon Bradford's reputation for understanding cultural differences in health and wellbeing, with the utilisation of two patient information leaflets already in use.

How did you implement the project

We met the draft NICE quality standard (Statement 1) using the local council’s consensus data to inform us of the size of the task and population demographic in Bradford. After consultations with all team members culturally appropriate, accessible and tailored pain management programme was developed and piloted.

The PMP included an overview from the Trust’s Muslim Chaplain of his role on the PMP, and how Islamic teachings promote self-management, compassion, physical activity and dispelling of cultural myths. The GP discusses pain medication management within holistic care, the physiotherapist emphasises the biopsychosocial approach of the PMP, including gentle increases in exercise. Psychology sessions focussed on how pain can affect patients emotionally and emphasised how patients could increase their self-kindness.

Key findings

The project met the initial aims and objectives. Patients made improvements in self-efficacy, anxiety and depression following the programme.

There was a statistically significant change in anxiety (t(3) = 4.7, P < 0.01), depression (t(3) = 5, P < 0.01), and self-efficacy (t(3) =8.18, P < 0.001) following the programme. There were 8 patients initially listed for the programme, 2 did not attend the first session and made no further contact. A further 2 patients attended the first session but did not bring their questionnaires with them nor continued on; 1 due to financial commitments and 1 patient due to ill health. The remaining 4 patients made the programme through to completion.

The Reliable Change Index (RCI) was used, and this found that 25% of patients made a reliable change in anxiety and 75% of patients made a reliable change in depression. Our project increased the services equality and diversity output, by catering to a large proportion of the population, whose needs were being unmet, by current service provision.

For staff, it meant a much more comprehensive service being brought together, to benefit patients, rather than being seen individually through interpreters. For patients, they felt they finally were beginning to understand their long term pain condition and how they could make positive behaviour change. All this was achieved in a way that was culturally appropriate to the population group.

Key learning points

Cultural competency is an important factor to consider when working with patients of a different background. Once this understanding is shared amongst the multi-disciplinary team, each member can begin to culturally adapt their approach to make it responsive to the changing population needs. If repeated again, would actively encourage local voluntary organisations to come along and speak to patients and offer drop-ins within our service location to allow patients the extended self-management support.

Further reading and resources:

Contact details

Mohammad Shoiab
Pain Specialist Physiotherapist
Bradford Teaching Hospitals NHS Foundation Trust / InHealth Pain Management Solutions

Secondary care
Is the example industry-sponsored in any way?