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Date: 2017
Abstract: Background: The English National Health Service (NHS) has significantly extended the supply of evidence based
psychological interventions in primary care for people experiencing common mental health problems. Yet despite
the extra resources, the accessibility of services for ‘under-served’ ethnic and religious minority groups, is considerably
short of the levels of access that may be necessary to offset the health inequalities created by their different exposure
to services, resulting in negative health outcomes. This paper offers a critical reflection upon an initiative that sought
to improve access to an NHS funded primary care mental health service to one ‘under-served’ population, an
Orthodox Jewish community in the North West of England.

Methods: A combination of qualitative and quantitative data were drawn upon including naturally occurring data,
observational notes, e-mail correspondence, routinely collected demographic data and clinical outcomes measures, as
well as written feedback and recorded discussions with 12 key informants.

Results: Improvements in access to mental health care for some people from the Orthodox Jewish community were
achieved through the collaborative efforts of a distributed leadership team. The members of this leadership team
were a self-selecting group of stakeholders which had a combination of local knowledge, cultural understanding,
power to negotiate on behalf of their respective constituencies and expertise in mental health care. Through a process
of dialogic engagement the team was able to work with the community to develop a bespoke service that
accommodated its wish to maintain a distinct sense of cultural otherness.

Conclusions: This critical reflection illustrates how dialogic engagement can further the mechanisms of candidacy,
concordance and recursivity that are associated with improvements in access to care in under-served sections of the
population, whilst simultaneously recognising the limits of constructive dialogue. Dialogue can change the dynamic of
community engagement. However, the full alignment of the goals of differing constituencies may not always be
possible, due the complex interaction between the multiple positions and understandings of stakeholders that are
involved and the need to respect the other’-s’ autonomy.
Date: 2008
Abstract: Objective To assess reasons for low uptake of immunization amongst orthodox Jewish families.
Design Qualitative interviews with 25 orthodox Jewish mothers and 10 local health care workers.
Setting The orthodox Jewish community in North East London.
Main outcome measures Identification of views on immunization in the orthodox Jewish community.
Results In a community assumed to be relatively insulated from direct media influence, word of mouth is nevertheless a potent source of rumours about vaccination dangers. The origins of these may lie in media scares that contribute to anxieties about MMR. At the same time, close community cohesion leads to a sense of relative safety in relation to tuberculosis, with consequent low rates of BCG uptake. Thus low uptake of different immunizations arises from enhanced feelings of both safety and danger. Low uptake was not found to be due to the practical difficulties associated with large families, or to perceived insensitive cultural practices of health care providers.
Conclusions The views and practices of members of this community are not homogeneous and may change over time. It is important that assumptions concerning the role of religious beliefs do not act as an obstacle for providing clear messages concerning immunization, and community norms may be challenged by explicitly using its social networks to communicate more positive messages about immunization. The study provides a useful example of how social networks may reinforce or challenge misinformation about health and risk and the complex nature of decision making about children's health.