Mechanisms underlying success in healthcare interventions for racially minoritised people with multiple long-term conditions

In this paper we describe the mechanisms by which 15 interventions targeted at healthcare providers/systems lead to improved health outcomes (or lack thereof) for racially minoritised people with multiple long-term conditions (MLTCs). We extracted the mechanisms attributed to change as reported by the authors and conducted a narrative synthesis. Success was defined as statistically significant improvements in health outcomes for the intervention group post-intervention. Our findings suggest that interventions which adopt integrated, collaborative, multifaceted, patient-centred, individualised care can improve health outcomes for racially minoritised people with MLTCs. Assuring equitable and inclusive care (e.g. by involving family members and/or using facilitators who share similar racial/ethnic and socioeconomic background as patients) fosters trusts between healthcare providers and racially minoritised people with MLTCs. Expanding the role of existing staff (e.g. nurses) and incorporating care coordinators/managers/liaisons to support both patients and healthcare teams can ensure holistic healthcare provision and continuity of care, important aspects of MLTCs management. Interventionists must recognise the influence of wider societal processes (i.e. social determinants of health and available resources) on health(care) provision. It is important to leverage community assets while maintaining strong links to primary care services. We provide a logic model depicting key mechanisms by which the health outcomes of racially minoritised people can be improved and illuminate barriers to success, both of which are particularly relevant for all who seek to address the growing racial inequalities in MLTCs through healthcare interventions.