An understanding of ‘strengths’ and ‘strengths based approach’ within older people from ethnic minorities in the UK. A qualitative systematic review

2.1 Patient and public involvement

Embracing the importance of putting people who have direct experience of care at the centre of research, the review team collaborated with the Lived Experience Panel of the Social Care Cluster at Birmingham University. This diverse group of individuals have experience of accessing care and support directly and/or as a family care, and includes those from South Asian and African-Caribbean communities. They were initially consulted on the outline of the overall purpose and questions of the research in relation to SBP within black and minority ethnic communities. There was then a second discussion with panel members to share the findings and the research teams’ initial interpretations of these and the related implications for future research and practice.

2.2 Aim

To conduct a systematic review and synthesis of qualitative studies to explore what older people from black and minority ethnic communities understand as strengths and assets within their day to day lives, consider how these strengths map against core elements of Strengths -Based Practice in social care, and identify implications for practice and future research.

2.3 Design

The overall methodology was qualitative systematic review to support the overall aim of presenting current understanding of participant experiences and perceptions of strengths and assets within their day to day to lives (Butler and Hall, 2016). This also reflected that the majority of relevant published studies have taken a qualitative approach.

2.4 Search strategy

The following databases were searched by a professional librarian at the University of Brimingham between February and March 2025: Social Policy and Practice, MEDLINE, SSCI and ASSIA with search terms ( Table 1) that reflect our interest on older people (i.e. those over 65 years old) from black and minority ethnic communities in the UK, and a strengths (or equivalent) based approach.

Articles published after 2010 were included to reflect the timeline of the focus across the UK governments on strengths (or asset based) working and those outside of the UK were excluded Table 2).

2.5 Search outcome

The search identified 3396 potentially relevant publications. After removal of duplicates, 2590 articles were screened based on title and abstract, which led to the exclusion of another 2501. The remaining 49 articles were read for eligibility, and a further 28 articles were excluded for not meeting the inclusion criteria. Two of the authors (LS-A and RM) then conducted a full screening of the remaining 21 articles, resulting a further 9 excluded studies. Searching of the references lists from these included papers led to a further 19 articles. As the quantitative articles provided little relevant data to respond to the aims of the research, the inclusion criteria was amended to only include qualitative studies. This resulted in the further exclusion of 14 articles using a quantitative methodology. This resulted a final inclusion of 16 articles that were then critically appraised. The PRISMA flow diagram demonstrates the screening process (Figure 1).

Figure 1. PRISMA flow chart.

2.6 Quality appraisal

Two of the authors (LSA and LB) separately assessed the methodical quality of the included studies using the Critical Appraisal Skills Programme (CASP) (CASP, 2022). A sample was then jointly considered, with any discrepancies between the reviewers resolved through discussion, or by consulting with the third reviewer.

The CASP checklist used considered the studies design, methods and reporting for reliability, relevance and validity. High quality was ‘Yes’ on 8 or more of the questions in the CASP. It was finally agreed that 1 study was of moderate and 10 studies of high methodical quality ( Table 3). A total of 5 studies were excluded due to low quality.

2.7 Data extraction and synthesis

We applied an abductive approach to the data extraction and synthesis. We started with deductive themes that reflected the research interests of the authors, and recognised elements of contemporary Strengths-Based Practice (Miller & Mahesh, 2025) (See Table 4 below). Although they denote theory-based premises, the themes also represent an incomplete observation of the likeliest explanation of how strengths may be understood and experienced in the lives of older people from minority ethnic communities. This ‘space’ allowed the generation of novel insights and the development of the most plausible inferences about the data (Barrett and Younas, 2023).

The process involved engaging with the data and themes, then standing, and reengaging with the data, ensuring, throughout the process, that the initial themes were considered flexible and open to review (Harding, 2019, Gibson and Brown, 2009). Consideration was given to their relevance, whether they are too broad or should be merged, or the need to add another code through the emergence of new themes from the data.

3.1 Characteristics of the included studies

Table 5 below outlines the 11 included studies that were published between 2010 and 2024. The studies utilised individual interviews and focus groups as their primary method of data collection, with the majority adopting a thematic analysis of the data.

Although the primary aim of the study is to explore what older people from minority ethnic communities understand as strengths and assets within their day to day lives, full screening revealed that most studies also included the reflections and experiences of the carers of, and practitioners that support older people from these communities. These insights were seen as relevant to the overall aims and were therefore also included in the analysis but were identified as being the views of carers and/or practitioners rather than the older people.

Several of the studies focused specifically on older people with dementia – these were included as the experiences of older people with dementia are important to understand in relation to strengths based practice (McGovern, 2015, Peacock et al., 2010), and where relevant findings are specifically connected with those who have dementia. It is also important to include these studies when consideration is given to the prevalence of dementia in older people living with dementia from Black, Asian and other Minority Ethnic origins. In 2017 this was approximately 25,000 and is expected to increase by 2026 to 50,000, and 172,00 by 2051 (Parveen et al., 2017), with people from Black, Asian and other Minority Ethnic communities likely to be diagnosed at a more advanced stage of the illness, and have a lower consumption of mainstream dementia services than older people from White British communities (Baghirathan et al., 2020).

None of the articles from either the database or citations searches, specifically referred to, or considered strengths-based or asset-based approaches in relation to older people from minority ethnic communities in their overall framing. Although, to some extent, this was anticipated by the authors, it was still surprising to see the dearth of studies that have sought to explore this topic when it is such a priority with adult social care policy and practice. Findings did though relate to a greater or lesser extent to the core elements of SBP outlined above even if they were not explicitly badged as being from this perspective.

3.2 Findings

As could be expected given the structural and intersectional nature of the challenges faced by older people from black and minority ethnic communities, and the often lack of culturally appropriate support within social care and health services, there is frequently greater profiling in the studies on those factors which negatively influence people’s wellbeing rather than strengths per se. Whilst the focus on this review is on the strengths, we have also included the challenges where relevant as addressing these will potentially both reduce negative factors and/or suggest what a positive would be (i.e. practice which demonstrates a strengths-approach). Furthermore, recognising the difficulties which people face, and the structural nature of these, was from the outset a core aspect of SBP.

As discussed in 2.7 there was a premise during the data analysis to adapt the apriori themes if necessary, and consequently Person Centred and Relational were merged, and Asset Based was merged with Community Orientated.

3.2.1 Wellbeing

A strong finding across several of the studies was the importance of faith and religion to the wellbeing of older people from minority ethnic communities (Sidhu et al., 2016, Parveen et al., 2013, Parveen et al., 2017, Victor et al., 2024). This was particularly significant in the studies of older people form the South Asian communities. Faith and religion is seen to provide a system of ongoing support, where ritual prayer or the demonstration of spiritual belief, highlights the significance of having faith (Sidhu et al., 2016). Additionally, other than simply an acceptance of Gods will, prayers were experienced as increasing emotional resilience, and a coping mechanism to manage distress, partly through the recognition of the limited control individuals have over aspects of their well-being (Sidhu et al., 2016). Similarly, Parveen et al. (2017) in her study of perceptions of dementia in minority ethnic communities, found that Indian and African/Caribbean groups used religion and spirituality as a form of personal control to cope with the negative effects of dementia. Alongside faith, another common strength in respect to wellbeing, is the deeply rooted relationships that exist within a number of BAME communities, where the family was found to be the primary source of emotional and practical support (Sidhu et al., 2016, Victor et al., 2012). This theme will be further explored in 3.2.3 as an asset in the lives of older people from minority ethnic communities.

For a number of older people across the studies, dignity and self-respect were crucial aspects of their wellbeing, with Giuntolia and Cattan (2012) suggesting that dignity was a “central expectation for all older people” (p. 1) however, the studies found that the diagnosis of, and living with dementia was a threat to these aspects of a person’s wellbeing. Parveen et al. (2017) found that older people from a Indian community felt that dementia was damaging to their self-respect whilst Manthorpe et al. (2012) reported that older people from BAME communities often experienced a lack of control and poor wellbeing when faced with declining health. The negative stigma often associated with dementia was prevalent for a number of South Asian participants in the study by Baghirathan et al. (2020), where dementia was framed within a context of superstition, coupled with a lack of knowledge and information of dementia as a distinct health condition, but making dementia ‘visible’ was only possible in settings that the older people were familiar with, and run by their own community members. Developing the theory of diminishment, Baghirathan et al. (2020) not only found that older people experience diminishment through experiencing the effects of cognitive impairment, but also potentially through the provision of statutory services that did not meet their cultural needs.

A sense of security was an important theme in several studies, and for a number of older people isolation and loneliness was a was found to have a detrimental impact on wellbeing (Manthorpe et al., 2012). Often this was connected with the loss of a loved one, or valued companions (Giuntolia and Cattan, 2012) or through separation from their country of origin. Despite the fact older people may have resided in the UK for a substantial period of their lives, Victor et al. (2024) they still experienced an emotional sense of not quite ‘belonging’ and not feeling fully ‘at home’, where a feeling of being an outsider was described as marginalising and was linked to experiences of hostility. The studies also revealed a need for financial well-being related to feelings of security, including being in control of finances and having the freedom to make choices (Joshi, 2020). However, Victor et al. (2012) found that BAME communities often experience high levels of financial disadvantage and emotional stress, particularly women, which impacted on their wellbeing.

The challenge of meeting the cultural and religious needs of older people from BAME communities through statutory health and social care services was a common finding in several studies and will therefore feature throughout this findings section. An issue which was found to directly affect an individual’s wellbeing, is where services failed to take into dietary choices, which were often linked to cultural and religious needs, in a range of settings such as hospitals and care homes (Joshi, 2020; Manthorpe et al., 2012; Victor et al., 2024; Ellins and Glasby, 2016).

3.2.2 Person-centred and relational practice

Sidhu et al. (2016) found that the accounts of first generation migrants contained little evidence of a patient-centred approach from health professionals (Sidhu et al., 2016) but identified in the same accounts was a desire from older people for professionals who derived from their own community, because of cultural understanding and linguistic reasons. (Sidhu et al., 2016, Parveen et al., 2017). Similarly, in studying of the experiences of hospital admissions of older people from minority ethnic communities, Ellins and Glasby (2016) found that language barriers, and a lack of information created intense feelings of anxiety and left patients feeling helpless and vulnerable. Participants reporting of having their dignity undermined through being left in a soiled bed for a long time, and a failure to meet their cultural and religious needs, such as the poor provision of vegetarian meals. In addition, participants reported as wanting to be seen “as a person with needs, wants and feelings, rather than as a problem to be fixed” (p. 50) with many feeling they were part of a conveyor belt.

In the study exploring the experiences of older people from minority ethic communities living in supported living in Scotland, Joshi (2020) found a lack of a shared language between residents and staff prevented any meaningful social interaction or relationship from forming, with the study arguing for housing and care options that meet specific social, language, and dietary requirements. Similarly, the study by Victor et al. (2024) on the professional understanding of dementia on minority ethnic communities, found services were found to be not culturally appropriate, with a lack of personalisation in care homes around crucial aspects like food and skincare (Victor et al., 2024). Contrary to this Manthorpe et al. (2012) found in their study of practitioners supporting older people from black and minority communities in social care and housing, examples of providing person-centred care in care homes such as providing female staff for a female’s personal care and listening to culturally specific needs such as foods.

It was identified in a number of studies a need to challenge the collectivist ethos that all members of the same ethnic minority group organise their health and social care according to their cultural principles, and individuals who decline services on cultural grounds as viewed as not needing or wanting support, instead each individual needs to be considered in their own right (Joshi, 2020, Giuntolia and Cattan, 2012). Similarly, Parveen et al. (2017) purport the need for a person-centred Dementia awareness work with older people from minority ethic communities in order to challenge harmful misconceptions around the causes of dementia, aggression and the needs of people living with dementia. The study also recognised that this work also needs to be extended to the wider family, where participants reported a “lack of support and understanding from extended family members following a dementia diagnosis” (Parveen et al., 2017, p. 738).

Good communication that included understanding and compassion was seen as important to older people (Giuntolia and Cattan, 2012) the most effective way for professionals to engage to engage with older was to through introductions by a trusted intermediary (Manthorpe et al., 2012). Trust was found to be an important factor for older people when having carers in their home. The study showed this was something which took time to develop regardless of ethnic background (Giuntolia and Cattan, 2012).

3.2.3 Asset based and community orientated

Developing on the importance of family on the wellbeing of individuals introduced in the previous section, the family feature in a number of studies as a core asset in the lives of older people from ethic minority communities, (Giuntolia and Cattan, 2012, Sidhu et al., 2016, Manthorpe et al., 2012, Victor et al., 2012, 2019) with family members often called upon to act as informal interpreters by older people when communicating with professionals (Ellins and Glasby, 2016). The family is viewed as consisting of immediate and extended family members living in one household or nearby, and embodies a system of support, whose members were trusted to show empathy, maintain confidentiality, and mitigate any fear of exposure of their personal issues to the wider community. (Sidhu et al., 2016) as well as the most trusted source for emotional, physical, and spiritual care (Manthorpe et al., 2012, Victor et al., 2012, Herat-Gunaratne et al., 2020). There also exists clear distinctions between strong, reliable relationships with close family and weaker relationships with friends (Victor et al., 2012).

The support from families in South Asian communities in particular was found to be based upon on cultural values such as intergenerational “filial piety” and a sense of “familial duty” (Sidhu et al., 2016, Victor et al., 2019, Herat-Gunaratne et al., 2020). Gender plays a key role within these values, with the spousal relationship viewed as the most important, with wives typically caring for husbands (Victor et al., 2012), and daughters also playing a significant role in helping older relatives to self-manage their condition on a daily basis (Sidhu et al., 2016). Older people are themselves often an asset themselves to families, often caring for children and grandchildren (Victor et al., 2012). In South Asian communities the family is found to be transnational, with networks spread across the UK, North America, Europe, and their countries of origin. Providing important social engagement and support during major life events, health information and traditional medicine from their countries of origin (Sidhu et al., 2016, Victor et al., 2012). However, it is found that these communities offer little in terms of direct care needs and support (Victor et al., 2012).

Drawing on the previous point made in 3.2.2 in reference to the need to develop a nuance understanding as to why some older people from minority ethnic communities are reluctant to or decline formal care services. Potential insights from the studies in this review, include the familial duty to care, carer guilt, and the expectation and reluctance of the older person to accept nonfamilial care (Victor et al., 2012, Herat-Gunaratne et al., 2020). The acceptance of professional care in Pakistani and Bangladeshi communities in the UK perceived as being the ‘last resort’ (Victor et al., 2019), with a preference to care for your own and not wanting strangers in their homes (Giuntolia and Cattan, 2012, Baghirathan et al., 2020, Manthorpe et al., 2012). It has been identified that an unwillingness to accept care emanates from previous experiences of culturally insensitive care (Herat-Gunaratne et al., 2020). Similarly, in respect of older people with dementia it was found that life course experiences of negative and hostile social and policy environments and services can be profound and long-lasting, and provide a prism through which accessing dementia care is experienced for many older people from minority ethnic communities (Victor et al., 2024).

Converse to the stance on accessing statutory support, several studies revealed that older people were more than willing to utilise community-based resources, like lunch clubs and day centres. They were considered to be a lifeline, and a key to ease the loneliness of older people from minority ethnic communities, with a significant cause of loneliness was the loss of contact with members from their own community of origin (Giuntolia and Cattan, 2012, Yarker, 2020). The proximity and physical location of community support was important, with older people from minority ethnic backgrounds in rural areas at heightened risk of isolation because they often lack the physical infrastructure of belonging, such as living near to a place of worship or a purpose-built community centre (Manthorpe et al., 2012). Religious group membership is also seen as a key system of support, with older people volunteering within their own communities, and enjoy being able to give, and value the opportunity to contribute to society (Sidhu et al., 2016).

For older people from minority ethnic communities, as discussed previously, as well there being a lack of awareness and knowledge of dementia, there also exists a considerable stigma around the condition, with it considered a “taboo subject”, with that people ashamed to speak about (Manthorpe et al., 2012). In these instances community leaders who are found to be important assets and recognise as “known and trusted individuals active in their respective communities” (Victor et al., 2024, p. 1174). Because of this lack of knowledge and stigma these leaders are a key source of support and information about all aspects of dementia, as well as allowing older people to access this trusted source, who are entrusted to keep the diagnosis of dementia confidential and contained from the wider community (Victor et al., 2024).

3.2.4 Collaborative

Collaboration within strengths-based practice involves care providers and professionals cultivating a collaborative relationship with the service user, with regular communication and involving service users in all decisions in order to provide a co-ordinated and holistic support to people and their families (Au and Mahesh, 2025). It requires professionals to be open in negotiation, and appreciate the authenticity of the of the views and aspirations of those who they collaborate with (Saleebey, 2009).

The studies identified in this review provided limited data for this theme. What they did outline was a problem with communication with professionals, services and older people from minority ethnic communities. There was a need for a need for an ongoing dialogue within and between service and between services and the people receiving care (Giuntolia and Cattan, 2012). Ellins and Glasby (2016) found that for older people admitted to hospital, they wishes for family members to be kept up to date with their health and discharge plans, with their own wishes were often not listened to and decisions made without family consultation.

3.2.5 Social justice

An aspect of strengths-based practice lost within a social care system orientated around individualistic care management approaches is the active promotion of social justice through addressing inequalities at both an individual and structural level (Miller & Mahesh 2025). Studies in the review found that older people from minority ethic communities experience high levels of inequalities in health including high rates of chronic illness, physical and mental health. With barriers preventing access to services these including a lack of familiarity with available services, cultural stereotypes that influence the attitudes and behaviours of health and social care professionals, a lack of culturally aware services and language difficulties (Victor et al., 2012, 2019, Manthorpe et al., 2012). The latter was found to negatively affect the quality and experience of care and present a formidable obstacle to the delivery of good quality care (Ellins and Glasby, 2016, Victor et al., 2024). The study by Joshi (2020) identified systemic failures with language barriers leading to delayed medical diagnoses, missed appointments, and access to vital care and benefits.

A number of studies in the review identified a number of solutions to address these issues; Firstly, the removal of language barriers through access to professional interpreters to ensure equitable access to care and support (Giuntolia and Cattan, 2012). Sidhu et al. (2016) found evidence of Health Services being reorganised, where self-management and preventive health care practices are locating outside of traditional health care settings and into community settings. They argue that providers and commissioners need to engage with the diverse minority ethnic communities to plan and manage this transition.