Identifying ‘Hidden Need’

Through research into the health and social care needs of Muslim elders in Exeter, Brenda Laker comes to the conclusion that need is not “hidden”. It just a question of knowing how and where to look.

The Context

On 16th June 2004 a conference will be held to deliver a piece of research that has been a long time in gesta tion. In the summer of 2002 the Policy and Projects Manager Equalities (Devon Social Services Directorate) met with members of the Olive Tree Project Trust, a community group based at the Islamic Centre Exeter, to look at the health and social care needs of the Muslim community. Members of the community had drawn attention to their perceived need for a culturally specific day service for the elderly; a focal point for provision of information, advice, social support and recreational opportunities.

Since existing community facilities were extremely poor, any provision would require a commitment from the statutory and other relevant bodies. A working group comprising representatives from Devon County Council Social Services Directorate, the Islamic Centre South West, Age Concern Exeter, and Connections-Consultancy Independent Social Work Agency agreed to research their claim.

Numerous challenges would have to be faced in the course of the research. Some of these challenges could be foreseen, such as difficulties of working with a community as diverse as the Muslim community (comprising 30 nationalities and speaking 15 languages). Others, like the outbreak of war in Iraq and it’s impact on the community, were not foreseeable.

Designing the study

The purpose of the research was to engage with older persons from the Muslim community with a view to:

· understanding the issues they were facing;
· identifying need and consider how that need could be met;
· identifying skills and resources in the community that could be developed;
· producing a model that could be replicated.

With this in mind the study was set up with two aims: firstly to provide a platform for Exeter’s Muslim elders to convey their unmet social and health care needs to relevant agencies; and secondly to consider, in the context of statutory obligations and local recommendations, a designated day service for Exeter’s Muslim and other minority ethnic elders.

It was clear from preliminary discussion that knowledge of the statutory agencies was poor and that there had been little formal contact. Building positive relationships was seen as a key foundation stone to any potential work. With this in mind the working group spent some time at the Islamic Centre discussing what the study ought to try and find out and the best way to undertake it. A number of important requirements were highlighted through these discussions:

· flexible methods of consultation (e.g. one-to-one, group, etc.);
· a mixture of consultation methods (questionnaire, community consultation);
· flexible venues (e.g. at home, at the Islamic Centre);
· use of interpreters;
· questionnaires which could be completed individually, or through interview.

Capacity to undertake the study

As the working group met, it became evident that there was no spare capacity to undertake the study. Within the Muslim community, there were no community development officers, or project workers who could be relied on to participate. An approach to the Strategic Health Authority had not met with any success and it looked as if the project would not be able to go ahead.

We contacted the University of Plymouth social work course and offered them a part-time student placement at the Islamic Centre to undertake the research. The University agreed that two students and placement supervisors would join the working group. The study could proceed afterall.

The questionnaire

It was decided that a joint health and social services assessment form would be used, but it would need amending. Designing the questionnaire proved difficult. Many ‘standard’ questions would not make any sense in this context, and could not be directly translated. For example when looking at allocation of work within the household, the cultural context had to be understood in that many men or women living in extended families would not be expected to do many household chores. The question of who does the chores might therefore not give a true picture of the abilities of the individual. Following much consultation and several re-writes, the working group finally agreed the questionnaire.

The findings

The study commenced following announcements at Friday prayers two weeks in succession by the Imam. The students undertook the one-to-one interviews in consultation with their placement supervisors using the questionnaire. However, before many interviews could take place, the invasion of Iraq occurred. There was great tension throughout the Muslim community and individuals became suspicious of our motives.
As a result the study was put on hold until the hostilities in Iraq had eased.

The results

The results of the study are not particularly earth-shattering. They reflect all national research on BME populations. However, the demographic make up of Devon reveals that there is a growing Muslim aging population. This is made especially pronounced by reason of the steady exodus of young people to the larger cities. This has meant that traditional means of support for the elderly have been breaking down.

The study was meant to be about “hidden need” but it was soon discovered that there was no hidden need. The Muslim population knew what their needs were. They were clear and open about them. The need was only ‘hidden’ from organisations and statutory agencies. There was nowhere for this knowledge to go. There was no contact with the agencies.

The co-ordination of five separate organisations, each with a different outlook, proved
challenging. All had to adapt their attitudes and ways of working and re-define their idea
of using a project approach with organisation led timescales. The reason that the project
was successful was that through working together over the months, the Islamic Centre
and the Social Services had forged a strong partnership. The interest and support of the
Director of Social Services provided an impetus to the project.

Whilst there were difficulties in conducting the study, the areas that presented the greatest challenges were the areas from which we have taken the clearest lessons:

· the need to be flexible and open to change;
· the need to avoid pre-conceptions and rigid templates;
· the need to allow questionnaire formation to take time to evolve;
· the need to allow the community to dictate the pace of the study;
· the need to give the community rather than organisations the power to decide the direction of the study;
· the fact that political realities can dictate the pace of a project.

Way forward

Whilst any leap from research partnerships to action partnerships is difficult, it is hoped that the positive experiences of this project will make future action partnerships easier. It is essential to establish credibility by delivering on the findings. Midst the rampant Islamaphobia and open hostility frequently directed at Muslims, meeting the needs of the Muslim community is more challenging and, at the same time, more important than ever before.

Brenda Laker is planning officer at the Social Services Directorate Devon County Council. ‘A Question of Fairness: an enquiry into the health and social care needs of Muslim elders in Exeter’ (2004) by Brenda Laker, Kauser Ahmed, Fiona Hutton and Julia Cornwell is available from blaker@devon.gov.uk.top