Understanding inequities in accessing neurodevelopmental pathways: a multiple methods study investigating healthcare...

Minoritised ethnic families in England experience disproportionate barriers to accessing neurodevelopmental disorder (NDD) assessment and support despite universal healthcare provision. Existing evidence has focused on caregivers' perspectives or non-UK settings but little is known about how healthcare professionals (HCPs) perceive and interpret these inequities. Addressing this gap is essential for improving access, service design and workforce development.

To explore HCPs' perceptions of the barriers and facilitators influencing minoritised ethnic families' access to NDD services in England.

A multiple methods design was used, comprising an online national survey (n=264) and two online focus groups with primary, secondary and allied health professionals (n=9). Survey data were summarised descriptively and free text responses analysed using summative content analysis. Focus group transcripts underwent reflexive thematic analysis. Findings were summarised following parallel analysis of each data set. Patient and public involvement and engagement members from minoritised ethnic backgrounds contributed throughout.

HCPs identified four interconnected barriers they perceived to influence access for minoritised ethnic families: (1) language, communication and meaning-making challenges, including differences in how concepts and expressions are understood, inconsistent interpretation and limited mental health literacy; (2) difficulties navigating complex, fragmented NDD pathways, exacerbated by digital literacy demands and unclear referral routes; (3) limited caregiver knowledge and understanding of NDDs, affecting symptom recognition and the ability to advocate effectively and (4) cultural norms, beliefs and stigma, including preferences for non-Western models of care, fear of diagnostic labels and the influence of extended family. Professionals also highlighted the impact of unconscious bias and limited cultural representation within services on referral decision-making and caregiver engagement. HCPs described several effective strategies for mitigating these barriers, such as culturally attuned communication, community-based engagement and flexible assessment approaches.

Inequitable access to NDD services arises from the interaction of cultural, relational and structural factors across the healthcare pathway. HCPs' insights reveal multiple entry points for improving equity, particularly through communication support, culturally responsive practice and simplified referral processes.

Embedding culturally informed communication, improving caregiver education, strengthening workforce diversity and coproducing service changes with communities may reduce avoidable delays and promote equitable access to neurodevelopmental assessment and support.