Abstract

Experiences of health, illness, and care among minoritised communities can vary significantly due to the interplay of cultural, structural, and socioeconomic factors. This thesis explores how these dynamics shape engagement with healthcare services, particularly in relation to chronic illness and mental health. Part A presents a qualitative study investigating the experiences of older South Asian adults in the UK living with multimorbidity. Using semi-structured interviews and reflexive thematic analysis, it investigates the ways cultural identity, caregiving roles, spiritual beliefs, and systemic barriers shape experiences of managing long-term conditions. Participants described how illness disrupted valued roles and how care systems often overlooked relational and emotional needs. Many drew on inner and community resources to sustain wellbeing despite fragmented services and unmet needs. Part B is a realist review assessing the effectiveness of culturally adapted digital cognitive behavioural therapy (CBT) for minoritised populations. Synthesising 15 studies, it explores how adaptations, ranging from language to deeper cultural alignment, affect engagement and outcomes. The review highlights the limitations of surface-level changes and emphasises the importance of addressing digital exclusion, stigma, and broader structural inequalities. Together, findings call for culturally responsive, relationally attuned, and structurally aware models of care that better reflect the realities of minoritised communities across both face-to-face and digital health landscapes.