Equality of opportunity for timely dementia diagnosis (equated): a qualitative study of how people from minoritized ethnic groups experience the early symptoms of dementia and seek help.

Introduction People from minoritized ethnic groups are diagnosed with dementia later in the disease. We explored pathways that may determine the timing of diagnoses in an ethnically diverse, urban area. Methods We conducted 61 semi-structured interviews, 10 community-dwelling older people from minoritized ethnic backgrounds with diagnosed and undiagnosed dementia (mean age = 72 years, males = 5/10), 30 family members (51, 10/30), 16 health or social care professionals (42, 3/15) three paid carers and two interpreters for people with dementia. We used reflexive thematic analysis, and the Model of Pathways to Treatment to consider diagnostic delay. Findings We identified three themes (1) Cultural identity and practices shape responses, gendered expectations that families relieve elders of household roles reduce awareness or concern when functioning declines, expectations that religious practices are maintained mean problems doing so triggers help-seeking. Second generation family members often held insider and outsider identities, balancing traditional and Western perspectives. (2) Becoming like a tourist, daily experiences became unfamiliar for people developing dementia in an adopted country, sometimes engendering a need to reconnect with a home country. For professionals and interpreters, translating meanings faithfully, and balancing relatives and clients voices, were challenging. (3) Naming and conceptualising dementia, the term dementia was stigmatised, with cultural nuances in how it was understood; initial presentations often included physical symptoms with cognitive concerns. Conclusion Greater understanding of dilemmas faced by minoritized ethnic communities, closer collaboration with interpreters and workforce diversity could reduce time from symptom appraisal to diagnosis, and support culturally competent diagnostic assessments. Keywords: dementia, diagnosis, inequalities, ethnicity ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement NIHR Three Schools Dementia Research Programme ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Camden & Kings Cross Research Ethics Committee (REC 23/YH/0034) approved this qualitative interview study on 1.3.23. Queen Mary University London I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors