Terms such as ‘race’, ‘ethnicity’, ‘BME’ (Black and Minority Ethnic) and ‘BAME’ (Black, Asian and Minority Ethnic) are commonly used in health practice and research. However, understanding of the terms varies and they are commonly misunderstood. This chapter provides a brief outline of the meanings frequently used for these terms and how they are applied in this text.

Attention then focuses on the concept of ‘hard to reach’ and its assignment to BME populations who do not engage in health services and research (Lamb et al, 2012; Liljas et al, 2017; Rockliffe et al, 2018; Liljas et al, 2019). The reasons why BME people are conceptualised in this way in health services and research are also discussed. It is recognised that academics and practitioners have been debating these issues for some time, but have made little progress in advancing the term and the exclusionary practices that accompany its application. Reflecting on when and why this has occurred, is an important starting point for introducing this text. Therefore, a historical account of the concept of ‘hard to reach’ is provided and the challenges faced when doing inclusive research are discussed.

The final section of this chapter highlights the problems of utilising this term. Specifically, it is argued that the term ‘hard to reach’ plays a debilitating role in ‘othering’ BME people within health services, as it is often synonymised with other terms such as: ‘vulnerable’, ‘problematic’, ‘marginalised’, ‘forgotten’, ‘less worthy’ and ‘disadvantaged’ (Edge, 2013; Rockliffe et al, 2018; Sydor, 2013; Bamidele et al, 2019).

This chapter aligns to existing research in this field, which acknowledges that BME people are still being treated differently by service providers and feel unequal to White British groups (Salway et al, 2016; Race Disparity Unit, 2019a). The implications of current exclusionary practices in research are discussed.

Key concepts

When completing research or working with different groups of people, it is essential that key concepts regarding their identity are understood. Misconceptions of these concepts can impact significantly on how the research or a programme of work is conducted and how the participants engage with the process.

Race and ethnicity are concepts that refer to features or characteristics of a person's identity that allow us to differentiate between people and/or groups (Kumar and Diaz, 2019). These concepts are often intertwined or misunderstood by researchers and practitioners, and they can be used inappropriately to identify, classify and categorise individuals and groups.