{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:18:54Z","timestamp":1784852334506,"version":"3.55.0"},"reference-count":43,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"content-version":"unspecified","delay-in-days":11,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100012682","name":"British Academy of Management","doi-asserted-by":"publisher","award":["COV19\\201225"],"award-info":[{"award-number":["COV19\\201225"]}],"id":[{"id":"10.13039\/100012682","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,2,23]]},"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To explore the experiences of South Asian female healthcare professionals in the UK National Health Service (NHS) during COVID-19, examining how the pandemic conditions exposed the ways in which race, gender and professional identity intersect to shape risk, silence and discrimination.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>A qualitative study using semi-structured interviews.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting and participants<\/jats:title>\n                    <jats:p>27 South Asian female doctors and nurses, employed across NHS trusts in London, Greater Manchester and Liverpool, were recruited through purposive snowball sampling between 2021 and 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>This study was conducted during the COVID-19 pandemic, a period when existing workplace inequality became more visible and consequential. Although the research was initially motivated by evidence of disproportionate COVID-19 risk among ethnic minority healthcare staff, participants consistently foregrounded experiences of voice, silence and power within the NHS. It was through these accounts, situated in the heightened pressures and uncertainties of the pandemic, that four key themes emerged: (1) how discrimination and ethnic bias suppress voice; (2) fear of retaliation and the consequences of speaking out; (3) internalised cultural norms and the emotional labour of adaptation; and (4) finding voice through experience and action. Participants reported microaggressions, disproportionate disciplinary scrutiny and informal silencing tactics that left them feeling vulnerable and voiceless. For many, cultural expectations around hierarchy and respect inhibited confrontation, even in the face of unfair treatment. Some women engaged in self-reflexive strategies, learning to interpret institutional codes, recalibrating their behaviour or selectively speaking out. For many, this process of adaptation\u2014learning, recalibrating and navigating institutional expectations\u2014was less a path to upholding their agency and more a survival mechanism within a system they perceived as structurally biased. While a few participants described finding ways to speak out and support others through union membership and legal awareness, most described adaptation as emotionally taxing and ineffectual in the face of structural barriers. Silence (eg, withdrawing, transferring departments, leaving their roles altogether) remained the dominant strategy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>COVID-19 did not create these dynamics, but it did expose and intensify pre-existing constraints on voice in the NHS. Drawing on South Asian women\u2019s accounts, this study provides insight into how institutional and cultural dynamics constrain voice and inclusion, particularly under conditions of heightened organisational pressure. We argue that voice is not just a personal capacity but a structural condition that can either reinforce silence or enable change. Our study highlights the need for structural reforms that strengthen psychological safety, ensure clarity around rights and protections and address the persistent gap between inclusion rhetoric and lived experience.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-110607","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T14:55:41Z","timestamp":1773327341000},"page":"e110607","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Navigating silence and voice: South Asian women healthcare professionals in the UK NHS during COVID-19 and beyond \u2013 a qualitative study"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7755-0180","authenticated-orcid":false,"given":"Saleema","family":"Kauser","sequence":"first","affiliation":[{"name":"People Management and Organisations, The University of Manchester Alliance Manchester Business School, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Paula","family":"Figueiredo","sequence":"additional","affiliation":[{"name":"The University of Manchester Alliance Manchester Business School, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhavna K","family":"Pandya","sequence":"additional","affiliation":[{"name":"Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,3,12]]},"reference":[{"key":"2026062609362194000_16.3.e110607.1","unstructured":"NHS Race & Health Observatory . Mapping of existing policy interventions to tackle ethnic health inequalities in maternity and neonatal health in England: a systematic scoping review with stakeholder engagement, 2022. Available: https:\/\/ hsrho.org\/research\/mapping-of-existing-policy-interventions-to-tackle-ethnic-health-inequalities-in-maternity-and-neonatal-health-in-england-a-systematic-scoping-review-with-stakeholder-engagement\/ [Accessed 13 Dec 2023]."},{"key":"2026062609362194000_16.3.e110607.2","doi-asserted-by":"crossref","first-page":"385","DOI":"10.4337\/9781800886605.00037","volume-title":"Research Handbook on Inequalities and Work","volume":"Edward Elgar","author":"Woodhams","year":"2024"},{"key":"2026062609362194000_16.3.e110607.3","doi-asserted-by":"crossref","DOI":"10.2196\/22581","article-title":"COVID-19 and Black, Asian, and Minority Ethnic Communities: A Complex Relationship Without Just Cause","volume":"7","author":"Phiri","year":"2021","journal-title":"JMIR Public Health Surveill"},{"key":"2026062609362194000_16.3.e110607.4","doi-asserted-by":"crossref","unstructured":"Rimmer A . Covid-19: Disproportionate impact on ethnic minority healthcare workers will be explored by government. 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From the frontline. Empowering staff to drive the NHS reform agenda, Available: https:\/\/ippr-org.files.svdcdn.com\/production\/Downloads\/From_the_frontline_Nov24_2024-11-21-164416_sdmh.pdf?dm=1732207456 [Accessed 22 Nov 2024]."},{"key":"2026062609362194000_16.3.e110607.13","unstructured":"Ross S , Jabbal J , Chauhan K , et al . Workforce race inequalities and inclusion in nhs providers. The King\u2019s Fund; 2020. Available: https:\/\/assets.kingsfund.org.uk\/f\/256914\/x\/eeb3fa7cd3\/workforce_race_inequalities_inclusion_nhs_providers_2020.pdf [Accessed 7 Jul 2020]."},{"key":"2026062609362194000_16.3.e110607.14","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.n1123","article-title":"David Oliver: A vision for transparent post-covid government","volume":"5","author":"Oliver","year":"2021","journal-title":"BMJ"},{"key":"2026062609362194000_16.3.e110607.15","unstructured":"NHS England workforce statistics, 2019. 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Grounded theory methods. In: Adamsons K , Few-Demo AL , Proulx CM , et al , eds. Sourcebook of family theories and methodologies: A dynamic approach Springer. 2022: 315\u201333.","DOI":"10.1007\/978-3-030-92002-9_22"},{"key":"2026062609362194000_16.3.e110607.27","first-page":"1408","article-title":"Are We There Yet? Data Saturation in Qualitative Research","volume":"20","author":"Fusch","year":"2015","journal-title":"TQR"},{"key":"2026062609362194000_16.3.e110607.28","doi-asserted-by":"crossref","unstructured":"Braun V , Clarke V . Thematic Analysis. 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Handbook of Business Legitimacy: Responsibility. Ethics and Society Springer, 2020: 1261\u201373.","DOI":"10.1007\/978-3-030-14622-1_50"},{"key":"2026062609362194000_16.3.e110607.33","doi-asserted-by":"publisher","DOI":"10.1177\/0018726710375481"},{"key":"2026062609362194000_16.3.e110607.34","doi-asserted-by":"crossref","unstructured":"Fricker M . Evolving concepts of epistemic injustice. In: Kidd IJ , Medina J , Pohlhaus G , eds. The Routledge Handbook of Epistemic Injustice Routledge. 2017: 53\u201360.","DOI":"10.4324\/9781315212043-5"},{"key":"2026062609362194000_16.3.e110607.35","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.r337","article-title":"Measuring race equality in the NHS workforce","volume":"388","author":"Esmail","year":"2025","journal-title":"BMJ"},{"key":"2026062609362194000_16.3.e110607.36","doi-asserted-by":"publisher","DOI":"10.1108\/14777260910942588"},{"key":"2026062609362194000_16.3.e110607.37","unstructured":"Kline R , Naqvi H , Razaq S , et al . NHS workforce race equality standard. Data analysis report for NHS Trusts; 2016. Available: https:\/\/www.england.nhs.uk\/wp-content\/uploads\/2017\/03\/workforce-race-equality-standard-data-report-2016.pdf"},{"key":"2026062609362194000_16.3.e110607.38","unstructured":"Olekanma O , Muhaso V . Black asian and minority ethnic group (bame) women senior leadership journey in uk national health service (nhs): bame senior women leadership journey. BAM2022 Reimagining Business and Management as a Force for Good Conference Proceedings; 2022:1\u201315."},{"key":"2026062609362194000_16.3.e110607.39","first-page":"1","article-title":"Intersectionality: Connecting experiences of gender with race at work","volume":"38","author":"Rosette","year":"2018","journal-title":"Res Organ Behav"},{"key":"2026062609362194000_16.3.e110607.40","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1111\/1467-8551.12487","article-title":"Gender Matters: A Multilevel Analysis of Gender and Voice at Work","volume":"32","author":"Cooper","year":"2021","journal-title":"British J of Management"},{"key":"2026062609362194000_16.3.e110607.41","doi-asserted-by":"crossref","unstructured":"Schatzki TR . The Timespace of Human Activity: On Performance, Society, and History as Indeterminate Teleological Events. Lexington Books, 2010.","DOI":"10.5771\/9780739142707"},{"key":"2026062609362194000_16.3.e110607.42","unstructured":"International Labour Office Geneva . International Labour Organization Global Commission on the Future of Work: Work for a brighter future, 2019. 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