Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, 13EN-228, Toronto, ON, M5G2C4, Canada.
University of Calgary, 2500 University Drive NW, Calgary Alberta T2N1N4, Canada.
Int J Equity Health. 2023 Oct 7;22(1):207. doi: 10.1186/s12939-023-02026-x.
Women are more likely to develop osteoarthritis (OA), and have greater OA pain and disability compared with men, but are less likely to receive guideline-recommended management, particularly racialized women. OA care of diverse women, and strategies to improve the quality of their OA care is understudied. The purpose of this study was to explore strategies to overcome barriers of access to OA care for diverse women.
We conducted qualitative interviews with key informants and used content analysis to identify themes regarding what constitutes person-centred OA care, barriers of OA care, and strategies to support equitable timely access to person-centred OA care.
We interviewed 27 women who varied by ethno-cultural group (e.g. African or Caribbean Black, Chinese, Filipino, Indian, Pakistani, Caucasian), age, region of Canada, level of education, location of OA and years with OA; and 31 healthcare professionals who varied by profession (e.g. family physician, nurse practitioner, community pharmacist, physio- and occupational therapists, chiropractors, healthcare executives, policy-makers), career stage, region of Canada and type of organization. Participants within and across groups largely agreed on approaches for person-centred OA care across six domains: foster a healing relationship, exchange information, address emotions, manage uncertainty, share decisions and enable self-management. Participants identified 22 barriers of access and 18 strategies to overcome barriers at the patient- (e.g. educational sessions and materials that accommodate cultural norms offered in different languages and formats for persons affected by OA), healthcare professional- (e.g. medical and continuing education on OA and on providing OA care tailored to intersectional factors) and system- (e.g. public health campaigns to raise awareness of OA, and how to prevent and manage it; self-referral to and public funding for therapy, greater number and ethno-cultural diversity of healthcare professionals, healthcare policies that address the needs of diverse women, dedicated inter-professional OA clinics, and a national strategy to coordinate OA care) levels.
This research contributes to a gap in knowledge of how to optimize OA care for disadvantaged groups including diverse women. Ongoing efforts are needed to examine how best to implement these strategies, which will require multi-sector collaboration and must engage diverse women.
与男性相比，女性更容易患上骨关节炎（OA），且 OA 疼痛和残疾程度更大，但她们接受指南推荐的治疗的可能性较小，尤其是少数族裔女性。针对不同族裔女性的 OA 护理以及改善其 OA 护理质量的策略研究还很不足。本研究旨在探讨克服不同族裔女性接受 OA 护理障碍的策略。
我们对关键信息提供者进行了定性访谈，并使用内容分析来确定构成以患者为中心的 OA 护理的主题、OA 护理的障碍以及支持公平及时获得以患者为中心的 OA 护理的策略。
我们采访了 27 名女性，她们的族裔群体（例如非洲或加勒比黑人、中国、菲律宾、印度、巴基斯坦、白人）、年龄、加拿大地区、教育程度、OA 位置和 OA 患病年限各不相同；采访了 31 名医疗保健专业人员，他们的职业（例如家庭医生、护士从业者、社区药剂师、物理治疗师和职业治疗师、脊椎按摩师、医疗保健高管、政策制定者）、职业阶段、加拿大地区和组织类型各不相同。来自不同群体的参与者在六个领域对以患者为中心的 OA 护理方法基本达成一致：建立治疗关系、交流信息、处理情绪、管理不确定性、共同决策和自我管理。参与者确定了 22 个访问障碍和 18 个克服障碍的策略，这些策略既涉及患者层面（例如为受 OA 影响的人提供不同语言和格式的文化规范的 OA 教育课程和材料），也涉及医疗保健专业人员层面（例如对 OA 以及针对交叉因素的 OA 护理的医疗和继续教育）和系统层面（例如提高对 OA 的认识和预防及管理 OA 的公共卫生运动、自我转诊和公共资金用于治疗、更多数量和族裔多样性的医疗保健专业人员、解决不同族裔女性需求的医疗保健政策、专门的跨专业 OA 诊所以及协调 OA 护理的国家战略）。
这项研究有助于填补有关如何为弱势群体（包括少数族裔女性）优化 OA 护理的知识空白。需要不断努力研究如何最好地实施这些策略，这将需要多部门合作，并必须让不同族裔的女性参与进来。
