Discordant indigenous and provider frames explain challenges in improving access to arthritis care: a qualitative...

Area of Science:

• Health Services Research
• Indigenous Health
• Rheumatology

Background:

• Access to specialist care is reduced for Indigenous populations in Canada.
• Arthritis is a leading cause of disability among Indigenous peoples, necessitating the resolution of care disparities.
• Understanding barriers and facilitators to arthritis care is critical for health services reform.

Purpose of the Study:

• To investigate healthcare access for Aboriginal people with arthritis from their perspective and that of healthcare professionals.
• To inform future health services reform by identifying key issues in arthritis care delivery for Indigenous populations.

Main Methods:

• Constructivist grounded theory methodology was employed.
• Semi-structured interviews were conducted with 16 patients and 15 healthcare providers in Alberta, Canada.
• Data analysis involved separate and combined analysis of patient and provider reports, refined through multidisciplinary discussions and participant validation.

Main Results:

• Indigenous participants described 'toughing it out' with arthritis and reported experiencing racism, deterring care seeking.
• Healthcare providers expressed frustration with disease severity and missed appointments, perceiving a lack of 'buy-in' from Indigenous patients.
• Complex healthcare systems created constraints, contributing to tensions between Indigenous patients and providers.

Conclusions:

• Low specialist care use by Indigenous people is not due to cultural preferences but systemic issues.
• Provider assumptions, stereotyping, and racism contribute to healthcare rejection.
• Strategies for 'working around' the system show potential for improved specialist service utilization, highlighting the need for culturally safe services in chronic disease management.