From Awareness to Action: Co-Designing Culturally Safe and Equitable Rehabilitation in Canada - Protocol for the...

Inequities in access, engagement, and outcomes persist across outpatient rehabilitation services in Canada, disproportionately affecting Indigenous Peoples, newcomers and refugees, gender- and sexually-diverse individuals, and people with lower income. Although rehabilitation professionals report strong awareness of equity, diversity, inclusion, and cultural safety principles, a persistent gap remains between knowledge and day-to-day clinical practice. Existing resources largely focus on education without providing practical, clinic-level tools or aligned patient-facing supports to enable sustained practice change.

The Inclusive Rehabilitation Equity Assessment and Consensus Hub (iREACH) study aims to co-design a national, evidence-informed roadmap of prioritised, actionable strategies to enhance cultural safety and equity in outpatient rehabilitation, including physiotherapy, occupational therapy, and chiropractic settings across Canada.

The iREACH study will use a two-phase, sequential co-design approach. Phase 1 will employ qualitative methods guided by Interpretive Description, including semi-structured interviews, to explore patients' experiences of cultural safety and unsafety in rehabilitation care. Participants will be purposefully sampled to reflect diversity across social identities and locations, geographic regions, and provider types. Data will be analysed using inductive Reflexive Thematic Analysis within the overarching framework of Interpretative Description. Phase 2 will involve a national co-design workshop with an intersectional panel of patients, clinicians, and system leaders. Findings from Phase 1 and prior research will be collaboratively translated into prioritised strategies and practical clinician- and patient-facing resources to support culturally safe and equitable rehabilitation care.

The primary outcome will be a bilingual (English and French) co-designed Shared Blueprint comprising prioritised, actionable strategies for clinicians, organisations, and health system leaders, together with complementary patient-facing resources to support culturally safe and equitable rehabilitation care across Canada. By integrating lived experience, clinical perspectives, and system leadership, iREACH aims to bridge the gap between cultural safety intent and implementation, supporting more equitable, accessible, and patient-centred rehabilitation care across Canada.

Patient partner has been actively involved in the study design, including development of the research questions, interview guide, and co-design approach. They will remain involved throughout the study as member of the research team contributing to data interpretation and the co-development of study outputs.